Following the establishment of the EMCDDA in 1993, the German Ministry for Health nominated the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA, Cologne), the German Centre for Addiction Issues (Deutsche Hauptstelle für Suchtfragen e.V., DHS, Hamm) and the IFT Institute for Therapy Research (IFT Institut für Therapiefoschung, Munich) to act jointly as the German national focal point (NFP) within the Reitox network of the EMCDDA. Together, the three institutions form the German Monitoring Centre for Drugs and Drug Addiction (DBDD) with the IFT as the institution responsible for the overall management of the NFP. Within the DBDD, the BZgA deals with prevention aspects, the DHS is mainly responsible for the working areas of addiction treatment and harm reduction, and the IFT is responsible for epidemiology, drug policy, legal framework information, information on drug-related harms, contributes to information on addiction treatment and harm reduction, coordinates the national Early Warning System (EWS) addressing new psychoactive substances (NPS) and trends, and administers the overall scientific coordination and management of the NFP. A formal agreement, which was accepted by the Ministry for Health in 1999 and updated in October 2014, forms the basis of the interinstitutional cooperation. The DBDD works closely together with the German representatives within the EMCDDA: Marlene Mortler, the German national drug commissioner, represents Germany within the EMCDDA’s Management Board; Professor Dr Gerhard Bühringer (IFT Munich, University of Dresden, Chair of the Scientific Committee) and Professor Dr Rainer Spanagel (ZI Mannheim) are the German members of EMCDDA’s Scientific Committee.
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Last updated: Monday, May 30, 2016
In Germany, epidemiological data on drug use is mainly available on the basis of regular national representative surveys and prevalence studies. The Epidemiological Survey of Substance Abuse (ESA) — a nationwide representative study on the use and abuse of psychoactive substances among adults in Germany — has been conducted at regular intervals since the 1980s. The latest available data are from 2012; a total of 9 084 people aged 18–64 responded to a questionnaire via mail, telephone or internet (response rate: 53.6 %). Last year prevalence of use of any illicit substance was 4.9 % in 2012; 5.1 % in 2009; 5.0 % in 2006; and 7.4 % in 2003. Last month prevalence was 2.6 % in 2012; 2.6 % in 2009; 2.5 % in 2006; and 3.9 % in 2003. Cannabis remained by far the most used drug — last year prevalence was 4.5 % and last month prevalence was 2.3 %. With regard to the last year prevalence of other substances, cocaine use was reported by 0.8 %, amphetamines by 0.7 % and ecstasy by 0.4 % of respondents. About 0.6 % of all respondents indicated ever having used new psychoactive substances (NPS), while last year prevalence of NPS use was 0.2 % and last month prevalence was 0.1 %. The consumption of illicit substances was higher in younger age groups. Thus 11.1 % of young adults (aged 18–34) reported cannabis use in the last 12 months, and 5.3 % in the last 30 days. However, the last year use of most substances among young adults in 2012 remained at the levels of 2006 and 2009. The survey indicates a decreasing trend in the last 12 month prevalence of cannabis use among 18- to 24-year-olds, following an increase until 2003.
The Drug Affinity Study (DAS), carried out by the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA), investigates the use, motives for use and situational conditions with regard to tobacco, alcohol and illegal intoxicants among adolescents aged 12–25; it has been conducted since 1973. The data from 2011 corroborated findings from other studies that cannabis is by far the most frequently used illicit substance among adolescents and young adults in Germany, and that the use of illicit drugs is more common among young males than females. The study also confirmed a declining trend in recent cannabis use over time among those aged 12–17 until 2011, reflecting a decline found in the ESA results. However, recent data from the Alcohol Survey 2012, a representative survey conducted by the BZgA in addition to the DAS, indicate that the last month prevalence of cannabis use was 2.0 % in 2012 compared to 1.9 % in 2011, while last year prevalence increased to 5.6 % in 2012 from 4.6 % in 2011. A declining trend was not observed among those aged 18–25, although the rates of recent cannabis use remained at or below the record rates observed in 2004.
The European School Survey Project on Alcohol and Other Drugs (ESPAD) carried out in 2011 indicated that 19 % of students aged 15–16 reported using cannabis at least once in their life (20 % in 2007; 27 % in 2003). Last year prevalence of cannabis use was 15 % and last month prevalence was 7 %. Lifetime prevalence of inhalants was reported by 10 %, amphetamines by 4 %, and hallucinogens and ecstasy by 2 %.
In summary, the trends observed in recent studies indicate a decrease in the experimental use of cannabis among younger age groups in Germany; however, the most recent data, deriving mainly from regional monitoring systems in 2012–14, have pointed out a possible stagnation or even reverse of cannabis prevalence rates among adolescents in some parts of the country.
