Managing Opioid Induced Constipation
Opioid medications are frequently used to help manage pain – both acute pain and chronic pain. While they are very effective at pain relief, that relief can come with a price. Opioids have side effects and many of them are related to the gastrointestinal system.
One side effect is the slowing down of the gut leading to constipation. This is the most common side effect and also one of the most debilitating. While other side effects may go away with time, constipation tends to be a side effect that stays present even with long-term use. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772344/)
So how can you manage when constipation becomes a problem?
There are two different approaches – those that use medications and those that don’t. Both can be effective tools in managing this problem and helping you to get back to a normal bathroom schedule.
The approach that doesn’t use medications typically involves practicing a good schedule of going to the bathroom. Many people ignore the urge to go to the bathroom until a later time and doing so will increase constipation when using opioids.
It can also be helpful to look at lifestyle factors. Not drinking enough water or eating enough fiber can contribute to constipation in anyone. So if you’re not drinking an adequate amount of water to begin with, this could help.
However, if you’re already someone who drinks adequate water and eats adequate fiber, adding more isn’t likely to help constipation caused by opioid drugs. In fact, eating too much fiber can actually make the problem worse and even lead to a bowel obstruction.
Instead, it may be necessary to begin a regimen of medications to help with this type of constipation. There are several options you can try by working with your physician and determining what makes the most sense.
One of the simplest choices is mineral oil. Mineral oil helps to lubricate the intestines and keep the colon from absorbing more water from the stool. While mineral oil is typically safe, it can cause complications.
The most significant is choking. To avoid choking, it’s important to take mineral oil in an upright position and to stay upright for at least 30 minutes after taking it. Mineral oil taken long term can also make it hard for your body to absorb fat-soluble vitamins. It’s important to have blood tests to confirm adequate vitamin levels.
Stool softeners work in a similar way. They help the body to add more water and fat to the stool so that it can pass more effectively. This is a very safe choice and is readily available over the counter.
Drugs note as osmotics work to add more water into the bowel. They can be taken orally or rectally. They are also available over the counter. These should be used with caution as they can cause excessive loss of fluids.
Stimulants can also be purchased over the counter to treat constipation. They cause the muscles of the intestines to move so that the waste can be pushed through the system.
Finally, if none of the over the counter remedies work there are prescription medications available that can block some of the effects of opioid medications and restore normal bowel function. It’s important to discuss options with your healthcare provider if you suffer from opioid induced constipation.
Are “Opiates” and “Opioids” the Same Thing?
News of the opioid crisis in the United States has become front and center in the world. Sometimes you hear the word “opioid” and sometimes you hear “opiate”. But are they the same thing? Read on to learn the difference.
People have been using natural plant extracts to help heal and relieve pain for thousands of years. The opium poppy plant is one such natural pain reliever. Drugs derived from the opium poppy include morphine, heroin, codeine, and opium.
Drugs derived from this plant have the powerful ability to relieve pain. However, they also are highly addictive.
Opioids are actually synthetic pain relieving drugs, or at least made partly of synthetic materials in a lab. Opioids work in much the same way as opiates, but they don’t require the opium poppy to be manufactured.
Some examples of opioids include fentanyl, hydrocodone, hydromorphone, methadone, and pethidine. These are prescribed by physicians to relieve both acute and chronic pain. Like natural opiates, opioids are highly addictive.
Both Work in the Same Way
Both opiates and opioids work in a similar fashion. They have chemicals that when taken internally will bind to opioid receptors on nerve cells. When they bind to those receptors, the nerve cells tell the brain that the pain is lower than it actually is.
Over time it takes more and more of the drugs to provide the same feeling of relief. At the same time if someone who is not in physical pain takes the drugs they will provide a feeling of euphoria (a high feeling) and also relaxation.
Many people who become physically and psychologically addicted to these medications start by being prescribed them for legitimate pain. But over time they become dependent on the drugs to feel normal or even to escape psychological pain.
In the early days of opioid manufacturing, physicians were told that these synthetic medications were not addictive and they began prescribing them widely. However, years of research and experience now show that these substances are highly addictive.
