S1165 Hidden Costs and Pill Burden: Evaluating the Utility and Economic Impact of Docusate Sodium for Opioid-Induced Constipation in Veterans

Introduction: Opioid-induced constipation (OIC) is a prevalent complication of chronic opioid therapy, particularly among Veterans, with high rates of chronic pain and polypharmacy. Despite minimal evidence supporting its efficacy, docusate sodium is frequently prescribed in inpatient settings as part of opioid order sets. This practice not only offers limited clinical benefit, but also contributes to pill burden, increasing the risk of nonadherence, medication errors, and workload for nursing staff. This study evaluates the prescribing patterns, economic burden, and contribution to overall pill burden associated with inpatient docusate use for OIC in Veterans, aiming to inform deprescribing efforts and support high-value care. Methods: We conducted a 6-month retrospective chart review at a VA hospital to evaluate the prescribing patterns of stool softeners among patients receiving opioid therapy. Patients were identified through an electronic medical record (CPRS) search of prescription data for opioids and stool softeners between May 2024 and November 2024. Stool softener prescriptions were categorized into four groups: docusate alone, docusate in combination with other laxatives or stool softeners, combination therapy containing both docusate and sennosides, and guideline-directed therapy excluding docusate. Results: A total of 239 patients were included in the retrospective analysis. Among these, 46.4% (n = 111) received guideline directed therapy, 11.7% (n = 28) were prescribed colace as the sole stool softener during their opioid treatment. A larger subset of patients 28.5% (n = 68) were prescribed docusate in combination with other laxatives or stool softeners, while a smaller subset 13.4% (n = 32) received a combination pill containing docusate and senna. Conclusion: This retrospective review highlights the routine use of docusate sodium in Veterans, despite limited evidence for its effectiveness in OIC. Nearly 50% of patients prescribed opioids also received docusate, adding to pill burden and avoidable system costs. In a population facing polypharmacy and chronic illness, unnecessary medications increase the risk of nonadherence, adverse events, and nursing workload. Though inexpensive per dose, docusate’s widespread use may cost hospitals over $25,000 annually, or $49.37 per bed per year, with little clinical benefit. These findings support VA deprescribing efforts. Strategies such as clinician education and order set revisions may reduce low-value care and improve treatment efficiency.