War on Drugs

Where Will Opioid Panic Lead? How About Regulating Your Access to Diarrhea Medication?

Meanwhile: The hunt is on to find somebody to blame for Prince's death.



It seems increasingly clear that musical genius Prince was likely addicted to painkillers (opioids—possibly Percocet), and they played a role in his death in April.

Authorities have now served search warrants to seize Prince's medical records at a medical center in Robbinsdale, Minnesota, a suburb of Minneapolis. The Minneapolis Star Tribune notes that a doctor named in the warrant treated Prince the day before he died and went to deliver test results to Prince on the morning he was found dead. But sources told the Star Tribune that the doctor was actually prescribing Prince medication to help to treat withdrawal from opioids, not additional opioids. The doctor in question is no longer working at the clinic and seems to have lawyered up and is keeping his mouth shut (which is smart of him and should not be taken as anything other than somebody who has received good legal advice).

Investigators are still looking into how Prince got his painkillers, and the Drug Enforcement Agency is even involved in the search. Thanks to the narrative that we have an "epidemic" of opioid overdose deaths, there's going to be significant pressure to make an example of somebody—anybody—who might have facilitated Prince's own decision to take painkillers.

In the meantime, crisis (even manufactured ones) serve as an opportunity for more federal regulation and spending. There's a whole bunch of bills related to opioid use being considered by the House this week. The New York Times counts 18 of them. On the good side, they don't appear to involve creating new federal crimes and penalties, and one of them (HR 3680) involves creating a grant program to fund the provision of medicines like naloxone to counter opioid overdoses. On the less good side, it looks like every single demographic (veterans and pregnant women, for example) will get its own special study on opioid addiction treatment methods, and there are calls for additional federal spending.

All this meddling should be a concern because of it leads to an environment where people fighting pain are treated on the presumption that they're likely to become addicts, even when that's statistically not likely to be true. It may well be true that painkillers are increasingly becoming the choice for addicts, but the reverse doesn't naturally follow, that those who use painkillers are destined for addiction. Neuropsychopharmacologist Carl Hart has challenged the myths of addiction and called for harm reduction (like the naloxone and education), rather than treating it like a public health crisis, exaggerating the reality of overdose deaths with language like "epidemic."

And this is where it all leads to: The absurd idea that maybe we need to monitor and regulate purchases of anti-diarrhea medication. Depriving addicts of their opioids has driven them to seek out alternatives. Heroin has been one choice, but some have also been turning to anti-diarrhea meds like Imodium. The active drug, loperamide, can provide a high, but as The New York Times notes, the amount necessary to achieve it is significant and potentially toxic. It has likely led to two deaths in New York and possibly played a role in deaths or near-death experiences in a dozen other cases in the past year and a half.

There should be a lesson here about the foolishness of trying to regulate away addiction through drug war nannying (lack of access creates a demand for alternatives in addition to a black market), but then there's this quote in the story:

Some toxicologists argue that the sales of loperamide should be limited, much as the nonprescription drug pseudoephedrine was restricted a decade ago to help prevent the manufacturing of crystal meth.

"It's time for someone to step in and regulate the purchasing of massive quantities," said Dr. Chuck O'Connell, an emergency medicine physician and toxicologist at the University of California, San Diego, who said he had seen two loperamide overdoses.

"The average person doesn't need 400 tablets of loperamide weekly," he said. "I've used a handful in my whole life."

Yes, there are people out there who want to put diarrhea medication behind the counter and make you jump through hoops to buy it on the basis of a statistically small number of tragedies. Of course, they're not going to have to be the ones to clean up the mess if somebody's bathroom situation gets a bit … urgent… at the pharmacy counter of CVS.