Opioids are some of the most common drugs prescribed to the population. These drugs are known as highly effective in treating pain conditions. They can be utilized in hospitals and medical settings, as well as prescribed to the patient to use at home. Continuous use of opioids, along with high doses, may lead to adverse effects though.
A wave related to deaths due to an opioid overdose started to develop in 1999. Between 1999 and the year 2018, it is estimated that just under 450,000 people died due to an overdose on opioids1.
Outside of the ongoing opioid overdose crisis, studies have also shown that the use of opioids may cause an increase in the risk of constipation. In some cases, this may yield additional complications for the patient.
We look at the relationship between opioid use and constipation in this post. We also address current treatment approaches to this matter and consider what steps can be taken to prevent opioid-induced constipation.
Why Do People Use Opioids?
In 2018, over 168 million prescriptions for opioid medication were provided to patients in the United States. The prescription rates for opioid drugs have continued to increase since 2018. In some countries, other than the US, the prescription rate is as much as six times higher than this rate, as reported by the Centers for Disease Control and Prevention2.
An opioid is a drug that was initially derived from a natural plant. Today, however, opioids are primarily made in laboratory environments. The chemical binds to what are called opioid receptors in the human body. These receptors are found in the brain. These drugs can be either illicit or prescription.
Once bound, the chemicals help to reduce sensations of pain experienced. This is why opioids have become preferred painkiller drugs in medical settings, especially following a surgical procedure. The drug can be administered orally or provided through intravenous administration. Both options provide an effective reduction in pain symptoms experienced by the patient.
A prescription opioid is given to a patient who experiences pain. It is rather common for a patient to obtain an opioid prescription following a surgical procedure. The illicit opioids are used for recreational purposes. Heroin is a common example of an illicit version of these drugs.
What Are the Common Side-Effects of Opioids?
Opioids are associated with numerous potential side-effects. Some of these side-effects are more common than others. The specific side-effects that will be experienced depending on several factors.
First, it is important to consider the type of opioid used by the patient. The side-effects may differ based on the specific drug. Prescription opioids have been linked to these side-effects3:
- Breathing may be slower than normal
Constipation is also listed as a potential side-effect, but we will discuss this in more detail soon.
The possible side-effects linked to the use of opioids become even more worrisome when considering drugs like heroin. Short-term use of these drugs may yield similar effects as opioids on the brain. Long-term use, however, can cause many dangerous effects4.
Physical changes to the human body have been noted in heroin users. There are also changes in the brain’s structure. This can cause problems with the hormonal balance in the body. Neuronal imbalances are also very common among those individuals who misuse opioids, as well as those who turn to heroin.
In some studies5, researchers provided evidence that heroin use is linked to a reduction in white brain matter. This can have a serious implication on the patient’s abilities to regulate their own behavior and make appropriate decisions in life. The response to situations that causes stress may also be adversely affected when the white matter of the brain deteriorates.
Researchers in this study explain that previous results had conflicted evidence since additional substitution drugs were used. These substitution drugs included both buprenorphine and methadone. In the new study, heroin was the sole focus of researchers. A significant deterioration of the brain’s white matter was observed when the body is chronically exposed to heroin.
Can Opioids Lead to Constipation?
When considering the side-effects of opioid use – whether for the purpose of treating pain or as an illicit drug, most focus is placed on nausea, confusion, and drowsiness that people experience. It is, however, important not to overlook the physiological effects that these drugs can have on the body.
A relatively common side-effect is constipation. While the initial effects of constipation as a side-effect might not cause serious harm, failure to address the issue can lead to dangerous complications.
There are several studies that have focused on this subject. Numerous patients undergoing treatment have reported constipation as a side-effect while using opioid medication. Additionally, constipation has also been frequently reported among prescription drug abusers, as well as those who use heroin.
One study6 explains that there is a physiological effect that needs to be considered here. When opioids are used, it can cause a peristalsis effect in the patient’s gastrointestinal tract. Peristalsis can affect the circular and longitudinal muscles located in the gastrointestinal tract. These involuntary movements may occur in the stomach, as well as the intestines. In some patients, it may even lead to involuntary movements of the esophagus muscles.
The use of opioids has also been found to delay the process of gastric emptying. This causes waste materials to remain in the body for a longer period of time.
These two physiological factors cause complications. There are two important complications that we need to consider here:
- Absorption in the gastrointestinal tract is adversely affected. It takes longer for medication to be absorbed in the gut, which can interfere with a treatment plan for the patient.
- Fluid absorption in the gastrointestinal tract is increased. With a more significant dose or consistent use of opioids, this essentially causes too little fluids to remain in the digestive tract.
When a lack of appropriate fluid levels is present in the gut, it causes stools to become hard. With opioid misuse and dependence, this problem continuously becomes worse. As stool hardens, the patient starts to develop constipation.
Constipation induced by opioids can have serious implications for the patient. Initial complaints generally tend to involve the inability to completely empty the intestines when the patient defecates. Additionally, straining is often also a complaint noted among patients who experience constipation caused by opioid use.
There are additional factors that need to be taken into consideration here, as well:
- Opioid use is linked to a reduction in pancreatic juice secretion. Researchers have also found a reduction in bile acid entering the gastrointestinal tract among people who use opioids, especially over a longer period of time. This can further affect the delayed emptying of the stomach.
