Addicts turning to Imodium/Loperamide – 10 Things You Need To Know

Walmart Loperamide

Imodium and Loperamide Bottles on the Shelf at Walmart

Since the news story about Loperamide Abuse broke last week, based on a study published in the Annals of Emergency Medicine, I’ve seen a bit of disinformation spreading around. Lots of misinformed comments on the news articles. There are many pieces written on Sobrietyland (like this, and this) dealing with the facts about Loperamide, its history, what it does in overdose situations, and offering my own experience, strength, and hope regarding loperamide addiction.

That said, let me clear a few things up for those commenters out there:

Some Random Factoids/Answers:

1. Yes. Imodium and Loperamide are essentially the same thing.

Imodium is simply a brand name for the drug Loperamide (just like Tylenol is a brand of the drug Acetaminophen).

Loperamide (pronounced low-PARE-a-mide) tablets have Loperamide HCl as their main ingredient. Inactive ingredients in the pills are generally fillers and binders. This is not true of liquid or combination formulations. Addicts generally use pill form loperamide. Generally speaking, users commonly call the drug Lope or Loperamide. Most consume it in pill form.

2. There are two types of Lope abuse going on.

  1. Some people use the drug recreationally as a means of getting high or as a mildly euphoric substitute for their opiate drug of choice. They’re usually disappointed as loperamide does not make a person high like a traditional opiate.
  2. The majority of users are opiate addicts trying to find a way to take away the withdrawal symptoms from their drug of choice (heroin, oxycontin, vicodin, etc.).
    • Some stop using loperamide after a week or so, being on it just long enough to through the initial withdrawal sickness.
    • A large proportion of people, however, do not stop and, over time, end up just as addicted to the loperamide as they would be to a more stereotypical opiate.

3. Addicts don’t buy brand name.

At least the ones I know don’t. So don’t bother pointing your finger at Johnson & Johnson, the makers of Imodium Brand loperamide. It simply isn’t all that popular in abuse situations. Generic loperamide is significantly cheaper and can be purchased in bulk from everyday pharmacies as well as Walmart (Equate) and Amazon (Kirkland). That, in and of itself, is a problem.

4. Selling Loperamide in bulk is an unnecessary and dangerous practice.

If you need loperamide for the occasional case of diarrhea, you should be able to purchase it. But do you really need 2800 tablets of it?

What do addicts buy? Big bottles. Selling 200+ pills at a time only serves to encourage the addicts to use more and exploits the abuse situation. And if you think 200 pills at a time is a lot, you can buy 2800 on Amazon for $50. A healthy person using Imodium as directed, would never need that much; anyone with IBS or another intestinal disorder should only use larger quantities under the direction of their physician. Reviews on Amazon like what is shown below are on most of these bulk Loperamide items. This seller definitely knows  his buyers are abusing the Loperamide they purchase from him. That’s why this dude sells so many in bulk.

An Amazon.com listing for 2800 tablets of Kirkland Brand Loperamide (Imodium).

An Amazon.com listing for 2800 tablets of Kirkland Brand Loperamide (Imodium).

5.0 out of 5 stars      best price around

By [REDACTED] on September 20, 2015

Verified Purchase

Massive amounts of “lope” . Great with an antacid like tagamet beforehand and washed down with white grapefruit juice. Works wonders. YES it does cross the bbb, or accumulates or overpowers the PGP inhibitors or whatever it works

5. Poop jokes aside, this is serious.

Yeah. Okay. Funny. We get it. Make all the poop jokes you want. We all know it’s coming. “No shit!” is the most common one. Get it all out of your system.

I’ll wait….

Then, respect the science. Loperamide is an opiate just like any other (though it was previously believed to be abuse-resistant, it’s not abuse-free). It is an opiate first, and an anti-diarrheal second.

Want to know if  these Lope abusers ever poop? Yes they do. Lope is no more constipating than any other “traditional” opioid like Vicodin or Oxycontin (even in high quantities). Speaking for myself, I ate a lot of fiber and never had much of an issue with constipation.

Remember too as you’re laughing about this, the reason this has become such a problem is SECRECY — embarrassing those who have a serious problem only discourages them from ever coming forward and asking for help. That’s how so many people are getting sick and dying. Your son or daughter could be doing this. If they wound up dead, how many people would you want snickering at their funeral? Just sayin’.

6. The news reporting Imodium abuse isn’t the same as giving permission.

Many people seem to think that by reporting loperamide abuse in the media that we are encouraging more people to try it. On the contrary: we want people to stop. Anyone with an internet connection can find out about using loperamide in mega-doses. That’s not hard at all. Anyone trying to detox off their favorite opiate has probably run across this “home remedy” in more than one internet search. And there are SO MANY sites and videos that tell people it’s perfectly safe and okay to take a hundred or so caplets of Imodium which is patently untrue. We are reporting that it will kill you. Addictions thrive in secrecy — bringing it into the open means that important conversations can start happening and fewer people wind up dead. And now that this story is hitting Big Media, more doctors and ER physicians will be made aware — they’ll better know what they’re dealing with and can save more lives. Addicts will know that Lope is not a safe substitute. It’s win-win for everyone.

