3 What is zpiclne? Zpiclne is a drug with very similar effects t benzdiazepines (like diazepam, temazepam). It is prescribed by dctrs fr the treatment f insmnia (difficulty sleeping), and in the recmmended dse brings n sleep fr perids f 6 t 8 hurs. Hwever, this leaflet is abut the use f zpiclne as a street drug and the risks and likely prblems this may cause fr drug users. 3
4 Zpiclne Yu can t really wrry abut yur prblems when yur brain has been zimmied int neutral Zpiclne and Z-drugs Zpiclne is prescribed in tablet frm, either as zpiclne r under the brand name Zimvane, which alng with zlpidem (brand name Stilnct) and zalepln (brand name Snata), are knwn as Z drugs that is, sleeping pills which begin with the letter z. Zpiclne tablets g by the street names f zimmers r zimmies and in sme parts f the cuntry zim-zims. As they have similar benzlike effects, it is likely that ther z-drugs are als sld as zimmers - the main way f distinguishing between street bught Z-drugs is that zalepln (Snata) is a capsule and zpiclne leaves a distinctive metallic taste in the muth (see page 5). Why d drug users use zpiclne? Sme regular herin users start ut using zpiclne t get the ld mnging ut effect when the quality f the lcal herin is pr. Crack users find zpiclne helps them sleep r takes the edge ff the cme-dwn, while ther peple use it t get ff their face and frget abut their prblems. Dctr, I m having truble sleeping! Dctrs are beginning t wise up t the fact that zpiclne is being blagged ff them and used as a street drug, s are becming mre cautius abut prescribing them t knwn r suspected drug users. Tablets sld n the street g fr abut 1 each, althugh the price cmes dwn if bught in bulk and ges up when there is a drught n. Legal status Zpiclne is nt classified under the Misuse f Drugs Act, and s is legal t pssess r use withut a prescriptin. Hwever, zpiclne is a prescriptin nly medicine (POM) under the 1968 Medicines Act, and s supply is legally restricted t dctrs (prescribing) and pharmacists (dispensing). Zlpidem (Stilnct) is the nly Z-drug cvered by the Misuse f Drugs Act - it was made a Class C drug in
5 Appearance Zpiclne tablets are prduced by at least half a dzen different cmpanies in the UK. Zimvane is the riginal UK brand name, but there many ther brand names used in ther cuntries. The tablets are usually film-cated and cme in tw main dses: 7.5 mg and 3.75 mg. The tablets can be rund r val and althugh usually white, but can be blue, range r varius ther clurs (fr imprted tablets). They can be marked with the 7.5mg r 3.75mg dse and can have the letter Z r ther letters n them. Sme drug users have bught tablets thught t cntain higher dses, which may have been either legally manufactured in anther cuntry r are fakes. 5
7 Physical effects and risks Trying t sit dwn can take a zimmer user half an hur it has t be seen t be believed, if it wasn t s sad it wuld be funny Physical effects Nt surprisingly, given that it is a sleeping pill, zpiclne gives yu a heavy feeling in the arms and legs, and makes yu want t clse yur eyes and fall asleep. But experienced users ften try t resist the urge t fall ver and snze, because nce this has passed (after an hur r s) they can experience the desired effects f sedatin and euphria ( mnged ut and buzzing ). Being n zimmers in public places increases yur vulnerability t street predatrs (muggers, rapists, etc) far mre s than the effects f herin r crack. That s why mst users stay at hme when getting ff it n zpiclne. It causes a lss f crdinatin (staggering, swaying, stumbling, etc..) and very slwed-dwn behaviur. It can take a great effrt t carry ut even the simplest actins. Metal muth Zpiclne causes an unpleasant metallic after-taste in the muth (dysgeusia), which is experienced by mst users within an hur r s f swallwing the tablet(s). Althugh peple using the drug t aid sleep generally d nt experience this taste until after they wake up, peple wh stay awake after using zpiclne experience the metallic taste during this semi-cnscius state. Regular users say the metallic taste becmes less intense ver time, althugh sme say that strng memries f this taste cme back t them when they have run