In Germany, the number of opioid addicts is increasing

Will there soon be thousands of opioid addicts in Germany too??

There is a real opioid epidemic in the US right now. The experts believe that prolonged use of opioid analgesics is the trigger for this condition. The problem is not only in the US, in Germany, too, the upper treatment limits are often not met.

The scientists of the University of Saarbrücken found in their study that in Germany far too often too high amounts of opioids are taken over a longer period of time. This can promote substance abuse. The results of the study were published in the journal "Pain".

More and more people in Germany take opioids. Such a treatment becomes problematic if the medication is taken too long or in too high a dosage. (Image: denisismagilov / fotolia.com)

Which dose should not be exceeded during long-term use?

Especially with a long-term use of opioid analgesics against non-tumor-related pain (LONTS) it must be ensured that a daily dose of 120 mg oral morphine equivalent (MEQ) should only be exceeded in extreme cases. A guideline on the correct use of opioids suggests that alternatives and the so-called indexedness of opioids should be checked beforehand.

In Germany, every tenth LONTS patient exceeds the recommended daily dose

The recommendation was based on data from a study of more than four million people with GI. This had shown that the intake of higher daily doses leads to increased complications. Not only in the US, but also in Germany, the recommended daily dose is often exceeded. Experts in Germany have found that in Germany the daily dose is exceeded in about one in ten LONTS patients. Such overdoses can then lead to an increased risk of risky effects and so-called substance abuse.

Physicians analyze the data of more than four million patients

The scientists analyzed the data from more than four million people with GKV for their examination. These data were collected in 2014. Of the participants, 0.8 percent had received a so-called LONTS (at least three consecutive quarters). An average daily dose was 48 mg MEQ (oral morphine equivalent), but one in ten patients received a much higher dose. The researchers found that one in ten patients received more than 120 mg of MEQ a day. In this high-dose group the mean dose was 211 mg MEQ / d. For the subjects in the group treated according to current guidelines, the average dose was 30 mg MEQ / d, the experts explain.

Which people are particularly likely to receive high-dose opioids?

Therapy with high-dose opioids has been particularly common in 40 to 59-year-olds. In addition, men were more likely to receive such high-dose opioid therapy as well as patients with chronic pain disorders, disc damage, osteoporosis, somatoform disorders and depression.

Many treatments do not follow the guidelines

The treatment guideline recommends that pain in patients with psychiatric comorbidities should not be treated with opioids. But it is precisely these types of patients who are frequently treated with high-dose opioids in the US and Europe. Unfortunately, these very people have the highest risk for the negative consequences of the treatment.

Frequently, sufferers also receive other medications

A so-called high-dose therapy is also more often associated with risky drug prescriptions, the researchers explain. Affected LONTS patients were also more likely to receive a tranquilizer at the same time (14.3 percent) compared to patients treated according to the guideline recommendations (11 percent). Likewise, the use of antidepressants was more common in non-guidelines-compliant people (53.1 percent vs. 38.2 percent).

High doses of opioids promote abuse

The prescriptions for the use of opioids often came from more than three different physicians at high doses (8.5 percent vs. 6.3 percent for normal doses). In addition, there was more evidence of abuse or dependency on the opioids used in people taking high doses of opioids. Such people were treated much more frequently because of mental health problems, behavioral problems or intoxication by opioids and other substances in a hospital (2.9 percent compared to 1.6 percent in patients treated according to the guidelines). High-dose therapy also led to increased health expenditure.

Recommended maximum levels of opioids should be strictly adhered to

The results of the study show that the guideline recommendations of a maximum of 120 mg MEQ / d for LONTS should be observed. It should be noted that people with chronic pain and concomitant psychiatric disorders need to be extra careful when handling opioids. (As)