A recent stream of overdoses due to ingestion of loperamide has led the Food and Drug Administration (FDA) to issue a warning about its opiate-like effects. Although most overdoses are accidental, there are reports of people taking the drug to deal with opiate cravings.

The abuse of loperamide can cause serious heart problems, including arrhythmia and cardiac arrest. It was also stated by the FDA that the risk of suffering heart problems due to the abuse of loperamide can increase if it is taken with other types of medicine that react with it.

Loperamide, in the generic form of Imodium, can be acquired through prescription and as an over-the-counter medication. Image Credit: Daily Hornet
Loperamide, in the generic form of Imodium, can be acquired through prescription and as an over-the-counter medication. Image Credit: Daily Hornet

Red alert on Imodium A-D

People seem to be abusing Imodium A-D, whose main component is loperamide, because of the effect of euphoria that it can cause in high doses. It can make patients feel great but also likely to suffer deadly heart problems. It was published in the Annals of Emergency Medicine that loperamide should be placed under stricter regulations, just like dextromethorphan, the infamous cough-syrup drug which can also be lethal in high doses.

FDA is taking the following measures to fight the abuse of loperamide, as it must first warn the public about the dangers of the misuse of loperamide, especially on patients that aim to relieve opioid withdrawal syndrome. Opioid withdrawal effects often lead patients to seek unhealthy methods of relief.

It is frequently prescribed to treat the symptoms of diarrhea. Loperamide shares a similarity with opioids where both serve as bowel retardants, thus reducing the need to eat and to evacuate.

People under loperamide prescription should take no more than 16 mg a day, while people using it sporadically should consume less than 8 mg per day.

Although loperamide has been on the market for almost 40 years, only 48 reports of severe heart problems have been communicated to the FDA concerning the use of the drug. 10 of the reported cases incurred in fatalities.

Loperamide is designed to cause similar physical effects to the ones native to opiates, but without the euphoric or painkilling sensation. But people still take unhealthy amounts of the drug to achieve such a high. Loperamide is not able to cross the blood-brain barrier by itself, but this changes when it is paired up with antibiotics, acid reflux medication, and HIV drug ritonavir. The drug is also often smoked along other substances such as tobacco or marijuana after it has gone through an extraction method.

America’s opioid crisis

The U.S. is undergoing a severe opioid crisis, as there has been a steady increase in the incidence of opioid-related deaths since 2010

The most significant source of opiates is prescription medicine. Many argue that the solution lies in regulation since medicines are provided by irresponsible physicians and then abused by patients. The estimated amount of opioid medication in the U.S prescribed in a year was 76 million in 1991, whereas it reached an astounding 207 million in 2013. The United States is the world’s biggest consumer of opiates, as it consumes almost the totality of the world’s hydrocodone and 81 percent of the world’s oxycodone.

Most opioids are more dangerous if they are taken through non-conventional methods, such as snorting, smoking or injecting. Also, when combined with other drugs, they tend to become lethal and addictive. The side-effects of most opioids are very similar to the ones of loperamide: constipation, drowsiness, and nausea.

States that have implemented a stricter method of pain medicine prescription have seen a decrease of 30 percent in the overall amount of prescription, which leads authorities to believe that there are much more cases of unadvised opioid prescriptions than what it is estimated. The reduction in the rate of prescriptions was evident just as the measure was issued, and so much more over the following two years after its implementation.

One of the latest high-profile victims of opioid abuse was Prince, who died from a fentanyl overdose, a drug that is usually prescribed for people suffering from cancer-related pain. CDC joins the bandwagon in saying that doctors are to blame for the opioid addiction crisis, as there are evident signals of an excess in prescriptions.

Opioids currently rule the market in the United States

Most opioids such as Vicodin, methamphetamine, oxycodone, fentanyl, Adderall, cocaine and Ritalin are Schedule II drugs, which are noted as medications that can be easily abused, thus becoming lethal for the patient.

A number of prescribed opioids in the U.S. on a yearly basis is enough for medicating every American adult for a month.

More changes will come as there is a lack of evidence that sets opioids as an effective medicine for successfully alleviating chronic non-cancer pain. The CDC has also recently published voluntary guidelines for prescribing opioids for chronic pain, which allows physicians to have a better ground on assessing whether to prescribe opioids for their patients or not.

Doctors are encouraged to discuss with their patient’s pain treatment options before mentioning prescription drugs. At least 165,000 people have died from overdose related to prescription opioids. Opioids are also likely to develop tolerance and dependence on the patient, side-effects that are often as dangerous as the medication itself.

Source: NBC