The Ambien High: America's Favorite Intoxicating Sleep Aid

Ambien is the most prescribed sleep aid in the United States.

Somewhat unsurprisingly if you take enough of it you'll likely get high. Appreciate it's euphoriant and mildly hallucinogenic effects. That's the thrust of several recently published papers about the recreational potential of zolpidem (Ambien).

Here are some recent findings:

  • Emergency department visits involving Ambien has increased from 2,400/year in the 90's to 11,000/year in 2005, according to a recent Drug Abuse Warning Network report13
  • Primates will self-administer Zolpidem to a greater extent than typical benzodiazepines (like Xanax) or barbiturates14
  • Humans reportedly prefer Zolpidem to other hypnotics, according to some studies published in the 90's15
  • According to data from a tertiary de-addiction center in India16, the most abused hypnotics were: alprazolam (50.6%), nitrazepam (23.5%), and zolpidem (11.2%).

Ambien is a sleep aid prescribed for sleep-onset insomnia (difficulty falling asleep). The drug has garnered a reputation for its recreational effects (aka, the "Ambien high").

Like other central nervous system depressants, Ambien has a dis-inhibiting effect.

Like alcohol, for example, Ambien decreases social inhibitions. For this reason, Ambien use is associated with sleep eating, sleep sex, sleep shopping, sleep driving, and other behaviors that one might think twice about if sober.

In other respects, Ambien is, to be frank, a bizarre drug. Consider that Ambien paradoxically rouses brain-injured patients from comatose states11.

Griffiths and Johnson15 developed a framework for looking at the abuse liability of hypnotic drugs. Zolpidem had an intermediate potential for abuse. Pentobarbital (part of the lethal injection cocktail) was the worst offender. On the other end of the spectrum, the melatonin-based drug Ramelteon exhibited zero abuse potential.

Interestingly, insomniacs with high norepinephrine levels and high sleep latency scores are more likely to escalate the self-administration of Ambien12. In this case, Ambien abuse is a form of self-medication.

Introduction

Ambien (zolpidem tartrate) is a psychoactive drug approved by the Food and Drug Administration (FDA) for the short-term treatment of insomnia, especially in cases where sleep initiation problems are prominent4:

It is a non-benzodiazepine (so it is not like alprazolam or diazepam) hypnotic, belonging to the class of z-drugs 4. Z-drugs and benzodiazepines alike bind the GABA(A) receptor, though at different binding sites. As is the case with many substances intended for the treatment of medical conditions, some people use Ambien recreationally to get “high”. On the street Ambien is allegedly referred to as “No-Go Pills”, “A-minus”, and “Zombie Pills”10.

Legal Status

The active ingredient in Ambien is none other than zolpidem tartrate.

The FDA classifies zolpidem tartrate as a Schedule IV controlled substance4. The implication is that it has a lower potential for abuse relative to substances in Schedule III (ex. hydrocodone, codeine, and buprenorphine)6.

Abuse Potential

Former substance abusers given a single 40 mg dose of zolpidem tartrate reported that its effects were similar, but not identical, to that of 20 mg of diazepam. But lower doses of Ambien (10 mg) failed to elicit effects that could be distinguished from placebo4.

Ambien is available in 5 mg and 10 mg strength tablets for oral administration4. A typical initial dose is 5 mg for women and 5-10 mg for men.

Many studies confirm that initial therapeutic doses of zolpidem (5-10 mg) lack recreational effects. Higher doses are apparently a different story.

The Ambien “High”

Considering that ~1% of patients prescribed Ambien will experience hallucinations and depersonalization4, it's no surprise that people not prescribed the drug will use it for its euphoriant effects.

The two main effects that illicit users of Ambien report are euphoria and hallucinations1; that is if they can actually stay awake after taking it.

Ambien takes between 15 to 30 minutes to kick in.