While most of these drugs can be prescribed, there are still non-prescription drugs such as heroin that are illegal. Unfortunately, many people who become addicted to prescription opiates and opioids move on to heroin when they’ve exhausted the ability to obtain prescriptions.
Along with the dangers of addiction and overdose, injection drug use also comes with risks of infection from hepatitis C and HIV. Along with the opioid crisis, the rate of these infections is increasing in the United States.
Another danger associated with heroin use is that street drugs are often cut with other ingredients. There is no regulation for street drugs. Often they are cut with synthetic drugs that make the heroin even more dangerous and increase the likelihood of an overdose.
While there are drugs that can help to reverse the effects of these drugs in the case of overdose, they aren’t always effective against heroin that is cut with synthetic drugs. The medical community is working to reduce the amount of prescriptions for opiate and opioid pain medications in an effort to prevent future addiction issues.
One of the most tragic results of the opioid epidemic in the United States is the rising number of babies being born addicted to opiates. Exposure to opiates in utero can have immediate consequences at birth as well as long-term consequences.
Pregnancy and Opioids
While opioids should not be taken during pregnancy, many women are prescribed them during their pregnancy. On the one hand there is a problem of women taking prescribed drugs and then on the other there are women who are taking these drugs illegally. And in both cases there can be detrimental effects for babies exposed to them.
Neonatal Abstinence Syndrome
When a pregnant woman uses opioids, the drugs can cross the barrier of the placenta and get into the developing baby’s body. Just as it does in an adult brain, the drug will bind to the opioid receptors of the baby’s brain and over time cause a tolerance or dependence on the drug.
Then when the baby is born, the supply of opiates from the mother’s bloodstream immediately goes away and he begins to experience withdrawal symptoms. There are many signs and symptoms associated with this.
Babies experiencing neonatal abstinence syndrome (NAS) may have tremors, seizures, and muscle twitches. They may also be very fussy and have a telltale high-pitched cry. They can have trouble feeding because their sucking instinct is poor.
NAS may also result in breathing problems, fevers and trouble sleeping. Gastric problems are also common such as vomiting or diarrhea. Obviously babies who are born with this syndrome are very uncomfortable and can be in pain.
This syndrome usually begins to show up within three days of birth and can last as long as six months after birth. But babies can be treated for this to improve their comfort and also prevent life threatening symptoms.
Medications can be used to manage withdrawal and help the baby slowly detox from the drugs. Babies are also treated with IV fluids and high calorie baby formula to prevent dehydration and encourage growth.
Babies also need lots of swaddling and skin-to-skin care to stay calm and feel comforted during this difficult process. Babies with NAS can be difficult to soothe so it’s important to stay calm and provide a calm environment.
If you know you have been using opioids during pregnancy, it’s important to talk with your healthcare provider so that you can plan to support your baby after she is born. Putting a plan in place can be lifesaving.
Long Term Effects
Using opioids during pregnancy can have long-term effects for your child. A child can have birth defects and is more likely to be stillborn as a result of opiate use. Long-term, children exposed to opiates can have developmental delays.
For example, they may take longer to develop language and math skills. They may also be more likely to have behavioral problems than children who are not exposed to opioids. Often children who are affected will require special education in school.
Ideally, it’s best for pregnant mothers to avoid opiates of any kind. If you’re using opiates, it’s a good idea to use birth control until you are no longer using them to avoid possible complications from fetal exposure to opiates.
Should You Take Opioids When Pregnant?
Opioids are drugs that are frequently prescribed for pain relief – and often even prescribed during pregnancy. But are they safe to take when pregnant? According to most research the answer is no. However, physicians still prescribe these medications frequently.
In fact, a study of women using Medicaid from 47 states found that 21.6% of women filled at least one opioid prescription while they were pregnant. If your doctor prescribes medication, it may seem safe. But in the case of opioids there can be devastating consequences. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795985/)
It’s important for you to understand what these drugs can do during pregnancy and make an informed decision. According to the March of Dimes, an organization dedicated to healthy pregnancies and births, there is much danger in using opioids during pregnancy.
Women who take opioids are more likely to experience a miscarriage. They are also more likely to develop pre-term labor and premature birth. Premature birth can lead to health problems and even death.
