Data From Germany Provide More Reasons For Policy to Shift From Prescription Pills to Harm Reduction

In February of this year, I co-authored a paper in the Journal of Pain Research explaining why there is no correlation between the amount of opioids prescribed and the incidence of non-medical use or prescription pain-reliever use disorder. That same month my colleague Jeffrey Miron and co-authors revealed similar findings in this Cato Institute Policy Analysis.

Now researchers in Germany have provided more evidence to pour cold water on the idea of any relationship between the volume of opioid prescribing and the incidence of opioid use disorder. Publishing in the German Medical Association’s international science journal, they found that “the number of persons addicted to opioids in Germany has hardly changed over the past 20 years,” with an average of 3.1 persons per 1000 inhabitants across Germany. This compares to data from the U.S. National Survey on Drug Use And Health showing no significant change in “pain reliever use disorder” in persons aged 12 and above from 2002-2014.

Germany ranks second only to the U.S. in opioid prescription volume. Canada and Australia rank third and sixth respectively.  An international group of investigators recently compared the opioid prescription volume per capita of Canada, Australia, Germany, and the U.S., from 1980-2015 using data provided by the International Narcotics Control Board and the World Health Organization. In the U.S., opioid volume (measured as morphine milligram equivalents per capita) began to increase in the late 1980s, accelerated in the mid-90s, and then surged in the early part of this century, peaked in 2012 and then began to taper. In Germany the increase in prescribing began slightly later than in the U.S.—in the mid-90s. But, as in the U.S., it surged in the early 2000s, peaked in 2012, and then began to recede. (The prescribing patterns followed similar trend lines in Australia and Canada but had not shown any evidence of peaking by 2015.)

A big takeaway is that, just as there is no correlation between prescription volume and opioid use disorder in the U.S., so too there is no correlation between prescription volume and addiction in Germany. But another point of comparison must not go unnoticed: the U.S. leads the developed world in per capita opioid-related overdose deaths, while Germany’s overdose rate is among the lowest in the developed world.

Germany’s overdose rate has been essentially unchanged for most of this century. Opioids were considered responsible for just under 800 overdose deaths in 2016, compared to more than 42,000 deaths in the U.S. that year. Also unlike the U.S., Germany has embraced harm reduction strategies for the treatment of substance use disorder and non-medical drug use for decades. These strategies include Safe Injection Facilities, needle exchange programs, Medication Assisted Treatment and Heroin Assisted Treatment, and distribution of test strips and naloxone.

U.S. and state policymakers remain obsessed over curtailing the prescription of opioids to patients in pain while the overdose rate continues to climb and patients suffer needlessly. To reduce overdoses, U.S. policy must shift from a war on drugs to a war on drug-related deaths. This means following Germany’s example and making harm reduction the central goal.