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What is Narcotic Bowel Syndrome?
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Medically Reviewed By:
Dr. Patricia Sullivan MD MPH on 1/24/2021
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Content Overview
What is Narcotic Bowel Syndrome?
Narcotic bowel syndrome (NBS) is a frequently overlooked but significant side effect of prolonged opioid use.
Long-term use of prescription narcotics, otherwise known as opioids or opiates, can severely impact your digestive system. NBS is incredibly painful and can lead to further health complications.
In this guide, we delve into NBS and the pain it causes.
If you’re experiencing health complications from the use of narcotics, help to stop addiction, and its consequences are possible.
Content
- Narcotic Bowel Syndrome Explained
- Causes and Complications of NBS
- Treatment for NBS
- Which Drugs Cause NBS?
- How Do I Get Help for NBS?
Understanding How Heroin Addiction Forms
When used properly, powerful opioids can be effective in relieving acute pain. But their potency means they have the potential to cause serious harm as well, especially if misused.
Narcotics and constipation are known to be linked even in short-term use. However, as narcotic use becomes prolonged, the potential for even worse digestive issues rises.
Narcotic bowel syndrome is an under-recognized side effect of opioid use, though it may be growing more prevalent. This is perhaps due to the significant rise of prescription opioid abuse in the United States, otherwise known as the opioid epidemic. Researchers estimate that 1 in 20 long-term opioid users will develop NBS.
NBS is a subset of a broader series of problems known collectively as opioid bowel syndrome or opiate bowel syndrome. The common symptoms are constipation, nausea, bloating, and sometimes pain.
When abdominal pain is the main symptom, however, the problem is specifically narcotic bowel syndrome.
The key feature of NBS is an ongoing or frequently recurring pain in the abdomen that worsens with continued or increased intake of opioids.
The pain from NBS will continue to progress despite any effort to relieve the pain using prescribed narcotics. NBS creates a seemingly inescapable cycle of pain.
As a user’s tolerance for the drug increases over time, the discomfort will worsen when the narcotic effect also wears down. This leads users to increase doses to try to ease the pain, leading to further increased pain.
Causes and Complications of NBS
The exact cause of NBS is unclear. Prolonged opioid use can increase pain sensitivity, but why it targets the gastrointestinal (GI) system is unknown.
Although the causes are uncertain, more is known about the complicating factors. For example, some doctors are, unfortunately, unaware that narcotic medications can actually sensitize patients to the pain and so may unwittingly add to the pain by prescribing narcotics to ease NBS.
If patients receive high doses of narcotics after surgery or otherwise abuse narcotic pain relievers, NBS can occur even if they have not had any previous GI issues.
However, those with existing GI issues may be especially sensitive to the symptoms of NBS. Eating can also make the symptoms worse. If the condition lasts for a while, unintentional weight loss can occur when patients stop or reduce eating for fear of aggravating the pain.
The symptoms of NBS are not very specific, so it can easily be confused with several other GI disorders. For instance, NBS may cause large amounts of buildup in the intestines, leading doctors to misdiagnose the cause of the pain.
The key to diagnosing it is recognizing that continuing or increasing doses of narcotics directly lead to worsening symptoms instead of relieving the effects.
Leaving NBS unaddressed can result in frequent visits to the ER, longer hospital stays, and even unnecessary invasive procedures.
Treatment for NBS
First and foremost, managing NBS requires detoxification. Detox is the process of stopping drug use and letting a substance completely exit your body. Due to withdrawal symptoms, this process can be unpleasant with any drug, but NBS can aggravate the discomfort.
Detox should not be done alone. It can be dangerous to stop drug use abruptly, and extreme discomfort can lead to relapse. Successful detox requires supportive measures to ease withdrawal symptoms, which you can usually find in the first step of many treatment programs.
The amount of time you have used opioids and the size of your doses can influence the amount of time that withdrawal symptoms last. Long-term users typically experience heightened withdrawal symptoms because their bodies have developed a dependence on the drugs, and it will take time to get used to functioning without them.
Medications
Detox generally involves a gradual withdrawal from opioids. The narcotics may be substituted with other medications that minimize withdrawal symptoms and manage pain.
NBS may be treated with antidepressants. These drugs have proven successful in the treatment of irritable bowel syndrome as well. This is because they can decrease pain signals traveling from the gut to the brain.
Doctors involved in withdrawal management may prescribe alternative painkillers, such as benzodiazepines, which can ease pain without aggravating the symptoms of NBS. When you can successfully manage your pain, you can focus better on treating your drug dependence.