The prevention of addiction is one of the four pillars of a comprehensive addiction and drug policy in Germany. Measures for addiction prevention fall within the competence of the ministries at federal and Land levels, and the Federal Centre for Health and Education, the Länder, municipalities and the self-governmental bodies of the social insurance share responsibility and funds for the implementation of drug prevention activities in Germany in a multifaceted way. The significance of prevention activities is also stressed in the National Strategy on Drug and Addiction Policy.
The online monitoring system Dot.sys collects information on prevention activities across Germany and enables researchers to monitor where the activities are conducted and what substances are being addressed. In 2014, for the first time, more than half of all illicit substance use prevention activities were aimed at the prevention of cannabis use.
The school environment remains the most important setting for universal drug prevention, while family-oriented and community-based interventions (for example in recreational settings) are not as widely available. School-based prevention activities are primarily focused on three substances — alcohol, tobacco and cannabis. In addition to information provision, the school-based prevention programmes promote life skills, and encourage students to think critically about drug use and to develop their own values. In 2012 a recommendation on Health Promotion and Prevention in Schools was issued by the Standing Conference of the Ministers of Education and Cultural Affairs. Klasse2000 is a programme developed in 1991 and it continues to be the most widespread health promotion programme for early school years. This programme is regularly evaluated, and a positive influence has been found on the health behaviour of children up to three years after finishing it. The programme KlasseKinderSpiel (developed in the USA as the Good Behaviour Game), targeting children in primary schools and those with special needs, was initially launched in the Cologne area in 2007, and has since been extended to neighbouring areas. The programme employs behavioural change techniques in a game setting, and in several evaluation studies proved to have a long-lasting protective effect. The peer education method for addiction prevention is applied in school settings and outside school, and is usually targeted at children in the 7th grade and older. In recent years a new universal prevention programme, Prev@WORK, has been developed to promote responsible substance use behaviours among young people in vocational training settings, and has been implemented in seven Länder. This programme also has training modules that aim to increase instructors’ skills in recognising problem behaviour and to promote the implementation of health promotion and substance abuse programmes. Other programmes, such as Unplugged, which targets secondary school pupils aged 11–14, and REBOUND — My Decision, which targets 15- to 25-year-olds, are also implemented in Germany.
Prevention programmes oriented towards families aim to increase their parenting skills, building families’ protective role and strengthening the basic life skills of children. In 2013 the Strengthening Families Programme, which has shown its efficacy and cost effectiveness in preventing problem behaviour in children in the United States, was adapted for use in Germany, and its first results are being evaluated. A number of universal prevention initiatives have focused on children and young people in recreational settings, for example in sports clubs (www.kinderstarkmachen.de). In addition, the creation of so-called ‘prevention chains’, which integrate healthcare into all areas of life, has become one of the priorities at the community level.
Innovative projects for selective prevention are constantly being developed, such as internet-based counselling, interventions in recreational settings, telephone counselling and projects specifically targeted at ethnic minorities, migrants, parents and high-risk families, and children with learning difficulties attending special educational establishments. The federal pilot programme Family Outreach Therapy for Risky Drug Using Adolescents and their Families assists the parents of drug-using children and adolescents, facilitating intra-family communication, and referring young people to services to enable early detection and intervention. Following an evaluation, it has been recommended for wider implementation. A German selective prevention project, FReD goes net, which targets young offenders, has now been implemented in some other European Union Member States.
The need to target at-risk children and young people is largely acknowledged. Therefore, these groups are important targets for indicated prevention programmes in Germany, especially children and adolescents with behavioural disorders and children in families affected by addiction. Trampolin is an indicated prevention strategy developed to assist children from families affected by addiction. A special programme to stop or reduce cannabis use among 14- to 25-year-olds has been running in Frankfurt since 2005, offering case management and counselling for students that use cannabis. These prevention programmes are delivered within a therapeutic or counselling context, while www.quit-the-shit.net is an evaluated online counselling programme for cannabis users. Progress has also been made in designing and providing brief, web-based intervention for high-risk adolescents, either fully automated or with therapeutic interactions via online chat.
The effectiveness of prevention programmes is increasingly gaining importance and has been in the spotlight during several recent debates among scientists, prevention specialists and policymakers. The Green List Prevention compiles a list of prevention programmes that have been evaluated and shown to have a beneficial outcome in Germany and recommends them for dissemination.
Up to 2012 the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) defined problem drug use as injecting drug use or long duration/regular use of opiates, cocaine and/or amphetamines. However, in 2012 a new definition of ‘high-risk drug use’ was adopted. This new definition includes ‘problem drug use’, but is broader (mainly in its inclusion of high-risk use of more substances). Details are available here.
