Personally speaking

moiFor those among you who have missed my personal stories and adventures, I do apologize. For obvious reasons — namely, that people I know personally now know about this blog — I have to edit myself a bit. But I’d still like to provide an update on how things are going.

I can tell you that things are generally going well. There are some major issues going on behind the scenes, but I’m managing.

I continue to be employed at our local thrift store. Yay! Employment! Tonight I am changing over from morning crew hanger/pricer to night crew cashier in preparation for this fall’s onslaught of day classes at the local community college. It’s something of a step down, but I requested it. Much as I would have loved to keep my day hours at work, it simply wasn’t in the cards. The specific classes I require for Nursing (right now, chemistry and psychology) are only available during the day, and only in Utica. UGH. Then, once the nursing-proper classes begin, they don’t even begin to offer night classes, so I might as well get used to that now. And getting used to being paid a lot less at work (but at least I’ll be employed).

That’s the part I’m really worried about. Since one of my two jobs cut my paid hours in half back in April, my personal financial matters have started slumping south. And as a person already living on the poverty line, this additional loss in wages will bump me significantly below that poverty line. I will have to invent a way to make up the deficit. Suggestions are welcome!

chalazionPersonally, my health is good (and yes, I’m still clean) but I could be doing a lot better — I have not been taking my own health very seriously lately, and I really need to. I’m tired and worn down most of the time, and my depression has been slowly creeping back (so far so good though). One particularly bothersome problem is that I’ve been plagued by a rash of chalazions lately; they’re rather like styes that take a ridiculously long time to go away (months!). I have never experienced these before, but they’re rather disfiguring and deeply upsetting. While I need to address the issue (and some others), instead, I keep finding excuses why I don’t have time. My own hesitation to deal with it frustrates me!

I have also been working for a local non-profit as their Promotions Chair. I’m enjoying it very much (aside from the fact that I’m not being paid). I’m allowed to bring my dog to the office  — so he’s not home alone all day — and I get to do some work (that I’m actually good at) in the comfort of central air conditioning and big windows.

upstatehealthcover

I’ll probably be featured in the fall issue; this is the summer issue.

I was interviewed this past week by University Hospital’s “Upstate Health” magazine staff regarding my experience with Loperamide abuse. They were wonderful! Jim Howe, the reporter, reassured me and listened while I chattered on during the interview itself. When it came to the photography part, I was worried about one new chalazion on my eye, but their photographers made me feel at ease, and with some good eyeliner, the bump should be hard to detect. Instead you’ll likely see a photo of me cross-eyed with my mouth agape while I’m blabbering on about something! Hah! (FYI: I also made sure to go easy on the eye makeup, avoiding that copper eyeshadow again. Eeeechh.) I still look like a dork though, so you’ll know it’s me.

And as always, I remain in touch with my doctors in Syracuse as well as my former therapist who you may recall was a regular and entertaining character on this blog. I miss him a lot — as I’m sure many of you do as well. In case you were wondering whatever happened to him, last I knew, he was doing very well for himself now and has a big office with an espresso machine and a big window. And a secretary! Woo!

I continue to regularly attend my 12-steppie meetings. We had a picnic this past week that was amazing! Way too much food! But lots of good times. It was kinda fun to attend an event where people weren’t getting slobbery drunk and acting like fools.

Speaking of which, a very dear friend of mine has fallen back into alcoholism (they may or may not ever see this blog). I pray for this person every day even though I’m absolutely certain they couldn’t care less. This person seems to equate my worry as if I’m being a pest, and I don’t know what to do about that. In the program, we often talk about dealing with loved ones who have active addiction issues. We remind ourselves that no addict/alcoholic can be helped unless they want it for themselves. This stand-by-and-watch attitude is extremely distressing for me though. I feel as if I am deserting this person in Hell. So, unable to follow them, I end up remaining in Limbo. Unfair.

I had a recurrent dream last night — the second dream in two days — where I’m back at my old house and my mother is there arranging to have her possessions moved out because she was leaving the house. She told me to gather my things, but there were too many to carry and I couldn’t choose what was important enough to take and what to leave behind. In the first dream, the house was being sold off; in the second, it was going to be torn down. I reacted to all this by being angry, yelling, screaming, pleading to be heard, but no one was listening. I was dismissed. I wanted to save the house — I insisted the house belonged to me! They can’t take it away — it’s mine! But nobody listened.

