I’ve gotten a few questions on the high-dose/mega-dose loperamide thing, so I figured I’d elaborate a bit more (as if that were even humanly possible).
How I began using it: I initially began using loperamide for opiate/opioid withdrawal (specifically from Vicodin) somewhere around 2009. Like many people, I’d read about it on the internet, and was desperate to alleviate the horrors of withdrawal, so I decided to give it a try. As I recall, I started around 10 2mg pills a day which was enough to take away the worst of the restless legs and those horrible electric ‘zaps’ I felt in all my extremities.
Again, if I recall correctly, I tapered down and stopped using it. Then after some time, I’d get some money to buy more Vicodin, then the whole process began all over again with withdrawal symptoms and loperamide. Then stop. Then start. Then stop. Then start. This happened a few times until at some point around 2011, I was forced to quit using Vicodin altogether (I ran out of $$) and went on the loperamide full time.
Why Loperamide? First, I couldn’t find any study saying that loperamide would have any particularly harmful side effects — and aside from the fact that every time I increased the dosage, I felt dizzy, couldn’t focus my eyes (nystagmus), and felt occasionally nauseous, I didn’t see any harm. I had no problems in the poop area either. Yeah, believe it or not. Second, loperamide won’t show up on a normal drug test and nobody would ever think that someone would abuse such a thing, so I felt ‘safe’ from drug testing. Third, I didn’t want my doctors — or anyone else for that matter — to know I had a drug problem. After all, I felt if I got my medical file red-flagged as an addict, I’d never see another controlled substance again. Finally, even after I left my big day job and started working for myself, I remained afraid of the consequences of my drug addictive behavior, so I kept myself hidden. Fear… What a demotivator!
Didn’t I have any idea this was bad for me? In fact, I was warned. On a website for recovering addicts, the loperamide method was recommended to me, but one person bravely fought the crowd and private-messaged me to say it was a bad idea. “You’re only trading one addiction for another” she pleaded, “and then you get hooked on Imodium and THEN what are you gonna do? It’s a bad idea. Please don’t do it!”
But I, like other addicts, knew ‘better’ and didn’t heed the warning. I was too smart to get hooked on diarrhea medicine, right?
How much was I taking? The first time, 144 (2mg tablets) at the time of hospitalization. The second hospital stay, about a year and a half later, I was taking up to 80 pills a day. Each time, I had been on that dosage consistently for at least 6-8 months.
Why so much? Honestly? Because Walmart sells double-bottle sets of 144 so it was an easy number to go by… eventually. Yes, I have ordered the 400-pks from Amazon, but more often than not, when I ran out, it was easier to go to Walmart and have the pills in my hands immediately than to place an order and wait. In fact, the habit was so crazy by then, and I used so many pills, I took to weighing the pills on my jewelry scale rather than counting them out. It was easier to dose that way.
I started out around 10 to ameliorate withdrawal, which slowly increased to 15 because I was too lazy to actually taper the stuff over time. Then I thought, well what’s another 5? Then it was 20. Then 30. Then why not 40? And so on. I’m not too sure why, but I do remember that inbetween each increase would be another month or so when I felt like crap, then some of the restless legs issue would return, so I’d get the genius idea to fix it by increasing the dose. You know, just temporarily until I got around to tapering down again. Other days, I was just feeling shitty (and maybe a little suicidal?) and would increase by a larger amount just to see what would happen. I know, genius, right?
Did I get high from it? Sometimes, just a little, but not much. Most of the time, I felt nothing. Some days, I felt a faint uptick in mood and felt decidedly chatty — for me, symptoms of central opiate effect — but nothing nearly as strong as the Vicodin. To me, it was just a bonus to my main goal of not feeling shitty from withdrawal. Joke was on me.
Did I take anything else to potentate the drug? The first time, I wasn’t taking anything at all except loperamide. I admit I tried a couple of times early on to get it to cross the blood-brain-barrier with Tagamet or Omeprazole, but I never had any luck with it, so the idea was abandoned early on. The second time, I used mass amounts of grapefruit juice and yes, I felt some response. I justified it by thinking “At least I’m not taking as much lope as I was before.” Not so smart, dude.
So what exactly was happening to my heart? Basically, the first time, heart was going into an irregular heartbeat and stopping. In the study, the medical terminology cites a condition called ventricular tachycardia (irregular heartbeat) degenerating into torsade de pointes (the most extreme of irregular heartbeats) followed by cardiac arrest (heart stops) due to prolonged QTc (an overly long time it takes your heart to reset after a beat).
Think of it like a runner on the track who has to jump hurdles. They have to pace their stride, their rhythm, to make it over those hurdles correctly, right? If their stride is too long, too fast, or irregular somehow, they stumble and have to reset themselves and start again. If they keep hitting hurdles, eventually they fall and if they can’t get back up again, game over.
Right? Clear as mud? Okay, let’s go on.
The second time, I was admitted for that prolonged QTc and a whole slew of conduction disorders (heart’s electrical circuits weren’t working right AT ALL) so they loaded me up on medications and kept me in overnight — allegedly — for observation. Things looked less grave the next day, so they sent me home with orders to stay off the lope and get some help.
