Murder: Another Ambien Side Effect?
Tuesday, May 13, 2014 10:34 AM
Forensic psychiatrists have found it challenging to unravel the role of zolpidem (Ambien) in several brutal murders committed against loved ones.  The cases may be the most extreme examples of an already known side effect of zolpidem -- that, even at recommended doses, people using the drug may get out of bed and do things while still effectively asleep, and don't remember it the next day.

Numerous reports have described people fixing meals, having sex, and even getting into their cars and driving away in the middle of the night, with no later recollection. A few "Ambien zombies" have wrecked their cars and even killed people in accidents.  But in at least three cases, a person with no apparent motive and no history of violence brutally murdered a spouse or close friend in the wee hours after taking more than the recommended dose of zolpidem along with other psychotropic medications.

The two cases in the 2012 paper involved a 45-year-old man and a 62-year-old woman, both of whom had taken at least two 10-mg zolpidem pills (the current maximum dosage is 5 mg for women and 10 mg for men) and had received other prescription psychotropic drugs including paroxetine (Paxil) and, in the man's case, quetiapine (Seroquel).

Sometime in the night, these patients got up and killed their spouses. Mr. A, as he was called, stabbed his wife more that 20 times. Ms. B went into her garage, picked up a metal pipe, and returned to the bedroom where she bludgeoned her husband and then put a plastic bag over his head.

Both Mr. A and Ms. B stayed alone with the bodies for hours, and then seemed glassy-eyed and confused when they finally emerged. They consistently denied any recollection of the events and were initially incredulous that they could have done such things.  Also, in both cases, the perpetrators reported being still sleepless after taking one zolpidem and had therefore taken additional pills.

In the 2013 case, a young man in Littleton, Colo., a suburb of Denver, named Andrew McClay beat his female housemate to death with a hammer. According to news reports, he had taken five zolpidem pills along with whiskey and naproxen. Other aspects of the crime and its aftermath were similar to those in the previous two cases.

Another similarity was that all three ended up criminally convicted. Mr. B was found guilty of second-degree murder at trial, and McClay pleaded guilty to the same charge; both received long prison sentences. Ms. B pled guilty to manslaughter in a deal with prosecutors and served 4-1/2 years before being paroled.

Amnesia -- even if a jury can be persuaded that it's genuine -- does not absolve someone of a crime he or she has committed. The fact that a murderer later doesn't remember doing it does not mean that he or she wasn't fully aware of it and its implications at the time.  But, in some states, murderers can argue that, as a result of some medical condition or medication they were taking, they were not in control of their actions through no fault of their own. It's called "involuntary intoxication" or "automatism" -- although a person may undertake seemingly deliberate acts, he or she may be effectively unconscious and not responsible for those actions.

The law is still evolving in this area. The traditional legal view has been that if an individual is aware of an impairment, he or she is obliged to mitigate the risks.  "The legal issue is, did you realize at some point, prior to [for example] violating the law by speeding or, worse, having an accident, that you were suffering from the impact of having ingested one or more hypnotics? In many states, the law says that if you realize this, you have a legal obligation to stop driving and pull over.  

The issue really is, does that logical description comport with the impact of the substance? What is the actual experience? Do they switch levels of awareness to diminished awareness? Awareness is also about judgment."

With regard to zolpidem, "we just don't know the answers."