Nicomorphinist
Bluelighter
I am hearing that there is another push to make loperamide harder to use back in the States, like packaging restrictions:
www.pharmacist.com
So something is up. Part I is a political rant. Part II is a somewhat detailed description of my research, including as a guinea pig.
It is the same pressure groups yelling about kratom, tianeptine, poppy seeds, who want more people paying five and six figures a pop for rehab or dying, and some retailers like Wal-Mart apparently rolled over even harder than that, jacking up the price, putting it behind the counter, which could have a couple of reasons. One article says "Customers buying more than one package . . . that gives pharmacists a chance to have a discussion with them."
No, particularly with what the US and most states and turned the profession into (who can name me a state where the old pharmacist prescribing ability is still in place?), and especially technicians and retail clerks, let me tell you as a longtime member of the brother and sisterhood in a number of capacities that doing such a thing is not your place, and if you do, you will only expose yourself to assault and battery and worsen the Inventory Shrinkage problem that plagues a lot of retailers in general, not to mention that some percentage of your techs and delivery people are going to get sticky fingers too. Maybe, as always the junior detectives amongst your number deserve to be hit in the face with a basket or crutch or cane for messing with customers, but why do you want to make more trouble for yourselves? The customer is always right; before I left the country because of all of this nonsense I always walked around with a cane with a big heavy silver head on it, hard-soled shoes, and at least four to six other people with me sometimes more than 10 and I am sure there are others especially old folks who could also start a nice riot for you.
Why are you people doing the work of the gangsters in the rehab business anyways? What kind of bone have they thrown you? I'm sure pharmacies get ripped off by the manufacturer on Suboxone just like patients do, and do they even let all pharmacies fill methadone for maintenance people? And how can you help them if they are dead? Don't tell me that all hydrocodone going to Schedule II and Darvon disappearing, even tramadol going to Schedule IV from uncontrolled and all of the prescription monitoring database rackets snaring codeine and dihydrocodeine syrup haven't cut into the fun that some of your unwise colleagues used to have diverting those medicines a few tablets or ml or an exempt register 120 ml bottle or four at a time. The new benzodiazepine and gabapentinoid jihad is already starting up . . . some of these bastards even whine about bupropion. What the fuck, as the kids these days say.
At least the prescription monitoring databases give some of your people new opportunities to ask for cash honouraria and handjobs, blowjobs, clit polishing and other fun when it is time to dole out the benzodiazepines, gabapentinopids, buprenorphine, codeine and the like, am I right? The Schedule II stuff too, now that I think of it. You don't want to fall behind doctors and inspectors and people from the prosecutors' offices and even the occasional journalist in getting yours, do you? Durum et durum non faciunt murum -- don't tell me they don't teach that to doctors, dentists, veterinarians, and those in the allied trades, do they? You are part of an honourable ancient iron triangle with doctors and patients, even if the regulators and politicians don't respect you. Or respect the the patients or doctors either. Stand up for yourselves and stop doing the politicians and rehab millionaires and De Sade gangster disciples' dirty work! Every time some politician and local doogooder wants some press it's going to get worse. Somebody has to break the spiral of silence . . .
If you people think all of this is going to give you new power and respect you are sadly mistaken -- just ask the doctors what is happening to them.
Do I even have to mention what the environmentally unfriendly package is doing to the elderly and others with arthritis? Then you have the people who melt the packages with a blow torch. A family or neighbours or bridge club or local political party can have a scissors party and have a bowl of 1000 tablets inside of an hour. So what good has it done?
I feel your anger. I know your dreams. What you have to do is fight back and get the latitude and respect that all of that studying for degrees and licensures should have guaranteed for you, even without decamping to Canada or Europe as at least a few have, not roll over. If I am preaching to the choir, you need to fight back within your professional organisations as well because they have not responded creditably to any of this.
