Sonata Addiction

Sonata Addiction

Sonata Addiction

Sonata AddictionAmericans are having a love affair with prescription drugs. They consider the pills they get from doctors less dangerous and less addictive than those they buy on the street, even though they are wrong on both counts.

The prescription drugs that are most abused are the ones that are prescribed most often. New kinds of sleeping pills, buoyed by clever and constant advertising on television, hit record sales in 2006 with 47 million prescriptions, and show no sign of decreasing. In 2011, these drugs were prescribed 60 million times, even though they are supposed to be used for only 14 days and most research finds they are only mildly effective.
Sonata is one of these new sleeping pills extensively marketed to the public and to doctors. Imaginative drug users now crush the contents of Sonata capsules and snort them for a high or simply swallow them in amounts no doctor would recommend.

For the first time in 2011, more Americans died of drug overdoses than were killed in car accidents.

What is Sonata?

Sonata is the trademarked name of a sleeping pill manufactured by King Pharmaceuticals in Bristol, Tennessee.

In the early 1990s, chemists developed zaleplon, zolpidem, and eszopiclone or the “z drugs,” called that because of their spellings and because they produce “Zzzz’s” or sleep. Zaleplon is the active ingredient in Sonata, zolpidem is in Ambien, and eszopiclone —Lunesta. Their manufacturers advertised these drugs heavily on television as safer and less addictive than barbiturates or benzodiazepines, and less likely to cause drowsiness the next day. The United States federal government, however, classifies the “z drugs” as Schedule IV Controlled Substances, which means they have potential for addiction and are highly regulated by the government, and if you are caught dealing, selling or possessing them without a doctor’s prescription, you can face severe penalties. Benzodiazepines are also classified Schedule IV. Although benzodiazepines and Sonata are marketed as dissimilar, a 1999 study comparing zaleplon to triazolam found that both drugs have a similar abuse potential and similar pharmacological profiles. Triazolam is a benzodiazepine sold under the trademarked name “Halcion.”

Sonata works by acting on certain receptors for the neurotransmitter gamma-aminobutyric acid or GABA, which in turns slows down the central nervous system and the rate of breathing, heartbeat, and so forth, relaxing patients and desensitizing them to noises, touch and sights that would ordinarily wake them up.

The chemical name of zaleplon is N-[3-(3-cyanopyrazolo[1,5-a]pyrimidin-7-yl)phenyl]-N-ethylacetamide; its chemical formula is C17H15N5O.

Zaleplon comes as a white to off-white powder that is practically insoluble in water, which makes it harder to abuse through injections.

What are the Medical Uses of Sonata?

Sonata is prescribed for the short-term treatment of insomnia. Although the United States Food and Drug Administration has approved Sonata and all the “z drugs” for short-term use only (14 days), many adults have been taking them for years.

The common doses for Sonata are 10mg for adults, 5mg for the elderly, and by doctor’s discretion only when prescribed to children. Although one in 500 children in the United States is taking sleeping pills, the practice is controversial, because there are no long-term studies about the effect of these pills on developing brains.

Compared to Ambien and Lunesta, Sonata is much shorter-acting. Its effects peak within an hour, which means it can help people fall asleep but not necessarily stay asleep. A 2006 study from Clinilabs Sleep Disorders Institute at St. Luke’s/Roosevelt Hospital in New York found that people who wake up in the middle of the night can find relief by taking Sonata, which is not true of the other “z drugs.”

In one study where Sonata was compared to a placebo, subjects taking the real drug took 30 minutes to fall asleep compared to 45 for those on the placebo, and both groups remained asleep for an average of six hours and 20 minutes. The Consumer Reports organization tested Sonata against Ambien, and found that people fell asleep an average of 14 minutes quicker on Sonata, and 20 minutes on Ambien compared to those using placebos. Similar studies have also shown that these drugs are only mildly effective at best, and that they reduce the time to fall asleep by an average of 13 minutes and increase sleep time by only 11.4 minutes. Consumer Reports researchers suggest that people should try over-the-counter drugs like Unisom and Nytol before they ask their doctors for “z drugs.” Their research also indicates that behavioral changes, such as going to bed at the same time every night and avoiding caffeine, can be very effective in treating long-term insomnia.

