Germany Country Drug Report 2019

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 the 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 opioid substitution treatment (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/ecstasy and hallucinogens. In recent years, guidelines for 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, the municipalities, communities, charities, private institutions and companies.

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 addiction counselling and treatment centres, psychiatric outpatient institutes, facilities for integration support and therapy facilities. Psychiatric clinics are also important in the drug treatment system. Most treatment facilities are provided 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 some treatment units specifically for illicit drug users.

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 these facilities, including low-threshold, detoxification treatment, crisis interventions, complex treatments for 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 in 2000 and heroin-assisted treatment in 2010. OST is offered mainly by the primary healthcare system, with about 10 % of inpatient facilities providing this treatment.

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Treatment provision

Based on the latest available data from 2016 and 2017, most treatment and care for drug users in Germany are 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. Since 2009, the proportion of users of stimulants other than cocaine seeking treatment has doubled.

Since 2015, the number of clients receiving OST has increased slightly and an estimated 78 800 clients received OST in 2017, the majority of whom received methadone or levomethadone.

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Methodological note: Analysis of trends is based only on those countries providing sufficient data to describe changes over the period specified. The reader should also be aware that monitoring patterns and trends in a hidden and stigmatised behaviour like drug use is both practically and methodologically challenging. For this reason, multiple sources of data are used for the purposes of analysis in this report. Caution is therefore required in interpretation, in particular when countries are compared on any single measure. Detailed information on methodology and caveats and comments on the limitations in the information set available can be found in the EMCDDA Statistical Bulletin.