Now, loperamide, which is a 4-phenylpiperidine opioid, a substituted prodine to be specific, with a relationship also to normethadone, a precursor along with norpethidine in the more common syntheses, also has potentially neurotoxic metabolites just like pethidine, and its potential cardiotoxicity at high doses, make for two reasons it is not used clinically for analgesia or stopping withdrawal. Which it does. Since I had an appointment with my cardiologist last week, I decided to try out loperamide for a couple of weeks and I can tell people the following:
It can be made to work in doses that are much lower than the media reports are talking about. After all, when it was first introduced in many markets it was regulated like pethidine (US CSA Schedule II), then codeine (to Schedule V in July 1977) then decontrolled in April 1982. Something is in that arse glue, which is why the rehab gangsters are whining about it.
There really is no need for gobbling 100 and 200 tablets at once which is very dangerous, even if you are going into this from a high dose of another narcotic. The relationship is not linear either, which is why no equianalgesia or equi-counterwithdrawal ratio can be determined. But the "poor persons' methadone" title is apt in that it is possible to build up a serum level which allows for lower doses and/or less frequent dosing later.
The very high doses from gobbling entire economy sized bottles do also increase the chances of paralytic ileus, intestinal blockage, and at a minimum gastric stasis vomiting after a day or more of increasing discomfort, especially with larger tablets like those with carminatives and/or attapulgite in them. They tend to have chalk in them in many cases.
With my fairly high hydromorphone dose supplemented with nicomorphine and Scophedal for breakthrough pain 0 to 2 times a day, I found that 24 tablets or 48 mg every 12 to 18 hours during the first 48 hours, which is the double loading dose that loperamide, difenoxin, and diphenoxylate need when used for diarrhoea, build up a bolus that allowed me to take 32-48 mg once a day for the next five days or so, then even skip days after that, or at least take doses q36h.
Omeprazole did seem to help some, I eat oodles of black pepper anyways on my food and I am sure that helped too, and hydroxyzine worked very well potentiating it, making it possible to use less. Given all the above, it behooves people to start out at just over the anti-diarrhoeal dose and can go up every four hours at the very beginning I suppose, or phase in the loperamide by increasing the dose 10 per cent each time and seeing how much of the other medicine you need to stop the withdrawal; I would start at 25 per cent of the old dose.
If you are going to use loperamide for a shorter period, like three or four days at most, it still does not require a huge dose. A one-off for analgesia or withdrawal-related diarrhoea the same thing. There are some people who when not on other narcotics notice some anxiolysis and analgesia from a single 2 mg tablet.
I must say, I was aware of all the literature going back to the beginning right when Janssen Pharmaceutica invented it as well as diphenoxylate and difenoxin and it went into many markets and knew about the morphine addicted monkeys and other experiments, and I did try it that one time at a high dose and it felt like piritramide but I also had a case of the Fear in the hours afterwards, psychosomatic no doubt . . . So when after I got into Stage II withdrawal and I gobbled the first loperamide, hydroxyzine, and omeprazole dose with ćevapčići covered with pepper and carbonated water and took a shot of orphenadrine and tripelennamine in the arse cheek and I felt the pressure on the back of my neck and the first curls of euphoria stealing over me 35 minutes later I thought "O my goodness! It actually works!" Which shouldn't be interpreted as carpe diem if you have a 300-count bottle of 2 mg liquigels in front of you. Look at the above and start much lower because who amongst you has five decades of tolerance in you?
So my experiment with loperamide worked, but I will tell you that I did feel healthier, and quickly, after my first doses back on hydromorphone and nicomorphine. And if you are going to plan a loperamide (or even better difenoxin or diphenoxylate) bridge you probably should start to taper it during the last 30 per cent of it because it does still add to your tolerance, just like anything else. I can also say from earlier experiments with mixing it with other narcotics, like DTO (laudanum) and paregoric with belladonna tincture and morphine mixed with tripelennamine IV confirmed that it may potentiate narcotic analgesics, or just replace the part of a prior dose that was removed. The possibility of it driving up tolerance even more than it might suggest is something that some Bluelighters have reported over the years.
Would I recommend doing any of the above if you have any other choice? Probably not. But they are not giving a lot of people other choices, which is why I decided to kvetch about loperamide. Hopefully you are in a situation when considering this that you can use potentiators to stretch out what you have left of the narcotic you are taking, but problems have a way of sneaking up on everybody when it comes to planning with narcotics sometimes, it seems.