Public Citizens Health Research Group concluded that the benefits of Sonata are so small that it should be taken off the market. Starnoc, a sleeping pill containing zaleplon, was discontinued in Canada in June 2006 for unknown reasons.

Sonata comes in capsule form, and costs about $2.50 to $3.50 a capsule.

What are the Side Effects of Sonata?

Common side effects for Sonata are dizziness, headache, nausea, muscle pain, pain in the abdomen, constipation, cough, eye pain, mental depression, clumsiness, trembling, wheezing, lightheadedness, and unsteadiness. If you take it for more than two weeks, you increase your chances of falling, especially if you are elderly. Side effects that are less common are hallucinations, strange behaviors, aggression, memory problems, suicidal thoughts, confusion, numbness or tingling in the feet and hands, sensitivity to noise, distortion in the sense of smell, painful menstrual periods and the sense of being outside your body. Sonata can worsen depression or cause people to develop it.

Patients report such side effects to their doctors; however, in the few scientific studies in which some people took Sonata and others took placebos, most of the side effects were probably psychological. For example, researchers found that between 30% and 35% said they developed had headaches from both Sonata and placebos; and 7% reported dizziness from both Sonata and placebos.

Tests on laboratory animals found that Sonata did not cause cancer, but it did decrease infertility if animals took 50 times the normal amounts.

Does Sonata Show Up on Urine Tests?

Routine urine tests at work or school usually do not detect the “z sleeping pills,” although some people who take them have produced false positives for benzodiazepines. Sonata has the shortest half-life of all the “z pills,” which means it is eliminated quickly in urine and the least likely to be detected. About 70% of Sonata is eliminated in urine within the first 48 hours. Only very sophisticated tests can detect Sonata.

What are the Risks of taking Sonata?

Several major studies have shown that people who take sleeping pills are much more likely to die than those who do not. For example, a recent study of over 33,000 people published in the British Medical Journal put the risk of death within two years at five times higher for those who took sleeping pills. A study of 15,000 people in Norway found that men were 1.5 times more likely to die and women 1.7 times if they took sleeping pills; a similar 2009 study in Sweden found sleeping pills increase the risk of death by 4.5 times in men. The researchers found that the number of pills taken could be as few as twenty a year, and yet the person still had an increased risk of death. These results do not mean that sleeping pills cause death, but rather that the people who take sleeping pills are probably not in good health. They may have serious underlying physical or mental problems that need to be addressed so the risk of taking Sonata and other such drugs is that they will not be treated for them. If Sonata does not cure a person’s insomnia within 10 days, or if the drug makes the condition worse, that usually indicates a serious psychiatric or medical illness.

The other main risks of taking Sonata are developing an addiction, developing physical dependence on the drug, and a rare form of sleepwalking.

Some people who take “z drugs” have gotten up and prepared meals, gone shopping, driven cars, had sex, made phone calls, and performed other activities, but have no recollection of doing these the next morning. People who taken these drugs in order to get some sleep during airplane flights have arrived at destinations not knowing where they are. This is called anterograde amnesia. The drugs have been used as defenses in murder trials with defendants claiming that they have no recollection of killing their victims. Taking alcohol with Sonata or other “z drugs” increases your chances of the sleep walking phenomenon.

On very rare occasions people have developed a life-threatening allergic reaction to Sonata called anaphylaxis. Symptoms can be extremely low blood pressure, rashes, hives, itching, hoarseness, difficulty breathing, coma and death. Anaphylaxis can sometimes subside on its own, but some people have died without medical treatment.

What is a Sonata Overdose?

Most of the people who show up in emergency medical facilities in incidences involving Sonata are either attempting suicide or taking the drug along with alcohol and/or other central nervous system depressants.

