Loperamide abuse is a new way addicts are getting a hit of opioids.
Have you heard about addicts turning to anti-diarrhea drugs if they can’t their hands on painkillers? So what exactly does the poor man’s methadone have in it? It might surprise you to know that Imodium A-D is actually a poor man’s methadone.
Consider this, there are up to 36 million people abusing opioids worldwide. This is based on a drug report released by the United Nations Office on Drugs and Crimes from 2012. A total of 7,000 tons of opium were produced worldwide. People abusing opioids find it harder to get their fix as officials crack down more and more. This is why they’re resorting to Imodium, which prevents diarrhea.
They will take it in high doses as they believe it manages their opioid withdrawal symptoms. The loperamide high is another reason addicts will abuse this over-the-counter drug. It is raising concern among doctors, the FDA, and the public. Here’s what you should know about its uses for people dependent on opioids.
The Loperamide High is Cheap and Easy to Obtain
Imodium A-D is easy to get because it’s legal. There is no boundary on how much you can buy at any given time. Costco sells 400 Loperamide 2 mg caplets for a mere $7.59. The opioid epidemic has led from one type of opioid abuse to another. As it gets more challenging for opioid addicts to obtain pain killers, they are reaching for the easiest thing they can.
It is cheap and gives users a bit of a euphoric feeling. They do pay the price, however. Imodium A-D, being an anti-diarrhea medication, is uncomfortably constipating for an opioid user. It is also toxic when so much is consumed. It’s also hard on the cardiovascular system, causing heart problems in the long run.
Imodium A-D for Methadone Withdrawal
Loperamide hydrochloride, or Imodium A-D, is an over-the-counter medication. It’s FDA approved use is to prevent diarrhea as it slows down intestinal movement as well as general digestion. It is an opiate receptor agonist so it will constantly signal the opioid receptors. This causes them to work as a response. The medication doesn’t go into the blood via the brain so there is no high to be had when taken at normal doses. It also doesn’t relieve pain.
What it does do is alleviate the extreme pain one experiences in the gastrointestinal system when going through opiate withdrawal. Imodium A-D is an opiate so addicts assume it can replace an opiate medication. This isn’t the case because it doesn’t activate receptors the same way buprenorphine does. Buprenorphine is part of the medicinal make up of Suboxone which is designed to help wean people from opioids.
Opiate detox should never be tried at home alone. Complications may occur so withdrawal should always be done under medical supervision. Using Loperamide to help with an at-home detox should be avoided. While some users have said that high doses of Imodium has helped them manage withdrawal symptoms, there are no studies to prove this is true.
A Loperamide high is pertinent once the dose of 60 milligrams or more have been ingested. It can also cause nausea and vomiting. The slight euphoric effects hardly seem worth it.
As discussed above, the Loperamide high will occur once you’ve taken a 60 milligrams or more at a time. The maximum dosage per day is 8 milligrams as an anti-diarrheal. With a prescription, you can take 16 milligrams per day. Opioid addicts are taking much more to manage opioid withdrawal symptoms and gain the high they’re missing.
There are no risks when using the recommended dose. The standard daily dose is four caplets. Each loperamide caplet is 2 mg. People who abuse the drug are known as ‘lobe abusers’. They will ingest up to 100 2mg tablets every day for two weeks.
Risks of Loperamide Abuse
For users that are constantly overdoing it with Loperamide, they are at risk of health problems and even death. A 24-year-old male who was dealing with opiate withdrawal experienced a Loperamide overdose, causing death. The toxicology analysis revealed that he had more than 25 times the regular recommended dose in his system.
Another case involved a 39-year old man who died from taking it. He had his opioid addiction under control with the use of prescription buprenorphine but started taking anti-diarrhea drugs.
Two deaths in New York City were part of a report by Annals of Emergency Medicine regarding abuse. Loperamide overdose lead to death or the heart rate became irregular, which is life threatening.
It has only been recently that doctors recognized abuse of the drug was possible. The data on the issue is minimal at this point. The likes of toxicologists and people working in the emergency department suspect that studies are grossly underestimating how many people are overdosing from Imodium A-D abuse.
Loperamide Abuse Side Effects
As there has been very little studies done up to this point when it comes to Loperamide, side effects aren’t verified scientifically. Overdosing on Imodium can cause the following side effects:
- Urinary retention.
