Prescribing of Opioid Analgesics in Germany: Opposite Trends When Different Quantification Measures are Used

Purpose: To describe trends in prescribing of opioid analgesics in Germany using different quantification measures. Patients and Methods: We conducted annual cross-sectional studies for the years 2005 to 2020 based on the so-called German Pharmacoepidemiological Research Database (GePaRD; claims data covering ~20% of the German population). Opioid prescribing was assessed based on outpatient dispensations of opioid analgesics. For each year, we calculated the age- and sex-specific and -standardized prescription prevalence (number of persons with ≥ 1 prescription per 1000 persons) as well as the sum of oral morphine equivalents (OMEs) in mg per 1000 person-years. Results: The standardized prescription prevalence per 1000 persons showed a relative decrease by 14.1% between 2005 (52.3/1000) and 2016 (44.9/1000) and a further decrease by 5.6% until 2020 (42.4/1000). Based on the standardized OME per 1000 person-years, there was a relative increase by 51.4% until 2016 (2005: 191,987 mg; 2016: 290,733 mg) and a decrease by 5.3% thereafter (2020: 275,218 mg). Conclusion: In Germany, opposite trends for opioid prescription prevalence and OMEs were observed between 2005 and 2016, while after 2016, both quantification measures showed a decreasing trend. Our study illustrates that trends in prescribing of opioid analgesics can vary depending on the quantification measure; therefore, it is advisable to calculate both measures when monitoring opioid prescribing. Plain Language Summary: This study looked at opioid pain medicines prescribed in Germany between 2005 and 2020. We used data from a large health insurance database covering about one fifth of the German population. To track changes over time, we applied two different ways of measuring prescribing: (1) the amount of people receiving at least one prescription per year (prescription prevalence) and (2) the total amount of opioids prescribed, taking into account the different strengths of opioids; this is expressed in a standard unit called oral morphine equivalents (OMEs). When we looked at prescription prevalence, the proportion of people receiving opioids went down steadily over time. In contrast, when we looked at OME, the total quantity of opioids prescribed increased until 2016, after which it declined slightly. These different results show that trends in opioid prescribing depend on how they are measured. Our findings highlight the importance of using both measures for a complete understanding of prescribing patterns. Keywords: opioids, drug utilization, pharmacoepidemiology, quantification measure