Estimation of the Number of People With Opioid Addiction in Germany

Changes in Opioid Agonist Treatment Practice in Germany during the COVID-19 Pandemic: What Have Physicians Done, and What Would They Like to Keep Doing?

INTRODUCTION

Opioid agonist treatment (OAT) is the most common and most effective treatment option for persons with opioid use disorders (OUD). In Germany, the prescription of OAT medications is regulated by the Narcotic Drugs Prescription Ordinance. With the introduction of restrictions to contain the SARS-CoV-2 virus, the German OAT regulations have been amended to ensure a legal continuation of OAT for people with OUD. In this study, we aimed to examine the use of the OAT regulations in practice, the experience made by physicians prescribing OAT medications, and their perspective on OAT regulations.

METHODS

Between September and December 2021, a questionnaire on the current situation and potential changes in the provision of OAT during the COVID-19 pandemic was sent out to 2,416 German physicians prescribing OAT medications. Differences between physicians with and without addiction medicine certification were analyzed.

RESULTS

The response rate of physicians was 22.8%. Their average age was 57.4 (±10.1) years, and 62.3% were male. During the COVID-19 pandemic, take-home periods for stable patients have been extended by 48.2% of physicians, and 52.6% would like to maintain this prescribing practice in the future. Most physicians (71.6%) indicated that patients handled the extended take-home prescriptions predominantly responsibly. A total of 71.8% of the physicians generally did not use video consultation. A corona pandemic-related switch of the OST medication to depot buprenorphine injection did rather not occur, as 71.2% reported no patients treated with depot buprenorphine, and only 2.6% switched first-time or more patients to depot buprenorphine due to the COVID-19 pandemic.

CONCLUSION

The corona situation opened up opportunities for physicians and patients and enabled change processes in OAT. Physicians had positive experiences implementing expanded take-home prescriptions for stable patients. Video contacts rarely took place, suggesting resistance to digital consultation. The number of depot buprenorphine prescriptions has not increased substantially since the pandemic's beginning and has remained at low levels. Further research is needed to assess to what extent the changes in OAT will be maintained over time and whether they will also lead to long-term benefits for OAT patients.

[Treatment of Opioid-dependent Inmates - Attitudes and Treatment Practice of medical Staff in Bavarian Prisons]

BACKGROUND

The present study examines the treatment practice and attitudes of medical staff towards opioid-dependent inmates in Bavarian prisons.

METHOD

We interviewed medical staff (n=20) from 18 Bavarian prisons about substitution practice and attitudes by semi-structured interviews.

RESULTS

With regard to the treatment routines and the attitudes of the medical staff, we found mixed results. From the perspective of the medical staff, the treatment decision depends on the patients' wishes, the severity and duration of the dependence, the length of sentence and organizational factors. Problems were discussed in particular with regard to the care situation inside and outside the prisons and difficulties in transition management.

CONCLUSIONS

Substitution therapy is considered a standard treatment method in prisons today. However, our respondents highlighted some disadvantages (e. g. passing on the substitution drug). Although the treatment goal of complete abstinence was generally viewed positively by a part of the medical staff, it was not considered very realistic. From the point of view of the respondents, special attention should be paid to the continuity of the chosen treatment strategy in the context of discharge management.

[First Aid Training for Drug Overdose in Opioid Addicts and Provision of Take-Home Naloxone on Release from Prison: Feasibility Study from the Bavarian Model Project]

INTRODUCTION

Between 22 and 30% of prisoners in Germany are reported to be intravenous drug users. There is a 12-fold increase in mortality, mostly as a result of opioid overdose in the first weeks after release from prison. We evaluated the feasibility of first aid training for drug overdose, including take-home naloxone in incarcerated opioid addicts.

METHODOLOGY

Within the Bavarian Take-Home Naloxone Model Project (BayTHN), a subsample of imprisoned opioid addicts was recruited in 5 Bavarian correctional facilities. Manualized first aid training for drug overdose, including take-home naloxone was provided. All surveys were conducted with standardized questionnaires or semi-structured interviews.

