Laxative use amongst Tasmanian aged care residents receiving controlled released (CR) oxycodone products and other opioids

Background
• Opioid induced constipation (OIC) is a common and often persistent problem
• Management of OIC has traditionally relied on the use of laxatives
• However recent years have seen peripheral opioid receptor antagonists (PORAs) emerge as another option
• The most widely used PORA is naloxone, given as oxycodone/naloxone CR
• Oxycodone/naloxone CR is the most prescribed long-acting opioid in Australia:
- 1.74 million prescriptions in the year to June 30th 2019
- Associated cost to government was $79.8million
• Oxycodone/naloxone CR is reported to be associated with less OIC than standard oxycodone CR, which is now available generically
• However little is known about the prevalence of laxative use in those who take oxycodone/naloxone CR and how this compares with other opioids

Method
• Retrospective review of data collected during medication reviews for Tasmanian aged care facility (ACF) residents
• Comparison of laxative use amongst Tasmanian ACF residents prescribed oxycodone/naloxone CR or other opioids

Findings
• 278 (31.7%) of 878 residents in 15 ACFs were using regular opioids
• Prevalence of regular laxative use:
- 51.4% in those taking oxycodone/naloxone CR
- 53% in those taking other opioids
- 56.6% in those taking other strong opioids

Conclusion
• Over half of ACF residents taking regular oxycodone/naloxone CR are taking regular laxatives
• Laxative use may be slightly less prevalent in those taking oxycodone/naloxone CR than other strong opioids
• However, is this sufficient to justify the price premium that the PBS pays for oxycodone/naloxone CR?