[Prescription of strong opioids by general practitioners in Germany.]

Undertreatment of cancer pain is a well-known and worldwide problem. Every country has its specific restrictions. In Germany studies have referred undertreatment to pain states and therapeutic aspects in transverse inquiries, and others to 6-month records of regional prescription data. This study adds some long-term (3 years) information about doctors' (330 general practitioners throughout Germany) prescribing habits concerning strong opioids.

This analysis is based on data from 330 computerized practices whose prescription data are all turned over to the MIDOC (Medizinische Informations- und Dokumentations-Gesellschaft mbH, Weinheim). The data were evaluated for the period May 1990 to April 1993.

Frequency of strong opioid prescription: The special prescription form for strong opioids ("Betäubungsmittelrezept" according to the narcotic drug law) was used in 0.026% of all prescriptions (Table 1). Of all cancer patients, 2.49% received at least one prescription for a strong opioid. Though the underlying pain states of the patients are not given among these data, there is no reason to suppose that German cancer patients will deviate to epidemiologically known pain severity and frequency (around 50% with severe opioid-sensitive pain, at least in the terminal phase). Prescription frequency in general practice: During the 3-year observation period, 37% of the practitioners used no opioid prescription forms at all, 38.6% used them for a single patient only, and in half of these, just once. The number of cancer patients per practice of opioid non-prescribers (81) did not differ from the average (85), but there was a wide range (0-592) in the number of cancer patients treated per practice during the 3 years. Dosage and administration interval: The most frequently prescribed strong opioid was the oral slow-release morphine tablet (45%), and the most frequent dose the 30-mg tablet; in more than 10% of cases the preparations prescribed were to be taken as required.

We urgently need more information on the underlying reasons for the undertreatment of cancer pain. The data presented so far make it possible to draw up guidelines and a graduated education programme for patients and health care professionals.