Nursing School Begins

seattlegrace.jpgI am not an ordinary student.

It’s funny how people react to me in Nursing School. At 50-years-old, I am what is commonly referred to as a “returning adult student” or, sometimes, a “non-traditional student.” Yale’s euphemism for us is the “educationally-interrupted.”

In my mind, I’m just another student going to class. Coloring my greying hair, taking ibuprofen for my aching back and all. I don’t see the old chick going back to school.

I cross the quad like any other student, with my 50-lb books in my grey North Face bookbag with my long red hair pulled back in a scrubby ponytail like many other students. I wear a tee shirt and jeans with nondescript sneakers or shoes on my very tired and aching feet. I do not walk briskly. Rather, I stroll, unencumbered by youth and first loves and first times away from home.

I’m not sure if other students automatically assume I’m a dotty teacher. Or maybe some weird adjunct faculty. I often forget that I’m not 18 years old anymore — and I forget that other people may not see me as just another student.

Which is fine with me at the end of the day, but it makes for something of a lonely experience. I don’t have much in common with most of these teenagers anyway. And the minute I open my mouth, it’s obvious that I’m not like everyone else.

Consequently, I think on a very different frequency than the much-younger students do. Consider that if they are 18 years old, they were only one-year-old when the towers fell on 9/11. I was thirty and a government employee working that day. I have a whole, long 9/11 story — they don’t. What I saw that day, they’ve only seen from the comfortable distance of time in movies or TV shows or books.

A brief survey of the Nursing 101 classroom convinces me that I am also possibly the oldest person there next to the teachers. Out of apx 60 incoming freshmen, there is a smattering of adult people either in their 30’s or 40’s. One woman wears her greying hair proudly. Two others have, what I like to call the “I want to speak to your manager!” haircut and color. But by and large, the student body is 18-22 YO.

In the grand tradition of the nursing profession, most are women; about 10-15% are male. One of my fellow students is a very nice lady who lives near me and offered to give me rides to clinicals on Fridays. Of all my classmates, she is probably the closest to my age — she is about 5 years younger than I am. She has a few kids who are teenagers and after years of home schooling her kids, she’s embarking on a long-dreamed of career as a nurse.

Interestingly, most people in the group are there because a nurse had a positive effect on them at some point in their life. That’s pretty cool.

But it’s clear that there’s differences in our thinking. I have a lot more experience with disease process than they do. Years of studying anatomy, physiology, medications — since I was about 10 — means I have a breadth of experience and knowledge they do not. I hear them speak about medicine and it reminds me of when I was 16, trying to make sense of my father’s failing health with the limited understanding I had at the time. I have much better comprehensive and complex understanding now.

BUT — and this is an important distinction — by-and-large, my cohorts are learning more and performing better than I am. Oh! For all I know, how much more there is to know!

Why did I fail? Honestly: hubris. Because so much of what we are learning feels like repeat information for me. Like it should be common sense. My brain is refusing to engage, refusing to really LEARN the way they want me to.

The importance of testing is paramount to passing Nursing school. Everything at college is geared toward passing that all-important apex — the NCLEX exam — the nursing licensure. So even the smallest detail is taken into account because, if the NCLEX thinks it’s important — even if my brain does not — it will be asked on the exam. And if I don’t know the answer because my brain is busy saying “that’s stupid!” — I will fail.

As happened last Thursday. Our first major NU101 exam.

Most of the first exam was comprised of legal issues, knowing the exact roles of the medical team, and infection control. I studied. I paid attention to details as best I could. But most of what we were learning felt rote and boring. My brain HATES that stuff. I am desperate to show off what I can do, and they’re making me learn the differences between a tort and a law.

So… despite, or due to, my cocky indifference, I failed. Not spectacularly, of course, but shamefully nonetheless at a mere 72 (75 is passing). About half the class failed the exam, so I’m in good company. Most of the rest passed by 5-10 points. The elite, however — well, they studied more effectively than I did and, therefore, did better than I did.

Now, you might say that 72 isn’t all that bad. Aw, that’s cute. You’re trying to appease me, and I appreciate that. But 72, nonetheless, is failing, so I must now endure a process called remediation. I meet with one of my professors to go over what I did wrong and how I will move forward in grace and start passing my exams. I’m sure there will be additional homework involved as well.

