[Prescribing strong opioids for pain therapy and for substitution therapy by established physicians]

The prescription of strong opioid by general practitioners was studied, particularly for the treatment of chronic pain. In a medium-sized town (around 250 000 inhabitants) 17,839 prescriptions of strong opioids were issued by 455 doctors over 5 years (1 January 1990 until 31 December 1994) to 1,939 patients. Of these patients 37.8-48.3 % of them received only one prescription for 6 months, 60.5-75.8 % received between 1 and 4 prescriptions for 6 months, and only 20.9-35.7 % of all patients received 5 or more prescriptions for 6 months. The amount of strong opioids prescribed for cancer pain relief seems to be almost the same in 1992 as 10 years ago. The consumption of oral morphine has steadily increased compared to 1982 and constitutes almost one-half of all narcotics prescribed for pain treatment by general practitioners. For pain treatment the value of strong opioids is recognized by both patients and physicians in contrast to the prescription of levomethadone as substitution therapy for drug-addicted patients. The 6.7 % of the physicians who participated in methadone substitution therapy prescribed more strong opioids (52.4 % of prescriptions) than all other physicians together prescribe for pain treatment. In order to safeguard the quality of medical care for pain treatment by strong opioid analgesics, unbiased training of physicians and a clear definition of narcotics is required. It is suggested that the expression "narcotic prescription" be changed related to the legislative terminology in the pharmacology-related expression "analgesic prescription". The prescribing regulations should not constrain medical treatment, but create a basic rule for the prescription of strong opioids.