RESULTS

Sixty-two long-term opioid addicts were included (age: 36 years (22-53 years); 53.2% women; age at first opioid use: 19.2 years (10-31 years). On average, 3.9 (1-10) opioid addicts participated per training session. At the time of training, the opioid addicts had been in prison on average for 42 (1-228) weeks and expected their release from prison in about 10 (1-64) weeks. 68% of participants reported having experienced a drug overdose by themselves. 84% had already experienced at least one drug emergency with another person, 36% more than once. Nearly one-third had not offered helped in the last emergency they had experienced, mostly out of fear of doing something wrong. Only 50% of participants had called emergency services. 25% tried to help, however, by not very effective means. 75% often consumed in the presence of other persons, such as partners and/or friends. The incarcerated opioid addicts were well motivated to participate and showed a significant increase in knowledge and skills for effective first aid in an opioid overdose situation.

CONCLUSION

The feasibility study carried out among imprisoned opioid addicts shows that manualized first aid training in handling opioid overdose, including take-home naloxone can be successfully implemented. A best-practice model for reducing initial caveats, organization, and prescribing take-home naloxone at release from prison was established. The high rate of drug overdoses and drug use in the presence of others (potential first responders) proves that the target group for successful use of first aid training along with take-home naloxone could be reached. However, a broad roll-out is needed to achieve a relevant reduction in mortality in opioid addicts after release from prison.

Prescription of opioid analgesics for non-cancer pain in Germany: study protocol for a mixed methods analysis

Aim

Long-term therapy with opioid analgesics bears the risk of complications, such as misuse, abuse, and dependence. An evidence-based guideline addresses the long-term use of opioid analgesics for non-cancer pain. Recent studies observed an increase in opioid prescriptions over the past two decades in Germany. However, the exact circumstances of this increase and if long-term therapy adheres to these guidelines in practice remains unknown. Therefore, this study aimed to evaluate the provision of opioid analgesics for adults with non-cancer pain from patients’ and physicians’ perspectives. Based on the results, recommendations for care strategies for the patient groups at risk of misuse, abuse, and dependence were developed.

Methods

Built on a mixed methods approach, this evaluation combines (i) interviews with primary care physicians and specialists, (ii) surveys of patients and physicians, (iii) analyses based on administrative claims data from a German statutory health insurance provider. Proceeding from the analysis of the evaluation results, the development of care strategies included (iv) semi-structured interviews with stakeholders and (v) expert workshops.

Conclusion

To our knowledge, this is the first attempt to analyze opioid prescriptions from the combined perspectives of patients and practitioners in Germany. The results are intended to facilitate the development of target group-specific care strategies and recommendations to establish a general framework for the implementation of care strategies.

Konsumutensilienvergabe in Deutschland: Ergebnisse einer Befragung von Einrichtungen der Drogenhilfe und Suchttherapie zur Ausgabe von Utensilien zum sicheren Drogenkonsum 2018

Ziel der Studie Deutschland hat sich dem globalen Public Health-Ziel der Virushepatitis-Eliminierung bis 2030 verschrieben. Maßnahmen der Schadensminimierung bei Drogengebrauchenden sind ein zentraler Baustein, um die Übertragung von HIV, Hepatitis B und C zu verringern. Es fehlte ein aktueller Überblick für Deutschland über Anzahl und Verteilung Konsumutensilien-ausgebender Einrichtungen, sowie welche und wie viele Konsumutensilien jährlich ausgegeben werden. Beide Fragen sollten mit dem Projekt für 2018 beantwortet werden. Außerdem sollte geschätzt werden, ob die Zielvorgaben der WHO bis 2020 von jährlich 200 ausgegebenen Spritzen/Nadeln je Person erreicht werden.

Methodik Konsumutensilien-ausgebende Einrichtungen wurden mittels der Datenbank der Deutschen Hauptstelle für Suchtfragen, online verfügbarer Auflistungen von Spritzenautomaten und Drogenkonsumräumen sowie durch Projektpartner identifiziert. Ausgebende Einrichtungen beantworteten einen Fragebogen zur Art und Anzahl der ausgegebenen Utensilien, Anzahl der versorgten Personen und Budget. Die Anzahl ausgegebener Konsumutensilien und versorgter Personen wurden deskriptiv analysiert. Die mittlere Anzahl in 2018 ausgegebener Spritzen/Nadeln pro OpioidkonsumentIn wurde je Bundesland ermittelt.

