Haha — did I say “no more”?

loperamidemolecule

The Loperamide HCl crystal, as seen through an electron microscope. It looks like the withdrawals feel! Photo Credit: Anne Cavanaugh & David McCarthy, UCL School of Pharmacy

I made it all the way to Saturday. Five full days. I couldn’t take it anymore.

Since the last dose I’d taken was on Monday morning and nothing since, I thought I was doing okay, but by Saturday, I could barely stand, hold myself upright, and be functional. With a half-life of around 12 hours, that’s about the right timeframe when the very last of the loperamide had exited the last of my cells and my body began scraping the bottom of the barrel to find nothing left. And it was pissed.

The extreme fatigue and jelly-belly feeling was just the tip of the iceberg. Much of it I could deal with — like the diarrhea which actually wasn’t all that awful. But the rest of it is Chinese Water Torture. A constant barrage of irritation — flashes of pain in my spine, restless legs, coupled with the constant contrast of exhaustion and inability to sit still absolutely brought about a sense of utter hopelessness.

None of which is ever even relieved by sleep for more than an hour or two. This is even with my leftover Ambien in addition to my other meds! What the hell?? Every night, completely and utterly exhausted, I go to bed early, usually by 9pm or earlier (which if you consider that the AA meetings I’m supposed to be attending are at 8pm, could pose a problem). In my exhaustion, I nod off quickly but wake up within an hour or two then struggle the rest of the night to go back to sleep — an occurrence that may last only a few minutes before I’m wide awake and ‘trying’ again. It’s bullshit, and I hate it!!

But what can I do? Aside from going back to the loperamide, there are only a limited number of options at my disposal, even with all the non-scheduled medications I have in my possession.

Sometimes I think all these meds do is salve a gaping wound.

So when I feel helpless, I do what I’ve always done from the time I was a little kid struggling to deal with my aging parents’ various diseases and disorders — I go to the library. I turn to science, working the scholarly aspect of the problem. Maybe if I can understand it, work the problem, and discover an avenue for a solution, I can fix it. Right?

Er… right?… (crickets)… Oh fine. Be that way.

I tried to figure out why the loperamide withdrawal is occurring — and if I can determine its cause, maybe the square-jawed NP and I can come up with a viable solution. One that, unlike the loperamide, won’t kill me. And I managed a couple of eureka moments, believe it or not! I even have a direction to go in. And now that I’ve come up with some options, I have to somehow present this to the NP on Wednesday and get him on board with potential treatment options. I want him to see hope, not failure.

But what if he gets upset with me for relapsing? I’m so afraid he’ll quit the case out of sheer frustration. The last time I broached a topic of discussion, he suggested he should send me to the addiction clinic down the road and be done with me. I can’t do this all over again, I just can’t. I worry that all he wants to see is success. What if he refuses to work with me now, disappointed that I relapsed and perhaps insulted that I’m trying to ‘do his job’? I mean, I see the research as helping him, not hindering. After all, I know he has a personal life and doesn’t want to make me his life’s work — that’s why I’m trying to present him with the research already done. See? Easy peasy. Appeal to his pride; look how smart HE is by solving the case, just don’t tell him it was my research that got him there.

I don’t want him to give up on me, but I’m so afraid he will!

Even in discovery, I feel alone and helpless.

And even while all this rages under the surface, life goes on, and nobody knows how hard my feet are swimming in a failing body just to keep my head bobbing above water. At work, my brain was a busy little bee even though my body was just keeping up. Physically, I was a mess. I had to be on my feet for hours, running around like there’s not an extra care in the world, but I was loagy and it was obvious.

And by this time next week, I’ll be back in my hovel apartment, where there’s no heat nor electricity and no car. Back to relying on my own foot power and moxie to get me through the day. Think that was loagy? You aint’ seen from loagy! Small and afraid again.

Now in the program, that’s when they say you should call a friend (one of the phone numbers collected from other addicts/alcoholics in the meetings). But what do I say? “Hey I’m at work and I can barely move and think I just want to quit all this. How’s YOUR day?”

I even thought about going to my boss and leveling with her on the QT about what was going on with me — tell her I’m detoxing off this awful drug and to please be patient. But I skunked that idea. I’d most likely get fired if I admitted to having a problem of that nature. (Ironically, our store’s mission is to raise money for a rehab center, but the staff of the organization looks down their noses at people with addictive problems and truly will fire you if you admit to having a problem).

