Z-Drugs Dependence: An Awakening Truth
Similarly to BENZODIAZEPINES (BZD), 'Z-drugs' - zolpidem, zopiclone and zaleplon - are positive allosteric modulators for GABAA receptors; they are usually regarded as having great hypnotic properties without the undesirable side effects of BZD. Initial trials with Z-drugs showed safer pharmacological profiles than BZD and little evidence for abuse and dependence, leading to an increase in prescriptions for the treatment of insomnia. However, there is growing evidence of significant rates of Z-drugs misuse and dependence. The authors’ objective was to briefly highlight relevant aspects concerning Z-drugs dependence. A search was conducted in PudMed, from which the relevant articles were selected and reviewed.
Evidence implies Z-drugs dependence might not be as neglectable as early trials indicated – nevertheless, it’s exact prevalence remains unclear. Seemingly predominant in the elderly, some studies show relevant prevalence in younger populations. Some studies suggest clinicians regarding Z-drugs as relatively safe comparing to BZD might underlie somewhat carefree (and not conforming with guidelines) prescriptions, promoting misuse/abuse and facilitating dependence. A French work showed national political and public health measures (e.g. prescription limits) were insufficient to address the problem. In France, Zolpidem recently was the top drug in forged prescriptions. A study was able to sort Z-drugs dependent users in two groups: one looking for amphetaminic/stimulant effects and the other showing dependence for hypnotic effects. Another study mentions the importance of the 'psychological' aspects of the dependence and the lack of help from clinicians in providing withdrawal strategies and treatment alternatives. Data also suggest using Z-drugs might be associated with high risk for BZD and recreational drugs use and dependence.
Recent evidence suggests Z-drugs dependence might more important than assumed before. More studies are needed to clarify epidemiological and clinical aspects but also to understand the different dimensions of the problem so that adequate health measures can be implemented.