Patterns in analgesic opioids use in Germany and France: improved pain management and risks of misuse

Background: Opioids are one of the most important and effective drugs in pain medicine with a key role in modern anaesthesia, palliative care, emergency medicine and specialised pain management. Although prescriptions of opioids are beneficial for managing chronic pain, they often lead to misuse or abuse, increasing the risk of public health consequences. In fact, the increase of opioid prescription over the past decade has led to higher numbers of analgesic opioids misuse, abuse and opioid-related deaths in most developed OECD countries. Considering Germany and France are two of the largest economies and the most populated countries in the European Union, the study of prevalence of analgesic opioids use and patterns in opioids prescription within these countries is crucial in the light of global opioid epidemic. The aim of this work is to provide evidence-based inputs from a systematic review of relevant literature in order to better inform adequate prevention strategies.

Methods: A systematic review of the prevalence of analgesic opioid use and patterns in opioid prescription in Germany and France between 2000 and 2016 was carried out by two independent researchers. The review included published and grey literature in English, German and French.

Results: For Germany and France, data analysed were mainly extracted from national insurance claims databases and national authorities’ registers. In the framework of a tigthly regulated use, the reviewed literature suggested an increase in the number of patients with opioid prescriptions and defined daily doses of opioids per recipient in Germany and France over time. The majority of opioid prescription seemed to be used by patients with chronic non-cancer pain. Opioid use tended to be more common among older people, women and, to a lesser extent, vulnerable populations. In both countries Tramadol (alone or in combination) was the most commonly used mild opioid, while Fentanyl was shown to be the most prescribed strong opioid. Although the use of analgesic opioids has increased in Germany over the last decade, with the country being the second user of prescription opioids in Europe in 2017, the number of opioid-related deaths has remained stable over time. At the same time, while France ranked fourth for analgesic opioids consumption in Europe, and the overall use of prescription opioids has decreased in the country, the misuse of prescription opioids and the number of opioid-related deaths have been on the rise.

Conclusions: Over the last decades, the overall prevalence of analgesic opioids use has increased in Germany while it has decreased in France. However, some similar trends in opioids prescription practices have been observed in both countries. Pain management has been improved over time, notably due to a wider prescription of opioid pain relievers for non-cancer pain treatment. In addition, there has been an increase in strong opioid consumption driven by a broaden use of Fentanyl and Oxycodone, while Tramadol has become the most commonly used mild opioid. Although, a rise in opioid prescription related morbidity-mortality already warrants attention in France, in Germany no signs of an opioid epidemic have been observed so far.