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Drug treatment overview for Germany

Map of Germany

1. National context

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 had cut the provision of outpatient services due to funding constrains.

There are approximately 1 300 outpatient psycho-social counselling centres, 300 psychiatric clinics, 300 psychiatric outpatient institutes, around 300 specialist hospital departments, 190 withdrawal clinics with motivational elements, 380 social therapy facilities (in- and outpatient) and 530 rehabilitation facilities (in- and outpatient). Additionally, there are about 460 programmes for outpatient assisted living and about 250 employment projects and qualification measures. In 2013 a total of 2 691 licensed doctors reported provision of OST.

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, and drug dependence problems are treated by outpatient counselling centres, which 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 of reintegration. Detoxification can also be administered in therapeutic communities. In the integration and after-care phase, a varied range of services relating to employment, housing and reintegration into society are provided. 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 2013 there were 77 300 clients in OST, of whom 60 217 were on methadone (or levomethadone) and 16 465 on buprenorphine. Codeine, dihydrocodeine and diamorphine are also occasionally used in substitution treatment (0.1 %, 0.2 % and 0.5 % of all clients in substitution treatment, respectively). Access to OST differs between Länder, with the eastern Länder contributing 3 % of the total number clients and 5 % of the total number of registered physicians providing OST. The availability of OST outside larger cities is considered insufficient by experts and by people eligible for the treatment.

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2. Treatment registries and monitoring systems

 A common reporting standard has been defined for clients in all addiction treatment facilities: the German Core item set (Deutscher Kerndatensatz). On an annual basis, the data are reported to a central agency (Deutsche Suchthilfestatistik). A total of about 61,000 clients with primary drug-related problems entered outpatient treatment centres in 2004.

Since 1 July 2002, every physician who prescribes substitution drugs for opiate addicts is obliged to report the prescription, the substitution drug and client (code) to the substitution register of the Federal Centre for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM). On the basis of a survey on 1 December 2004, a total of 57,700 ongoing substitution treatments were reported by the register.

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3. Treatment demand

Table 1: Number of clients entering treatment in Germany by year
Clients in treatment 2010 2011 2012 2013
Number of all clients entering treatment 71507 75532 76323 80624
Number of all clients entering treatment with known primary drug 71507 70971 76260 80624
% of which for opioid use 46.1  44.3 40 37.1
% of which for cocaine use 6.0  5.9 6 5.9
% of which for cannabis use 33.6  33.0 34 36.3
% of which for stimulants use (other than cocaine) 8.6  11.0 13 14.9
Number of new clients entering treatment 15961 20519 20979 21099
Number of new clients entering treatment with known primary drug 15961  18637 20968 21099
% of which for opioid use 19.1  19.2 16 15.2
% of which for cocaine use 6.8  6.2 6 6.1
% of which for cannabis use 57.9  54.9 55 52.7
% of which for stimulants use (other than cocaine) 12.6  15.2 17 19.2
Notes:
The variation across time, in particular with regard to the absolute numbers of clients in treatment, should be interpreted with caution as coverage data may have changed over time. For further information on coverage details please refer to the relevant EMCDDA Statistical Bulletin.
A revision in the German Core Data Set have taken place in 2008.
For an explanation of terms used, see the definitions of terms.
Sources:

Reitox national reports 2014 and TDI tables.
EMCDDA Statistical Bulletin 2015.

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4. Treatment provision

Table 2: Opioid substitution treatment provision in Germany
Opioid substitution treatment 2010 2011 2012 2013
Number of clients in opioid substitution treatment 77400 76200 75400 77300
of which with methadone 62462 61112 59566 60217
of which with buprenorphine 14396 14630 15080 16465
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
‘N. Av.’ stands for ‘No information available’.
For an explanation of terms used, see the definitions of terms.
Sources:
Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2014.
Table 3: Year of official introduction of opioid substitution treatment substances in Germany
Applied substances in opioid substitution treatment Officially introduced in
Methadone (MMT) 1992
Buprenorphine (HDBT) 2000
Heroin assisted treatment 2003
Slow-release morphine N.App.
Buprenorphine/naloxone combination N.Av.
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
‘N. App.’ stands for ‘Not applicable’.
For an explanation of terms used, see the definitions of terms.
Sources:
Reitox national reports.
Table 4: Legal framework of opioid substitution treatment in Germany
Legal framework of opioid substitution treatment Methadone Buprenorphine
Do office-based medical doctors have the right to initiate the prescription of substitution treatment? Yes Yes
Do specialised medical doctors have the right to initiate the prescription of substitution treatment? Yes Yes
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
For an explanation of terms used, see the definitions of terms.
'Specialised medical doctors' refers to specifically trained or accredited office-based medical doctors.
Sources:
Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2014

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5. References and links

Related EMCDDA resources

 

External links

Please note that the EMCDDA is not responsible for the content of external sites.

Treatment inventories

Treatment research centres

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About the EMCDDA

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies. Read more >>

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Page last updated: Friday, 22 May 2015