Then came Friday, my first real clinical, where I am assigned a patient in an actual hospital and get to “practice” on them.

It was my first time in this particular hospital. I was walking around in my green student scrubs and white lab coat (I was the only one of my classmates who chose to wear The Coat.) I noticed several other teams of students from other schools wandering around the hospital looking lost too.

But, keep in mind, I was coming off the failed test the day before, still beating myself up about actually failing what should have been an easy test through nothing more than sheer hubris. Maybe I’m not meant to be a nurse, I thought, maybe this whole thing was a mistake.

My team of 10 met in the cafeteria around a large table where we would choose our patient assignments. Our instructor rattled off the condition of the first (a simple UTI) and one of the girls chose it. I was grumpy and miserable and wanted nothing to do with this. I thought, for sure, I’d get thrown out for being a fraud. Who was I to think I could be a nurse, anyway? It was 7am, I was half-asleep and I had barely consumed any caffeine, had only a granola bar in front of me for breakfast. I felt thorougly and completely sorry for myself.

The next patient assignment was a 66-year-old woman admitted two days prior in a hypertensive crisis. “Big whoop,” i thought. Dammit, if I wasn’t determined to be miserable! As my instructor continued the rundown of the 66 YO’s condition, I could actually feel my brain start stir a little. It was getting interesting. This poor lady had a laundry list of problems including renal failure.

Then, once my instructor started listing off the lady’s medications, after one particular mention, I looked up from my half-eaten granola bar and said out loud, “Wait. What?!?” It was a medication that I knew. I knew was contraindicated for renal failure. Why is an elderly woman in renal failure being prescribed a med that will worsen her condition?

I’LL TAKE IT.

Brain now alive and zipping along at 100 miles an hour, I hopped on the elevator with my cohorts with my phone fishing through Medscape and looking at the latest research on renal failure and hypertension. We reached our floor and wing, and were set loose to our assigned patients.

First step, check patient’s records. As a novice, I didn’t know where the records were, and I didn’t have a password for the computer systems yet, so my ability to get data was limited. They had a med list for her — a mile long — filled with unnecessary medications and duplications. I wanted to read through Miss M’s chart — a three ring binder with several pages and pages of procedures and history — but didn’t get much chance before I was shuffled into her room to do an impromptu head-to-toe basic physical exam.

So I went in to introduce myself to my patient.

They say you always remember your first patient. I don’t know if they mean as a student, or while you’re in practice, but I will likely remember Miss M for the rest of my career either way. She was a surprisingly spry 66YO AA female, about 5’3″ tall, sitting up in bed and having her breakfast, most of it was uneaten. She grimaced as she took a sip of her coffee (it wasn’t to her liking.)

Most of the students are shy at first. They don’t know how to act in this new environment without feeling foolish. Me? I was a stage performer before all this, so I know how to feel foolish AND greet a crowd of strangers. I just walked into her room as if I owned the whole hospital, smiled, and greeted my patient openly and fondly.

I found her to be alert and oriented, though softspoken, and very cooperative despite what I had been told by staff. I’m a pretty friendly person, so it’s possible that my efforts to put her to ease helped her mood. I noted that she was missing her entire bottom row of teeth. Admitted two days for hypertensive crisis and is in end-stage renal failure for which she’s been receiving dialysis treatments three times a week for the last six months.

As I was standing over her bed asking questions about her medical history, I tried to be careful with what I said. I had to remember what we were taught in class (the test I failed) on SCOPE OF PRACTICE — I am not yet a real nurse, so I must remember my place. I must not overreach.

Also, I felt a growing discomfort in the power difference while standing OVER her bed. I remember what it was like to have med students and nurses standing over me poking me and prodding me and asking me things. It’s intrusive. Lying on a bed, you’re so vulnerable…. frankly, it felt rude. So I grabbed a chair and sat down to chat with her in a more eye-to-eye fashion. No sooner did I do this, than my instructor came in and hurried me back out to view an IV procedure.