So that’s all the news that’s fit to print. Sadly, I must leave you now, dear reader, having completed my update. I have to get ready for my new night shift at work. Pleasant dreams, and well wishes!


“The fact that you live in a broken-down house in the midst of restoration makes everything more difficult. It removes the ease and simplicity of life. It requires you to be more thoughtful, more careful. It requires you to listen and see well. It requires you to look out for difficulty and to be aware of danger. It requires you to contemplate and plan. It requires you to do what you don;t really want to do and to accept what you find difficult to accept. You want to simply coast, but you can’t. Things are broken and they need to be fixed. There is work to do.”

— David Paul Tripp

 

 

 

 

 

 

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Loperamide Presentation ACMT 2016

For those among the unwashed masses, a lot of scientific research isn’t necessarily found in magazines and journals. A lot is presented during medical conferences. Sometimes it’s in presentation form before an audience (like an interactive power point presentation); sometimes it’s a poster session where the researchers stand around a poster explaining their work and taking questions. Sometimes both.

The first presentation regarding Loperamide abuse and its cardiac effects was presented as a poster session at the 2012 Annual Meeting of the North American Congress of Clinical Toxicology following my overdose in February of that same year. (See research page) The authors? Those smart and impossibly good-looking folks from Syracuse’s Upstate Poison Control Center. (Seriously, those docs from Upstate University Hospital are so good-looking, they’re like wandering bands of Grey’s Anatomy actors come to life.)

The following poster session, however, was presented by researchers from University of California, San Diego, who may or may not be as smart and as good-looking as the docs from Syracuse. Or are they?

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loptab3Poster Session: Life-threatening Arrhythmias Associated with Loperamide and Cimetidine Abuse

Charles W. O’Connell 1, 2; Amir A. Schricker 3; Aaron B. Schneir 1; Imir G. Metushi 4; Ulrika Birgersdotter-Green 3;  Alicia B. Minns 1,2
1. Division of Medical Toxicology, Department of Emergency Medicine, UCSD
2. Department of Emergency Medicine, VA San Diego
3. Division of Cardiovascular Medicine, UCSD
4. Center for Advanced Laboratory Medicine, UCSD

Conclusions: Loperamide, taken chronically and and in high doses, can cause life- threatening cardiac conduction dysfunction and ventricular arrhythmias. The effects can be seen many days after discontinuation. Isopreterenol used to increase heart rate may be a useful medicinal modality to limit arrhythmogenic effects in the setting of loperamide overdose.

2016 American College of Medical Toxicology
ACMT Annual Scientific Meeting
Bench to Bedside: Neurologic and Metabolic Toxins
March 18-20, 2016
SOURCE

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FW: Condemnation, or Compassion?

elmerhill

Pastor Sam, of Rome’s First Presbyterian Church, is one of the coolest people I know here in Rome. Wise and compassionate, he wrote this terrific blog post regarding a recent tragedy to befall our city — not far, in fact, from where I used to live. A state trooper headed home after a long day at work with his 4-month-old son in the child seat in the back of the car. The man forgot, and went inside; sadly, the infant was dead by the time he remembered the child was still in the car.

These things happen. They are accidents — cold and cruel — but still accidents. Yet people comment shameful cruelties from the safety of their computer keyboards and are fast to judge! Don’t you think that man is wracked with grief now? Do we really need to plan his lynching before all the facts are in?

It reminds me of all the negativity surrounding people with addiction problems. Especially from those in the medical community (surprise!) as well as those in government. Don’t get me wrong — addicts can be a pain in the ass — demanding, selfish, fussy assholes. But that doesn’t mean that those with such problems don’t warrant compassionate care rather than further criminalization.

Sam’s blog, while not about addiction, is well worth the read.

To quote Sam:

“But condemnation will not heal. Condemnation will not bring the dead back to life. Condemnation will only divide people. We need compassion. Compassion understands that we are all human, that we can identify with the mistakes of another person, even when it horrifies us to imagine ourselves in that same position. “

PLEASE READ: Source: Condemnation, or Compassion?

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Another tragic death from Loperamide Overdose

evanbrownfbThese stories float by my mailbox so often and haunt my thoughts like ghosts. So many have died from this, and the worst tragedy is the number of people who dismiss it.

