Deb was in a near-fatal car accident. Her arms, legs, and pelvis were severely injured and would require multiple surgeries. She relied on opioids to ease the pain. Along with her other day-to-day medical challenges and constant setbacks, she suffered from constipation which her doctor attributed to her use of painkillers. But he offered no treatment or advice, nor did any other members of the hospital’s medical team. With all of Deb’s serious health problems, constipation wasn’t on the list of issues the team felt obligated to address. The medical team, therefore, allowed Deb to suffer, perhaps needlessly, from a common and potentially treatable side-effect of opioid use: constipation.
According to Deb’s husband, “The docs did recognize the possibility of OIC. They had Deb on over-the-counter medication that they thought would help. However, this actually became their excuse for dismissing our concerns about constipation. ‘She’s on [the medication]….’ was their response, as if that resolved the reality that nothing was happening. When Deb complained about her constipation, it was not treated in a prompt and appropriate fashion. In the end, I had to help her expel a large stool the consistency of modeling clay. Imagine, by way of comparison, that an infection gets worse after the healthcare team dismissed it for days with, ‘Well, she’s on an antibiotic.’ No one would stand for that.”
Deb was lucky in a sense because, by the time she experienced OIC, she was able to talk. However, as her husband reminded me, patients with OIC can’t always communicate their constipation. IV sedation removes the patient’s input. In those cases, constipation detection is at the mercy of staff who, without more awareness, tend to “let it go for another day to see what happens.” As Deb’s husband said, “Something more needs to be done….and promptly. The medical community needs to know the seriousness of the problem to remove their safe haven of dismissal about OIC.”
Opioid-Induced Constipation Commercial Airs During Super Bowl 50
There is medication that can help some pain patients, like Deb, with Opioid-Induced Constipation (OIC). Yet when a 60-second commercial for one of those OIC drugs aired during the Super Bowl of 2016, there was an instant backlash. The ad was the object of derision and even anger. White House Chief of Staff Denis McDonough tweeted, “Next year, how about fewer ads that fuel opioid addiction and more on access to treatment.” Dr. Andrew Kolondy, Executive Director of Physicians for Responsible Opioid Prescribing, was quoted as saying, “It’s very disturbing to see an ad like that.”
Similarly, articles from such media outlets as the Los Angeles Times and USA Today scorned the advertisement and accused the pharmaceutical industry of inappropriate and tasteless advertising. In the minds of many, OIC was either a joke or an appropriate punishment for people who probably shouldn’t be taking opioids, anyway. In their opinion, it was morally wrong to advertise a solution to a side effect created by opioids when we were in the middle of an opioid epidemic.
And the negative response to the “Super Bowl 50” ad still hasn’t ended. As recently as February 4, a story appeared in Inverse titled, “The Shitty Legacy of 2016’s Super Bowl Constipation Ad.” The article criticizes the commercial as a “sheepish attempt to capitalize on a national epidemic” and calls it the most “horrifying ad in the history of American television.”
Super Bowl Commercial Is No Joking Matter, and Neither Is Opioid-Induced Constipation
I strongly disagreed with the complaints about the Super Bowl commercial when it aired, as I said in my blog, This Is the Reason OIC Is No Joking Matter. Deb’s story, and the experiences of so many other people with disabling OIC, convince me that the public has a right to know that treatment exists for opioid-induced constipation (OIC). As I explained in my blog, treating constipation doesn’t exacerbate the opioid crisis. Moreover, it is necessary to treat a serious health problem that can destroy, or even end, a patient’s life.
OIC can cause dyspepsia, GI reflux, aspiration, abdominal distention, urinary tract infections, sepsis, and even death from bowel perforation. Additionally, OIC can interfere with pain management. The Patient Reports of Opioid-related Bothersome Effects (PROBE) survey found that 33% of pain patients “missed doses, decreased the dose, or stopped using their opioid medication to relieve bowel-related side effects.” Subsequently, 92% of those patients experienced increased pain, and 86% of them reported that it reduced their quality of life and ability to engage in activities. It appears that those who dismiss OIC as an illegitimate medical problem are willing to accept the consequences of increased pain as reported in the PROBE survey.
Treatments for Opioid-Induced Constipation Are Available
Fortunately, there are new and effective treatments for OIC available for people who must use opioids to control pain. I have worked with many pharmaceutical companies to develop these drugs. They can provide an enormous improvement in quality of life. It strikes me as twisted reasoning to refuse to treat OIC just because one opposes the use of opioids.
Of course, it would be better to avoid opioids and not develop OIC, but that is not always possible. For people like Deb, OIC is yet another punishment for the perceived offense of being a person in pain who uses opioids.
Taking opioids can be risky. However, it is also risky not to treat OIC. Regardless of whether one believes pharmaceutical companies should advertise, healthcare professionals are obligated to provide the best care possible, including treatment of constipation whether it is with an over-the-counter therapy or one of the new OIC medications. It is time to set aside our biases towards opioids and focus on what is best for patients.
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Copyright 2017, Lynn Webster, MD