Assessment of the Consumption and Consequences of Zopiclone (Zimovane) [Among Drug-Takers in a North-East Town]

Zopiclone Assessment of the consumption and consequences of zopiclone (Zimovane) [among drug-takers in a North-East town] Dr. Russell Newcombe Senior Researcher, Lifeline Produced in September 2008 Released in September 2009 C o n t e n t s Summary 3 1. Introduction 4 2. Methods 4 -5 3. Findings 6 -18 3.1 Overview of literature on zopiclone 6-12 3.2 Research with service users and staff concerning zopiclone use 12-18 4. Conclusions 19 References 20-21 Acknowledgments Thanks for help and assistance are due to the staff and six service users at the North East drug agency which participated in this research. Lifeline Publications and Research, 39-41 Thomas Street, Manchester M4 1NA. Telephone: 0161 8392075 E-mail: [email protected]. Web: www.lifeline.org.uk Lifeline is a registered charity No: 515691 2 Executive Summary A focus group with six local service users who had used zopiclone was conducted at a drug agency in a North-East town in July 2008, with additional This report focuses on zopiclone use, and has information provided by two senior staff. The two main parts: an overview of the literature on participants confirmed that the main methods of zopiclone; and a presentation of the methods and obtaining zopiclone, known as ‘zimmies’ or ‘zimmers’ findings of research into zopiclone use among drug to local users, involved buying diverted tablets (from users in a town in North-East England in 2008. Its people prescribed them) or imported tablets. The main application is to provide a knowledge base on two main reasons given for taking zopiclone were (1) which to produce a publication about zopiclone to using it as a substitute for heroin when the latter’s inform and educate users of the drug. availability or quality was poor, and/or (2) using it to cope with the stimulant effects or come-down from Zopiclone belongs to a sub-group of hypnosedatives crack use. called cyclopyrrolones. It is often grouped together with other benzodiazepine-like drugs (notably Participants generally reported swallowing zopiclone zolpidem and zaleplon) under the name of ‘Z-drugs’. tablets, though two had injected them, one regularly. Though not controlled under the UK’s Misuse of Average doses were 6 to 12 tablets for lighter users, Drugs Act, zopiclone is a prescription-only drug, and 20 to 40 tablets for heavier users. The typical used by doctors to treat insomnia. It is produced pattern of zopiclone use involved bingeing – periods in two doses – 3.75 mg and 7.5 mg – and has one of daily or near-daily use interspersed with periods of proprietary brand (Zimovane), though there are a abstinence (related to availability and other factors). variety of non-proprietary tablets which come in The main drugs ‘mixed’ with zopiclone were crack- many forms (colours, shapes, etc.). cocaine and alcohol. Recent prevalence studies suggest that less than The main physical effects of zopiclone were reported 1% of the UK population had used unprescribed to be an unpleasant metallic taste, and lack of zopiclone in the past year, though more than 1% may coordination – including an inability to carry out have been prescribed it – there were almost four and simple actions like sitting down. The main desirable half million prescriptions for zopiclone in England mental effects were reported to be sedation and in 2007, making it the second most commonly euphoria. Less desirable mental effects included prescribed hypnosedative after diazepam. memory problems (notably post-use amnesia) and emotional problems – notably feeling numb and In addition to its primary effect of inducing and (conversely) aggressive outbursts. sustaining sleep, zopiclone also causes sedation and cognitive deficits (impairments in reasoning and Heavier users also reported that regular zopiclone memory). Its main physical effects include a metallic use had led them into dependence, including taste in the mouth, and reduced coordination. strong craving and severe withdrawal symptoms on Experience of both euphoria and dependence discontinuing use - notably fatigue, aching limbs, (craving, tolerance, and withdrawals) appear to be sweats and insomnia. However, no participants associated with four inter-linked factors: (a) non- reported overdosing on zopiclone nor requiring prescribed versus prescribed use; (b) heavy versus medical attention. lighter (standard-dose) use; (c) escalating rather than stable doses; and (d) taking zopiclone for It was concluded that publications designed to pleasure (staying awake), rather than using it to provide relevant information to zopiclone users sleep. Duration of use per se is not a critical factor should focus on the following consumption risks in zopiclone dependence. and harmful consequences: amounts used; methods of use; patterns of use; use with other drugs; The main health risks of zopiclone, particularly behavioural and social problems; and reducing the from regular and/or heavy use, include cancer, risks of accidents, overdose, and dependence. reduced immunity, accidents/injuries, and overdose/ poisoning. The number of deaths from poisoning by zopiclone or zolpidem in England & Wales climbed from zero in 1993 to an average of 40 to 50 per year in the noughties. Most fatal overdoses from zopiclone involved other drugs, notably alcohol. 