- Dysfunction of the liver.
- Intestines not functioning.
- Heart rate is depressed, as is breathing.
- Abnormal heart rate.
- Central Nervous system is depressed.
- The user may end up in a stupor.
- User may lack coordination.
Imodium-AD Abuse On the Rise
Loperamide abuse is more prevalent than it should be due to the lengths officials are taking to limit opioid abuse. Experts within the field are worried that addicts are going to turn to anti-diarrheal tablets on a grander scale. They compare it to drinking mouthwash when the alcoholic has run out of whiskey.
William Eggleston is a lead author of the report conducted at SUNY Upstate Medical Center. He is a clinical toxicologist. This is what he had to say about the problem,
“We’ve seen patients who have been on Loperamide for months at a time, a subset of patients take it to get high, and other patients use it as a bridge.”
Patients are taking it in the even they can’t get heroin or morphine. It eases withdrawal symptoms like muscle pains, vomiting, diarrhea, and nausea.
The FDA and Their Stance on Anti-Diarrhea Drugs
The FDA is concerned about the serious health problems that come with Loperamide abuse. Imodium A-D and other brands or over-the-counter anti-diarrhea drugs are easy for users to get. While it’s a safe drug when taken as prescribed, when users take dangerous quantities, it becomes a drug of concern.
The strategy of opioid addicts includes using it to increase opioid absorption in the gut to get a greater high. So what is the FDA doing about it? The FDA plans to take appropriate action as soon as they can. Interestingly enough, Loperamide was once a prescription drug and controlled substance. It was put in the same class as cocaine and methadone. It was approved by the FDA in 1976 and eventually became an over-the-counter medication in 1988.
Limiting Sales of Loperamide
Part of the potential solution is to limit sales on Loperamide 2 mg caplets of any kind. While it acts as an opioid receptor in the gastrointestinal tract, it doesn’t go into the central nervous system like methadone. There is no high when taken at recommended doses. Large doses can produce a slight high.
So if Loperamide was limited, this could alleviate the problem, toxologists believe. This is the same philosophy as limited pseudoephedrine to prevent the manufacturing of crystal meth. People who see the problem first hand in the emergency room say it’s time to intervene and prevent the mass quantity purchases of anti-diarrhea medication. It’s fair to say that the average person doesn’t require 400 caplets per week.
Side Effects of Loperamide
The long-term side effects of Loperamide abuse include problems with the heart. A 28-year old woman was taking 400-600 milligrams of the drug every day for a few months. When doctors conducted an electrocardiogram on her, it revealed a dangerous irregular heartbeat. She also had abnormal electrical conduction through her heart.
People that have abused the drug will often report that the high was not the health risks. It causes one to have to take stool softeners to combat the anti-diarrhea effects. People that have taken it will say you can get high from it but you can also kill yourself with it.
Loperamide Not Being Screened in Emergency Rooms
It is hard to say how many people have died from abusing Imodium AD. Overdose, health problems, and death when abusing Loperamide are not being monitored properly. The drug screens in the emergency room do not detect it. A toxicologist at the University of Texas Health Science Center of Houston says that the urine toxicology done doesn’t pick it up. She believes that cases are being missed.
Drug abusers will come to the hospital not breathing or in a lethargic state. It seems as though they’ve overdosed on heroin but they don’t find a trace of the drug in their system. They may give the person Naloxone which is an anti-opioid drug. It’s also quite expensive to administer.
There was a case where a 19-year old was suspected of opioid abuse when found dead in his home. They had a distended bladder full of urine but when they did a drug screen, the deceased came up clean. The hospital used a test that ended up finding the trace of Loperamide in the system.
While there are very few reports that have come out about anti-diarrhea medications being abused, experts are aware of the ramifications of the problem. A doctor says that a Loperamide high occurs when the user takes enough and it rushes the system enough to penetrate the blood-brain barrier. When this is accomplished, Loperamide can then act on the central nervous system and users will get the high they’re craving.
As the FDA fights against the opioid epidemic in the US, they are aware that Loperamide is part of the concern. People are overdosing and there simply isn’t enough documentation to establish how serious this can become. As experts urge some sort of control over how much Imodium A-D can be purchased over a period of time, it’s still possible for anyone to abuse Loperamide. This is not the answer for medical detox. It is a dangerous game that may cause death or serious heart problems, leading to death.