Problematic Medication With Benzodiazepines, “Z-drugs”, and Opioid Analgesics

Abstract

esides their intended effects, medicines often have unwanted side effects, including the development of prescription drug misuse, potentially leading to dependence. In Germany, an estimated 1.4 to 2.6 million people are dependent on prescription drugs (1-3), primarily sleeping drugs and tranquilizers (benzodiazepines [BZD] or Z-drugs [ZD]) or opioid analgesics (OA). According to a study by Buth et al. (4), 5.1% of the German population were taking BZD (including tetrazepam) and a further 1.1% one of the socalled Z-drugs in 2010. These rates were significantly higher among female patients and especially the elderly. Based on a 3-year period (2006 to 2008), 16.7% of patients who were prescribed BZD and/or ZD were found to show a problematic pattern of use (5). The majority were elderly patients taking the drugs in low doses over very long periods of time. This so-called low-dose dependence can have significant adverse effects on the health of these patients; for instance, it often leads to fractures (6, 7), pneumonia (8), or dementia (9). OA are indispensable for the treatment of severe pain and in palliative care. However, there is a risk of patients developing opioid dependence (10). In the United States and Canada, physicians have prescribed OA in large quantities over prolonged periods of time for less severe or temporary pain. Many patients developed OA dependence and later switched to more potent analgesics or to heroin (11). Similarly, the amounts of OA prescribed in Germany increased by 21% between 2007 and 2016 (12). According to a study by Schubert et al. (13), 4.5% of all patients covered by statutory health insurance (Gesetzliche Krankenversicherung, GKV) received an OA (excluding codeine-containing preparations) in 2010. Ten years earlier, the prevalence had been only 3.3% (13). Even though, apart from cancer care, there are few indications for the longterm prescription of OA (14, 15), prolonged treatment with these drugs is common (13, 16). The aim of this paper is to describe trends in the prescription of BZD, ZD, and OA among the GKVinsured population during the years 2006 to 2016-by sex and age-and to investigate how frequently whole-year prescriptions for these medications were issued.

Trends in risky prescriptions of opioid analgesics from 2011 to 2015 in Northern Germany

“…In line with previous research in the field, our findings confirm that despite a slight increase in the overall number of OA prescriptions, an epidemic spread of OAs cannot be observed for the recent years in Germany ( Buth et al, 2019 ; Rosner et al 2019 ; Seitz et al, 2019 ). Also, between different patient groups (NCPs/CPs, OA prescription periods and doses), we found no substantial changes in the proportions of long-term prescriptions between 2011 and 2015.…”

“…Between 2011 and 2015, the annual number of SHI patients with OA prescriptions was between 500,000 and 550,000 ( Table 1 ). This correspondents to a prevalence rate of 4.5% in 2011 and 4.8% in 2015 ( Buth et al, 2019 ). Based on co-medications, about 15% of these patients were identified as CPs.…”

“…The basis for the probable intake duration of the last prescribed medication was the average concentration per day of previous prescriptions. If a patient had received only one single prescription of a medication group within a year, the duration of intake was set as the number of DDDs of the medication (for detailed information see Buth et al, 2019 ).…”

“…Between 2015/2016 and 2017/2018, however, the prevalence of OA intake decreased slightly ( Taylor et al, 2019 ). In Germany in 2014 the prevalence rate of taking prescribed opioids among patients with statutory health insurance (SHI) was 4.8% (without-codeine prescriptions), and the proportion of long-term users, with 28.8% among all patients with OA prescriptions, was much lower ( Buth et al, 2019 ).…”

Effektivität von Screeningverfahren zur Identifizierung von Medikamentenabhängigkeit: Vergleich der Severity of Dependence Scale (SDS) und des Kurzfragebogens zu Medikamentenmissbrauch (KMM)

“…In der zuvor durchgeführten Studie, die ausschließlich die Durchführung der Diagnostik beinhaltete, betrug die Ausschöpfungsrate 83 % [33]. Eine weitere Limitation stellt der Ausschluss von älteren Patienten (70 + ) dar, bei denen die Langzeitverschreibung abhängigkeitserzeugender Medikamente deutlich erhöht ist [34]. Gleichzeitig weisen die Vergleiche der diagnostizierten und nicht diagnostizierten Screening-positiven bzw.…”