People who are trying to avoid opioid withdrawals or get a high are more frequently turning to an over-the-counter diarrhea medication, leading to an increase in overdoses from the drug.
Researchers from Rutgers University found that overdoses from loperamide—known as “the poor man’s methadone” and sold under the brand name Imodium AD—increased steeply between 2011 and 2016, although they remained very rare, with only 26 cases reported, according to the study published in the journal Clinical Toxicology. At the same time, calls to poison control about the drug rose more than 90%.
Despite the relatively low numbers, the trend caused alarm for people who see loperamide as an opioid that is easy to access and hard to detect in drug tests.
Diane Calello, executive and medical director of the New Jersey Poison Control Center at Rutgers New Jersey Medical School and lead study author, said in a news release that loperamide is safe when taken as instructed.
However, some opioid users take up to 50 times the recommended dosage, at which point the drug becomes very dangerous.
“When used appropriately, loperamide is a safe and effective treatment for diarrhea—but when misused in large doses, it is more toxic to the heart than other opioids which are classified under federal policy as controlled dangerous substances,” she said. “Overdose deaths occur not because patients stop breathing, as with other opioids, but due to irregular heartbeat and cardiac arrest.”
Calello said that over the past years there have been multiple deaths related to loperamide in New Jersey. Because of this, Calello and others recommend that there be changes to the way that loperamide is sold, as well as more public awareness about the risks of the drug.
She said, “Possible ways of restricting loperamide misuse include limiting the daily or monthly amount an individual could purchase, requiring retailers to keep personal information about customers, requiring photo identification for purchase and placing medication behind the counter. Most importantly, consumers need to understand the very real danger of taking this medication in excessive doses.”
In May 2018, the Food and Drug Administration announced changes to the way that loperamide is packaged and sold. FDA head Scott Gottlieb requested that online retailers stop selling large quantities of the drug, and that it be packaged in blister packs, which require users to individually open each pill. These requirements could curb misuse, while also keeping the drug available to people with digestive issues who need it regularly.
“We’re very mindful of balancing benefit and risk and the needs of patients in our mission to promote and protect public health,” Gottlieb wrote.
“The FDA’s actions to address drug misuse and abuse must be informed by an understanding of the complex social environment in which changing patterns of drug consumption occur. The agency is committed to addressing emerging issues of abuse and misuse while taking steps to safeguard the needs of patients who depend on these medicines.”
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