It is hard to believe that people will chug down 30 or 40 or more anti-diarrhea pills to get high, but it’s true. Common drugs for diarrhea contain diphenoxylate, a substance very similar to the narcotic painkiller Demerol. People who are addicted to illegal narcotics or narcotic prescription painkillers turn to diarrhea drugs when they want to experiment with something new or when they cannot get their drugs of choice. A major problem with drugs that contain diphenoxylate is they are relatively easy to obtain by simply scheduling a doctor’s visit and asking for them by name.
In order to get around the addictive quality of these diarrhea drugs, their manufacturers add an anticholinergic designed to make people sick to their stomachs. The thing is most people don’t get sick. Instead, the main deterrent to addiction to drugs containing diphenoxylate is that they are expensive.
What is Lomotil?
Lomotil is a medicine prescribed to control diarrhea. It has two active ingredients: diphenoxylate, which is a narcotic, and atropine, an alkaloid made from belladonna and other plants.
Diphenoxylate works by slowing the contractions and wavelike movements of the intestine.[i] It is chemically similar to meperidine, an opioid painkiller commonly known by the trademarked name Demerol.[ii] Diphenoxylate metabolizes into difenoxin, which works on the opioid receptors in the brain, spinal cord and intestines.
Atropine is an anticholinergic or a drug that blocks the passage of impulses through the parasympathetic nervous system. This system is involved in the bodily functions of salivation, tears, urination, digestion and defecation. Atropine relieves spasms in the gastrointestinal tract and helps control diarrhea by drying up bodily fluids.[iii] Because it can produce nausea and weakness, atropine is sometimes put into opioid products as a way to discourage addiction.
The United States federal government classifies diphenoxylate as a Schedule II Controlled Substance, defined as one that is highly addictive but with some medical uses. Diphenoxylate is a narcotic like meperidine, oxycodone, and other Schedule II substances. If you are caught selling or possessing diphenoxylate without a doctor’s directive, you can incur some of the severest fines and penalties under drug laws. When diphenoxylate is combined with atropine, the government classifies it as a Schedule V Controlled Substance, which means it is only somewhat addictive and has medical uses. Lomotil and other combinations of diphenoxylate and atropine are available by prescription only.[iv]
The chemical name of diphenoxylate is ethyl 1-(3-cyano-3,3-diphenylpropyl)-4-phenylpiperidine-4-carboxylate
What are the Medical Uses of Lomotil?
Lomotil has been prescribed for diarrhea for decades; in fact, President John F. Kennedy and the Apollo Space Team used it back in the 1960s.[vi] It probably does not work for Irritable Bowel Syndrome, and it can worsen “traveler’s diarrhea,” a condition that affects between 40% to 60% of visitors to countries in the Third World.[vii]
Lomotil comes as a liquid, which you take through a dropper, or in tablet form. At first you usually take it three to four times a day, and it should stop diarrhea within 48 hours.[viii] Then you taper off to once a day.[ix] One tablet and 5 ml of Lomotil liquid each has 2.5mg of diphenoxylate and 0.25 mg of atropine.[x]
The highest dose typically used is 40 to 120 tablets for 40 to 70 days. Taking more can cause addiction.[xi]
What Drugs Interact with Lomotil?
Combining Lomotil with monoamine oxidase inhibitors (MAO’s) such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane) can cause severe high blood pressure and lead to a stroke.[xii] Lomotil reacts with potassium, clorgyline, digoxin, furazolidone, moclobemide, nialamide, pargycine, rasagiline, selegiline, tapentadol, and toloxatone.[xiii] Atropine reacts with belladonna, beztropine, dramamine, pamine, digoxin, mepenzolate, mepenzolate, and medications for urinary and bladder problems.[xiv]
Because Lomotil contains an opiate, you should not take it with other medications that slow the central nervous system, such as drugs for allergies and colds, sleeping pills, tranquilizers, seizure medications, muscle relaxants, antihistamines, barbiturates, sedatives, and anesthetics.[xv]
What are the Side Effects of Talking Lomotil?
When taken as prescribed by a doctor, Lomotil can cause drowsiness, dizziness, headaches, blurred vision, dry mouth, and loss of appetite or anorexia.[xvi] You should stop using Lomotil if you experience any of the following serious side effects: stomach pain, bloating, watery or bloody diarrhea, depression, numbness in arms and legs, confusion, unusual thoughts, fast heart rate, severe nausea, vomiting, shortness of breath, depression, swollen gums, restlessness, tremors, and problems in urination.[xvii]
What Are the Risks of Taking Lomotil?
If you take Lomotil on a long-term basis, you can become addicted to it. You will develop a tolerance for its effects and need to take more in order to achieve the effect you want. Your physical dependency on Lomotil will include cravings for the drug and a withdrawal syndrome when you stop using it. Doctors do not usually prescribe Lomotil to patients with histories of drug abuse or alcoholism because it is addictive.