Symptoms of a Sonata overdose are clumsiness, confusion, drowsiness, low blood pressure, dullness, sluggishness, trouble breathing, weak or floppy muscles, and dizziness. Some will people enter comas. Treatment might include administering intravenous fluids and flumazenil as an antidote.

Who Should Not Take Sonata?

Sonata is not routinely prescribed to the elderly because it increases their chances for falling. There have not been enough adequate studies to definitively determine if Sonata is safe to use during pregnancy. Sonata is not usually prescribed for people with histories of drug abuse, alcoholism, breathing problems, depression, or liver diseases.

What Drugs Interact with Sonata?

The United States Food and Drug Administration reports 615 moderate interactions, 17 minor interactions, and five major interactions when Sonata is combined with certain drugs. In general, the drug should not be combined with any central nervous system depressant because you can slow your breathing down to the point that it stops. These drugs include alcohol, sedatives, narcotic pain killers, illegal narcotics, antidepressants, barbiturates, tranquilizers, sleeping pills, phenobarbital, anti-histamines, muscle relaxants, and anesthetics (even ones for dental surgery). Specific names of such drugs might be propoxyphene, Darvocet, Darvon, Levothemadyl, Orlaam, Sodium Oxybate, Xyrem, oxycodone, hydromorphone, Primidone, Tapentadol, Zolpidem, Fospropofol, cimetidine, paraonpamil, Rifampin, Tofranil, and Rifadin, among others.

What is Sonata Withdrawal?

Patients who take Sonata as medically recommended –10mg a night for fewer than 15 nights– will not experience severe withdrawal symptoms when they stopped taking the drug. Some will develop “rebound insomnia” or trouble sleeping the first few nights they stopped using Sonata, and this effect will be worse if they were taking more than 10mg a night. Most doctors will taper off the amounts their patients are taking gradually in order to prevent withdrawal syndrome.

If you have been abusing Sonata or taking it levels not medically recommended, you can develop a difficult withdrawal syndrome that is similar to the one produced by dependence on benzodiazepines. Symptoms might include muscle and abdominal cramps, wedding, sadness, shaking, vomiting, shakiness, and even seizures, and these are difficult and dangerous to manage on your own.

How do People Abuse Sonata?

Abusing Sonata means taking it without a prescription or in ways not medically recommended.

Some people begin their abuse of sleeping pills by taking it for insomnia, but then they start using it to relax and unwind during the day, until the drug and its side effects gradually take over their lives.

However, a more typical scenario is that of a polydrug user who takes Sonata only at night. This person is abusing cocaine, methamphetamine, Ritalin or other stimulants and requires a pill to get to sleep or to simply relax. Likewise, those addicted to “downers” like alcohol, narcotics, painkillers, muscle relaxants and other central nervous system depressants need sleeping pills at night because their drugs have interfered with their natural abilities to relax.

Some people grind up the contents of Sonata capsules and then inhale the powder up their noses. This method, called insufflation, can cause hallucinations lasting 45 to 60 minutes. In one study, a 28 year-old man who had been abusing a variety of drugs got addicted to taking 70mg to 80 mg of zaleplon a day, snorting eight capsules at a time to produce euphoria. He went into a severe withdrawal syndrome when he tried to quit.

People who are addicted to Sonata will develop drug cravings when they cannot obtain their drug, tolerance for its effects, and withdrawal syndromes when they try to stop.

Because it interferes with memory, Sonata is sometimes abused as a date rape drug.

What Treatments are Available for Sonata Addictions?

If you are abusing Sonata along with illegal drugs or alcohol or if you are snorting Sonata and cannot stop on your own, you may have developed a drug addiction that will only get worse until you address your problem. Drug addiction is considered a progressive disease in that it will get worse without treatment, because you will develop a tolerance for the effect of your drug and then keep needing to increase the amounts you are taking to achieve the same highs. Using Sonata or other drugs at high levels will eventually take over your entire life in that obtaining and using drugs will become all that you do or care about. When that happens, you are no longer in control and you are a drug addict. Eventually, you will break down your health and cut years off your life.

