Background:
Pain-relief prescriptions have led to an alarming increase in drug-related
abuse.
Objective:
In this study, we estimate the pain reliever prescription rates at a major German academic
hospital center and compare with the nationwide trends from Germany and prescription reports from
the USA.
Methods:
We analysed >500,000 discharge summaries from Charité, encompassing the years 2006
to 2015, and extracted the medications and diagnoses from each discharge summary. Prescription
reports from the USA and Germany were collected and compared with the trends at Charité to identify
the frequently prescribed pain relievers and their world-wide utilization trends. The average
costs of pain therapy were also calculated and compared between the three regions.
Results:
Metamizole (dipyrone), a non-opioid analgesic, was the most commonly prescribed pain
reliever at Charité (59%) and in Germany (23%) while oxycodone (29%), a semi-synthetic opioid,
was most commonly ordered in the USA. Surprisingly, metamizole was prescribed to nearly 20% of
all patients at Charité, a drug that has been banned for safety reasons (agranulocytosis) in most developed
countries including Canada, United Kingdom, and USA. A large number of prospective
cases with high risk for agranulocytosis and other side effects were found. The average cost of pain
therapy greatly varied between the USA (125.3 EUR) and Charité (17.2 EUR).
Conclusion:
The choice of pain relievers varies regionally and is often in disagreement with approved
indications and regulatory guidelines. A pronounced East-West gradient was observed with
metamizole use and the opposite with prescription opioids.
Effects of nalfurafine on the reinforcing, thermal antinociceptive, and respiratory-depressant effects of oxycodone: modeling an abuse-deterrent opioid analgesic in rats
