Opioid addicts who can't afford painkillers turning to cheaper anti-diarrhea drugs

Opioid addicts who can't afford painkillers turning to cheaper anti-diarrhea drugs

‘The poor man’s methadone’

More and more opioid addicts these days are turning to a common type of over-the-counter (OTC) anti-diarrhea drug to help stave off withdrawal symptoms, or just to get high. Why anti-diarrhea drugs? The common active ingredient in Imodium A-D, Ultra A-D oral, Diamode, Imogen and a very long list of others, is Loperamide HCL, a drug that interacts with opioid receptors in the gut to help stop diarrhea by slowing down the contractions of the intestines. Generally, loperamide dosages are two to four milligrams. But as addicts are discovering, when enough of it is consumed – megadoses of 10 or 20 times the usual dose – loperamide can break through the blood-brain barrier and activate the opiate receptors in the brain, just like any other opioid. For this reason, Imodium and chemically similar OTC and prescription medications are colloquially called “the poor man's methadone,” the prescription opioid prescribed for heroin and other opioid addicts. Like methadone, loperamide can quiet down withdrawal symptoms, and even create a small but detectable “high.”

Side effects are very real and dangerous

Hospital ERs are reporting recent increases in emergencies concerning loperamide side effects. These can be unpredictable, affecting one person and not another – and they can be serious, even life-threatening. Adverse drug reactions most commonly associated with loperamide are constipation, dizziness, nausea and abdominal cramps. Other rare side effects include a whole list of nasty conditions – and these are just for the recommended dosages. And there’s a long list of risky and dangerous drug interactions that most users of loperamide should definitely investigate, too. However, the big danger of the megadoses used by addicts are abnormal heart rhythms. A report in Annals of Emergency Medicine details two deaths in New York related to loperamide abuse. And according to a recent New York Times article, loperamide overdoses “have been linked to deaths or life-threatening irregular heartbeats in at least a dozen other cases in five states in the last 18 months.”

Dependence and addiction

Loperamide has been shown in lab animals to create dependence. But the real evidence of loperamide dependence, abuse and addiction comes from the addicts themselves. For example, a recent article in NJ.com featured a lengthy interview with a former loperamide addict who was strung out on the drug for years. He said his intake reached 48 milligrams (24 tablets) a day, and he was going through four value-sized boxes of Imodium a week. “I was to the point that I was hopping from supermarket to drugstore to steal boxes of the stuff,” he told the newspaper. He said the effect was subtler than heroin or Percocet, but enough to feel “a slight, somewhat pleasant tickle.” As a long-term opioid addict, he said, that was all he needed. “It's a dirty, poor man's way to get by,” he said. “That's really what it is. But it works.”

Loperamide should be checked for

After it was patented in 1973 by its inventor, Janssen Pharmaceuticals, and named Imodium, it was FDA approved and reached the market in 1976. The opioid-like properties of loperamide led the DEA and FDA to categorize it as a controlled substance, the same as codeine and heroin. Then, in 1988, after its patent expired, it was reclassified as safe for OTC sales. Many generic and branded forms of the medication now exist. However in spite of its opioid-like activity, up to 2012 there had been no reports of abuse. But by 2015 that all changed. These days, with so many new synthetic “designer drugs” around, hospital and police labs (and coroners) are adding loperamide to the list of drugs to check for. And since the drug itself remains over-the-counter, it’s abuse is expected to keep spreading. Here at Novus, we’re expert at helping people get their lives back from opioid abuse, dependence and addiction. If you or someone you care for needs help, don’t hesitate to give us a call.

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