Increase in Opiate Prescription in Germany Between 2000 and 2010

Schubert, Ingrid; Ihle, Peter; Sabatowski, Rainer

doi:10.3238/arztebl.2013.0045

Cited by 97 publications

(115 citation statements)

References 61 publications

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“…Concurrent with the marked increase in the number of opioid prescriptions in Europe and in the United States over the last 10 years, 22,33,37 a multitude of reports have cast doubt onto the previously postulated harmlessness of long-term opioid treatment in both cancer and non-cancer patients based on the growing number of opioid-related deaths and adverse events. 3,4,8,21,26,36 The reasons for these unintentional opioidassociated deaths are not sufficiently understood.…”

Section: Introductionmentioning

confidence: 97%

Sleep-disordered breathing decreases after opioid withdrawal

Schwarzer

Aichinger-Hinterhofer

Maier

et al. 2015

Pain

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An increased cardiovascular event rate in elderly patients under opioid medications was recently reported. One reason for this increase could be the occurrence of nocturnal apnea and hypoxia, as a consequence of sleep-disordered breathing (SDB). Using a controlled study, we prospectively analyzed SDB using polysomnography in a total of 18 patients before and after opioid withdrawal (opioid withdrawal group [OG]) and 14 patients before and after comprehensive pain management (without any strong-acting opioids) who served as the control group (CG). To analyze the differences, unpaired/paired t tests and Mann-Whitney U tests/Wilcoxon rank tests were used. At baseline, the OG presented more nocturnal apneas/hypopneas than the CG with an apnea-hypopnea index (AHI) of 41.4 ± 27.8 vs 21.8 ± 15.9 (P = 0.018). After treatment, the AHI decreased significantly only in the withdrawal group (OG: 16.7 ± 8.9; CG: 20.1 ± 12.9) (P < 0.01). Before treatment, none of the CG but half of the OG patients showed central apnea, which disappeared afterwards. A mean O2 saturation during rapid eye movement sleep lower than 90% was found in 27.5% of the OG patients before opioid withdrawal and in none of the patients after withdrawal (P < 0.01). The AHI was not significantly affected by body mass index, age, or sex. Obviously, nocturnal apnea and O2 desaturation occurred more frequently, as was clinically expected in patients with opioid intake; these findings may explain the opioid-associated cardiovascular morbidity. Thus, SDB may be a risk at lower opioid doses than hitherto described, and particular caution should be exercised in patients with comorbidities that might make them vulnerable to the consequences of SDB.

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Section: Introductionmentioning

confidence: 97%

Sleep-disordered breathing decreases after opioid withdrawal

Schwarzer

Aichinger-Hinterhofer

Maier

et al. 2015

Pain

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“…In the past two decades, the use of opioid analgesics also significantly increased in Europe (DCAMC, 2012, Ruscitto et al, 2014, Zin et al, 2014, Schubert et al, 2013, Bandieri et al, 2009, Garcia del et al, 2008, Poulsen et al, 2013, Fredheim et al, 2010, Hawton et al, 2012, NHS, 2011,but it is unlikely that in the UK and elsewhere in Europe the non-medical use of prescription opioids will become as prevalent as in the U.S. (Fischer et al, 2014, Weisberg et al, 2014. In the U.S. opioids are widely available as they are often given by family and friends or can be obtained by "doctor shopping" or purchased from semi-legal and illegal pain clinics.…”

Section: Introductionmentioning

confidence: 99%

Ranking the harm of non-medically used prescription opioids in the UK

Amsterdam

Phillips

Henderson

et al. 2015

Regulatory Toxicology and Pharmacology

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Running head: ranking prescription opioidsKey words: opioids, MCDA, risk assessment, ranking, prescription drugs, harm,street heroin Both forms of heroin scored very high: overall harm score of 99 for injected heroin and 72 for smoked heroin on a scale of 0-100. The main feature that distinguishes both forms of street heroin use is that their harm to others is more than five times that of the other eleven opioids. The overall harm score of fentanyl (including injection of fentanyl extracted from patches) and diamorphine (medically prescribed form of heroin) was 54 and 51, respectively, whereas that of orally used opioids ranged from 32 (pethidine) to 11 (codeine-containing pharmaceuticals).Injected street heroin, fentanyl and diamorphine emerged as most harmful to users, with the latter two very low in harm to others.Pethidine, methadone, morphine and oxycodone are also low in harm to others, while moderate in harm to users.We conclude that the overall harms of non-medically used prescription opioids are less than half that of injected street heroin.These data may give a basis for precautionary regulatory measures that should be considered if the rising trend in non-medical use of prescription opioids were to become evident in the UK.

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“…In Germany, the percentage of patients receiving at least one prescription for opioid increased from 3.3% in 2000 to 4.5% in 2010 [3].…”

mentioning

confidence: 99%