Ergebnisse Es wurden 2.158 potenziell ausgebende Einrichtungen recherchiert, von denen 475 (22%) antworteten und die Ausgabe von Konsumutensilien bestätigten. Diese entfielen auf 280 Träger/Einrichtungen, von denen 155 (55%) den Fragebogen zur Art und Anzahl ausgegebener Utensilien beantworteten. Die geographische Abdeckung war sehr heterogen. Im Durchschnitt wurden 2018 119 Spritzen und 156 Nadeln pro Person ausgegeben. Jeweils 17 bzw. 19 der kreisfreien Städte oder Landkreise mit Angaben erreichten das WHO-Ziel für 2020 von 200 ausgegebenen Spritzen/Nadeln pro Person. Niedrigschwellige Einrichtungen und Drogenkonsumräume spielen eine Schlüsselrolle bei der Konsumutensilien-Vergabe. Mehr als ein Drittel der Einrichtungen gaben an, dass das Budget für eine bedarfsgerechte Versorgung nicht ausgereicht habe.

Schlussfolgerung Die erhobenen Daten können als erstmalige Orientierung für die bundesweite Versorgungslage dienen. Nur in wenigen Gebieten wurde 2018 das für 2020 gesetzte Ziel der WHO von 200 ausgegebenen Spritzen/Nadeln pro Person erreicht. Eine Steigerung der Konsumutensilienausgabe und Versorgung auch in strukturschwachen Regionen ist zu empfehlen, um die Ziele der Hepatitis-Eliminierungsstrategie nicht zu gefährden. Eine neue Erhebungswelle ist für 2022 geplant.

Age, period, and cohort effects on trends in outpatient addiction care utilization in the general Berlin population from 2008 to 2016

Background

The aim of this study was to decompose independent effects of age, period, and cohort on trends in outpatient addiction care utilization resulting from alcohol (AUD) and illicit substances use disorders (ISUD). Decomposing trends in addiction care utilization into their independent effects by age, period, and cohort may lead to a better understanding of utilization patterns.

Methods

Individuals seeking help in Berlin outpatient addiction care facilities between 2008 and 2016 with an age range of 18–81 years for AUD (n = 46,706) and 18–70 years for ISUD (n = 51,113) were standardized to the general Berlin population using data from the German Federal Statistical Office. Classification of utilization as AUD- (F10) or ISUD-related (F11, F12, F14, F15, F16, F18, F19) help-seeking was based on primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. Age was measured in years and period as year of data collection. Cohort was defined as the mathematical difference between period and age. Age, period, and cohort analyses were conducted using the intrinsic estimator model on AUD- and ISUD-related outpatient addiction care utilization.

Results

Age effects on AUD-related utilization were highest in 18- to 19-year-old and in 39- to 59-year-old individuals. ISUD-related utilization declined almost continuously with increasing age. Period effects on AUD- and ISUD-related utilization were small. AUD-related utilization was highest in cohorts born from 1951 to 1986. ISUD-related utilization increased in cohorts born between 1954 and 1973 where utilization peaked, followed by a decline of the same order.

Conclusions

Age and cohort effects were the strongest drivers of trends in AUD- and ISUD-related outpatient addiction care utilization. Onset of help-seeking in earlier phases of AUD development should be enhanced as well as help-seeking for AUD and ISUD in general. The highest cohort-related rates in the baby boomer and following cohorts for AUD and ISUD underline an increased demand for addiction care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12744-6.

Novel Synthetic Opioids (NSO) Use in Opioid Dependents Entering Detoxification Treatment

INTRODUCTION

Over the last decade, the use of New/Novel Synthetic Opioids (NSO) has emerged as an increasing problem, and especially so in the USA. However, only little is known about the prevalence and history of NSO use in European heroin dependents.

