May 9th, 2016
Misuse of over-the-counter anti-diarrhea medication is on the rise among people attempting to self-treat their opioid addictions, according to a new study. The Annals of Emergency Medicine reported that opioid effects do not occur at the regular recommended dose of the drug loperamide—also sold under the brand name Imodium—but that they do occur after a “supratherapeutic” dose (aka taking a shit-ton of it).
Consumption of these high doses in order to manage opioid withdrawal symptoms or get high can result in fatal cardiac arrest; the study describes two cases in which misuse of the drug led to death. Both cases involved people with histories of opioid addiction and of being prescribed buprenorphine, the opioid maintenance drug. In the second case, a young man had stopped buprenorphine a few years before, and had been self-treating with loperamide ever since.
“Because of its low cost, ease of accessibility and legal status, it’s a drug that is very, very ripe for abuse,” warns lead author William Eggleston, a doctor of pharmacy and fellow in clinical toxicology at the Upstate New York Poison Center, which is affiliated with SUNY Upstate Medical University.
People frequently discuss using loperamide to ease opioid withdrawal symptoms on online support forums, sometimes using the colloquial term “lope.”
“At the Upstate New York Poison Center, we have had a sevenfold increase in calls related to loperamide use and misuse over the last four years,” Eggleston said.
Eggleston and his co-authors want sales of loperamide to be restricted in the same way as pseudoephedrine—dispensed from behind the pharmacy counter, and in limited doses, rather than available to anyone on drug-store shelves.
But is that the best solution?
Perhaps these (rare) fatalities are a side effect of the pressure that the abstinence-focused community often puts on people in recovery to taper off maintenance drugs. If people are pressured into getting completely “clean,” some will inevitably seek out alternatives. If it’s not loperamide, it’ll be something else. Substitutes that seem harmless, like Imodium, may not be. Wouldn’t better, cheaper access to buprenorphine and methadone help people to restrict their Imodium use to treating diarrhea?