Opioid-Induced Constipation: A New Drug to Treat the Side Effects of Opioids

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During the 2016 Super Bowl, an advertisement featured a man suffering from opioid-induced constipation. Superficially, the commercial appeared to raise awareness of a distressing condition and suggest a solution to the problem. On a deeper level, it kicked off a discussion on how opioid-induced constipation might be better addressed by first reducing the use of opioid-based painkillers.

Opioids are big business in the United States. In 2014 alone, doctors wrote over 240 million prescriptions for opioid painkillers. That same year, there were 28,648 opioid-related deaths from overdose. U.S. opioid consumption has risen by 300% since 1999, and our 5% of the global population consumes 80% of prescription opioid painkillers.

Opioids are commonly prescribed for pain relief. While drugs like Vicodin, Percocet, and codeine are household names, this familiarity masks the addictive nature of these medications. For some, the Super Bowl ad started a debate about whether the problem of opioid-induced constipation is being tackled in the right way; for others, they are relieved the subject is now being talked about openly.

Constipation is a common side effect of opioid use, but many people feel too embarrassed to discuss it with their doctor. In addition, traditional laxatives work poorly against this form of constipation. For some people, the constipation is so much worse than the pain that they often opt for the pain over opioid constipation.

It is estimated that 28-35 million people suffer from opioid-induced constipation. This represents around half of those who are on long-term pain relief. The side effect happens at such a high rate because of the mode of action of the drug. Opioids block pain by acting on mu-receptors in the brain which tell the body it’s in pain. At the same time, opioids also act on mu-receptors in the bowel wall which means the bowel’s movements are sluggish, promoting constipation.

The new drug alluded to in the Super Bowl ad works by preventing opioids from attaching to the mu-receptors in the bowel wall, but not in the brain. Thus inhibiting the pain messages but not bowel movements. The active ingredient, naloxegol, also has side effects including nausea, flatulence, vomiting, and diarrhea.

While raising awareness of a problem such as constipation is a good thing, opponents of the Super Bowl ad argue the money would have been better spent by alerting patients to the addictive nature of opioid painkillers. Indeed, 2.2 million U.S. citizens need treatment for opioid addiction.

Of course, people in pain don’t choose to become addicted to their medications, and nor did they choose drugs based on the side effects—although their doctors and pharmacists should warn them of the effects. Above all, it is ironic that the very companies who command profits by selling opioid-based painkillers have uncovered a large new market to combat the side effects of their other drugs.

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