[Treatment of cancer pain with opioid analgesics in outpatients 1993 and 1996. Results of a population based evaluation].
Pertinent guidelines recommend opioid-type analgesics for management of severe pain. However, in the past, opioids were prescribed for only a minority of these patients. In this representative study we examined the prevalence of cancer patients with and without opioid prescription in their final year of life in 1993 and 1996 in Bremen, Northern Germany.


METHODS
Complete four-months-samples of patients with cancer in Bremen were abstracted from the death certificates of 1993 and 1996. For the final years of these patients information on opioid-type prescriptions were recorded using the duplicates kept in the pharmacies. To assure data privacy the matching was performed in a cryptographic computer program installed on laptop computers.


RESULTS
A total 489 (453) prescriptions could be matched to 435 (421) deceased patients with cancer in 1993 (1996) in 92% of all pharmacies in Bremen. In 1996, 20% of the patients with cancer received at least one prescription, including 14.5% who received opioids for eight weeks or longer. Average morphine-equivalent for each treated patient was 3712 mg (median=462 mg). There was no trend in prescription prevalence and the proportion of prescribing medical practices. The proportion of patients who received opioids for longer periods increased 4%. However, among the treated patients the average morphine-equivalent increased 23%.


CONCLUSIONS
The prescription prevalence of opioids remains low among cancer patients in their final year of life. However, our study provides some evidence for positive developments with respect to prescription times and dosage between 1993 and 1996. These changes are likely due to a limited subgroup of practioners.
Munzinger
H
H
Bremer Institut für Präventionsforschung, Sozialmedizin und Epidemiologie (BIPSE), Bremen.
Horstkotte
E
E
Hoffmann
W
W
D000553:Ambulatory Care / Q000639:trends; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000639:trends; D005858:Germany; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000453:epidemiology / Q000503:physiopathology*; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology; D010166:Palliative Care / Q000639:trends; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
D000701:Analgesics, Opioid