So after a couple of hours at work, frustrated, and weak from withdrawal, I went in the bathroom and took some loperamide. Ten pills. Twenty milligrams. I knew that would pull me out of the physical tailspin, get me working (so I didn’t get fired), but not enough to get me into too much cardiac danger (at least theoretically).

Within about an hour, the tingling in my legs and arms began to modulate. My solar plexus felt stronger, and after about two hours, I stood upright, walked around with relative ease and didn’t feel like I was going to collapse. By afternoon, I felt almost like myself — but now I had traded my triumphant clean time for a guilty secret.

I wanted to go to a meeting. Even if it was in the next town over, I thought, “I really need to go.” I also thought I should call one of those numbers on the list I had. There was one lady I talked to after a meeting on Thursday (where I was given my first clean-time chip) who was so kind and helpful to me. But if I called, I would have to admit to her that I used again and she’d be so disappointed in me. I couldn’t go. I couldn’t face them.

But today, there’s a meeting at noon, and I will go, damn the consequences to myself. I have to try.

See, here’s the thing: I don’t want to take the loperamide. I don’t. I truly, honestly do not ever want to take it ever again. But what else is there? In my opinion, living with long-term withdrawal like that creates an unbearable quality of life. And yes, theoretically it won’t last forever, but come on. With a long half life like loperamide has, we’re talking at the very best weeks probably months. Many months or maybe a year or two of constant struggle and physical agony. Yet living with the loperamide will eventually kill me too.

These are my options? It can’t be. I refuse to believe that’s it.

So I researched and researched and researched until I’d practically burned out the printer at the library with white papers and scientific articles on loperamide. Everything from molecular structure, to its parentage and DNA, to lab studies in mice, rats, pigs, and of course human subjects. I read articles old and new. I think I have some answers, but I have to admit that even after a few eureka moments and one thirty-second dance party (that was a good one!), much of what I ultimately concluded made me feel more helpless.

Here’s what I uncovered: Loperamide, in addition to its opiate binding, appears to have a blockade effect on the calcium channels in the peripheral nerve cells when used in higher doses. Basically, it calms the nerves, thereby reducing pain — something scientists didn’t think was possible since the drug does not readily cross into the brain, where they believe that pain response is supposed to happen. (And it only happens in higher doses.)

Therefore, one could deduce that by withdrawing the drug, those calcium channels are now zipping along at hyperspeed, causing the overexcited tingling and electric sensations I am now tortured by.

What can be done? Well, that’s the problem. There’s not much available in that arena. Calcium channel blocking is used most often in some targeted heart medication (which has little-to-no effect on the rest of the body), but very little medication is available for peripheral nerve involvement. However, one drug, Lyrica (you’ve probably seen their commercials), has been shown to have effect at some of the calcium channels in legs and arms (not necessarily the ones I need), and might help. But since it’s a scheduled drug (only a V, but still!), I’m fairly certain that the NP won’t even consider prescribing it for me.

But this is where I could use the square-jawed NP’s pharmacologic brain. Maybe he knows of something — anything — that might be able to help. I need to bring him onboard with this and convince him he’s the very genius that can solve this dilemma. But how to do that?

There are other drugs that might help, effecting other neurotransmitters which could, possibly, compensate for the damaged calcium channels in other ways, but most if not all have significant side effects such as fatigue which I already have in abundance. I’m willing to try them, but… I have to get the NP on board to even try.

Folks, my patience with the process is running out. Or maybe it already has. I will continue to advocate and warn people as much as I can to stay away from using loperamide for opiate withdrawal, but I’m not sure I have the strength to keep from using it myself. Nobody knows how hard this is — and trying to get someone to listen is exhausting.
I’m just hoping somebody hears me and stays away from it. This is a nightmare no one should have to endure. Especially from some stupid over-the-counter medication.

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“… We predicted that there would be little or no abuse of this substance as long as drugs like codeine in cough medicine, paregoric, and diphenoxylate were available at much lower costs.” — from the potential for abuse study on loperamide that the FDA cited when recommending complete decontrol of the drug, freeing it from prescription scheduling and allowing it to be sold freely over-the-counter. Quote from: NIDA Research Monograph, “Abuse Potential of Loperamide: Adaptation of Established Evaluative Methods to Volunteer Subjects”; J.H. Jaffe, M Kanzler, and J. Green; 1981 Feb;34:232-40.

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About madmargaret

Nursing student, Mac nerd, medical 'genius', recovering addict, singer, ex-actor, and all-around swell egg. Really!
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