Methadone Treatment and—Dare We Say It—Constipation

You’ve made the decision to come in from the cold, get off the streets, give up the life—and stop using opioids illegally. Whether you were addicted to pain pills or if you fell all the way down the rabbit hole into heroin addiction, you’ve finally opted for methadone treatment. Life is much better these days because you feel better and you actually have your life back. But there’s one problem that comes with methadone treatment and even with buprenorphine therapy: You’re woefully constipated.

The truth is that all opiates cause constipation. They simply slow down the natural movement, or peristalsis, of the digestive system. Even people who take pain pills for just a couple days after a dental extraction can experience troublesome episodes of going to the bathroom—but not going to the bathroom. The thing is, you didn’t notice your constipation much before you got help with methadone treatment. Your other lifestyle choices including poor diet or excessive drinking may have kept your intestines moving. But now, you’re making all the right choices, and in that one area of your life, you feel awful.

Relieving Constipation During Methadone Treatment

It’s not a good idea to rely on laxatives to relieve constipation while you’re in buprenorphine or methadone treatment. Your body will come to rely on them, and you really want to preserve your body’s natural ability to eliminate without medication. These ways are tried-and-true:

1. Drink plenty of water. It’s a good idea to keep yourself well hydrated when you’re in methadone treatment simply because you were not well hydrated when you were abusing drugs. You’ll hear healthy people talk about drinking a couple or three bottles of water per day, and that’s not too much. In fact, people who follow the Mediterranean diet determine how much water they should drink based on their body weight. If you weigh 150 pounds, for example, you should drink 75 ounces of water per day. The longer that stools sit in your intestines without going into your toilet, the harder they’ll become. Fill up that bottle and get glugging.
2. Eat nine helpings of fruits and vegetables per day. OMG, you’ll be saying; you can barely manage to eat a few green beans at dinner time, so how can you manage nine helpings? Start with a quickie can of a fruit or vegetable juice like V8—one three-ounce can counts as a serving. Eat a banana for your morning break. Have a salad at lunchtime—use two cups of greens and it counts as two servings. You’re almost halfway there.
3. Take magnesium tablets. It’s a good idea to pick up a bottle at your local pharmacy simply because you’ve begun buprenorphine or methadone treatment, because a common side effect involves restless legs. Magnesium can relieve restless legs as well as constipation. Start with two 250 mg tablets at night. If you don’t go, take three the next night. And so on. Your body will tell you what your daily dose should be.
4. Increase your daily fiber intake. If you’re eating all your fruits and vegetables, you’ve probably got this one under control. But just in case you’re skipping suggestion number two, pick up a box of fiber bars in the breakfast bar aisle at the grocery store. Try bars with at least 5 mg; if they produce too much gas and bloating, cut back to 3 mg until you can tolerate it.
5. If you decide to try a laxative to relieve constipation during methadone treatment, choose your brand carefully. There are two types of laxatives: Some of them irritate the lining of the intestines so that you go to the bathroom quickly and painfully. Others bring water to the intestines so that you have a more natural, gentle experience. Products like brand-name MiraLax and the store-brand copycats work well. You can even find glycerin suppositories at the store if you are desperate, but you don’t swallow them. They go up the hatch, so to speak.

Last Words

If all else fails, ask your doctor for a prescription to relieve constipation. This is especially important if you are a pregnant woman. It’s not a good time for you to take a stimulant laxative and have an explosive experience.

Women in methadone treatment are more likely to experience constipation than men. The reason is that women’s intestines are generally 10 centimeters, or 2.5 inches, longer than men’s. This most likely relates to their need to retain additional water during pregnancy. Whatever the reason, the result is that they experience more constipation and bloating than do men.

The doctors who manage your health while you’re in methadone treatment at a medication-assisted therapy program will not be surprised by any symptom you report—they’ve heard it all. So don’t be shy! If you’re experiencing constipation during this time, speak up. Because some things, you just can’t hold onto. Aren’t you glad we had this talk?