This is the Reason OIC Is No Joking Matter

According to a recent Washington Post story, six in ten American adults take prescription drugs, and this has created a “vast market for new meds to treat the side effects of the old ones.” The article is titled: “The drug industry’s answer to opioid addiction: More pills.”

The article describes Jonathan Moss’s working on a treatment for “opioid-induced constipation,” or OIC.

You may have seen the controversial Super Bowl ad for Movantik, a drug that’s meant to treat constipation in people who use opioids for pain. Movantik is a new class of medication that reverses OIC.

The ad has been broadly criticized.

Bill Maher, who is usually a level-headed (and funny) comedian, tweeted this comment: “Was that really an ad for junkies who can’t shit? America, I luv ya but I just can’t keep up. #superbowl50.”

In a USA Today article, White House Chief of Staff Denis McDonough was quoted as responding in this way to the Super Bowl commercial: “Next year, how about fewer ads that fuel opioid addiction and more on access to treatment.”

Maher and McDonough aren’t alone. According to The Daily Northwestern, Senator Dick Durbin recently said, “The industry has also been responsible for television advertisements that normalized the use of opioids and made people work to convince their doctors to write them a prescription.”

Really! It is not clear what normalizing use of opioids means.

Insensitivity to the Needs of People with Pain

These attitudes suggest an insensitivity to the needs of people with pain who find opioids necessary to function. It seems some people are suggesting that treating opioids’ side effects, such as OIC, only allows for more opioids to be unnecessarily prescribed which leads to addiction.

That is silly. This belief demonstrates a lack of understanding about opioids, addiction, and the needs of people in pain. It also further stigmatizes both people with opioid addiction and people with pain. In this case, their lack of knowledge can cause people in pain more suffering.

Furthermore, people with active opioid addictions are rarely constipated. This is because they nearly always experience episodes of withdrawal. Opioid withdrawal causes diarrhea, not constipation. Therefore, it is a mistake to associate OIC with opioid addiction.

OIC ia Real Problem

OIC is a real problem. It can be disabling and cause other problems, such as COPD from chronic passive aspiration, dyspepsia, nausea, vomiting, and so forth. It can also cause bowel perforation and even death. OIC can occur after a patient ingests just one pill following surgery or in people who are on chronic opioid therapy.

A few years ago, a colleague complained to me that, following his surgery, he had to be readmitted to the hospital due to his opioid-induced constipation and uncontrolled pain. He was upset because his pain was severe, but he couldn’t take the opioid he needed (and was prescribed) due to his constipation. He tried other medications to control the pain, but they were inadequate. Sadly, this is not an uncommon occurrence.

The Post article seems dismissive of OIC as do Senator Durbin, Bill Maher, and Chief of Staff Denis McDonough. The article implies that Pharma is inappropriately profiting from treating a complication due to inappropriate opioid prescribing when, instead, Pharma should be reducing its output of opioids.

Of course, it would be preferable if OIC could be managed without this new class of medication. Reducing or eliminating opioids would be an ideal first step, but this is not always the best approach for people who feel opioids are necessary for them to function.

OIC has long been a problem for people who use opioids. We must take it seriously. Denying treatment for OIC is not going to have any impact on the prevalence of addiction, but it may increase the suffering of people in pain. Certainly, that is no joking matter.

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Copyright 2016, Lynn Webster, MD photo courtesy of unsplash


Originally published at thepainfultruthbook.com.