This young man, Evan Brown, of Oregon, studied computer science. He had a beautiful girlfriend. And a family who loved him. He liked music and had fun with his friends. Then one day, he died. Among the many victims of our nation’s drug abuse crisis — and as in so many cases lately, he died from a loperamide addiction.

Like many, Evan started using Loperamide to help his withdrawal from opiates. And like so many, he became addicted to it, eventually losing his life to it.

His family adds:

“This was a tragic accident, he was trying as best as he could to live a clean life for those he loved most…. Evan’s family would like you to please think twice before trying anything on your own, and to seek professional help, if you are struggling with any addiction, not the internet! You have family and friends who love you no matter what.”

My deepest sympathies go out to Evan’s family. Nobody should have to go through this. Nobody. Now that Loperamide Abuse is getting the attention it needs from the scientific community, the press, and now the FDA, perhaps we can agree to treat these patients with the dignity they deserve as humans on this earth.

https://www.facebook.com/EvanBrownstone?pnref=story

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FDA Issues Loperamide Warning

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Handful of loperamide tablets. Pic © Sobrietyland 2016

FDA Drug Safety Communication: FDA warns about serious heart problems with high doses of the antidiarrheal medicine loperamide (Imodium), including from abuse and misuse

The U.S. Food and Drug Administration (FDA) is warning that taking higher than recommended doses of the common over-the-counter (OTC) and prescription diarrhea medicine loperamide (Imodium), including through abuse or misuse of the product, can cause serious heart problems that can lead to death. The risk of these serious heart problems, including abnormal heart rhythms, may also be increased when high doses of loperamide are taken with several kinds of medicines that interact with loperamide (see Examples of Drugs that Can Potentially Interact with Loperamide).

The majority of reported serious heart problems occurred in individuals who were intentionally misusing and abusing high doses of loperamide in attempts to self-treat opioid withdrawal symptoms or to achieve a feeling of euphoria. We continue to evaluate this safety issue and will determine if additional FDA actions are needed.

Health care professionals should be aware that use of higher than recommended doses of loperamide can result in serious cardiac adverse events. Consider loperamide as a possible cause of unexplained cardiac events including QT interval prolongation, Torsades de Pointes or other ventricular arrhythmias, syncope, and cardiac arrest. In cases of abuse, individuals often use other drugs together with loperamide in attempts to increase its absorption and penetration across the blood-brain barrier, inhibit loperamide metabolism, and enhance its euphoric effects. If loperamide toxicity is suspected, promptly discontinue the drug and start necessary therapy. If loperamide ingestion is suspected, measure blood levels, which may require specific testing. For some cases of Torsades de Pointes in which drug treatment is ineffective, electrical pacing or cardioversion may be required.

Advise patients taking loperamide to follow the dosing recommendations on the label because taking higher than recommended doses, either intentionally or unintentionally, may lead to abnormal heart rhythms and serious cardiac events leading to death. Also advise patients that drug interactions with commonly used medicines also increase the risk of serious cardiac adverse events. Refer patients with opioid use disorders for treatment (see Additional Information for Health Care Professionals).

Patients and consumers should only take loperamide in the dose directed by their health care professionals or according to the OTC Drug Facts label. Do not use more than the dose prescribed or listed on the label, as doing so can cause severe heart rhythm problems or death. If your diarrhea lasts more than 2 days, stop taking loperamide and contact your health care professional. Seek medical attention immediately by calling 911 if you or someone taking loperamide experiences any of the following:

  • Fainting
  • Rapid heartbeat or irregular heart rhythm
  • Unresponsiveness, meaning that you can’t wake the person up or the person doesn’t answer or react normally

Ask a pharmacist or your health care professional if you are not sure how much loperamide to take, how often to take it, or whether a medicine you are taking may interact with loperamide. Always tell your health care professionals about all the medicines you are taking, including OTC medicines (see Examples of Drugs that Can Potentially Interact with Loperamide).

Loperamide is approved to help control symptoms of diarrhea, including Travelers’ Diarrhea. The maximum approved daily dose for adults is 8 mg per day for OTC use and 16 mg per day for prescription use. It is sold under the OTC brand name Imodium A-D, as store brands, and as generics.