In my few moments with Miss M, I found her to be friendly and engaging. She lives alone not far from the hospital in her own apartment. She has a daughter and two sons. One son helps lay out her medication for  her and checks on her when he can. She has trouble taking her medication because there is so much of it, it’s confusing. She also has dialysis for her kidney failure three times a week, but often cannot go.

I want to tell you I know more, but that’s about it. I got shuffled out so fast, I really didn’t have a chance.

And frankly, I was so disoriented in the hospital, being that it was my first day, I didn’t know what to do. And my instructor had 8 other students to work with, so I had minimal oversight. I busied myself with the stack of paperwork I was given to fill out, most of which could be done from her charts — which were incomplete.

The five hour shift passed surprisingly quickly, and soon we were all in the cafeteria again for a debrief on our patients. I have to tell you — I should have, but I honestly didn’t care about anyone else’s patient. I only cared about mine. I can’t report much on the UTI patient (I believe she was being discharged), nor do I know much about anyone else’s patient (or, rather, client as they like to call them now). I was busy on my phone checking research and cross-referencing medications.

When the teacher came around the table to me and asked about my experience, my brain lit up like a neon sign and went to town.

I was chattering away a mile a minute. I presented the case. I talked about my patient’s history, the circular link between hypertension and kidney disease, how the pharmacology of the meds she is on could be exacerbating the situation. How if I could, I’d talk to her physician about her polypharmacy issues. How dangerous some of the meds are and how, particularly this one and this one, have unexpected consequences when prescribed together.

I expounded. I spoke definitively. I spoke from a place of earnestness and evidence-based fact. I cited papers. Seriously. I cited papers. All off the top of my head.

Shit, I admit — I impressed myself.

I felt like a race horse that had finally been let out of the barn.

Then my teacher looked at me and said, quietly, “So what are your nursing implications?”

My nursing WHAT?

“Your nursing implications,” she said calmly. “What would you do for your patient? As a nurse.”

Silence. You could practically hear crickets. I was momentarily silenced and dumbfounded. I had to switch gears..

“Uhm,” I began unsteadily, “I guess I would watch for edema and monitor her fluid levels? Make sure input and output are consistent?”

“What else?”

“Uh… well… uh… I would begin planning her discharge. Her BP is stable. I would maybe recommend her to social services to make sure she was hooked up with someone who could make sure she gets her meds on time and goes to her dialysis appointments regularly so she doesn’t get into a crisis situation again.”

“Anything else?”

I’m sure she was looking for more nursey-type things like watching for pressure sores and such, but I couldn’t think of any. So, I went with what I knew.

“I would talk to her treating physician about all those meds. I know this is an acute care situation, but somebody needs to do something about that!”

“Do you think that’s within your scope of practice?” She asked.

“I don’t know, but I would feel morally and ethically bound to say something.”

“If you did, what would you say?”my instructor pressed.

“Huh?” I asked, dumbfounded again. What was she driving at? “What do you mean?” I asked.

My instructor said, “You would do your research, right? And present the doctor with your specific findings and cite those sources of yours, right? You would be specific, right? Because sometimes doctors don’t always get it right. They don’t always know every side effect and interaction, right? You need to be respectful.”

“Yes ma’am.”

I don’t know if I was right or wrong. I am not an ordinary student.

Now if I can just pass, I’ll be fine.


“Pretty good is not good enough, I wanna be great.” — Christina Yang, Grey’s Anatomy


 

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Economy-Sized Loperamide Being Phased Out

lopebottles

I recently noticed that our local Walmart has clearanced out their large quantity loperamide bottles (their 200-count size bottles). Right now, the max quantity available is 48. When I asked management why there has been a change, they said they were directed by corporate to clearance out the drug; it will no longer be available in that quantity in stores.

This change is the direct result of the rise in overdoses and deaths resulting from the abuse of Loperamide (brand name: Imodium), an over-the-counter opioid used to control diarrhea. This past spring, the FDA sent out a call-to-action to drug manufacturers and sellers, requesting that they no longer sell bundled packages of mass quantities of the drug voluntarily, hoping to slow the tide of addicts who are turning to the drug as part-and-parcel of the nation’s opioid crisis.

