OBJECTIVES

Opioids are integral to the management of chronic pain but are associated with adverse events including opioid induced constipation (OIC) and other gastrointestinal disturbance. We examined the association between the spectrum of OIC and healthcare costs.

METHODS

The study was conducted using the Clinical Practice Research Datalink; a large UK primary care dataset linked to hospital inpatient and outpatient data. Patients prescribed strong opioids during 2016 were selected and continuous episodes of opioid therapy constructed. Episodes with ³ 84 days exposure classified as chronic. Constipation during the opioid episode was defined by ³2 laxative prescriptions issued during the opioid episode. Patients for whom initial laxative therapy was escalated by switch, augmentation or increased dose were defined as OIC-unstable, and the first three lines of OIC escalation were classified. In addition, patients seen as gastroenterology outpatients or with a constipation related inpatient admission were flagged. Primary and secondary healthcare costs accrued in the first 12 months (maximum) of the opioid episode were aggregated and compared.

RESULTS

There were 5,916 chronic opioid episodes (mean duration 3.9 years (sd 3.5)). Of these, 3,030 (51.2%) were classified as OIC and 1,945 (32.9%) were considered unstable-OIC: 849 (14.4%), 360 (6.1%) and 736 (12.4%) escalated therapy 1,2, or 3+ times, respectively. 901 (15.2%) attended gastroenterology outpatients and 524 (8.9%) had a constipation related admission. Initial 12-month costs associated with opioid use were £3,822 for non-OIC, £4,725 for OIC- stable and £4,815 for OIC-unstable (£4,696, £4,749, £4,981 for 1-3 therapy lines respectively).

CONCLUSIONS

OIC is a common adverse event of opioid treatment and for a large number of patients is poorly controlled. Poor control was associated with overall increased healthcare costs. The impact of OIC should be considered when prescribing opioids.