Drug War

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.

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Imodium
Imodium

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. 

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  1. The hunt is on to find somebody to blame for Prince’s death.

    OJ Simpson will find the real killers.

    1. I think they already found the guilty party. I heard the person was found in an elevator.

  2. End the drug war and so many problems vanish for everyone (not directly profiting from the drug war).

    1. Next thing, you’ll be wanting to legalize prostitution and other so called victimless crimes. Why do you want the terrorists to win?

  3. The hunt is on to find somebody to blame for Prince’s death.

    But when will they tackle the scourge of unproscribed and overproscribed auto-erotic asphyxiation? Justice For David Carradine!

    1. The five-finger death grip got him in the end.

      1. I heard that when they found him, they thought he had a fist full of mashed potatoes.

  4. Where Will Opioid Panic Lead?

    To people in chronic pain staying in chronic pain, of course. Unless that person is a Senator or other member of the ruling elite, they can have all they want. But we have to protect the little people by letting them suffer.

    1. Also, heroin addiction. Damn those unforeseen predictable consequences.

    2. We like to think torture is bad, but inflicting torture on people by denying them effective pain relief is just the price we have to pay to prevent certain people from having unauthorized fun; the worst kind of fun.

    3. Not everyone will stay in chronic pain. The sad truth is that some pain patients may become suicidal.

  5. fund the provision of medicines like naloxone to counter opioid overdoses

    I suppose offering it OTC is out of the question. Sure, why not throw a ton of money at giving something away rather than spending no money to sell it cheaply.

    1. It will be just like the ephedrine panic. Now you can’t actually buy sinus medicine that works, without showing your driver’s license. Too many pants shitters have really stunk up the place.

      1. Just like the Sudafed panic, only it makes even less sense. You can’t turn diarrhea meds into heroin.

        1. But if we can save just one child, shouldn’t we do this anyway?

      2. Went to the drug store the other week to buy some Sudafed for myself and some Childrens’ Sudafed for my daughter (the latter of which was doctor-recommended). I had to jump through so many hoops I’m still shocked the pharmacist didn’t put on a nitrile glove and ask me to turn my head and cough.

        1. I bought some Claritin D once and I was mocking the ephedrine pants shitting law to the pharm, just as an excuse to talk to her because she was pretty hot, and she sort of freaked out. Not sensing the sarcasm, she took on a sort of nervous mode and then told me in a hushed down tone that a couple had come in and bought several boxes of the stuff and that she couldn’t stop them because it was within the legal limit, but that she knew what they were up to. I just stopped talking and swiped my card.

          1. That’s too bad. Just because you are subject to regulations doesn’t mean you have to think they are a good idea. If I were a pharmacist, I’d be very apologetic about that crap.
            I always make my wife buy that stuff now because I don’t trust myself not to make a lot of comments that might arouse suspicion.

    2. Some states are making it OTC, or at least easier to get without a prescription.

  6. You can’t get high off of Immodium. Period.

    1. It appears that loperamide binds to opioid receptors in the gut. It may be plausible to take a large enough does to saturate gut opioid receptors and activate receptors in the brain. Just speculating.

      1. It doesn’t really cross the blood-brain barrier.

        If you take enough to get high (assuming that it’s possible at all), you’re gonna find yourself in the ER with a severely impacted bowl. Is it possible that this has happened before? Sure, most likely in Florida.

        But the drug warrior was only able to cite 2 cases total. That dude can suck my balls.

        1. That dude can suck my balls.

          That goes without says.

        2. severely impacted bowl
          So it’s gonna spill my cereal? Fuck.

        3. The irony here is that if you look through some of the more unsavory areas of the internet, one discovers that the most common use of loperamide amongst addicts is to ease withdrawal.

          Then again maybe this was already known, and the idea of drug users being able to get themselves off opiates was just too much self determination for someone to handle.

