BERGEN COUNTY — He didn't think it would come to this.

He stood in front of the mirror and looked at himself: 22 years old and addicted to anti-diarrhea medication.

It sounded funny — he knew that. If he were using the medication for its intended purpose, one box of Imodium, which has 24 tablets, would be more than enough. But he wasn't using it to treat a bathroom problem.

He'd break the seal of the blue-and-white box and down its contents in one sitting. Minutes would pass. Then a gut-clenching constipation would set in, accompanied by a certain heaviness in his legs and an uncomfortable itch in his back.

Then, slowly, he would feel the dull, but fairly satisfying, tingling sensation he sought.

Loperamide, the active ingredient in Johnson & Johnson's Imodium A-D, is meant to be taken in dosages of two to four milligrams. When ingested in megadoses — for some, up to 24 times the minimum dosage — it induces a weak high.

Its opioid-like properties were the reason the U.S. Food and Drug Administration categorized it as a controlled substance until 1988, putting it on par with codeine and methamphetamine.

Casual drug users who might experiment with it would be unlikely to experience any perceptible high. But to an opioid addict, the high is just strong enough, and familiar enough, to quell some withdrawal symptoms.

The dangers of bingeing on loperamide have been noticed by the U.S. Food and Drug Administration, which issued a safety alert this past June to warn that large doses of the medicine could cause serious heart problems.

There is some evidence of its growing prevalence, including a jump in calls to poison control hotlines about it. Hard numbers, however, are scarce or non-existent.

In drug use and treatment circles, Imodium and chemically similar anti-diarrheal medications are colloquially called the "poor man's methadone," the prescription substance used by addicts suffering through withdrawal.

Some use the pills to taper off dependency, experts say, while others may use it as a halfway measure to get high.

There are scattered reports of loperamide abuse in New Jersey – side effects of the state's well-documented heroin and prescription abuse epidemic.

Altogether it reflects a larger problem with widespread opioid addiction and the availability of treatment, said Dr. Anthony Kolodny, a national prescription opioid and heroin expert and founder of the Phoenix House, a chain of rehab centers in 12 states.

"If they're addicted and treatment is too difficult to come by, they will do whatever they can to get that opioid effect," he said.

For severe addicts looking to get clean with paltry funds, no insurance, and a criminal record, the chance of securing a bed in a coveted inpatient unit is slim. In such cases, Imodium can become a risky home remedy for tapering off opioids.

The former loperamide addict, now 27, said he tried Imodium with some trepidation for the first time five years ago. He asked that his name be withheld to respect his privacy.

"The recommended dose is 2 to 4 milligrams," he said. "I took about 40 milligrams."

Eventually, he said he raised his intake to 48 milligrams a day, or 24 tablets a day, and ingested around four value-sized boxes of Imodium a week.

"I was to the point that I was hopping from supermarket to drugstore to steal boxes of the stuff," he said.

The effect was subtler than his highs with heroin or Percocet, he said. But it was enough to feel a slight, somewhat pleasant tickle, and as a long-term opioid addict, that was all he needed.

He said his drug use began when he was in his teens, when he and his girlfriend at the time experimented with Percocets prescribed to her mother for a shoulder injury.

A year later, he said, he was taking them every day.

"At this point I know what's going on, but I'm too deep into it," he said. So he remained quiet. He finished high school and enrolled in the biology program at Penn State in 2007.

Once at college, he said, his main focus was on getting pills.

He sold marijuana, which he had started smoking at 15, to finance his Percocet habit. He stopped going to class when the money from selling drugs became too tantalizing.

Two years into college, he flunked out, and he returned to his family's home in New Jersey – just in time for the start of the suburban heroin craze.

"Everyone was going down that path and doing heroin because it was a lot cheaper," he said.

Not too long after returning home, he said he started using heroin with his girlfriend from high school.