What does this mean for you?

If you have occasional diarrhea, it isn’t really going to effect you. You can still obtain loperamide/Imodium on store shelves in quantities up to 48-count. If you have a gastrointestinal disorder that requires 8 pills a day, this means you will have to buy your loperamide/Imodium more frequently as mass-quantity bottles will become harder to find. The drug remains inexpensive and maintains its over-the-counter availability.

However, if you are an addict who has been using loperamide in mass quantity, this may become a changing time in your life.

As an opioid addict, the thing I feared most of all — even above nodding off and never waking up again — was withdrawal. I know many addicts who feel the same way and will do whatever it takes to make that feeling go away. Until you know what withdrawal feels like, it’s hard to imagine why anyone would do something crazy like take 144 tablets of an anti-diarrheal drug in order to make that feeling stop.

In medical school, we are taught that withdrawal is like a bad flu — hot and cold flashes, aches and pains, chills, sneezing, runny nose, etc. But withdrawal from an opioid is many orders of magnitude worse — aside from sharing a similar set of symptoms on paper, they have nothing in common.

I am clean now and have been for years, but I had to go through hardcore withdrawal to get here. Not only did I have to experience withdrawal from a traditional opiate, later, I got to do it all over again with a much worse opiate — loperamide. I have spoken to so many people who completely agree with me that withdrawal from loperamide is far worse than any regular opiate they’d been addicted to previously (including heroin withdrawal).

All the more reason not to use loperamide in mass quantity.

But people do it anyway. And that’s why the FDA and others from around the country are making efforts to help. Part of that effort is limiting access to the drug. So far, there is no governmental mandate — nothing in the law — that says loperamide cannot be sold. The FDA requested voluntary packaging restrictions directing their concerns at companies such as Amazon and Walmart. Amazon, for one, offered loperamide in quantities as high as 10,000 pills at one point. Today, that is not so.

Those that have been marketing and selling the drug in mass quantity to addicts are not happy about these changes, but that’s too bad.

I know that there has been some legitimate concern raised among those in the IBS communities that limiting access to loperamide will affect their ability to live and live comfortably. Again, I stress that nobody wants to take the drug away from those who need it for legitimate medical reasons; however, it is necessary to find ways to limit its destructive power.

I am glad to see that the world is finally taking notice, taking this addiction seriously, and responding.


“Education is the most powerful weapon which you can use to change the world.” — Nelson Mandela


 

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Advocacy and Updates

Georgetown

Hello everyone!

I have returned from a conference at Georgetown U. regarding the Loperamide issue. It was an incredible experience to discuss the issue and review current research with some of the top brains from around the country including representatives from poison control centers, gastroenterologists, substance abuse centers, drug manufacturers, non-profits, and government entities. I will report more on our discussions in a future update, but I wanted to take a moment to clear up something that has become a bit of a concern.

Nobody wants to take loperamide away from those who need it and are using it safely. I don’t know why, but I’ve been getting a lot of mail on this in the last couple of weeks. For those suffering from IBS, colonectomies, and other intestinal issues, let me reassure you — NOBODY recommends removal of loperamide from the shelves so that patients cannot get what they legitimately need. If you are having problems acquiring the medication, that has nothing to do with me or my advocacy efforts. Stores in my area are still selling bottles of up to 200 pills and you can still get them from Amazon.

The official FDA recommendation (seen here) requests that manufacturers and resellers restrict sales of bundled packages of loperamide which are often targeted and marketed toward those misusing or abusing the drug.

So what does this mean for you? If you are used to buying 1600 tablets at a time, yes, you will experience some inconvenience.

That said, if you are taking more than the recommended dose, outside of a physician’s supervision, you should be concerned. It has been shown that taking loperamide in large enough doses over a long enough period of time will result in cardiac arrhythmias and/or death. If you are taking high doses and have been doing so for a long period of time (misuse, as opposed to abuse), this should concern you.

The fact is, we do not know what that “high enough” dose is, nor can we quantify how long you have to be taking that dose to achieve cardiotoxicity. We are researching how that happens and why — and while there are theories, nobody has a definitive answer — yet.

