OBJECTIVES: Analyses of commercially insured patients have found that opioid-induced constipation (OIC) is associated with increased healthcare costs. These analyses have defined constipation based on diagnosis alone, rather than diagnosis or medication use. The objective of this study was to compare healthcare utilization and costs between non-cancer patients with and without constipation among Medicaid enrollees with opioid use. METHODS: Patients aged ≥18 years old initiating opioids from 1/1/2009-6/30/2013 (index date) were identified in the MarketScan Multi-State Medicaid claims database. Patients were required to have continuous enrollment in the 6 months prior to index date and 12 months following index date (post-period) with no evidence of addiction, cancer, or functional or inflammatory bowel diseases. The presence of constipation in the post-period was defined as a medical claim with a diagnosis or procedure indicative of constipation or a pharmacy claim for an over-the-counter or prescription constipation medication. Healthcare utilization and costs during the post-period were compared between propensity-score-matched cohorts. RESULTS: There were 2,716 patients in each cohort after matching (mean age 47 years; 26%-28% men). The most common pain conditions diagnosed were arthritis, musculoskeletal pain, and low back pain. Total costs were significantly higher for patients with constipation than those without constipation (mean $28,234 [SD $104,362] vs. mean $13,709 [SD $29,008], p<0.001). The proportions of patients with an inpatient admission (IP) or an emergency room visit (ER) were significantly higher for patients with constipation than those without (IP: 29% vs. 14%, p<0.001; ER: 59% vs. 47%, p<0.001), resulting in higher mean costs (IP: $13,532 [SD $100,706] vs. $4,591 [SD $24,085], p<0.001; ER: $703 [SD $1,345] vs. $429 [SD $929], p<0.001). CONCLUSIONS: Among Medicaid enrollees, OIC was associated with an increase in healthcare utilization and costs in the 12 months following opioid initiation for non-cancer pain.