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Will there be thousands of opioid addicts in Germany soon?
There is currently a true opioid epidemic in the United States. Experts believe that long-term use of opioid analgesics is the trigger for this condition. The problem is not only in the United States, the upper limits of treatment are often not adhered to in Germany.
In their investigation, the scientists at the University of Saarbrücken found that, too often, too high amounts of opioids were taken over a long period in Germany. This can promote substance abuse. The results of the study were published in the "Pain" journal.
Which dose should not be exceeded with long-term use?
Especially with long-term use of opioid analgesics for non-tumor-related pain (LONTS), it is essential to ensure that a daily dose of 120 mg oral morphine equivalent (MEQ) should only be exceeded in extreme exceptions. A guideline on the correct use of opioids advises that alternatives and the so-called indication of opioids should be checked beforehand.
In Germany, the recommended daily dose is exceeded for every tenth LONTS patient
The recommendation was based on data from a study of more than four million SHI patients. This had shown that taking higher daily doses leads to increased complications. Not only in the USA, 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 every tenth LONTS patient. Such overdoses can then lead to an increased risk of risky effects and so-called substance abuse.
Doctors analyze the data of more than four million patients
For their investigation, the scientists analyzed the data from more than four million SHI patients. This data was already collected in 2014. 0.8 percent of the participants had received a so-called LONTS (at least three consecutive quarters). The 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 group with too high a dose, the mean dose was 211 mg MEQ / d. For the subjects from the group who were treated according to current guidelines, the dosage was on average 30 mg MEQ / d, the experts explain.
Which people particularly often receive high-dose opioids?
Therapy with high-dose opioids has been prescribed particularly frequently in people aged 40 to 59 years. In addition, men received such high-dose opioid therapy as well as patients with chronic pain disorders, spinal disc damage, osteoporosis, somatoform disorders and depression.
Many treatments do not adhere to the guidelines
The treatment guideline recommends that pain in patients with psychiatric comorbidities should not be treated with opioids. But it is precisely such patients who receive treatment with high-dose opioids in the United States and Europe. Unfortunately, these people are at the highest risk for the negative effects of the treatment.
Those affected often also receive other medications
So-called high-dose therapy is also more often associated with risky medication prescriptions, the researchers explain. Affected LONTS patients also received 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 people who did not comply with the guidelines (53.1 percent versus 38.2 percent).
High doses of opioids promote abuse
The prescriptions for the use of opioids often came from more than three different doctors in high doses (8.5 percent compared to 6.3 percent for normally dosed treatments). People who took high doses of opioids also had more evidence of abuse or dependence on the opioids used. Such people were treated much more often in a hospital for psychological problems, behavioral problems or intoxication by opioids and other substances (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 amounts of opioids should be strictly observed
The results of the investigation show that the guideline recommendations of a maximum of 120 mg MEQ / d at LONTS should be observed. It should be noted that people with chronic pain and accompanying psychiatric illnesses must be particularly careful when handling opioids. (as)