The Over-the-Counter Medicine Driving Junkies Wild—and Stopping Their Hearts

It can also stop your heart.

"I could look at the blood vessels on my wrist and tell my heart was about to stop. I could definitely tell I was about to go into cardiac arrest. I could just feel my chest and feel my heartbeat wasn't consistent. There were long pauses in between my heartbeats and everything," says Chris.

Chris is a 26-year-old recovering heroin addict from North Carolina. But for this seasoned drug user, the scariest high of his life didn't come from heroin or fentanyl. The drug that almost stopped his heart was loperamide the active component of Imodium.

Loperamide is a weak opiate, in the same category of drugs as heroin or methadone. Just like heroin or methadone, the drug works by binding itself to your body's natural opioid receptors.

Unlike heroin or methadone, loperamide only targets the receptors in your stomach and can't get into the brain. The recommended dose of two to four milligrams is considered next to harmless. Too much loperamide, however, overwhelms your brain's defenses and works the same way as harder drugs.

For people without an opiate tolerance, a mega dose of loperamide (also known as "lope") results in a high described by users as "uncomfortable," "barely relaxing," and "not recreational." For people with higher tolerances, though, loperamide has become a dangerous solution for managing "dope sickness," or opiate withdrawals.

After reading up on the Internet, Chris thought lope could be the solution to his problems. In addition to being sold over-the-counter, loperamide is also undetectable in drug tests.

"I was trying to quit using heroin before a job interview," he says, "so I got myself a thing of Imodium. After the withdrawals came in, I took like 15 of the two-milligram pills [for 30 milligrams total]."

By taking close to 10 times the doctor recommended dose, Chris joined a growing group of opiate addicts who use loperamide to combat their withdrawals.

Brutal withdrawals can be the biggest barrier to recovery for many addicts.

"For me, going through withdrawals is just like trying to crawl out of your skin," Chris says. "Just the worst aches and pains on top of the worst flu you've ever had in your life. You'll be as cold as you've ever been in your life one second, and then sweating like a slave not seconds after that. The whole time you're going through withdrawals, you'd do almost anything to get whatever your drug of choice is in your system."

Reports of people using lope to manage withdrawals appeared on drug web sites BlueLight and Erowid as far back as 2007. The websites aim to create anonymous, judgment-free spaces to talk about safe drug use as a form of "harm reduction." Many discussions center on how to avoid withdrawals or beat an addiction.

It on these sites that loperamide became touted as an over-the-counter savior. Later, a study in the American Journal of Forensic Medicine and Pathology called loperamide "poor manʼs methadone" because of its growing popularity among addicts.

In April, physicians directly linked heart failure to loperamide overuse. In these cases, fatal arrhythmias were linked to patients who had over five times the recommended amount of loperamide in their blood.

"Part of what this drug does is is that it disrupts the ability for the heart to conduct electricity. The heart has an electricity system, and the electricity system is responsible for making the impulses that actually make the heart contract and everything. Loperamide prolongs the conduction period in the heart, and that can lead to fatal arrhythmia," explains Dr. Alice Perlowski, a practicing interventional cardiologist and assistant professor at UC Irvine and the VA Long Beach Healthcare System.

During the 40-plus years that the drug has been FDA-approved, there have been 48 reported cases of serious heart problems associated with loperamide. Of those reported cases, over half of them happened after 2015. This is likely due to the skyrocketing rates of opiate addiction currently ravaging the country. According the Centers for Disease Control, between 1999 and 2014, opiate overdoses increased by 369 percent. Opiates were the leading cause of drugs overdoses in 2014, and by 2016, Frontline reported that there were 12 states in the country that had more opiate prescriptions than people.

At the start, lope offered Chris the exact type of relief he was looking for.

"It made me feel wonderful," he says. "You know, I was still a little dope-sick, but I could actually get up and walk around. I could function as a normal person after just taking a handful of Imodium."

But the escape from withdrawals was quickly eclipsed by the risky side effects.

"That first day, I was fine," he says. "I was only doing this for three days until the drug test. I was planning on drinking a lot of water and flushing my system right before the test, just to make sure that I passed it.

The second day of me doing Imodium, there wasn't any warning that anything bad was about to happen. But on the third day, dude, I kid you fucking not… That fucking shit made my heart beat so fucking crazy."