- The sphincter tone of the patient who has opioid-induced constipation may increase. When this happens, there is a risk that the defecation reflex could become impaired. This is a potential cause behind an anal blockage, which could sometimes lead to serious complications.
All of these effects can occur with the use of prescription opioid use. Among individuals who misuse opioids, including prescription and illicit options, the side-effects and complications may be worse. The more opioid-related chemicals that enter the body, the worse the effects may be on the gastrointestinal tract, liver, and pancreas.
How is Opioid-Induced Constipation Treated?
In patients who experience opioid-induced constipation, medical treatment is advised. This type of constipation can lead to the development of an anal blockage. In such a scenario, the patient is at risk of experiencing dangerous complications.
There are effective treatment options available in these cases. The specific treatment may differ from one patient to the next. A healthcare provider will need to assess the patient first. An understanding of the specific cause, including the type of opioid used, needs to be provided to the physician. The physician also needs to understand the duration of opioid use, dosage, and how long the patient had been experiencing signs of opioid-induced constipation.
A common treatment option for opioid-induced constipation involves the use of a stimulant. There are two stimulants currently used in the treatment of these opioid-related complications, including:
The stimulants may assist in helping the body to expel an accumulation of stool.
A stool softener may also be used. Docusate is the most common type of stool softener provided to the patient. It is important to note, however, that a stool softener is mostly advised for cases where constipation is not yet noted. This medication can help in a preventative strategy.
When the patient does have constipation, they may sometimes be provided both a stimulant and a stool softener. The combination may provide more effective relief of symptoms.
An osmotic laxative is sometimes used instead. These laxatives will be provided to the patient as a daily medication. The patient is advised to take the capsule as directed over a period of several days.
Apart from these options, a newer drug that is now also used to treat constipation induced by opioids is known as Methylnaltrexone bromide. This is an opiate antagonist that acts on the peripheral nervous system. The drug may be provided subcutaneously to the patient. It has been proven to provide a more effective relief on opioid-induced constipation when compared to naloxegol and lubiprostone.
Can Constipation Be Prevented in Opioid Users?
Prevention is always better than waiting for a condition to develop and then seeking out treatment. For this reason, it is important for physicians and care providers to consider preventative measures. These measures should be taken in patients at risk of opioid-induced constipation. This may include individuals who have recently been found to abuse these drugs. Additionally, when a high dose of opioids is prescribed to patients following a serious surgical procedure, such preventative measures can also be considered.
There are lifestyle changes that can help to reduce the risk of opioid-induced constipation in the patient. This starts with a diet that is high in fiber content. Fiber assists in keeping the digestive system regular and may help to reduce the slowed gastrointestinal emptying that can occur during opioid use.
Adequate fluid intake is another important factor in the prevention of constipation in these patients. This helps to ensure there is enough fluid to prevent stool from hardening, even when fluid absorption in the gastrointestinal tract increases.
Another important lifestyle factor that the patient needs to concentrate on is exercise. Physical activity has been shown to assist in enhancing bowel motility. This can help to improve the emptying of the gastrointestinal tract, thus reducing the risk that stool will harden.
Opioid doses should be limited. The doctor needs to understand the patient’s risk of experiencing constipation when using opioids. The daily dose should then be adjusted based on the physician’s findings.
Seeking Help With Opioid Use Disorder
While opioids are used in medical settings to treat pain symptoms, these drugs hold the potential to cause dependence. Habit-forming behavior related to opioids can lead to serious adverse effects. When addicted to the drug, several behavioral changes may be observed in the affected patient. Side-effects associated with the use of opioids, including constipation and hardening of stool, may worsen.
Patients are able to obtain treatment for a dependency that is developed. An opioid addiction rehab center in North Texas, like Stonegate Center, can provide the patient with both counseling and medicated treatment options.
Individuals with a serious dependency on the drug might need to consult a 24/7 medical detox for opioid addiction near Dallas-Fort Worth. This includes a detoxification process, helping the patient cope with the withdrawal symptoms that develop soon after the last dose of opioids.
1 Centers for Disease Control and Prevention. Opioid Overdose: Understanding the Epidemic. [online] Available at: https://www.cdc.gov/drugoverdose/epidemic/index.html
2 National Institute on Drug Abuse. Prescription Opioid DrugFacts. [online] Available at: https://www.drugabuse.gov/publications/drugfacts/prescription-opioids
3 National Institute on Drug Abuse. Prescription Opioid DrugFacts. [online] Available at: https://www.drugabuse.gov/publications/drugfacts/prescription-opioids
4 National Institute on Drug Abuse. Heroin Research Report. [online] Available at: https://www.drugabuse.gov/publications/research-reports/heroin/references
5 Brain Research Journal. (2013) White matter impairment in chronic heroin dependence: a quantitative DTI study. [online] Available at: https://pubmed.ncbi.nlm.nih.gov/23895765/
6 StatPearls. (2020) Opioid Induced Constipation. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK493184/#:~:text=Opioid%20drugs%20are%20known%20to,hardening%20of%20stool%20and%20constipation
John Eckelbarger is a Business Development Representative for Stonegate Center. With a BSA in Chemistry from the University of Texas at Austin, he has an interest in the neurobiology of addiction & pharmacology of drugs. He hopes to bolster Stonegate Center to the forefront of addiction medicine through bold, innovative content. He is currently pursuing his MBA in Finance from Texas Christian University.