Impact of opioid-induced constipation on opioid substitution therapy management: the patient perspective

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Background: Although opioid-induced bowel dysfunction is a well-known and frequent adverse event correlated with opioids, it is scarcely investigated in patients on opioid substitution treatment (OST) and no standard of care is currently available for this population. We aimed to explore the opinion of patients on the impact of constipation on the management of OST and quality of life (QoL).

Methods: We performed a survey that was directed to opioid-dependent patients treated with OST and followed-up in a Service for Addiction Treatment in Italy. The questionnaire included questions about sociodemographic characteristics, the experience of constipation, general QoL, OST management, interference of opioid-induced constipation (OIC) with opioid management, the experience of OIC treatment in the health system, and risk factors for constipation.

Results: Constipation at the moment of the survey (n=105) was reported by 81% of patients and was the most frequent adverse event of OST; 73% of respondents reported at least one severe or very severe symptom of constipation in the last 2 weeks. OIC was reported to hinder adherence to OST by 33% of respondents and 38% of them felt that control of craving had been more difficult since initiation of constipation. Overall, 34% of patients interfered with their OST by changing the schedule on their own in an attempt to improve constipation. Patients were proactive in looking for a solution for constipation but reported poor help from the healthcare system.

Conclusion: Our patient-based survey suggests that careful and efficient management of constipation could increase adherence to OST and improve patient satisfaction and QoL.

Keywords: constipation, heroin, opioid substitution treatment, quality of life.

Citation: Lugoboni F, Hall G, Banerji V. Impact of opioid-induced constipation on opioid substitution therapy management: the patient’s perspective. Drugs Context. 2021;10:2021-7-2.

Contributions: FL generated the questionnaire. GH and VB produced the survey. All authors analysed results, revised and approved the final manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole and have given their approval for this version to be published. The information supporting the findings of this study is available from Insight Dojo.

Disclosure and potential conflicts of interest: FL is a member of the Italian Board on Opioid-Induced Constipation, supported by Molteni. Insight Dojo received payment from Molteni and Shionogi for conducting the research, and GH and VB were employed in Insight Dojo at the time of the research. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at:

Acknowledgements: The authors thank Domenico Alvaro for his critical revision of the manuscript. Editorial assistance was provided by Aashni Shah and Laura Brogelli (Polistudium Srl, Milan, Italy). This assistance was supported by Molteni.

Funding declaration: This study has been possible thanks to the unconditional support of Molteni Farmaceutici and Shionogi Srl.

Copyright: Copyright © 2021 Lugoboni F, Hall G, Banerji V. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2021 Lugoboni F, Hall G, Banerji V. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

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Correspondence: Fabio Lugoboni, Addiction Unit, Verona University Hospital, P.le Scuro 10 – 37134 Verona, Italy. Email:

Provenance: Submitted; externally peer reviewed.

Submitted: 6 July 2021; Accepted: 21 September 2021; Publication date: 22 October 2021.

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