In the 39 years from when loperamide was first approved in 1976 through 2015, FDA received reports* of 48 cases of serious heart problems associated with use of loperamide. This number includes only reports submitted to FDA, so there are likely additional cases about which we are unaware. Thirty-one of these cases resulted in hospitalizations, and 10 patients died. More than half of the 48 cases were reported after 2010. The serious heart problems occurred mostly in patients who were taking doses that were much higher than recommended. In other cases, patients were taking the recommended dose of loperamide, but they were also taking interacting medicines, causing an increase in loperamide levels. Additional cases of serious heart problems associated with the use of loperamide were reported in the medical literature.1-9 Cases reported to FDA and in the medical literature indicate that individuals are taking significantly high doses of loperamide in situations of both misuse and abuse, often attempting to achieve euphoria or self-treat opioid withdrawal. They are also combining loperamide with interacting drugs in attempts to increase these effects.

We urge patients, consumers, and health care professionals to report side effects involving loperamide or other medicines to the FDA MedWatch program, using the information in the “Contact FDA” box at the bottom of the page.

*The cases were reported to the FDA Adverse Event Reporting System (FAERS).

 

READ MORE:

SOURCE

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Imodium/loperamide story in and on the news

walgreens vaults

Since the loperamide story broke, Walgreens has placed their Imodium in “vaults” — security containers to prevent theft.

Hi — Yeah, it’s me. I’m still here.

For those of you who may have missed the story on CNY Central, my real name is Kate and I am an addict. (Hi Kate.) Yep, I’m busted.

I’m fat and on TV. UGH! Not exactly the way I wanted this all to go, but it had to be done. And yes, OMG that eyeshadow! What was I thinking? The whole interview was set up VERY quickly, and I had to go right after work, so I looked like a hot mess. But whatever. It’s done, it’s out there. Better eyeshadow next time. The gentleman who conducted the interview, Alex Resila, was terrific and eased my anxieties for the interview. Everyone has really been great and supportive!

moi

Kate: the real Margaret

I’m the person featured in the story. I am the author behind this blog. My pen name has been Mad Margaret (Marguerite Furieux) for a few years, and I think I’ll keep using it for now. I like to amusingly think of it as the whole Stephen King/Richard Bachman thing. Just a nom-de-plume I can continue to write under.

There has now been A LOT said about the Imodium/Loperamide crisis. And the media is getting a few things wrong in the translation. Let me clarify one particular thing that’s really been bothering me.

They said that Imodium gets you as high as heroin or oxycodone if you take it in a large enough dosage. 

ht_160512_william_eggleston_120x156

Dr. William Eggleston: is he cute, or what?

Not really. I think Dr. Eggleston (who is even more adorable in person!) was trying to explain that an opiate is an opiate is an opiate — in other words, any one of them will get you high in the right quantity — and he compared it to heroin and oxy. The news media took that to mean that loperamide will get you just as high as heroin and… well, it just doesn’t work like that.

While chemically this is more-or-less accurate (it does induce a type of mild euphoria) with loperamide, any “high” you get is, in reality, pretty disappointing if you ask me. Especially if you’re expecting a heroin-like high. Speaking for myself, I often became chatty after dosing with Lope, but never got “high” per se. Most people I’ve talked to say the same thing. In reality, most abusers of loperamide (an estimated 75% 0f them) are seeking relief from the withdrawal from the “real” opiates like heroin or Oxy or Vicodin. The high isn’t what they’re in it for — it’s the lack of agony from withdrawal. And for that use, it is indeed effective. Just, you know, deadly.

People need to understand one basic fact: Loperamide is an opioid first and an anti-diarrheal second. All opiates are constipating and are therefore, anti-diarrheals. They ALL constipate you. And they will ALL get you high in some form or another as well.

The important difference with loperamide lies in its chemical structure: other opiates like heroin aren’t going to send your heart into a deadly arrhythmia; they aren’t cardiotoxic.  An overdoses on heroin or oxycodone can kill you mainly through respiratory arrest. From just one overdose, a person’s entire central nervous system can shut down until you stop breathing. You nod out and die.

A drug like Narcan (Naloxone) can be used to reverse the effects of a traditional opiate and save the patient’s life.

