OBJECTIVES: Elderly patients with impaired renal function or with a risk of kidney failure due to diabetes mellitus (DM) or with hypertension are at risk for accumulation of metabolites from certain opioids as well as for drug-drug interactions (DDI) because of their multimorbidity.  The purpose of this analysis is to analyze the share of patients treated with opioids prone to accumulation of metabolites (e.g. morphine) or DDI via CYP450 (e.g. oxycodone, tramadole)  in Germany. METHODS: This study was performed using retrospective longitudinal aggregated patient data from the IMS Disease Analyzer. All patients 65 years or older with at least one diagnosis of DM (ICD10 E10-E14), hypertension (I10-I15), renal failure (N17-N19), glomerular disease (N00-N08) or renal tubulo-interstitial disease (N10-N16) with at least two prescriptions of extended-release (ER) morphine, hydromorphone, oxycodone or tramadole in 2008 were included. The “P450 Drug Interaction Table” of the Indiana University was used as the source for substances with potential DDI. RESULTS: A total of 6565 patients aged 65 years or more with at least two ER opioids prescriptions in 2008 met the criteria of the high risk group for DDI and metabolite accumulation because of impaired renal function/ risk of kidney failure. A total of 702 (10.7%) patients from this group were treated with morphine, 528 (8.0)% with hydromorphone, 1.603 (24.4%) with oxycodone, 3.732 (56.8%) with tramadole. Fifty-two percent of patients treated with oxycodone and 44% of those treated with tramadole concomitantly received a systemic therapy with a potential risk of DDI. CONCLUSIONS: The majority of patients were treated with an opioid prone to accumulation of metabolites or DDI that can cause additional costs. For this group of patients the choice of  hydromorphone  can possibly avoid these potential complications.