FRANK: BACKED UP “BIG TIME”
If you haven’t seen the commercial, you probably don’t watch TV, because it’s everywhere lately: A manly looking guy named Frank, at work on a construction site, looks away from the camera and says, “I had a bad back injury. My doctor prescribed opioids, which…helped with chronic pain, but backed me up – big time. I tried prunes, laxatives, but…still constipated. Had to talk to my doctor, and she said, ‘How long have you been holding this in?’” Then Frank laughs. A sad, fake half-chortle that suggests he’s been “holding it in” for a very long time, and that it’s not very funny. Not lost on many viewers is the irony of a Big Pharma company (in this case AstraZeneca) making scads of money on a problem it helped create.
The commercial is for Movantik, a new drug “specifically designed for opioid-induced constipation (OIC).” OIC may be a new diagnosis to most people, but to opiate/opioid addicts, people addicted to painkillers like Percocet, Vicodin and Norco, illegal drugs like heroin, or “Medication Assisted Treatment (MAT) drugs like methadone or overuse of Suboxone, it’s a way of life, an aspect of addiction that can run the gamut from bothersome and embarrassing, to painful, to excruciating, to life-threatening.
FROM EMBARRASSMENT TO DEATH
Elvis Presley’s personal physician, Dr. George “Nick” Nichopoulos says flatly that Elvis, who was an opioid and speed addict, died of an “embarrassing case of chronic constipation.” Some addicts go so long without a bowel movement that they would rather die than go another day without pooping.
How long is “so long”? A former heroin addict and a client of mine as an Addiction Therapist, John A, “went 28 days without pooping. My parents knew I was using, and they were waiting for me to surrender and go to rehab. Meanwhile, they would wait outside my bathroom every time I tried to go and make sure I didn’t faint from pushing so hard.”
I’m not sure if 28 days is any kind of record, but for me that’s enough. Most people are horrified at the idea of not going for even a week. (Constipation is clinically defined as less than two or three bowel movements a week.)
This statement from a former heroin/methadone addict named Paul C. describes a case of extreme OIC:
“I had horrible constipation, so much I was terrified to go. I would go for weeks with no action. I bled every time I had a bowel movement, and the water in the toilet looked like tomato juice, which terrified me. I walked like a monkey. The only thing that was near comfortable was laying (sic) down. The pain was excruciating. I was always scared that something like a caveman’s club would come out of me. My anus, I realized now, was ripped open. I ate as little as possible for fear I would hurt more the next day. I was stupid and using harsh laxatives like Miralax instead of stool softeners and prunes. Once in a while I would stop and let myself go into horrible withdrawals and at least then I would have massive diarrhea. But it got a lot of stuff out of me, and I would start slamming immediately. This went on for five years. I think one of the best things about being clean today is that I have normal bowel movements, and the fear of constipation is one of the major reasons I stay clean today.”
A more typical experience with OIC is described by Selby M, who was a little luckier than Paul:
“I had massive back surgery in 2015, and although I had done my share of drugs, I was never a heroin or painkiller addict. They loaded me up with fentanyl and who-knows-what on the day of the operation, and sent me home with a prescription for 90 ten-milligram hydrocodones. The first two days I was out of it, and took maybe ten of them. On the third day I took two on awakening, and realized I hadn’t pooped since the operation. So I took a couple more that day, and of course no bowel action. I started feeling so full and horrible on the fourth day, and scared I might explode, so I took a ton of laxatives, the really harsh kind, only took one hydrocodone, and ignored my back pain. I was literally scared shitless.
What finally came out of me felt like a bowling ball, and I thought I was going to split open. I had never seen anything so big in a toilet. Needless to say, that cured me. To this day, I get scared if I don’t have a movement by 10 AM. If I have bad pain, and I have to take a painkiller, I never take more than 20 milligrams, and never after 3PM. It’s not worth it.”
WHY DO PAINKILLER AND HEROIN USERS GET CONSTIPATED?
Opiates are a central nervous system depressant, and they stifle brain responses to pain without affecting the cause of the pain. These drugs, as an essential function of their painkilling mechanism, throttle the autonomic nervous system, those functions that happen without our volition, like breathing and heart rate, and bowel movements. Opioids decrease the amount of time it takes food to move through the digestive tract. They also paralyze the stomach, reduce digestive secretions, and decrease the urge to defecate, sometimes to the point where sufferers just can’t go at all.
WHAT CAN YOU DO ABOUT OIC?
One common denominator in combating OIC is water, lots of water.
If you really need painkillers, or if you’re on a maintenance program, you can try to reduce the amount you take, slowly and carefully, under a physician’s direction if possible. There are drugs, like the aforementioned Movantik, and Relistor, that are specifically designed to relieve OIC constipation without interfering with opioid pain relief. Those drugs are new, so they are expensive. For less severe cases of constipation, prune juice and stool softeners might work. There is also evidence that magnesium citrate works for a lot of people.
Dr. John Harsany, an addiction specialist who is also an expert on medication-assisted treatment (MAT), suggests sorbitol, a natural sweetener found in fruits and vegetables, “30 cc (or mg) twice a day, and at least eight ounces of water every three hours from 8 am to 8pm.”
For more severe cases, enemas or colonics often work. For extreme cases, a visit to the emergency room may be in order.
More than 1 in 3 American adults ― 35 percent ― were given painkiller prescriptions by medical providers last year. The total rate of painkiller use is even higher ― 38 percent ― when you factor in the number of adults who obtained painkillers for misuse via other means, from friends or relatives, or via drug dealers, according to the Washington Post. “Two million people actually had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin,” writes the America Society of Addiction Medicine (ASAM). It stands to reason that millions of Americans suffer from OIC.
If you’re addicted and you’re not using painkilling substances for legitimate pain concerns, the best solution is to seek help and try to quit. You can start at SAMHSA National Helpline or Google rehabs in your area, but beware of scams and quick, easy cures. Opioid addiction is a lifelong struggle, so be prepared for a struggle.
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline
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