The population of high-risk opioid users are estimated in Germany by means of three multiplier methods using three data sources — police contacts (1), drug-related deaths (both estimates are based on 2014 data) and treatment admissions (the most recent estimate is based on 2013 data). These estimates range from 1.06 to 3.20 high-risk opioid users per 1 000 inhabitants aged 15–64. It corresponds to an absolute number ranging from 56 200 to 169 400 people, and is slightly lower than in 2013. The estimated number of high-risk stimulant users based on treatment data from 2013 ranges from 70 840 to 84 122 people (1.34 to 1.59 per 1 000 inhabitants aged 15–64). This indicates an increase in the high-risk stimulant user population.
The most recent estimate of high-risk drug use is based on treatment data from 2013, including heroin, cocaine and amphetamine use. It estimates a prevalence ranging from 213 500 to 253 500 people (4.04 to 4.80 per 1 000 inhabitants aged 15–64), and does not differ from 2012 reports.
An estimate based on a 2012 general population survey indicated that 0.6 % of 15- to 64-year-olds in Germany used cannabis daily or almost daily.
(1) The police multiplier only refers to heroin users.
Data on people entering treatment come from several national sources integrated in the German Core Data Set on the Documentation of Addiction Treatment for providing data on the EMCDDA treatment demand indicator (TDI) protocol. Germany is currently working on the implementation of the TDI protocol version 3.0. The treatment demand data in Germany for 2014 were based on 837 outpatient centres (72 % of all outpatient centres), 206 inpatient centres (62 % of all inpatient centres), 35 low-threshold agencies (34 % of all such agencies) and 17 treatment units in prison (49 % of all such units), achieving a high level of coverage.
In 2014 a total of 69 004 clients entering specialised treatment were reported via the national treatment statistics, of which 22 089 were new clients entering treatment for the first time. Among all treatment clients the majority (38 %) sought treatment for cannabis use, followed by 35 % for primary opioid use, 16 % for primary stimulant and 6 % for cocaine use. This is the first time cannabis has been the most prevalent drug among all treatment clients. Among new treatment clients, 58 % sought treatment for cannabis use, 19 % for stimulants use, 13 % for primary opioid use and 5 % for cocaine use. Overall, the proportion of clients who seek treatment for opioid use has reduced over the years, in contrast to those who seek treatment due to cannabis use, whose proportion has continuously increased. Moreover, since 2009 the proportion of stimulant users (mainly of methamphetamine) seeking treatment in Germany has almost doubled. Injection is more popular among opioid users, as TDI data indicate that around one-third of them inject it. Many clients reported polydrug use, where two or more substances are used in combination at the same time or consecutively.
In 2014 the mean age of all treatment clients was 31, while new treatment clients were on average aged 27. With regard to gender, the male to female ratio was 4 to 1 for both new and all clients entering drug treatment.
The human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), sexually transmitted infections (STI) and blood-borne infections unit within the Infectious Disease Epidemiology Department of the Robert Koch Institut (RKI) collects nationwide data on infectious diseases, including HIV and hepatitis. All laboratories in Germany have been obliged since 1987 to anonymously report to the RKI any confirmed HIV antibody tests.
According to the Robert Koch Institut, 3 525 newly diagnosed HIV cases were reported in 2014, which is a 7.2 % increase in comparison with 2013. Of all the cases with a known transmission route (80 %), 3.9 % were people who inject drugs (PWID). In 2000 some 12.4 % of those newly diagnosed with HIV were PWID and a clear downward trend can be observed between 2000–09 with some signs of stabilisation in recent years. The HIV incidence study that was carried out from 2008 to 2010 indicated that the proportion of recently contracted HIV infections was higher among PWID compared to other transmission groups. According to the 2014 National report, HIV prevalence among tested primary opioid clients in outpatient treatment was 5 % in 2013. However, in light of the large number of unknown cases this value represents a conservative estimate of the actual prevalence and must be interpreted with caution.
The incidence of reported cases of hepatitis B virus (HBV) has been stable in recent years, and in 2014 was 0.9 per 100 000 inhabitants . The incidence of newly diagnosed cases of hepatitis C virus (HCV) in 2014 was 7.2 per 100 000 inhabitants, which interrupts the downward trend with some stabilisation observed in recent years (6.3 in 2013; 6.1 in 2012; 6.1 in 2011; 6.5 in 2010; 6.6 in 2009; 7.5 in 2008). It is not possible to differentiate between acute and chronic HCV infections with the current reporting system. Reliable information was available on the mode of transmission in 1 555 (27 %) of the newly diagnoses cases reported. Of these, injecting drug use, which is highly likely to be causally linked to the diagnosed HCV cases, was reported for 1 267 cases (82 %).
