[Prescription of opiates. Analysis of outpatient care of pain patients insured with the AOK.].

INTRODUCTION

The efficacy of morphine and other opioids in the treatment of severe pain, especially cancer pain, is undoubted. If opioids are used according to the WHO guidelines no severe side effects or psychological dependence develop. In Germany the use of strong opioids is controlled by law and requires a special prescription with offical forms and difficult regulations.

METHODS

In Bochum, a city in Germany with about 400000 inhabitants, we analysed the treatment of outpatients with strong opioids in the last 3 months of 1989 and the first 3 months of 1990.

RESULTS

Only 55 of the 92842 people insured with the Bochum branch of the AOK, a large health insurance company, received a prescription for strong opioids in these two quarters (0.059% of all members): 42 of these patients had a cancer disease and 13 a disease of nonmalignant origin. In all, these patients received 504 prescriptions for strong opioids (0.078% of the total number of prescriptions). Most of the patients received only one to five prescriptions. Only two patients with cancer pain received more than 20 prescriptions. Of all physicians in Bochum only 10.88% prescribed strong opioids.

CONCLUSIONS

The prescription patterns we found demonstrate inadequate medical care of patients with severe pain. Continuous pain therapy with strong opioids was found in only a few cases. The main reason for this situation is the law pertaining the use of opioid drugs, with its difficult and restrictive regulations. This law cannot stop the development of increasing illegal drug consumption, but obstructs the medical care of patients with severe pain.