Pittsburgh, Pennsylvania, USA: The medical examiner has determined a Fox Chapel (Pittsburgh Metro) man, Arjun Patel, 29, died as a result of loperamide poisoning. Loperamide is the active ingredient in anti-diarrhea products like Imodium A-D. Structurally, it’s similar to methadone, an opioid commonly used to treat addiction to other drugs such as heroin.In recommended doses, loperamide is safe. But when taken in large quantities, it can produce a high. Recreationally, it’s known as “loping.”
Arjun Patel died in November, but the cause of death was not released until this week.
According to the U.S.Food and Drug Administration, FDA, the approved daily dose of loperamide for adults is 8 milligrams per day for over-the-counter use and 16 milligrams per day for prescription use. In order to get a high, you’d have to take in the “dozens or hundreds of pills kind of range, which wouldn’t happen accidentally,” said Lynch.
People often take loperamide in such high amounts to try to treat their withdrawal symptoms from other opioids. Loperamide acts on the opioid receptors in the gut to slow down digestion and reduce the number of bowel movements.
The danger is that high doses of loperamide can affect the electrical currents generated in the heart, which can cause fatal heart arrhythmias. In 2017, researchers reported that a 38-year-old woman had a cardiac arrest after using high doses of loperamide to treat the symptoms of heroin withdrawal.
Locally, loperamide poisoning cases have sharply risen over the past two years.
“Since 2015 through the end of 2017, just at the Pittsburgh Poison Center, we saw a 167 percent increase in calls related to loperamide toxicity, with more than half of those people needing to go to the hospital,” Dr. Michael Lynch, of UPMC’s Pittsburgh Poison Center, said.
Addicts have been buying hundreds of pills and taking them to get high.
Given the trend, the FDA announced in January that they are working with manufacturers to limit the number of doses per package of antidiarrhea medication. The FDA asked manufacturers of anti-diarrhea medications to change the way they package their products. The FDA says the voluntary measures are needed to curb the growing abuse of loperamide.
“We continue to receive reports of serious heart problems and deaths with much higher than the recommended doses of loperamide, primarily among people who are intentionally misusing or abusing the product, despite the addition of a warning to the medicine label and a previous communication,” the U.S.Food and Drug Administration, FDA, said. “Loperamide is a safe drug when used as directed.”
The annual cost of treating opioid addiction and overdoses has risen dramatically over the last 13 years, as the epidemic tightens its grip on the country.
In 2016, people with health coverage through their employer received $2.6 billion in opioid treatment services, compared to $273 million in 2004, according to an analysis released Thursday by the Kaiser Family Foundation.
Opioid use on employer-based health plans peaked in 2009 with about 17.3 percent of enrollees receiving at least one prescription that year. It has since fallen to its lowest level in more than a decade — 13.6 percent, the Kaiser report shows.
Yet, the opioid epidemic has shown no signs of slowing down. Deaths involving opioids rose nearly 28 percent from 2015 to 2016, an increase driven largely by powerful synthetic opioids, one of which is up to 50 times more potent than heroin.
The cost of inpatient treatment has increased dramatically, from $5,809 in 2004 to $16,104 in 2016, according to Kaiser.
Congress and the Trump administration have been wrestling with how to halt the opioid epidemic and how best to boost access to treatment services and curb the overprescribing of opioids.
The Senate Health Committee on Wednesday released a bipartisan draft of legislation to curb the opioid epidemic. On the other side of the Capitol, the House Energy and Commerce Committee hopes to have an opioid package on the House floor by Memorial Day weekend.
Fox Chapel in Allegheny County, Pennsylvania, USA, and is a suburb of Pittsburgh.