ut f zpiclne and are craving it. Other physical effects Sme lng-term heavy users may eventually find that they experience stimulant-type effects frm the drug t including cnstantly talking, fidgeting, lack f appetite, and sleep disturbances. Vmiting and cnstipatin/diarrhea can ccur when using, while sme peple reprt experiencing hangver-like symptms (e.g. headaches) when cming dwn frm zpiclne use. Cancer and ther physical prblems Research has shwn that, even at recmmended dses, prlnged use f zpiclne may cause cancer (affecting brain, lung, bwel, breast and bladder). Zpiclne can als have an adverse effect n the immune system (increasing rates f clds and infectins), and is nt recmmended fr peple with liver r kidney disease, pregnant r breast-feeding wmen, r children. 7
8 Mental effects and risks Mental effects Zpiclne helps yu sleep, thugh users wh manage t stay awake n it can feel drwsy and calm. Zpiclne can turn dwn the intensity f yur emtins, and this makes it desirable t peple trying t escape frm unpleasant feelings and memries althugh zpiclne can als blck r lessen gd feelings as well as bad nes. Eventually, it makes yu lse all yur feelings, it makes yu feel ttally numb This can include sexual feelings, which users say are almst ttally eradicated when under the influence f zpiclne. A girl culd strip naked in frnt f yu, and yu wuld nt want sex with her, yu have n strength r energy fr sex, and n interest in it - r anything at all really. Amnesia and invisibility Zpiclne users ften say that ne f the wrst things abut using the drug is the inability t think ratinally r clearly; alng with memry prblems (e.g. cnstantly frgetting what yu were saying ); and partial r ttal amnesia. Sme peple reprt hiding things (like drugs r mney) when wrecked n zimmers and then having n memry f where they had hidden them nce the drug has wrn ff. Like heavy users f temazepam, zpiclne users can get ver-cnfident, with the wrst cases becming deluded that they are mre-r-less invisible perhaps reflecting their shrunken sense f self-awareness. Cmbined with fuzzy thinking and minimal memry, this can lead users int unplanned risky activities, believing that they wn t get caught like shplifting in a stre frm which they are banned. I necked a handful f zimmers, then a few hurs later I came rund in my flat t find myself surrunded by leather jackets but I had n memry f hw they had cme t be there. Aggressive and vilent behaviur Zpiclne misuse may increase aggressin and vilence - amng wmen as well as men and sme users becme insensitive t pain. Herin and crack users wh usually fund their habits by ding crimes like shplifting and credit card fraud ften say that perids f zpiclne use led them int carrying ut mre vilent crimes like mugging with sme admitting t utbursts f randm vilence. Als, when waking up frm the deep slumber which ended zpiclne sessins, users cmmnly had n memry f their vilent actins (amnesia). I ften frgt abut vilent behaviur until friends with wunds and bruises reminded me later n what I had dne t them. 8
9 Overdse and death The risk f verdsing n zpiclne increases when: higher dses are used; when it is injected and when it is mixed with ther drugs Zpiclne deaths Abut 40 t 50 British peple die each year due t pisning by either zpiclne r zlpidem thugh ther drugs are usually invlved. The risk f verdse n zpiclne increases (a) with higher dses, (b) when it is injected rather than swallwed, and (c) when it is mixed with depressant drugs like alchl, sedatives (tranquillisers and sleeping pills), r piids (ntably herin r methadne). Higher dses The dses f zpiclne prescribed by dctrs fr the treatment f insmnia usually range frm 3.75 mg t 7.5 mg a day fr adults (zpiclne is nt recmmended fr children). By cntrast, the number f tablets generally taken in a sessin by drug users can range frm three (abut 20 mg) fr new users up t 20 (150 mg) fr regular users with sme lngterm users taking even higher dses. The higher the dse yu use, the greater the risk f verdse and death. Injecting zpiclne All prescribed users swallw zpiclne tablets, as d mst street users. Sniffing r smking zpiclne tablets is highly impractical and rarely heard f. The tablets are practically insluble which means that they d nt disslve, even after biling and s injecting is extremely messy and dangerus. Thse peple that d inject the tablets, d s by scraping 9
