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Use of opioid-containing drugs in Germany
Opioids are among the most effective drugs to treat moderate to severe pain. Considering the WHO analgesic ‘ladder’, their use in tumor-related pain, acute pain, and palliative care is internationally accepted. For chronic noncancer pain, however, the use of opioids is controversial due to the limited evidence for their medium- and long-term benefits. The sharp increase in opioid use in the United States since the 1990s has been attributed primarily to a relaxation of the legal requirements for prescribing these drugs for the treatment of such chronic noncancer pain. The fact that in the United States, the increase in opioid prescriptions has been accompanied by an increase in opioid-associated deaths has been described as an opioid crisis or opioid epidemic, which was declared a national Public Health Emergency in the United States in October 2017.
In Europe as a whole, there is no evidence of an opioid epidemic to date; however, it has been reported in some countries, such as France, Finland, and the Netherlands, that opioid prescriptions and some indicators of opioid-related risk (e.g., opioid-associated emergencies and deaths) have increased at the same time. In most European countries, per capita consumption of potent opioids (fentanyl, hydromorphone, morphine, oxycodone, pethidine) increased since the 1990s; in fact, in 2014-2016, Germany had the highest per capita consumption of potent opioids in Europe and a higher one compared with the United States.
Despite the high per capita consumption of opioids in Germany, some studies conclude that there is no evidence of an opioid epidemic in this country. On the other hand, there is also evidence to criticize the conclusion that there is no opioid epidemic in Germany. All previous studies are based not earlier than 2016. More recent data on the use of opioid-containing medicines and comprehensive evaluations of possible opioid misuse in Germany are lacking to date.
Therefore, the aim of this project was a comprehensive characterization of the prescribing behavior regarding opioid-containing medicines in Germany including the investigation of temporal trends based on data from statutory health insurances.
The project is funded by the Federal Institute for Drugs and Medical Devices (BfArM) as part of a call for proposals for pharmacovigilance research. The final report is currently being prepared. The results of the project will be published in 2024
Scholle O, Jobski K, Viebrock J, Haug U. Prescribing of opioid analgesics in Germany: Opposite trends when different quantification measures are used. 39th International Conference on Pharmacoepidemiology & Therapeutic Risk Management (ICPE), 23-27 August 2023, Halifax, Canada. (Abstract published in: Pharmacoepidemiology and Drug Safety. 2023;32(S1):102)