So please — I understand those of you who are concerned that your access to this drug could be limited. I fully respect that. It is a very important part of the discussion and should not be overlooked. After all, the World Health Organization considers loperamide one of their top essential medicines. But, if this drug isn’t as safe as you thought it was, why are there no alternatives? Advocate for an alternative. Demand one.

It’s out there — we just need to fund it, research it, and find it.

In the meantime, we have loperamide. I assure you, NO ONE benefits from taking it away.

But me? I am advocating for the rights of those who have become addicted to loperamide (and other opioids) and trying to spread the word to educate physicians and medical professionals as well as the addict population that loperamide is being abused and misused. It is NOT a safe alternative to a traditional opioid. It is not a “Poor-man’s methadone”. It is a deadly substitute that needs to be respected for what it is — it is an opioid.

It is part of the opioid crisis, whether we like it or not. I will continue to be a voice for all those affected by loperamide — particularly for those who have come to misuse and abuse it and fear social retribution or stigmatization.

I have hundreds of letters from addicts and their families who know the bad that this drug can do. I know first hand as well. And if I can get better, other addicts can too.

I offer here my experience, strength, and hope for all those seeking help.

Good night, and good health.

MM


“The meaning of life is to find your gift. The purpose of life is to give it away.” —William Shakespeare


Posted in AA, addiction, blessings, education, family, gratitude, loperamide, loperamide abuse, Loperamide in the News, opiates, sobrietyland

Lebensunwertes Leben

32956680_10160293427205034_3060097995774099456_n.jpg

I just had a rather heated discussion with a now former friend on facebook regarding their opinion that addiction is a choice, not a disease.

I welcome anyone who is judgmental of me and of other addicts, and feels that we are weak-willed, contemptible slags who deserve to die… you may ALL go ahead and unfriend me on Facebook right now. Kiss my rear bumper and don’t let the door smack your bottom on the way out.

Don’t get me wrong. I understand the frustration that happens when trying to comprehend the incomprehensible. I mean, why would ANYONE do something repeatedly that is killing them or ruining their lives? WHY?

Why can’t you just STOP! Cut it out! If I can drink just one beer and stop — why can’t YOU??

Why would an addict put a needle in their arm? Why would a pill-popper pop pills? Why would an alcoholic drink themselves into an early grave? Why don’t they just pull up their big girl pants and just STOP?

Here’s the key everyone needs to understand. Once the brain is hijacked, It’s no longer a choice. It’s a disease. Plain and simple. Science bears this out.

Long-term changes happen within the brain that reinforce the need for more of whatever it is the addict is doing. It becomes an overwhelming need — higher on that Malsow’s Hierarchy of Needs chart than food or water. The brain becomes rewired to consider the need for that substance to be a matter of sheer survival.

Science — not suspicion — backs me up here.

We as a country are fighting an uphill battle in trying to come up with treatment for those with substance abuse issues. The opioid crisis has brought it to the forefront of our attention. While the DISEASE is well-understood, treatment is not. Treatment fails in many cases.

Relapse rates are around 50% within one year.

That doesn’t mean we shoudn’t keep trying. And it does NOT help the fight to deny that these addicted people have a real problem.

Many babies are born addicted. Does that make them scumbag addicts too? Are they losers who deserve to die? Just stop shaking, loser baby! That heroin is bad for you! Don’t you know that?

Why does the diabetic, for instance, not eat properly and take their medicine accordingly? Could it be that the overwhelming desire to eat sugary snacks (driven by their hijacked insulin-resistant systems) can sometimes overwhelm common sense?

Or how about the guy with high blood pressure. He knows he should take his meds, but they make him feel tired, so he doesn’t take them like he should. How outraged are you when he develops congestive heart failure? What an ass! He deserves it!

And what about the smoker who has a 2-pack a day habit for 20 years and is diagnosed with lung cancer. Scumbag smoking asshole deserves to die, gasping for breath, right?

And guess what? Relapse rates for those being treated for high blood pressure, diabetes, and heart disease is ON PAR with relapse rates for addicts. Around 50% are noncompliant or stop taking their meds within one year.

