Addicts Who Can't Get Opioids Are Overdosing on a Diarrhea Drug

[Chip (OP)]

source: https://www.theatlantic.com/health/archive/2017/04/opioids-diarrhea-drugs-imodium/522195/

the cat is out of the bag so it may just get this med scheduled ... and take the source link for the "I've done some horrible things for dope" video

Addicts Who Can't Get Opioids Are Overdosing on a Diarrhea Drug (APR 7, 2017)

“We’ve had patients tell us they take 400 to 500 tablets day … They put it in a blender and make a smoothie and drink it over one or two hours.”

Opioid painkillers have an inconvenient, lesser-known side effect: terrible constipation.

Perhaps then it’s no surprise that people addicted to opioids have considered the converse. If a drug that gets you high causes constipation, could a drug that causes constipation get you high?

Yes, and that drug is another opioid called loperamide, better known by its brand name Imodium as an over-the-counter treatment for diarrhea. At extremely high doses—dozens or even hundreds of pills a day—it can produce a high or ease withdrawal symptoms. And in the middle of a national opioid epidemic, overdoses of loperamide are rising, too.

“It’s a cheap, legal, and easily accessible opioid alternative,” said William Eggleston, a clinical toxicologist at SUNY Upstate Medical University.  Eggleston authored a case report last year about two men who died of loperamide overdoses. Such case reports have been piling up—in Texas, Arizona, and most recently Rhode Island. Nationally, the number of calls to poison centers for intentional loperamide exposure more than doubled between 2010 and 2015. And the FDA has issued an alert for doctors to look out for loperamide misuse.

Doctors have been playing catch-up on the loperamide trend. In 2012, Raminta Daniulaityte, a public-health researcher at Wright State University, published a paper about discussions of “lope” in a web forum for drug users. At the time, she said, “there was no research at all and nobody really knew about it.” Yet forum users had plenty to say, describing detailed loperamide regimens for treating withdrawal. One commenter called it “my new best friend.” Some, perhaps understandably, expressed skepticism: “would the consipation [sic] rate be worth it? 10 grams is at least 5000 times the recommended dose.”

“It’s a cheap, legal, and easily accessible opioid alternative.”

Which is to say: Loperamide is extremely safe at recommended doses for treating diarrhea and extremely inefficient if the goal is getting a fix. Eggleston said he’s heard of people taking 400 or 500 tablets a day. “They put it in a blender and make a smoothie and drink it over one or two hours,” he said. It causes constipation but no worse than other opioids, which people who are addicted often manage by taking stool softeners or laxatives.

Loperamide is also available as a generic, and it is cheap. You can buy 400 tablets for little more than $10 online.

Unlike opioids prescribed as painkillers, loperamide doesn’t usually reach brain cells. A naturally-occurring protein called P-glycoprotein pumps the drug out of the brain. But at very high doses, loperamide overwhelms those pumps and floods the brain’s opioid receptors. Eggleston said that’s led some people to try taking a second over-the-counter drug that disables the pumps, so they can use smaller doses of loperamide. The long-term consequences of that combination are unclear, but once in the brain, loperamide has similar effects as other opioids: drowsiness, depressed breathing, and maybe even death in the worst cases.

But massive doses of loperamide also have a second surprising and deadly consequence. The drug blocks calcium channels, which affect the beating of the heart. Too much loperamide and the heart is unable to keep a regular rhythm. Somwail Rasla, an internal medicine resident at Memorial Hospital of Rhode Island, saw a 28-year-old man come in with a particular and unusual pattern in his EKG. “There’s no reason such a young patient should have it, except as a congenital abnormality or medication induced,” said Rasla. It was the latter. The man said he been taking 100 to 150 tablets of loperamide a day. He was put into the ICU and given magnesium to stabilize his heart rhythm. He survived. After nine days in the hospital, he was discharged.

“We felt like this case really needed to be published to increase the public awareness,” said Rasla. Until just a few years ago, the cardiac effects of loperamide were unknown even to most doctors—simply because people weren’t taking the drug in big enough doses until the opioid epidemic. And the trend is unlikely to go away soon. “We will see more cases because the more restrictions [there are] on opioids, the more doctors are afraid of trying to extend their prescriptions, the more people will seek different substances,” said Rasla.

The same thing happened with heroin, Eggleston pointed out. When doctors put the squeeze on prescription painkillers, people went looking for alternatives—many of them to illegal alternatives like heroin and fentanyl and some to legal ones like loperamide.

