Many opioid addicts go to desperate lengths to get their fix, from selling their bodies on the street to burglarizing homes and stealing from their parents.
Some addicts are chasing their high using an easier, legal but still dangerous method: by ingesting large amounts of an anti-diarrhea drug, loperamide. Some addicts are taking as many as 500 pills a day of the medication, which is also widely known by its brand name, Imodium. An alert posted in 2016 by the Food and Drug Administration warns that taking higher than recommended doses of the over-the-counter medication “can cause serious heart problems that can lead to death.”
Most of the reported cases of serious heart problems involved people who were intentionally taking high doses of loperamide, an opioid that, when taken in high doses, can produce some effects similar to other opioids, such as euphoria and drowsiness. Some people take large doses of loperamide to self-treat opioid withdrawal symptoms, according to the FDA. The FDA’s alert advises that health care professionals should be aware that higher than recommended doses of the medication can cause severe heart problems such as ventricular arrhythmias and cardiac arrest.
[See: How to Avoid a Second Heart Attack.]
Economics is driving loperamide misuse, says William Eggleston, a clinical toxicologist at SUNY Upstate Medical University in Syracuse, New York. Some addicts spend hundreds of dollars daily to support their heroin or opioid habit, a need for cash that prompts some people with substance dependencies to turn to criminal activity. Loperamide, on the other hand, is relatively inexpensive, he notes. For example, a box of Imodium containing 24 caplets costs $14.99 at a CVS store in the District of Columbia. Instructions on the box advise that users should take no more than four caplets every 24 hours. Off-brand and generic versions are even less expensive; two bottles of Kirkland Signature anti-diarrhea drugs, which contain a total of 400 caplets, are priced at $7.59 online at Costco.
Massive dosages
Some addicts are using anti-diarrhea medication to achieve a high or to try to ward off withdrawal symptoms. Some addicts are ingesting far more than the recommended dosage. “If you take 50 to 500 tablets [of Imodium] a day you can get the same effects of opioids like oxycodone or heroin,” Eggleston says. Some addicts dump hundreds of caplets into a blender to liquefy them. “It’s a pretty big undertaking to take hundreds of tablets a day. It’s time-consuming,” he says. “A smoothie speeds things up.”
The number of people misusing loperamides is quickly growing. From 2010 to 2015, there were 1,736 intentional loperamide exposures reported to the National Prison Data System, according to a report published in the January edition of the Annals of Emergency Medicine. About half of those exposures were reported to the 55 poison centers of the American Association of Poison Control Centers in 2015 and 2016 alone, says Dr. Michael Lynch, a toxicologist at the University of Pittsburgh Medical Center and director of the Pittsburgh Poison Center. There were 382 intentional ingestions in 2015 and another 552 in 2016.
Deadly opioid epidemic
The nationwide opioid epidemic is driving the increase in loperamide misuse. In 2015, drug overdoses connected to opioids — such as heroin, which is illegal, as well as legal prescription pain medications, including oxycodone, codeine, hydrocodone, morphine and fentanyl — were the leading cause of accidental death in the U.S., according to the American Society of Addiction Medicine. There were 20,101 fatal overdoses related to prescription painkillers and 12,990 stemming from heroin, according to ASAM.
Studies are needed to learn more about the misuse of loperamide, says Dr. Sarah Shafer, a medical toxicology fellow at the North Texas Poison Control Center in Dallas. Based on her observations and reading online forums of people who use the drug, Shafer says people misusing loperamide typically fall into one of three categories:
[See: 11 Strategies for Staying Sober While Traveling.]
Addicts seeking to get high. Teenagers and adults who lose access to their supply of prescription opioids or heroin are among the people misusing loperamide, Shafer says. This could include addicts whose dealer was arrested or who live in an area where the supply of illicit drugs is low, she says. Some addicts will take high doses of loperamide to try to get their usual fix. Some opioid addicts use loperamide as a “bridge” to blunt their withdrawal symptoms until they take their next hit of heroin, fentanyl, oxycodone or whatever their drug of choice is.
Some people mix loperamide with other medications to accentuate its effects on the brain, Shafer says. For example, some people use the medication with quinine, an anti-malarial drug that’s also found in small amounts in tonic water. Mixing these drugs “increases the chances of having a heart issue,” she says.
People trying to wean themselves off opioids. Some addicts try to “engineer their own recovery” without the benefit of drug treatment or help from clinicians. People who stop using opioids often suffer terrible withdrawal symptoms, including muscle aches, anxiety, heavy sweating, abdominal cramping, nausea, vomiting and diarrhea. Some addicts believe high doses of loperamide are safe because it’s an over-the-counter medication, and rationalize that using it could help blunt the symptoms of withdrawal, Shafer says.
Kids and teenagers seeking excitement. Some adolescents who don’t have access to alcohol and lack the funds to buy hard street drugs use loperamide instead, Shafer says. “These would be thrill-seeking, curious teenagers who may have heard about loperamide or read about it online,” she says. “Some teenagers will try to get high from something they can get at a drugstore, which they have access to.”
[See: 4 Opioid Drugs Parents Should Have on Their Radar.]
Some people who misuse loperamide may believe it’s not dangerous because it doesn’t require a prescription, Shafer says. The medication is safe if taken in the correct dosage, but it can cause severe health problems — even death — if misused.
In large doses, loperamide can interfere with the way the heart functions, causing blockages of channels that allow electrolytes to go in and out of heart cells, Shafer says. “When you block those channels, the heart doesn’t function correctly,” she says. This can lead to abnormal heart rhythms and cardiac arrest. A research paper published by the Centers for Disease Control and Prevention in November, 2016, coauthored by Eggleston, reported four deaths from loperamide use, as identified by the National Poison Data System, between January 1, 2008 and March 31, 2016.
But the number of deaths linked to loperamide is likely underreported because medical officials weren’t looking for them, Eggleston says. For example, the office of the North Carolina Chief Medical Examiner reexamined deaths dating from 2012 and implicated loperamide as contributing to or causing the deaths of 19 people, Eggleston says. These cases were reported in July in the Journal of Analytical Toxicology Advance Access. More cases of loperamide misuse are likely to be reported in coming years, Eggleston says. “We are at the beginning stages of the level of abuse we can potentially see,” he says.
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Some Opioid Addicts Are Using an Anti-Diarrhea Drug to Get Their Fix originally appeared on usnews.com
