Screening for physical and behavioral dependence on non-opioid analgesics in a German elderly hospital population

Addict Behav. 2019 Mar;90:265-271. doi: 10.1016/j.addbeh.2018.11.009. Epub 2018 Nov 11.


Objective: To provide further evidence of dependence on non-opioid analgesics (NOAs).

Methods: Post-hoc-analysis of a cross-sectional study of a ≥ -65-year-old non-demented German general hospital population. Four hundred in-patients (75 ± 6.4 years; 63% females) were included and screened for current and past dependence on NOAs using a structured interview (SKID-I) based on DSM-IV-TR. The addiction section of SKID-I was expanded to the following NOAs: gabapentinoids, acetaminophen, metamizole, flupirtine, and non-steroidal anti-inflammatory drugs (NSAIDs).

Results: We found twenty-eight seniors (7%) who fulfilled the criteria for a NOA-dependence. Of whom, twenty-four and four patients were currently dependent and in remission, respectively. According to SKID-I, twenty-one (75%) patients were mildly, five patients (17.9%) moderately, and two (7.1%) patients severely dependent on NOAs. All patients showed at least one sign of physical dependence (tolerance and/or withdrawal symptoms) and most of them reported additional behavioral dependence symptoms. Whereas there was one dependence on gabapentinoids or acetaminophen only, NSAIDs and metamizole were involved in the majority of cases (n = 25; 89.3%). Of note, ten (35.7%) seniors had a de-novo substance dependence exclusively on NOAs - including 2 females with signs of a de-novo dependence on metamizole, a NOA which yet has been not in the focus of addiction medicine.

Conclusion: This cross-sectional study provides further evidence of the existence of a physical and behavioral dependence on NOAs including NSAIDs. Furthermore, preliminary evidence of a de-novo dependence on metamizole is provided which needs further verification.

Keywords: Acetaminophen; Addiction; Flupirtine; Gabapentinoids; Liking; Metamizole; NSAID; Wanting.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analgesics, Non-Narcotic / adverse effects*
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Cross-Sectional Studies
  • Female
  • Geriatric Assessment / methods*
  • Geriatric Assessment / statistics & numerical data
  • Germany / epidemiology
  • Humans
  • Inpatients / statistics & numerical data*
  • Interviews as Topic
  • Male
  • Severity of Illness Index
  • Substance-Related Disorders / diagnosis*
  • Substance-Related Disorders / epidemiology*


  • Analgesics, Non-Narcotic
  • Anti-Inflammatory Agents, Non-Steroidal