In contrast to 54.7 million DDD of weak opioids only 9.6 million DDD of strong opioids were prescribed. Strong opioids like morphine or methadone are in Germany prescribed on triplicate prescription forms. But neither pain therapy nor palliative care is taught in german medical schools as a compulsory subject. Knowledge and education in pain therapy is up to the personal efforts of every physician in Germany. The most severe obstruction is the german opioid legislation regulating the prescription of strong opioids.
Limits exist for the total amount of opioids, the daily amount, the duration of every priscription.
These limits have been eased over the last years in certain steps. But limitations still exist suggesting that opioid use is dangerous. These results are coincident with earlier investigations indicating a severe undertreatment of cancer pain. But there must be additional barriers to effective cancer pain treatment, where the reasons are hard to explain. Programs in Germany As mentioned above 16 palliative care wards are supported by the government.