It's not surprising at all, though. For starters, the said medicine can be acquired over the counter and is inexpensive. It is also readily available and completely legal.
On Jan. 30, the FDA requested manufacturers to produce packages with low quantities of the drug for short-term use in an attempt to curb the problem.
Loperamide, the generic name of the medicine, is considered safe at 8 milligrams a day, or four tablets. There's a 16-milligram cap for prescription strength doses, too, but these are generally low levels and can't enter the blood or brain. Some individuals, however, are consuming between 50 to 400 pills each day to feel high, said William Eggleston, pharmacist and clinical assistant professor at Binghamton University. He's also Upstate New York Poison Center's clinical toxicologist.
Ingesting that many pills each day is practically impossible, but people have been creative. Eggleston explained that, for example, one patient crushed hundreds of anti-diarrhea pills and mixed them in with this smoothie.
But why? Well, Eggleston said loperamide can act as an opioid, but when taken in low levels, it does not incur the same effects anywhere, except in the intestinal region of the body. When someone takes somewhere up to 50 pills a day and above, they'll feel akin to having injected heroin or even morphine.
"You can get that same high sensation, that euphoria," said Eggleston. The sensation of being high, however, isn't as potent as one would encounter by injecting more severe drugs. It doesn't provide the same level of "head rush" that heroin does, he said.
Abusing Loperamide To Avoid Withdrawal
Some abusers are taking significant amounts of loperamide not to satisfy their addiction, but to actually prevent it. Some patients abuse the drug to function without the use of morphine, fentanyl, or heroin. But given a high enough dosage, some patients report feeling an opiate-like experience.
"The issue of opioid misuse and abuse remains one of my highest priorities and we believe it's going to take carefully developed, sustained, and coordinated action by everyone involved to reduce the tide of opioid addiction and death afflicting our communities; while maintaining appropriate prescribing for patients in medical need," said FDA commissioner Scott Gottlieb.
As a preliminary preventive measure, the FDA is changing how loperamide is packaged. As mentioned, it's asked manufacturers to limit the amount of loperamide in retail packaging. For example, a blister packaging that contains eight 2-milligram capsules. It also plans to reach out to online distributors and ask them voluntary steps to mitigate the issue. It wants to eventually stop bulk sales of the medicine, which is one of the ways that could lead to individuals abusing it.
Currently, loperamide can be purchased on Amazon for $10.99, which contains 400 pills. The FDA's solution can't persist in the long term, according to Eggleston. Making loperamide a behind-the-counter drug might work, but that's a huge step to take, and will likely only happen when the abuse grows more abysmal.