‘Z-trip’? A comprehensive overview and a case-series of Zolpidem misuse
Laura Orsolini 1, 2, 3*, Stefania Chiappini 1, Paolo Grandinetti 3, 4, Angelo Bruschi 5, 6, 7, Roberta Testa 8, Alessandra Provenzano 9, Umberto Volpe 2, Domenico De Berardis 3, 10, 11
1Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, AL10 9AB, Herts, UK., 2Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy., 3Polyedra Research, Teramo, Italy., 4NHS, Department of Territorial Assistance, Service for Addictions (SerD), ASL 4 Teramo, Italy., 5NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Belcolle Hospital, Viterbo, Italy., 6Catholic University of the Sacred Heart, Rome, Italy., 7“La Sapienza” University, Rome, Italy., 8NHS, Department of Mental Health, AUSL Reggio Emilia, Italy., 9NHS, Department of Mental Health, ASL Viterbo, Italy., 10NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4 Teramo, Italy., 10NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4 Teramo, Italy., 10NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4 Teramo, Italy., 10NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4 Teramo, Italy., 10NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4 Teramo, Italy., 11Department of Neuroscience, Imaging and Clinical Science, University “G. D’Annunzio”, Chieti, Italy., 11Department of Neuroscience, Imaging and Clinical Science, University “G. D’Annunzio”, Chieti, Italy. , 11Department of Neuroscience, Imaging and Clinical Science, University “G. D’Annunzio”, Chieti, Italy., 11Department of Neuroscience, Imaging and Clinical Science, University “G. D’Annunzio”, Chieti, Italy. , 11Department of Neuroscience, Imaging and Clinical Science, University “G. D’Annunzio”, Chieti, Italy.
Received: February 7, 2020; Revised: March 26, 2020; Accepted: March 26, 2020; Published online: March 26, 2020.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Although believed safer compared to short-acting benzodiazepines (BZD), in the past few years a growing concern has developed relating to the abuse of Z-drugs, and specifically of zolpidem. Here we aim to review the evidence for the misuse of zolpidem and describe several related cases collected in Italy. A comprehensive overview is here carried by using several databases, and by combining the search strategy of free text terms and exploding a range of MESH headings relating to the topics of Zolpidem and Abuse and/or Misuse as follows: ((Zolpidem[Title/Abstract]) AND (Abuse[Title/Abstract]) OR (Misuse[Title/Abstract])), without time and/or language restrictions. Furthermore, a case series of 8 cases of zolpidem misuse and/or abuse, collected in different Italian psychiatric settings (psychiatric public hospital, psychiatric private rehabilitation clinic, and private practice), have been here described. According to our findings, zolpidem should be prescribed with the same caution as BZDs, especially in patients with a history of drug abuse or in the elderly. Behavioural modifications, including bizarre behaviours, psychomotor agitation, sleep-related complex behaviours have been reported. Monitoring of zolpidem use in selected populations is warranted. Psychiatrists and physicians should be aware of the misuse potential of zolpidem and adopt measures restricting its use.
Keywords: Zolpidem, Z-drug, Z-trip, dissociation, high, abuse, misuse


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