Morinan and Keaney Journal of Medical Case Reports 2010, 4:403 http://www.jmedicalcasereports.com/content/4/1/403 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Long-term misuse of zopiclone in an alcohol dependent woman with a history of anorexia nervosa: a case report Alun Morinan*, Francis Keaney Abstract Introduction: The Z-drugs, zaleplon, zopiclone and zolpidem, are short-acting hypnotics which act at the same receptor as the benzodiazepines, but seemingly without the potential for misuse and the development of dependence of the older benzodiazepines. However, with increased prescribing of Z-drugs, reports of misuse and possible dependence began to appear in the literature, particularly in people with a history of substance misuse and comorbid psychiatric illness. Here we report the case of a woman with a history of chronic zopiclone use and anorexia nervosa, admitted for alcohol detoxification. Case presentation: A 31-year old Caucasian British woman with a history of long-term zopiclone use and anorexia nervosa was admitted as an inpatient for a ten-day alcohol detoxification. Her weekly (four days out of seven) intake of alcohol was 180 units and her daily intake of zopiclone, 30 mg. Apart from a short period five years ago, she had been taking zopiclone for 13 years at daily doses of up to 90 mg. She admitted to using ‘on top’ of her prescribed medication, purchasing extra tablets from friends or receiving them gratis from her partner. After detoxification from alcohol and zopiclone, she was prescribed diazepam which she found ineffectual and voiced her intention of returning to zopiclone on leaving the hospital. Conclusion: Zopiclone is generally regarded as safer than benzodiazepines, however, this particular individual, who was using high doses of zopiclone over many years, may provide further evidence of a risk of dependency when this drug is prescribed for substance users with a comorbid psychiatric illness. Introduction Insomnia is a subjective experience of poor or unre- freshing sleep that may be apparent from a delayed onset or decreased duration of sleep [1]. The short act- ing hypnotic cyclopyrrolone derivative, zopiclone (RP 27,267) was synthesised in the late 1970 s and intro- duced into clinical practice some ten years later. Zopi- clone, like the other Z-drugs, zolpidem and zaleplon, interacts with the same molecular target as the benzo- diazepines on the GABAA (g-aminobutyric acid) recep- tor [2,3]. Zopiclone is available as the racemic mixture although the S-enantiomer, eszopiclone, has a 50 times higher affinity for the receptor than the R-enantiomer [4]. In terms of clinical efficacy and adverse reactions, * Correspondence: alun.morinan@kcl.ac.uk King’s College, University of London, Institute of Psychiatry, National Addiction Centre and South London and Maudsley NHS Foundation Trust, Box 048, 4 Windsor Walk, London, SE5 8BB, UK the Z-drugs showed little difference from the short act- ing hypnotic benzodiazepines [5] although the fatality toxicity index (deaths/106 prescriptions) for zopiclone, 2.1, was much lower than the 9.9 for temazepam [6]. When the Z-drugs were first introduced, there was lit- tle epidemiological evidence of misuse; however, as time went on, more cases began to appear in the literature. In a report published in 1995 [7], zopiclone misuse was identified in three male teenagers attending their local CDAT (Community Drug and Alcohol Team). The zopiclone had either been prescribed or bought on the street (zim-zims) at a cost of £1 a tablet. In two indivi- duals, zopiclone was being used to intensify and prolong the effects of alcohol while the third, a polysubstance user, was crushing up the tablets for intravenous injec- tion. However, in none of the three was there any evi- dence of dependence. © 2010 Morinan and Keaney; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.