Constipation Isn’t a Fitting Punishment for People With Pain
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.
Filed under: General Problems
The criticism of chronic pain sufferers who also afflicted with OIC has been Bullshit, No Pun Intended. From McDonough and Kolondy to Bill Maher making a joke on Twitter during the 2015 Super Bowl about “helping junkies shit” has been nothing short of hateful and incredibly unsettling. The public scrutiny and criticism of people in pain who also suffer from OIC is unforgivable. Our battles are coming at those of us in chronic pain sufferers from all directions. Public figures or Officials and even celebrrties who are labeling us all as addicted because of their personal beliefs, and without honest scientific fact is the harshest form of profile discrimination anyone should ever be forced to endure.
Honestly it’s all the same exact treatment that people of the Muslim faith are getting today by others who are too stupid to realize that the a religion doesn’t make a person a terrorist. Thier ideals and interpretation of how they choose to follow their religion does. Just because because your a Christian doesn’t mean your going to go into a Mosque with a gun and open fire on the Muslim people who are there praying, and just because we use opioids to manage our pain doesn’t make us all Addicts. Compassion and understanding only works if it’s equal and fair to all religious beliefs, race, color, creed or all effected by chronic pain, disease, OIC, mental illness, and yes even addiction. This is where all our medical professionals should stand up against a system that’s purposely discriminating against their patients. No one has ever accused all heart patients of being a terrorists because they carry around Nitro Glicerin in their pockets just in case. So why do they accuse all pain patients of being addicts?
Just go ahead and turn on your television to any station that has paid advertising and count how many commercials for drug and alcohol addiction treatment centers come on. Watch how much they advertise during the most expensive advertising time, prime time broadcast hours. Just last night I counted 4 commercials for the Addiction Relief Network between 8 and 9 pm on the Discovery Channel. I’ve done additional counts on Passages Malibu and many, many others with the same results, multiple commercials in a one hour period on multiple channels.
From “This is your Brain, now this is your Brain on Drugs”, to “I was addicted to Crack, I was addicted to Heroin”, and the host of other drugs they name on the Addiction Relief Network commercials. My question is.
If all these addiction centers are not for profit organizations, how the hell are they all able to afford to advertise up to 4 times per hour during prime time on multiple television and news networks and even during major sporting events? After prime time hours they double their advertising to up to 8 commercials and hour. Since the Super Bowl airing of the OIC commercial I’ve probably only seen that commercial a dozen or more times. Passages Malibu and the Addiction Relief Network commercials I’ve seen hundreds or even thousands of times. So, the criticism about the OIC advertising and the treatment by famous people and public officials is in my opinion, criminal. Plus we have the addiction recovery centers that are obviously pushing that all opioid usage is addiction, and they are doing this for profit.
I had a horrible experience with OIC a few years back but did not have a clue what it was then. I just knew I was so miserable and it was starting to affect standing up or walking. The ER doctor screamed at me saying, “Don’t you ever come back to this ER for constipation!” It was rather humiliating for everyone to stop and pay attention.
If this aint’ bigotry/prejudice and shear grotesque prejudice onto the medically ill w/painful injuries..Any kind of REAL doctor would of not shown such grotesque cruelty,and cruel prejudice,,,Like saying in thee old days,,rub salt in those whip wounds.,,,he should be expelled from ever practicing medicine every again,,,what a bigot,,,,,cruel,,,inhumane not even a person,,let along a doctor,,sue the crap out of em,,,u got 90 days to file a lawsuit for a doctors error,,maryw