Babies exposed to opioids can also develop birth defects. In particular, heart defects and spina bifida are related to use of opioids. Babies who experience exposure are also likely to have low birthweight and even be smaller than they should before birth.
Neonatal abstinence syndrome can also be caused by opioid use during pregnancy. This is a condition that occurs when a baby is exposed to drugs in the womb and then experiences withdrawal after they are born. This can happen even if you take opioids prescribed by your doctor exactly the way he or she directed.
Opioid drugs haven’t been studied in pregnant women the way they have in other populations because of ethical restrictions. Therefore, it’s difficult to find facts and figures that would allow the limitation of these drugs during pregnancy.
However, healthcare providers have studied trends in women who report opioid use or who are positive for opioids and there is strong evidence that they are related to all of these negative consequences.
If you are taking opioids, it’s a good idea to use birth control until you are no longer using them and are ready to become pregnant. This can eliminate the side effects associated with opiate use.
If you’re already taking opioids and become pregnant, it’s important not to stop cold turkey. Both you and your baby can experience withdrawal and this can increase your risk of miscarriage, placental abruption, preterm labor, and even stillbirth.
In this instance, it’s important to talk with your physician about weaning off of these drugs and moving to safer medications for pain relief. There are medications that can be used to help decrease your withdrawal symptoms and there are medications that are safe to use during pregnancy for pain relief.
If you’re struggling with abuse of opioid drugs, it is helpful to work with a healthcare provider and to seek treatment during pregnancy so that you can minimize the harmful effects of the drugs on both you and your baby.
Ideally, you will have no exposure to opioids during all parts of your pregnancy. But if you become pregnant while using opioids it’s important to move away from them as soon as possible for the best outcomes.
Who is at Risk for Opioid Addiction?
While anyone can become addicted to opioid medications, there are some risk factors that make one more likely to have dependence. Let’s take a look at some of those factors that can help screen patients for potential abuse.
As science is breaking open the secrets of DNA, we’re finding out that more and more of our problems are related to genetics. Addiction is no different. If someone has a family history of addiction, they’re at greater risk for developing it as well.
While some people can use opioids and have no problems with addiction, there are some that feel the effects of addiction early in their use. Genetics may play a bigger role than any other factor.
In fact, scientists estimate that genetics are responsible for 50-75% of addiction issues. Unfortunately, there’s no test on the market to help determine if you have a genetic predisposition. But looking at family history can give a window into this possibility.
Psychological Risk Factors
Some people also have risk factors due to psychological issues. For example, having a high stress lifestyle or issues with anxiety and depression can make one predisposed to addiction when opioids are introduced.
People who tend to be very impulsive or thrill seeking may also be at higher risk of addiction. Some personality disorders or psychiatric disorders also make it more likely that using opioids will result in addiction.
Environmental Risk Factors
While some people have built-in biological risk factors, others experience things in their environment or experience that make drug addiction a higher risk. Often these are related to trauma that has occurred.
For example, people who have experienced physical, sexual, or emotional abuse are more likely to become addicted to substances. This is also true for people who have experienced traumatic violence or war.
Growing up with a parent or family member who struggled with substance abuse or addiction can also increase the risk for future addiction whether or not genetics play a role. Having substance abuse in the home creates an environment where there is more access to these substances as well as normalizing substance abuse.
There can also be cultural influences that increase the risk of substance abuse and addiction. When the culture around a person normalizes this use, it’s more likely to seem like something appropriate.
Gateway Substance Use
Individuals who begin using substances at a young age have a higher likelihood of developing addiction issues later in life. For example, if alcohol or nicotine are used at an early age one is more likely to begin using more and more powerful substances.
These less powerful substances act as a gateway normalizing substance use and misuse. They also may begin to lose their effect over time causing a person to seek stronger drugs to achieve the same effects.
The Challenge for Professionals
While these factors can increase the risk of addiction, there are still many challenges for health professionals working to prevent and treat addiction. Many of these factors are hidden and not obvious to a physician trying to make decisions about medication prescriptions.