METHOD

A cross-sectional multicenter study, carried out with the means of both standardized interviews and urine toxicology enhanced screening, in a sample of opioid addicted patients referred for an in-patient detoxification treatment.

RESULTS

Sample size included here n = 256 patients; prior to admission, 63.7% were prescribed with an opioid maintenance treatment. Lifetime use of heroin and opioid analgesics was reported by 99.2 and 30.4%, respectively. Lifetime NSO/fentanyl use was reported by 8.7% (n = 22); a regular use was reported by 1.6% (n = 4), and ingestion over the 30 days prior to admission by 0.8% (n = 2). Most typically, patients had started with a regular consumption of heroin, followed by maintenance opioids; opioid analgesics; and by NSO. Self-reported data were corroborated by the toxicology screenings carried out; no evidence was here identified for the presence of heroin being contaminated by fentanyl/derivatives.

DISCUSSION

NSO and also opioid analgesics did not play a relevant role in the development and the course of opioid/opioid use disorders in German patients referred for an inpatient detoxification treatment.

Modellprojekt zur Durchführung deutschlandweiter qualitätsgesicherter Take-Home Naloxon Schulungen

Etwa 600 Menschen sind 2020 infolge des Konsums von Heroin und anderen Opioiden gestorben 1. Viele dieser Todesfälle hätten durch den Einsatz eines Naloxon-Nasensprays vermieden werden können. Das einfach und sicher anwendbare Medikament Naloxon kann innerhalb weniger Minuten die atemlähmende Wirkung von Opioiden wie Heroin, Fentanyl oder Methadon aufheben und damit Leben retten. Doch bislang kommt das Notfallmedikament viel zu wenig zum Einsatz: Seit der Zulassung 2018 wurde das verschreibungspflichtige, aber erstattungsfähige Nasenspray nur etwa 260 Mal an Drogengebraucher*innen ausgegeben (Bundestagsdrucksache 19/18361: S. 2) – bei geschätzten 165 000 Opioidkonsument*innen in Deutschland 2.

Association of Testosterone Levels and Steroid 5-Alpha-Reductase 2 Polymorphisms with Opioid Craving

BACKGROUND/AIMS

Opioid dependence is a severe disease which is associated with a high risk of relapse, even in cases of successful withdrawal therapy. Studies have shown alterations of the hypothalamic-pituitary-gonadal axis in opioid-dependent patients, such as decreased testosterone serum levels in affected males. Sex hormones and the steroid 5-alpha-reductase 2 (SRD5A2) V89L polymorphism are associated with craving during alcohol withdrawal, but little is known about their impact on symptomatology of opioid dependence.

METHODS

In this study, we analyzed 2 independent male cohorts of opioid-dependent patients for possible alterations in testosterone serum levels compared to non-opioid-dependent controls. In one of the cohorts, we additionally investigated associations of testosterone serum levels and 3 SRD5A2 polymorphisms with symptoms of opioid dependence, measured by the Heroin Craving Questionnaire (HCQ).

RESULTS

In the patient groups, we found significantly decreased testosterone serum levels compared to the control groups. Furthermore, we found significant associations of both the testosterone serum levels and the SRD5A2 V89L polymorphism with opioid craving assessed by the HCQ.

CONCLUSION

Our data show a possible role of testosterone metabolism in opioid dependence, which may be relevant for the establishment of future treatment strategies.

[Critical discussion of new data regarding prevalence of opioid use disorder in patients with chronic pain in Germany]

Hintergrund

Es gibt keine Opioidkrise in Deutschland. Neue Studien mit Nichttumorpatienten mit chronischen Schmerzen (CNTS) in Deutschland zeigen jedoch eine unerwartet hohe Prävalenz von Opioidgebrauchsstörungen nach Diagnostic and Statistical Manual for Psychiatric Diseases 5 (DSM-5).

Ziel der Arbeit

Kritische Diskussion neuer Studienergebnisse zur Prävalenz von Opioidgebrauchsstörungen bei Schmerzpatienten in Deutschland.

Material und Methoden

Selektive Literaturrecherche und multiprofessionelle Einordnung der Ergebnisse durch Expertenrunde (Schmerztherapie, Neurologie, Psychiatrie, Palliativmedizin, Allgemeinmedizin und Suchttherapie).