In 2012 a study on drugs and chronic infectious diseases, including serosurveys among people who inject drugs, was launched in eight cities. The study indicates large geographical variations in the HIV, HCV and HBV rates among PWID during 2012–14. The prevalence of HIV ranged from 0–9 %, HCV antibodies prevalence from 37–73% (with a prevalence of active HCV infection ranging from 23–54 %) and HBV prevalence from 5–33 % (with prevalence of active infection ranging from 0.3–3 %).
In Germany, drug-induced deaths are registered by two country-wide documentation systems: the Police Register of the Federal Office of Criminal Investigation (Bundeskriminalamt/BKA) and the General Mortality Register of the Federal Statistical Office (Statistisches Bundesamt). Drug-induced deaths are recorded in the BKA register by the Criminal Police Offices in the individual Länder, while the BKA is responsible for data quality management and collection. The amount of data reported for each drug-induced death varies between Länder. Data extraction and reporting from the General Mortality Register is in line with EMCDDA definitions and recommendations, whereas collection of data in the Police Register follows national guidelines. Hence only data from the General Mortality Register should be used for European-wide comparisons.
The most recent data according to the national definition (BKA) show that in 2014 a total of 1 032 people died because of the use of illicit drugs, which is an increase from 2013 (1 002) and 2012 (944), but remains below the levels reported before 2010. In 2014 compared to 2013, the increase concerned in particular the young age groups (87 deaths were among those under the age of 25, compared to 59 cases among the same age group in 2013). The mean age of the deceased was 38 years, and the majority of victims were male. Opioids (including medication for opioid substitution treatment) alone or in combination with other substances remain the most common cause of drug-induced deaths, followed by cocaine or crack and amphetamines. According to the General Mortality Register, there were 1 179 drug-induced deaths in 2013, also indicating an increase against 2012 data.
The drug-induced mortality rate among adults (aged 15–64) was 18.6 deaths per million in Germany in 2014 compared to the most recent European average of 19.2 deaths per million.
In Germany, responsibility for the implementation of drug treatment falls to the federal Länder and municipalities. Available treatment ranges from low-threshold contacts and counselling services to intensive treatment and therapy in specialised inpatient facilities, with a large offer of opioid substitution treatment (OST) and the availability of long-term rehabilitative treatment, and social reintegration options. Special guidelines are available for the treatment of opioid addiction and psychological and behavioural problems related to the use of cannabis, cocaine, amphetamines, ecstasy and hallucinogens. In recent years guidelines for the treatment of addiction among elderly people and recommendations on how to deal with somatic and psychosomatic comorbidity have also been developed. Funding for treatment is provided by many actors: 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 due to funding constrains.
Family doctors play a special role as they are often the first point of contact for addicts and at-risk individuals. The core of the addiction support system is provided, in addition to family doctors (for whom no detailed treatment data is available), by the approximately 1 300 addiction counselling and treatment centres, approximately 300 psychiatric outpatient institutes, approximately 800 facilities for integration support and about 500 (all-day) outpatient and 320 inpatient therapy facilities. The psychiatric clinics have a particular importance. The majority of the support facilities are run by free, charitable bodies. State and commercial organisations are also found, in particular, in the area of inpatient treatment.
In parallel and in part in cooperation with professional support services, numerous self-help organisations also exist in the area of addiction. So far they have mostly been aimed at alcohol addicts and older target groups; however, it is the aim of the German Self Help Associations to open themselves up increasingly to addicts of all addictive substances and to convince more young addicts of the idea of self-help.
Most drug treatment takes place in centres and institutions that deal with addiction in general, although there are also treatment units for illicit drug users only. Treatment is offered by the primary healthcare system, mainly in the field of OST. In 2014 a total of 2 650 licensed doctors reported provision of OST. Outpatient counselling centres provide psychosocial care and psychotherapy, and they are often an entry point for clients. While these centres traditionally provide psychosocial treatment, all forms of treatment are now offered through the centres themselves or in collaboration with general practitioners specifically qualified in addiction medicine. Psychiatric facilities for addiction represent the second major pillar of drug addiction treatment in Germany. A wide range of services are provided in inpatient, outpatient and day-care settings of these facilities, including low-threshold, qualified detoxification treatment, crisis interventions, a complex treatment 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. Recently, a remarkable number of new treatment programmes specifically addressing cannabis users have been offered by treatment providers.
