Substance Use and Related Disorders
Maria Sarmiento, DO
Resident
UMass Chan Baystate
Suffield, Connecticut
Paige V. Mastalerz, MD (she/her/hers)
Psychiatry Resident PGY 2
Baystate Medical Center
Worcester, Massachusetts
Brianna Carey, MPAS
Physician Assistant
Baystate Medical Center
Springfield, Massachusetts
.jpg "Sonia Riyaz, MD photo")
Sonia Riyaz, MD
Associate Medical Director for the Division of Adult Consultation-Liaison Psychiatry
UMass Chan-Baystate
Springfield, Massachusetts
Walter J. Kilpatrick, III, DO, FACLP
Assistant Professor
UMass Chan Medical School - Baystate
Springfield, Massachusetts
Background:
Intussusception in adults is extremely rare, accounting for 5% of all cases of intussusception (Brill, 2023). Adults using substances, primarily opiates and cannabis, could be at increased risk of experiencing intussusception due to the mechanism of action of these substances on the GI system. However, there are only a few case reports that discuss this topic. This report will review current literature on intussusception caused by opiate and cannabis use, while discussing the implications of using MAT for substance use treatment.
Case:
Psychiatry was consulted to evaluate a 28yo female with history of PTSD, MDD, opiate use disorder on methadone, cocaine use disorder, and cannabis use disorder for assistance with methadone induction after the development of idiopathic intussusception requiring a total abdominal colectomy. Abdominal imaging did not show any acute abnormalities. It was believed that intussusception was caused by active heroin and cannabis use. The patient requested to be restarted on methadone for opiate use disorder, but given her history of intussusception, there was hesitancy about restarting methadone.
Discussion:
A few case reports discuss the association between chronic cannabis use and the development of intussusception. Cannabinoids have shown to have an anti-peristaltic effect through the activation of the cannabinoid type 1 receptors in the epithelial cells of the GI tract and myenteric/submucosal nerve plexus (Kothadia, 2022). However, there was only one case report highlighting an association between opiate use and adult intussusception (Khan, 2017). Opiates can cause dysmotility by affecting the μ-receptors in all three intestinal layers, which can reduce peristaltic activity, ultimately increasing the risk of intussusception. As seen in our case, although rare, adult patients can develop intussusception from active substance use. Given the risk for worsening dysmotility, we were apprehensive about restarting MAT for opiate use disorder, weighing options of starting suboxone vs. methadone vs. not starting MAT. From literature, PO methadone is sometimes used for treating postoperative intussusception pain as it is less constipating (Mercadante, 1997). Given our patient’s chronic history of heroin use, when considering a harm reduction model, we decided to start our patient on methadone for opiate use cravings.
Conclusion:
Opiate use and cannabis use can synergistically increase the risk of intussusception in adult patients. Although its occurrence is rare, providers should consider this association. Additionally, providers should also weigh the risks and benefits of starting MAT in these cases, keeping in mind goals of care and a harm reduction model.
References:
Presentation Eligibility: Not previously published or presented
Diversity, Equity, and Inclusion: With the rise of the opiate epidemic, marginalized communities are often more likely to face barriers in accessing high-quality medical and substance use treatment. This topic gives light to medical consequences of opiate use disorder, and ways in which psychiatry providers can help advocate for patients to get access to MAT despite having other medical comorbidities.
