Bowel Dysfunction in Opiate Substitution Patients

Background: Chronic use of opioids is clinically known to be often associated with bowel dysfunction, most often with constipation.

Objective: We examined the correlates of bowel dysfunction in methadone and suboxone patients.

Methodology: 68 patients (mean age 40.3, SD=9.5; 40 men, 28 women) participated. The average number of years using opiates prior to treatment was 6.9 (SD=7.2) and the average number of years in the substitution treatment was 7.2 (SD=3.1). Seventeen were on suboxone (mean dose 14.7 mg, SD=8.6) and 51 on methadone (mean dose 70.4 mg, SD=29.6). All responded to a survey questionnaire about frequencies of 8 types of bowel dysfunction: constipation, nausea, emesis, abdominal pain, loss of appetite, heartburn, acid reflux, and intestinal bloating. For each of these 8 symptoms, the response categories were: never=0, only rarely=1, sometimes=2, often=3, very often=4, and always=5.

Results: When categories “very often” and “always” were pooled, the frequencies of bowel dysfunction were as follows: constipation (42.6%), nausea (7.4%), emesis (2.9%), abdominal pain (10.3%), loss of appetite (14.7%), heartburn (10.3%), acid reflux (7.5%), and abdominal bloating (14.7%). A higher dose of methadone was significantly (p<.05, 1-tailed) correlated with acid reflux (r=.47), bloating (r=.37), constipation (r=.36), abdominal pain (r=.29), and heartburn (r=.31). A higher dose of suboxone was significantly (p<.05, 1-tailed) correlated with more frequent nausea (r=.47) and emesis (r=.42). Years of opiate use were unrelated to bowel dysfunction.

Discussion and Conclusions: The majority of patients (57.4%) reported that at least one of the 8 bowel dysfunction symptoms occurs “very often” or “always.” Constipation was by far the most frequent symptom. The bowel dysfunction was more frequent in patients with higher methadone or suboxone doses. Only 5.9% of patients indicated that they “never” experience any of the 8 bowel symptoms.

Keywords: opiate induced bowel dysfunction, narcotic bowel, addiction, opiates.