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Addicts abusing opioid-containing Imodium, experts say

Drug abusers are discovering the anti-diarrhea medication Imodium A-D, whose main ingredient is an opioid, is a supercheap and potentially dangerous way to cope with their addiction, experts say.

Sold over-the-counter, Imodium is being exploited by drug abusers to either manage withdrawal symptoms from opioids or as a pill-popping way to get high, a team of pharmacy experts said Tuesday.

New research examining the chemistry of Imodium and its growing appeal among drug abusers is outlined in a medical report published Tuesday in the Annals of Emergency Medicine. The analysis also discusses two case studies involving substance abusers.

“We have been struggling for some time to get this information out there,” said William Eggleston, a pharmacist and fellow in clinical toxicology at the upstate New York Poison Center, which is affiliated with SUNY upstate Medical University in Syracuse. He emphasized that when used in therapeutic doses, such as those outlined on the drug’s label, Imodium is safe and very effective.

“The key ingredient is loperamide, and that is actually an opioid,” Eggleston said. “In large doses it works in the body the same way as heroin, morphine and oxycodone.”

Abusers, he said, are taking anywhere from 50 to 300 tablets a day.

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The medication’s four-decade-long safety record has made it difficult for Eggleston and his research collaborators to convince primary care doctors of a potential for abuse, Eggleston said. His research of the drug’s pill form notes a detrimental effect on the heart when it is taken in excessive doses. Substance abusers have developed deadly cardiac arrhythmias, he said.

Opioid-class drugs act on the opiate receptors in the brain causing a sense of euphoria, Eggleston and other experts explained Tuesday. Taking the drug in the small recommended dosage to treat diarrhea does not produce the euphoria associated with heroin and other opioids.

“When you take it in the recommended dose, you don’t absorb enough of the drug to have that effect,” Eggleston said.

Johnson & Johnson, makers of Imodium, did not return Newsday’s phone inquiry Tuesday. The medication was sold prescription-only in the 1970s but was approved for over-the-counter sales by the U.S. Food and Drug Administration in 1988.

The company sells the drug in “caplets” and liquid formulations. It works by slowing down the movement of the gut. Imodium is also used to treat ongoing diarrhea in people with inflammatory bowel disease.

Eggleston said Imodium is arguably the least expensive opioid in legitimate sales venues and the black market. A container with 400 tablets is sold at big-box stores for $7.59, he said.

“Loperamide’s accessibility, low cost, over-the-counter legal status and lack of social stigma all contribute to its potential for abuse,” he added.

Dr. Jeffrey Reynolds, chief executive of the Family & Children’s Association in Mineola and a leading Long Island expert in the treatment of substance abuse, said legislators should swiftly craft a measure requiring that Imodium be sold behind-the-counter.

“We are knee deep in an opioid crisis and we need to do everything possible to address it,” he said, noting that until informed by Newsday, he had no idea that a widely sold anti-diarrhea medication contained an opioid as its active ingredient.

“The level of desperation among addicts is very, very high,” said Reynolds, who added they will try any method to achieve the euphoria associated with opioid drugs.

“While it’s hard for you and I to comprehend swallowing 300 pills, if you are knee deep in addiction — partly driven by physical dependency — swallowing 300 pills is a lot easier than holding up a gas station,” Reynolds said.

Given the expanding scope of opioid addictions on Long Island and beyond, selling Imodium behind-the-counter would help curb some of the problem even though people in need of an anti-diarrhea drug would endure a small amount of inconvenience, Reynolds and Eggleston said.

Numerous nonprescription medications currently are sold behind-the-counter and require state-issued identification for purchase. Decongestants containing pseudoephedrine require ID. Pseudoephedrine’s chemical structure is similar to amphetamines.

Nonprescription cough medicines containing dextromethorphan are also behind-the-counter drugs. Dextromethorphan has long been called the poor man’s PCP.

Eggleston noted that postings to web-based forums that focus on loperamide usage have increased 10-fold since 2010. A majority of that content, he wrote in his analysis, pertained to loperamide as a self treatment for opioid withdrawal. A quarter of those posters, however, cited abusing the medication for its euphoric properties.

He said his poison center has documented a sevenfold increase in calls related to loperamide abuse and misuse between 2011 through 2015. That rise is consistent with national poison center data, Eggleston said, which has recorded a 71 percent increase in calls related to intentional loperamide exposure from 2011 to 2014.

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