This story came to me from West Virginia a couple weeks ago, but as you may know we've been too immersed in talking about a conversation for workers' comp to get to any truly serious stories. The “conversation” will be back on the table later this week, but for this particular Monday, we are shifting the discussion to an issue of true substance. Even if the substance isn't particularly pleasant. 

Apparently the creative minds of the drug addicted have found yet another way to get high when they cannot get their hands on their preferred opioid selections. Calling it the “poor man's methadone”, experts are finding that some addicts are turning to massive amounts of Immodium and other anti-diarrhea medications to get high. There are, of course, a few flaws with this new drug regimen. In addition to binding one up for the next century, the drug, in massive quantities can be toxic to the heart.

And by massive quantities, we are talking upwards of 100 pills a day. Compare that to the recommended dosage of 2 pills every 12 hours. It is the sort of overuse that could make your colon look like a 1930's dustbowl.

That is generally never a good thing.

According to the New York Times, “A report published online in the Annals of Emergency Medicine recently described two deaths in New York after loperamide abuse.” I tried locating the report, but turns out I was googling the “anals” of Emergency Medicine. That produced a host of disturbing results. I don't recommend you try it, at least not on your office computer.

In case you did not know, loperamide is the generic name for the active ingredient in these types of medicines. At one time loperamide was a prescription drug and a controlled substance, in the same class as cocaine or methadone. The F.D.A. approved it in 1976, and it became an over-the-counter drug in 1988. The NYT also reported that “overdoses have been linked to deaths or life-threatening irregular heartbeats in at least a dozen other cases in five states in the last 18 months.”

The issue is apparently compounded by the fact that physicians are generally not looking for this type of drug, and are potentially missing cases that are passing through their office (and apparently that is the only thing that is “passing” with these cases). I would suggest they start paying closer attention to the general health questionnaire their patients fill out. If the answer to the question “When was your last regular bowel movement?” is “2012”, then they might have an issue there.

Experts are warning that abuse like this may increase dramatically as efforts are made to reign in this country's opioid issues. They say these types of drugs may have to be secured, similarly to how pseudoephedrine was to prevent the making of crystal meth. It seems people don't actually need 700 pills of loperamide a week, and some think they should be locked away and controlled by retailers.

Now, I ask, in all earnestness; is an anti-diarrheal the type of drug we should be making people wait for while some stock boy retrieves it at the supermarket? It could make for some distinct challenges, not to mention some fascinating listening over the store public address system. You might hear, “I need a box of Immodium at register three”, only to be followed a few minutes later by “Cancel the Immodium. And we need a clean-up at register three”. 

For its part, the FDA is all over this. A spokeswoman for the them said, “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.” She indicated, after a review, that the agency “will take appropriate steps as soon as possible.” 

Which means we will might see action in our lifetime, if we live to be 150.

So, we in the workers' compensation realm must be ever vigilant on this issue. When we encounter an individual we are trying to wean from opioid use, we need to know the signs. Their story may not be the only thing that is full of crap.

Just sayin'….


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