Best Laxative for those on Opioids?

[Hammilton]

Don't laugh- I mean this question quite seriously. What's the best laxative for those who take daily opioids? I just started taking methadone again, and if I were to take it for a while and allowed my body to get into a rhythm, I wouldn't even need one, but the first few days can be a bitch.

So, what do you guys suggest?

I want to make this a poll, but I don't think it's working for some reason (were they disabled perhaps?) so I'm just gonna put a numbered list of options, and when you reply, if you could post the number you chose first, followed by any information you want to include, so like this:

3. I prefer saline laxatives because morphine really dries up my bowels. Milk of Magnesia (Ex-Lax) moisturizes and conditions, allowing my intestine's natural motion to work my bowel movements out easily, no need to strain or work in over-drive on the can.

I'm planning on putting together an FAQ from the data I'm able to gleam from your responses. I know there have been discussions of this before, but I think there are some people who would be afraid to ask these sorts of questions. I honestly think that this is an important topic, and it's really no joke. Chronic constipation, like many of us here deal with, can be a major risk factor for developing intestinal and colon cancers- not to mention the massive and annoying hemmorhoids that are damn near unavoidable in the long-run.

So, the options here are:

1. Saline Laxatives. ie: "Milk of Magnesia" aka Magnesium Hydroxide- found in Exlax

2. Stimulant Laxatives. ie: Sennosides from Senna, Bisacodyl

3. Stool Softeners. ie: MiraLax (Propylene Glycol), Ducosate Sodium

4. Bulk Forming or Fiber Laxative. ie: Insoluble Fiber

5. Lubricant Laxative. ie: Mineral Oil

6. Other. ie: naloxone, caffeine, nicotine


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Thanks any responses I may get in advance. This is a problem I'm currently facing, and I've tried 1 and 3 today, and I've not gotten much for results.

There's another question I'm also considering, as well, in regards to Saline Laxatives like ExLax. I've used it on a couple occasions, and my results have always been quite different from what the bottle says will happen. The bottle says you can expect a bowel movement in 1/2 to 6 hours, but I've never had one in under 8 hours after using even the maximum adult dosage, and typically it has taken me 10-12 hours.

That's quite a length of time considering Saline Laxatives are supposed to be very fast-acting. So much so that they recommend not taking it at times when you will be unable to hit the bathroom immediately or you risk having to shower instead of flushing.

I assume that my response is probably typical of all opiate-users as our intestinal motility is reduced by the drugs. I've seen this phrasing used quite a bit re: opiate-induced constipation, and I've always assumed that it meant the contractions in the intestinal walls that propel bowel movements onward are reduced substantially or even stopped for a period.

If that's the case, then it makes sense that it would take much longer for a saline-laxative to work, or at least it does to me. Perhaps I'm wrong and I should seek medical advice.

This second question is more important to me (personally) than the first. For those who know much about me, you know that I am, at times, a hyper-neurotic person very prone to panic attacks from small things.

Well, this is definitely one of those times. Though I rarely get panic attacks, I have had 3 a day for the past two days because of this. Last night I almost drove myself to the hospital in a strange city because I was having so many fucking panic attacks and near-contant anxiety. My bowel movements may not have caused this wave of panic attacks, but their absence has definitely provided hours of rumination and fodder for over-thinking and obsessing.

You know how opiates can sometimes make it a bit more difficult to urinate? I think this is a guy thing, only, but I dunno, girls. Anyway, I never had much problem with that, maybe a very little. Well, my anxiety managed to make that wonderful 30 second affair into a half-hour worry-fest that can only be cured by reading inactive ingredient labels and organic-chem books while replaying unrelated events (not that there are many urination-related events in my life!).

Christ, even this post is neurotic as hell. I dunno why I'm going so fucking neurotic-nuts right now, but any help would be appreciated.

feel free to PM or AIM me (you can reach me via the AIM thing on the left side of this post) with little things I already know, like: "you'll be fine" or "opiates can't cause your bowels to kill you"- little reassurances to let me know that what I know is correct.

sorry for this post, I'm going a little bit crazy

[bronyraur]

Number 1 works well for me, Hamm.