10 ff the film cating, chpping up the remaining tablet very finely then adding water, stirring and heating in a spn r cker. Althugh sme add disslving agents like citric acid r Vitamin-C pwder, this desn t really disslve the pwder. The thick chalky sludge that results is difficult t inject and is much mre likely than herin r crack t cause damage t the veins, resulting in abscesses, deep vein thrmbsis (DVT), aneurysm, ulcers, varicse veins and gangrene. Injecting zpiclne greatly increases the risk f verdse and death, vein damage and picking up viruses like hepatitis C and HIV. Zpiclne mixed with ther drugs Zpiclne is smetimes crushed and mixed with herin befre it is sld (withut the users knwledge), increasing (yu guessed it) the chances f verdse. Thse wh chse t use zpiclne smetime use it tgether with crack, and/r herin, t increase their main effects and reduce their after-effects. Sme peple use zpiclne with bze as this substantially magnifies the effects (and the risk f verdse) f bth the alchl and the zpiclne. Even at prescribed dses it is advised nt t mix zpiclne with ther depressant drugs, particularly ther sleeping pills and alchl as this greatly increases the risk f verdse and death. But sme peple will use zpiclne with anything they can get hld f. When I ve had zimmers, they make me feel pen t taking just abut anything, even stuff I wuldn t usually tuch. This state f mind is very similar t the disinhibitin brught abut by heavy alchl use. Bad reactins have als been reprted when zpiclne has been taken at the same time as erythrmycin (antibitic fr peple allergic t penicillin), trimipramine (tricyclic anti-depressant), r carbamazepine (anticnvulsant and md stabiliser). Mixing zpiclne with ther drugs greatly increases the risk f verdse and death. 10
11 Dealing with zpiclne verdse Signs f verdse Overdse frm zpiclne (and ther z-drugs) is a result f excessive sedatin and depressed respiratry functin (falling int a sleep s deep yur breathing slws dwn r stps) which may prgress t cma and death. Knwing when a drug user has verdsed n zpiclne is very difficult, as mst f the signs f verdse listed in the medical bks - drwsiness, swaying and staggering, clumsiness and slurred speech - are nrmal fr peple using at higher dses. Hwever, if a friend is having difficulty breathing, yu ntice any strange nises r gurgling sunds, their muths r lips turn blue r they can t be wken - it is still best t put them in the recvery psitin (t stp them chking t death n their vmit) and call an ambulance. Calling an ambulance The ambulance service d nt autmatically call the plice t verdse situatins. Zpiclne verdse can be treated with the benzdiazepine receptr antagnist flumazenil, which rapidly reverses the effects f zpiclne, s yu shuld tell paramedics if yu knw r suspect the persn has taken zpiclne. The recvery psitin 11
12 Addictin Zimmers are really addictive, and the rattle is abut five times wrse than the rattle frm gear Addictin When they are used in prescribed dses t treat insmnia (ne r tw tablets per day) - dependence t zpiclne is fairly rare and takes a mnth r lnger. Drug users ften start n a dse f abut three tablets a day, which increases t abut 10 t 20 tablets a day ver a perid f ne r tw weeks befre many say they feel hked n zimmers. Cravings Cravings fr zpiclne (an verwhelming cmpulsive desire t use) are said t be strnger than cravings fr ther drugs, even crack r herin. I made sure that I always had credit n my phne, s that I did nt miss any calls frm dealers abut new batches f zimmers but waiting fr the dealer t turn up with the tabs was agnising yu end up pacing the flr, smashing things, and cursing them Once a zpiclne habit is well established, users say they much preferred t travel several miles n buses r trains t the surce f the drugs rather than wait fr them t be delivered, because the anxiety experienced while waiting fr dealers t turn up at their hmes is t unbearable. Much wrse than when waiting fr rcks r gear. Withdrawals After