Germany Country Drug Report 2017

Treatment

The treatment system

The German National Strategy on Drug and Addiction Policy focuses on treatment and counselling alongside prevention and early intervention. In Germany, the responsibility for the implementation of drug treatment lies with the federal Länder and municipalities. Available treatments range from low-threshold contacts and counselling services to intensive treatment and therapy in specialised inpatient facilities. Long- term treatment options exist in the form of OST, long-term rehabilitative treatment and social reintegration options. Special guidelines are available for the treatment of opioid dependency and psychological and behavioural problems related to the use of cannabis, cocaine, amphetamines, MDMA and hallucinogens. In recent years, guidelines for the treatment of addiction among elderly people, the treatment of methamphetamine-related disorders and recommendations on how to deal with somatic and psychosomatic comorbidity have also been developed. Funding for treatment is provided by many organisations: the Länder, pension and health insurance bodies, municipalities, communities, charities, private institutions and companies. In recent years, however, some municipalities have cut the provision of outpatient services because of funding constraints.

Family doctors play a special role, as they are often the first point of contact for drug users and at-risk individuals. At the core of the dependency support system lie, in addition to family doctors, addiction counselling and treatment centres, psychiatric outpatient institutes, facilities for integration support and outpatient and inpatient therapy facilities. The psychiatric clinics are also important in the drug treatment system. Most treatment facilities are provided free of charge by charitable bodies. State and commercial organisations are involved mainly in the provision of inpatient treatment. Most drug treatment takes place in centres and institutions that deal with dependence in general, although there are also treatment units for illicit drug users specifically.

Outpatient counselling centres provide psychosocial care and psychotherapy and are often an entry point for clients. These centres provide treatment either directly using their own resources or in collaboration with general practitioners who are specifically qualified in addiction medicine.

Psychiatric facilities for dependency represent the second major pillar of drug treatment in Germany. A wide range of services are provided in inpatient, outpatient and day-care settings in these facilities, including low-threshold, qualified detoxification treatment, crisis interventions, complex treatments of comorbidity and planning for reintegration. Detoxification can also be administered in therapeutic communities. In the integration and aftercare phase, a varied range of services relating to employment, housing and reintegration into society are provided. A number of new treatment programmes addressing cannabis users specifically are offered by treatment providers.

OST with methadone was introduced in 1992, buprenorphine was introduced in 2000 and heroin- assisted treatment has been available since 2010. OST is offered mainly by the primary healthcare system, with about 10 % of inpatient facilities providing this treatment.

 

Trends in percentage of clients entering specialised drug treatment, by primary drug in Germany
 

NBYear of data 2015.

Opioid substitution treatment in Germany: proportions of clients in OST by medication and trends of the total number of clients

NBYear of data 2015. DHC: dihydrocodeine.

Treatment provision

In Germany, most treatment and care for drug users is provided in outpatient settings. The proportion of clients who seek treatment for opioid use has decreased over the years, in contrast to the proportion of those seeking treatment for cannabis use, which has increased continuously. Moreover, since 2009, the proportion of stimulant users (mainly users of methamphetamine) seeking treatment in Germany has almost doubled.

The number of clients receiving OST in Germany increased continuously until 2010. Since then, the number has remained largely stable and an estimated 77 200 clients received OST in 2015, of whom the majority received methadone (or levomethadone).

Access to OST is subject to strong regional differences. The availability of OST outside larger cities is considered insufficient by both experts and people eligible for treatment.


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