I take the maximum dosage and I'm usually shit free in a day.

[alowishus]

After a couple yrs of old hard little dry rocks, I ate a bunch of watermelon one day, and it cleared my system, I was amazed. I dropped 5 pounds, I swear

It's all I use, well all I used to use anyway.

[candyshop]

my son had a bad bout of bronchitis this winter-they gave him coedine cough syrup-even after pushing fluids like mad he got so constipated he did not go for 5 days,horrible discomfort-the dr. put him on a 3 day clear
fluid diet and had him drink this weird lemon lime flavored stuff--magnesium sulfate, you buy it in soda sized glass bottles at the pharmacy--it seemed to do the trick-

[Mallum-In-Se]

I just use the publix brand generic stuff, seems to work fine. Though the people who make duco-lax make a laxative combined with a stool softener, its like 11 bucks though. I would give that a try cause all the laxatives in the world aren't going to do shit if you are all bound up and shit.

[alowishus]

my son had a bad bout of bronchitis this winter-they gave him coedine cough syrup-even after pushing fluids like mad he got so constipated he did not go for 5 days,horrible discomfort-the dr. put him on a 3 day clear
fluid diet and had him drink this weird lemon lime flavored stuff--magnesium sulfate, you buy it in soda sized glass bottles at the pharmacy--it seemed to do the trick-

Mmmhhh, that stuff in the bottle sounds good.

[Rhonda]

I dont know if anyone has ever heard of this one but theres black licorice. If you eat a couple of pieces of real black licorice it helps make things move a little easier. I always used to notice it when I was little. Id eat some black licorice and later or the next day it was so easy! no pushing or anything and it's natural no chemicals.

[MissyAggravation]

i'm with alowishus in that i prefer to go the natural route. i eat a LOT of fresh fruit. apples and watermelon are great natural laxatives. fresh apples are the best and you want to leave the skin on to get the most out of them(most of the vitamins are in the skin anyways!). an fresh apple with each meal or three times a day as a snack really helps. not only is it really good for your bowels it's just plain good for you. if you don't like fresh apples - a few bowls of applesauce a day will help as well - though not as much because like i said the skin of the apples is crucial for the laxative effect. watermelon also is a great natural laxative as alowishus stated. instead of your usual breakfast(or in addition to a big bowl of some fiber rich cereal) sit down with a huge honking slice of watermelon(i've been known to eat 1/4 to 1/2 a decent sized watermelon in one sitting). it's mostly water and there are no calories so you can eat as much as you want, just don't overdo it to the point where you're sick(it can cause a mean bellyache if you eat too much).

as far as liquids go - it's very important to drink 64oz of water a day(this is on top of other fluids that you should be consuming ie juices, milk). that's one gallon. it helps your body by absorbing soluble fibers thus softening your stools. also, there's the constipation cure-all that my mother always administered as a child - a huge glass of straight up prune juice(i hear it works quicker when warmed). orange juice is another great liquid laxative. as is lemon juice. as far as the water goes - how i get down my 64oz of water a day is by adding a few drops of lemon juice to each glass. if you're drinking tap water it helps get rid of that "tap water" taste and even if you're drinking bottled water a few drops of lemon juice i find greatly improves the taste. oh and apple cider is great, as well as natural apple juice(not the oversweetened stuff).also, if you can find aloe vera juice it's a VERY potent natural laxative as it causes small contractions in the colon. if you find aloe juice and decide to use it - do not take more than the suggested serving no matter how plugged up you are as it can be VERY powerful, so powerful that you may even want to start a little below the suggested serving and work your way up. if you can't find the aloe juice i hear that the aloe gel caps can help as well.

and if you're having constipation problems it is very important to avoid alcoholic beverages and caffeinated beverages as they only dehydrate you thusly making it still more difficult to get a good poo. :)

other natural foodstuffs that can aide in proper digestion - dandelion greens(they are everywhere right now if you live anywhere in the u.s., not sure about other areas). either pick a bunch from a safe area(meaning not next to any roadways or industrial aread), wash them and use them as salad green, or cook them down and use them as side dish to accompany your lunch or dinner. also, rhubarb, prunes and figs work well. and always go for fresh fruits and veggies firstly - second best would be frozen - and try to avoid canned altogether. avoid white breads and go for anything dark and grainy as far as bread go. i would also avoid potatoes while constipated. and any fruits and veggies that you DO consume - try to leave the skins/peels on if possible because that's where a lot of the fiber and nutrients are.