7. Why is this making news when this has only happened to a couple of people?

It hasn’t only happened to a couple of people. The literature from the last couple of years reports numerous cases of this. On this site, I link to at least two dozen articles. And those are just the people who are in the case studies. Many more are not. And while Eggleston’s paper follows only two cases of people who died, many more deaths have been attributed to loperamide and anecdotally reported to me — and countless others hospitalized, many likely died because of the ignorance of the medical community and the patient’s fear of revealing their secret habit.

8. Some kind of regulation is in order.

Enough people have died or been hospitalized that this has been called “a growing public health danger,” so something needs to be done. Eggleston, et al, suggest that loperamide should become a restricted, over-the-counter medication (like Sudafed) that you have to request from your pharmacist. Loperamide started off life as a controlled substance, by prescription only. This would not re-schedule the medication, but make it so you would request a pack of Imodium from your pharmacist for occasional diarrhea instead of buying it off the shelf. It can also serve to restrict sales of high-quantity bulk packs. Perhaps those who require long-term use to control IBS can get a waiver. I’ll leave that up to the powers that be. If such a minor inconvenience could serve to save the life of you or someone you know, is that really so bad?

9. Just let ’em all die is not an option.

Come on folks, seriously? The number of letters I receive from parents, siblings, brothers, sisters, friends, spouses, and the addicts themselves speaks to the desperation and heartbreak that addiction causes. Calling for the death of all addicts is just insane. The next addict you see could be someone you love — they may be there already, but they’re afraid to tell you because they know you will treat them with contempt instead of kindness. Nice job.

10. Who am I and what do I have to do with any of this?

I’m the index case. Patient zero. The canary in the coal mine. The warning shot. The first reported case since one overdose received a paragraph at a medical conference way back in 1994 (if you dig deep enough, you might find that one). I’ve been here long enough to know the history of this thing. The researchers from Upstate Poison Control who wrote the most recent paper, “Loperamide Abuse Associated With Cardiac Dysrhythmia and Death” are the same ones who treated me back in 2012, and published my case later that same year. I thank them for my life every day and have been willing to set aside my own dignity to try to save the lives of other addicts following the same tragic path. I’ve made it my mission to gather data about loperamide abuse and help disseminate it to the general public, fellow addicts, and any medical personnel willing to listen.

Make my life matter: learn from me.

I can be reached via email at capathy@me.com.

 


“If you can quit for a day, you can quit for a lifetime.” – Benjamin Alire Sáenz


 

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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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15 Responses to Addicts turning to Imodium/Loperamide – 10 Things You Need To Know

  1. Jason ßird says:

    I’m going to see my GP today, see if I can’t beg my way into inpatient treatment. Trying to quit by myself has only descended into a foray with insanity.

    Thank you, MM – on behalf of us all; still banging our heads against the loperamide wall.

  2. Thank you for your words, I find them so comforting.. I am someone who was told by a GP that loperamide is safe to take, as much as I want, when I need it. I went to my GP with IBS symptoms which were ruining my life. For 2/3 years since then, I’ve taken loperamide on a daily basis to stop my IBS symptoms. I’ve taken an over does 3 times now, by accident, I must stress.. My usual dose was between 2/6, 2ml pills a day, more to satisfy my anxiety related to IBS, I am in the process of stopping now, I can’t go on the way I have done. I don’t seem to be having a withdrawal, mostly stress & anxiety because I’m without pills which controls my stomach movements for so long. Loperamide is a scary, unpredictable and dangerous drugs. Loperamide taking goes allot further than we all thought.

  3. Sarah M. says:

    I don’t have a colon (entire colectomy), so for me buying an Anti-Diarrheal in bulk is actually necessary.

    • madmargaret says:

      Thank you for your response. We will definitely be taking patients with conditions such as yours into consideration going forward. Appreciate your input! Thanks

