title: Lomotil (diphenoxylate) dependence in India.
abstract: BACKGROUND
  Lomotil (diphenoxylate atropine combination) has been in use as an antidiarrhoeal agent. Due to presence of opioid (diphenoxylate), there are chances of abuse. The reports of abuse of lomotil have been few in published literature. This chart review aimed to evaluate the characteristics of patients with dependence on lomotil coming to our centre.
  
  
  METHODS
  This retrospective chart review was conducted at the Drug De-addiction and Treatment Centre of PGIMER, Chandigarh, India. The records of patients who had presented to the centre with dependence on Lomotil in the last five years were identified, and clinical details were extracted from the records.
  
  
  RESULTS
  We identified 41 patients who had presented to our centre with dependence upon lomotil as the primary substance of abuse. The cases were typically married and employed males, educated up to 10(th) grade, belonging to a rural Sikh extended or joint family. Most of the patients had taken other opioids too. The number of tablets taken in a day varied from 3- to 250 (median 25). The reasons of initiation were to relieve withdrawals, as a cheap substitute opioid, curiosity, and on suggestion of friends.
  
  
  CONCLUSIONS
  Lomotil is a medication with a potential of abuse and regulatory controls are required to prevent escalation of misuse of this easily available prescription drug. Lomotil (diphenoxylate and atropine combination) has been used since a long time as an anti-diarrheal agent. Reports of abuse of diphenoxylate had surfaced. We present a series of 41 cases of opioid dependence presenting with the use of the diphenoxylate as the primary substance. The cases were typically married and employed males, educated up to 10(th) grade, belonging to a rural Sikh extended or joint family. Most of the patients had taken other opioids too. The number of tablets taken in a day varied from 3 to 250 (median 25). The reasons of initiation of diphenoxylate were to relieve withdrawals, as a cheap substitute opioid, curiosity, and suggestion of friends. Regulatory controls are needed to prevent escalation of use of this easily available prescription opioid.
authors.affiliation: Department of Psychiatry, Level 3, Cobalt Block, Nehru Hospital, PGIMER, Chandigarh, India.
authors.forename: Aseem
authors.initials: A
authors.lastname: Mehra
authors.forename: Siddharth
authors.initials: S
authors.lastname: Sarkar
authors.forename: Debasish
authors.initials: D
authors.lastname: Basu
keywords: Dependence; India; diphenoxylate; lomotil; opioids