Loperamide doesn’t do that. With lope in mega-doses, over time, there is a cumulative effect that isn’t well understood right now. A patient’s heart will begin to beat erratically leading to cardiac arrest. Narcan won’t save them.

For this reason, loperamide in high doses is considered far more deadly than other opiates, including heroin.

BloodBrainBarrierIn normal doses (1 or 2 two-milligram pills), people feel no high at all from Imodium. Their diarrhea is relieved and that poor pooped-out patient goes about their merry day. (Ha! See? A poop joke!) It does this because the body’s system (unlike with other opioids) prevents the drug from reaching the brainthrough the Blood-Brain-Barrier (BBB). A protective enzyme called “P-glycoprotein” or PgP spits any lopermide that tries to sneak in right back out into the bloodstream — and by doing so, it protects the brain from the dangers of the drug.

But addicts are taking multiple times that normal dose. It overwhelms our brain’s bouncer PgP, so some lope manages to sneak into the brain and stays there long enough to do its damage.

Addicts report that they take high doses of Loperamide for a long time (weeks to years) until the cumulative effect finally strikes; their hearts take on an uncontrolled rhythm and they drop dead from cardiac arrest. (There’s lots more on my site and in the literature about the specifics of this and the mechanism of action.)

Bottom line is: use high-dose loperamide and you will die. It’s just a matter of time. No joke.

Okay. So that’s out of the way. On to a few other matters.

The world reacts using Kübler-Ross’s stages of grief from On Death and Dying.

It’s very interesting that regular people seem to be in a type of denial about the whole thing. Commenters on the loperamide news story on various sites, by-and-large have had some pretty mean and assholey things to say. That’s pretty hateful considering that statistics show that 1 in 5 families have an pain-pill addicted family member, and 4 in 10 Americans know someone who is addicted to prescription painkillers; that’s not counting the ones who are addicted to heroin or other types of drugs. It makes me shudder to think how such caustic comments might be targeted at one of their family members who is struggling with addiction. I mean, I can understand that the normal populace is probably sick and tired of hearing about it, and/or sick and tired of dealing with it. But come on? Where’s the compassion?

Then I realized, it’s really just a form of denial.

In the Life Span Developmental Psychology class I just completed (in which I earned an A, thankyouverymuch), we covered the death and dying process. Of course, Elizabeth Kübler-Ross’s five stages of death and dying were discussed. For those who don’t remember her stages are:

  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance

And truly, this is the reaction structure for the mind’s coping mechanism and how it deals with virtually ANY bad news. If your boss calls you in and says you’re fired, your first reaction would be, “this isn’t happening!” then you’ll try to talk your boss out of it, then you get mad. Once the realization that you really have lost your job hits you, depression settles in. Finally acceptance and the job hunting process begins.

So here the general public is in denial; they have just heard an outrageous and horrible story about people taking a few hundred poop pills to “get high” and they’re all like, “What? No way! What a bunch of dumbasses. Get this off my TV!”

Am I right? Or am I right?

But it doesn’t change the fact that it’s happening. It’s really happening.

Once they’re done denying and bargaining, then they get angry. And this is kinda where we’re sitting with this story right now.

The important thing is, people know now and the conversation finally beginning.The next step is discussing what needs to be done for the hundreds or thousands of addicts who will soon be out of their maintenance medication.

Loperamide, addicts, and the FDA

For those addicts who started using Loperamide as a substitute for heroin or oxy or vicodin, or whatever, the bulk loperamide supply will soon dry up. According to the New York Times article, the FDA will be reviewing the loperamide crisis and will most likely recommend that it be held behind the pharmacy counter like pseudoephedrine.

“The F.D.A. is aware of recent reports of adverse events related to the intentional misuse and/or abuse of the anti-diarrhea product loperamide to treat symptoms of opioid withdrawal or produce euphoric effects…. [the agency] will take appropriate steps as soon as possible.” — Sarah Peddicord to the New York Times

So then what? Good question.

Aftermath: treating the loperamide addiction.

Where does this leave loperamide addicts who are using multiple pills a day just to maintain normalcy? Up shit creek? (Haha! See? I made another poop joke!!)

Here’s the thing: many people who aren’t addicts or who are not in the business of detox or recovery treatment really just don’t get this whole addiction thing. They don’t know how it works, how much people take, or what happens when they stop. It’s really hard for most “normal” people to handle what’s going on, which is why they retreat and deny or point fingers.