The first year was a whirlwind of drug-related problems: He became addicted to heroin, and he and his friends were arrested for drug activity.

Within two years, he was homeless.

"I was kicked out of my house. Girlfriend gone. I had (expletive)-d everything up."

Eventually he checked into treatment, was released, and remained sober for a couple of months. He was living with his family again.

But he longed for a high – even a mild one. Then he found a loperamide thread on an online drug message board.

He had heard about loperamide a few years before, he said, but he had never tried it. All he needed to do was find some Imodium.

It was easy: There was a store a block from his house.

He soon was tearing through boxes a day, he said, coupling it some days with alcohol and marijuana. For some months at a time, he used harder opioids in lieu of Imodium.

"I was a hardcore, in-the-dumps junkie," he said. "I didn't give a (expletive) about the social stigma of diarrhea medication. And the fact that it's a dirty, (expletive)-y high."

When he would take breaks from the loperamide, he said the physical withdrawal symptoms were more intense than he anticipated. There weren't many mental withdrawal symptoms, like with other opiates, but the physical symptoms were just as painful.

"You start sweating — and this is about 24 to 48 hours after your last dose. You start sweating, your pupils get huge - everything consistent with opiate abuse," he said. "It's just as bad as any other opiate withdrawal, even though it's not as intense as other highs."

The addiction went on for a year-and-a-half, he said. On days when he took a megadose, he'd have no bowel movement, yet also said he suffered no long-term health complications from the drug.

Using loperamide was expensive, at $12.99 for a box of 24 tablets, compared to $3 or $4 for a bag of heroin in Paterson, but it was enough to keep him satiated.

"It's a dirty, poor man's way to get by," he said. "That's really what it is. But it works."

The addiction ended abruptly when he was arrested for stealing a car and driving it to Vermont, as well as for manufacturing counterfeit concert tickets, and possessing drugs. He was sentenced to prison in 2011, according to public records, and released last August.

When loperamide is taken in its recommended dosage, it safely and effectively treats diarrhea, said Marc Boston, a spokesperson for Johnson & Johnson, the company that manufactures Imodium.

Loperamide binds to opioid receptors in the gut wall and increases the tone of the anal sphincter. When used in small amounts, it is impossible to get a high. In megadoses, loperamide overwhelms the blood-brain barrier, the filter that insulates the brain and spinal cord from alien material, and produces feelings that could be identified as euphoria or relief from pain.

"As with any medicine, abuse or misuse can lead to serious side effects, and consumers should always read and follow the Drug Facts label for Imodium before taking the medication. We support the FDA's effort to raise awareness among consumers and health care professionals about the safe use of loperamide and all medicines," Boston said.

There is some debate about whether all anti-diarrheal medications should be prescription grade. Currently, there are over-the-counter versions of the medication, such as Imodium A-D, and prescription-strength versions of Imodium.

A report in a clinical toxicology journal described a 28-year-old man hospitalized for losing consciousness due to low blood pressure and an irregular heartbeat after ingesting 396 tablets of 2-milligram loperamide daily, totaling to more than 792 milligrams.

Similar reports exist for patients who abused anywhere from 35 to 100 anti-diarrheal tablets a day. All three people survived.

For addicts, they'd rather risk the chance of death than experience withdrawal, said Kolodny, the addiction treatment expert.

"Once you are opioid addicted, once you run out, it's not like experiencing the flu," he said. "It feels like a panic attack. You feel like you're going to die."

It's an unexceptional two-story home in an ordinary, tree-lined suburban neighborhood in late July - and the former loperamide addict is fine with that.

His life is "pretty regular," he said. "I live a pretty normal life. I have a girlfriend."

He said he's between jobs, and he's working to pay off traffic and prison fines and school loans. He hasn't touched loperamide since he left prison.

"I'm doing all right."

Katie Park may be reached at kpark@njadvancemedia.com. Follow her on Twitter@kathspark. Find NJ.com on Facebook.