Opioids include a wide range of drugs ranging from illegal substances, such as heroin and opium, to prescription pain medications like oxycodone, hydrocodone and morphine. All of these drugs share similar characteristics because they stimulate opioid receptors in the body’s nerve cells. Some opioids are much more toxic to the body than others, but all opioids carry some risk of dependency.
Prescription opioids are highly effective at treating pain, and they are harmless if used for a short period of time. Unfortunately, they can also be very addictive, which sometimes causes people to abuse the drugs by taking greater quantities than prescribed or buying them on the black market. Even regular doctor-directed opioid use can lead to dependence. An opioid overdose can be fatal.
Aside from seeking pain relief, many people take opioids for the brief euphoria they can induce. Once a person has become dependent on opioids, they can experience severe and even deadly withdrawal symptoms if they suddenly stop, so medical treatment is often necessary to recover from addiction.
Prescription drug abuse has reached epidemic levels in the U.S. during the past few decades, and heroin use has increased as well. Some medical professionals suspect that prescription opioids have served as a gateway to heroin for many addicts.
What is OIC?
One of the side effects of all opioids is opioid-induced constipation, or OIC. The receptors that opioids bind to in the central nervous system to block pain also happen to be found in the bowels and intestinal tract. Consequently, opioids obstruct the waste elimination process, so chronic constipation can occur. OIC can even continue after opioids are discontinued. Constipation is considered chronic when a person has less than three bowel movements per week for several weeks. Methadone, which is used to treat heroin addiction, can also cause OIC, so chronic constipation remains a problem for recovering addicts. A combination of medications, laxatives and dietary changes can help relieve OIC.
Opioid Abuse Risks
According to the CDC, over 200 million prescriptions for opioids were written in 2010. Nearly 12 million people are estimated to be abusing these medications. Three out of four heroin users admit to previously abusing prescription opioids. The annual number of deaths resulting from opioid overdoses is greater than the number of deaths attributed to all illegal drugs combined.
Short term symptoms of both opioid use and withdrawal commonly include vomiting, diarrhea and delayed reaction time. Long-term consequences of opioid abuse are a suppressed immune system, respiratory issues and other gastric complications in addition to OIC. People who use opioids intravenously are also at risk for abscesses, infections and blood borne illnesses such as HIV.
Chronic constipation, whether opioid-induced or not, carries its own significant health risks.
In addition to discomfort, OIC can lead to hemorrhoids, anal fissures, fecal impaction and rectal prolapse. Left untreated, these conditions can cause infections and drastically affect a person’s quality of life.
Opioid Abuse Treatment
Treatment for opioid dependency must usually begin with a detox to get the drugs out of the patient’s body. Supervision by a medical team is necessary because of the harsh side-effects of withdrawal. Medications such methadone or buprenorphine, which are less toxic opioids, may be prescribed to help with the transition. Medical detoxification is an in-patient procedure due to the safety risks involved.
After successful detox, patients are referred to a residential rehabilitation clinic or an outpatient therapist or support group. The duration and type of treatment will depend on the patient’s level of dependency, their social support network and what is financially accessible.
In-patient rehabilitation programs usually last between 30-90 days and include individual and group therapy. Treatment is focused on identifying triggers for drug use and developing healthy coping skills to avoid relapse. Heavy opioid users may need a more long-term arrangement like a halfway house or a sober living community. Peer support groups that meet regularly can also help recovering addicts stay away from opioids.
Realizing that prescription opioid use often leads to illegal drug abuse, some hospitals are now taking precautions to help ween patients off of opioid painkillers. Interventions for preventing opioid dependency include a combination of physiotherapy, counseling, meditation and acupuncture.
Whether someone takes oxycodone for pain or heroin for pleasure, they are likely to experience OIC. As discussed above, OIC can continue even after a person stops taking opioids, and drug treatments like methadone can make OIC worse. Below are some dietary suggestions and behavioral strategies that may assist the bowels:
Exercise: Physical activity helps activate the lymphatic system, which in turn stimulates the intestinal tract. Endorphins released during exercise also act as a natural pain reliever.
Herbal Cleanses: Plant-based laxatives like triphala or detox teas can be found at most health food specialty stores.
Probiotics: Probiotics are supplements containing bacteria cultures that promote digestion and elimination. There are many different types of probiotics, so patients should consult with a medical professional if possible and only use probiotics as directed.
Fresh Juices: Fruits and vegetables contain many of the nutrients the body needs to regulate bowel functions. Making homemade juice can be messy and time consuming, but canned or bottled juices are not an adequate substitute for freshly processed fruits and vegetables. Commercial juicing removes many parts of the plants, which means that vitamins and nutrients get lost in the process. Anything that adds fiber to the diet is also likely to be beneficial.
Enemas: Enemas are the oldest treatment for constipation. Over-the-counter enemas are inexpensive and easy to use. They work by pushing water into the rectum to create pressure and force out feces. Colonic irrigation, which is a more complex procedure performed by a medical professional, may also help chronic constipation.
Get Comfortable: Stress doesn’t help constipation, so getting comfortable is a prerequisite to having a successful bowel movement. Some people just need extra time and privacy, so those suffering from OIC should make their bathrooms into a place they are OK sitting for an hour or so if they need to.
Medications for OIC
To preempt OIC, some doctors often prescribe laxatives or cathartics for a patient whenever they prescribe opioids. Cathartics speed up bowel movements, and laxatives make defecation easier by softening feces. Some medications have both laxative and cathartic properties. Medical treatments that are commonly used to alleviate OIC include: osmotic laxatives, which increase the volume of water in the intestinal tract; emollient cathartics, which lubricate stools allowing for easier evacuation; stimulant cathartics, which promote intestinal activity; and prostaglandins drugs, which alter how the intestines absorb electrolytes to increase the bulk and frequency of bowel movements. There are also drugs that prohibit interactions between opioids and receptors in the bowels.
In 2015, the U.S. Food and Drug Administration approved a new medication to treat OIC called Movantik. Movantik caused controversy in early 2016 when an advertisement for the drug aired during the Superbowl. Some politicians and other public figures expressed concern that promoting drugs for OIC also promotes opioid abuse. Considering that the U.S. has an exceptionally high rate of prescription opioid abuse, their worries are not unfounded. Many addicts use products for treating OIC while also abusing opioids; however, such drugs may also help recovering addicts and patients who are in pain mitigate the side effects of opioid withdrawal and improve their quality of life.