<p>Regional Differences in Opioid Prescribing in Germany – Results of an Analysis of Health Insurance Data of 57 Million Adult People</p>

Abstract

Background: Regional variations of opioid use have been reported from many countries. The objective of this study was to examine opioid prescribing patterns in Germany including low-and high-potency opioids (LPO and HPO) focusing on regional differences. Methods: Data source was the "Information system for health care data" comprising statutory health insurance funds data for about 70 million Germans of all ages. For 2010, we received aggregated data (by age, sex, federal state and district) of Germans (18+) who had been prescribed at least one opioid including the number of prescribed packages. For each stratum, we further received the number of insured persons. We calculated LPO and HPO prevalences and the mean number of prescribed packages. Results: Among 57 million adult Germans (mean age: 50.2 years, 53.8% female), opioid prevalences were 38.7 per 1000 persons for LPOs and 12.8 for HPOs. Prevalences rose with increasing age and were higher in women than in men. On average, LPO users were prescribed fewer packages than HPO users (3.5 vs 7.0). LPO use was highest in the eastern states ranging from 32.9 per 1000 persons (Hamburg) to 47.2 (Saxony-Anhalt). HPOs were most often prescribed in the North and in the East with prevalences varying between 10.6 per 1000 persons (Baden-Württemberg) and 16.9 (Mecklenburg-Western Pomerania). On the district level, prevalences varied by the factors 2.6 and 3.2 for LPOs and HPOs, respectively. Conclusion: We found large regional variations in opioid prescribing which probably cannot only be attributed to differences in patient characteristics.

Antidepressant drug use and regional prescribing patterns in Germany: results from a large population-based study

“…The major limitation was the limited timeliness and the restriction on only 1 year of data, however, this was for the most part due to the process of data access, since it currently still takes several years from data collection to data provision, after which those wishing to access the data still need to go through a very lengthy application process. Therefore, only a few studies were published based on these comprehensive data so far (Ihle et al , 2018; Hoffmann et al , 2020; Jobski et al , 2020; Thoren et al , 2020). Further, the data were restricted to its initial purpose and for reasons of data protection and did not include information on related diagnoses, the duration and dose of drug intake and potential combination therapies.…”

“…Regional variations in opioid prescribing have been reported with an overall east-west divide, although in this study, the prescribing prevalence was higher in eastern German states. The authors discussed that in this context a higher burden of pain, which has also been associated with a lower socioeconomic status, has been reported from the eastern compared to the western German states (Jobski et al, 2020). However, given that, for example, higher healthcare expenditures for specific drugs or higher proportions of vaccinated persons were found in the eastern compared to the western states, a general east-west divide with respect to drug prescriptions or healthcare utilisation could not be determined yet .…”

“…However, little is known about geographical disparities in antidepressant use on a state level within the same health care system. Since the year 2014, gathered claims data of all German statutory health insurance (SHI) companies can be analysed for scientific purposes (Rommel and Schmidt, 2018; Rommel et al , 2018; Hoffmann et al , 2020; Jobski et al , 2020). These data include health insurance data of about 70 million inhabitants, which corresponds to 85% of the German population and provides robust data for regional analyses also in different age groups.…”

The Burden of Unlawful Use of Opioid and Epidemiological Characteristics in Africa: A Scoping Review protocol v1

“…An estimated 62 million people globally used opioids in 2019, and 36.3 million were impacted by their associated problems (UNODC, 2021) [10]. Currently, reports indicate an ongoing upsurge of opioid misuse/abuse, fatal overdose, and other related disorders; in the US has an increasing estimated of 70,029 in 2020 to 80,816 in 2021 [11], in Canada, 7,560 opioidrelated fatalities in 2021 [12], in Italy opioid addiction affects more than ve people per 1000 [13], in Germany a regional study among 57 million adults indicate an opioid prescriptions of 38.7 or 12.8 /1000 persons of low-and high-potency opioids in 2020 [14]. But in low-income impulsivity, improve energy [26], relieve stress [27], peer pressure from friends [28], to engender "morale" and "courage" to engage in sex work and " ght" potentially abusive clients [29].…”