3 1. Introduction (3) Unstructured interviews were also conducted with two members of staff at the agency following the focus group session, who also provided further Over the last decade, drugs workers in the North- information over the following two weeks via East have become increasingly aware of the misuse telephone calls and emails. of zopiclone (Zimovane) among local drug users. The analysis and reporting stages of the research Zopiclone is a hypno-sedative drug, prescribed by were carried out from July to September 2008. doctors to people suffering from insomnia, and has been commercially available in Europe since Focus group participants - profile. At July 2008, the second half of the 1980s. In order to improve the drug agency had 1,061 registered clients, and their understanding of the misuse of zopiclone, and although only 12 were recorded as using ‘other to provide a knowledge base on which to design prescription drugs’ or ‘other sedatives’ under the publications (information products) for zopiclone NDTMS classification of primary drug use, the agency users, Lifeline Publications were commissioned to managers believed that “a good number” of clients conduct a small-scale action research project. The had used zopiclone as ‘secondary drugs’ in recent project was designed to meet two key objectives: years. Six suitable individuals were recruited by the agency to participate in the focus group, based (1) To conduct focus groups and interviews with on the primary criterion that they had been or were clients and staff of a drug agency in a North-East users of zopiclone - including three men (M1, M2, town about local zopiclone use, and produce a report M3) and three women (F1, F2, F3). Two participants on the research findings, incorporating an overview had been attending the Lifeline service for about four of the literature on zopiclone use and misuse; years; two had been attending for about six months; (2) To produce a publication for drug service and one had been attending for about a year. The clients, providing them with information about (a) sixth participant (F2) was not attending the service, zopiclone’s consumption, effects and consequences, but was the friend of one of the five service-user and (b) how to minimise the risks and harms participants (F1). Three participants were in their associated with zopiclone use. early twenties, and three were in their mid-thirties. All six clients were White and British, five of whom 2. Methods of investigation were English, and one of whom was Scottish (M1). All were current residents of the North-East town Overview. The design and setting up of the research in which the agency was based. Two participants took place in June 2008. The data-collection stage of (M1 and F3) were in a sexual relationship. All six the research had three components, each of which participants were alert and attentive throughout was carried out in July 2008: the discussion, and none were considered to be (1) An overview of the literature on zopiclone (both too intoxicated by drugs to participate effectively. published work and grey literature); Indeed, the majority of participants contributed (2) Focus group work: this was conducted on a great deal of useful information, and, with the the premises of a North-East drug agency on the exception of M2, they approached the task in an afternoon of Tuesday 8th July, and ran for almost enthusiastic and constructive manner. one and a half hours. The focus group took place in a large room with a central table and chairs, and Focus group procedure. In order to promote some seating along one wall, with those present a confidential atmosphere and encourage honest seated in a roughly circular fashion. In addition to responding, all relevant responses were written down the six volunteer clients, two Lifeline drugs workers by the researcher, rather than tape-recorded. As in were present, along with the Lifeline researcher (RN). any focus group, a degree of meshing (participants The session began with the researcher explaining speaking at the same time) inevitably occurred, the aims and objectives of the research, including which, combined with a degree of mumbling from making it clear to the clients that participation some participants, resulted in the loss of a small was voluntary, confidential, and anonymous, and amount of information. Participants generally stuck that their assistance would be rewarded with £10 to the main topic of discussion (zopiclone and its payment. A second focus group was also an option effects), and discussion of tangential or irrelevant within the research plan, but, following negotiations, topics took up less than about 5% of the time.

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