Blessèd Pain Relief

Abstract

Increased prescription of opioids leads to improved care, particularly for patients with cancer pain. If you share that opinion, you may find you change your mind about the situation in Germany after reading the article “Increase in Opiate Prescription in Germany Between 2000 and 2010: A Study Based on Insurance Data” by Ingrid Schubert, Peter Ihle, and Rainer Sabatowski (1). There was indeed a 37% increase in the rate of opioid prescription in the authors’ sample between 2000 and 2010, together with a 109% increase in total daily doses. Distinguishing between different preparations of WHO step 2 and step 3 opioids and between patients with and without cancer disease shows the following: While the prescription of immediate release preparations of WHO step 2 opioids decreased moderately, there was a marked increase in the frequency of prescription of immediate release WHO step 3 opioids. The prevalence of treatment with extended release WHO step 3 opioids was similar in patients with and without cancer in the year 2000, but 10 years later the treatment prevalence in patients without cancer disease was almost double that in in patients with cancer disease. A particularly sharp rise was observed in the prescription volume of fentanyl. Overall, 76.7% of all opioids prescribed in 2010 were for patients without cancer disease. The proportion of long-term treatments (>90 days) rose from 4.3% to 7.5% during the observation period. Despite all the limitations of using routine data from health insurance providers, the study by Schubert et al. highlights some alarming trends. The steep increase in the prescription frequency of immediate release WHO step 3 opioids and the intensification of opioid treatment in patients without cancer disease may point to the same kind of undesirable developments in opioid treatment that have already been described in other European countries and especially in the USA.