But even the medical community hasn’t had to deal with loperamide addiction issues before, so this is all going to be new to them. Until a month ago (before this story broke in the news) most doctors, addition specialists, and pharmacists, had no idea this was happening and no plan to deal with it. Now they know this is a real thing and will take it more seriously. We hope. And that’s good news!

Treatment can be done in an out-patient setting. Standard opioid-addiction treatment is what’s recommended. Drugs like clonidine, trazodone, etc., are often utilized to make withdrawal symptoms more bearable. Some choose to go through a rapid-detox program where the addict is placed in a deeply sedated and medicated state until they’re out of acute withdrawal.

More recently, a drug called “Suboxone” or “Subutex” has been used for chronically-addicted patients who need additional support through the withdrawal process or who need a maintenance drug. Should loperamide-addicted patients use this?

Well, that answer is complicated.

Some important crap to know (ha! See? Another poop pun!): Loperamide has a very long half-life (basically, that’s the time it takes to clear half the drug from your system). Why is that important? Think about the last time you got a prescription that said “Take one pill every four hours.” The half-life on that drug is likely 4 hours. Loperamide’s half life is estimated at about 14 hours — and recent research indicates that in chronic, high-dose use, it’s probably much longer. Loperamide’s half-life may be 18-20 hours.

So why does that matter? If a doctor plans to treat a loperamide-addicted patient with a drug like Suboxone (buprenorphine), he/she has to wait until loperamide has fully cleared the patient’s system. In a patient who has been taking most “normal” opiate addicts on heroin or oxy or vicodin the recommendation about 24 hours before their system is fully cleared of the drug before starting treatment with Suboxone. BUT — and this is important — in an loperamide patient, because the clearance time is so much longer, that wait could be several days or a week or so. If Suboxone is started too early, the patient goes into what’s called “precipitated withdrawal” — all the symptoms of withdrawal hitting suddenly and much more intensely. It’s excruciating.

Personally, I don’t recommend treatment with Suboxone therapy for loperamide-addicted patients. The reactions are too unpredictable and too poorly understood right now. Personally, I didn’t use it, and I’m very glad I didn’t. But ultimately, that choice is between patient and their medical provider to decide.

Regulating loperamide: Ramifications

Don’t worry. If the FDA chooses to put loperamide behind the counter, you can still get it. You will be able to buy what you need to treat short-term diarrhea situations. Loperamide is actually a really great drug for this and is safe and effective when used as directed. The World Health Organization considers it one of their most essential medications.

fdabldgRegulation of the drug to prevent mega-dosing won’t effect this. Nor will it stop you from getting it when you need it. And for Crohn’s disease patients, IBS-D patients, or those undergoing chemotherapy (or other legitimate needs), you too will still be able to obtain all the loperamide you require. Yes, you will have to go to the pharmacy counter and sign for it, but that’s not really that big a deal, is it? Seriously? Come on. So what? When was the last time you drove to Walgreens at 3AM searching for a 200-pack of Imodium?

Regulation will stop the exploitative massive bulk sales of the drug marketed and targeted directly at addicts. You won’t be able to go into Walmart and buy a pack of 144 or 200; and you won’t be able to get packs of 2400 or more on Amazon either.

A bit of history on Loperamide Abuse

The rise of Imodium/Loperamide abuse can be traced to the rise of the internet. Truly. It all happened concurrently — as home-based broadband reached more homes, more information became disseminated very easily. Combine that with the rise of prescription opioid abuse, and you have a perfect storm. I’ve been following this for a long time — you can trust me. I watched it happen from a front row seat.

In a recent study conducted by Wright State University, researchers were able to trace internet chatter regarding loperamide back to 2005. That said, I remember reading about it quite a few years prior to that, in the late 1990s. It started with just a few posts, amateur home-chemists and addicts, trying to figure out if loperamide, a non-high-inducing opioid-based drug that was easy to obtain and legal, could be turned into the legal drug they could get high on.

