Prescribing Behavior Is a Cause
US researchers invented the “dolorimeter” at the end of the 1980s. This instrument is used to rapidly gauge the subjective severity of pain (scale 0–10) by means of a questionnaire. Since 1990, opiate prescriptions in the USA have increased 10-fold and opiate-related deaths have more than quadrupled. Excess opiate use may be due to prescribing habits—for example, as a result of the rediscovery of oxycodone, a German preparation dating back to 1916. Barnett et al. (1) analyzed data from older patients who received treatment in emergency departments in the USA between 2008 and 2011 (conditions of illness/pain did not differ). The treating physicians were categorized into two groups. The first group included those who prescribed a high numbers of opiates (“high-volume opiate prescribers – 24%“). The second group included those who tended to prescribe fewer opiates (“low-volume opiate prescribers 7%). Long-term opioid use was significantly higher among patients treated by high-intensity prescribers than among patients treated by low-intensity prescribers. Furthermore, rates of long-term opioid use were increased among patients who had not previously received opioids and received treatment from high-intensity opioid prescribers. The data give rise to the suspicion that we prescribing physicians may be responsible for this catastrophic problem.
Meißner et al. (2) reported on the quality of postoperative pain therapy in German hospitals and concluded that, especially at university medical centers, pain therapy is inadequate. Dolorimeter values between 4.5 and 6 after different surgical procedures were reported in this setting. Younger age, female sex, and chronic pain were associated with a greater intensity of pain. Presumably, this problem can be solved only by even more opiate prescriptions.
It would be interesting to know if the opiate prescribing patterns in the different analyzed hospitals were different and whether or not the authors can provide information on the long-term effects of the pain therapies. The QUIPS register may contain more information relating to these questions. Ultimately, the enormous pressure from the pharmaceutical industry to prescribe opiates is also responsible for the opiate-abuse problem.
Prof. Dr. med. Friedrich C. Luft, MD
Experimental and Clinical Research Center, Berlin
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Barnett ML, Lenski AR, Jena AB: Opioid-prescribing patterns of emergency physicians and risk of long-term use. N Engl J Med 2017; 376: 663–73 CrossRef MEDLINE PubMed Central|
|2.||Meißner W, Komann M, Erlenwein J, Stamer U, Scherag A: The quality of postoperative pain therapy in German hospitals—the effect of structural and procedural variables. Dtsch Arztebl Int 2017; 114: 161–7 VOLLTEXT|