The opioid epidemic is one of the biggest disease epidemics in history and it’s definitely the most significant illicit drug-use crisis in modern times. An opioid is a highly addictive class of drug that includes prescription painkillers, heroin, and synthetic analogs like fentanyl. The crisis is currently raging across the United States, so much so that President Trump declared the opioid epidemic a Public Health Emergency in 2017.
The opioid crisis as radiated out to other points of concern beyond opioid addiction and overdose. In areas that are plagued by opioid addiction, crime rates, prostitution, violence, and infectious diseases also increase. Recently, officials have noticed a new consequence of the crisis. People are using the over-the-counter drug Imodium to get high and treat opioid withdrawal symptoms.
Imodium is the trade name for a drug called loperamide, which is used as a remedy for diarrhea. It can be purchased from most drug stores and pharmacies without a prescription. The drug is an opioid receptor agonist like most opioid pain relievers; however, the normal dosage is much weaker than heroin or prescription pain-relievers. Plus, it has a very low oral bioavailability. That means, when it’s taken by mouth, only a small amount (0.3 percent) actually makes it to your bloodstream.
The drug specifically acts on opioid receptors in the large intestines, affecting smooth muscles in a way that cause matter to stay in your gut for longer. This allows your intestines to absorb more water from food particles, which in turn, keeps things a little more solid. Even though the drug is easily obtainable and relatively safe, it seems to be posing a threat. The U.S. Food and Drug Administration (FDA) has recently cracked down on Imodium packaging and sales.
Find out why Imodium might be more dangerous than it appears and what it has to do with the opioid crisis.
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Last year, the FDA required that Imodium packaging have a warning on the label that informed consumers about the potentially dangerous effects of misuse. In January 2018, the FDA again announced its intentions to pursue new restrictions on packaging, only allowing enough Imodium for short-term use to be sold over the counter. Currently, the drug is approved for a maximum of 8 mg per day in over-the-counter strengths and 16 mg per day in prescriptions. However, the FDA is recommending a move to selling just eight capsules containing 2 mg each per blister pack.
But why is the FDA cracking down on a diarrhea medication? Unfortunately, it is being abused in high amounts that can result in dangerous side effects. However, people aren’t just abusing Imodium for its own sake. Most are people who have become addicted to other opioids like heroin or oxycodone. When their normal drug of choice becomes too hard to obtain or too expensive, they might turn to less regulated options.
In some cases, young teens might try the get high using legal medication they can acquire without a prescription like Imodium. However, the FDA’s new regulation would make it more difficult to get enough Imodium to achieve a high.
In other cases, Imodium is used as a makeshift treatment for opioid withdrawal symptoms. The lower powered opioid agonist can theoretically ease withdrawal symptoms when someone who is addicted or dependent on opioids. However, to achieve the desired effects, a person would have to take doses of Imodium that are much higher than the recommended dose. This can result in a number of side effects, some of which can be deadly.
Like most medications, Imodium comes with a standard set of side effects that can come from regular use of the drug. There are also a few rare side effects that are more serious and may require medical attention. Rare side effects typically occur in people who have contraindications like people who are hypersensitive to Imodium, patients who have certain gastrointestinal issues like ulcers, and infants. However, rare and dangerous side effects may be more likely in people who abuse the drug.
The fairly normal side effects include:
While these symptoms are fairly mild and only occur in approximately five percent of users, it’s important to keep track of symptoms and consult a doctor if they persist for too long. Abdominal cramping and pain that lasts for too long may indicate more dangerous symptoms.
Rare symptoms typically occur in less than a percent of cases but they can be particularly dangerous. Extremely high doses have a higher likelihood of causing more dangerous symptoms, which include:
The excessive doses of Imodium that are required to achieve a significant high can cause some life-threatening symptoms that aren’t typically seen in normal use of the drug. Studies have shown that extreme dosing, as in cases of recreational use or self-treating opioid withdrawal, can lead to cardiac arrhythmia, which is characterized by abnormal heart beating. More specifically, excessive Imodium use has been seen leading to ventricular arrhythmia, which is when the lower chamber of the heart beats too quickly. This kind of heart condition can lead to dangerous symptoms like palpitations, chest pain, fainting, and cardiac arrest.
One study looked at five patients that were abusing Imodium because of an opioid addiction. Three of the patients experienced life-threatening cardiac arrhythmias and one experienced a second episode of arrhythmia after resuming Imodium abuse. In all cases, abnormal cardiac symptoms ceased when the patients stopped using the drug. Researchers in the study surmised that efforts to curb the distribution of prescription opioids in response to the epidemic might drive more people to seek Imodium as a substitute.
Opioid withdrawal syndrome is an uncomfortable process where your body recovers from opioid dependence. Your brain and nervous system become chemically unbalanced when you quit after forming a chemical dependence on opioids. Withdrawal symptoms are extremely unpleasant and can cause flu-like symptoms and extreme opioid cravings. In very rare cases, opioid withdrawal can be deadly, but this usually involves a secondary medical condition.
Some harm reduction forms and websites recommend Imodium as an over-the-counter remedy to ease withdrawal but there are safer and more effective methods. In opioid addiction treatment and medical detox, medical professionals can help treat symptoms of opioid withdrawal while maintaining your safety.
The first step in addiction treatment is usually medical detox, which is the highest level of care and involves 24/7 medically managed services. In detox, you will be given care and medication to ease symptoms and avoid any dangerous complications.
In some cases, medications like Suboxone are approved to treat opioid withdrawal. These medications are used to wean people off of more powerful opioids but they can also prolong the withdrawal timeline.
In addiction treatment, you will receive a variety of therapies designed to get to the root of your substance use disorder and to treat any co-occurring mental health issues. Through evidence-based therapies from licensed therapists, you can address underlying issues and learn relapse prevention strategies. One of the most commonly used therapies for addiction treatment is cognitive-behavioral therapy (CBT), which has been proven to be effective in treating opioid addiction.
CBT is designed to treat a variety of addiction-related issues but focusing on how your thoughts influence your behavior. In the CBT model relapse starts in the way you respond to triggers, cravings, and stress before you actually use again. With CBT, you can learn to cope with life’s stressors in positive ways, to safeguard your sobriety for years to come.
Opioid addiction is a serious problem that’s gripping the United States and has led to thousands of overdose deaths. It seems to be getting worse before it gets better. However, you don’t need to be another person adding to the numbers. If you or someone you know is struggling with opioid addiction, don’t attempt to treat it on your own with over-the-counter medications. Call the addiction specialists at Delphi Behavioral Health Group 844-899-5777 to learn more about your addiction treatment options. The road to long-lasting recovery and a productive life may just be a call away.
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Glatter, R., MD. (2018, January 31). FDA Cracks Down On Imodium Abuse. from https://www.forbes.com/sites/robertglatter/2018/01/31/fda-cracks-down-on-otc-imodium-abuse/#42d0daee36e3
National Institutes of Health. (1991, November). Relapse Prevention. from https://pubs.niaaa.nih.gov/publications/arh23-2/151-160.pdf
O’Connell, C. W., Schricker, A. A., Schneir, A. B., Metushi, I. G., Birgersdotter-Green, U., & Minns, A. B. (2016, May). High-dose loperamide abuse–associated ventricular arrhythmias. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419750/
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