The war on opioids is beginning to show progress, and as we start winning that battle, unexpected skirmishes will undoubtedly arise. Those skirmishes can and will be tragic tributes to man’s creativity; our ability to adapt and adopt, even when the consequences of avoiding new controls means continued addiction and even death. Such is the case with unexpected deaths from an over the counter anti-diarrheal drug, Loperamide.

The over the counter medication, commonly sold under the brand name Imodium AD, has become an unexpected element in the continuing fight against our nations opioid addiction problem. And the death of a 29-year-old Pennsylvania man this week is a reminder that just removing a drug from availability is not a solution by itself.

His death was one of almost 20 from Loperamide overdoses in the past 8 years.

According to a spokesman for the University of Pittsburgh’s Medical Center, the Pittsburgh Poison Center has seen a “167 percent increase in calls related to Loperamide toxicity” between 2015 and 2017. Over 50% of those people required a hospital visit to deal with the problem.

According to the source story:

“As an anti-diarrhea agent, Loperamide works primarily on opioid receptors in your gut to slow down the movement of your intestines. That’s why one of the side effects of Loperamide and other opioids is constipation. The U.S. Food and Drug Administration (FDA) has deemed Loperamide safe when used at approved doses, which for adults is a single 4 mg initial dose followed by 2 mg after each loose stool. As the FDA stated, each day the dose should not exceed 8 mg per day for over-the-counter use and 16 mg for prescription use.”

Loperamide contains small amounts of opioids but is not as strong as OxyContin or Vicodin. It doesn’t have the same effect as those drugs, but it turns out that taking “dozens or even hundreds of Loperamide tablets” can produce an opioid high.  Some people have found that it can also help with withdrawal symptoms when stronger drugs are suddenly not available. Apparently, some accomplish this by creating “constipation smoothies.” They put “hundreds of tablets in a blender” to create that concoction.

The Food and Drug Administration is responding to this new wrinkle in the struggle over opioid abuse. In January it asked makers of the anti-diarrhea drug to offer the medications in smaller amounts to make them harder to abuse. The FDA would prefer to have this medication packaged with as few as eight tablets per package. Some generic versions today are sold in boxes of up to 200 tablets. The agency is also looking to get online retailers to make it harder to order bulk amounts of the drug.

I wonder how long it will be before this medication joins common cold medicines (useful in meth production) behind the counter at your local pharmacy. In my opinion, reduced quantities in packaging may help, but will not treat the underlying problem of people not being properly weaned from these drugs.

It is simply more evidence that you can win a battle while continuing to lose the war. Humankinds ability to find alternatives to blocked routes will continue to challenge us as we make progress on the primary fronts. While we need to change our drug prescribing ways for the future, this is a reminder that simply removing access for those already addicted is not by itself a solution.

If we don’t do this properly, people will prove that to us every day. Sadly, an overdose death by any other drug will still be just as tragic.

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