A user named “onzero” on drugs-forum.com7 reported the high to be similar to being drunk with a wobbly and goofy effect.

Another forum-dweller reported that if you are benzodiazepine-naive that Ambien will elicit some initial weird effects. Such effects are similar to intoxicated from good old ethanol, or the "rush" that comes with dextromethorphan (dxm) or ketamine.

Swim has been taking ambien for about 2 years now, in doses of 20mg+ rectally, IV (Extracted), insufflation, sublingually and orally once or twice...

Saying this drug has little recreational value is a huge understatement. Although people seem to either hate it or love it.

But with little to no tolerance to benzo's/barbs the initial effects are very weird. The buzz comes on with a drunken rush akin to dxm or ketamine, the hallucinations are usually major distortions like watching swiys clothing on the floor morph and move, or text on swiys monitor moving. Alongside the hallucinations you will feel anxiety free, motion feels distorted, and overall super relaxed... damn swim loves Ambien and would take it over any benzo on the US market for sleep/recreation/ or to relieve anxiety.

Onzero reported hallucinations, i.e., seeing clothes on the floor or text on a computer screen morph. S/he further reports euphoria, motion distortion, and relaxation. The "Ambien Walrus" is an embodiment of the drug's side effects5.

Summary of the Intoxicating Effects of Ambien

  • Euphoria
  • Hallucinations
  • Similar to being drunk
  • Motion distortion
  • Relaxation

Risks Of Taking Ambien To Get High

However, as with most drugs, there are risks associated with taking Ambien even as prescribed and these risks tend to only increase with recreational use.

These risks may be increased by the fact that people using Ambien to get “high” probably take more than the recommended dose. These risks can range from memory loss to even engaging in such complex behaviors as driving and not remembering it.

Redditor “Uptomyknees” comically reports inadvertently purchasing a $400 pair of pants while under the influence of Ambien in Dubai9:

I'm staring at the four hundred dollar pair of pants I just bought, shocked and offended at their presence in my hotel room.

In my head, I tried to do the math, tried to find the exact origin point of these pants presence in my life. They'd snuck in, that much was certain. I didn't wake up this morning thinking "what I really need is some exorbitantly expensive but otherwise unremarkable pants." But the fact of the matter is that I didn't wake up today at all.

Sleep-driving is also linked to both recreational and therapeutic Ambien use. Unremarkably, sleep-driving is more likely to occur when multiple central nervous system depressants are combined4.

It's not uncommon for Ambien users to engage in complex behaviors while under the influence and be unable to recall what transpired. Alcohol intoxication also causes blackouts; the difference is that Ambien has more pronounced effects on memory consolidation and less effects on coordination. Therefore Ambien intoxication is less obvious to unaware spectators.

Ambien users have been noted to prepare and eat food, make phone calls and send emails, and have sex. The development of addiction and dependence is possibly among the worst risks of chronic Ambien abuse1.

Risks of Combining Drugs

It goes without saying that recreational drug users are prone to polypharmacy, i.e., combining two or more drugs. Such cocktails can be fatal. Ambien is known to interact with a total of 775 drugs23. With 128 of these interactions being major drug interactions, 611 being moderate drug interactions, and 36 being minor drug interactions. On the list of drugs which cause a major drug interaction when taken with Ambien are many drugs that someone using Ambien illicitly might also use illicitly and combine with Ambien. For example, fentanyl, dihydrocodeine, pure codeine or codeine mixed with other ingredients such as acetaminophen. Furthermore, alcohol interacts with Ambien.

Withdrawal Effects

After a few weeks of illicit use tolerance and withdrawal symptoms will develop and these symptoms are not pleasant 1. In some cases withdrawal might be so severe that the person needs to go to a rehabilitation facility8.

