Prevalence of opioid-induced constipation in the emergency department: a retrospective study.

Opioids are widely prescribed for the treatment of moderate to severe pain. Gastro-intestinal side effects are common with opioid use, of which opioid-induced constipation (OIC) is the most prevalent. OIC can be difficult to manage, and may lead to increased healthcare utilization, including emergency department (ED) visits. However, data on the prevalence of OIC in the ED are limited. We conducted a retrospective, single-center study of 2017 adult long-acting opioid users presenting to the ED between 2016 and 2022. OIC was diagnosed in 129 patients (6.4%; 95% CI 5.4-7.6%). Treatment included dose escalation of existing laxatives (37%), initiation of additional laxatives (25%), administration of enemas (47%) and use of peripherally acting µ-opioid receptor antagonists (16%). A modest dose- and treatment time-response effect was observed, with higher opioid doses and longer treatment durations slightly increasing the risk of OIC at ED presentation. Cancer patients had significantly higher odds of having OIC at their ED visits compared to non-cancer patients (OR 8.81; 95% CI 5.89-13.17; p < 0.001), while sex was not associated with OIC (OR 0.84; 95% CI 0.56-1.28). Oxycodone use was linked to higher odds of OIC (OR 1.95; 95% CI 1.30-2.91), whereas tramadol use was associated with a significantly lower risk of OIC. 23 patients revisited the ED within 30 days due to OIC, and there were three deaths related to OIC. These findings highlight the clinically relevant burden of OIC in the ED, particularly among cancer patients and oxycodone users. Clinical awareness of OIC is needed, especially in patients with increased risk.