  4. B Cali says:

    Hi I have irritable bowel syndrome due to multible surgeries on my rectum. I use Loperamide on a daily basis to control my symptoms. I take generally 4 tabs a day maybe 6 tabs on a bad day so I can easily go through a 200 count bottle of Loperamide in 2 months. I called every Walmart in my area and even ones further away, none of them have this medication in anything other than Immodium, which I cannot afford at all. I literally have liquid diarrhea running out of me and have ruined multiple pairs of cloths. I am currently headed to the ER cause I do not know what else to do. This is just rediculous that I cant find this medicine I understand people are overdoseing but I think it’s obvious that if you take 100 pills that you may have adverse reactions and even pass away. Ive never been high from it and it works well for me and I have lived relatively normal for 10 years with no problems on it. I totally understand limiting the number of bottles being sold but please, I beg retailers or whoever PLEASE don’t stop selling the 72 count bottles so I can at least come and buy this Medicine at ANY Walmart once a month. I have read a lot of stuff about this medication and abuse and yes there is abuse but it is not anything like how many people are abusing and dieing of heroin, and I have read many of stories were people have successfully used this medication to get off serious drugs such as heroin and stopped using the Loperamide as well. In my opinion this drug helps way more people then it hurts and is very hard to overdose on. All drugs are dangerous and if you take too much it can be hazardous to your health or kill you. Taking this medication away is hurting way more people then its helping, and whats sad is it is probably easier for an addict to go buy heroin but here I am just a normal person trying to go to work and I cant because the store where I used to buy a simple LEGAL medication no longer sells it.

    • madmargaret says:

      I totally understand. We are working with the FDA and CHPA to find a balance so that those with legitimate need can still get the medication while reducing the opportunities for overdose in the addicts. We are definitely addressing your concerns — thank you for voicing them!

  5. Donna McCubbin says:

    I am devastated by the new restrictions on Loperamide/Imodium. I’ve suffered with IBS-Diarrhea for many years, and I’m only able to have a normal life when taking fairly large doses of the drug. I’ve been taking 12/day for 5 years with no adverse effects whatsoever. Because of the new FDA restrictions, I don’t know what to do. I’ve tried every other IBS drug on the market, and none have worked for me. I’m at my wits end about what to do at this point. I can’t go back to living like I was before the Loperamide changed my entire life for the better; I just can’t. To say the FDA restriction has ruined my life is an understatement. I’ve never felt as angry, frustrated and hopeless as I do right now.

    • madmargaret says:

      Hi Donna, I’m afraid I’m not really sure what you mean by FDA restrictions. The only restrictions are on sales particularly online of multiple bottles of 200. And that is only a suggestion, requesting that stores and manufacturers not sell it in quantities of, for instance, 1200 pills at a time. The drug is still readily accessible via Amazon and your local drugstore. Including Walmart. In fact, my Walmart sells bottles of 200 right now. I also would like to add, that I am in no way in favor of removing loperamide as a drug, particularly because people like you with IBS and gastrointestinal problems require the drug for daily life. I totally respect that. Best of health to you, mm

  6. Donna McCubbin says:

    Thank you, Madmargaret, for your reply. The Walmarts in my area are only selling quantities of 12 tablets/customer, as are drugstores. They’re all saying that the FDA have mandated that they do that. I haven’t done the research, but I wonder how many deaths/year are caused from Tylenol, yet you can buy huge quantities of that.

  7. Amanda Geipe says:

    I am with all the other individuals that have a medical need for loperamide. My 6 year old son is considered “short gut.” He lost most of his small intestines and half of his large intestines due to a twist in his intestines. He is on TPN (IV nutrition) and requires 22 loperamide pills a day. These pills help him retain what little he gets from his intestines and keeps him from having continuous explosive diarrhea. All of his bowel movements are liquid already and without this drug it would be so much worse. A 200 pill bottle I go though in 9 days. It is ridiculous on top of all the other medications I have to remember to get refilled through the pharmacy that I then have to buy this one in small quantities. I am a strong advocate for larger quantities being available for those that need access to them. As an aside, addicts unless motivated to change will find what they are looking for to get that high. It doesn’t matter how much you regulate something, they will just find another way. We need to invest more time and energy into harm reduction methodologies as opposed to the stringent control of substances. Just my two cents.

    • madmargaret says:

      Hi Amanda — thank you for voicing your concerns. I’m very sorry for what your son is going through. It has to be a tremendous challenge for him (and for you) to go through that, and as a parent, I can only imagine how much your heart breaks at the thought that this helpful medication could become inaccessible. I have said before, I am not, in any way, promoting restriction of the medication for those who need it. I also reiterate that the current FDA recommendation is limiting purchases of multiple packs of 200 tablets (which encourages abuse), not eliminating sales of the 200 tablet packs themselves. We need to strike a fair balance. My advocacy is both for addicts and patients who are either purposely or inadvertently exceeding the recommended daily dosage of 16 mg per day. My concern is also that this medication, which up until now was considered innocuous, may not be as safe as was once thought. High dosages over a long period of time will cause deadly arrhythmias. Right now, we have not exactly defined what that dose is, or how long the timeframe is before we reach cardiotoxic levels. And if there is based on a cumulative effect, how exactly is that happening? The truth is, we don’t know yet. I want to better understand this medication, so that perhaps I might help develop more effective treatments. And that is why I am pursuing medicine as a career. I want to make a meaningful difference to everyone in need — including patients like your son. Again, thank you for your input and for the loving care you take with your son. Best wishes for good health — Warmly, MM

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