If you try to stop using Sonata and your other drugs on your own, you may enter a difficult withdrawal syndrome that is dangerous to manage at home. The safest thing to do is to enter a rehabilitation center and do your detoxification from drugs under medical supervision. If you have been taking a variety of drugs along with Sonata, the detoxification process can be complex, but doctors lessen your discomfort by gradually weaning you off drugs or even by using other drugs to ease your symptoms.

The vast majority of people who become addicted to drugs have underlying psychiatric problems such as depression, post-traumatic stress syndrome, unresolved childhood traumas like a history of sexual molestation, and even undiagnosed mental illnesses, including bipolar or personality disorders. If enter a good residential treatment center for drug addiction, the staff can help you deal with your underlying issues that did not necessarily cause your addiction but can contribute to keeping it ongoing.

The state-of-the-art treatment for drug addiction is about taking a holistic approach to the problem and treating the whole person emotionally, physically, spiritually and intellectually. You will probably develop a close one-on-one relationship with a professional counselor who can help you work through unresolved issues in your current relationships or old problems from your past. As you live with others facing similar challenges at your treatment center, you can develop better levels of physical fitness together, socialize and help each other as you work through your programs. You may participate in art, music or drama therapy, journaling, classes in drug education, and relaxation techniques such as yoga and meditation. Once you return home, you will continue in an after-care program of psychotherapy, counseling, and attending self-help support meetings.

How can I Tell if I have a Problem with Sonata?

If you can answer “yes” to one or more of the following questions, it may be time to consult your local mental health facility, an addiction specialist at a residential treatment center or your family doctor about advice for your problem with Sonata.

  • Are you using Sonata without a prescription?
  • Do you obtain Sonata by going from one doctor to another?
  • Do you obtain Sonata from illegal sources?
  • Are you abusing alcohol or other drugs along with Sonata?
  • Have you tried to quit using drugs but failed?
  • Do you find it impossible to get to sleep without using Sonata?
  • Have you been using Sonata for more than 15 days?
  • Do you experience withdrawal symptoms when you try to quit using drugs?
  • Do your friends and/or family members criticize you for using drugs?
  • Is your drug use interfering with your job or school work?
  • Do you find it impossible to go more than a few days without using drugs?
  • Is much of your social life planned around using drugs or alcohol?
  • Do you have certain physical problems that you know are caused by using drugs?
  • Do you snort Sonata?
  • Do you feel guilty or ashamed about your drug abuse?

Sources:

Rabin, Robin. “New Worries About Sleeping Pills,” The New York Times, March 12, 2012. See also Saul, Stephanie. “Sleep Drugs Found Only Mildly Effective, but Wildly Popular,” The New York Times, October 23, 2007.

“Drug Deaths Now Outnumber Traffic Fatalities In U.S., Data Show,” The Los Angeles Times, September 17, 2011.

“Drug Scheduling Actions,” The U.S. Department of Justice, Drug Enforcement Agency, see http://www.deadiversion.usdoj.gov/fed_regs/rules/1999/fr0915.htm

Rush CR, Frey JM, Griffiths RR: Zaleplon and triazolam in humans: acute behavioral effects and abuse potential. Psychopharmacology (Berl) 1999; 145:39–513.

“Are Sleeping Pills Addictive?” The New York Times, July 16, 2010.

“Zaleplon,” The RX List, see http://www.rxlist.com/sonata-drug.htm

Saul, Stephanie. “Sleep Drugs Found Only Mildly Effective, but Wildly Popular,” The New York Times, October 23, 2007.

“Zaleplon (Oral Route),” The Mayo Clinic Staff, see http://www.mayoclinic.com/health/drug-information/DR601443

Duenwald, Mary. “Doctors Ponder Drugs for Sleepless Nights of Adolescence,” The New York Times Consumer, November 15, 2005.

