During midterms, many students suffer from sleeping disorders. Some students drink sleep-inducing beverages like ‘Slow Cow,’ while some might be more dependent on drugs. Likewise, many people these days are suffering from sleeping disorders such as insomnia and thus, the demand for sleeping pills has also increased. In addition, there are a number of zolpidem addicts behind this. For this reason, the Sungkyun Times (SKT) now introduces zolpidem and its dangers, the reason why accidents caused by zolpidem are constantly increasing, and the ways to improve the current situation.
What is Zolpidem?
Zolpidem is a type of sleeping pill for treating insomnia, and it is the most used sleeping pill around the world. It is also known as the most commonly prescribed medication for a patient suffering from insomnia. As zolpidem works directly on the central nervous system, it is classified as anti-psychotic drug. Although the prescriber of zolpidem does not have to be a psychiatrist, patients cannot take it without a doctor’s prescription. Currently in Korea, 19 types of zolpidem from different pharmaceutical companies are being sold. Moreover, zolpidem accounts for about 55% of domestic sleeping pill sales. Considering these facts, it can be seen that zolpidem is used popularly and extensively. On account of zolpidem being three times more effective than any other sleeping pills, a lot of people are taking zolpidem, making it the easiest sleeping pill to be found around. Just like every anti-psychotic drug, however, zolpidem also has a risk of addiction. Since zolpidem can be easily found, patients can be exposed to zolpidem addiction.
Dangers of Zolpidem Addiction
High Dependency
Zolpidem has a very short half-life. A short half-life means that the effect of a drug appears very quickly after taking the drug but lasts for only a short while. Due to this nature, many hospitals prescribe zolpidem as a one-off drug. Zolpidem’s prescription is recommended for one pill per day, for up to four months, and its maximum number of prescription days is 28. These facts make patients feel that the duration of the drug efficacy is too short. For this reason, many o f the patients voluntarily increase their doses without a doctor’s order. I f the abuse of zolpidem continues and accumulates, the patient eventually will be unable to escape from the high dependence of zolpidem, leading them to possibly become addicts.
Abnormal Behaviors During Sleep
As zolpidem rapidly declines in the body, it causes the patient to be in a semi-hypersensitive state. Taking adequate pills does not matter. In the case of addicts, however, patients wake up, being drugged out of zolpidem, and act abnormally without recognizing it. According to experiments on zolpidem addicts, research by Korea University showed that patients suddenly woke up during sleep, made phone calls, went out, and cut their hair with scissors. A famous swimmer, Grant Hackett, for instance, was found naked and wandering around confused. This case also turned out to be the example of zolpidem addiction. Moreover, zolpidem addiction can even lead people to commit suicide. Mayo Clinic, a psychiatry hospital in the United States (US), declared that zolpidem alone can increase suicidal tendency even when examined separately from the effects of depression. Patients with these abnormal behaviors cannot remember anything that they did and even might attempt to kill themselves.
Why do problems still occur?
Even though it is obvious that zolpidem has some risks, incidents caused by zolpidem are constantly increasing due to several reasons.
Unscrupulous Prescribing of Hospitals
Generally, medical items are divided into two categories. They are pay items and non-payment items. The former are medications which are paid by medical insurance and in this case, the patient’s prescriptions are on the record. A non-payment item, on the other hand, is a medication where a patient has to pay the expense of an MRI or plastic surgery, and the prescriptions are untraceable as a non-payment item is not recorded. In case of zolpidem, 28 tablets of zolpidem per month are prescribed as a pay item. The problem is the way some unscrupulous hospitals prescribe zolpidem. They prescribe zolpidem as non-payment item. In other words, even if a patient has already been prescribed zolpidem for a set period, patients can purchase zolpidem again by paying money. A Korean TV program, “I Want to Know It”, showed that it is possible to get about 50 pills per person in 10 different hospitals in just one day. According to the Ministry of Health and Welfare, however, it is not possible to enforce the regulations if the pay item is provided to the patient as a non-payment item. In general, in order to investigate unscrupulous hospitals, it is necessary to conduct preliminary investigation and reporting. The Ministry of Health and Welfare, however, claims that there is no clues to trace unscrupulous hospitals since there are no records left. As drug prescription belongs to the authority of a doctor, it is not a violation of the medical law to provide a pay item as a non-payment item. In other words, whether to prescribe zolpidem or not is up to a doctor’s discretion. This makes doctors prescribe lots of zolpidem if a patient’s condition is getting better as a result of the medication. However, prescribing medicines to patients who are addicted to those prescribed drugs is a big problem.
