I do not think anybody has reliable information on how much Americans take sleeping pills.  Most scientific discussion cites data from the National Prescription Audit, a survey system conducted by IMS America, Ltd. Their survey methods are proprietary, and I do not know in detail what they are, but they involve computerized monitoring of retail pharmacy sales. According to the New York Times, data from IMS Health showed there were 43.1 million prescriptions for hypnotics in the U.S. in 2005 . I believe this may be an underestimate.

First, although the National Prescription Audit includes certain mail-order pharmacies and drugs distributed to private nursing homes as well as retail pharmacies, it does not monitor all medications distributed by health maintenance organizations, hospitals, or public clinics such as community mental health centers. Obviously, HMO's are becoming a growing part of the medical market. Also, it does not include drugs distributed by the Department of Veterans Affairs or Public Health Service and military hospitals, which provide a substantial portion of America's medical care. National hypnotic consumption figures based on the National Prescription Audit simply ignore numerous avenues of distribution.

This lack of monitoring might seem surprising, considering that the sleeping pills are addicting drugs governed by the narcotics laws, and everybody knows that they are occasionally drugs of abuse. Recently temazepam became popular among drug abusers in England. Rohypnol, the "date rape" benzodiazepine not sold legally in the United States, has obviously become widely available. Pharmacologically, Rohypnol is not distinct from other marketed benzodiazepine hypnotics. Who knows why drug abusers prefer "reds" (Seconal?) one year and Rohypnol another? In any case, the federal ostrich has its head in the sand.

Even given the likely underestimations of the National Prescription Audit data, I believe that the popular estimates of the percentage of Americans who use hypnotics must be incorrect. Consider, the National Prescription Audit reported 37,000,000 yearly prescriptions for hypnotics in 1970, with an average of about 40 pills per prescription, a total of perhaps 1,480,000,000 hypnotic pills. Yet the 37,000,000 prescriptions would have been be sufficient to provide about 4,000,000 Americans with one pill per day, or 99,000,000 Americans could receive 15 pills per year. At that time, NIH scientists were estimating that only 3.5% of American adults were using any hypnotic pills per year .  Something is terribly inconsistent about those survey estimates.  In France and Germany, a much higher percentage of the population is said to take hypnotics, for the most part chronically.  I wonder if the American figures aren't really closer to the European figures than our scientists have realized.

At some personal expense, I filed Freedom of Information requests, asking the FDA, the Drug Enforcement Administration, and Customs what the sales of hypnotics were in the United States.  Under penalty of law, the government agencies stalled, but once threatened with legal action, these government agencies stated that they did not have the information.  I believe it.  I believe that the U.S. government does not know how many sleeping pills Americans use and what percentage of Americans use them.  Considering that the hypnotics are addicting drugs and drugs of abuse, I think our government ought to pay better attention.

Continued in Chapter 8