gms | German Medical Science

Background: Pain medication is frequently prescribed in Germany; however, information on its use on a regional level is scarce. For metamizole (a frequently used step I analgesic of the World Health Organization’s (WHO) analgesic ladder) and low- and high-potency opioids (LPO and HPO, step II and III of the WHO ladder, respectively), prescribing differences between states and regions have been reported based on data of one German insurance fund. The aim of this study was to analyze prescribing of metamizole and opioids in Germany on a regional level using a larger data basis.

Materials and methods: We used the German information system for health care data which covers data from the statutory health insurance funds for about 70 million insured persons. For the year 2010 we received aggregated data of persons aged 18 years or older with at least one prescription of metamizole or opioids as well as the number of prescribed packages. We calculated the prescribing prevalence per 1000 persons as well as the mean number of prescribed packages stratified by age, sex, state and district.

Results: Among 57.0 million insured persons (mean age: 50.2 years, 53.8% female), the prevalence of metamizole use per 1000 persons was 93.3, whereas 38.7 and 12.8 persons received LPO and HPO, respectively. The mean number of packages prescribed per user were 2.2 (metamizole), 3.5 (LPO) and 7.0 (HPO). On a state level, metamizole prevalence varied between 70.1 in Saxony and 111.1 per 1000 persons in Schleswig-Holstein. The district with the lowest prevalence was Suhl, Thuringia (43.1), whereas the highest prevalence was found in Uelzen, Lower Saxony (143.0). LPOs were least often used in Hamburg (32.9 per 1000 insured persons) and most often in Saxony-Anhalt (47.2). On a district level, prevalence varied between 23.3 (Garmisch-Partenkirchen, Bavaria) and 59.7 (Osterode am Harz, Lower Saxony). Use of HPOs per 1000 insured persons ranged from 10.6 in Baden-Württemberg to 16.9 in Mecklenburg-Western Pomerania (on a district level from 6.5 (Munich, Bavaria) to 21.1 (Speyer, Rhineland-Palatinate)). Overall, median opioid use was lower in urban than in rural areas (12.1 vs. 14.6 per 1000 persons for HPOs and 37.7 vs. 41.3 per 1000 persons for LPOs).

Conclusion: In 2010 use of metamizole and opioids in Germany was common and varied substantially between states and districts. Besides some general trends (metamizole prevalence higher in the Western than in the Eastern states, opioid use most common in the North East of Germany) we found large regional differences which certainly cannot solely be explained by patient-related factors.