oh and if you add powdered fiber to your diet(which i would only do as a last resort - better to go the natural food/beverage way really) be sure that it's the psyllium husk kind and add it gradually. you don't want to take huge doses at the start because if you're already constipated it's not gonna help by just adding more bulk to your intestines - work your way up and it will help.

and staying away or severely moderating your intake of red meat can be helpful as well. especially if you're already really backed up. eating a 12oz porterhouse will do nothing for the cause - only make you feel more like shit(no pun intended!)

also, regular physical activity is very crucial to digestion. whether it be cycling, walking or jogging or some form of aerobic workout. anything to get your body moving and your metabolism going. and i can't help but think that just the general idea of jostling your body around for a good 20-30 minutes a day(at minimum) can do wonders to shake things loose. just make sure that if you are working out in some way and sweating a lot that you replace those lost fluids on TOP of the normal 64oz of water a day you should be consuming.

keep in mind that you should be having at least three bowel movements a week. anything less than that would mean that you are most definitely constipated in a serious way. and you don't want to get too backed up because it can cause fecal impactions and other serious issues and generally just make you feel really icky and backed up.
but then again don't spend any more than a few minutes trying to go poo, otherwise you are straining and you're going to give yourself a hemorrhoid. so just wait until you have the natural urge to go. don't force it or you'll be really sorry. i had my first ever hemo a few months ago and it was horribly traumatic! it's one of those things that you only MIGHT wish upon your most mortal enemy.

and i guess if all else fails you could try the old castor oil trick. i really know nothing of how it's supposed to administered but i'm sure it could be googled easily.

AND - last but not least - avoid highly processed foods and junk foods. they will do nothing to aide in digestion and if you are already backed up you don't need this shit lingering in your system just making you even more toxic. don't get me wrong - i love big macs and greasy fries - but when i'm having bowel issues i force myself to avoid them for a while.

that's all my knowledge on the matter. i hope it made some sort of sense and that it helps someone somewhere.

here's to regularity!! :)

[alowishus]

If anyone wants to check out an old thread about fecal impaction and why NOT to have one see this (http://forum.opiophile.org/showthread.php?t=200).

[OpiBli$$1988]

pickle juice is the miracle cure for constipation.

[ProdigalSon]

Dude, I swear on my balls magnesium citrate. No pains, cramps, its a wonderful thing. Be careful, youll be plugged up fer days upon days and take some of that shit and boy oh boy is it painful

[Paregoric Kid]

methylnaltrexone, alvimopan, magnesium, mineral oil
the first two I listed aren't out yet but will be in the next year, they are peripherally-acting mu opioid receptor (PAM-OR) antagonists and will be the end of constipation from narcotics.

[Majortom]

I used senna leaf tea to help my problem. Sometimes it works well but sometimes I 'd taken more serious !! precautions.:cool:

[NastyZilla]

Stool softeners, but only rarely needed. Here's something to make you guys jealous.... I used to have irritable bowel disease before I got addicted (you know, shits all the time, never knew when or why they'd strike). GONE with opiates! My family still wonders why I suddenly stopped having IBS!

"Addiction... The IBS Miracle Cure"

[Majortom]

as far as liquids go - it's very important to drink 64oz of water a day(this is on top of other fluids that you should be consuming ie juices, milk). that's one gallon. it helps your body by absorbing soluble fibers thus softening your stools.
here's to regularity!! :)[/quote]

Just a small correction. No offense...

1 oz = 33.8 liter

64 x 33.8 = 2,1638 liters

1 Gallon is 3,7854 liters that makes a little more then half a gallon. (0.65)


I agree w/ the fact that drinking juices help but milk doesn't apply the same outcome with everyone.

[Majortom]

Stool softeners, but only rarely needed. Here's something to make you guys jealous.... I used to have irritable bowel disease before I got addicted (you know, shits all the time, never knew when or why they'd strike). GONE with opiates! My family still wonders why I suddenly stopped having IBS!