So before you start spouting off about how addiction is a choice not a disease, consider what you’re really saying. If you universally consider “choice” in these situations, all of us would be shot on sight.

Compassion is the cornerstone to any treatment plan for addicts. i’m not saying it’ll fix everything — some people are gonna be assholes whether they’re addicted to something or not. And some are simply worse off than others. And yes, choice does come into play — people need to WANT to get well — but isn’t that true of anything?

The cancer patient has to WANT treatment. But if treatment fails, is that the cancer patient’s fault for not WANTING it enough?

Consider the suffering before you stand in judgment of someone who struggles every day with this. Weak-willed? These people are survivors on a level that a “normal” person will never know.

I have NEVER met a person struggling with addiction who wanted it. Nor did the person with lung cancer want it. Or the man who got diabetes choose it. Or the baby born addicted to heroin — okay, that little bastard probably had it coming. LOL

Seriously though….

Take your hate elsewhere. We don’t need it.

*Note: “Lebensunwertes Leben,” the title of this article, is German for “life unworthy of life”, a term used in Nazi Germany to justify eugenics.


“60,000 Reichsmark is what this person suffering from a hereditary defect costs the People’s community during his lifetime. Fellow citizen, that is your money too.”

From a 1938 poster put out by Neues Volk, a propaganda magazine that proposed sterilization or death for “undesirables” in Nazi Germany


 

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Update and Commentary

meeting

Hey everyone!

It’s been a while since I posted, and for that, I apologize. Life happens.

I will likely be going to nursing school this fall. I have a 4.0 GPA in my prereq classes (Chemistry, A&P, etc.), rocked my TEAS exam, and didn’t act like a bumbling fool in the interview, so I’m waiting to hear for sure if they’re letting me in. (They probably will.) Moohoohahaha.

I mentioned this success to a young doctor the other day who smiled at me, tilted her head to one side, and said (more than a little condescendingly), “That’s great. See? It’s never too late.”

Okay. First of all, seriously? I mean, granted, I forget sometimes that I’m not 18 years old anymore. But it’s not like I’m a 90-year old great-grandmother going after my GED. Sheesh! Secondly, being a doctor you should appreciate how difficult it is to pursue any kind of medical degree; try doing that and working to support yourself at the same time AND maintain a 4.0 average. Yeah. So there.

*crickets*

Wow. Tough room.

So there’s that.

More importantly, I wanted to let readers know that I will be attending a get-together with people on the front lines of the loperamide issue very soon.

Do you have questions or concerns that you want me to carry forth?

Everyone who writes to me increases our knowledge of the scope of this problem and how to better approach it. So your input is important to me. Your letters inform and sometimes break my heart. I’m so appreciative for all you have written.

I know a few people have raised legitimate concerns regarding the present OTC status of loperamide and the potential impact if that changes. I promise to take all that into consideration and bring your thoughts to the table with me.

What do you want people to know? How has loperamide addiction has affected your life?

Comment below and let me know. Thanks!


“Be sure you put your feet in the right place, then stand firm.” — Abraham Lincoln


 

Posted in + recovery, addiction, loperamide, loperamide abuse, Loperamide in the News, sobrietyland | 1 Comment

FDA Recommends Limiting Loperamide Quantities

51WOvornzjLThe FDA has recommended that loperamide (brand name: Imodium) be sold in limited quantity and in blister packs in the hope that such a move will stifle the growing problem of addicts abusing the drug.

If the manufacturers agree, it’s a terrific first step in preventing deaths from loperamide abuse.

My longtime readers know that I, myself, was addicted to loperamide for a couple of years. I was also the Index Case in this loperamide abuse crisis — having gone into cardiac arrest and almost dying in February 2012 from an overdose of the drug. Lots of research has gone on since then. (Please feel free to peruse my site for more information on this).

I became convinced that I could help prevent people from dying as I did. So, for a few years now, I have worked with the toxicologists at the Upstate Poison Control Center in Syracuse NY to battle this ongoing problem that has become part and parcel to the nation’s Opioid Epidemic. The doctors at Upstate have seen countless patients presenting in their emergency rooms, some of whom have sadly died as a result of abusing loperamide.

