by Matthew Edlund, M.D.
Snorting Sleeping Pills to Treat Your Feet
Not everyone snorts prescription sleeping pills to treat their feet. Aerosmith rocker Steve Tyler podiatric self-management included snorting lunesta (eszopiclone.) When he tried it while performing in South Dakota in 2009 he fell off the stage.
Please don’t do this when you’re judging American Idol, okay?
As fans of the Darwin awards know well, people can and do use drugs in surprising, ingenious ways. One of my better remembered patient encounters involved a Houston undergraduate who liked to get high injecting Vicks Vapo-Rub. He would grab his preferred substance, uncap the bottle, pour the liquid into a syringe, then subcutaneously inject. He never got infected and assured me he became “pleasantly whacked” for a while, though later he felt really tired.
Sleeping pills have different uses, but some are silly and others downright dangerous. Here are a few sleeping pill “uses” you may wish to avoid:
1. Getting high. Steve Tyler is not alone in his predilection for sleeping pills as a way to get “up”, though snorting them has hitherto been unfashionable. Many people use the class of benzodiazepine drugs, of which valium (diazepam), Librium (chlordiazepoxide), and ativan (lorazepam) are just some of the more popular members, to get high. Many of these “highs” occur in conjunction with other drugs including alcohol, opiates, and cocaine.
The problem – though very effective for anxiety disorders, benzodiazepines and drugs that mimic them, like lunesta and ambient (zolpidem,) can become physically addictive. Combined they can make you very dead. Many a celebrity, like the Beatles’ manager Brian Epstein and Australian actor Heath Ledger, died of overdosing on sleeping pills. Often sleeping pill lethality is increased through adding alcohol. Like many addicting drugs, sleeping pills also produce tolerance – you just need more and more of the stuff. Not recommended.
2. To nap. Sleeping pills, especially short acting ones like lunesta and ambient often let people fall quickly into sleep – so fast people use them to nap.
The problem – beyond the issues of dependence and tolerance, short acting sleeping pills have been implicated in hair-raising sleepwalking episodes where people drive their cars for hours or try to jump off buildings. They also leave their users, after a short two hours of exposure, in terrible shape to walk, move, or do anything requiring intelligence, as shown in a recently published study by Kenneth Wright done at the University of Colorado. Short acting sleeping pills hit some of the same benzodiazepine receptors in the brain that long acting ones, like valium, do. Benzodiazepines are famous for causing many accidents and falls, in part because people think they’re better navigators than they really are. Benzodiazepines produce a kind of global Lake Woebegone effect – taking them convinces people their reactions and driving skills are superior – when they’re really impaired.
Plus using sleeping pills for naps vastly complicates obtaining normal sleep at night. Sleeping pills for naps are Not Recommended, except perhaps in movies, weepie novels and some complicated jet lag strategies.
3. “Topping off” other sleeping pills. When you can’t sleep, you get frantic. Many respond by taking more pills. Occasionally they will sleep better that night, and perhaps a couple of nights or even weeks more.
The problem – you’re usually just adding another drug, like ambien, to what is functionally the same class of drug, for example valium or restoril (temazepam.) You’ve blasted the new drug onto the few remaining receptors that don’t already have pharmaceuticals attached, but the effect won’t last. Tolerance hits quickly, and much of the “effect” leading to sleep is the brain simply recognizing there’s a different sedating drug coming in. The overall results on balance, thought, cognition, and memory are generally highly unfavorable. Definitely not recommended.
4. Shifting different sleeping pills from day to day. Perhaps it’s the nature of my clinical practice, but I usually observe this particular strategy happily engaged in by Europeans and globe trotting Americans who notice they sleep “better” when they vary their dosing in ancient Chinese menu style – one pill tonight from column A, two tomorrow from column B, the next night one from column A and column C…
The problem – people will certainly feel a different buzz, but lots of what goes into sleeping pill use is behavioral. The old team at Henry Ford hospital, especially Tim Roehrs and Leon Rosenthal, years ago did a lovely study where they gave habitual sleeping pill users their choice of different colored pills. One color contained what they had been taking for years; the other was placebo.
They took equal amounts of each.
For long term users, placebo=sleeping pill of choice.
So shifting drugs night by night may give the illusion of an effect that is different and “powerful.” Yet beware. Combining different sleeping pills from day to day not only increases tolerance but leads to unpredictable cognitive and physical results as different drugs are detoxified in very different manners and speeds. There are times in the 24 hour day when you get far more or far less stuff working than users think – which can lead to terrible accidents as well as increasing dependence.
The Larger Problem
A major public health difficulty of sleeping pills is that they don’t produce normal sleep. Recent studies of short acting agents like ambien place them more in the category of inducing mini-coma than anything resembling sleep.
Rest is regeneration. You rebuild body and brain through sleep. The natural kind is still best.
The best uses of sleeping pills remain temporary ones. And they’re definitely not to be used for foot pain.