Methadone was introduced as a substitute in 1992, and the majority of clients in maintenance treatment are on methadone. Buprenorphine, which was introduced in 2000, is also used in substitution treatment in Germany. A model project on heroin-assisted treatment started in 2003 and was evaluated in 2006. In 2009 and 2010 legal provisions were passed to make the treatment a part of routine practice.
Since 2002 information on OST has been recorded by the substitution register, to avoid double prescriptions of substitution drugs and to monitor the implementation of specific quality standards in therapy. As of 1 July 2014 there were 77 500 clients in OST, of whom 59 210 were on methadone (or levomethadone) and 17 515 on buprenorphine. Codeine, dihydrocodeine and diamorphine are also occasionally used in substitution treatment (0.1 %, 0.2 % and 0.7 % of all clients in substitution treatment respectively). Access to OST is subject to strong regional divergences: the proportion of substitution patients in the total population is much higher in the city states than in the large area states. The availability of OST outside larger cities is considered insufficient both by experts and by people eligible for the treatment. In addition, the proportion is significantly higher in the western than in the eastern Länder, with the latter contributing approximately 3 % of the total number clients and 5 % of the total number of registered physicians providing OST.
Harm reduction is one of the four pillars of the German national drug strategy. The primary aim of harm reduction is to reduce mortality and morbidity. In the last few decades a system of low-threshold measures has been constructed that have an important function, in particular, in the drug scenes of cities.
Needle and syringe programmes have operated unofficially in some cities since 1984 but were only legalised in 1992. According to a recent survey, Germany has the highest number of needle and syringe vending machines in the world — around 160 vending machines across nine of its 16 Länder are reported by the German Aidshilfe. Since the quality of reporting varies very much between Länder, it is possible that some vending machines are missing from the data. One needle and syringe programme is available in prison. Data on the number of syringes distributed are not available for the country as a whole.
There are also drug help centres, which serve as a contact point for drug users and give support in emergency cases by offering psychosocial and medical help; many also offer outreach services. A review of safer use initiatives across the country documented that at least one-quarter of rural and urban districts have a syringe distribution site (a vending machine or other facility). Drug consumption rooms can be opened if the government of the Länder passes a special regulation on the basis of a national law. This was done by six of 16 Länder, and currently there are 23 drug consumption rooms at fixed locations in Germany and a drug consumption vehicle operates in Berlin. Another development regarding the prevention of opioid overdose deaths is the expansion of take-home naloxone programmes in 2014–15, with two programmes operational and two in a planning stage.
There are about 300 low-threshold services and counselling facilities, which are, for the most part, funded by public funds.
In terms of drug trafficking, south-west Asia, mainly Afghanistan, remains the most important source of heroin trafficked to Germany. Cocaine seized in Germany mainly originates in South America and enters Germany via airmail or air couriers, or directly by sea. The Netherlands and, to a much smaller extent, the Czech Republic (especially for methamphetamine) are the main countries of origin for synthetic drugs such as amphetamine and its derivatives. Cannabis is extensively cultivated in Germany. A total of 873 cannabis plantations were seized in 2014, and a considerable increase in large and professional plantations is noted.
Although in Germany the number of seizures and quantities seized experience large annual variations, cannabis remains the most frequently seized substance. In 2014 the quantity of cannabis herb and cannabis plants seized increased when compared with 2013, while the number of cannabis resin seizures slightly decreased. It is notable that the total amount of seized herbal cannabis in 2014 (8 514.64 kg) was almost twice the amount reported in 2012. In total 132 257 cannabis plants were seized in 2 400 police operations (107 766 plants reported in 2013). The quantity of heroin seized was 779.951 kg, which is almost three times more than reported in 2012 and 2013, and comparable with quantities seized prior to 2010 (758 kg in 2009). The synthetic stimulant market is more complex, but for all substances an increase was noted in 2014 in comparison with the preceding year. The methamphetamine market has experienced its largest expansion in recent years; in 2014 there were 3 905 seizures, and 73.171 kg of the substance was seized (75 kg in 2012 and 77 kg in 2013). Although the amount seized in 2014 was below that seized in 2012 and 2013, it still is double and triple the amounts reported in 2010–11 (26.8 kg in 2010; 40 kg in 2011). The quantity of amphetamine seized was 1 411.3 kg, which is slightly higher than in 2013 (1 262 kg), with further analysis of a number of reported amphetamine seizures indicating an overall expansion of the amphetamines market over the last decade. Compared to 2013, the number of ecstasy seizures increased in 2014 (3 122 in 2014; 2 233 in 2013), as did the number of ecstasy tablets seized (486 852 in 2014; 480 839 in 2013). In general, however, there has been a massive drop in ecstasy seizures, when compared with the period 1999–2007; however, an increasing tendency is notable since 2011. A total of 1 567.91 kg of cocaine was seized in 2014 (1 315 kg in 2013).