As chest pains and an uneven heartbeat set in, Chris knew he had gotten himself into a life-threatening situation. A family member called 911, but Chris refused to wait for paramedics. Even during this emergency, Chris's fear of getting caught high or holding trumped his fears for his health.

For many, loperamide is the cheapest and most accessible way to self-medicate. You can find a bottle in any drugstore, and Amazon lists 200 pills of generic loperamide for just $6.69. Unlike medicine with pseudoephedrine, there is no limit on how much loperamide you can purchase, or how much is kept in the pharmacy.

"Just think about it. If you go to the CVS now, a lot of them have self-checkout. So I could go, and I could stuff away 50 Imodium boxes in my basket and just check out, and no one's ever gonna stop me," says Perlowski.

Regular loperamide users contend that they manage the health risks by carefully monitoring their intake and dosage. Matt, a drug user from Virginia, began using loperamide to deal with his heroin habit after he was arrested back in April.

"I got pulled over, and I got busted for possession of Suboxone (a drug used to treat opiate addiction and withdrawal) and less than a gram of weed," says Matt. "After that, I went straight back to heroin daily, and I've been on heroin since."

But because Matt's habit is costly and the availability of dope is unpredictable, he balances his chemical intake with loperamide. Even though he uses lope daily, he doesn't see his habit as dangerous because of the way he carefully monitors his dosage."If I have comfort meds (other drugs used to aid withdrawals)," says Matt, "I'll take like 4 to 12 milligrams. If I have zero comfort meds, and the day is over, and I know for a fact there is no way of me copping or getting well at all, I will take anywhere from like 12 to 20 milligrams. But I refuse to take over 24 milligrams. And if I take over 20, I always make sure to do it on a full meal, and if I don't do it on a full meal, it always gives me this horrible stomach feeling, bloat-y and stuff like that."

Part of what complicates loperamide's effect is its long duration. It takes 48 hours for loperamide to fully leave your body, compared to the four hours it takes for heroin. This long duration makes it difficult to gauge the effect and easy to increase your dose quickly. This also means it's easy to grow a large tolerance quickly.

Despite his own use, Matt strongly urges people to avoid lope at all costs.

"I've read about at least ten or more horror stories of tolerance going through the roof on Reddit," he says. "There's been quite a few deaths over it. I know over 13 total. It's serious. People are using it to quell their symptoms, and they're getting a worse habit. Seriously, this is making heroin look safer sometimes."

Matt has mixed feelings about the possibility of access to loperamide being limited. He understands people are using the drug dangerously, but doesn't think that should limit people who rely on loperamide for relief.

"I would stock up just for safety reasons. I would buy anywhere from 300 to 1000 [pills. I'm not gonna push it, but I would definitely stock up to make sure I had what I needed." he says. "I don't blame the [FDA]. Some people are getting hurt because they're not knowledgeable or just not reading before ingesting… I guess regulating it might deter some people that are looking for legal highs though."

Scarier still, some people are trying to push their loperamide highs even further. On several drug forums, users report combining loperamide with other drugs to increase its effect.

BlueLight user by the name of Shimagora agreed to talk to Broadly about loperamide on the condition of anonymity.

"I used omeprazole [sold under the brand name Prilosec, a heartburn medication] to help loperamide cross the blood brain barrier," says Shimagora. "This can be more dangerous, or less dangerous, depending on your perspective.

Because omeprazole helps the loperamide into the brain, you need to take less of it to get the same mental effect. This means you can get the same high while having less of the drug affect your heart (in theory, at least). On the downside, this means that, if you consume a potentially dangerous drug or poison, you are allowing it to more easily cross into your brain."

There isn't yet any medical research about these interactions.

In light of recent medical studies, the FDA released a warning about the risks of loperamide. Physicians have recommended putting the drug behind the counter.

"Unfortunately, people are not very smart about their health when it comes to addictive substances. Sometimes we have to take the options out of people's hands when they abuse it," says Perlowski.

For Chris, his encounter with loperamide was a turning point in his life.

"The chest pain was so bad, I would take the worst restless leg syndrome—which is typical for opiate addicts—I've ever had over feeling my heart shutting down like that again," he says.

Not long after, Chris began methadone maintenance therapy. He is currently in recovery from his heroin addiction.

"Loperamide is what finally made me get on a [methadone] maintenance program," he says. "It was about time for me to start really knowing what I'm putting into my body."