• Drug use among the general population and young people
• Prevention
• Problem drug use
• Treatment demand
• Drug-related infectious diseases
• Drug-related deaths
• Treatment responses
• Harm reduction responses
• Drug markets and drug-related offences
• National drug laws
• National drug strategy
• Coordination mechanism in the field of drugs
• Public expenditure
• Drug-related research

Drug use among the general population and young people

The latest representative survey, the nationwide Epidemiological Survey on Addiction (ESA) was conducted in Germany in 2009. A total of 8 030 respondents aged between 18–64 responded to a questionnaire through mail, telephone or Internet (response rate 50.1 %). It shows that 26.7 % of the 18–64-year olds questioned have used illegal drugs at least once in their life (lifetime prevalence). Compared to the results of the ESA carried out in 2006, lifetime prevalence of all substances has slightly increased. However, for the last-year and last-month prevalence, the most recent figures remained stable (5.1 % in 2009; 5.0 % in 2006; 7.4 % in 2003 and last month 2.6 % in 2009; 2.5 % in 2006; 3.9 % in 2003). Cannabis remains by far the most used drug. Last-year prevalence of cannabis use is 4.8 % and last-month prevalence is 2.4 %. With regards to the use of other substances during the last year, cocaine is reported by 0.8 %, amphetamines by 0.7 % and ecstasy by 0.4 % of respondents. In terms of a younger age range (18–34 years), a decline in the last-year use of most substances, including cannabis, is reported.

The 2008 results of the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung/BZgA) (12–17 years of age), also indicated a strong decline in cannabis use compared to 2004, reflecting that shown by the ESA results.

The latest ESPAD survey (2011) indicate that 19 % of the students, aged between 15–16 years, reported a use of cannabis at least once in their life; while in 2007, it was reported by 20 % and in 2003, it was reported by 27 % of the sample. In 2011, the last-year prevalence of cannabis use was 15 % and the last-month prevalence was 7 %. Regarding other substances, lifetime prevalence of inhalants was reported by 10 %, amphetamines by 4 % and the same lifetime prevalence for hallucinogens and ecstasy  use by 2 % of the sample.

The trends observed in all recent studies might indicate a possible decreasing readiness for experimental use of cannabis among younger age groups.

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Prevention

Federal agencies, Länder and community administrations share responsibility for implementation of drug prevention activities in Germany.

The school environment still remains the most important setting for universal drug prevention in Germany. Prevention activities are primarily focused on three areas; alcohol, tobacco and cannabis. Apart from information, the school-based prevention programmes promote life-skills, form critical thinking and values. In recent years, a new universal prevention programme ‘Prev@WORK’, which is now spread to seven Länder, addresses young people in vocational training setting and promotes responsible substance use behaviours. ‘Family ties’ is an example of intervention aiming to increase parenting skills. 

Innovative projects for selective prevention are constantly being developed, such as Internet-based counselling, interventions in recreational settings, telephone counselling, projects specifically targeted at ethnic minorities, migrants and parents and high-risk families. The federal pilot programme ‘Parents.active — proactive parental work in ambulatory addiction help’ reaches out to parents of drug-using children and adolescents, thus facilitating early detection and intervention by referral to services. A selective prevention project (FReD goes Net) targeting young offenders is now being implemented in 17 other EU Member States.

The need for targeting at-risk children and young people is largely acknowledged. Therefore, these groups are an important target group for indicated prevention programmes in Germany, especially children and adolescents with behavioural disorders and children in families affected by addiction. A special programme for the cessation of cannabis use among 14–25-year olds is implemented since 2005 in Frankfurt (Case management and counselling for cannabis using students). These prevention programmes are delivered within a therapeutic or counselling context.

Several instruments were developed in the past years to monitor drug prevention initiatives. As an example, the quality of 40 drug prevention projects has been measured using a ‘QIP — Quality in Prevention’ instrument. Around 340 facilities have recorded in total more than 34 000 prevention activities in the Dot.sys monitoring system in 2010. The system enables the monitoring of where the activities are conducted and what substances are addressed through these activities.

View ‘Prevention profile’ for additional information.

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Problem drug use

The most recently available estimate of problem drug use including the users of opiates, cocaine and amphetamines is based on treatment data and refers to the year 2009. According to the data, the prevalence is estimated to be between 182 000 and  217 000 (3.4–4.0 per 1 000 inhabitants, aged 15–64).