Along with the pain of NBS, treatment should also address the problem of constipation. Opioids are notorious for causing constipation, and although they may not be as severe as abdominal pain, they can still cause significant discomfort.
When treating NBS, healthcare workers involved in your treatment may also prescribe a laxative if you are experiencing symptoms of constipation.
Treatment for opioid abuse often uses medications to reduce cravings. Certain medicines, including methadone, can bind to the same brain receptors as opioids or block the receptors to suppress the drug’s effects. This can help people stay longer in treatment and prevent relapse.
Therapy
Treatment does not end with medication. Patients with NBS typically have opioid dependence issues and must undergo further treatment to recover fully. Furthermore, the research on NBS indicates that co-occurring mental health issues worsen NBS symptoms. Patients diagnosed with NBS should also be evaluated and treated for any mental health problems.
Behavioral therapy, commonly used in drug abuse treatment, can help with substance dependence and mental disorders, which can both affect pain levels. Behavioral therapy helps people with addictions change their damaging behaviors and gain healthy coping skills to stay away from drug use and prolong their recovery.
Seeking treatment from a general physician may not always be helpful for NBS specifically. In many cases, doctors may be unaware of the presence of NBS and will continue to prescribe opioids for pain, making the situation worse. This is why it can be helpful to receive care from a drug abuse treatment program that will focus not only on treating pain but also on managing withdrawal and helping you cope without using opioids.
What Drugs Cause Narcotic Bowel Syndrome?
When people refer to narcotics, they typically mean opioids or prescription pain relievers. These drugs are also sometimes called opiates. Narcotics have properties that can relax the body and ease unpleasant sensations.
This is why doctors commonly prescribe them to treat severe pain, often after surgery. But because these drugs can cause a relaxing “high,” they are sometimes used for non-medical reasons as well.
Misusing narcotics can be dangerous because they are highly addictive and can easily lead to a fatal overdose. Heroin is also an opioid, but it is never used as a medication.
Common prescription narcotics include:
- hydrocodone (Vicodin)
- oxycodone (OxyContin, Percocet)
- morphine
- codeine
- Fentanyl
For the most part, prescription narcotics are safe when taken as prescribed by a doctor. Doctors generally only prescribe opioid pain relievers for a short amount of time. Because these drugs are so powerful, using them for prolonged periods can have unintended effects. And even though they are safe to use in certain situations, prescription opioids can still be misused.
Taking medicine to get high (instead of for pain relief) is considered abuse, even if you have a prescription for it. Misuse also includes taking more or for a longer amount of time than prescribed. People may also misuse narcotics by taking someone else’s medication without a prescription.
Repeated misuse of prescription opioids can lead to an addiction. This can make it extremely difficult to stop using the drug despite negative consequences, like NBS or other effects.
How to Get Help for NBS and Addiction
Narcotic bowel syndrome is so devastating because the pain seems unavoidable. It worsens whether the narcotics wear off or increase, creating a cycle of discomfort and drug use, exacerbated by other gastrointestinal symptoms.
As the opioid crisis escalates, NBS has become a bigger issue. It can affect anyone who uses opioids long-term, even if they’ve never had a history of digestive issues.
With proper treatment, the condition can improve. However, NBS is an under-diagnosed problem, and doctors may sometimes unknowingly make the situation worse by prescribing other opioids for the pain.
This is why addiction treatment can be more effective for ending the pain. Drug abuse treatment aims to combat pain without using opioids and can help you adapt to life without relying on pain relievers.
Opioid use can still be a serious issue in other ways before it leads to severe pain. Opioids are known to cause constipation and other stomach issues that don’t always lead to NBS. But misuse can also affect you mentally and lead to addiction, impacting all aspects of your life, not just your health. Your relationships, work-life, and family can all suffer as a result of opioid abuse.
Proper treatment will help you get past the pain so you can move on to solving any further issues and learning how to live without relying on opioids.
If you are living with NBS pain, you don’t have to suffer in silence. Treatment programs near you are equipped to help you ease the pain and manage your drug use.
We can guide you in the right direction toward a happier, healthier life. Reach out today at 912-214-3867 for more information about your treatment options.
The Helpline is free. Dial (888) 906-0952 and press 1.
Sources of Information
- https://www.drugabuse.gov/publications/drugfacts/prescription-opioids
- https://www.ncbi.nlm.nih.gov/books/NBK493207/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2074872/#:~:text=Narcotic%20bowel%20syndrome%20(NBS)%20is,may%20be%20becoming%20more%20prevalent
Health-Related Content
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