In his new autobiography, Matthew Perry reveals that his colon burst as a result of his addiction to opioid painkillers. The 53-year-old actor, who played Chandler Bing on Friends, was in a coma for two weeks after the incident and had to wear a colostomy bag for nine months.
Many people take prescription opioids, such as codeine and hydrocodone, to manage pain. This news can therefore be quite alarming. But can prescription opioids really burst your colon?
Opioids reduce bowel activity, which is why they are sometimes used to treat diarrhea. And people who take it often suffer from constipation.
Over time, the body develops a tolerance to many of the effects of opioids, but the constipation tends not to improve – in fact, it may become more severe.
In extreme cases, the colon ends up stretching, sometimes irreversibly. And if there’s something else wrong with the colon, opioids can make it worse. The intestine can perforate – as it did in Perry’s case – but this is quite rare.
The powerful analgesic effects of opioids have been known for thousands of years. Some people, like Perry, get addicted to them, but most people who take them for pain don’t.
However, these are delicate drugs with unexpected effects. The most dangerous is suppressed breathing.
Opioids depress the respiratory center in the brainstem, and if they take enough, people stop breathing. This is the most dangerous of the pharmacological effects of opioids. Although the body develops a tolerance to the effects of opioids and the sedation decreases, the effects on breathing do not decrease as much.
People who do not appear sedated may develop low blood oxygen levels after their dose is increased. This may be how Tom Petty and Prince died from the effects of opioids.
With long-term use, the analgesic effects of the drug also decrease. As a result, doses are often increased.
Surprisingly, at doses of 120 mg of oral morphine per day or more, the pain worsens. This is called opioid-induced hyperalgesia. Why this happens is not well understood.
Unlike alcohol, opioids do not cause tissue damage, but they do cause a drop in testosterone (hypogonadism) in men. Hypogonadism also occurs in women, but less frequently. The extent to which it is reversible is unclear.
Not just the body
High-dose opioids cause reversible cognitive and behavioral changes. The sedative effect of drugs impairs the ability to pay attention and concentrate.
Opioids can also affect abstract thinking; it becomes difficult to think about problems or understand situations from different points of view.
The ability to experience pleasure decreases and people lose interest in activities. Social and family life may become more restricted or cease altogether. Although this type of behavioral change is often attributed to the underlying condition and pain rather than the mind-numbing effects of the drug.
This miserable prospect is not inevitable. Even when people have been on opioids for a long time, there are solutions.
Low doses work better than high doses, and some people do better without painkillers at all. With help, doses can be reduced slowly, but this is notoriously difficult once people take high doses.
Until now, it was assumed that opioid doses generally increased very slowly, making it difficult to realize that a problem was developing before it was too late.
In a recent study, my colleagues and I reviewed the primary care records of all patients taking high-dose opioids in a practice in Wales. None showed a long, slow rise. In all cases, people quickly reached doses of 120 mg or more of oral morphine per day – in weeks or even days. It could happen at the start of treatment, but it also sometimes happened suddenly after years at much lower doses.
It seemed like a one-way process. After crossing the high dose threshold, none returned to low doses.
In a previous study, we described an intervention in which patients taking high-dose opioids were rapidly switched to low-dose methadone (also an opioid). Methadone was chosen because it is eliminated very slowly from the body. It gives a stable blood level, which is helpful in minimizing the dose.
A group of 20 patients reported significant improvements in their level of activity and well-being. Although they were given the option of resuming their previous drug treatment if they wished, none did. Some have reported improvement in pain or their ability to manage it.
I wouldn’t advocate for people to avoid opioids altogether, but when modest doses fail, high doses are unlikely to work long term.
Rob Poole, Professor of Social Psychiatry, Bangor University
This article is republished from The Conversation under a Creative Commons license. Read the original article.