Zolpidem, Complex Sleep-Related Behaviour and Volition

Abstract

A commonly prescribed hypnotic, Zolpidem, has been linked to accidental death, driving offences and a very uncommon legal defence – automatism.The deaths and prima facie criminal behaviour that have triggered legal concern and considerable publicity have occurred while the person was in a sleep-like state and apparently acting involuntarily after ingesting the drug. Australian courts have had a mixed response to these claims, and have closely examined the expert evidence that is essential to establishing the link between the conduct and the medication. Accepting that a connection has been established, in 2014 a Victorian Coroner suggested that guidelines issued in Australia should reduce recommended dosages of Zolpidem and increase warnings about adverse effects. However, forensic issues associated with unpredictable, complex sleep-related behaviour triggered by Zolpidem will not be resolved entirely by these changes. Exploration of the legal implications of this conduct is essential as the issue is likely to be of continuing and particular significance in Australia, where reports of adverse effects associated with this hypnotic have been more frequent than in other countries.

Keywords: Zolpidem, hypnotics, automatism, involuntary intoxication, volition