People addicted to opioids have found a way to get high off anti-diarrhea medication, too.
The problem is serious enough that U.S. Food and Drug Administration Commissioner Dr. Scott Gottlieb asked makers of loperamide, sold over the counter as Imodium AD, to change the way they package the product.
Today the medication comes in blister packs. You cannot buy more than 48 grams per package.
I knew that opioid use causes constipation. Have you seen the commercial with the good-looking middle-aged man at the construction site, happy his pain is gone but all bound up? Making jokes about it?
“Do you have OIC? Opioid? Induced? Constipation?”
High on constipation after taking 300 anti-diarrheal pills?
As an April 2017 article in The Atlantic put it, “If a drug that gets you high causes constipation, could a drug that causes constipation get you high?
Turns out, the answer is yes.
“It’s an opioid agent and it helps to bind receptors in the brain and cause a similar euphoria or high,” said Dr. Scott Krakower, a physician who specializes in addiction disorders at Northwell Health.
“Folks that are desperately addicted, folks that are looking to stave off withdrawal symptoms will do whatever it takes sometimes, really extreme things,” Dr. Jeffrey Reynolds, of the Family and Children’s Association, added. “So, in the scheme of things, taking 300 pills is not unheard of.”
This is what has led to Gottlieb’s latest directive, which is a noble effort even if it’s like throwing a bucket of water on a burning house.
“The FDA is requesting that sponsors of OTC loperamide ‒ an FDA-approved product to help control short-term symptoms of diarrhea, including Travelers’ Diarrhea – change the way they label and package these drugs to stem abuse and misuse that leaves us deeply concerned,” Gottlieb announced in a statement.
“Abuse of loperamide has been increasing in the United States. When used at extremely high and dangerous doses, it’s seen by those suffering from opioid addiction as a potential alternative to manage opioid withdrawal symptoms or to achieve euphoric effects of opioid use.”
Loperamide is safe at approved doses, Gottlieb said. But when higher than recommended doses are taken, reports of serious heart problems and deaths with loperamide have occurred. This especially occurs among people who are intentionally misusing or abusing high doses.
These measures only work if people want to stop anyway
The FDA asked loperamide manufacturers and online retailers to limit the amount of loperamide in a package.
“The abuse of loperamide requires the purchase of extremely large quantities,” Gottlieb said.
In a story in The Atlantic, the author reported, “Diarrhea-drug misuse is just a small, almost absurd part of the larger opioid epidemic.”
The author argued policies like requiring a photo ID to buy loperamide only work when addicts are discouraged by such measures to the point of seeking treatment.
“It only works if the restrictions drive people to treatment rather than to heroin,” The Atlantic reported.
Which sadly seems very unlikely. Similar measures on ephedrine have not curbed the crystal meth epidemic.
Does opioid addiction begin at home?
A separate study has shown that heavily medicated families tend to have more opioids on hand.
Research published in JAMA Internal Medicine revealed something not too surprising: When one member of a household has opioids, such as Vicodin or hydrocodone, other family members have a greater likelihood of dipping into it, too, when compared to households that simply stock NSAIDS.
This massive study of 20 million insurance beneficiaries covered prescriptions dispensed from 2000 to 2014. Two-thirds were given opioids; a third were given non-opioid pain relief.
Marissa Seaman led the team of researchers from Johns Hopkins University Bloomberg School of Public Health. They looked at a range of patient ages, from newborns to the elderly.
Some households well-stocked with other addictive prescriptions
The study illuminated a nuance, if nothing else: Households receiving opioids, as opposed to NSAIDS, were more likely to be stocked with other addictive and/or mind-altering substances as well. Those medications included benzodiazepines (anxiety medication), SSRIs (depression medication), muscle relaxers and more.
In a value-driven consumer healthcare system, patients have very little problem obtaining opioids, benzodiazepines, or other addictive drugs. It especially is easy for patients who do not appear to be in the throes of addiction.
Prescription monitoring databses are available to catch patients with multiple prescriptions, but most doctors don't use them.
Stigma is killing your children, your parents, your neighbors
IOften, those who become addicted to opioids face another dangerous demon: Stigma.
They’re not going to tell anyone they are abusing prescription medications. And if they do, other family members often keep it under wraps.
Is your purse well stocked with anxiety medications and pain pills? Do you hand them out to friends and family?
Nobody is to blame if this blog hits a note.
The people to blame are our lawmakers. Most cozied up to pharma and big healthcare as the industry addicted America to opioids.
If you or someone you know has an opioid addiction, know that it affects every segment of society.
And now there are people so desperate for an opioid-like high they'll swallow 300 diarrhea pills.