Rectal use of opiates???!!!

[RNOTODAY, BSN, RN]

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?????

[turnforthenurse, MSN, NP]

I have heard narcotics being given rectally, but they were actually ordered that way and the preparation was a suppository.

[RNOTODAY, BSN, RN]

thanks, so i bet this was an attempt on his part to "enhance" the oxycontin...idk???

[Whispera, MSN, RN]

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.

[danggirl]

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!

[tewdles, RN]

Rectal use of opioids is not uncommon in hospice care. Notify the MD and reconcile the meds...

[TheCommuter, BSN, RN]

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.

[RNOTODAY, BSN, RN]

Thank you everyone. I had no idea.

[RNOTODAY, BSN, RN]

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?

[FL4763]

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.

[FLArn]

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?????

Recently Oxycontin was reformulated and no longer is able to be given per rectum as the med has been altered to prevent absorption through the lower GI tract. It also is not absorbed if crushed.

[Asystole RN]

Recently Oxycontin was reformulated and no longer is able to be given per rectum as the med has been altered to prevent absorption through the lower GI tract. It also is not absorbed if crushed.

OxyContin OC was reformulated to OxyContin OP, both are controlled-release forms of the medication oxycodone. It can be absorbed if crushed and absorbed rectally. That being said, crushing a controlled-release med and administering it usually ends up bad. The new formulation was meant to limit the absorption of the med if crushed but it still releases a large dose very fast. In addition, OxyContin OP is not labeled for rectal use, in fact, the clinical study showed that there was actually a far greater rate of absorption rectally and so is much more dangerous given via that route.

I wonder if the OP, or more likely the patient, was refering to OxyIR or some other immediate release form of oxycodone.