Ergebnisse

Die Kriterien für die Diagnose „Opioidgebrauchsstörung“ des DSM‑5 sind auf Patienten mit CNTS nur eingeschränkt anwendbar, können aber für problematisches Verhalten sensibilisieren. Hierbei ist die Diagnose Opioidgebrauchsstörung nicht mit der Diagnose einer Substanzabhängigkeit nach ICD-10 gleichzusetzen, da die Diagnose nach DSM‑5 ein deutlich breiteres Spektrum abdeckt (mild, moderat, schwer). Risikofaktoren für eine Opioidgebrauchsstörung sind jüngeres Alter, depressive Störungen, somatoforme Störungen und hohe Opioidtagesdosen. Die interdisziplinäre Leitlinie zur Langzeitanwendung von Opioiden bei chronischen nichttumorbedingten Schmerzen (LONTS) enthält Empfehlungen, welche das Risiko für eine Opioidgebrauchsstörung reduzieren sollen.

Diskussion

Eine Anpassung der DSM-5-Diagnosekriterien der Opioidgebrauchsstörung an die besondere Situation von Patienten mit CNTS und eine Validierung dieser Kriterien könnte helfen, in der Zukunft genauere Daten zu Opioidgebrauchsstörungen von Patienten mit chronischen Schmerzen in Deutschland zu erheben. Verordner sollten für diese Problematik sensibilisiert werden, ohne die Patienten zu pathologisieren oder gar zu stigmatisieren. Weitere Forschung zur Einordnung dieses bisher unterschätzten Phänomens ist notwendig.

[Opioid Substitution Treatment in Germany: Physicians' View on the Effects of the 3rd Revision of the Narcotic Drugs Prescription Ordinance]

STUDY AIM

Opioid substitution treatment (OST) is the most effective drug treatment for opioid dependence worldwide. This form of therapy is also well established in Germany. Nevertheless, there are gaps in the provision of care, especially in rural areas and some states, due to a decreasing number of physicians involved in implementing the substitution programs. The 3rd revision of the Narcotic Drugs Prescription Ordinance (NDPO), which came into force in 2017, transferred medical therapeutic tasks of OST to the policy-making power of the German Medical Association. This comprehensive reform of the general conditions for OST led to greater legal certainty for this form of treatment. The present study aimed to analyze the effects of the 3rd revision of the Narcotic Drugs Prescription Ordinance from the providers' perspective.

METHODS

Between August and December 2019, a questionnaire on individual experiences with the changes implemented in 3rd revision of the Narcotic Drugs Prescription Ordinance was sent by the Federal Opium Agency and the Associations of Statutory Health Insurance Physicians of the chosen federal states to 2,503 physicians implementing the substitution program in Germany as well as 563 physicians in Hamburg, Bavaria, North Rhine-Westphalia and Saxony who were not or no longer involved in this field of medical practice.The evaluation distinguished between physicians with and without further training in addiction medicine and between urban and rural districts.

RESULTS

The response rate of physicians was 34.1%. The average age was 57.9 (±8.7) years, and 64.5% were male. The most relevant changes of the NDPO revision were found to be no time limit for achieving opioid abstinence (85.3%), new assessment and treatment using additional psychotropic substances (71.0%), extending take-home regulation to a maximum of 30 days (70.0%) and greater legal certainty (66.2%). Widening of consultative care up to 10 patients met with little approval (14.8%); 36.7% did not believe that care of substituted patients was assured either now or in the future.

CONCLUSIONS

The NDPO revisions were considered to be relevant in terms of increased legal certainty and treatment liberties. Information was needed in rural areas, among physicians who carried out substitution therapy without advanced training in addiction medicine and physicians no longer involved in substitution therapy.

