In 1992, the FDA approved a new drug that was meant to change the sleep aid market. With medications such as Halcion and Valium posing major side effects and abuse risks, the prescription Ambien was supposed to be a lesser evil, as an insomnia treatment which would be effective without near as many side effects.
Zolpidem, as it is pharmaceutically known, was part of a new generation of hypnotic sedative drugs. In regular form, zolpidem begins working within 30 minutes of ingesting, and be fully active within 90 minutes to help those struggling to fall asleep. Taking Ambien CR, the extended-release formula, allows for zolpidem to be continually released to help those struggling with staying asleep.
However, startling side effects of zolpidem soon came to light following widespread prescription use.
The medication guide for Ambien warns “you may get up out of bed while not being fully awake and do an activity that you do not know you are doing.” These “activities” can range from sleepwalking, sleep-driving, sleep eating, and even sleep sex; all without being able to recall those actions the next day.
It was not until 2013 when the FDA issued a warning for “risk of next-morning impairment” for zolpidem and required manufacturers to lower the recommended dosage of the sleep aid. Current recommended dosage for Ambien is one 5mg tablet for women and 5-10mg for men followed by 7-8 hours of sleep, and the medication should not be taken for more than 7-10 days continuously.
Ambien has come to the forefront in Montgomery County as the cause behind a wreck involving Montgomery County Judge Mark Keough, a parked Precinct 5 Deputy Constable, and a civilian vehicle. In his interview with DPS, Keough informed Troopers he took Ambien “two or three times a week,” but the prescribed dosages and whether the prescription was for regular or extended-release tablets is not part of DPS’ public report.
According to the sworn affidavit filed by TxDPS, “Keough did not recall how the crash occurred or any aspect of it.”
This dangerous caveat of zolpidem has seen its day in court. In 2006, Rhode Island Representative Patrick Kennedy smashed into a road barrier at Capitol Hill under the influence of Ambien, a charge he pled guilty to; paying a $350 fine and sentenced to 50 hours of community service, 1 year of probation, and weekly Alcoholics Anonymous (AA) meetings.
In a study published by The Journal of the American Academy of Psychiatry and Law, researchers Christopher Daley, Dale McNiel, and Renee Binder reviewed multiple cases in which defense arguments based on being under the influence of a prescription medication was enough to reduce and even dismiss charges, citing “In several of the cases reviewed, defendants advanced an argument of reduced or negated criminal liability attributable to involuntary intoxication.”
Unfortunately, taking this method of defense brings its own set of consequences, especially for public officials. The study concluded “Witnesses who claim that they were acting in an unconscious state of mind assert an affirmative claim to mitigate their personal responsibility.”
In Keough’s position as County Judge he has direct oversight of county operations for Montgomery County, including Emergency Management, a vital cog in the wheel directing resources amidst a global pandemic that has infected 22,578 and killed 185 Montgomery County residents alone. The morning of the unfortunate crash, Keough was on his way to a meeting in The Woodlands in his capacity as County Judge; he was also on the phone with Montgomery County Attorney B.D. Griffin, all with 155.5 ng/mL of zolpidem and 65 ng/mL of amphetamines still in his system.
Entire legal defenses have been built around the neuro and psychological effects of zolpidem within the system, even after several hours of sleep. For a medication to hold the potential for illegal and dangerous actions that the user may be completely unaware of absolutely brings into question the safety of zolpidem and similar sleep aid medications. Unrestricted in its ability to impair across socioeconomic backgrounds, it can make even the seemingly astute lose their critical thinking skills.
As County Judge, Keough has been responsible for many critical decisions regarding the handling of the COVID-19 pandemic, including business closures/re-openings, mask requirements and enforcement, alongside the handling and expenditure of $105 million in federal CARES Act funds allocated to Montgomery County.
Even when used properly, zolpidem can provably have long-reaching effects unbeknownst to the user of the medication, such as mental and physical impairment. Since it is unknown how long Keough has been using the medications found in his system and in what dosage, leaves wide open the question if all of the duties performed in Keough’s official capacity were free of impairment, or not.