“Zaleplon (Oral Route),” Drugs.Com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/cons/zaleplon.html

Jaret, Peter. “Choosing the Right Sleep Medicines, or None at All,” The New  York Times, August 8, 2007.

Rabin, Robin. “New Worries About Sleeping Pills,” The New York Times, March 12, 2012.

“Consumer Reports Best Buy Sleeping Drugs,” Consumer Reports, 20-page pamphlet, see http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/InsomniaUpdate-FINAL-July2008.pdf

Saul, Stephanie. “Sleep Drugs Found Only Mildly Effective, but Wildly Popular,” The New York Times, October 23, 2007.

“Consumer Reports Best Buy Sleeping Drugs,” Consumer Reports, 20-page pamphlet, see http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/InsomniaUpdate-FINAL-July2008.pdf

Saul, Stephanie. “Sleep Drugs Found Only Mildly Effective, but Wildly Popular,” The New York Times, October 23, 2007.

“Consumer Reports Best Buy Sleeping Drugs,” Consumer Reports, 20-page pamphlet, see http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/InsomniaUpdate-FINAL-July2008.pdf

“Zaleplon (Oral Route),” The Mayo Clinic Staff, see http://www.mayoclinic.com/health/drug-information/DR601443

“Consumer Reports Best Buy Sleeping Drugs,” Consumer Reports, 20-page pamphlet, see http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/InsomniaUpdate-FINAL-July2008.pdf

“Zaleplon,” Medline Plus, National Institutes of Health, see http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601251.html

Rabin, Robin. “New Worries About Sleeping Pills,” The New York Times, March 12, 2012.

“Consumer Reports Best Buy Sleeping Drugs,” Consumer Reports, 20-page pamphlet, see http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/InsomniaUpdate-FINAL-July2008.pdf

“Zaleplon (Oral Route),” Drugs.Com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/cons/zaleplon.html

“Zaleplon (Oral Route),” Drugs.Com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/cons/zaleplon.html

Rabin, Robin. “New Worries About Sleeping Pills,” The New York Times, March 12, 2012.

1“Zaleplon (Oral Route),” Drugs.Com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/cons/zaleplon.html

Saul, Stephanie. “Study Links Ambien Use to Unconscious Food Forays,” The New York Times, March 14, 2006; see also Rabin, Robin. “New Worries About Sleeping Pills,” The New York Times, March 12, 2012.

“Zaleplon (Oral Route),” Drugs.Com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/cons/zaleplon.html

“Zaleplon,” Medline Plus, National Institutes of Health, see http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601251.html

Ibid, and “Zaleplon (Oral Route),” The Mayo Clinic Staff, see http://www.mayoclinic.com/health/drug-information/DR601443

“Zaleplon (Oral Route),” Drugs.Com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/cons/zaleplon.html

“Zaleplon (Oral Route),” The Mayo Clinic Staff, see http://www.mayoclinic.com/health/drug-information/DR601443

“Zaleplon (Oral Route),” Drugs.Com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/cons/zaleplon.html

Ibid.

“Zaleplon (Oral Route),” The Mayo Clinic Staff, see http://www.mayoclinic.com/health/drug-information/DR601443; and “Zaleplon,” Medline Plus, National Institutes of Health, see http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601251.html

“Zaleplon (Oral Route),” Drugs.Com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/cons/zaleplon.html

“Zaleplon,” Medline Plus, National Institutes of Health, see http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601251.html

Rush CR; Frey JM, Griffiths RR (Jul 1999). “Zaleplon and triazolam in humans: acute behavioral effects and abuse potential”. Psychopharmacology, 145 (1): 39–51

Sandell, Laurie. “Diary of a Sleeping Pill Junkie,” Glamour Magazine, March 2008.

Rush CR; Frey JM, Griffiths RR (Jul 1999). “Zaleplon and triazolam in humans: acute behavioral effects and abuse potential”. Psychopharmacology, 145 (1): 39–51

Letters to the Editor, November 01, 2008, “Intranasal Zaleplon Abuse,” American Journal of Psychiatry 2008;165:1489-1490.

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