Relevanz und Auswirkungen der 3. BtMVVÄndV für die Opioidsubstitutionstherapie

Hintergrund Die Opioidsubstitutionstherapie (OST) ist in Deutschland die wichtigste Therapieoption zur Behandlung der Opioidabhängigkeit. Trotz ihrer Effektivität limitieren strukturelle Rahmenbedingungen und die Zurückhaltung v. a. jüngerer ÄrztInnen, die Substitution anzubieten oder fortzuführen, die Ausweitung dieser Behandlung. Mit der 3. Verordnung zur Änderung der Betäubungsmittel-Verschreibungsverordnung (3. BtMVVÄndV) wurden 2017 umfassende Reformen der Rahmenbedingungen der Opioidsubstitutionstherapie verabschiedet. In dem vorliegenden Artikel werden die Ergebnisse leitfadengestützter Interviews mit substituierenden ÄrztInnen als ein Bestandteil einer umfassenden Evaluation dieser Änderungen vorgestellt.

Methode Im Zeitraum zwischen Dezember 2019 bis April 2020 wurden in den deutschen Bundesländern Hamburg, Nordrhein-Westfalen, Sachsen und Bayern insgesamt 31 qualitative Interviews mit substituierenden ÄrztInnen geführt. Der Interviewleitfaden beinhaltete Fragen zu den in der 3. BtMVVÄndV beschlossenen Neuerungen, zu strukturellen Voraussetzungen sowie Vorstellungen für eine zukünftige Gestaltung der Opioidsubstitutionstherapie.

Ergebnisse Das Durchschnittsalter der interviewten ÄrztInnen lag bei 58,5 Jahren, 77,4% waren männlich und 54,8% konsiliarisch tätig. Die Veränderungen der Substitutionsrichtlinie werden überwiegend positiv bewertet; bezogen auf die praktische Relevanz bestehen jedoch bundeslandbezogene Unterschiede. Eine hohe praktische Relevanz wird der Ausdehnung der Take-Home-Verordnung auf 30 Tage, der Ausnahme vom Sichtbezug auf 5 Tage sowie dem veränderten Umgang mit Beikonsum zugeschrieben. Von untergeordneter Bedeutung ist die Möglichkeit, nunmehr 10 anstatt 3 PatientInnen unter der Konsiliarregelung behandeln zu dürfen.

Schlussfolgerungen Die veränderten Vorschriften dürften nicht ausreichen, um neue ÄrztInnen für die Opioidsubstitutionstherapie zu gewinnen. Kooperationen mit Apotheken, Pflegeeinrichtungen und staatlichen Institutionen werden zukünftig an Bedeutung gewinnen. Ferner ist eine Unterstützung niedergelassener ÄrztInnen durch Substitutionsambulanzen, Psychiatrische Institutsambulanzen sowie Bezirkskrankenhäuser erforderlich. Der Behandlung von Abhängigkeitserkrankungen sollte in der Ausbildung von MedizinerInnen ein größerer Stellenwert zukommen.

[How to assess the elimination of viral hepatitis B, C, and D in Germany? Outcomes of an interdisciplinary workshop]

Hintergrund

Die Weltgesundheitsorganisation (WHO) hat 2016 eine Strategie zur Eliminierung von Hepatitis-B-, -C- und -D-Virusinfektionen verfasst und Indikatoren zum Monitoring des Fortschritts definiert. Das Robert Koch-Institut hat 2019 ein interdisziplinäres Arbeitstreffen zur Verbesserung der Datenlage veranstaltet.

Ziele

Ziele waren die Vernetzung der Akteure, die Erstellung einer Übersicht zu den in Deutschland vorhandenen Datenquellen zu Hepatitis B, C und D und die Diskussion methodischer Aspekte.

Material und Methoden

Die für Deutschland relevanten WHO-Indikatoren wurden extrahiert und es wurde bestimmt, wie diese anhand vorliegender Daten konstruiert werden können. Bei dem Arbeitstreffen mit AkteurInnen aus dem öffentlichen Gesundheitsdienst, aus Kliniken, Laboren, von Krankenkassen, Forschungsinstituten, Datenhaltern und Registern wurden in Arbeitsgruppen Erhebungsmethoden diskutiert, welche dazu dienen können, fehlende Daten zu ermitteln. Die Datenquellen und Daten wurden hinsichtlich Qualität, Vollständigkeit sowie praktischer Umsetzbarkeit evaluiert und priorisiert.

