What Is Lunesta?
Lunesta is what’s known as a non-benzodiazepine hypnotic medication. Drugs in this class—sometimes also referred to as “Z-drugs”—are used to manage insomnia.1,2 Though once promoted as safer, less-side-effect-laden alternatives to benzodiazepines, drugs like Lunesta still carry many of the risks of benzodiazepines, including abuse liability, physical dependence, withdrawal, and addiction.1,3
Why Do People Abuse It?
Though chemically distinct from benzodiazepines, Lunesta has both a similar mechanism of action and effects profile to these drugs. Both are Schedule IV controlled substances, meaning there is a recognized potential for abuse and dependence4—a risk that may be increased when the drugs are consistently misused at higher-than-prescribed doses or more frequent dosing schedules.
People may misuse drugs like Lunesta for many of the reasons that benzodiazepines are used for nonmedical purposes—including their shared potential to elicit a dose-dependent euphoria.2 In addition, this effect may be increased by the simultaneous use of certain other drugs, such as alcohol and opioids. Such a combination can increase the inherent risks of these substances, and could increase the likelihood of dangerous central nervous system (CNS) depression.2
Potential Consequences of Misuse
In 2015, surveying by the Substance Abuse and Mental Health Services Administration (SAMHSA) indicated that nearly 100,000 people were estimated to have misused eszopiclone substances (including both generic formulations and the brand Lunesta).5 Many of the dangers of Lunesta misuse lie in the CNS depressant actions mentioned previously. Too much of these drugs can result in dangerous sedation and other potentially-injurious health effects such as respiratory slowing. Also as mentioned, such pharmacodynamic actions could pose additional health risks when alcohol and other drugs are simultaneously being consumed.6
Other potential adverse effects include:2,7,8
- Taste disturbances.
- Light-headedness or dizziness.
- Paradoxical effects (e.g., excitability, anxiety, agitation).
- Stomach upset.
- Complex sleep behaviors (e.g., sleep-driving).
Sedative-hypnotic drugs like Lunesta may be associated with a worsening of depressive symptoms, including an increase in suicidal thoughts and attempts. An international review study found zopiclone (marketed as the more active chemical variant eszopiclone in the United States) to be involved in nearly 30% of all cases of “intentional overdoses” that involved Z-drugs.2,3
In addition to these risks, problematic misuse of Lunesta can also promote the development of compulsive patterns of use, physical dependence, and an associated withdrawal syndrome.2,6
Compulsive Use and Addiction
A diagnosable condition, known as a sedative, hypnotic, or anxiolytic use disorder, sometimes develops in people who either begin to escalate their nonmedical use of a drug like Lunesta or, in other cases, start taking it therapeutically, but at some point gradually increase their dose and/or frequency of use to problematic levels. With considerable conceptual overlap with addiction, such a diagnosis is reserved for those people whose compulsive use begins to significantly and negatively impact various areas of their lives.
Though not a complete list, some of the criteria used to make a diagnosis of a substance use disorder involving Lunesta include:8
- Lunesta is taken in larger quantities and/or over a longer period of time than originally intended.
- There is a persistent desire and, potentially, previously unsuccessful attempts to cut down or quit using Lunesta.
- Strong cravings develop for continued use of the drug.
- There’s an avoidance of once important work, social, or recreational activities with family and friends as a result of compulsive Lunesta use.
- An increased amount of time becomes dedicated to obtaining and using the drug, as well as recovering from the effects of such use.
- A withdrawal syndrome develops when use of the drug slows or altogether stops, or continued use of the drug is necessary to relieve such discontinuation effects.
