• G Lindena and S Müller.
• MUNDIPHARMA GmbH, Mundipharma Strasse 2, D-65 549 Limburg (Lahn).
• Schmerz. 1996 Dec 16;10(6):319-25.

AbstractAccording to WHO guidelines, morphine is the first choice for the treatment of chronic cancer pain, preferably as a controlled-release preparation administered orally. The WHO classifies the quality of pain management of a particular country by its morphine consumption for medical reasons. For this article, data from clinical and market research were collected. In Germany, the amount of morphine prescribed is low, both in the total quantity of morphine prescribed and related to the individual patient treated. Also the number of patients receiving opioid prescriptions is low. In a longitudinal evaluation of general practitioners' prescription practices, only 0.1 % out of 1,218,436 patients were given a controlled opioid prescription. Only 0.04 % of more than 16 million prescriptions were opioid prescriptions. Only 1.2 % of 47,252 cancer patients received a strong opioid. The reasons for this low use of opioids are to be found in the special regulations for controlled drugs, specified by German narcotic drug legislation. The report also focuses on physicians' subjective viewpoints and prejudices. When strong opioids are only rarely prescribed, a general practitioner then has difficulties in assessing pain and possible side effects and treatment evaluation. Clinical research, too, is hampered by special regulations concerning controlled opioid administration.

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