Rectal use of opiates???!!!

  1. 0
    I had a patient tell me that he takes his oxycontin rectally, because it dissolves faster, and doesnt have to go through his digestive tract? He said he had a gastric bypass, so this works for him, although his doctor didnt order it that way. Has anybody ever heard of this? Is this legit, or just another way to abuse narcotics?????

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  3. 19 Comments...

  4. 1
    I have heard narcotics being given rectally, but they were actually ordered that way and the preparation was a suppository.
    maelstrom143 likes this.
  5. 0
    thanks, so i bet this was an attempt on his part to "enhance" the oxycontin...idk???
  6. 2
    If he had gastric bypass, it's actually a good way to take the medication. Otherwise he'd lose part of the dose as it flew through his digestive tract. His doctor needs to know what he's doing though, since he might be prescribing a dose that's consistent with having had bypass surgery.
    turnforthenurseRN and Altra like this.
  7. 1
    I've heard about this from some of my ED patients. For the drugs that have a lower oral bio-availability and/or for enhanced effect people will take the drugs rectally. On the street they call this "plugging". For example, apparently hydromorphone (Dilaudid) p.o. has a pretty low oral bio-availability but it is completely dissolved in water...patients tell me if they don't want to use IV, they dissolve it and inject it in their rectum. The one warning I take away from these discussions is that whatever dose the patient is supposed to be taking orally should be titrated down to account for not passing through the digestive tract. The things I learn at work!
    maelstrom143 likes this.
  8. 2
    Rectal use of opioids is not uncommon in hospice care. Notify the MD and reconcile the meds...
    michelle126 and maelstrom143 like this.
  9. 0
    This is legitimate. When I worked in LTC, the continuous care hospice nurses would give MS Contin and Oxycontin rectally to patients who were too unresponsive to swallow and making the 'transition' from life to death.
  10. 0
    Thank you everyone. I had no idea.
  11. 0
    but.. dangrl and whispera make a good point... does the dose really need to be lowered because it does not go thru the digestive tract? what does everybody think?
  12. 1
    Bioavailability of a drug is higher when given per rectum because it is not subject to first pass metabolism (except for the superior veins of the rectum). So yes, dosage must be adjusted.
    maelstrom143 likes this.

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