Twenty illegal laboratories, 13 of them producing amphetamine and/or methamphetamine, four MDMA and three other substances (DMT, GHB, NPS) were dismantled in 2014.
In 2014 a total of 282 177 drug-law offences were reported, which is more than was reported annually for the period 2007‒13. More than half of the offences were related to cannabis, followed by amphetamines. Around 74 % of all drug-law offences were use-related offences committed against the Narcotic Act (unauthorised possession, purchase and distribution of narcotic substances).
The German Federal Narcotics Act defines schedules of narcotic substances, the framework and procedure for legal turnover and prescription of narcotics, criminal and administrative liability; and alternative measures for drug-addicted offenders. Use of drugs is not mentioned as an offence. Unauthorised possession of drugs is a criminal offence, but there are various possibilities within the law to refrain from prosecution if only small quantities of narcotic drugs for personal use are involved. Important criteria for such a decision are the amount and type of drugs, involvement of others, personal history and public interest in prosecution. Most of the Länder have defined values for ‘small amounts’ of cannabis, and a few have established such values for heroin, cocaine, amphetamine and ecstasy; for methamphetamine, a federal ruling limits the ‘non-small’ amount to 5 g of the active substance. When a sentence is given, the principle of ‘treatment instead of punishment’ still allows — under certain circumstances —a postponement or remission of the punishment if the offender undergoes treatment instead.
The illicit supply, cultivation and manufacture of narcotic drugs carry penalties of up to five years’ imprisonment. This increases to 15 years if there are also aggravating circumstances, which include: ‘not insignificant’ quantities of narcotic drugs; an adult supplying narcotics to a person under the age of 18; a person trafficking narcotics ‘professionally’ or as a member of a gang; or carrying a weapon when committing a serious drug-related offence.
Notable changes since 1981 include the legal bases for ‘therapy instead of punishment’ (1981), opioid substitution treatment and distribution of sterile disposable syringes (1992), the prerequisites for the establishment of drug injecting rooms at the discretion of the Länder (2000) and diamorphine-assisted substitution treatment (2009). The Act on diamorphine-assisted substitution therapy entered into force on 21 July 2009, and stipulates that diamorphine (pharmaceutically produced heroin) is eligible for prescription — on very narrow criteria — as a narcotic drug for heavily dependent opioid addicts. In 2010 additional legal provisions were passed to regulate the availability of the therapy through statutory health insurance and to promote appropriate training of medical professionals.
In 2011 cannabis was transferred from Schedule I to Schedule III of the Narcotic Act, which for the first time enabled cannabis-containing proprietary medicinal products to be manufactured and prescribed, after clinical testing and licensing by the Federal Institute for Drugs and Medical Devices (BfArM). In 2012 further regulations to amend Schedules I to III of the Narcotic Act were passed by the Bundesrat in order to include some new psychoactive substances. The maximum amounts of narcotic substances that can be prescribed were altered (e.g. methylphenidate) or stipulated for the first time (e.g. cannabis extract, dexamphetamine and flunitrazepam).
The German Federal Narcotics Act is used to control new psychoactive substances.
In March 2010 the Drug Commissioner of the Federal Government called for the development of a new federal drug strategy. As a result, the National Strategy on Drug and Addiction Policy was adopted on 15 February 2012 by the Federal Cabinet. The Strategy’s primary aim is to help individuals to avoid and reduce their consumption of licit (alcohol, tobacco and psychotropic pharmaceuticals) and illicit addictive substances and related addictive behaviours (such as pathological gambling). The overall goals of the strategy are reflected in its four pillars: (i) prevention; (ii) counselling and treatment, help in overcoming addiction; (iii) harm reduction measures; and (iv) repression.
The comprehensive scope of the strategy, which focuses on addictive substances and behaviours, can be seen in its six areas: (i) alcohol; (ii) tobacco; (iii) prescription drug addiction and prescription drug abuse; (iv) pathological gambling; (v) online/media addiction; and (vi) illegal drugs. Each of the six areas contains a set of goals and measures to deliver the strategy.
The Federal Government, Länder and municipalities share the responsibility for the drug and addiction policy: according to the German Constitution, the Federal Government has legislative competence for narcotic drugs law, penal law and social welfare law. On this basis, it defines the legal framework for drug policy and prescribes standards.
