The days when you could walk into a drugstore and buy a box of opium-soaked tampons have gone the way of the steel-boned corset, but plenty of law-abiding drug consumers still use over-the-counter medications to get high while racking up rewards points.
While robotripping is out of vogue (mostly), the legal high du jour comes from the active ingredient in anti-diarrhea drugs: loperamide. If the thought of eating 20, 30, or more Imodium tablets makes you feel skeeved out and a little scared, that's because it should. Loperamide is addictive and cardiotoxic, but people aren't using it because they're idiots in search of a cheap high -- the reasons go deeper than that, and implicate not only the disease of addiction, but the US medical system as a whole. Dr. Howard Wetsman, chief medical officer and founder of Townsend Addiction Treatment Centers, lays it out (and mercifully avoids scatological humor).
What is loperamide?
"It's a weak opioid agonist that doesn't cross the blood-brain barrier very well," Dr Wetsman says. "It's meant to treat diarrhea by stimulating the opioid receptors of the gut without affecting the opioid receptors in the brain."
"Meant to" being the operative phrase. Some users report effects ranging from moderate sedation to mild euphoria. "Its that down time period where u r very comfortable and relaxed after a huge shot of heroin [sic]," writes a user on Drugs-Forum.com. "idk why its not illegal but fuck heroin i like this better."
So, in short, loperamide is a legal, cheap, readily available opiate substitute.
Why would anyone want to get high on an anti-diarrhea drug?
Did you read the sentence above this paragraph? That should answer your question, but to break it down further, there are basically two reasons. The first reason is because some people like the experience of being high and will try just about anything to get there. (I used to be that person, back in my robotripping days.)
The second reason is because they're weaning themselves off opiates. Dr. Wetsman says far more people fall into the latter group than the former. "[People are] seeking to self-medicate opiate withdrawal," he says. "This is happening because there isn't enough treatment available to people."
Anti-diarrhea drugs aren't new, so why is this just now becoming a thing?
Because the US is experiencing what Dr. Wetsman calls an opioid crisis. He says the seeds for this epidemic were planted about 30 years ago, when both the government and non-government agencies such as the Joint Commission on Accreditation of Healthcare Organizations began requiring doctors and hospitals to do more about treatment of chronic pain. Some studies showed patients with chronic pain couldn't get addicted to opiates, which goes to show you that not every study can be trusted. "So there was widespread pressure on physicians to prescribe opioids for patient pain," Dr. Wetsman says. "Things got so bad that currently, there are physicians that feel like they could lose their jobs if they have poor patient satisfaction ratings, and patients with addiction threatening them with those ratings in order to get medication."
Hospitals can lose their accreditation if ratings plummet -- so they may put pressure on doctors to push pills, too. "The problem is a lot larger than opioids," Dr. Wetsman adds.
The crackdown on opioids may not be helpful
The tide may be turning. The Centers for Disease Control issued guidelines for prescribing physicians that limit patients with chronic pain to no more than three months of narcotics. But what happens when a lot of addicts are suddenly without their fix? They turn to Imodium... or heroin. According to the American Society of Addiction Medicine, four in five heroin users started out with prescription painkillers. It's possible the government could restrict or even schedule loperamide -- but Dr. Wetsman says this approach misses the real issue.
So what should we do?
Drug crises aren't new. Remember the crack epidemic of the 1980s? "What we've missed in each [epidemic], and still miss today, is that opioids aren't the problem," Dr. Wetsman says. "Addiction is. Until we address the brain illness, this pattern will continue."
Dr. Wetsman isn't confident that the current opioid crisis will spur change. "What we should do is treat addiction," he says. "But I doubt that will be done. We almost always go for the quick fix. I hope I'm wrong."
Me too. Because nobody should have to choose between overdosing on anti-diarrhea drugs or facing heroin withdrawal.
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