Loperamide is an over-the-counter anti-diarrhoeal agent. In supratherapeutic doses, loperamide penetrates the blood-brain barrier, exceeds the efflux capacity of P-glycoprotein and binds to central opioid receptors. We report a case of a 33-year-old woman with a history of opioid abuse, who had a long-term excessive daily intake of loperamide in order to achieve a euphoric effect. Cardiac arrhythmias, respiratory depression and death have been reported in relation to excessive loperamide use.