          1. Like the rehab industry, perhaps?

        4. Loperamide crosses the blood-brain barrier but is immediately pumped out by P-glycoprotein. Massive doses, especially combined with P-glycoprotein inhibitors, can overwhelm that pumping and result in central effects. But let’s not understate just how extreme the amounts involved are… a normal dose is 1-2 2mg tablets; relief from physical withdrawal can take 20-30 tablets, trying to get central effects people will take 50-100+ 2mg tablets at once. The most extreme abusers are at 400+ tablets per day.

          Further, doses at the alleviating withdrawal level won’t constipate an addict worse than the opiates they were already taking. This level of dosing is generally harmless, and the extreme dosing of people trying to get high is indeed rare. So of course no need to put it (back) on the controlled substances list (it was originally Schedule V).

    2. Is paregoric still a thing?

  7. This could get messy.

    1. They’re using a spray and pray strategy.

  8. I thought it was the Artist’s fault.

  9. my neighbor’s mother-in-law makes $75 hourly on the laptop . She has been out of a job for five months but last month her income was $21953 just working on the laptop for a few hours.

    try this website ????????? http://www.richi8.com

  10. Make people with diarrhea wait longer in line, winning strategy.

    “Look, we managed with sudafed because those people were only getting snot all over the counter.”

  11. Celebrities need to take better care of themselves and avoid drug abuse…because if they kill themselves their deaths will be used by politicians to promote new, bad, laws.

  12. Alt-text like a muthafucka

  13. The hunt is on to find somebody to blame for Prince’s death.

    Yeah, because blaming him for his own death is just unthinkable. He wrote pop ballads in the 80s. And he liked purple.

    1. Why should anyone even care whose “fault” it is? Something unfortunate happened. Shit happens.

  14. Home 3D printers are already wetting plenty of panties around the globe as far as guns go. It will get better and better, eventually printing electronics, metal, and materials of all descriptions, including chemical, coming closer and closer to the duplicating machines of science fiction. And they will also gradually make their own diverse final materials from generic ingredients. Governments won’t be able to stop them.

    I bet within 50 years, this will be the norm. You won’t buy toasters or guns or clothes, you will download patterns.

    Governments are gonna shit themselves, not before time.

    1. They’ll put chips in them that will disallow you to print anything not on the state approved list. Sure, certain people will get around that, but I’m going to guess that having a modified printer or the act of modifying a printer to avoid the regulations will be tantamount to terrorism. They’ll use every sort of scare mongering you can imagine and soccer moms and other assorted pants shitters will see that the law is passed and enforced vigorously.

      There is no way the government is going to let people just print whatever the want to, for the children of course.

      1. But they will be cheap and far too common to stop. The Soviet Union couldn’t even stop fax abuse, and they controlled the phone lines; they had no more luck controlling copy machines.

        Copy machines here have those invisible yellow dots to trace them, and supposedly recognize bills and refuse to copy them, which might seem like a point in your favor. But very few people give a crap about either misfeature. Duplicators wont be the same — the ease of use will make people far more aware of how they have been crippled, and the government won’t be able to stop the flood of firmware replacements.

      2. I bet that won’t happen. Accuse me of blind optimism if you want. People will fret, but it won’t be politically feasible to stop it.

    2. Because of patents and such, they will likely require a license to own such a device. Like the license that allows you to own a still for legal purposes such as distilling water or vinegar, a condition of having such a license will be allowing government agents to search your property at any time with no warrant or warning.

      1. Duplicators will be too cheap and handy for the government to get away with restricting them, just as they were with the first VCRs and with drone regs now. Government bans only work when enough people want to obey them.

        1. There will also be a economic component to a distributed high value-added manufacturing base, such things as golden geese modify politicians quickly, no matter the regime.

  15. Where’s the fun in mocking the pants-shitting over being too loose with the diarrhea medicine? You people aren’t even trying any more.

  16. Prince is dead because of the DEA.

    Buprenorphine (suboxone), one of the most effective meds used to treat heroin and opiate addiction, is harder to get than heroin itself. Prince was trying to find a doctor to prescribe it when he overdosed.

