John McCain and Ambien

Is he sleep-driving through the campaign?

After the last three weeks of erratic and unpredictable behavior from presidential candidate John McCain, it seems reasonable to revisit an issue first raised in May by ABC News: Is McCain’s use of the drug Ambien as a sleep aide affecting his behavior and judgment?

After the press was allowed a brief look at candidate McCain’s medical records earlier this year, Dr. Peter A. Fotinakes of the St. Joseph Sleep Disorders Center in Orange, California, told ABC News that, while Ambien was generally a safe medication, “Taking more than the recommended dosage of Ambien or combining it with other sedative-hypnotics--for example, alcohol—may result in amnesia, fugue states, and sleep walking.”

Ambien’s official website lists other reported effects: “A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of sedative/hypnotics. Some of these changes may be characterized by decreased inhibition (e.g. aggressiveness and extroversion that seemed out of character)....”

In addition, some users have reported bizarre personality changes such as excessive agitation and depersonalization (a dissociative disorder in which the patients self-perception is disrupted). A very small percentage of patients suffer hallucinations attributed to Ambien.

However, the most baffling side effect of Ambien is so-called “sleep-driving,” in which a person on Ambien drives a car, even though they are not fully awake, and then suffers amnesia about the event afterwards. Combining alcohol and Ambien increases the risks of such amnesiac behaviors, variations of which can include “preparing and eating food, making phone calls, or having sex,” all without conscious awareness, according to the Ambien website.

And there are particular caveats associated with the use of Ambien in elderly patients. “Impaired motor and/or cognitive performance after repeated exposure or unusual sensitivity to sedative/hypnotic drugs is a concern in the treatment of elderly and/or debilitated patients.... These patients should be closely monitored.”

Finally, Ambien users may also experience some of the following central and peripheral nervous system side effects: Confusion, vertigo, euphoria, agitation, difficulty concentrating, emotional lability, and “decreased cognition.” Ambien causes withdrawal symptoms when abruptly discontinued. Moreover, like the benzodiazepines, it can be addictive for some people.

Last year, the U.S. Food and Drug Administration (FDA) tightened labeling regulations on the newer sleep drugs like Ambien to reflect the possibility of these strange behaviors. In 2006, a class action suit was filed against Sanofi-Aventis, the makers of Ambien.

McCain on Drugs

Full speed ahead on the Drug War.

One issue largely missing in action during the presidential campaign has been the Drug War, and all the policy implications for addiction treatment that go with it. Our thanks go out to OnTheIssues blog for compiling the admittedly skimpy record of public statements about drug policy by both candidates. In this post, we examine the on-the-record views of Republican candidate John McCain.

In his long career in the U.S. Senate, John McCain’s support for the Drug War has never wavered. Campaigning for president in 2000, McCain’s positions were the most hawkish of the four major candidates, the Boston Globe reported. “He wants to increase penalties for selling drugs, supports the death penalty for drug kingpins, favors tightening security to stop the flow of drugs into the country, and wants to restrict availability of methadone for heroin addicts.”

This latter position was embodied in the “Addiction Free Treatment Act” that McCain introduced in the Senate in 1999, which called for defunding any drug program that used methadone, unless the program followed a restrictive set of guidelines.

McCain has criticized the former Clinton administration for going “AWOL on the war on drugs,” and has pushed tirelessly for greater military assistance to drug-exporting nations like Columbia.

In more recent activity, Senator McCain sponsored a a 2005 bill, “The Clean Sports Act,” mandating drug testing in all major professional sports leagues. And in 2006, McCain signed on to the “Safe Streets Act Amendment,” which called for federal grants to Indian tribes to fight methamphetamine addiction.

This year, “McCain met with Mexican President Felipe Calderon to discuss immigration, trade and the recently passed Merida Initiative, a $400 million U.S. aid package to help Mexico fight an increasingly bloody drug war that has claimed more than 1,800 lives this year.”

“Drugs is a big, big problem in America,” McCain said in a fact-finding trip to Columbia in July. “The continued flow of drugs from Colombia through Mexico into the United States is still one of our major challenges for all Americans.”

McCain’s response last year to a New Hampshire police officer’s question about the failure of the Drug War does not bode well for the prospects of responsible changes in drug awareness and addiction treatment in a McCain administration: “Look, I've heard the comparison between drugs and alcohol. I think most experts would say that in moderation, one or two drinks of alcohol does not have an effect on one's judgment, mental acuity, or their physical abilities. I think most experts would say that the first ingestion of drugs leads to mind-altering and other experiences, other effects, and can lead over time to serious, serious problems."

A search of the McCain-Palin campaign website for the term “drug war” came up empty.