Verordnungshäufigkeit, Missbrauch und Abhängigkeit von Benzodiazepinen, Z-Substanzen und Opioidanalgetika

Zusammenfassung

Die Verordnung von Benzodiazepinen (BZD) ist in den meisten westlichen Industriestaaten seit mehreren Jahren rückläufig. Entgegengesetzt war die Entwicklung bei den Z-Substanzen (Z-Drugs), wobei sich jedoch dieser Verordnungsanstieg abflachte und – zumindest in Deutschland – in den letzten Jahren die Verordnungen ebenfalls zurückgehen. Die Prävalenzraten zeigen dabei erhebliche regionale Unterschiede. Diese Daten umfassen jedoch nur die Verordnung zu Lasten der gesetzlichen Krankenversicherung bzw. der staatlichen Gesundheitssysteme in den skandinavischen Staaten und Großbritannien. Zumindest in Deutschland gibt es daneben eine beträchtliche Dunkelziffer, weil etwa 30–50% der Verordnungen von BZD und Z-Drugs als Privatrezept erfolgen.

Belastbare bevölkerungsbezogene Daten über die Verbreitung von Missbrauch oder Abhängigkeit von diesen Substanzen gibt es nicht, weil in epidemiologischen Studien keine hinreichend genauen Diagnosen gestellt, sondern lediglich Hinweise auf eine mögliche substanzassoziierte Störung gewonnen werden können. Eine weitere Möglichkeit zur Abschätzung der Verbreitung von Missbrauch oder Abhängigkeit von BZD und Z-Drugs besteht darin, Prävalenzdaten aus der Untersuchung klinischer Stichproben auf die Bevölkerung hochzurechnen.

Dieselben methodischen Einschränkungen gelten auch für Opioidanalgetika. Die Verordnungshäufigkeit hat seit Beginn der 1990er Jahre weltweit z. T. dramatisch zugenommen, wobei die regionalen Unterschiede der Prävalenzraten noch deutlich größer sind als bei BZD und Z-Drugs. Hinsichtlich des Gesamtverbrauchs pro Einwohner belegt Deutschland zusammen mit den USA und Kanada einen Spitzenplatz. Missbrauch und Abhängigkeit (bei Patienten mit chronischen nichttumorbedingten Schmerzen) sind seltener als bei BZD und Z-Drugs. Für alle drei Substanzgruppen gilt, dass Missbrauch und Abhängigkeit im höheren Lebensalter deutlich seltener auftreten.

Abstract

The use of benzodiazepines (bzd) has been in decline in most western countries in the past 20 years while the use of z-drugs has increased. However, this increase has weakened and even started to decline in Germany, although prevalance rates show great differences between countries. But this data only covers prescriptions within statutory health insurance and public health services. There is a great amount of unreported cases in Germany with about 30–50% of total prescriptions being so-called private prescriptions that have been completely paid by the patients themselves.

There is no substantiated data concerning population-based prevalence rates of abuse and dependence on bzd and z-drugs, as epidemiological studies merely generate presumptions through screening tools and don’t use a valid diagnosis. Projection of data from clinical studies on population-based prescription rates are used to estimate the extent of abuse and dependence on bzd and z-drugs.

The same limitations are true for prescription opioids. Prescription rates of these drugs have been dramatically increasing throughout the world since the early 1990’s, while regional differences differ even further between bzd and z-drugs. The total use per inhabitant is highest in USA, Canada, and Germany. Prevalance of abuse and dependence on prescription opioids (in no-cancer pain) is significantly lower than with bzd and z-drugs. With all these three groups of drugs, abuse and dependence is lower in old age.

Schlüsselwörter

Pharmakoepidemiologie - Benzodiazepine - Z-Substanzen - Opioidanalgetika - Opioid-Krise

Key words

pharmacoepidemiology - benzodiazepines - z-drugs - prescription opioids - opioid epidemic

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