I’d like to think that my efforts, in some small part, have contributed to the research in this field and in changing attitudes of healthcare workers and the general public toward those with addiction issues. I hope that, perhaps this recommendation — requesting that the manufacturers and sellers of Loperamide voluntarily comply with the new FDA recommendations of limits on the packaging —  will save some lives.

In a nutshell (TL;DR) the recommendation is that loperamide be sold in smaller quantities — instead of selling bottles of 200 — and that they are blister-packed instead of sold loosely in a bottle. This allows the general public to still have access to necessary medication but limits the addict’s ability to get into trouble.

For those who are already addicted, now is your wakeup call. You may, like me, have been waiting for the “right time” to get off the drug. Now is that time. Get yourself into a treatment program where you can get the help that you will need! Outpatient may be all you need — you may not need residential treatment. Treatment for loperamide addiction follows much the same course as a traditional opiate with certain exceptions due to the nature of the drug. Talk to a treatment counselor. Ask lots of questions. Let them work with you to form a TEAM to fight the addiction. You CAN do this — I know because I did (and I’m the hardest-headed person I know!).

Don’t wait or it’ll be too late.

And to those on Amazon (and other sites) who sell Loperamide in ridiculously high quantities (like, 2400 tablets at a time) knowing that addicts are your number one customer: YOU ARE ON NOTICE. Enjoy your sales now because it will end soon. I have a particular set of skills. Skills acquired over a very long career. Skills that make me a nightmare for people like you. I will look for you, I will find you, and I will make you stop selling drugs to people and killing them. You will be held accountable.

Push your shit somewhere else. I’m shutting you down.

FDA NEWS RELEASE

WASHINGTON POST

From the FDA News Release:

Today, toward these goals, we have taken a new action related to how one opioid product is packaged as a way to help address a growing problem of abuse and misuse of this product. The FDA is requesting that sponsors of OTC loperamide ‒ an FDA-approved product to help control short-term symptoms of diarrhea, including Travelers’ Diarrhea – change the way they label and package these drugs to stem abuse and misuse that leaves us deeply concerned.

Abuse of loperamide has been increasing in the United States. When used at extremely high and dangerous doses, it’s seen by those suffering from opioid addiction as a potential alternative to manage opioid withdrawal symptoms or to achieve euphoric effects of opioid use. The maximum approved daily dose for adults is 8 milligrams per day for OTC use and 16 milligrams per day for prescription use. It’s sold under the OTC brand name Imodium A-D, as store brands, and as generics.

Loperamide is safe at these approved doses. But when higher than recommended doses are taken we’ve received reports of serious heart problems and deaths with loperamide, particularly among people who are intentionally misusing or abusing high doses. The majority of reported serious heart problems occurred in individuals who were intentionally misusing and abusing high doses of loperamide.

The FDA added a warning to the product label in the spring of 2017 to warn of ingesting high doses of loperamide, including from abuse and misuse. Evidence suggests that package limitations and use of unit-dose packaging may reduce medication overdose and death.

Today we sent letters to the OTC manufacturers requesting that they implement changes consisting of packaging limitations and unit-of-dose packaging. We’re requesting that packages contain a limited amount of loperamide appropriate for use for short-term diarrhea according to the product label. One example is a single retail package containing eight 2-milligram capsules in blister packaging. We asked the manufacturers to take the necessary steps to implement these changes in a timely fashion to address these public health concerns.

I also plan to reach out to those who distribute loperamide online, through retail web sites, to ask them to take voluntary steps to help us address this abuse issue. The new packaging should help make limits on sales more easily achieved. The abuse of loperamide requires the purchase of extremely large quantities. Often this is done through the purchase of large bottles of loperamide, which is a common configuration in which the pill form of the medication is currently packaged. Today’s action is intended to change how the product is packaged, to eliminate these large volume containers. We know that many of the bulk purchases of these large volumes are being made online through major online web retailers.

I believe anyone who is distributing health care products has an obligation to be a partner in helping address the most pressing public health challenges like opioid abuse. If you’re selling a drug with the potential for abuse and misuse through an online website, you’re no longer in the business of selling widgets, or books. You have a social contract to take voluntary steps to help address public health challenges.

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