    Why couldn’t he find a doctor? THE LAW. Commonly know as the 30/100 law:

    “If physicians take and pass an 8 hour course and meet other qualifications, they become eligible to apply for a special waiver which allows them to treat addiction with above mentioned medications in an office-based setting. This same law, void of any supporting science, arbitrarily caps the number of addicted patients a physician can treat at any one time to 30 through the first year following certification, expandable to 100 patients thereafter. ”

    That’s right, a specialist can only treat 100 patients at a time. For no fucking reason. More here.

    I’ll say it again: Prince was addicted to opiates because of Prince, but he’s dead because of the DEA.

    1. Dude, you don’t understand. If doctors are allowed to treat addiction, and if addicts are allowed to buy medicine to treat overdoses, then there will be more addicts. You see, allowing treatment makes addiction seem safe, or just delay the inevitable. That will encourage more people to become addicts and drag out addictions. The best way to discourage addiction is to criminalize addiction treatment. That way people won’t become addicts. Or something.

      /drug warrior “logic”

      1. You can’t make an omelet without a few dead addicts?

        1. i think the rationale is that allowing easy access to treatment makes addiction seem safe. By making it difficult to get treatment, then addiction becomes less attractive. As if people think that shit through. “Golly, I better not become addicted to this stuff because it’s hard to get treatment” or “Golly, I think I’ll become an addict because it’s easy to get treatment.” It’s along the same lines of putting up Gun Free Zone signs and expecting them to deter murderers.

          1. Addiction is safe. Government makes it dangerous.

            1. True.

            2. Yeah, especially opiate addiction. If you know your dose and don’t fuck around, you can be perfectly healthy on opiates/oids for your whole life. Prohibition is to blame for most ODs and most of the harm caused by that kind of drug. Without prohibition, they’d be very cheap. It’s probably best not to be an oxycodone addict, but absent prohibition, it wouldn’t be that big of a deal.

              1. and it’s certainly preferable to being an alcoholic, and opiates are a good informal alternative to that.

          2. William Halsted.

            Basically the father of modern surgical technique. Addicted to morphine for his entire adult life. Lived to be almost 70 years old.

            Today, he would have been locked in a cage.

            1. Today, he would have been locked in a cage.

              Probably not. Sounds like a smart fellow. Smart people tend to avoid getting caught. Cops aren’t that bright, so it doesn’t take much to outwit them.

              1. But he would have had to steal morphine to maintain it nowadays. With all the monitoring and accounting today, it’s easy to get caught.

        2. Ewww. I knew there was some nasty secret behind the new Perkins menu.

    2. Buprenorphine (suboxone), one of the most effective meds used to treat heroin and opiate addiction, is harder to get than heroin itself.

      Suboxone – is that stuff sold in a vaporizing cartridge where it looks like you’re smoking even when you’re not?

      1. No idea. I don’t take opiates. I don’t think it’s a vapor, though. Pills, and a sublingual if you’re unconscious.

        1. Opiates, even low dosage, make me violently ill. I’m talking projectile vomit ill. I guess I won’t be getting addicted.

          1. I don’t care for them. At. All.

            1. A couple decades ago I was totally wasted at a party, and some asshole shot me up with heroin. I didn’t agree to it, but I was too wasted to fight him off. I got to tell you, it was one hell of a high. I liked it. A lot. Then for the next two days I felt like I had the flu, and using more was all I could think about. I didn’t do any more of course. Liked it way too much. So on the one had I can see how people can get hooked on the stuff, but on the other hand I call bullshit on the claim that once a person tries the stuff they are incapable of not becoming addicts.

              1. It’s not a party without needles, amirite?

                1. That’s the other reason I couldn’t become a heroin addict. I hate needles. I bet I snorted a pound of cocaine in my 20s, but those days are long gone. Speaking of which, I have no idea how people become addicted to cocaine. I could always take it or leave it. I don’t know how many times I would do a few lines at a party, then at some point politely refuse to do more. People looked at me like I had three heads. No, I had to work the next day. If I did any more then I couldn’t get any sleep.

