There was one question that inevitably echoed in the minds of millions of Americans watching the Super Bowl yesterday, and it had nothing to do with the football action: Why are we being subjected to an advertisement about constipation?
As gross as the ad may be, it certainly hit home with a lot of viewers. With so many Americans using opioid painkillers, it was only a matter of time before pharmaceutical companies developed a pill to take care of one of the painkillers' most common side effects: gastrointestinal distress, including constipation. It's a sign of the times that pharmaceutical company AstraZeneca found it worthwhile to buy a Super Bowl spot for their ad, for a drug called Movantik that specifically treats opioid-caused constipation.
About 40 percent of people who take opioids for non-cancer pain suffer from constipation.
Just how many people was AstraZeneca trying to target? In 2012, health-care professionals wrote 259 million prescriptions for painkillers, enough for nearly every single person in the United States, according to data from the Centers for Disease Control and Prevention. Not everybody who gets a prescription uses their painkillers inappropriately, but many argue that such widespread prescribing has led to America's opioid addiction epidemic.
But no matter; whether you use them appropriately or inappropriately, taking opioids for longer than a few weeks can lead to constipation. About 40 percent of people who take opioids for non-cancer pain suffer from constipation, a recent meta-analysis found. And it seems the usual methods of getting the bowels moving often don't work for these unlucky individuals. In one study, fewer than half of constipated opioid users said they received consistent relief from laxatives, compared to 84 percent of people who were constipated for other reasons. At the Super Bowl party I attended yesterday, one woman asked, "Why not just take some Metamucil?" Here's your answer, Sharon.
There are myriad ways opioids cause constipation and other gastrointestinal distress, which we won't list here. (If you need to know, try this review.) Suffice it to say the drug advertised yesterday works by reversing the effects of opioid painkillers in the intestine, while maintaining—mostly—the effects of the painkiller on the central nervous system, which senses pain. The Super Bowl constipation drug is basically naloxone for your gut.
OK, so Movantik is a sign of the times. But is that a good sign? Perhaps not. Movantik is aimed at people who have taken opioids for a long time, for chronic suffering such as back pain. But, according to some experts, this is just the kind of patient who should never have been prescribed opioids. Opioids are generally considered helpful for short-term pain patients, such as someone recovering from a broken bone, and for the pain of terminal illness. Opioids haven't proven effective for chronic pain, reviews have found, especially when compared alongside their potential side effects including dependence, addiction, overdose, and, yes, constipation.
"Sometimes I think the real answer is that no one should have started chronic opioids in the first place because you just get stuck and it's hard to get out of it," says Jonathan Chen, a physician and instructor at Stanford University's Department of Medicine. And then you have to take a separate medicine just to deal with the special constipation that comes with your painkiller.