Opioid addicts looking for a cheap high are turning to an over-the-counter anti-diarrhea medication, prompting a federal agency to ask manufacturers to change the way the drug is packaged in an effort to curb abuse.
According to the U.S. Food and Drug Administration, loperamide, also known by the brand name Imodium A-D, is being abused by some opioid addicts to either self-treat withdrawal symptoms or get and maintain a high. The drug is inexpensive, costing about $10 for 400 capsules.
The recommended dose for loperamide is eight milligrams a day for over-the-counter use and 16 milligrams a day for prescription use.
But drug addicts are taking anywhere between 50-300 capsules a day to induce a euphoric high that is akin to heroin, morphine or oxycodone, according to a 2016 study published in the Annals of Emergency Medicine.
“Folks that are desperately addicted, folks that are looking to stave off withdrawal symptoms will do whatever it takes sometimes, really extreme things,” Dr. Jeffrey Reynolds, of the Family and Children’s Association, told CBS New York at the time that study was published.
At these high doses, loperamide has been reported to cause serious heart problems and even death. The majority of reported cases where heart problems developed were due to intentional abuse.
The FDA said in a statement this week that manufacturers should consider switching to blister packaging that limits the number of pills a customer can purchase at a time.
In a statement, FDA Commissioner Scott Gottlieb M.D. called for immediate action on the part of manufacturers.
“At the FDA, we believe one of our key roles in addressing the opioid epidemic is to reduce new addiction,” Gottlieb said. “We’re exploring ways we can reduce exposure to opioids through our influence on prescribers, particularly through our Risk Evaluation and Mitigation Strategy (REMS) authorities.”
“We’re also actively exploring how we can use changes in packaging as a way to give providers better options for tailoring how much they prescribe to the clinical need,” he said.
Also realizing that the majority of purchases of loperamide are made online in bulk, Gottlieb stated that he also intends to reach out to the the online marketers and ask them to cooperate as well.
“I also plan to reach out to those who distribute loperamide online, through retail websites, to ask them to take voluntary steps to help us address this abuse issue,” Gottlieb said. “The new packaging should help make limits on sales more easily achieved. The abuse of loperamide requires the purchase of extremely large quantities…We know that many of the bulk purchases of these large volumes are being made online through major online web retailers.”
In the latest twist in the war against opioid addiction, on Thursday Blue Cross Blue Shield of Michigan enacted a policy that will limit the number of opioid prescription drugs that can be prescribed to new patients. Patients new to opioid therapy will be prescribed a short-acting, five-day supply of opioid pills – something like a trial period. After that, if pain persists, they will be prescribed refills in a limited 30-day supply.
Detroit Free Press