Critical discussion of new data regarding prevalence of opioid use disorder in patients with chronic pain in Germany

Background There is no opioid crisis in Germany. However, new studies involving patients with chronic noncancer pain (CNCP) in Germany show an unexpectedly high prevalence of opioid use disorder according to DSM-5 (Diagnostic and Statistical Manual for Psychiatric Diseases). Objectives Critical discussion of new study results on the prevalence of opioid use disorder in CNCP patients in Germany. Materials and methods Selective literature search and multiprofessional classification of results by an expert panel (pain therapy, neurology, psychiatry, palliative medicine, general medicine and addiction therapy). Results The DSM-5 criteria for the diagnosis of opioid use disorder have limited applicability to patients with CNCP, but may raise awareness of problematic behavior. The diagnosis of opioid use disorder is not the same as the diagnosis of substance dependence according to ICD-10, as the DSM-5 diagnosis covers a much broader spectrum (mild, moderate, severe). Risk factors for opioid use disorder include younger age, depressive disorders, somatoform disorders, and high daily opioid doses. The interdisciplinary guideline on long-term opioid use for CNCP (LONTS) includes recommendations intended to reduce the risk for opioid use disorder. Conclusion An adaptation of the DSM-5 diagnostic criteria of opioid use disorder to the specific situation of CNCP patients and a validation of these criteria could help to collect more accurate data on opioid use disorders of patients with chronic pain in Germany in the future. Prescribers should be sensitized to this problem without pathologizing or even stigmatizing patients. Further research is needed to classify this previously underestimated phenomenon.

Automated summary

Although there is no opioid crisis in Germany, new studies have revealed a surprisingly high prevalence of opioid use disorder among patients with chronic noncancer pain. The DSM-5 criteria for diagnosis may not be fully applicable to these patients, but can help raise awareness of potential issues. Risk factors for opioid use disorder include younger age, depressive disorders, and high daily doses of opioids. More research is needed to better understand and address this previously underestimated phenomenon.