                  1. I never got that either. I could totally see how one would become and opiate addict. But coke just seems silly. At some point it’s time to go to sleep.

                    1. The worse thing that happens when you run out of coke is that you go home and go to bed.

              2. How can anything be liked too much? The concept doesn’t make sense. You didn’t do it any more, so obviously you didn’t like it enough.

      2. I think there’s a nasal spray version for unconscious people.

    3. Prince is dead because of the DEA

      You wackos are so funny. If there wasn’t a DEA there would be pushers on every playground and on every corner. All of your children and your mum would be addicted to the hard stuff. Bath salt zombies in every street, you couldn’t even leave your house! You people never think about these things.

    4. It’s no different that the myriad of seemingly meaningless regulations they’ve come up with to regulate legal cannabis. You can have 2oz, you can have 10 plants, but only 3 can be mature at the same time. You think they think about these things? They don’t, they just make this shit up, because making shit like this up is what they do.

  17. The last thing you want to be addicted to is opioids.

    Our best painkillers are those, and as your tolerance goes up for them, the medical world’s ability to kill pain goes down. It happens to so many people, but it’s about the last thing you want to get addicted to.

    1. I think I’d choose opiate addiction over stimulant addiction.

      1. Not Lemmy. Speed all the way!

        1. It’s probably mostly personal preference. I like sleeping too much.

  18. This is insanely dumb. I know a couple of people with IBS-D (diarrhea variant). If it wasn’t for loperamide, they’d basically be shut-ins. And loperamide is the only known opioid the activity of which is limited almost exclusively to the GI tract; it’s extremely difficult to get it to cross the blood-brain barrier. You have to shatter it into nanoparticles with special equipment and then mix it (IIRC) with DMSO. Otherwise, no dice.

    1. “Loperamide was first made in 1969 and used medically in 1976.[6] It is included on the World Health Organization’s List of Essential Medicines, the most important medications needed in a basic health care system.[7] ”

      So of course some asshole wants to regulate it.

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

    The average Chipotle customer does.

    1. Clearly you’ve never met my anus.

        1. Tighter than a snare drum. Not a drip.

      1. Well, not that I’m aware of…

        1. But if you play your cards right…

  20. Now I understand, Cytotoxic must be addicted to Imodium

    1. That dude is at least 50 lbs heavier.

  21. If they do this I will totally lose my shit.

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  23. I thought it was already “settled science” – every problem (real or imaginary) will be handled my more government regulation.

  24. Thank God that somebody is standing up against the idiotic manufactured hysteria over opioid drug “abuse”. All I see are fears about the “epidemic” of abuse and ignorant statements that “nobody needs them” for chronic pain, from people who have themselves never experienced it and found that nothing else works for some people. This happened a generation ago and it took 20 years before they rediscovered that depriving people of effective pain medication is abusive and created a huge welfare issue for pain patients. Looks like it’s happening all over again.

  25. Why are they looking for someone to blame?! It should be obvious that the doctors did not believe him when he told them he was sick! He, most likely, had something that was “all in his head” that ended up killing him. The doctors did not mind collecting the fees for their dis-service. They just have a problem looking deeply for a cause for the illness that they though was imagined! Blame the poor diagnosticians for his death! What was causing a “normal” male to be anemic? Maybe he was a “sick” male and not “normal at all! Will they have on his tombstone, “I told them I was sick!”?

  26. As a Crohn’s Disease sufferer, I buy an inordinate amount of Immodium. I use it daily. I’d hate to think that opioid panic would reduce, or block my access to a medication that allows to me to function normally throughout the day.

    1. Now, you don’t think this sudden panic over teh evilz of Imodium might have something to do with the recent approval of Entyvio (which costs upwards of four figures) for Crohn’s, do you?

  27. Check out this article about the present state of bills around the US pertaining to the War on Drugs and another overview of the issue. It gives great context to the current state of this war in US legislation.
    http://bit.ly/28YHQJR

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