  • Abnormal or aggressive behavior
  • Anxiety and agitation
  • Confusion
  • Hallucinations
  • Insomnia
  • Suicidal thoughts and depression
  • Sweating
  • Fatigue
  • Intractable insomnia
  • Irritability
  • Stomach cramps
  • Panic attacks
  • Delirium
  • Seizure

Conclusion

Ambien (zolpidem tartrate) is effective for the short-term management of insomnia. Illicit use of Ambien comes with serious risks. The cognitive side effects of hypnotics should not be taken likely. Even taken at prescribed dosages, Ambien use is associated with amnesia, sleep-driving, and cognitive impairment that does not always remit after cessation of use.

The general consensus among recreational drug users is that the risks of using Ambien recreationally outweigh its euphoriant effects. Furthermore, the fact that the FDA classifies zolpidem tartrate as a Schedule IV controlled substance 4 suggests that its recreational value is limited.

References

  1. Addiction Blog. (2012, February 26). Does Ambien get you high? Retrieved from: prescription-drug.addictionblog.org/does-ambien-get-you-high/

  2. Drugs.com. (2017, March 2). Ambien (zolpidem) Drug Interactions. Retrieved from: https://www.drugs.com/drug-interactions/zolpidem,ambien.html

  3. Drugs.com. (2017, March 2). Ambien Dosage. Retrieved from: https://www.drugs.com/dosage/ambien.html

  4. FDA. ( 2008, April 23). NDA 19908 S027 FDA approved labeling 4.23.08 HIGHLIGHTS OF PRESCRIBING INFORMATION. Retrieved from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/019908s027lbl.pdf

  5. Fisher, T. (2017, April 7). What the 'Ambien Walrus' Really Is, According to the Person Who Made It Up. Retrieved from: https://vanwinkles.com/what-is-the-ambien-walrus

  6. MedShadow Foundation. (2017, March 14). Drug Classifications, Schedule I, II, III, IV, V. Retrieved from: http://medshadow.org/resource/drug-classifications-schedule-ii-iii-iv-v/

  7. Onzero. (2009, October 6). What is the ambien high like? Retrieved from: https://drugs-forum.com/threads/what-is-the-ambien-high-like.103249/

  8. Patterson, E. (2017). The Effects of Ambien Use. Retrieved from: http://drugabuse.com/library/the-effects-of-ambien-use/

  9. Uptomyknees. (2014). I accidentally bought a $400 pair of pants while high on Ambien in Dubai. Retrieved from: https://www.reddit.com/r/Drugs/comments/4dsoq2/iaccidentallyboughta400pairofpantswhile/

  10. Ekern, J. (2014, March 27). Ambien Abuse Causes, Statistics, Addiction Signs, Symptoms & Side Effects. Retrieved from: https://www.addictionhope.com/ambien/

  11. Williams ST, Conte MM et al.. Common resting brain dynamics indicate a possible mechanism underlying zolpidem response in severe brain injury. Elife. 2013 Nov 19;2():e01157

  12. Roehrs TA, Roth T. Hyperarousal in insomnia and hypnotic dose escalation. Sleep Med. 2016 Jul;23():16-20

  13. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Drug Abuse Warning Network, 2005: National Estimates of Drug-Related Emergency Department Visits. Rockville MD: 2007. DAWN Series D-29, DHS Publication No (SMA) 07-4256.

  14. Rowlett JK, Platt DM, Lelas S, Atack JR, Dawson GR. Different GABAA receptor subtypes mediate the anxiolytic, abuse-related, and motor effects of benzodiazepine-like drugs in primates. Proc Natl Acad Sci USA. 2005;102:915–920.

  15. Evans SM, Funderburk FR, Griffiths RR. Zolpidem and triazolam in humans: behavioral and subjective effects and abuse liability. J Pharmacol Exp Ther. 1990;255:1246–1255.

  16. Shukla L, Bokka S et al.. Benzodiazepine and "Z-Drug" Dependence: Data From a Tertiary Care Center. Prim Care Companion CNS Disord. 2017 Feb 16;19(1):

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