Topics
1. National context
In Germany, the implementation of drug treatment falls under the responsibility of the Federal States and municipalities. Most of the drug treatment takes place in centres and institutions which 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 substitution and by specialised centres for drug dependence problems, which provide psychosocial care and psychotherapy. While the tradition of these centres is to provide psychosocial treatment, today all forms of treatment are offered through the centres themselves or in collaboration with general practitioners specifically qualified in addiction medicine. In Germany, funding of treatment is provided by many actors: the Federal Länder, the German pension and health insurance bodies, municipalities, communities, charities, private institutions and companies.
In 2009, there are little less than 1 300 outpatient treatment centres offering contact, motivation and outpatient care as well as psychosocial care for patients in substitution treatment. Furthermore, there are 420 specialised inpatient rehabilitation treatment centres providing long-term withdrawal and abstinence as a pre-condition for restoring the working capacity of the client. With regards to substitution treatment provided by licensed doctors in 2009, there were a total of 2 700 doctors reporting provision of the treatment through the special register.
Methadone was introduced as a substitution substance 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 substitution treatment has been recorded by the substitution register with the purpose of avoiding double prescriptions of substitution drugs and to monitor the implementation of specific quality standards in therapy. In 2009, the total number of clients in substitution treatment amounted to 74 600 clients, 60 202 of whom were on methadone and 13 876 on buprenorphine. Codeine and diamorphine are also used in substitution treatment, however at very limited share (0.1 % and 0.3 % of all clients in substitution treatment, respectively). Access to the opioid substitution treatment however differs among the Länder, with the eastern Länder contributing to less than 3 % of total number clients and 5 % of total number registered physicians providing opioid substitution therapy.
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.
3. Treatment demand
| Clients in treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of all clients entering treatment | 48475 | 62835 | 67495 |
| % of which for opioid use | 50.3 | 49.4 | 47.2 |
| % of which for cocaine use | 7.9 | 7.4 | 6.5 |
| % of which for cannabis use | 29.9 | 31.1 | 33.5 |
| % of which for stimulants use (other than cocaine) | 7.0 | 7.1 | 7.0 |
| Number of new clients entering treatment | 19493 | 13780 | 15570 |
| % of which for opioid use | 28.5 | 20.6 | 19.6 |
| % of which for cocaine use | 8.1 | 8.4 | 7.4 |
| % of which for cannabis use | 49.8 | 57.4 | 58.6 |
| % of which for stimulants use (other than cocaine) | 10.4 | 10.6 | 10.3 |
| 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 2009 and TDI tables (ST34) V. 1.0-2007, questions 13.1.1 and 13.1.2. EMCDDA Statistical Bulletin 2005, 2007 (Tables TDI 4 and 5) and 2011 (Tables TDI 2 and 5). | |||
4. Treatment provision
| Type of treatment | Availability |
|---|---|
| Psychosocial out-patient interventions | Full |
| Psychosocial in-patient interventions | Extensive |
| Detoxification | Full |
| Substitution/maintenance treatment | Extensive |
| Notes: For an explanation of terms used, see the definitions of terms. Based on question 3.1 " Please assess the current availability of the treatment interventions below in relation to the user needs, judging the degree to which treatment capacity matches the demand" of Structured Questionnaire SQ27P1 on 'Treatment programmes'. Rating Scale (level of availability):
Reitox national reports 2008, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |
| Opioid substitution treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of clients in opioid substitution treatment | 68800 | 72200 | 74600 |
| of which with methadone | 55315 | 57976 | 60202 |
| of which with buprenorphine | 12797 | 13645 | 13876 |
| Notes: For a detailed European overview please see Table HSR-3 in the EMCDDA Statistical Bulletin 2011. ‘N. Av.’ stands for ‘No information available’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |||
| 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 Table HSR-1 in the EMCDDA Statistical Bulletin 2011. ‘N. App.’ stands for ‘Not applicable’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |
| 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 Table HSR-2 in the EMCDDA Statistical Bulletin 2011. 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: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | ||
Treatment availablity in Europe
The graphic below presents an overview of treatment provision by different types of service (psychosocial outpatient, substitution, psychosocial inpatient and detoxification) in different European countries and can be used for comparative purposes. Click on the thumbnail to view it.
Figure 1: Treatment availability in Europe, 2007
5. References and links
Related EMCDDA resources
- Health and social responses statistics
- Treatment demand statistics
- Annual report on the state of the drugs problem
- National reports for Germany
- Country overview for Germany
- Drug treatment responses page
- Best practice portal
- Treatment demand key indicator page
For a comprehensive overview on drug treatment systems, availability and utilisation in Europe, please consult the 2008 online report on ‘Quality of treatment services in Europe — drug treatment — situation and exchange of good practice’ published by the Directorate General for Health and Consumers.
External links
Please note that the EMCDDA is not responsible for the content of external sites.
Treatment inventories
- Bundesverband für stationäre Suchtkrankenhilfe(DE)
- Deutsche Hauptstelle für Suchtfragen (DE, EN, ES)
- Deutsche Gesellschaft für Suchtmedizin (DE)
- Gesamtverband für Suchtkrankenhilfe (DE)
Treatment research centres
- Institut für Suchtprävention und Angewandte Pädagogische Psychologie, Email: isapp@nord-com.net
- Insitut für Therapieforschung IFT München (DE, EN)
- University of Hamburg (DE, EN)
- University of Dresden (DE, EN)
- University of Würzburg (DE)
- Deutsche Gesellschaft für Suchtmedizin (DE, EN)
- BZgA Informationen für junge Leute und Partygänger (DE) - FCHE information for young people and party goers
- Landesprojekt in Sachsen für junge Leute Laender (DE, CZ, FR, ES, EN, RU, IT) - Project for young people in Saxony
- Candis Projekt (DE, EN)
- INCANT - International cannabis need for treatment (DE)