Why do they think it’s the loperamide and not just something peculiar about me? I am the lucky owner of a very healthy heart and cardiovascular system. No cholesterol issues, no heart problems aside from the occasional harmless PVC (premature ventricular contraction). That lack of history, and my lack of of polypharmacy (only the one drug, not many) PLUS the fact that my heart condition went back to normal after withdrawing from the loperamide led them to conclude that loperamide could have been the only source of the problem.
When I withdrew from the drug, what withdrawal symptoms did I have? Panic feeling. Anxiety. Hot/Cold flashes. Sniffling. Sneezing. Runny nose. Restless legs in extremis. Deep depression. Severe insomnia. The jitters. Diarrhea. It was outrageously difficult.
Why would I ever start using it again after that? I put up with all this suffering for about 8 weeks with no further medical intervention (because I was broke and had no insurance) before I finally caved after another sleepless night and took 15 loperamide tablets. After about an hour, I could immediately feel the electric sensations modulate and disappear. I cried — both from fear (thinking I was going to die again) and from sheer relief.
Originally, I was planning to taper down. I was partly successful, decreasing every few days until I was around 7 pills a day — that is, until I hit another bump in my emotional rollercoaster ride and literally said, “fuck it” and bumped the dose to 20. I didn’t care at that point. Fuck it.
Yeah, not too smart — but then, no addict thinks THEY are the problem. I figured when my Medicaid was finally approved, I’d be able to get medical help.
That didn’t work out so well. I was approved for Medicaid, but then I couldn’t get any help for my addiction — the one doctor in town who did Suboxone therapy turned out to be an utter moron who had signed up to deal Suboxone without really understanding anything about it. So I refused and settled on the idea of tapering down myself again.
But I never did. The time was never right. I was too busy. I had plans and work and other things to do. It was never convenient.
The dose increased again and again until by this past summer, I was using up to 80 pills a day. And — surprise! — ended up in the hospital again with severe arrhythmias. Fortunately, no fainting spells this time, and no zaps from the paddles, but it was close. “We’re going to have to call poison control” they told me in the ER. I responded with, “Yeah, tell them I said ‘Hi’,” only half kidding. I was pissed at the world and pissed at myself.
What was different the second time that caused me to stop taking it? I was mortified — and angry with myself for letting it go out of control again. I sought treatment because I realized this was a death sentence. The only thing I really had going for me this time was health insurance, so I used it. I went to my GP and got a referral to the Square-Jawed NP Shrink that I now see somewhat regularly. He was able to prescribe Clonidine and various other drugs that have helped me get off the one that was killing my dumb ass. That and discovering that AA isn’t the most horrible thing in the world to have to go to — those are my weapons. My new tools in my toolbox that I’m learning to use.
How long have I been off it, and am I still going through withdrawal? I’ve been totally clean for about six weeks, and yes, I’m still experiencing some withdrawal symptoms. This is not unusual for a drug that is lipophilic (fat soluble) and has a long half-life. In general, I actually feel pretty good and definitely better than when the withdrawal first started. Most of the problems — like restless legs, anxiety, depression, etc. — are under control with meds. I don’t have any of the hot/cold flashes or the sneezies/yawnies either. I also (surprise!) have had pretty severe (and embarrassing) diarrhea which is particularly problematic now. And it’s about the only thing that not much can be done for except to wait it out. The NP and I try to deal with symptoms as they come up, so things should steadily get better.
Still seems extreme. How do I know it isn’t just me? Am I some special little snowflake? Do I carry some special gene that makes me respond this way and not others? I think not. I believe that those of us being cited in these cases — two in the initial study, three reported through the literature, and one or two that have died in earlier reports are proof that something is going on. Others had some polypharmacy, but I did not. Explain that one.
Five or six reported is still a pretty small number. Why should you care? Since the internet has ensured us that the loperamide-for-detox trend has exploded in popularity, and is likely to continue, you will likely see more and more health problems as a direct result of this trend — what you see now may be just the tip of the proverbial iceberg. There may even be more (maybe many more) who died or were hospitalized for their symptoms already without ever telling their doctors what they were on or having it reported to poison control centers and other reporting entities.
Bottom line is, for me, the science doesn’t lie. Something is happening. If you ask me, if people continue using/abusing high-dose or mega-dose loperamide for long periods of time, they will eventually experience serious problems, whether those are cardiac (likely) or the shutdown of other organs — it cannot continue without consequences.
Could it be I was just too stupid to stop before it was too late like some kinda scumbag junkie? Feel free to criticize and say that I’m the one who was just obviously stupid. I overdid a good thing. I had some kind of death wish. Ruining it for everyone else. Other addicts are ‘obviously’ smarter than I was and would never let such a thing happen to them. Cardiac problems from a diarrhea medicine! Bah! Pffft! You’re making this up!
Or, take the warning for what it’s worth and — should you experience heart problems as a result of using loperamide in mega doses above what’s recommended on the bottle — you just let me know how that works out for you. Remember, you were warned.
“Woe betide the leaders now perched on their dizzy pinnacles of triumph if they cast away at the conference table what the soldiers had won on a hundred bloodsoaked battlefields.”― Winston Churchill, “Memoirs of the Second World War”