Loperamide will now come in limited-dose packaging
The changes apply to the packaging for tablet and capsule forms of the brand-name OTC antidiarrheal medications Imodium A-D, Imodium Multi-Symptom Relief, and Be Health Loperamide HCI Capsules, according to an FDA safety communication. Each pack will now contain no more than 48 mg of...
So something is up. Part I is a political rant. Part II is a somewhat detailed description of my research, including as a guinea pig.
It is the same pressure groups yelling about kratom, tianeptine, poppy seeds, who want more people paying five and six figures a pop for rehab or dying, and some retailers like Wal-Mart apparently rolled over even harder than that, jacking up the price, putting it behind the counter, which could have a couple of reasons. One article says "Customers buying more than one package . . . that gives pharmacists a chance to have a discussion with them."
No, particularly with what the US and most states and turned the profession into (who can name me a state where the old pharmacist prescribing ability is still in place?), and especially technicians and retail clerks, let me tell you as a longtime member of the brother and sisterhood in a number of capacities that doing such a thing is not your place, and if you do, you will only expose yourself to assault and battery and worsen the Inventory Shrinkage problem that plagues a lot of retailers in general, not to mention that some percentage of your techs and delivery people are going to get sticky fingers too. Maybe, as always the junior detectives amongst your number deserve to be hit in the face with a basket or crutch or cane for messing with customers, but why do you want to make more trouble for yourselves? The customer is always right; before I left the country because of all of this nonsense I always walked around with a cane with a big heavy silver head on it, hard-soled shoes, and at least four to six other people with me sometimes more than 10 and I am sure there are others especially old folks who could also start a nice riot for you.
Why are you people doing the work of the gangsters in the rehab business anyways? What kind of bone have they thrown you? I'm sure pharmacies get ripped off by the manufacturer on Suboxone just like patients do, and do they even let all pharmacies fill methadone for maintenance people? And how can you help them if they are dead? Don't tell me that all hydrocodone going to Schedule II and Darvon disappearing, even tramadol going to Schedule IV from uncontrolled and all of the prescription monitoring database rackets snaring codeine and dihydrocodeine syrup haven't cut into the fun that some of your unwise colleagues used to have diverting those medicines a few tablets or ml or an exempt register 120 ml bottle or four at a time. The new benzodiazepine and gabapentinoid jihad is already starting up . . . some of these bastards even whine about bupropion. What the fuck, as the kids these days say.
At least the prescription monitoring databases give some of your people new opportunities to ask for cash honouraria and handjobs, blowjobs, clit polishing and other fun when it is time to dole out the benzodiazepines, gabapentinopids, buprenorphine, codeine and the like, am I right? The Schedule II stuff too, now that I think of it. You don't want to fall behind doctors and inspectors and people from the prosecutors' offices and even the occasional journalist in getting yours, do you? Durum et durum non faciunt murum -- don't tell me they don't teach that to doctors, dentists, veterinarians, and those in the allied trades, do they? You are part of an honourable ancient iron triangle with doctors and patients, even if the regulators and politicians don't respect you. Or respect the the patients or doctors either. Stand up for yourselves and stop doing the politicians and rehab millionaires and De Sade gangster disciples' dirty work! Every time some politician and local doogooder wants some press it's going to get worse. Somebody has to break the spiral of silence . . .
If you people think all of this is going to give you new power and respect you are sadly mistaken -- just ask the doctors what is happening to them.
Do I even have to mention what the environmentally unfriendly package is doing to the elderly and others with arthritis? Then you have the people who melt the packages with a blow torch. A family or neighbours or bridge club or local political party can have a scissors party and have a bowl of 1000 tablets inside of an hour. So what good has it done?
I feel your anger. I know your dreams. What you have to do is fight back and get the latitude and respect that all of that studying for degrees and licensures should have guaranteed for you, even without decamping to Canada or Europe as at least a few have, not roll over. If I am preaching to the choir, you need to fight back within your professional organisations as well because they have not responded creditably to any of this.
