Last Sunday, like millions of other people, I watched Superbowl 50. As usual, there were some great commercials throughout the game. However, I can’t forget one commercial from the 2nd quarter. Not because it was funny and creative like most of them were, but because of the targeted medical condition: opioid induced constipation (OIC). The reason I can’t forget it was how embarrassed I felt as my friend with whom I watched the game laughed at the inappropriate humour the pharmaceutical company used to promote its product. For those of you who don’t suffer from chronic pain or have never had the need to take opioid (narcotic) pain medications for pain relief, I assure you this condition is a real thing. The Australian Pain Society states, “One of the most common adverse effects of chronic opioid therapy is constipation. Up to 95% of patients prescribed an opioid report constipation as a side effect, which can occur soon after taking the first dose.”

Opioid induced constipation is also known as opiate bowel dysfunction (OBD); and according to the American College of Gastroenterology “constipation may be debilitating among those who require chronic analgesia [pain relief]. OIC/OBD affected an average of 41% of patients taking an oral opioid for up to 8 weeks.”   The reason for this is that “opioids cause constipation by binding to specific receptors in the gastrointestinal tract and central nervous system, resulting in reduced bowel motility through direct and indirect (anticholinergic) mechanisms.”  In short, the opioid pain medications delay or block messages throughout the body that tell you when you need to empty your bowels.

I understand that a commercial’s purpose is to grab its audience’s attention in a short time. However, the tone of this commercial failed to convey the seriousness of this condition, while using lowbrow humour to flog the product. Practical Pain Management, a publication founded and written by pain experts, notes that although opioids have been in use for centuries; it’s only in recent decades that this kind of medication has received any significant attention and investigation. Sadly, “we are only beginning to understand and identify the many side effects of opioids. Constipation, nausea, emesis, pruritus, respiratory depression, and somnolence are well known. However, not so well known are effects on immune function, urinary retention, endocrinopathies, gastroesophageal reflux (GERD), gastroparesis, sleep apnea, cardiovascular system, osteoporosis, emotions, dentition, and renal function.”

This lack of knowledge about opioids begs the question, how many people know that if a patient that has OIC/OBD does not receive the proper medical treatment it “may cause rectal pain and bleeding, abdominal pain and distension, urinary incontinence, faecal impaction, rectal tearing, and, in very severe cases, bowel obstruction and colonic perforation?”  How aware are people that OIC/OBD can reduce a person’s quality of life as much as the chronic pain doctors prescribe the opioid medications to treat? The Australian Pain Society also notes that, “Some patients would rather endure chronic pain than suffer from the severe constipation that can arise with long-term opioid therapy. One study found that approximately one-third of patients missed, decreased or stopped using opioids in order to make it easier to have a bowel motion; the majority (86%) of these patients experienced increased pain as a result, which reduced their quality of life. Reducing the opioid dose is not considered useful, as analgesia [pain relief] may be compromised and constipation may not resolve.”

I know that 30 seconds isn’t a long time and not all the points I raise most likely could have been touched on in that amount of time. However, I do know that the pharmaceutical company could have approached this issue in a more dignified way. When the commercial ended – and my friend’s laughter died down –, I did educate him about the seriousness of OIC/OBD, and how I’m affected by this condition because of the large doses of opioid pain medications I have to take to manage my pain. I hope that others who might have been in the same situation during the game were able to have similar conversations. If not, here’s a link to a therapeutic brief from an Australian Pain Society study that gives information about OIC in plain language in a downloadable PDF file: Opioid-induced constipation– a preventable problem

Bob Dylan – Dignity