Although frequently prescribed, Lomotil can cause fatal overdoses. One warning on the label says, “Lomotil is not an innocuous drug and dosage recommendations should be strictly adhered to. Overdose may bring death or permanent brain damage.”[xviii]
A few people are allergic to Lomotil and experience a life-threatening syndrome that might include hives, rashes, swelling of the face and lips, difficulty breathing, itching, and other symptoms of anaphylaxis. They should be treated in an emergency medical facility.[xix]
Will Lomotil Show up on Urine Tests at Work and School?
Lomotil does contain an opiate which can be detected in urine tests eight to 24 hours after taking it. It can show up as a false positive for Demerol, depending on how much you took. It will show up in hair follicle tests for 90 days and tests using saliva for one to two days.
Who Should Not Take Lomotil?
Doctors usually do not prescribe Lomotil to patients with histories of alcoholism or drug abuse, colitis, Down syndrome, dysentery, emphysema, asthma, bronchitis, enlarged prostrates, liver diseases, thyroid problems, gallbladder disease, glaucoma, heart disease, high blood pressure, intestinal blockages, kidney disease, hiatal hernia, or myasthenia gravis.[xx]
Since children can be overly sensitive to Lomotil, it is not usually prescribed to them. Geriatric patients can experience shortness of breath and difficulty breathing after taking Lomotil. Lomotil is not usually prescribed to pregnant women.[xxi]
What is Lomotil Overdose?
This drug can be toxic at 75mg to 100mg. Symptoms of an overdose are constipation, convulsions, respiratory depression, hallucinations, coma, flushing, drowsiness, difficulty in urination, pinpoint pupils, shortness of breath, dryness of skin and mucus, and fast heart beat. The person may stop breathing. Lomotil overdoses can occur 12 or more hours after taking the drug. The usual treatment is to induce urination, pump the stomach and to administer laxatives, charcoal, IV fluids, and/or opiate antidotes such as naloxone. Most people recover within 24 to 48 hours. The majority overdosing on Lomotil have combined it with alcohol or other central nervous system depressants.[xxii]
What is Lomotil Withdrawal?
Lomotil withdrawal is a syndrome that can occur when you stop taking Lomotil. It will only happen if you have been abusing it, taking it a long time, or taking it in amounts not recommended by doctors. Withdrawal can be very unpleasant for any opiate drug, including Lomotil.
The first withdrawal symptoms might be agitation, anxiety, muscle aches, eyes tearing, insomnia, runny nose , sweating and yawning. Later symptoms are diarrhea, abdominal cramps, dilated pupils, nausea, and vomiting. The legs of some people in withdrawal will shake, and some get goosebumps — this is where we get the terms “kicking the habit” and “going cold turkey.”
If you undergo withdrawal with medical supervision, your doctor may administer certain drugs like clonidine, which can alleviate your symptoms, and Subutex, which can shorten withdrawal time.[xxiii]
What is Lomotil Abuse?
Atropine, an ingredient in Lomotil and similar drugs for diarrhea, is supposed to prevent people from becoming addicted to them because it causes headaches and nausea. Apparently, not enough atropine is in these drugs to achieve this purpose. As Dr. Jonathan Rubinstein wrote in his study of Lomotil addiction, “Doses of less than 2mg of atropine are unlikely to produce any clinically significant dysphoric effects — even 60mg of Lomotil would not do it.” A Lomotil pill contains only 0.25mg of atropine. People extract diphenoxylate by various methods in order to bypass the atropine in Lomotil and similar pills.
Addicts who typically take 20 or 30 or more pills at a time claim they do not get sick. The effects of Lomotil at such high levels can be an euphoria that lasts several hours, and that is similar to the states caused by heroin, oxycodone and other strong opioids. At these high levels, Lomotil can cause also giddiness and hallucinations, blurred vision, fast heart beat, loss of balance, photophobia, and nausea. Too much Lomotil also causes severe constipation and extreme dry mouth.
Addiction to Lomotil is possible after long term use. Dr. Rubenstein studied a 32-year-old former heroin addict who was taking 60 to 100 Lomotil pills with alcohol to achieve euphoria. The highest number of Lomotil pills he took at one time was 140. What Dr. Rubenstein found remarkable was how easy it was for this person to acquire Lomotil prescriptions from physicians without their questioning him. Dr. Rubenstein did an informal survey of 20 doctors, all of whom said they prescribed Lomotil occasionally or often, and yet only six of them knew it was a narcotic.
“One must question the clinical sagacity of prescribing an opiate drug before less hazardous drugs have been given an adequate trial,” he concluded in his study.[xxiv]
What Treatments Are Available for Lomotil and Other Prescription Drug Abuse?
Withdrawing from Lomotil on your own is not only unpleasant, it can also be dangerous. You can accidentally die from aspiration, which means breathing in the contents of your stomach into your lungs. Vomiting and diarrhea could cause a dangerous disturbance of your electrolyte balance. Also, many people who withdraw on their own return to drug use, and most fatal overdoses occur when such people go back to using narcotics.[xxv] It is safer to undergo withdrawal in a medical facility, such as a residential treatment center for drugs or a hospital clinic, where you also can be taught how to live without drug use.