Blackboard with the chemical formula of Loperamide

Some tried (at home) altering the chemical structure thinking they could create a Frankendrug of sorts, but with no success. I remember one person recommended trying to consume loperamide with lots of strawberry ice cream; the Polysorbate-80 ingredient in strawberry ice cream was believed could “coat” the molecules and make them cross over the blood-brain-barrier and get you high. It didn’t work. Eventually, the amateur chemists concluded that the chemical structure of the loperamide molecule couldn’t be altered except in a big lab with just the right equipment.

Occasionally some addict would chime into the conversation and say he took 100 of them and felt a “dirty high” that went on for hours, but nobody believed him. Nobody could be that crazy and live, would they?

Then some desperate addicts going through withdrawal figured out that if they used 10 or 20 Imodium tablets, they could stop withdrawal in its tracks. And so many claimed that it worked, the conversation took off.

Soon 1o or 20 turned into 40. Then 60. People tried to combine loperamide with known PgP inhibitors to get it to more readily cross the blood-brain-barrier. Some claimed success. So more people tried that too.

That’s how things like this get started: desperate people doing desperate things.

Logo-JanssenLoperamide (as I understand it) started out life in the labs of Belgiums Janssen Pharmaceuticals somewhere around 1970. They were monkeying around with the chemical structure of fentanyl trying to create another super-painkiller, but the best they came up with was a drug that sucked for treating pain, but even in low doses was an effective constipator. It wasn’t what they were shooting for, but they ran with it and, in 1976, obtained approval from the FDA to sell Imodium as a controlled-substance (Sch IV) prescription drug in the USA. It was descheduled in the 1980s and was eventually sold over-the-counter. The FDA believed it to be safe thanks to Jaffe, et al’s 1980 research paper titled “Abuse potential of loperamide” which concluded that addicts were not likely to abuse loperamide in the high doses demonstrated in the study, as long as there were other opiate sources available to them.

Very important, that last bit there. As the opiate crisis has skyrocketed, and now legitimate sources of opiates dry up, the desperate addict seeks other means of maintaining “normal”.

And here we are. Talking about people taking mass quantities of poop pills.

That’s how it all started. Respect the chemistry.

Admitting the unadmittable.

Because of all the news coverage, I had to “come out” as an addict for the first time to my family, friends, and co-workers. My friends and co-workers — most of whom did not know — were all incredibly supportive. My family is struggling with how to react, mostly I think they’re just worried. (I think they need time to absorb it.) It’s disappointing, but that’s reality. And I’m OK with that.

ienewsThis past week, we did an interview with syndicated news program, Inside Edition (air date TBD), and this time you’ll be happy to know, I remembered to wear better eye makeup. Thank God! I also have been contacted by a women’s magazine interested in sharing my story (though I have yet to hear back from them). There may be more. I hope there’s more.

My whole point in coming forward is to put a human face on this addiction problem — the same human face I’ve seen in other addicts, and on the faces of the dead whose pictures have been sent to me. Men, women, young people, older people. Professionals. Students. Mothers. Daughters. Husbands. These people do not deserve the laughter and ire of the commenting community. I am willing to be the voice of those not as brave or crazy — or as alive — as I am to come forward and ask for help and understanding.

Feedback from the medical community, however, has been tremendous. They are taking it seriously. So when I call and ask to speak to them, they are finally in a position to say, “Oh yes, I’ve heard of this!” rather than laughing me off the phone. That’s an incredibly important step. This will save lives in a very immediate way.

Some pharmacies around the area are now placing their Imodium and Loperamide products in theft-resistant “vault” containers, and at least one has put the drug behind the counter for people to request. It’s a great first step.

The conversation has finally started.

I am MadMargaret and I am Kate. I have been many other things in my life too: a daughter, a co-worker, a student, a singer, an actor, an artist; I am wise, I am good, and I work hard and fight for things that matter — and (as it so happens) I am also an addict. I am alive today because of some of the fastest-thinking doctors in the world. I owe them my life. I want to make them proud that they worked so hard to give me a second chance.

And doesn’t everyone deserve that?

Stop contributing to the hate, and start helping create an atmosphere where those who have an addiction issue  — whether loperamide or not — feel safe to come out of hiding and seek treatment. To not do so sentences them to death and forces more into silence.


“You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, ‘I lived through this horror. I can take the next thing that comes along.'” — Eleanor Roosevelt.


 

 

 

 

Posted in addiction, loperamide, loperamide abuse, sobrietyland | 7 Comments