Ergebnisse

Für die Allgemeinbevölkerung können die Indikatoren zu Prävention, Testung, Diagnose, Behandlung, Heilung, Folgeschäden und Mortalität aus Diagnose‑, Versorgungs- und Registerdaten, Daten aus Laboren und klinischen Zentren sowie einzelnen Studien konstruiert werden. Datenquellen für vulnerable Gruppen beschränken sich auf einzelne Studien zu Drogengebrauchenden, Männern, die Sex mit Männern haben, und HIV-Ko-Infizierten. Daten für MigrantInnen, Inhaftierte und SexarbeiterInnen sind kaum verfügbar; ebenso fehlen aktuelle Daten zur Krankheitslast chronischer Hepatitisinfektionen in der Allgemeinbevölkerung.

Diskussion

Für alle ausgewählten Indikatoren konnten Datenquellen, ihre Besonderheiten und Limitationen identifiziert werden. Im nächsten Schritt gilt es, die entwickelten Ideen in konkrete Projekte mit einzelnen Datenhaltern umzusetzen.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-020-03260-2) enthalten.

Trends in risky prescriptions of opioid analgesics from 2011 to 2015 in Northern Germany

INTRODUCTION

Due to their euphoric and sedative effects, opioid analgesics have high potential for abuse and dependence. In the last decade in the USA and many Western European Countries the prescription rates of opioid analgesics have steadily increased.

OBJECTIVE

This study describes 5-year trends in the prescription of opioid analgesics and risk indicators such as duration, dose and 'doctor shopping' in Northern Germany.

METHODS

The annual rates of opioid analgesic prescriptions have been analysed for patients with statutory health insurance processed by the North German Pharmacy Data Center for the years 2011-2015. A distinction was made between non-cancer patients and cancer patients, and different groups according to prescription duration and dose level.

RESULTS

Between 2011 and 2015, the annual number of patients with opioid analgesic prescriptions increased from 500,000 to 550,000. About half of non-cancer-patients (85% of the total sample) and cancer patients received opioid analgesics for 90 days or less. The rates for long-term prescriptions (⩾9 months) ranged between 6-7% for non-cancer patients and 7-8% for cancer patients. Between 1.2-1.8% received opioid analgesics in doses of more than two defined daily doses. The majority of non-cancer patients with opioid analgesic prescriptions were female. The average age of non-cancer patients was 66 years. About 80% of non-cancer patients with first opioid analgesic prescription received World Health Organization step II medication.

CONCLUSION

For the first time, this study provides comprehensive patient-related analyses of opioid analgesic prescriptions in Germany over a 5-year period. Despite a slight increase in the overall number of opioid analgesic prescriptions, an epidemic spread of opioid analgesics cannot be observed.

Prevalence of Opioid Dependence and Opioid Agonist Treatment in the Berlin Custodial Setting: A Cross-Sectional Study

BACKGROUND

Among people living in detention, substance use is highly prevalent, including opioid dependence. Opioid agonist treatment (OAT) has been established as an evidence-based, first-line treatment for opioid dependence. Despite high prevalence of opioid dependence, conclusive data regarding its prevalence and the OAT practice in German prisons is scarce; rather, the existing data widely diverges concerning the rates of people in detention receiving OAT.

MATERIALS AND METHODS

We conducted a cross-sectional survey of all detention facilities in Berlin. On the date of data collection, a full census of the routine records was completed based on the medical documentation system. For each opioid dependent individual, we extracted sociodemographic data (i.e., age, sex, and non-/German nationality, whether people experienced language-related communication barriers), information about OAT, comorbidities (HIV, hepatitis C, schizophrenia), and the detention center, as well as the anticipated imprisonment duration and sentence type. The data was first analyzed descriptively and secondly in an evaluative-analytical manner by analyzing factors that influence the access to OAT of people living in detention.