One proposed policy fix is making loperamide harder to buy, like requiring an ID the way stores now do with cough syrup containing dextromethorphan. That would put the squeeze on another end of the opioid supply though; it only works if the restrictions drive people to treatment rather than to heroin. Diarrhea-drug misuse is just a small, almost absurd part of the larger opioid epidemic.

[Joseph Hopeless]

Hell yeah it gets you high! I get so high from it I feel normal!

God, what the fuck. Has anyone ever actually gotten a buzz from lope? I've been taking boxes upon boxes just to function the past week or so and all I get is functional from it. Jesus, please don't let these get scheduled because of dumb fuck journalists.

[Esoteric Anhydride]

1 - supplement potassium and magnesium, not too much tho as it's easy to OD on these

2 - work up to your dose, lop takes HOURS to work. For me usually at least 4-5hrs before I feel better

[Chip (OP)]

would an opiate naive person actually get a nod/opiate glow from mega doses ?

I'm just curious what the abuse potential is here.

[Joseph Hopeless]

How much potassium and magnesium? And word, I'm glad to hear I'm not alone here. I thought it was just me that it took around 4ish hours, up to 5, where I'd feel the most out of 'em..If you don't mind, could you break down your regiment exactly?

@chipper   Yeah, I'm very curious re: abuse potential for these as well. I really don't think anyone ever gets a buzz or anything more than functional from 'em. Idk, maybe some people have/do, but I've personally never heard of anyone actually getting a buzz from 'em.

[Chip (OP)]

I thought so. I would add Gabapentinoids to the mix to add more comfort.

there is new treatment research going on using Scapolamine and anesthesia to detoxify opiate users over 15 days if they are seeking treatment.

more on that later. But Lope sounds like a good tool also.

if people don't get buzzed from it then it will stay unscheduled.

I should add that most research and my own observations over a lifetime shows that detoxification is mostly a waste of time as opiate use is a chronically relapsing situation for most addicts.

so you lose the habit and you're opiate free but then what ? nothing else has changed and your circle of friends and dealers is still there. you probably have been trashed financially, moved underground and lost your job. all your problems are also there and dealing  them is often a daunting task.

most will go back to using quickly due to drug craving, anxiety and unable to transition into mainstream society.

my thoughts on this.

[Esoteric Anhydride]

How much potassium and magnesium? And word, I'm glad to hear I'm not alone here. I thought it was just me that it took around 4ish hours, up to 5, where I'd feel the most out of 'em..If you don't mind, could you break down your regiment exactly?

I just follow the recommendations on the bottles, usually 1 each potassium and magnesium (my diet doesn't really call for calcium supplementation). With lop, I generally take 40mg to supplement my methadone, if needed.

[Joseph Hopeless]

@Esoteric Anhydride What do you mean by "usually 1 each potassium and magnesium"? You mean 1 each of what the bottle says is one dose? And you mean you usually take 40 mg of lope, right?

And @chipper, yeah I'm fairly young(27), but I'm already certain that I'll never quit. I like your quote there too, "detox is mostly a waste of time"..Made me chuckle. It sure is hard to fill that void when you stop, though; Hence why I don't think I can ever stop for good. But I accept that now, it is what it is.

[Esoteric Anhydride]

What do you mean by "usually 1 each potassium and magnesium"? You mean 1 each of what the bottle says is one dose? And you mean you usually take 40 mg of lope, right?

250mg Magnesium, 100mg Potassium -- the dose recommended on the bottle.

Might not be a bad idea to supplement calcium as well.

And ya, 40mg is a pretty standard dose for me..

[FreedomOrBust]

Another stupid article by straighties that just don't get it, don't want to get it, and never will get it.

So you shut off the pill mills in 2009?  Congratulations, you just created a heroin epidemic.  Nice work, assholes.  Shut down the poppy pod market?  Here comes seeds, RC analogues, and IOP's to the rescue.  Going to shut all those down too?  Probably.  They just had Operation Pangea IX in their neverending quest to make everyone as uptight and miserable as they are.

Honestly, pppl will invevitably be driven to doing their own guerilla grows.  Good luck stopping that.  Dumb fucks.

[Indy]

God, what did we ever do to them? They just keep fucking with every little scrap of happiness we cling onto, pods, kratom, IOPs, just LEAVE ME ALONE UNCLE SAM!