Abstract
: Current data suggest that the opioid epidemic represents a worsening problem in the United States. However, prescribing rates of opioids have been steadily declining, suggesting that alternative opioids are becoming a major contributor to this crisis. One medication that has shown an increase in nonmedical use is loperamide. Loperamide is a peripheral mu-opioid agonist that is intended to be used for diarrhea. However, when taken at high doses and/or in combination with P-glycoprotein inhibitors, it acts centrally by penetrating the blood-brain-barrier. Loperamide crossing the blood-brain-barrier results in similar central nervous system depression as other opioids. Loperamide's over-the-counter availability and growing media presence has resulted in more cases of loperamide substance use disorder, predominantly to minimize opioid withdrawal symptoms and to produce a euphoric state. This case series presents 3 patients with loperamide-associated opioid use disorder who have been successfully treated with on-going buprenorphine treatment. To our knowledge, this is the first case-series to explore long-term buprenorphine treatment for loperamide use disorder. Our findings suggest that buprenorphine can be used for loperamide us...Continue Reading
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