RESULTS

Among the 4,038 people in detention in the Berlin custodial setting under investigation, we identified a 16% prevalence of opioid dependence. Of the opioid-dependent individuals, 42% received OAT; 31% were treated with methadone, 55% were treated with levomethadone, and 14% were treated with buprenorphine. Access to OAT seemed mainly dependent upon initial receipt of OAT at the time of imprisonment, detention duration, the prisons in which individuals were detained, German nationality, and sex. The overall prevalence of HIV was 4-8%, hepatitis C was 31-42%, and schizophrenia was 5%.

CONCLUSIONS

The prevalence of opioid dependence and access to OAT remains a major health issue in the custodial setting. OAT implementation must be especially intensified among male, non-German, opioid-dependent individuals with a short detention period. Treatment itself must be diversified regarding the substances used for OAT, and institutional treatment differences suggest the need for a consistent treatment approach and the standardized implementation of treatment guidelines within local prison's standard operating procedures. Testing for infectious diseases should be intensified among opioid-dependent people living in detention to address scarcely known infection statuses and high infection rates.

Ranking the Harm of Psychoactive Drugs Including Prescription Analgesics to Users and Others-A Perspective of German Addiction Medicine Experts

Background: Over the past 15 years, comparative assessments of psychoactive substance harms to both users and others have been compiled by addiction experts. None of these rankings however have included synthetic cannabinoids or non-opioid prescription analgesics (NOAs, e.g., gabapentinoids) despite evidence of increasing recreational use. We present here an updated assessment by German addiction medicine experts, considering changing Western consumption trends-including those of NOAs. Methods: In an initial survey, 101 German addiction medicine physicians evaluated both physical and psychosocial harms (in 5 dimensions) of 33 psychoactive substances including opioids and NOAs, to both users and others. In a second survey, 36 addiction medicine physicians estimated the relative weight of each health and social harm dimension to determine the overall harm rank of an individual substance. We compared our ranking with the most recent European assessment from 2014. Results: Illicit drugs such as methamphetamine, heroin, cocaine and also alcohol were judged particularly harmful, and new psychoactive drugs (cathinones, synthetic cannabinoids) were ranked among the most harmful substances. Cannabis was ranked in the midrange, on par with benzodiazepines and ketamine-somewhat more favorable compared to the last European survey. Prescribed drugs including opioids (in contrast to the USA, Canada, and Australia) were judged less harmful. NOAs were at the bottom end of the ranking. Conclusion: In Germany, alcohol and illicit drugs (including new psychoactive substances) continue to rank among the most harmful addictive substances in contrast to prescribed agents including opioid analgesics and NOAs. Current laws are incongruent with these harm rankings. This study is the first of its kind to include comparative harm rankings of several novel abused substances, both licit/prescribed and illicit.

Trends In Substance Use And Related Disorders: Analysis of the Epidemiological Survey of Substance Abuse 1995 to 2018

BACKGROUND

Changes in the use of psychoactive substances and medications and in the occurrence of substance-related disorders enable assessment of the magni- tude of the anticipated negative consequences for the population.

METHODS

Trends were analyzed in the consumption of tobacco, alcohol, cannabis and other illegal drugs, analgesics, and hypnotics/sedatives, as well as trends in substance-related disorders, as coded according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The data were derived from nine waves of the German Epidemiological Survey of Substance Abuse (Epidemiologischer Sucht- survey, ESA) from 1995 to 2018. The data were collected in written form or by means of a combination of paper and internet-based questionnaires or telephone interviews.

RESULTS

The estimated prevalence rates of tobacco and alcohol consumption and the use of hypnotics/sedatives decreased over time. On the other hand, increasing prevalence rates were observed for the consumption of cannabis and other illegal drugs and the use of analgesics. The trends in substance-related disorders showed no statistically significant changes compared to the reference values for the year 2018, except for higher prevalence rates of nicotine dependence, alcohol abuse and dependence, analgesic dependence, and hypnotic/sedative dependence in the year 2012 only.

CONCLUSION

Trends in tobacco and alcohol consumption imply a future decline in the burden to society from the morbidity, mortality, and economic costs related to these substances. An opposite development in cannabis use cannot be excluded. No increase over time was seen in the prevalence of analgesic dependence, but the observed increase in the use of analgesics demands critical attention.