Cheap highs getting cheaper: Addicts abusing anti-diarrhea meds for opioid effects

WASILLA — It’s not just prescription opioid painkillers anymore that heroin addicts are using to get high. It’s the over-the-counter antidiarrheal, loperamide.

As the primary active ingredient in Imodium, loperamide is designed to treat gas, bloating, cramps and intestinal pressure, in addition to diarrhea, according to Imodium.com. The website also reveals that the drug “works faster than loperamide alone.”

An Annals of Emergency Medicine article published this past April revealed that, though oral consumption of loperamide as directed has no opioid effects, extremely high concentrations can cause, and have resulted in, death.

The report described the fatal overdoses of two men, ages 24 and 39, who had previously been treating their opioid addictions with buprenorphine. The younger man was found unresponsive and seizing with six empty boxes of loperamide nearby. The older man, after sustained use of the antidiarrheal to treat his opioid addiction, suddenly gasped and collapsed, perishing before he reached the emergency room, despite resuscitative efforts.

Autopsies showed evidence of cardiomegaly, or abnormal enlargement of the heart, in both cases.

In a May New York Times article that referenced the Annals report, journalist Catherine Saint Louis reported that loperamide overdoses “have been linked to deaths or life-threatening irregular heartbeats in at least a dozen other cases in five states in the last 18 months.”

The use of loperamide in place of opioids isn’t new to this country, though, according to the Annals report: oral loperamide abuse was apparently reported in online forums as early as 2005.

And it’s happening in Alaska now.

A member of the Mat-Su Opioid Task Force recently received a phone call from an old friend regarding a child struggling with opioid addiction. The friend reported finding a bunch of needles and empty bottles of anti-diarrhea medicine in the house, and asked the task force member about the combination.

In response to a task force-wide query, Mat-Su Regional Medical Center’s Dr. Michael Alter said abuse of the drug — think, 300-plus pills a day — was “very deadly” and “hard to reverse with Narcan,” the overdose reversal drug most commonly used in emergency situations.

But because long-term or excessive usage of loperamide produces side effects not necessarily associated with other opioids — such as severe heart arrhythmia and respiratory depression, Alter said — an addict who is trying to get high but not overdose might experience severe health risks without realizing it.

“It’s not necessarily an OD,” Alter said. “It’s a little bit more complicated than just that.”

Loperamide use and abuse will be discussed further at the next Mat-Su Opioid Task Force meeting, which is scheduled for Tuesday, Sept. 6 at Wasilla City Hall from 4 to 6 p.m. Contact task force chairman Michael Carson at carsons@mtaonline.net for more information.

Contact reporter Caitlin Skvorc at 352-2266 or caitlin.skvorc@frontiersman.com.