As a result, the medical community is working to create pain management plans that are free from opioids to reduce the risk of anyone becoming addicted.
How Opioids Cause Addiction
We all have heard that opioids can be addictive, but what actually causes opioid addiction? It turns out that the answer isn’t simple. While there is a physical addiction to the medications there are also psychological and social issues that can contribute to the problem.
The first part of addiction is the result of changes that take place in the brain. Opioids work by binding the opioid receptors in the nerve cells of the brain and other organs. They connect to these receptors like a key in a lock.
In this case the result of the connection is that the nerve sends a signal to the brain that pain is at a lower level than it really is. At the same time, opioids activate the reward system of the brain. They cause the body and mind to feel pleasure.
This sense of pleasure can cause people to keep taking the drugs repeatedly in order to feel the pleasure. But over time, the body becomes more tolerant to the drug and it takes more and more of the drug to feel pleasure – or even just normal.
This occurs because over time, the brain cells with the opioid receptors become less responsive with repeated exposure to the drug. More of the drug is needed to stimulate these receptors and the reward center of the brain.
When the opioid is taken away, the brain cells release excessive chemicals to reverse the suppression of the opioid. As a result one feels anxiety, jittery, and physical symptoms such as diarrhea, nausea, and muscle cramps appear.
Obviously those symptoms are very uncomfortable and the easiest way to counteract them is to reintroduce the opioid. And the body becomes more and more dependent on the drugs to avoid these negative symptoms.
This begins to lead to a craving for the drugs and a compulsive need to have them. However, it is possible to taper off and reduce many of these symptoms so that the drug can be discontinued.
For people who are not at risk of addiction, this tapering off will be sufficient. But addiction is complicated and isn’t just about the physical tolerance of the drug. There are other factors at play.
Many people who struggle with addiction have additional genetic factors at work. These are not well understood, but people with a family history of addiction are more likely to experience the biological issues associated with it.
People who are more vulnerable to stress often battle addiction at higher rates than typical peers. There are also conditions such as mental health disorders that can make addiction a greater risk. Many people seek the feelings of pleasure to counteract negative feelings and experiences.
Environmental and Experiential Factors
The environment also plays a factor in addiction. People who struggle with trauma that has occurred often find the psychological pleasure associated with opioids a relief. It provides a temporary band aid for their emotional pain.
People who are exposed to drugs throughout their lives through family members or friends also normalize drug use and can be more likely to experience addiction.
How We Got Here: The Opioid Crisis in America
More than 90 Americans die each day from opioid overdose (https://www.drugabuse.gov/drugs-abuse/opioids/opioid-crisis). Opioids are a class of drugs that include prescription pain relievers such as codeine, oxycodone, and morphine as well as illicit drugs such as heroin.
This high rate of abuse and death didn’t happen overnight. In the late 1990s, physicians began prescribing these drugs more frequently. The pharmaceutical companies that produce the drugs assured the medical community that patients wouldn’t struggle with addiction.
However, that assurance was false. Opioids are highly addictive drugs and as more and more physicians began to prescribe them they became more widespread and people began misusing them at alarming rates.
In fact, the federal government even brought criminal charges against one pharmaceutical company for claiming that Oxycontin was safer and less addictive than other opioids.
This cost the company more than $600 million in fines and caused three executives to be charmed criminally. Unfortunately, the damage was already done. And, it turns out that OxyContin is one of the most addictive opioid substances on the market.
Over time the number of people who become addicted to opioids and misuse them has skyrocketed. According to the National Institute of Drug Abuse, 33,000 Americans died as a result of overdose in 2015 and another 2 million people suffered from substance use disorders.
Not only do people suffer directly as a result of substance misuse, but there can be indirect consequences. For example, the rates of HIV and hepatitis C have increased as a result of sharing infected needles.
Additionally, there is a rising rate of babies suffering from withdrawal as a result of their mother using opioids during pregnancy. This is a public health crisis of great proportion and seems to be getting worse every day.
However, the medical community and the government are now focusing their efforts on working to reduce the misuse and abuse of opiate drugs. A recent report revealed that Congress approved measures that made it easier for drug companies to distribute opioids into the community.
