A new study published in the journal, Clinical Toxicology has uncovered a new
threat in the opiate epidemic: Overdoses of loperamide-containing diarrhoea
medication, have been steadily increasing in number and severity over the past five
Misuse of the drug is particularly alarming because
non-prescription drugs like loperamide are inexpensive, readily available
online and in retail stores, undetectable on routine drug tests and can be
bought in large quantities at one time.
“When used appropriately, loperamide is a safe and
effective treatment for diarrhoea – but when misused in large doses, it is more
toxic to the heart than other opioids which are classified under federal policy
as controlled dangerous substances,” said senior author Diane Calello,
executive and medical director of the New Jersey Poison Control Center at
Rutgers University Medical School. “Overdose deaths occur not because
patients stop breathing, as with other opioids, but due to irregular heartbeat
and cardiac arrest.”
The study, published in the journal Clinical Toxicology, found increasing
instances in which patients with opioid use disorder misused loperamide to
prevent or self-treat withdrawal symptoms. To a lesser extent, some took
massive doses to get a high similar to heroin, fentanyl or oxycodone.
The researchers reviewed cases of patients with loperamide
exposure reported by medical toxicologists to a national registry, the
Toxicology Investigators’ Consortium, from January 2010 to December 2016,
reporting a growing number of cases over that time frame. The Poison Control
Center database (National Poison Data System) also reported a 91% increase
during that time period, which in 2015 included 916 exposures and two deaths.
The patients reporting misuse in the study were
predominantly young Caucasian men and women. The majority used extremely high
doses of loperamide, the equivalent of 50 to 100 two-milligram pills per day.
Calello noted that New Jersey Poison Control has reported
several fatalities or near-fatalities from loperamide in the past 12 months.
“Possible ways of restricting loperamide misuse include
limiting the daily or monthly amount an individual could purchase, requiring
retailers to keep personal information about customers, requiring photo
identification for purchase and placing medication behind the counter,”
she said. “Most importantly, consumers need to understand the very real
danger of taking this medication in excessive doses.”
VR, et al. Loperamide misuse to avoid opioid withdrawal and to achieve a
euphoric effect: high doses and high risk. Clinical
Toxicology. Published online 26 December 2018.