Problem opiate users were estimated on three sources — based on treatment, drug-related deaths and police contacts. In 2009, an estimate of the number of problematic opiate users for Germany falls between 1.6–3.2 per 1 000 inhabitants, corresponding to a total number of between 89 014 and 171 171 persons and the estimated trend of problem opiate use is rather stable in the country, although with a larger intervals. The EMCDDA defines problem drug use as intravenous drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.

The EMCDDA defines problem drug use as intravenous drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.

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Treatment demand

The treatment demand data in Germany for 2010 were based on 777 outpatient centres, 189 inpatient centres and 34 low-threshold agencies and treatment units in prison.

In 2010, an estimated total of 71 584 clients entered treatment, out of which 15 961 were estimated as new treatment clients. 57.9 % of those who sought treatment for the first-time were cannabis users, 19.1 % opioid users and 12.6 % stimulant users, while the figures for all persons entering treatment shows a different distribution: 46.1 % were opioid users, 33.6 % were cannabis users and 8.6 % were stimulant users.

In 2010, 32 % of estimated clients entering treatment were aged less than 25 years. On the other hand, first-time treatment clients were considerably younger, with 51 % under the age of 25 years. With regards to gender distribution among all clients entering treatment, 79.4 % were estimated to be male and 20.6 % female. Likewise, distribution was also estimated among first-time treatment clients with 81.6 % male and 18.4 % female.

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Drug-related infectious diseases

The HIV/AIDS department of the Robert Koch-Institut (RKI) collects nationwide data on infectious diseases, including HIV and hepatitis. All laboratories in the Federal Republic of Germany have been obliged since 1987 to anonymously report to the RKI any confirmed HIV-antibody tests. Due to changes within the collection of new HIV cases, the exclusion of multiple reporting was made more effective.

According to the Robert Koch-Institut, 3.7 % (2009: 3.5 %; 2008: 5.0 % and 2007: 6.3 %) among those diagnosed with HIV for the first time in 2010 (2 918) were injecting drug users (IDUs). In 2000, this figure was reported at 12.4 %  and the clear downward trend in new HIV cases among injecting drug users is observed in recent years. The ongoing HIV incidence study  indicates that slightly more than a third of all new HIV cases (35 %) are diagnosed among injecting drug users and it is regarded as relatively high rate for Germany.

In 2010, the prevalence of HIV infection among opioid clients in outpatient treatment tested for HIV antibodies is 7 %. According to the Federal Criminal Police Office in 2008, a positive HIV-status was found in 3.1 % of drug-related deaths (45 out of 1 449) compared to 3.4 % in 2007.

The incidence of reported cases for hepatitis B in the year 2010 was reported at 0.9 per 100 000 inhabitants (2009: 0.9 and 2008: 1.0). Incidence of symptomatic hepatitis C cases was reported at 6.5 per 100 000 inhabitants (2009: 6.6 and 2008: 7.5) in 2009. For both HBV and HCV, a downward trend in incidence is to be observed. Discrimination between acute and chronic hepatitis C infections in the case reports is not possible with the current reporting system. In 2010, for 2.8 % of hepatitis B infections and 32.6 % of hepatitis C infections, intravenous drug use was reported as the most likely route of infection. According to the 2011 National report, in 2010, HBV and HCV prevalence among tested opioid clients in outpatient treatment was 10.1 % and 54.2 % respectively.

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Drug-related deaths

In Germany, drug-related deaths are registered by two countrywide 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). In order to simplify the registration of drug-related deaths and to reduce mistakes, the BKA has specified the categories for drug-related deaths in a leaflet (BKA, 1999). Data from the General Mortality Register are available as drug-related deaths standards, a standard protocol for extracting data on drug-related deaths from registers in the Member States of the European Union (which includes acute deaths directly related to drug consumption or overdoses).

The most recent data according to the national definition (BKA) in 2009 show that a total of 1 237 persons died in connection with illicit drugs, which is less than in 2008 and 2009 (1 449 and 1 331 respectively). According to the General Mortality Register, there were 1 276 drug induced deaths in 2009 (1 326 in 2008).