"Addiction... The IBS Miracle Cure"

Good point really, thats why Atrophine is used in that sort of medication. This morphine derived substance can be used to ease w/d .

[Hammilton]

Atropine isn't derived from morphine. It's a tropane alkaloid, found in many members of the Solanaceae family- ie the nightshades. Cocaine is also a tropane alkaloid, although it's got vastly different effects.

I don't think Atropine is actually in Lomotil for its anti-diarrheal effects. I think it's there for its ability to prevent people from abusing Lomotil for its Diphenoxylate content. Not that the super-tiny quantity of atropine is enough to prevent someone with a low tolerance from abusing it.

oh, and atropine won't do shit for withdrawal. It's actually been shown to make it worse in some animals.

[TappyTibbons]

COCAINE AND CIGS

[Hammilton]

I really, really, like the idea of using a peripheral mu-antagonist to prevent constipation. Do you know if methylnaltrexone is orally active? If it is, or another peripheral mu antagonist ("permant") is, there's no reason it shouldn't be added to every single painkiller on the market- especially those intended for long-term use, like methadone and OxyContin.

I would imagine that the addition of a simple thing like this would, in large part, prevent physical dependence. Sure, it's not going to completely prevent it, but I would seriously be surprised if it didn't completely revolutionize the way people think of physical dependence. There are lots of people who won't use painkillers, who are afraid of them, because they're afraid of "addiction."

I'm sure this would really make a difference in tolerance too!

[Mallum-In-Se]

I really, really, like the idea of using a peripheral mu-antagonist to prevent constipation. Do you know if methylnaltrexone is orally active? If it is, or another peripheral mu antagonist ("permant") is, there's no reason it shouldn't be added to every single painkiller on the market- especially those intended for long-term use, like methadone and OxyContin.

I would imagine that the addition of a simple thing like this would, in large part, prevent physical dependence. Sure, it's not going to completely prevent it, but I would seriously be surprised if it didn't completely revolutionize the way people think of physical dependence. There are lots of people who won't use painkillers, who are afraid of them, because they're afraid of "addiction."

I'm sure this would really make a difference in tolerance too!

Well I guess the cats out of the bag. So now I can let you all in on my secret I was going to patent and make a bazillion dollars off of.
"Oxy-lax"
Yep, Instead of mixing Apap with oxycodone I say we mix it with a laxative, shit maybe just got for a stimulant like dextro-amphetamine (adderol). For the people who were straight they will dig it because they won't get constipated on it, and for the people who abused it it will be like a speedball. Came up with this idea bout two years ago.

[l4l5]

best laxative is a diet high in fibre, i.e vegetraian, vegan and keep eating, I use opiods on long term basis and never get backed up ever unless i dont eat properly

[Paregoric Kid]

methylnaltrexone works IV, SC, and orally. it is jointly being developed by Wyeth and Progenics Pharmaceuticals. they recently submitted an application to the FDA to market the drug and are waiting for approval.

unfortunately alvimopan, which was being developed by Glaxo Smith Kline and Adolor Corp., suspended the development of alvimopan until long term safety studies are evaluated :( they even had plans of combining alvimopan with opioid agonists. I have a feeling wyeth will also try to market opioid agonist+methylnaltrexone combinations once it's out.

either way peripheral acting MOR antagonists are the future.

[Hammilton]

Well I guess the cats out of the bag. So now I can let you all in on my secret I was going to patent and make a bazillion dollars off of.
"Oxy-lax"
Yep, Instead of mixing Apap with oxycodone I say we mix it with a laxative, shit maybe just got for a stimulant like dextro-amphetamine (adderol). For the people who were straight they will dig it because they won't get constipated on it, and for the people who abused it it will be like a speedball. Came up with this idea bout two years ago.




You realize that "stimulant laxatives" aren't remotely similar to Stimulants? Mixing Amphetamine salts with Oxycodone won't prevent constipation. I take amphetamine with methadone all the time and have never had any benefit.

I have had good luck with caffeine as a laxative in large doses (500mg).

