Opioid Induced Constipation & The Undignified Big Pharma Response

Last Sunday, like millions of other people, I watched Superbowl 50. As usual, there were some great commercials throughout the game. However, I can’t forget one commercial from the 2nd quarter. Not because it was funny and creative like most of them were, but because of the targeted medical condition: opioid induced constipation (OIC). The reason I can’t forget it was how embarrassed I felt as my friend with whom I watched the game laughed at the inappropriate humour the pharmaceutical company used to promote its product. For those of you who don’t suffer from chronic pain or have never had the need to take opioid (narcotic) pain medications for pain relief, I assure you this condition is a real thing. The Australian Pain Society states, One of the most common adverse effects of chronic opioid therapy is constipation. Up to 95% of patients prescribed an opioid report constipation as a side effect, which can occur soon after taking the first dose.”

Opioid induced constipation is also known as opiate bowel dysfunction (OBD); and according to the American College of Gastroenterology “constipation may be debilitating among those who require chronic analgesia [pain relief]. OIC/OBD affected an average of 41% of patients taking an oral opioid for up to 8 weeks.”   The reason for this is that “opioids cause constipation by binding to specific receptors in the gastrointestinal tract and central nervous system, resulting in reduced bowel motility through direct and indirect (anticholinergic) mechanisms.”  In short, the opioid pain medications delay or block messages throughout the body that tell you when you need to empty your bowels.

I understand that a commercial’s purpose is to grab its audience’s attention in a short time. However, the tone of this commercial failed to convey the seriousness of this condition, while using lowbrow humour to flog the product. Practical Pain Management, a publication founded and written by pain experts, notes that although opioids have been in use for centuries; it’s only in recent decades that this kind of medication has received any significant attention and investigation. Sadly, we are only beginning to understand and identify the many side effects of opioids. Constipation, nausea, emesis, pruritus, respiratory depression, and somnolence are well known. However, not so well known are effects on immune function, urinary retention, endocrinopathies, gastroesophageal reflux (GERD), gastroparesis, sleep apnea, cardiovascular system, osteoporosis, emotions, dentition, and renal function.”

This lack of knowledge about opioids begs the question, how many people know that if a patient that has OIC/OBD does not receive the proper medical treatment it “may cause rectal pain and bleeding, abdominal pain and distension, urinary incontinence, faecal impaction, rectal tearing, and, in very severe cases, bowel obstruction and colonic perforation?”  How aware are people that OIC/OBD can reduce a person’s quality of life as much as the chronic pain doctors prescribe the opioid medications to treat? The Australian Pain Society also notes that, Some patients would rather endure chronic pain than suffer from the severe constipation that can arise with long-term opioid therapy. One study found that approximately one-third of patients missed, decreased or stopped using opioids in order to make it easier to have a bowel motion; the majority (86%) of these patients experienced increased pain as a result, which reduced their quality of life. Reducing the opioid dose is not considered useful, as analgesia [pain relief] may be compromised and constipation may not resolve.”

I know that 30 seconds isn’t a long time and not all the points I raise most likely could have been touched on in that amount of time. However, I do know that the pharmaceutical company could have approached this issue in a more dignified way. When the commercial ended – and my friend’s laughter died down –, I did educate him about the seriousness of OIC/OBD, and how I’m affected by this condition because of the large doses of opioid pain medications I have to take to manage my pain. I hope that others who might have been in the same situation during the game were able to have similar conversations. If not, here’s a link to a therapeutic brief from an Australian Pain Society study that gives information about OIC in plain language in a downloadable PDF file: Opioid-induced constipation– a preventable problem

 

Bob Dylan – Dignity

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10 thoughts on “Opioid Induced Constipation & The Undignified Big Pharma Response

  1. Thank you for sharing this. I wish instead of, or in addition to, opioids and other highly addictive medications, “lifestyle management” was prescribed more often. Doctors give the quick fix meds so easily these days, and then pharm companies make more money by creating more drugs to fix the side effects. It’s frustrating.