Congress is working to close the loopholes that allowed this to happen and prevented the DEA from going after these companies. However, this measure will take time.
At the same time the Centers for Disease Control (CDC) is working to provide new guidelines to physicians for helping patients to deal with chronic pain. These new guidelines suggest avoiding opiates and instead using over the counter pain relievers with a combination of behavioral therapies that aid in pain relief.
Additionally, large retail chains such as CVS are working on plans to restrict filling prescriptions for opioids in order to prevent misuse of them. Better tracking of prescription and distribution can help to make a difference.
There is also a movement to improve access to treatment and recovery programs for those who find themselves in the throes of addiction. Many pharmacies are also improving access to drugs that help reduce overdoses such as Narcan.
All of these measures can work together to help lower the numbers of people affected by this crisis. However, there’s no magic bullet and with such a severe crisis it may take decades to have a real impact.
How Can You Tell if Someone is Addicted to Opioids?
Opioid addiction has reached epidemic proportions in the United States. But how can you tell if someone is addicted to opioids versus using them appropriately to manage pain? Read on for some signs of addiction.
Physical Signs of Addiction
You can’t tell someone is addicted just by looking at them. However, there are some physical signs you can look for. And if you see them over and over they can indicate a problem.
For example, you may notice someone is drowsy almost sedated and seems confused. Pupils that are constricted can also indicate opioid use. You may also notice euphoria – a state of intense excitement. Someone who loses consciousness or has slow breathing can also be showing signs of addiction.
Another common physical sign of addiction is constipation. However, even using opioids as prescribed for legitimate reasons can cause this particular symptom.
Behavioral Signs of Addiction
While physical signs can be a clue, one’s behavior can give a better picture of possible addiction. This is not about something that happens one time – rather it’s about a pattern of behavior.
A dramatic change in behavior or mood swings can be an indicator of a problem. If someone was once very outgoing and now begins to become socially isolated along with other factors you may be seeing signs of addiction.
Addiction to drugs can be an expensive problem. First you have the cost of the medications and second you may have decreased income when you’re experiencing physical symptoms and can’t work. So if you notice a big change in financial circumstances it can be a sign of addiction.
You may also notice that someone is doctor shopping. This happens when one doctor stops prescribing the addictive medications or won’t prescribe a higher dose. The addict then shops for another doctor to prescribe higher doses or just more of a medication.
While this can still happen, pharmacies are doing more to track prescriptions so that it’s harder to fill multiple prescriptions for opioids.
Withdrawal is another sign that someone has addiction. Even someone taking opioids as prescribed can experience physical withdrawal. And in some cases withdrawal can be dangerous. It’s important to be medically supervised when trying to stop taking opioids.
Signs of withdrawal include headaches, nausea, vomiting, sweating, diarrhea, fatigue, anxiety, and sleeplessness when the drug is removed from the system. It can seem like the affected person has the flu when really it’s just a result of the body withdrawing from the medication.
How to Help
Noticing that someone is addicted to opioids can be heartbreaking. You may want to help a friend or family member kick this disease. It’s nearly impossible to handle opioid addiction without professional help.
First a person must safely detox from the drugs in order to get them completely out of the system. This requires medical intervention. The next steps include therapy and long-term 12 step programs to address the psychological aspects of addiction.
It’s important not to enable an addict by helping to financially support them or provide them with the medications they’re seeking. In most cases it’s best to seek professional help in order to help someone with this serious addiction.
.Opioids: Safe Use and Disposal Guidelines
Opioids are prescription pain relievers that your doctor may prescribe to help you experience pain relief. This can be for acute pain or for chronic pain. While they may be prescribed, they are also highly addictive even when used as prescribed.
It’s important to follow some safety guidelines to help prevent addiction for both you and those living in your household. Read on to learn some basic safety guidelines that will help you to make your home as safe as possible.
Don’t Mix Medications and Other Substances
When you begin taking opioids, it’s important to make sure they won’t interact with any other medications that you take. You should also avoid alcohol or any other type of illegal drug as this can be dangerous and cause overdose.
