Laxative prescriptions to cancer outpatients receiving opioids: a study from the Norwegian prescription database.
BACKGROUND
During opioid treatment of cancer pain, constipation is one of the most prevalent and bothersome side effects. Guidelines suggest that treatment with laxatives should be initiated when opioid therapy is started.


OBJECTIVE
This study aims: (1) to determine to what extent patients, starting on opioids due to cancer pain, receive laxatives; (2) to examine the temporal relationship between initiation of opioid therapy and initiation of treatment with laxatives; and (3) to study to which extent the treatment follows current guidelines.


METHODS
Data from the Norwegian prescription database (NorPD) were used to investigate dispensed prescriptions of laxatives to outpatients in Norway, who are receiving opioids for cancer pain. Data from NorPD cover all dispensed prescriptions of drugs to outpatients, making it possible to follow patients over time. The study cohort was followed from 2005 to the end of 2008.


RESULTS
Of 2,982 patients who started opioid therapy directly with WHO step III opioids, 1,325 patients (44.4 %) did not receive laxatives during the study period. Only 738 patients (24.7 %) received laxatives at the same time as opioid therapy was initiated. Another 657 patients (22.0 %) received laxatives after their initiation of opioids at some time during the study period.


CONCLUSIONS
Of those who started directly on a strong opioid, only one fourth received laxatives concomitantly with the first opioid, and nearly half did not receive laxatives at all. These findings indicate that the current guidelines are not followed.
National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Symptom Disorders, St. Olavs University Hospital, Trondheim, Norway. lars@skollerud.com
Lars Morten
LM
Skollerud
Olav Ms
OM
Fredheim
Kristian
K
Svendsen
Svetlana
S
Skurtveit
Petter C
PC
Borchgrevink
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D003248:Constipation / Q000139:chemically induced / Q000517:prevention & control*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D054368:Laxatives / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D009664:Norway; D010166:Palliative Care; D010818:Practice Patterns, Physicians'
D000701:Analgesics, Opioid; D054368:Laxatives