Now, loperamide, which is a 4-phenylpiperidine opioid, a substituted prodine to be specific, with a relationship also to normethadone, a precursor along with norpethidine in the more common syntheses, also has potentially neurotoxic metabolites just like pethidine, and its potential cardiotoxicity at high doses, make for two reasons it is not used clinically for analgesia or stopping withdrawal. Which it does. Since I had an appointment with my cardiologist last week, I decided to try out loperamide for a couple of weeks and I can tell people the following:
It can be made to work in doses that are much lower than the media reports are talking about. After all, when it was first introduced in many markets it was regulated like pethidine (US CSA Schedule II), then codeine (to Schedule V in July 1977) then decontrolled in April 1982. Something is in that arse glue, which is why the rehab gangsters are whining about it.
There really is no need for gobbling 100 and 200 tablets at once which is very dangerous, even if you are going into this from a high dose of another narcotic. The relationship is not linear either, which is why no equianalgesia or equi-counterwithdrawal ratio can be determined. But the "poor persons' methadone" title is apt in that it is possible to build up a serum level which allows for lower doses and/or less frequent dosing later.
The very high doses from gobbling entire economy sized bottles do also increase the chances of paralytic ileus, intestinal blockage, and at a minimum gastric stasis vomiting after a day or more of increasing discomfort, especially with larger tablets like those with carminatives and/or attapulgite in them. They tend to have chalk in them in many cases.
With my fairly high hydromorphone dose supplemented with nicomorphine and Scophedal for breakthrough pain 0 to 2 times a day, I found that 24 tablets or 48 mg every 12 to 18 hours during the first 48 hours, which is the double loading dose that loperamide, difenoxin, and diphenoxylate need when used for diarrhoea, build up a bolus that allowed me to take 32-48 mg once a day for the next five days or so, then even skip days after that, or at least take doses q36h.
Omeprazole did seem to help some, I eat oodles of black pepper anyways on my food and I am sure that helped too, and hydroxyzine worked very well potentiating it, making it possible to use less. Given all the above, it behooves people to start out at just over the anti-diarrhoeal dose and can go up every four hours at the very beginning I suppose, or phase in the loperamide by increasing the dose 10 per cent each time and seeing how much of the other medicine you need to stop the withdrawal; I would start at 25 per cent of the old dose.
If you are going to use loperamide for a shorter period, like three or four days at most, it still does not require a huge dose. A one-off for analgesia or withdrawal-related diarrhoea the same thing. There are some people who when not on other narcotics notice some anxiolysis and analgesia from a single 2 mg tablet.
I must say, I was aware of all the literature going back to the beginning right when Janssen Pharmaceutica invented it as well as diphenoxylate and difenoxin and it went into many markets and knew about the morphine addicted monkeys and other experiments, and I did try it that one time at a high dose and it felt like piritramide but I also had a case of the Fear in the hours afterwards, psychosomatic no doubt . . . So when after I got into Stage II withdrawal and I gobbled the first loperamide, hydroxyzine, and omeprazole dose with ćevapčići covered with pepper and carbonated water and took a shot of orphenadrine and tripelennamine in the arse cheek and I felt the pressure on the back of my neck and the first curls of euphoria stealing over me 35 minutes later I thought "O my goodness! It actually works!" Which shouldn't be interpreted as carpe diem if you have a 300-count bottle of 2 mg liquigels in front of you. Look at the above and start much lower because who amongst you has five decades of tolerance in you?
So my experiment with loperamide worked, but I will tell you that I did feel healthier, and quickly, after my first doses back on hydromorphone and nicomorphine. And if you are going to plan a loperamide (or even better difenoxin or diphenoxylate) bridge you probably should start to taper it during the last 30 per cent of it because it does still add to your tolerance, just like anything else. I can also say from earlier experiments with mixing it with other narcotics, like DTO (laudanum) and paregoric with belladonna tincture and morphine mixed with tripelennamine IV confirmed that it may potentiate narcotic analgesics, or just replace the part of a prior dose that was removed. The possibility of it driving up tolerance even more than it might suggest is something that some Bluelighters have reported over the years.
Would I recommend doing any of the above if you have any other choice? Probably not. But they are not giving a lot of people other choices, which is why I decided to kvetch about loperamide. Hopefully you are in a situation when considering this that you can use potentiators to stretch out what you have left of the narcotic you are taking, but problems have a way of sneaking up on everybody when it comes to planning with narcotics sometimes, it seems.
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I may try it.