Use Caution with Activities
Opiates can affect your judgment and coordination. When you first begin using them you should avoid operating heavy machinery including driving. Over time you may build up a tolerance and be able to resume these activities but do so with caution.
Talk with your doctor if you feel too impaired to carry out necessary activities. You may be able to take less medication or change to a different type of medication.
Take as Directed
It’s important to pay careful attention to your prescription and take only the amount that is prescribed. This is particularly important if you’ve never taken opioids before. Taking too much can over medicate you and even lead to overdose. This can be deadly.
Do not cut, chew, dissolve or crush your opioid pills. This can lead to overdose and can be deadly. If you use pain patches with opioids always remove the first one before putting on a new one.
Opioids should always be kept in the original prescription packaging and inside a locked location such as a locking medicine cabinet or a lockbox. They should be kept out of reach of small children who may not know what they are.
Be aware of how much medication is in the bottle and how much you should have left. While it isn’t fun to think about, many people who abuse prescription drugs steal them from friends or family members.
If you notice medication missing, it’s important to contact authorities and file a police report. Never give your medication to someone else. It should only be used by the person for whom it is prescribed.
There was a time when people were instructed to flush medications down the toilet, but that has been found to contaminate the water supply with drugs. The best thing to do is to turn medication in to a disposal program.
Many communities host take-back events and programs in cooperation with law enforcement. They will collect your medications and incinerate them. Some retail pharmacies will also take back medications.
If that isn’t available in your area, mix your pills (but do not crush them) with used coffee grounds, kitty litter, or dirt and place them in a sealable bag. Then throw them in the trash.
You may also be able to order free medication bags that contain a substance that breaks the medication down and allows for safe disposal. These are available online and through physicians’ offices.
The Difference between Opiate Agonist and Antagonist Drugs
If you turn on the news, it doesn’t take long to hear about the opiate crisis in the United States. There’s a lot of discussion about these drugs and how they behave. You may have heard the terms “agonist” and “antagonist” but not really understand them. Read on to learn more about the differences between these two categories of drugs.
Agonist drugs are those that activate opioid receptors in the brain and other areas of the body. These drugs bind to receptors found on the cells of the brain and then cause a reaction. In the case of opiates, the when these drugs activate the receptors the result is that pain signals are blocked.
However, they can also cause side effects such as drowsiness, nausea, constipation, mental confusion and even cause a decrease in breathing rates. And when taken in higher doses they can cause euphoria, or a feeling of being high.
Over time, one can become addicted to an opiate drug. This happens because the more your body is exposed to a drug, the more it adapts to it. In other words, you need more and more of the drug to experience the same pain relief.
If this happens, you’ll experience withdrawal symptoms when you stop taking the medication. Symptoms can include restlessness, diarrhea, vomiting, sweats, and pain. Tapering down rather than stopping cold turkey is a way to minimize the experience of physical withdrawal.
When opiates are misused, as is often the case, it can lead to a higher risk of overdose. There is also a high risk of transitioning from prescription opioid dependence to heroin use and addiction.
An overdose of opiates can cause severe reactions, including death. It can cause your breathing rate to slow and even stop. This is especially true if you combine opioids with other drugs including alcohol.
Opiate antagonist drugs are those that actually attach to opioid receptors in the body, but don’t activate them. They block the effects of opioid agonists without causing a high. Some antagonists actually do produce a weak effect while others produce no effect at all.
Why would this be useful? In the case of opioid overdose, antagonist drugs can be used to reverse the symptoms and prevent death. This can be given during an acute episode.
But for long-term use these drugs are sometimes effective in treating opioid dependence. They block the euphoric feeling caused by opioids and by taking them, the individual is less likely to continue to abuse the opioid.
The most common antagonist drugs include Naloxone, Naltrexone, Narcan, Narcon, Narcotan, Vivitrex, and Zynol, though there are more than a hundred drugs on the market.
Many addiction treatment professionals believe that the use of antagonist drugs, particularly those that are long-acting, is a key to solving the problem of opiate addiction.
For example, Vivitrol is a medication that blocks opioid receptors for a month at a time. That allows a patient to go a month between visits to the doctor and decreases the likelihood of opioid relapse.
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