Background: Reports of loperamide abuse to achieve euphoric effects have been increasing. In September 2019, the Food and Drug Administration stated that manufacturers will limit package sizes of loperamide to reduce inappropriate use.

Objective: We aimed to characterize pharmacist knowledge of loperamide abuse at the point of retail access and determine what pathways pharmacists have throughout the United States to limit the sale of loperamide packages when abuse is suspected.

Methods: A nationwide telephone survey was conducted until 3 pharmacies from each U.S. state and the District of Columbia were included. Pharmacists in each pharmacy were asked to take a 3 question telephone survey assessing previous knowledge of loperamide abuse, knowledge of how abuse occurred, and ability to restrict suspicious sales. Responses were collected and pharmacists responses to "ability to restrict sale" were characterized into 1 of 8 themes.

Results: A total of 318 pharmacies were contacted, and 153 pharmacies were included. In total, 75.2% (n = 115) of pharmacists reported being aware that loperamide was abused, 24.8% (n = 38) were aware of how abuse occurred, and 30.7% (n = 47) felt they could reduce the quantity purchased or deny the sale if abuse was suspected. Only 3.2% (n = 5) of the pharmacists had placed the product behind the counter or had a purchasable quantity restriction. A total of 20 (13.8%) respondents referenced the inability to oversee purchases elsewhere as a barrier to reducing abuse.

Conclusion: Considerable opportunity exists to educate pharmacists on loperamide abuse at the point of access. Few pharmacies currently regulate its sale, and no regulations exist to prevent purchasing at nonpharmacy outlets. Interested pharmacies can implement policies to reduce excessive access and prevent harm. However, collateral purchasing at other retail stores may still occur without increasing pharmacists' ability to monitor sale.