Article
Changes of Prescription Patterns of Opioid Analgetics for Non-Cancer Pain in the Federal State of Germany Schleswig-Holstein
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Authors
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Heike Voss
- Medizinischer Dienst der Krankenversicherung Nord, Hamburg, Hamburg, Germany
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Reinhard Schuster
- MDK Nord, Medizinischer Dienst der Krankenversicherung, Lübeck, Germany
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Timo Emcke
- KV-SH, Bad Segeberg, Germany
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Marc Heidbreder
- MDK Nord, Lübeck, Germany
| Published: | September 6, 2019 |
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Outline
Text
Background: Whereas opioids remain a cornerstone in the therapy of cancer related pain predominately in a palliative setting there are upcoming concerns regarding long-term treatment of chronic non-cancer pain (CNCP) with opioid analgesics especially in case of non-specific back pain with respect to the ‘opioid’ crisis in the U.S.A. In addition, Zeng et al. recently reported that among patients aged > 50 years suffering from osteoarthritis, initial prescription of tramadol was associated with a significantly higher rate of mortality over one year of follow-up compared to patients receiving nonsteroidal anti-inflammatory analgesics.
Methods: We analyzed numbers of prescriptions of opioids to all outpatients suffering from non-cancer pain in the Federal State of Germany Schleswig-Holstein reimbursed by statutory health insurance in quarters 1/2 2013 and in quarters 1/2 2018. Pseudonymized patient IDs including age and gender considered as suffering from CNCP were identified by elimination of the ‘International Statistical Classification of Diseases and Related Health Problems’ (ICD)-10-CM codes C00-D48 followed by adjustment of data regarding involvement of oncologists/radio-oncologists to eliminate further patients with a current or previous history of cancer. Additional data was analyzed to evaluate continuity of treatment of patients from quarter 4 2017 until quarter 3 2018.
Results: Numbers of patients diagnosed for instance with chronic back pain (M54) increased from 304.470 in 2013 to 382.423 in 2018 (126%) that of diagnosed with degeneration of intervertebral discs (M51) from 91.909 to 130.415 (142%). Significant differences were observed in numbers of prescriptions of opioids between female and male patients both in quarter 1/2 2013 and in 1/2 2018. Female patients were at a higher risk to receive a prescription of an opioid analgesic compared to male patients. Analysis of prescriptions patterns of various opioids (fentanyl, hydromorphone, oxycodone, oxycodone+naloxone, tapentadol, tilidine+naloxone, tramadol and tramadol+paracetamol) revealed some striking differences between 2013 and 2018. The sum of all prescribed opioids has had slightly increased (52.731 prescriptions in 2013 vs. 62.181 in 2018 [118%]) whereas numbers of patients assumed to suffer from CNCP and treated with opiod analgetics increased from 49.478 in 2013 to 57.064 in 2018 (115%). Number of prescriptions of tramadol exceeded that of other opioid analgesics by far (quarters 1/2 2013 27.413 declining to 20.355 in quarters 1/2 2018). Notably, prescription numbers of the combination tramadol+paracetamol increased to 1.473 prescriptions in 2018 (2013 126 prescriptions). Prescriptions of oxycodone amounted to 6.211 in 2013 and increased to 8.824 in 2018. Notably, a pronounced increase of prescriptions of the combination of tilidine+naloxone was observed (1.711 in 2013 vs. 15.785 in 2018, 923%).
Discussion: Overall, amount of prescriptions of opioids slightly increased from 2013 to 2018. From 2017 to 2018 74% of patients received prescriptions continuously for the duration of one year. Despite increasing number of patients diagnosed with chronic back pain and increasing prescription numbers of opioids our analysis revealed that Schleswig-Holstein does not seem to face an opioid epidemic. There are no obvious reasons that could explain the peculiar increase in prescriptions of tilidine+naloxone.
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
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