The goal of a new study published in the Journal of Oncology Pharmacy Practice was to describe the presence of laxative co-medication, the reasons for not starting laxatives and to evaluate changes in stool patterns of opioid initiators. This was an observational study, wherein community pharmacists evaluated the availability of laxative co-medication in starting opioid users and registered reasons for non-use. Here, two opioid initiators per pharmacy were invited to complete questionnaires (Bristol stool form scale and Rome III Diagnostic Questionnaire for the Adult Functional Gastrointestinal Disorders) on their defecation prior to and during opioid use. Data was collected from 460 opioid initiators. Among these subjects, 74.8% used laxatives concomitantly. The main reason not using laxatives was that neither prescribers nor patients considered them necessary. Among the 75 opioid starters with two questionnaires completed, 89.3% were not constipated at opioid initiation, but 16% developed constipation during opioid use. On follow-up, 10.6% of laxative users were constipated compared to 20.7% of those who were not on laxatives. Thus, one in four opioid starters did not prefer laxative co-medication, mainly because they were not considered necessary by either the prescriber or the patient. However, the prevalence of constipation doubled during opioid use. It was suggested that a vigilant waiting strategy for the use of laxative co-medication might include a monitoring of defecation patterns with validated questionnaires.