¹AOK Research Institute, Berlin, Germany
²Carl von Ossietzky University Oldenburg, Oldenburg, Germany
³Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany

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Background: Assessing regional variations in opioid prescribing is essential for understanding prescribing practices. Recent data on the extent of regional differences in opioid prescribing are lacking, particularly for non-cancer pain, where opioid use remains controversial. This study aimed to describe regional variations in the prescribing frequency of opioids for non-cancer pain in Germany.

Materials and Methods: This cross-sectional study utilized claims data from Germany’s largest statutory health insurance (~27 million persons). We included persons without a cancer diagnosis. Users were identified as persons with at least one opioid outpatient prescription (ATC code N02A). For each district, we calculated the age- and sex-standardized prescription prevalence and incidence for the year 2023, both for all opioids and for high potency opioids.

Results: The study sample included at least 9,500 persons in each of the 400 districts. Across all districts, the prescription prevalence of opioids ranged from 35.32 to 69.38/1,000, with the 5^th and 95^th percentiles at 40.53 and 63.31/1,000, respectively (median: 51.68/1,000). For high-potency opioids, the prevalence ranged from 6.85 to 28.60/1,000, with the 5^th and 95^th percentiles at 9.64 and 21.88/1,000, respectively (median: 15.05/1,000). The opioid prescription incidence showed similar differences across the districts. For example, for high-potency opioids, it ranged from 3.10 to 12.53/1,000 (median: 6.19/1,000).

Conclusion: The prescribing frequency of opioids for non-cancer pain varied substantially across German districts, particularly for high-potency opioids. As the extent of these variations is unlikely to be driven by differences in morbidity, our results suggest potential for improving rational prescribing of opioids in certain regions.