Residential treatment has the highest success rate for recovery from drug addiction. Most abusers of Lomotil are addicted to other narcotics, barbiturates, alcohol and/or sedatives. These pain relievers also numb “psychic pain” from undiagnosed psychological problems such as depression, posttraumatic stress syndrome, childhood trauma, and so forth. The majority of people in rehab have these “comorbidities,” which are addressed as separate problems. In other words, drug addicts need to be treated in a holistic manner, and not just as drug addicts.
In order to recover from your addiction, you need to change your entire lifestyle. Sometimes that means letting go of certain people and changing your career path. In order to achieve this, you will need a lot of help from professional counselors. In a residential treatment center, you have your own personal psychotherapist, and you also participate in group and family therapy. Activities designed to increase your physical fitness, and to help you get in touch with your emotions through art, drama and music are also components of any state-of-the-art program. When you return home, you usually remain in an aftercare program that includes continued psychotherapy and support, and attending self-help meetings in your local community.
How Can I Tell If I Am Addicted to Lomotil and Other Prescription Drugs?
If you can answer yes to any of the following questions, it may be time to discuss your drug problem with an addiction specialist or your family physician.
· Are you using Lomotil along with other drugs?
· Are you lying to doctors in order to obtain Lomotil?
· Does your drug abuse interfere with your functioning at work or school?
· Do your family members and friends criticize you for using drugs?
· Have you tried to quit using drugs but failed?
· Do you find it hard to go more than a day or two without drugs?
· Do you feel guilty or ashamed about your drug use?
· Do you have trouble with certain side effects of drugs, such as constipation?
· Do you spend too much time thinking about, obtaining and using drugs?
· Do you feel as if your life is going nowhere because of your drug use?
· Are you afraid you will be arrested or face other legal consequences because your drug use?
· Have you ever driven under the influence of drugs or otherwise endangered yourself physically, because of drugs?
[i] “Diphenoxylate,” Medline, The United States Library of Medicine, see http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601045.html
[ii] Rubinstein, Jonathan. (MD) “Deliberate Abuse of Diphenoxylate,” Western Journal of Medicine, 1979 August; 131(2): 148–150.
[iii] “Atropine,” Drugs.com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/mtm/atropine.html
[iv] “Code of Federal Regulations, Schedule V, Section 1308,” The United States Drug Enforcement Agency, see http://www.deadiversion.usdoj.gov/21cfr/cfr/1308/1308_15.htm
[v] “Lomotil,” The RX List, see http://www.rxlist.com/lomotil-drug.htm
[vi] Altman, Lawrence and Todd Purdum. “In JFK File, Hidden Illness,” The New York Times, November 17, 2002.
[vii] “Travelers Diarrhea,” The New York Times Health Topics, see nytimes.com
[viii] “Diphenoxylate,” Medline, The United States Library of Medicine, see http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601045.html
[ix] “Lomotil Medical Facts,” Drugs.com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/mtm/atropine.html see http://www.drugs.com/mtm/lomotil.html
[x] Pfizer Pharmaceuticals, Lomotil, see http://www.pfizer.com/products/rx/rx_product_lomotil.jsp
[xi] “Lomotil,” The RX List, see http://www.rxlist.com/lomotil-drug.htm
[xiii] “Lomotil Medical Facts,” Drugs.com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/mtm/atropine.html see http://www.drugs.com/mtm/lomotil.html
[xiv] “Atropine,” Drugs.com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/mtm/atropine.html
[xv] “Lomotil Medical Facts,” Drugs.com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/mtm/atropine.html see http://www.drugs.com/mtm/lomotil.html
[xvi] “Side Effects of Lomotil,” The RX List, see http://www.rxlist.com/lomotil-side-effects-drug-center.htm
[xvii] “Lomotil Medical Facts,” Drugs.com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/mtm/atropine.html see http://www.drugs.com/mtm/lomotil.html
[xviii] “Lomotil: Warnings and Precautions,” The RX List, see http://www.rxlist.com/lomotil-drug/warnings-precautions.htm
[xx] “Lomotil Medical Facts,” Drugs.com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/mtm/atropine.html see http://www.drugs.com/mtm/lomotil.html
[xxii] Lomotil Overdoses, The New York Times Health Topics, see nytimes.com; and “Lomotil Overdose,” The RX List, see http://www.rxlist.com/lomotil-drug/overdosage-contraindications.htm
[xxiii] “Opium Withdrawal,” Pub Med, The United States Library of Medicine, see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001945/
[xxiv] Rubinstein, Jonathan. (MD) “Deliberate Abuse of Diphenoxylate,” Western Journal of Medicine, 1979 August; 131(2): 148–150.
[xxv] “Opium Withdrawal,” Pub Med, The United States Library of Medicine, see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001945/