Even if you were to use a *real* stimulant laxative, like bisacodyl, with oxycodone, I doubt anyone would enjoy it- even as a laxative. Stimulant laxatives are well known for their ability to produce unimaginable stomach pain. I've only really passed out once, and it was due to the intense pain that one of those fucking bisacodyl tablets caused! Not even the max dose.

[Naomi]

i swear by movicol.
my momma demanded it for me; she is a nurse and they use it for bedridden elderly patients all the time.

whats good about it is, it treats fecal compaction. you know, you lose water when crap is stuck in the colon waiting to come out (we all know what thats like and how painful!). it brings water back to the crap stuck there, whereas, other laxatives like senna dont do that right? at least, i dont think they do. maybe i am wrong.

all i know is i couldnt shit for nearly 2 weeks, i got this stuff and after 1.5 days of taking it i could go. okay, it hurt a bit but i can remember lying on the floor afterwards praising jesus.

movicol. or is it movical? you other english people will know.

[resorcinol]

I use stool softeners daily because they're gentle compared to other laxatives, and saline laxatives if the stool softeners ever don't work for a few days and a backup happens. Saline laxatives are POTENT.

[Duckfeet]

My experience is that they all work at first, but also, if yer dose is too high, or u just get out of whack, it's very easy to get past the point of no return, and then u get really familiar w/that area of the drugstore that has the horrible sour tasting pre-surgical shit...and suppositories...and enemas(in douchebag area) ...but of course, then u face the unhappy realization--just like w/dope--that ur colon gets used to this little bit of help, and natural dumps become just a fading memory....IMHO...

Or, drop down to 30mg mdone maint...and u'll find yerself trotting home in agony, but totally happy, cuz u know finally and forever...yer gonna take righteous dump...so it all works out...and some are o.k. on steady opys...and some never get rite....

[Raisin]

Withdrawals and large doses of cocaine always work for me.

[SHELLEY]

i don't know about other opiate users
but the best "laxative" for me (i am on 90mg/day methadone) is fruit
i don't even keep any laxative in the house
but i eat peaches, plums, apples, oranges, all that stuff
and it works every time

[Dan Steely]

Withdrawl. Hold out on the morning dose til ya getcha business taken care of.

[Duckfeet]

I agree absolutely w/this one in theory...but my own troubled reality has taught me, that there usually comes a point where I say "fuck it", and get up and dose...and I'll tell myself all kinds of things: "I'll go to the drugstore later and get some of that nasty pre-surgical sour crap to drink" or "I'll give it another day of just eating tangerines, *then* I'll go to the emergency room..." and about five other "put off until tomorrow" excuses I use, when I *know* I can get dope...

So I've found that this never works as good for me as I intend it to...maybe I'm just not a "morning person" and "getting right" takes on all kinds of serious import by about 9 a.m.


Withdrawl. Hold out on the morning dose til ya getcha business taken care of.

[LorTabitha]

Thanks to whoever mentioned watermelon. Worked like a dream yesterday!

[Duckfeet]

*No* thanks to whoever mentioned 'golitely'...probably me, as even at this low level--26mg, I'm still not out of the woods, and once I go past 2-3 days without a BM...I take measures...

But yep, fruit--not fruit *juice*--and a daily large salad, and 30min run, are making things better...but not 'well', yet...


Thanks to whoever mentioned watermelon. Worked like a dream yesterday!

[irish]

I'll take some miralax for a couple of days at a relatively high dose and then take 8-9 senekot-s tabs before bed. This pretty much guarantees that I will shit a lot the next day. If you really want to clean yourself out, take the miralax in high doses for about 3 days and then dring come citro-mag. Make sure that you have a free day for this becasuse you need to be within 20ft of a bathroom when the ctro-mag kicks in.

[Duckfeet]

I *hate* the tast of everything, and even miralax doesn't work all that good, once I get past 2-3 days w/out a dump....but cutting back in methadone dose...that works...miserably...

I'll take some miralax for a couple of days at a relatively high dose and then take 8-9 senekot-s tabs before bed. This pretty much guarantees that I will shit a lot the next day. If you really want to clean yourself out, take the miralax in high doses for about 3 days and then dring come citro-mag. Make sure that you have a free day for this becasuse you need to be within 20ft of a bathroom when the ctro-mag kicks in.

