More and more opioids are being prescribed for pain relief in Germany. This is the conclusion arrived at by Ingrid Schubert, Peter Ihle, and Rainer Sabatowski, whose study of a sample of inhabitants of the state of Hesse with health insurance from a large statutory provider is published in the latest issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2013; 110(4): 45-51).
Behind this study lies the intention to improve pain treatment with opioids, particularly for patients with cancer. Prescribing too little results in inadequate alleviation of pain, while supplying too much entails the risk of addiction, especially in patients who do not have cancer.
The proportion of persons in the sample who received opioids increased between 2000 and 2010, and so did the number of daily doses per recipient. 3.7 million inhabitants of Germany received opioids in 2010, a million more than in 2000. The frequency of prescription of WHO step 3 opioids increased--most of all in noncancer patients, in spite of the lack of good evidence for this indication.
The study points to inappropriate provision: Despite the increase in opioid prescription, it cannot be concluded that cancer patients are receiving opioids in adequate amounts.