Growth in opioid use prompts safety concerns

By Joanna Lyford, Senior medwireNews Reporter

Prescriptions for opioid drugs have increased significantly in Germany over the past decade, a survey of insurance data has found.

Of special concern was the rise in prescriptions for highly potent immediate-release opioids, a trend the authors believe raises safety signals in view of potential link with drug dependency and overdose.

Schubert's team analyzed information from a German health insurance company to determine the prevalence of opioid prescriptions between 2000 and 2010.

The percentage of insurees who received at least one opioid prescription rose from 3.31% in 2000 to 4.53% in 2010, a relative increase of 37%, the authors report in Deutsches Ärzteblatt International.

Throughout the study period opioids were prescribed predominantly to people with chronic noncancer pain; this group accounted for 76.7% of opioid recipients in 2010, down from 80.6% in 2000.

The distribution of opioid use by potency changed over the study period. Treatment with immediate-release preparations fell by almost 25%, driven mainly by a fall in prescription of Step 2 (ie, the second tier on the World Health Organization's "ladder" for pain relief) drugs since 2004.

By contrast, use of extended-release Step 2 drugs increased by 178%, primarily due to greater use of tilidine/naloxone and tramadol. The use of immediate-release morphine rose from 0.04% to 0.12%, a 178% increase, as did use of immediate-release preparations of hydromorphone, oxycodone, and fentanyl. Prescriptions for extended-release Step 3 opioids also increased almost fourfold between 2000 and 2010.

Interestingly, in people with cancer weak and strong opioids were used in roughly equal quantities, whereas in people with noncancer pain there was a sharp decrease in use of Step 2 opioids and a doubling in use of long-acting Step 3 drugs.

Schubert et al say that the most likely explanation for the increased consumption of hydromorphone and oxycodone is "intensive marketing" and note that the increased consumption of opioids "may be directly connected with a large number of deaths."

The steep increase in use of immediate-release fentanyl for indications other than cancer pain is "especially controversial," they write, adding that "there are already early signs that these substances can lead to symptoms of addiction" not only in cancer patients but also in controlled studies.

"The findings… point to possible shortcomings in the care of patients with chronic non-cancer pain," the researchers conclude. "Particularly in light of the potential risks involved, a close eye needs to be kept on the developments in opioid treatment."

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