Tuesday, 9 May 2017

Opioid Constipation and other problems.

   More than fifty thousand Americans died from drug overdose last year.   Death from synthetic opioids including Fentanyl rose to 9,580.  Deaths from prescription drugs like oxycontin are on the increase and are easily available both legally and illicitly.  CDC figures indicate that American life expectancy has decreased for the first time in many years, in no small part due to drug overdose.  Contemporary statistics for  Canada do not seem to be available but published estimates for 2007 indicated 47,000 addiction related deaths.  Despite the removal of oxycontin from the Ontario drug plan because of the ease of abuse and its decrease as one of the drugs of addiction, closely related drugs are available the overall rate of opioid fatality has increased by 24%.

   Testimony to the widespread  extent of the problem is the fact that opioid constipation is a favorite topic of big pharmacy advertisements these days.  In my many years of medical practice opioid constipation was rather uncommon outside hospital where patients who required narcotics were usually successfully treated prophetically with stool softeners and laxatives as necessary and sent home on them.  Opioids were prescribed for severe pain that was was not relieved adequately by the many other types of analgesics /anti inflammatory drugs that are less addictive and debilitating.  Narcotics were prescribed a great deal more judiciously in those days despite the fact that we were just as concerned with pain relief as contemporary physicians.  Physicians who did prescribe excessively were likely to get a visit from the RCMP.  Narcotic prescribing was sometimes suspended and on occasion licenses were revoked.  We were very aware of and concerned with the consequences of narcotic prescription for more than short time periods and the objective was  always to control pain with less noxious and toxic treatments.  Often, we were successful.
   Now opioids are prescribed so frequently that Opioid Constipation is a common disorder in working, walking and driving patients.  Turn on your TV to watch the news during dinner, and you may well be greeted with Big Pharma's cavalier witty ad for their bold new treatment for Opioid Constipation.  The healthy looking patient jokes with his doctor on receiving his prescription, "I guess I've been holding it in too long, doc!!"  Very funny!  Movantik, (Naloxegol) is believed to reduce the constipation effects of the opioids without reversing the pain relieving or analgesic effects of the  opioid, when given in  the prescribed dosage.  It too has its side effects.
    The recently published guidelines regarding prescription  of opioids for non cancer pain may help, but guidelines are only guidelines, not rules and it may be difficult to explain them to the addicted patient on the other side  of your desk.  Physicians will have a very difficult time in getting the genii back in the bottle, particularly when the permissive society is busy uncorking other bottles. 

"We lost our son in July 2014 at age 22 from Heroin overdose after a long eight year spiral into drug use which started with abusing marijuana. During these years he easily bought illegal drugs as well as prescription drugs from his friends parents medicine cabinets… He also purchased synthetic packaged drugs from “Smoke Shops” also called “Head Shops” which sale their harmful addictive products in decorated packages, call them different names and can legally sale them. Our son was sold “bath salts” from a Smoke shop which he crushed and snorted. The product ate holes in his brain and was causing liver damage and his body to shut down within one week of daily use. He was delusional and put into ICU for two days. He survived it but damage done… Society has a whole has to make changes. People have to be educated on the disease of addiction, doctors have to be more restricted on writing prescriptions, much tighter border control, Smoke shops regulated, kids taught about the dangers of drugs use and what they are saying no to. “Just Say No” is not working anymore and Red Ribbon Week has become more about door decorating and dress up than the seriousness of drug use in most schools. A change of mind set and the ability to deal with stress and pain has to start at a young age so as people get older they will not rely so much on pain killers and drugs which alter the brain. Xanax was very easy for H  to get and so addictive. He later took up Heroin and this became his drug of choice. Families should not have to live the way we did with our son during his battle. Society has much work to do to combat this problem."
   Universities across the land are finally attempting to  take some measures to address the growing problem and some are using Narcan kits, an emergency opiate antagonist that reverses the effects of an overdose, in the hope of saving lives.

   Sometimes, it  looks as though the permissive society is going to self-destruct.

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