Medicines: Sharply increasing opioid intake

Use of opioids increased significantly in 2015
More and more Germans are taking strong-acting painkillers in the form of so-called opioids, according to the latest announcement from the Federal Association of German Pharmacists' Associations (ABDA). The supply of corresponding medicines rose last year by 4.5 percent to a total of 18.4 million packages, the ABDA reports, citing the figures from the German Medicinal Products Institute. V. (DAPI). An extremely worrying development, since taking opioids can have drastic side effects.

With the massive increase in the prescription of strong painkillers, according to the ABDA, the need for advice in pharmacies has also increased significantly. The total number of packs dispensed corresponds to around 900 million tablets, capsules, plasters or other pharmaceutical units. "On average, more than 12 of these units per year accounted for each of the 72 million legally insured," emphasizes Dr. Andreas Kiefer, President of the Federal Pharmacy Chamber and Chairman of the Board of DAPI. The regulations for private insured persons and the need for office hours were not recorded in the statistics and are added.

Combination therapy always advised
In the current press release, the Federal Association of German Pharmacists' Associations also points out that the opioids "should always be used in combination with other medications". There are two main reasons for this. On the one hand, pain therapy is basically carried out in three stages according to the recommendation of the World Health Organization (WHO), with opioids being assigned to stages 2 and 3. According to this step-by-step scheme, they should be combined with level 1 pain relievers. According to Dr. Jaws contain level 1 pain relievers, among other things "the active substances ibuprofen or paracetamol, which are available in some dosages or pack sizes without a prescription." The pharmacists have a special responsibility here in the consultation. In addition to the painkillers, the doctor can also prescribe an accompanying medication, the active ingredients of which were originally developed for other diseases such as depression or epilepsy, the ABDA reports.

Accompanying medication for side effects
The second reason for the combination therapy when using the opioids is the avoidance or elimination of side effects that occur. For example, the strong pain relievers often cause constipation, which makes continuous taking of a laxative inevitable, explains Dr. Jaw. In such cases, the over-the-counter laxatives can be prescribed by the statutory health insurance. The high-fiber diet alone is not enough to remove constipation caused by opioids, and taking laxatives is essential for most patients. However, over-the-counter laxatives are also often not suitable for long-term use. According to Kiefer, advice in the pharmacy on the selection of the right laxative is advisable.

Do not cut preparations without prior advice
Patients should also inform themselves about the correct use of the preparations. Because there are different dosage forms for strong pain relievers, whereby many preparations release their active ingredient only after a delay. This intentional delay (retardation) can be destroyed if the tablet is broken, warns Dr. "Whether you can share a tablet depends on the respective preparation and can vary depending on the manufacturer for the same active ingredient," explains the expert. The pharmacist's expertise should therefore be obtained before a tablet is divided, continues Kiefer.

Be careful when using pain patches
If the strong pain reliever is applied to the skin with a plaster, the effect only begins slowly and then lasts for a few days. But for pain patches to work properly and not more than intended, Dr. Some jaws are noted. "The patch may e.g. can only be glued to undamaged skin and must not be cut, ”emphasizes the expert. If you need pain plasters, you should also get thorough advice in the pharmacy.

Increased documentation effort at pharmacies
The ABDA further explains that many powerful analgesics are legally narcotics that are prescribed on a three-part yellow prescription that is only valid for seven days. In the pharmacies, the narcotics must be kept in the safe and the handling of them must be documented meticulously. This documentation effort for narcotics is very large, which is why the Federal Association of German Pharmacists' Associations also advocated an increase in the documentation fee, which has remained unchanged at 26 cents per pack for a good 40 years.

Critical increase in opioid prescriptions
However, the increasing supply of opioids remains to be discussed not only from an economic point of view. The regulation should also take greater account of alternative treatment methods. Painkillers often only help temporarily and, according to the latest study results, they can also trigger chronic pain in the long term. There are also massive other side effects and the risk of fatal overdoses. An increase in prescriptions by 4.5 percent within one year is therefore extremely critical from this point of view. (fp)

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Video: The Generation Lost to The Opioid Crisis. VICE on HBO (January 2022).