Opioid analgesics are an essential component in the management of chronic pain with their primary mechanism of action being the activation of the mu-opioid receptors in the central nervous system resulting in analgesia. However, the effective pain management of chronic pain, including that associated with palliative care, is complicated by gastro-intestinal side effects as a result of the binding of opioids to the mu-opioid receptors in the enteric nervous system.

The most common, and problematic, gastro-intestinal side effect is constipation which remains throughout opioid analgesic treatment.  With continued opioid use, patients can experience hardened stools as well as severe abdominal discomfort and bloating.   As a result of these opioid-induced side effects, patients can suffer from physical and functional deterioration with the pain.


Opioid Induced Constipation (OIC) is becoming an increasingly common complication as the use of opioids in cancer and non-cancer treatment increases with the aging population. .

Up to 45% of opiate users suffer from the condition, often compromising their pain relief. Across the six major pharmaceutical markets, US, France, Germany, Italy, Spain, and the UK there are an estimated 6.5 million patients experiencing symptoms (2014).

Current treatment relies on inexpensive, traditional laxatives which have poor clinical efficacy, lack strong evidence and compound the problem with further side effects.  The value of the current market is relatively low at $145m .

The market landscape is set to change with a radical change in treatments from inexpensive laxatives to OIC targeted therapies designed to tackle the underlying cause.

The cash value of this market is expected to grow at a compound annual growth rate (CAGR) of 31.9% to $1.98 billion from 2012 to 2017.1

This growth in the OIC market is a function of three major drivers:

  • A growing number of OIC sufferers due to the overall population growth and continued use of opioids in the treatment of chronic pain;
  • The introduction of several highly targeted, oral, peripherally-acting mu-opioid receptor antagonist (PAMORA) therapies; and
  • The launch of Amitiza® across the EU and the approval of Linzess® for OIC, which will increase physician and patient awareness of non-laxative prescription options to treat constipation.

1.  Global Data Opportunity Analyser: Opioid Induced Constipation – Opportunity Analysis & Forecasts to 2017
2. Amitiza is a registered trademark of Sucampo Pharmaceuticals, Inc.
3. Linzess is a registered trademark of Ironwood Pharmaceuticals, Inc.