High Accessibility to Zolpidem Without Prescription
Another problem is that people who are not prescribed zolpidem can also get drugs easily since the distribution routes are diverse.
•Zolpidem Addict Websites
In many community sites, there are a number of hidden zolpidem purchasing websites. Through those websites, zolpidem addicts share and sell zolpidem. By joining the websites once, zolpidem addicts can easily get drugs just by posting or commenting that they are looking for zolpidem. Addicts can also get their drugs in a short time through messenger such as Kakao Talk. According to the Food and Drug Administration, it took only a minute to make contact with a drug dealer.
•Online Illegal Transaction
Zolpidem can also be purchased easily through other online routes. When searching the Internet for zolpidem, there are many posts selling zolpidem at a price of 50,000 for 12 pills. Moreover, by browsing the word “zolpidem sale,” anyone can reach about 80,000 websites only in foreign sites. Many of those websites set the name of sites as “** pharmacy”, just like a formal pharmacy which sells zolpidem legally. Furthermore, zolpidem is even on sale on personal blogs and other popular secondhand websites. The police force stated that it is hard to trace back illegal transactions among individuals if they use platforms such as messenger services.
Doctors' Lackadaisical Recognition Toward Zolpidem
A lot of physicians do not consider the risk of zolpidem as it is not classified as a dangerous drug and has good efficacy in relieving insomnia. No Hwan-Kyu, the former chairman of the Korean Medical Association, indicated that the doctors have lackadaisical recognition that there might be no way for patients to get more zolpidem than they are supposed to have, and this thought is the fundamental reason of the accidents caused by the increasing number of zolpidem addicts. Not being able to estimate the number of zolpidem addicts, it is dangerous to prescribe zolpidem with lackadaisical recognition.
Ways to Go Forward
Obligation of DUR System
The Drug Utilization Review (DUR) is a system that prevents inappropriate drug use. Through the DUR system, the doctor can inquire the prescription records of a patient in real time during the prescription process of medicines. It is also possible to control drugs which are not supposed to be used in combination. If a doctor sends prescription records of a patient to the Health Insurance Review & Assessment Service (HIRAS) at prescription stage, the HIRAS then compares the patient’s medication history and sends a warning message to the doctor within a second if there is any problem. This system allows the physician to prevent the use of drugs or specific ingredients that are already being used by the patient or that has been prescribed earlier. If a patient who has already been prescribed zolpidem from other hospitals, doctors can detect the record by using the DUR system and in this case, doctors cannot prescribe the drug or suspend prescribing it. Unfortunately, however, the DUR system is not used by every hospital as the system has not yet been obligated for the reason that it could violate a doctor’s discretion. Doctors, therefore, do not have to computerize all patients’ prescriptions. The Ministry of Health and Welfare stated that if medical records of patients were computerized, it is possible to track down the duplicated prescriptions and unscrupulous hospitals based on the mandatory system.
Reinforcement of the Crackdown on Illegal Online Transaction
•Increasing Personnel
Under the current law, medication trade between individuals is illegal. According to Articles 44 and 50 of the pharmaceutical affairs law, it is illegal to sell drugs in places other than designated pharmacies. Furthermore, only designated pharmacists have the discretion to sell specific medications. Nonetheless, the Ministry of Food and Drug Safety has declared that more than 10,000 cases of illegal online drug transactions are detected every year. Although countless illegal transactions are being made, the team that controls and investigates the illegal deal has only seven members of the Cyber Inspection Team under the Ministry of Food and Drug Safety. The cyber-security team insists that an additional team should be established, including a central investigating team with more personnel like experts in the pharmaceutical field and monitoring staff for promptness.
•Strengthening Penalties for Illegal Drug Purchasers
Selling drugs or anti-psychotic drugs through online or mediating sales are punishable based on the Act on the Management of Narcotic Drugs. Those who illegally distribute drugs are sentenced to imprisonment for at least five years and up to 10 years depending on the types of drugs. In addition, fines will be imposed on distributers of up to 100 million if the types of anti-psychotic drug or the substance being contained are found. When illegal transactions are discovered, however, only sellers get penalties currently. Some argue that not only the seller but also the purchaser should be punished on the same basis since as there is demand, there is supply.
Zolpidem is a drug that can be easily prescribed even to students. Just as there are no drugs without side effects, it is necessary to be more careful while using zolpidem since it is easy to obtain and can easily be found. Drug addiction may occur through a lack of one’s will, but complacent society can also be a negative factor that can cause people to become addicted. As all of us could be potential drug addicts, it is important to improve the regulations related to zolpidem.