The Office of the Federal Government Commissioner on Narcotic Drugs is attached to the German Federal Ministry of Health. The Commissioner on Narcotic Drugs coordinates the drug and addiction policy of the German Federal Government. The main areas of responsibility of the Federal Government Commissioner on Narcotic Drugs include: promoting and supporting initiatives and activities for addiction and drug prevention; developing new methods and new areas of focus in addiction and drug policy for timely and appropriate help with the aim of preventing or alleviating health, social and mental problems; and representing the German Federal Government’s addiction and drug policy on an international level and in public.
The National Board on Drugs and Addiction (Drogen und Suchtrat, DSR) is an advisory body that follows the federal actions and partly evaluates them. It is composed of representatives of the respective government and Länder departments, funding organs, associations, and research and self-help organisations.
The Federal Centre for Health Education (BZgA) is responsible, at federal government level, for planning and executing prevention campaigns, and monitoring addiction prevention activities and their quality assurance.
The enforcement of federal laws mainly falls within the responsibility of the Länder. The Länder also have, in addition to responsibility for prison legislation and law enforcement, their own legislative competence in areas that are of relevance for drug and addiction policy including school, health and education systems. The actual implementation of the drug and addiction policy – in particular its funding – mainly lies in the hands of the Länder and municipalities, which may well set different focuses within the framework of statutory provisions and common goals.
Coordination between the federal government and the Länder takes place in the conferences of government departments and their working groups.
In Germany the drug action plans do not have associated budgets and there is no review of executed expenditures. Since the funding of drug initiatives is the responsibility of a number of different bodies — the Länder, federal government, local government and social security — information on drug related expenditure is not aggregated regularly. However, in 2010 a study estimated the total drug-related public expenditure for the year 2006 (1,2).
In 2006 total drug-related expenditures ranged between 0.23 % and 0.26 % of gross domestic product (GDP). Expenditure on public order and safety represented more than 60 %, health and social protection less than 35 % and general coordination activities less than 1 % of the total (Table 1).
The available information does not allow trends in drug-related public expenditure in Germany to be reported.
Table 1: Total drug-related public expenditure, 2006 (a).
Expenditure (thousand EUR)
% of total
COFOG classification (b)
Public order and safety
3 366 342–4 219 542
Health and social protection
1 787 272–1 814 472
General public services
5 193 899–6 074 299
% of GDP (a)
(a) EMCDDA estimations based on Mostardt et al. (2010) calculations.
(b) According to the United Nations Classification of the Functions of Government (COFOG) Eurostat data sources: http://epp.eurostat.ec.europa.eu/ (general) and http://unstats.un.org/unsd/cr/registry/regcst.asp?Cl=4.
Source: Mostardt et al. (2010).
(1) Some of the funds allocated by governments for expenditure on tasks related to drugs are identified as such in the budget (‘labelled’). Often, however, the bulk of drug-related expenditure is not identified (‘unlabelled’) and must be estimated by modelling approaches. The total budget is the sum of labelled and unlabelled drug-related expenditures.
(2) S. Mostardt, S. Floeter, A. Neumann, J. Wasem and T. Pfeiffer-Gerschel (2010), ‘Schätzung der Ausgaben der öffentlichen Hand durch den Konsum illegaler Drogen in Deutschland’, Das Gesundheitswesen 73, pp. 886–894.
Research on drugs in Germany covers the entire range of basic and applied research. There are also several academic research centres that apply for funding in tendered projects or receive basic funding. The exchange of information in the research community is to a large extent organised by researchers themselves, networks and professional companies, and takes place primarily through research conferences and scientific journals addressing the drugs field; clinical guidelines and transfer processes, through which initiatives with a positive evaluation are implemented more widely, are also used. Recent drug-related studies mainly focused on aspects related to responses to the drug situation, consequences of drug use, and the prevalence, incidence and patterns of drug use; but also covered predictors of drug use and methodology issues.
