Role of opioid use in gastrointestinal obstruction and perforation: A retrospective review

Pain is one of the most common complaints that brings a patient to a hospital. For this, usually, the patient might have already consumed various types of pain killer combinations, either prescribed or over-the-counter. In some of these cases, a patient consumes these medicines unmonitored for a long time and then comes with complications, among which gastrointestinal tract obstruction and perforation are the most life threatening.

Case files from the Department of Surgery were retrieved and studied. Patients were contacted telephonically for details of drug abuse history. These were then further studied in detail.

Forty-eight (68 percent) patients out of a total of 78 had a history of drug abuse. The most commonly abused pain killer was a combination of anti-inflammatory and other salts, which was found in 22 (46 percent) patients, followed by tramadol, NSAIDs, opium, and alcohol (23, 17, 10, and 4 percent, respectively). These groups were comparable in socio-demographic details except in the mean age, occupation, and gender distribution, and the difference was significant (p < 0.01). The most common cause for starting to use any of the above-mentioned pain killer was persistent pain. The most common site of obstruction in drug abusers was the stomach (60 percent), followed by the small intestine (38 percent) and the large intestine (2 percent).

(1) This is an observational retrospective record review. (2) Records were studied in hospital settings, so results should be generalized cautiously. (3) Risk of recall bias is present.

Pain killers should always be prescribed with caution and for a short duration. Alternative options for pain relief should be made available, and doctors should be trained. Drug abusers tend to have a gastrointestinal complication at an early age, which means they are prone to further complications and recurrence if the problem is not addressed on time.