    Liked by 1 person

    • It is frustrating.
      In my case it was the opposite. My early encounters with doctors not prescribing the correct level of pain medications is in part what led to my chronic pain. I was told my condition wasn’t “supposed” to cause me so much pain so they under-prescribed pain meds for me. I’ve since learned that this is typical for women who report high levels of pain because doctors tend to assume that our complaints are psychological. Since then I’ve had no choice but to modify my lifestyle significantly to cope with the pain.
      That being said, even with the lower doses of opioid pain meds I still suffered these side effects. Now with the high doses of meds I take the side effects need as much attention as my illness.

      Liked by 2 people

      • That’s great that you have since found ways to modify your lifestyle to manage and cope with the pain. And I think it would help greatly if this was always taught to people who suffer chronic pain, in addition to the pain meds they get prescribed. I can’t remember if I’ve asked you this before, but have you worked with a healthcare professional who sits down with you and analyzes the patterns of your flareups, diet, exercise, all of your activities throughout the day to give you actual environmental, physical, and activity modifications for you? I feel like this is so needed in treating individuals with chronic pain so that drug dependence and these awful side effects are minimized. It’s no way to live.

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        • Actually the lifestyle modification hasn’t been so great. I’ve had to cut a lot of activity out of my daily life to prevent pain flare ups, which also means that I spend most of my time at home on my own.
          As far as the kind of analysis you mention goes, apart from sessions with an Occupational Therapist and regular Pain Clinic appointments, I’ve been doing that for myself. I keep a detailed medication calendar and let my doctors know when I experience changes in my body that cause me significant discomfort, drowsiness, fatigue, loss of appetite, swelling in extremities, and a long list of other symptoms since becoming ill.
          However, I don’t disagree with you that a component like this is needed in healthcare for anyone suffering from a chronic illness.

          Liked by 1 person

  2. I don’t know how prevalent the side effect of constipation is, but I doubt that it’s 95%. I can’t say that I had this problem during the ten years I was on opioids, but I was nevertheless prescribed drugs to treat it. I’m not sure why I didn’t have problem with constipation, but maybe it has to do with my mostly soft diet.

    Now, without opioids, I do have this problem every once in awhile. Maybe due to stress. (And in case you’re wondering, yes, cannabis does treat constipation.)

    I suppose these kinds of commercials are as embarrassing as erectile dysfunction commercials, but what I found more interesting was the response from American politicians. Instead of seeing the treatment of constipation as a rather bad side effect of having to take opioids, some politicians said the commercial was in poor taste due to America’s opioid “epidemic.” Some even said the commercial advocated for more drug use, seeing as how Big Pharma created an antidote to one of the side effects.

    Sometimes it seems like ignorance is America’s largest export. 🙂

    Liked by 1 person

    • According to the studies I read to get more information about the issue, doctors are supposed to prescribe a laxative or stool softener with opioids. I’m guessing not all do and that even when they do constipation is still a significant side-effect. I had both prescribed with my meds and it still became a problem.
      I’m not surprised about the political response to the commercial. It’s easier to blame the victims than address the fact that opioid medications have been around for so long and pharmaceutical companies have made so much money without ever addressing the social and health crises these medications cause. When big pharma is such an influential lobby what else can you say or do?

      Liked by 1 person

      • Actually, Big Pharma is putting big money into helping the government fight the opioid war, so I hope everyone likes the results. I’ve even read that several federal government agencies in my country want to take all opioids off the market, leaving only the more expensive and less effective “abuse-deterrent” opioids. Sad to say that when the U.S. makes these kinds of changes, other countries follow suit. I guess ya’ll are lucky in Canada with your new Prime Minister, who will hopefully tell the U.S. to mind its own business. 🙂

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        • Of course Big Pharma is working with the government to “fight the opioid war” that exists because of them. I see nothing altruistic in this because whenever a new drug is created patents protect drugs from generic versions for 20 years. So Big Pharma will have a chance to make money hand over fist until cheaper versions of the “abuse-deterrent” opioids can be made.

          Liked by 1 person

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