Many people are surprised to find that addiction to Lunesta is even possible. However, as with other prescription CNS depressants with similar pharmacologic action, the use of these drugs can result in reinforcing, euphoric effects and is associated with both physical dependence and an acute withdrawal syndrome.1
Though once heralded as a safer, nonaddictive alternative to benzodiazepine hypnotics, there is now significant evidence of misuse, abuse, and dependence phenomenon associated with these drugs.3
Though originally marketed as having a reduced propensity for both tolerance and withdrawal development (due to a more favorable pharmacokinetic profile relative to their benzodiazepine/barbiturate counterparts), troublesome and potentially-serious withdrawal effects are now known to be associated with Lunesta and other Z-drugs.1,3
Particularly after the abrupt discontinuation of long-term (e.g., 4 or more weeks), high-dose misuse, withdrawal effects might include:3,9,10,11
- Increased blood pressure
- Increased heart rate
Depending on the length of use and magnitude of associated physical dependence, acute Lunesta withdrawal can be uncomfortable and, in some cases, give rise to complications such as seizures. As part of a medical detoxification protocol, patients can be made to be more comfortable during acute withdrawal with a tapered dose schedule, medication administration, and supportive care.7,11
Even beyond the acute period, some degree of Z-drug withdrawal effects may persist in the longer term (several months) and may ultimately require additional therapeutic consideration for proper management.10
A Time for Healing
As mentioned, an important component of early recovery from Lunesta and/or other CNS depressant drugs is commonly a medical detox—which may involve a tapered course of the drug (or a substituted sedative agent) as well as specific medical interventions (such as seizure prophylaxis and other symptomatic management).
Detox can help prepare someone for a longer-period of addiction treatment or rehabilitation. Whether it is conducted in an outpatient or residential/inpatient setting, rehabilitation for compulsive Lunesta use will consist of additional behavioral therapy, group and individual counseling, psycho-education, as well as planning for aftercare services prior to discharge to maintain recovery momentum and prevent relapse.6,7,11,12
Because an underlying case of insomnia may have prompted initial therapy with Lunesta, additional therapeutic attention may need to focus on alternative pharmacologic support (e.g., trazodone) and/or improved sleep hygiene and other non-pharmacologic interventions.7,11 Many treatment programs will offer clients the opportunity to learn more natural ways of dealing with insomnia—such as meditation and other stress management approaches—that don’t require medication.
When possible, the process of selecting a treatment program should be approached with some contemplation and careful consideration. When available, the advice of a physician, counselor, or other clinician familiar with addiction treatment can be hugely instrumental in facilitating this process. There is no one-size-fits-all option in the addiction rehab world. However, many reputable professional rehabilitation programs will carefully factor individual circumstances and needs when devising a solid plan of treatment—finding one that does will ultimately improve the rehab experience and lay the groundwork for sustained recovery.
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
- U.S. Department of Health and Human Services—Food & Drug Administration. (2019). Labelling-Medication Guide: Lunesta.
- Schifano, F., Chiappini, S., Corkery, J. M., & Guirguis, A. (2019). An Insight into Z-Drug Abuse and Dependence: An Examination of Reports to the European Medicines Agency Database of Suspected Adverse Drug Reactions. The international journal of neuropsychopharmacology, 22(4), 270–277.
- United States Department of Justice—Drug Enforcement Administration. (2019). Controlled Substances Schedules.
- The Substance Abuse and Mental Health Services Administration. (2016). Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug use and Health.
- National Institute on Drug Abuse. (2018). Prescription CNS Depressants.
- Parsons, G. (2012). Pharmaceutical Journal. Dependence on benzodiazepines or Z-drugs: having that conversation.
- Diagnostic and statistical manual of mental disorders: DSM-5(5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
- Agravat, Aasha. (2018). Progress in Neurology and Psychiatry. ‘Z’-hypnotics versus benzodiazepines for the treatment of insomnia.
- Davies, J., Rae, T.C., Montagu, L. (2017). Long-term benzodiazepine and Z-drugs use in England: a survey of general practice. British Journal of General Practice2017; 67 (662): e609-e613.
- Kaiser Permanente. (2019). Benzodiazepine and Z-Drug Safety Guideline.
- Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.