[Consumed.]

all of them besides stool softeners have long term bad effects.

[Duckfeet]

I agree...but so does most everything else on this planet: trading in fucked tomorrows for happy todays is human nature...which is why underfunding union pension funds--and laxatives and enemas--are so appealing...that's right, I live in San Diego ;-)


all of them besides stool softeners have long term bad effects.

[bronyraur]

I agree...but so does most everything else on this planet: trading in fucked tomorrows for happy todays is human nature...which is why underfunding union pension funds--and laxatives and enemas--are so appealing...that's right, I live in San Diego ;-)

So very true...here we are using all types of opiates/opioids and ingesting them in all sorts of ways (some with potentially harmful side effects), and yet we worry about the long term effects of laxatives...

...fucked up, isn't it?

[Consumed.]

Hey I agree bron, but besides for the sociological and psychological effects opiates are one of the safest drugs there is for the body. Its what people have to do to get them and how that effects their bodies that really does the damage.

DFs number one complaint is constipation so with that said I was trying to put my .02 for people who do a fairly well job of not ruining their body on opiates and dont get their GIs dependent on harsh laxatives so after months they cant take a shit without them.

I wrote that thread especially for DF about that new drug thats coming out for people that are on opiod treatment, hopefully that will be the answer for a lot of people.

here's the thread again for those that missed...

http://forum.opiophile.org/showthread.php?t=18406

[Duckfeet]

Yep I liked that whole article, and it sounds really hopeful, but it's categorized as "experiemental" and it takes an act of congress--really!--to get the V.A. to perscribe anything they don't buy in bulk, so unless i had a private doc, it would be no go...I"m afraid...

[Consumed.]

Yep I liked that whole article, and it sounds really hopeful, but it's categorized as "experiemental" and it takes an act of congress--really!--to get the V.A. to perscribe anything they don't buy in bulk, so unless i had a private doc, it would be no go...I"m afraid...

O I know DF Im just being really hopeful and trying to make a point that the gov't is the one that really makes us into junkies due to sociological factors the the addict becomes forced into...

I mean shit, if things worked the way they should it's the long term effects of laxatives we should have to worry about vs. opiates! For real! One can be totally healthy and lead a long satisfying life on opiates. Unfortunately all the consequences of opiate use forced on us by gov't leads us to become unhealthy and to not give a fuck and put these horrible substances into our body. It shouldnt fuckin be like that. All the control the gov't has over our health in an inadvertent way is totally fucked and we all know the reprocussions and still take the chances.... http://forum.opiophile.org/images/icons/icon8.gif

[Duckfeet]

I know...and I hate to think it might be the main motivating force in me getting off methadone...but I just cannot abide it anymore, the whole physical constipated feeling is just no good to me, and I can't drink anymore golitely or any of the presurgical crap, not even once a week: I just throw it back up...I'm just tired of it, makes me too wretched...

I have other reasons, not the least of which I actually *have* been happy off of opiates, for years at a time, so I'll eventually get down to zero, and hopefully hang in there, but I know what the odds are...but what a horrible trade-off, for me...and to think they have meds they could perscribe, even the injections, where I could avail myself of opiates, and still have BMs...

But anyway, life is what is, not what might be...


O I know DF Im just being really hopeful and trying to make a point that the gov't is the one that really makes us into junkies due to sociological factors the the addict becomes forced into...

I mean shit, if things worked the way they should it's the long term effects of laxatives we should have to worry about vs. opiates! For real! One can be totally healthy and lead a long satisfying life on opiates. Unfortunately all the consequences of opiate use forced on us by gov't leads us to become unhealthy and to not give a fuck and put these horrible substances into our body. It shouldnt fuckin be like that. All the control the gov't has over our health in an inadvertent way is totally fucked and we all know the reprocussions and still take the chances.... http://forum.opiophile.org/images/icons/icon8.gif

[dharma bum]

The stimulant free milk of magnesia always cured my constipation. It cleaned me out completely but like irish said---it was a daily event.
Frosted mini-wheats always worked too. But i'm sure you guys have tried these...