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


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

Lebensunwertes Leben

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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


 

Posted in + recovery, AA, addiction, depression, family, loperamide, loperamide abuse, open letter, relationships, sobrietyland, therapy, thought of the day | Tagged , , , , , , | 1 Comment

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.

Posted in + recovery, AA, addiction, loperamide, loperamide abuse, Loperamide in the News, sobrietyland, therapy | 7 Comments

Thinking Fast and Slow

System-1-vs-System-2.jpg

On Facebook this morning, I ran across a recommendation by ZDoggMD (government name: Dr. Zubun Damania) — a book called “Thinking Fast and Slow” by From Daniel Kahneman. This piqued my interest for a couple of reasons. First, Kahneman, despite being a psychologist, won the Nobel Prize for Economics in 2002. Second, the book’s subject matter is Human Irrationality. In other words, why do we do stupid shit despite the fact that it’s bad for us?

Take, for example, drug abuse. It’s estimated that over a half-million people die every year from various forms of drug abuse. So, with overwhelming evidence saying that using is a bad thing (whether it’s tobacco, alcohol, or illicit drugs), why do people still choose to light up, drink up, or shoot up?

According to Kahneman (and other researchers involved in the project), it comes down to the way the brain is wired. How we perceive incoming data. We have inherent biases in our thinking that influence our memories of experiences.

He postulates that we have two systems of thinking going on. System 1 (the fast one) is pretty instinctual. It makes a decision at a subconscious level. But it works fast and cheap  — yet it’s pretty inaccurate. Example: You see a bowl of cherries with a cockroach sitting on top. You may instinctively feel intense revulsion. Your brain thinks, cockroach is bad, therefore, cherries are bad. From then on, you think cherries=bad.

System 2 (the slow one) happens at a conscious level. It’s methodical. Takes time. System 2 would sort through the information so you can see that cherries are still good even if you saw the cockroach on it. It considers that situation in a more logical, “scientific” way.

But System 2 takes time and it’s exhausting. It’s lazy. If it gives up too soon, System 1 takes over and you remain cemented in your belief that all cherries suck because… well… maybe your brain won’t even remember that cockroach after a while. You just remember knowing in your heart of hearts that cherries are gross. Period. Stuck in that belief because that’s just how it is. Harrumpf!

I’ve only started reading this intriguing book, but let me allow the New York Times to summarize what I’m trying to say:

“… the remembering self does not care about duration — how long a pleasant or unpleasant experience lasts. Rather, it retrospectively rates an experience by the peak level of pain or pleasure in the course of the experience, and by the way the experience ends.”

So… example… someone like me takes a Vicodin tablet. I’d taken Vicodin before and, while I enjoyed it, I never really loved it. It was a slow release, and even though the experience was pleasurable, it wasn’t really all that great. But I DO remember the day it hit me like a freight train! For various reasons, the drug gave me an intense high one day unlike any other — and the intensity of the experience shifted my bias. I wanted that to happen again and again and again. I pursued it into the ground despite all evidence that my life was spinning wildly out of control. I almost died trying to recreate that experience.

This is what Kahneman describes as the “Peak-End Rule” — not so much the duration of the experience, but the intensity by which it is felt — that drives my recollection and pursuit of repetition despite all logic to the contrary.

In truth, I have wondered about this theory for a long time. I’m pleased to see that a Nobel Prize-winning psychologist/economist has done the legwork for me. That perhaps it is not the length of time we do it, but the intensity of the experience that drives addiction. They don’t call it “chasing the dragon” for nothing. Always chasing that first high.

And perhaps that is why so many drug treatment plans fail — they cannot overcome that cognitive bias created by the peak of the drug experience. Going to classes all day, going to meetings, plodding along in our recovery — how can that possibly compare to the fireworks created by your drug of choice?

It can’t. That’s why healthcare workers recommend that treatment last so long even though insurance companies only want to pay for a couple of weeks or the traditional 28 days. 28 days isn’t nearly enough for System 2 to kick in. Not nearly enough. A dear friend of mine has been in treatment for almost a year now — and he does everything he’s supposed to do. He takes all the classes. He does all the work. He goes to meetings. He does every assignment he is given. Yet, while they have quieted, the urges are still there. If Kahneman’s theory of a mild experience for a long time versus an intense experience over a short time is true, the likelihood that my friend will relapse remains pretty high.

