To address the question of whether the current estimate of persons with an opioid dependence is an underestimate, it should be noted that this is an estimate accounting for the use of “illegal opioid-containing substances” (1). This does not rule out the existence of a group of individuals who have become addicted to opioids, for instance, by means of pain therapy. Our conclusion that the size of the first group did not increase, and that the situation has not “gotten worse”, must therefore be seen in the context of this target group.
The prevalence of the group of individuals who have become addicted to prescription opioid analgesics is estimated to be around 1% of the general population in Germany (2). The prevalence of opioid analgesic disorder among non-cancer pain patients based on German medical health insurance data was estimated at 0.56% (3). Whether the size of this group has increased in the context of increased opioid analgesic prescriptions is unknown.
Changes in the scale of the first group are conceivable in two circumstances: due to an increase in the number of persons with opioid addiction induced by the consumption of illegal opioid-containing substances, or to an increase in persons with iatrogenic opioid addiction who move to the illegal market. Our estimate compared with previous data and trend analyses of drug-related deaths due to opioids (4) do not indicate such a development.
In the US, the majority of people with iatrogenic opioid addiction have switched to the black market (5). This development has not been observed in Germany until now. Nevertheless, in view of the increase in treatment with opioid-containing analgesics, the indication and duration must be critically examined.
Footnotes
Conflict of interest statement
The authors of each contribution declare that no conflict of interest exists.
References
- 1.Kraus L, Seitz NN, Schulte B, et al. Estimation of the number of people with opioid addiction in Germany. Dtsch Arztebl Int. 2019;116:137–143. doi: 10.3238/arztebl.2019.0137. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Aydin D. Konsumstörungen im Zusammenhang mit opioidhaltigen und nicht opioidhaltigen Schmerzmitteln - Prävalenz in der Bevölkerung und prädiktive Effekte. Bacheloarbeit. Fernuniversität in Hagen. 2018 [Google Scholar]
- 3.Marschall U, L’hoest H, Radbruch L, Häuser W. Long-term opioid therapy for chronic non-cancer pain in Germany. Eur J Pain. 2016;20:767–776. doi: 10.1002/ejp.802. [DOI] [PubMed] [Google Scholar]
- 4.Kraus L, Pfeiffer-Gerschel T, Seitz N-N, Kurz A. Analyse drogeninduzierter Todesfälle. Berlin. 2018 [Google Scholar]
- 5.Pergolizzi JVJ, LeQuang JAT R.Jr., Raffa RB Group NR. Going beyond prescription pain relievers to understand the opioid epidemic: the role of illicit fentanyl, new psychoactive substances, and street heroin. Postgraduate Med. 2018;130:1–8. doi: 10.1080/00325481.2018.1407618. [DOI] [PubMed] [Google Scholar]