Contribution short abstract:

This paper traces the processes and politics around Daridorexant, the first insomnia medication that can be prescribed long-term in Germany. I discuss how attempts to common Daridorexant rely on emphasizing the ‘commonness’ of insomnia and on ‘uncommoning’ the idea that sleeping pills are dangerous.

Contribution long abstract:

Daridorexant was launched on the German pharmaceutical market in 2022. It is the first drug in Germany that has been approved for long-term insomnia treatment, i.e. it can be prescribed for more than four weeks (which is the limit for other insomnia medications, notably benzodiazepines and Z-drugs, that are known to be addictive). Promotors of the drug, and the related change of policy, have celebrated it as a ‘game changer’ while critics are skeptical both of Darideroxant’s actual efficacy and of what the shift in policy may imply for how insomnia is understood and treated.

Based on ethnographic observations at sleep medicine conferences, my paper traces the politics and contestations around drug-based therapy for insomnia in Germany. I discuss how attempts to ‘common’ Daridorexant rely on emphasizing 1) the high prevalence of insomnia; 2) a massive treatment gap and 3) on ‘uncommoning’ the idea that sleeping pills are dangerous. The latter, in particular, also depends on shifting common ‘psychological’ understandings of insomnia to more biological ones. Supporters of Daridorexant mobilize ideas of patient well-being, clinical expertise and evidence to render the drug acceptable. These marketing strategies are often convincing, even though it is well-known that trials and experts have been commissioned by the pharmaceutical producer. My paper shows how the (un)commoning of drugs happens through the skillful manipulation of complex legal, clinical, economic and moral rationalities which makes it hard even for critical researchers to disentangle economic interests from patient well-being, evidence from advertisement, and good drugs from bad ones.