cravings, the ther withdrawal symptms mst cmmnly mentined included fatigue and muscular weakness ( bdy like jelly ); aching limbs ( dead legs ), sweats, appetite prblems (reduced r increased hunger), and insmnia. Withdrawal symptms listed in medical reprts include anxiety, increased heart rate, sweats, flushes, palpitatins and fits. Users ften say that cming ff zpiclne is far mre unbearable than a herin-related cld turkey. The duratin f the zpiclne withdrawal syndrme is cmparable t the duratin f the herin withdrawal syndrme. Yu rattle fr abut three t five days... after the wrst is ver, the craving and ther stuff - like thinking abut the metal taste - g n fr weeks and weeks. 12
13 Cming ff Zpiclne withdrawal As with withdrawals frm herin, ne f the wrst symptms f zpiclne withdrawals is insmnia (difficulty sleeping), because the lack f sleep magnifies the unpleasantness f the ther withdrawal symptms, and reduces yur will t deal with them. Peple addicted t zpiclne prescribed t them by their dctr may be advised t switch t an equivalent dse f the lnger lasting diazepam and then slwly reduce ver several mnths. Hwever, dctrs and drug clinics d nt usually prescribe benz-like sleeping pills t drug users recvering frm zpiclne dependence (r fr any ther reasn). This is because f the risk f verdse and dependence n benzs. The main medicatin prescribed tends t be Nytl. Getting help Sme users have tried reducing the symptms f withdrawal n their wn by using piates r ther drugs ver several mnths. Hwever, this is extremely unpredictable and may well cause mre prblems than it slves. If yu want t cut dwn, stp r get sme advice, cntact yur lcal drug service and get sme specialist help (see back page fr details). Drug testing The available bdy fluid tests fr illicit drug use (including urine, saliva and sweat tests) d nt usually include zpiclne. Diazepam and temazepam are the nly hypnsedatives (sleeping pills) rutinely cvered by drug testing devices at present. Drug users attending sme criminal justice/drug services as part f a curt rder are required t be drug free. It has been nticed that even thugh sme peple are testing negative they are still turning up heavily intxicated n zpiclne. Nytl cntains diphenhydramine an (Over The Cunter) antihistamine, which is nt s habit frming - althugh a lt f drug users cmplain it desn t get them t sleep unless they take, way ver the recmmended dse. 13
14 Summary and reducing risk.... Zpiclne tablets cme in a variety f different shapes and clurs, usually in 3.75mg and 7.5mg dses. Beware f imprted tablets as these may be cunterfeit, adulterated, r higher dses. Using bigger dses f zpiclne ver time increases the risk f dependence and verdse, as des regular use f high dses. Regular use fr lng perids can reduce immunity (mre clds and infectins), and even increase the risk f varius kinds f cancer. Avid driving r attempting anything hazardus like cking r ging ut when zimmied. In fact the safest place t use zpiclne is at hme in bed. Lking after children shuld als be avided when n zpiclne. Zpiclne passes int breast milk, s shuld nt be used by nursing mthers. Users wh return t taking high dses f zpiclne after a perid f abstinence - when their tlerance has drpped face a high risk f verdsing. Zpiclne verdse can be treated with the benzdiazepine receptr antagnist flumazenil, which rapidly reverses its effects. S call an ambulance and tell the paramedics what has been taken. The plice are nt rutinely called t verdses. It is a bad idea t inject zpiclne. The tablets are practically insluble s there is a very high risk f vein and tissue damage alng with the usual risk f picking up and passing n infectius diseases like hepatitis C and HIV. Mst deaths frm zpiclne invlve mre than ne drug. In particular, using zpiclne in cmbinatin with alchl, benzdiazepines and piates increases the risk f verdse. Adverse reactins can ccur if zpiclne is mixed with any f three prescriptin drugs, namely erythrmycin, trimipramine, r carbamazepine. 14
15 The chemical structure f zpiclne. The full chemical name is chlrpyridinxtriazabicyclnnatrienylmethylpiperazinecarbxylate
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