Prescription of Opioid Analgesics for Chronic Non-Cancer Pain in Germany despite Contraindications: Administrative Claims Data Analysis

Anja Niemann (), Nils F. Schrader, Christian Speckemeier, Carina Abels, Nikola Blase, Milena Weitzel, Anja Neumann, Cordula Riederer, Joachim Nadstawek, Wolfgang Straßmeir, Jürgen Wasem and Silke Neusser
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Anja Niemann: Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
Nils F. Schrader: Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
Christian Speckemeier: Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
Carina Abels: Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
Nikola Blase: Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
Milena Weitzel: Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
Anja Neumann: Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
Cordula Riederer: DAK-Gesundheit, Nagelsweg 27, 20097 Hamburg, Germany
Joachim Nadstawek: Association of German Doctors and Psychotherapists Practicing in Pain Medicine and Palliative Care (BVSD e.V.), Katharinenstraße 8, 10711 Berlin, Germany
Wolfgang Straßmeir: Association of German Doctors and Psychotherapists Practicing in Pain Medicine and Palliative Care (BVSD e.V.), Katharinenstraße 8, 10711 Berlin, Germany
Jürgen Wasem: Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
Silke Neusser: Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany

IJERPH, 2024, vol. 21, issue 2, 1-14

Abstract: In Germany, long-term opioid treatment (L-TOT) for chronic non-tumor pain (CNTP) is discussed as not being performed according to the German guideline on L-TOT for CNTP. In the present analysis, the occurrence and predictors of inappropriate care/overuse in a cohort of German insureds with L-TOT for CNTP by the presence of a contraindication with concurrent opioid analgesic (OA) therapy were investigated. We also analyzed whether prescribing physicians themselves diagnosed a contraindication. The retrospective cohort study was based on administrative claims data from a German statutory health insurance. Eight contraindication groups were defined based on the German guideline. Logistic regressions were performed in order to identify predictors for OA prescriptions despite contraindications. The possible knowledge of the prescribing physician about the contraindication was approximated by analyzing concordant unique physician identification numbers of OA prescriptions and contraindication diagnoses. A total of 113,476 individuals (75% female) with a mean age of 72 years were included. The most common documented contraindications were primary headaches (8.7%), severe mood disorders (7.7%) and pain in somatoform disorders (4.5%). The logistic regressions identified a younger age, longer history of OA therapy, opioid related psychological problems, and outpatient psychosomatic primary care as positive predictors for all contraindication groups.

Keywords: contraindication; opioid analgesics; long-term prescription; chronic non-cancer pain; guideline; logistic regression; administrative claims data; pain in somatoform disorders; severe mood disorders; primary headaches (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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