How bad’s the opioid crisis? It may curb purchases of familiar diarrhea remedy

immodium-300x169The opioid epidemic has become so pernicious that it can be exhausting to even try to see its expansive harms. But it’s crucial to keep confronting the many ways this lethal scourge affects Americans and their lives, if only to hope that politicians, policy-makers, doctors, hospitals, and many others get off their duffs and do something about it.

This crisis — which includes more than 64,000 overdose deaths in 2017 alone — has reached in a surprising new way into many households’ medicine cabinets. It’s not due to potential abuses of potent pain-killers that many may have stashed there. Nope, now federal officials are fretting about the current dosages of the key ingredient in common, over-the-counter anti-diarrhea medications like Imodium.

It turns out that the substance known generically as loperamide, useful in stopping the runs, happens to be part of the opioid family, an addictive drug class that includes morphine and oxycodone. Drug users have turned now to abusing anti-diarrhea meds, which are sold in high-count packages and at dosages that authorities want reduced.

Stat, the online health information news site, reported that officials want voluntary maker “sales restrictions on [loperamide] similar to [those for] pseudoephedrine, the decongestant in Sudafed that can be processed into methamphetamine. Pharmacies now keep Sudafed and related medicines behind the counter and limit purchases. But such restrictions generally require changes to federal law from Congress.”

Johnson and Johnson, Imodium’s maker, hasn’t said if it will comply with the request from the federal Food and Drug Administration.

Meantime, other drug makers and suppliers, and separately, even the U.S. Postal Service, are catching heat for their roles in the opioid drug epidemic.

To its credit, a small Charleston, W. Va., newspaper that has been at the fore in covering the opioid crisis in its state has followed up with congressional investigators. They are demanding to know why Miami-Luken and H.D. Smith, two regional drug wholesalers, shipped 20.8 million prescription painkillers to two pharmacies four blocks apart in a southern West Virginia town with 2,900 people. The supplies of hydrocodone and oxycodone — two powerful painkillers — flooded the town of Williamson, in Mingo County.

Company employees also blew the whistle on purported pain doctors who were prescribing big shares of the tidal wave of Oxycodone (sold under the brand names  OxyContin and Percocet) and hydrocodone (Vicodin and Lortab) washing over the poor, rural area.

The companies say they have received communications from the federal investigators about the unchecked flow of their drugs and are still researching what happened. They have promised a reply.

Alas, it may come too late for the readers of the plucky Gazette-Mail, which has broken some shocking and important stories on how West Virginia has been staggered by the opioid drug abuse epidemic. The paper, like many across the country, has struggled with the economics of covering the news in the free information Internet age. It has declared bankruptcy and announced its impending sale.

As for opioids’ sale, congressional investigators also have been busy on that front, finding how shockingly easy it can be to buy prescription as well as illicit painkillers and more potent drugs on the Internet from foreign makers — especially in China — and  to get them delivered by the international arm of the USPS. The cyber-savvy, of course, also are tapping bit coins, the trendy and hard to comprehend payment means for their illegal trafficking.

Critics fault the postal service because, as the congressional staff found, drug abusers prefer to use it because, unlike private shipping companies, USPS does not “collect advanced electronic data, a bar code with information about the sender, the recipient, and what is in the package,” Vox, the online information site reported. Some lawmakers want to require the service to do so, but there are international treaty and cost obstacles before this can occur.

In my practice, I see the major harms that patients suffer while seeking medical services and the big damages that can be wreaked on them by dangerous drugs, including prescription painkillers, heroin, and fentanyl. As a nation, we must start addressing the opioid crisis by coming to grips with what Consumer Reports rightly calls our “love affair” with pills. This sick relationship is fostered no doubt by billions of dollars in marketing and advertising spending by Big Pharma, targeting consumers as well as medical providers.

It’s good to see media organizations, congressional staff, and agencies like the FDA take their singular and even sustained actions about this huge health bane. It’s an issue, however, in which Big Pharma, doctors, hospitals and the medical establishment, along with the federal government, must step up and do much, much more. As the Economist has pointed out, this crisis is fueled not just by demand (for which doctors and hospitals must share blame) but also by supply (for which Big Pharma should hang its head in shame).

The Trump Administration has failed on its repeated promises to develop and execute an all-out campaign to curb this epidemic’s harm, appointing a disappointing “blue-chip panel” to provide recommendations that haven’t gone anywhere and failing to fund or to support proven anti-opioid efforts. I’ve written separately about how unhelpful it has been that top health policy leaders in this administration — at the Health and Human Services (HHS) department and now the Centers for Disease Control and Prevention — also appear to have been poorly vetted and then to have immolated their professional standing with unacceptable ethics lapses.

The president has praised newly nominated and confirmed HHS chief Alex Azar and challenged him to tackle the opioid drug crisis and skyrocketing prescription drug prices. To succeed with these formidable goals, Azar — a lawyer, former HHS bureaucrat and a drug industry executive — will need to crank up the heat on Big Pharma.

But, as Kaiser Health News has found, he is but one of hundreds of Washington insiders who spin in a career revolving door, moving between health care companies, congressional staff posts, and jobs in federal agencies overseeing various aspects of the industry. As the nonpartisan, independent KHN reported of this crowd, including Azar:

Nearly 340 former congressional staffers now work for pharmaceutical companies or their lobbying firms, according to data analyzed by KHN and provided by Legistorm, a nonpartisan congressional research company. On the flip side, the analysis showed, more than a dozen former drug industry employees now have jobs on Capitol Hill — often on committees that handle health care policy. ‘Who do they really work for?’ said Jock Friedly, Legistorm’s president and founder, who called that quantity ‘substantial.’ Are they working for the person who is paying their bills at that moment or are they essentially working on behalf of the interests who have funded them in the past and may fund them in the future?

The nation has pressing, even dire needs for effective ways to deal with our drug problems. We must demand more from the people we have put in offices to take on this huge task.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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