|Problem opioid use (rate/1 000)||2013||2.7 - 3.2||0.2||10.7|
|All clients entering treatment (%)||2014||35.0%||4%||90%|
|New clients entering treatment (%)||2014||13.1%||2%||89%|
|Purity — heroin brown (%)||2014||1||15.6%||7%||52%|
|Price per gram — heroin brown (EUR)||2014||EUR 54||EUR 23||EUR 140|
|Prevalence of drug use — schools (%)||2011||3.0%||1%||5%|
|Prevalence of drug use — young adults (%)||2012||1.6%||0%||4%|
|Prevalence of drug use — all adults (%)||2012||0.8%||0%||2%|
|All clients entering treatment (%)||2014||5.9%||0%||38%|
|New clients entering treatment (%)||2014||5.3%||0%||40%|
|Price per gram (EUR)||2014||EUR 77||EUR 47||EUR 107|
|Prevalence of drug use — schools (%)||2011||4.0%||1%||7%|
|Prevalence of drug use — young adults (%)||2012||1.8%||0%||3%|
|Prevalence of drug use — all adults (%)||2012||0.7%||0%||1%|
|All clients entering treatment (%)||2014||16.0%||0%||70%|
|New clients entering treatment (%)||2014||19.4%||0%||75%|
|Price per gram (EUR)||2014||EUR 16||EUR 3||EUR 63|
|Prevalence of drug use — schools (%)||2011||2.0%||1%||4%|
|Prevalence of drug use — young adults (%)||2012||0.9%||0%||6%|
|Prevalence of drug use — all adults (%)||2012||0.4%||0%||2%|
|All clients entering treatment (%)||2014||0.0%||0%||2%|
|New clients entering treatment (%)||2014||0.0%||0%||2%|
|Purity (mg of MDMA base per unit)||2006||48 mg||27 mg||131 mg|
|Price per tablet (EUR)||2014||EUR 9||EUR 4||EUR 16|
|Prevalence of drug use — schools (%)||2011||19.0%||5%||42%|
|Prevalence of drug use — young adults (%)||2012||11.1%||0%||24%|
|Prevalence of drug use — all adults (%)||2012||4.5%||0%||11%|
|All clients entering treatment (%)||2014||38.1%||3%||63%|
|New clients entering treatment (%)||2014||57.8%||7%||77%|
|Potency — herbal (%)||2006||7.8%||3%||15%|
|Potency — resin (%)||2006||6.7%||3%||29%|
|Price per gram — herbal (EUR)||2014||EUR 11||EUR 3||EUR 23|
|Price per gram — resin (EUR)||2014||EUR 10||EUR 3||EUR 22|
|Prevalence of problem drug use|
|Problem drug use (rate/1 000)||2013||4.04 - 4.8||2.7||10.0|
|Injecting drug use (rate/1 000)||:||:||0.2||9.2|
|Drug-related infectious diseases/deaths|
|HIV infections newly diagnosed (cases / million)||2014||1.4||0.0||50.9|
|HIV prevalence (%)||:||:||0%||31%|
|HCV prevalence (%)||:||:||15%||84%|
|Drug-related deaths (rate/million)||2014||18.6||2.4||113.2|
|Health and social responses|
|Syringes distributed||2013||2 085 999||382||7 199 660|
|Clients in substitution treatment||2014||77 500||178||161 388|
|All clients||2014||84 028||271||100 456|
|New clients||2014||24 820||28||35 007|
|All clients with known primary drug||2014||84 028||271||97 068|
|New clients with known primary drug||2014||24 820||28||34 088|
|Drug law offences|
|Number of reports of offences||2014||282 177||537||282 177|
|Offences for use/possession||2014||209 514||13||398 422|
b Break in time series.
p Eurostat provisional value.
: Not available.
1 Gross domestic product (GDP) is a measure of economic activity. It is defined as the value of all goods and services produced less the value of any goods or services used in their creation. The volume index of GDP per capita in Purchasing Power Standards (PPS) is expressed in relation to the European Union (EU-27) average set to equal 100. If the index of a country is higher than 100, this country's level of GDP per head is higher than the EU average and vice versa.
2 Expenditure on social protection contains: benefits, which consist of transfers in cash or in kind to households and individuals to relieve them of the burden of a defined set of risks or needs.
3 Unemployment rates represent unemployed persons as a percentage of the labour force. Unemployed persons comprise persons aged 15 to 74 who were: (a) without work during the reference week; (b) currently available for work; (c) actively seeking work.
4 Situation of penal institutions on 1 September, 2014.
5 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold, which is set at 60 % of the national median equivalised disposable income (after social transfers).
|Year||Germany||EU (27 countries)||Source|
|Population||2014||80 767 463||506 944 075 bep||Eurostat|
|Population by age classes||15–24||2014||10.8 % b||11.3 % bep||Eurostat|
|25–49||33.6 % b||34.7 % bep|
|50–64||21.7 % b||19.9 % bep|
|GDP per capita in PPS (Purchasing Power Standards) 1||2014||124||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2013||29.0 % p||:||Eurostat|
|Unemployment rate 3||2015||4.6 %||9.4 %||Eurostat|
|Unemployment rate of population aged under 25 years||2015||7.2 %||20.3 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2014||81.4||:||Council of Europe, SPACE I-2014.1|
|At risk of poverty rate 5||2014||16.7 %||17.2 %||SILC|
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Head of national focal point: Mr Tim Pfeiffer-Gerschel
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