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Treatment responses

In Germany, the implementation of drug treatment falls under the responsibility of the Federal States 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 therapy and availability of long-term rehabilitative treatment and social reintegration options. 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 outpatient counselling 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 2010, there are approximately 2 000 outpatient treatment centres offering contact, motivation and outpatient care, as well as psychosocial care for patients in substitution treatment. Furthermore, there are approximately 470 inpatient facilities providing long-term withdrawal and abstinence as a pre-condition for restoring the working capacity of the client in in-patient or outpatient settings. With regards to substitution treatment provided by licensed doctors in 2010, there were a total of 2 710 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 2010, the total number of clients in substitution treatment amounted to 77 400 clients, 62 462 of whom were on methadone (or levomethadone) and 14 396 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 3 % of the total number clients and 5.2 % of the total number of registered physicians providing opioid substitution therapy. Moreover, offers of OST outside of larger cities are yielded as insufficient by experts as well as persons eligible for the treatment. 

View ‘Treatment profile’ for additional information.

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Harm reduction responses

Harm reduction is one of the four pillars of the national drug strategy. The major aim of harm reduction is to reduce mortality and morbidity. During the last few decades, a system of low-threshold measures has been built up which has an important function, in particular, in the drug scenes of cities.

Outreach work is one method of supporting harm reduction in Germany. There are also drug help centres, which serve as a contact address for drug users and give support in emergency cases by offering psychosocial and medical help. Needle and syringe exchange programmes exist nationwide since 1984, although data on the number of distribution points or the number of distributed syringes are not available for the country as a whole. The latest reviews on different safer-use initiatives across the country found that more than a quarter of rural and urban districts have at least one syringe distribution offer (a vending machine or other). Germany has the highest number of needle and syringe vending machines in the World. Around 160 vending machines are installed in 10 Länder. Drug consumption rooms can be installed, if the government of the Federal Land passes a special regulation on the basis of a national law. This was done by 6 out of 16 Länder and currently, there are 28 drug consumption rooms in Germany.

There are about 300 low-threshold services and counselling facilities which are, for the most part, funded by public funds.

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Drug markets and drug-related offences

In terms of drug trafficking, south-west Asia, mainly Afghanistan, remains the most important source for heroin, with Turkey and the Balkans as main importation routes and the Netherlands as a destination country. In 2010, cocaine, seized in larger individual quantities if compared to previous years, mainly originated from Paraguay, Colombia, Argentina and Brazil and entered Germany via ports or directly by air. In many cases the seized cocaine was intended for further distribution to Spain or UK. The Netherlands and, to a much smaller extent, Austria, Belgium and also the Czech Republic are the main countries of origin for synthetic drugs such as amphetamine and its derivatives. The Netherlands and Morocco are the most important countries of origin and departure for cannabis products seized in Germany. Larger quantities of cannabis entered Germany also via Belgium, France and Austria. Furthermore, airmail deliveries from India for further distribution in Europe have been seized in various German airports.

In 2010, seized quantities of herbal cannabis, cocaine and  methamphetamines increased with a total of 4 298 kg in 2009 to 4 875 kg in 2010; 1 707 kg in 2009 to 3 031 kg in 2010; and 7 kg in 2009 27 kg in 2010  respectively. The number of seized cannabis plants, following a rather stable period of seizures at high levels, dropped to 101 549 plants and has reached the lowest level since 2005. The quantities of seized heroin decreased considerably in 2010 compared to 2009 (474 kg and 758 kg respectively). Strong decline in the seized amounts between 2009 and 2010 is recorded also for ecstasy, LSD and amphetamines.

In 2010, 16 illicit laboratories producing mostly methamphetamine were uncovered, however, the detected sites were rather small and intended to meet its operator’s personal demand. For the first time, an illicit laboratory manufacturing synthetic cannabinoids was detected.

In 2010, a total of  231 007 drug-law offences were reported, out of which more than half were cannabis law offences followed by amphetamine law offences and heroin law offences. Around 72 % of all drug-related offences were general offences committed against the Narcotic Act (unauthorised possession, purchase and distribution of narcotic substances).

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National drug laws

Under German law, unauthorised possession of drugs is a criminal offence. Nevertheless, there are various possibilities within the law to abstain 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. When a sentence is given, the principle ‘treatment instead of punishment’ still allows a reduction or remission of the punishment if the offender undergoes treatment instead of imprisonment.

