gms | German Medical Science

Background: There is a lack of data on trends in prescribing of opioid analgesics in Germany based on individual-level data. Further, studies in this field mostly focused on prescription prevalence, while only few studies also considered morphine equivalency as a quantification measure. This study aims to assess trends in prescribing of opioid analgesics in Germany using different quantification measures.

Materials and methods: We conducted annual cross-sectional studies for the years 2004–2020 based on the German Pharmacoepidemiological Research Database (GePaRD; claims data from 20% of the German population). We included all persons with continuous insurance or those who died in the respective year and identified all outpatient prescriptions of opioid analgesics prescribed to these persons in the respective year. As quantification measures, we used the prescription prevalence (number of persons with ≥1 prescription per 100 persons) and the sum of prescribed oral morphine equivalents (OME) in mg per 1,000 person-years by using the drug-specific amount and equianalgesic ratio to morphine. We calculated these two measures overall and stratified by age group (0–19, 20–39, 40–59, 60–79, and ≥80 years) and sex. In addition, the measures were directly standardized to the German population (31 December 2020). The study was financed by the German Federal Institute for Drugs and Medical Devices (BfArM).

Results: The number of eligible persons ranged from 11,407,266 in 2004 to 17,181,878 in 2020. The standardized prescription prevalence steadily decreased from 2004 (5.5%) to 2016 (4.5%; relative decrease: 18%) and further decreased thereafter (2020: 4.1%). A decreasing prevalence was observed in all age and sex groups except for females aged ≥80 years (increase between 2005 and 2016, decrease thereafter) and males aged ≥80 years (increase between 2005 and 2008, stable thereafter). Based on the standardized OME per 1,000 person-years, there was an overall increase until 2016 (2004: 187,979 mg; 2016: 290,734 mg; relative increase: 55%) and a slight decrease thereafter (2020: 276,253 mg). The OME per 1,000 person-years increased in most age and sex groups between 2004 and 2016.

Conclusion: In Germany, the overall prescription prevalence of opioid analgesics decreased between 2004 and 2016, while the opposite (increase) was observed when oral morphine equivalents were considered. Our study illustrates that trends in prescribing of opioid analgesics can strongly depend on the quantification measure being considered.