Which isn’t to say that the “System 2” cognitive version of Drug Rehab — the most common here in the United States — can’t or won’t work. It can and does for many people.  It may work for my friend. But perhaps we need to consider that if most of our patients are failing in this method of treatment, we need to reassess what we’re doing.

I wonder if that is why the controversial treatment of Ibogaine for opiate addiction has found a modicum of success as a ‘cure’ in other countries where it is legal — because it proffers an alternate psychoactive experience, one that shares a “Peak-End” in direct conflict with the original episode. Perhaps the two cancel each other out? I would be curious to find out more.

(I’m not in any way, shape, or form recommending Ibogaine, but I DO find that its results present us with new data that should be considered.)

At any rate, I think this book is a really intriguing read! Although I’ve just started reading it, I think this book is offering some real insight given our current drug crisis. Check it out! (It comes ZDoggMD recommended too!)


“Intelligence is not only the ability to reason; it is also the ability to find relevant material in memory and to deploy attention when needed.” —Thinking Fast and Slow, Daniel Kahneman.

 


 

Posted in + recovery, AA, addiction, education, loperamide, loperamide abuse, sobrietyland, therapy | Tagged , , , , , , , ,

Relapse: The Silent Killer

Let’s talk about the thing nobody in recovery wants to talk about.

Many things can be talked about freely “in the rooms” — i.e., in a 12-step meeting. You can talk about relationships. You can talk about a particular step. You can even discuss having gone to jail or rehab. But there is one topic above all others that scares the living crap out of a 12-step meeting.

Relapse.

There. I said it.

Relapse.

How much more dangerous it is when it remains unspoken.

It happens. It happens to the best of people. The most hardcore. The ones with 20 years of sobriety under their belts. Relapse. It’s the thing people in recovery fear the most out of any word in the English language. But it happens all the time.

A friend of mine recently re-entered rehab for what seems like the four billionth time. Everyone worries whether or not this time will stick — and they have a right to be concerned. Everyone — that is — except those who abandoned him after he relapsed. Even family members and friends fear relapse because the consequences are so dire. Every time an addict relapses, there’s the possibility (probablility?) that they could die this time. That all the bad things will happen all over again.

When I initially quit taking loperamide, withdrawals were so bad that one night I couldn’t take it anymore and took a few pills just so I could get a few hours of peace and rest. The next day, I attended a meeting and confessed what I’d done — I was EVISCERATED by the group for my relapse. My main mistake was, in explaining what had happened, saying “I know it’s a part of recovery” — to them, this was pure blasphemy, so I was told, in no uncertain terms, that was unacceptable.

Yet, I was not wrong. Relapse is an expected part of recovery. It doesn’t have to be, but it happens more often than any of us would prefer.

relapserates

Source: JAMA, 284:1689-1695, 2000

Relapse in addiction recovery is no different than any other disease. (By the way, some people differentiate between a “slip” and a “relapse” but, to me, that’s just a matter of semantics. As I will be discussing it, they are the same thing.) Below is a chart that appeared in the Journal of the American Medical Association (reused by the National Institutes of Health) that compares relapse rates between drug addiction and other chronic illnesses such as Type I Diabetes, Hypertension, and Astham. Those illnesses require lifelong patient compliance, frequently with medication, and the breakdown of patient adherence to a treatment plan often causes a relapse of symptoms and repeated medical intervention.

 

Those who think Substance Abuse Disorder isn’t a disease need to consider this chart carefully.

Relapse is so terrifying because the consequences of it are so dire. As with any chronic disorder, it can quickly lead to hospitalization or death. The diabetic stops taking insulin, it doesn’t take long before glucose builds up and bad things happen. Untreated high blood pressure can lead to strokes and long-term irreversible damage. Untreated asthma can lead to hypoxia and death in minutes. Nobody wants this — but it can and does happen.

The important thing to remember is that relapse doesn’t have to be the end. It is a call to action. Renewed intervention in the disease process can lead to continued recovery with swift and decisive action.

But never give up. Never give up on the family member or friend who slips. And never give up on yourself. Recovery is an ongoing war; the loss of one battle doesn’t need to signal the end.

 

 

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