Since 1981, the increasing number of drug addicts and drug-dependent offenders has led to the inclusion of detailed provisions on activities in the Narcotics Act to reduce the demand for narcotics and to reduce drug-related harm. These include the legal bases for ‘therapy instead of punishment’ (1981), substitution-based treatment and distribution of sterile disposable syringes (1992), the prerequisites for the establishment of drug injecting rooms at the discretion of the Federal Länder (2000) and diamorphine-assisted substitution treatment in 2009. The illicit trafficking, cultivation and manufacture of narcotic drugs carry penalties of 1–15 years’ imprisonment. Aggravating circumstances include ‘not insignificant’ quantities of narcotic drugs; an adult supplying narcotics to a person under the age of 18 years; someone trafficking narcotics ‘professionally’ or as a member of a gang; or, when committing a serious drug-related offence, carrying a weapon.

The Act on diamorphine-assisted substitution therapy entered into force on 21 June 2009. It created the legal preconditions for a transfer of the diamorphine-assisted therapy into regular care by changing the Narcotics Act, the Medical Products Act and the Regulation on the Prescription of Narcotic Drugs. The act stipulates, among others, that diamorphine (pharmaceutically produced heroin) becomes eligible to prescription — on very narrow criteria — as a narcotic drug used for heavily dependent opioid addicts. In 2010, additional legal provisions were passed to regulate availability of the therapy through the statutory health insurance and promote appropriate training among the medical professionals. In 2011, cannabis was transferred from Schedule I to Schedule III of the Narcotic Act which, for the first time, enables manufacturing and prescription of cannabis-containing proprietary medicial after clinical testing and licensing by the BfArM.

View ‘Legal profile’ for additional information.

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National drug strategy

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. Prevention lies at the core of the strategy’s primary aim to help individuals to avoid and reduce the consumption of legal and illegal addictive substances. The overall goals of the strategy are reflected in its four levels: (1) prevention; (2) counselling and treatment, help in overcoming addiction; (3) harm reduction measures; and (4) repression.

The comprehensive scope of the strategy, which focuses on addictive substances and behaviours, can be seen it its six areas of focus: (1) alcohol; (2) tobacco; (3) prescription drug addiction and prescription drug abuse; (4) pathological gambling; (5) online/media addiction; (6) illegal drugs. Each of the six areas contains a set of goals and measures to deliver the strategy. While the strategy does not have a defined timeframe, it is intended to run for between five and ten years.

View ‘National drug strategies’ for additional information.

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Coordination mechanism in the field of drugs

The Federal Drug Commissioner is responsible for the addiction policy of the Federal Ministry for Health (BMG) and coordinates the drug and addiction policy of the whole Federal Government.

The ‘Drugs and Addiction Council’ is an advisory body which accompanies the federal actions and evaluates them. It is composed of representatives of the respective government and Länder departments as well as funding organs, associations, research and self-help organisations.

The Federal Länder and the local authorities are to a large extent responsible for the implementation of the national policy on drugs and some Länder may have a different list of priorities concerning some elements of the plan.

Coordination between the Federal Government and the Länder takes place in the conferences of government departments and their working groups.

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Public expenditure

In Germany, the drug action plans do not have associated budgets and there is no review of executed expenditures. Recently, however, a study estimated the total drug-related public expenditure (¹)(²) for the year 2006.

In 2006, total drug-related expenditures ranged between 0.23 % and 0.26 % of GDP. Expenditures on public order and safety represented more than 60 %, health and social protection represented less than 35 % and general coordination activities less than 1 % of the total.

The available information does not allow reporting on trends in drug-related public expenditures in Germany.

(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) Mostardt, S., Floeter, S., Neumann, A., Wasem, J., and Pfeiffer-Gerschel, T. (2010), ‘Schaetzung der ausgaben der oeffentlichen hand durch den konsum illegaler drogen in Deutschland’, Das Gesundheitswesen 73, pp. 886–94.

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Drug-related research

Research focusing on drugs in Germany covers the entire range of basic and applied research. There are also several academic research centres which 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 field, but the drafting of clinical guidelines and transfer processes through which initiatives with a positive evaluation are wider implemented are also used. Recent drug-related studies mentioned in the 2011 German National report mainly focused on aspects related to responses and interventions, but also cover drug-use prevalence issues and research on determinants of drug use and on the consequences of drug use.

View ‘Drug-related research’ for additional information.

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