Country overview: Germany
- Situation summary
- Data sheet
- Barometer
Contents
- 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
- Drug-related research
| Year | Germany | EU (27 countries) | Source | ||
|---|---|---|---|---|---|
| Population | 2008 | 82 217 837 | 497 455 033 | Eurostat | |
| Population by age classes | 15–24 | 2008 | 11.6 % | 12.6 % 1 | Eurostat |
| 25–49 | 36 % | 36.3 % 1 | |||
| 50–64 | 18.6 % | 18.4 % 1 | |||
| GDP per capita in PPS (Purchasing Power Standards) 2 | 2007 | 114.8 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 3 | 2006 | 28.7 % p | 26.9 % p | Eurostat | |
| Unemployment rate 4 | 2008 | 7.3 % | 7 % | Eurostat | |
| Unemployment rate of population agends under 25 years | 2008 | 10 % | 15.5 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 5 | 2006 | 95.8 | Council of Europe, SPACE 2006.1 | ||
| At risk of poverty rate 6 | 2006 | 13 % | 16 % 7 | SILC, 2007 | |
p Eurostat provisional value.
1 2007 figures.
2 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.
3 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.
4 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.
5 Situation of penal institutions on 1 September, 2006.
6 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold in the current year and in at least two of the preceding three years.
7 EU-25 countries.
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 2006. It shows that 25.4 % of the 18–59 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 2003, lifetime prevalence of all substances remained almost unchanged. However, in the 12-month and 30-day categories, the most recent figures are markedly lower than the ones found in 2003 (12 months: 25.4 % in 2006; 25.2 % in 2003; 30-days: 2.7 % in 2006; 3.9 % in 2003). These declines can almost exclusively be explained by lower prevalence of cannabis. Cannabis is by far the most used drug. Last year prevalence of cannabis use is 4.7 % and last month, 2.2 %. As regards the use of other substances during the last year, cocaine is reported by 0.6 %, amphetamines by 0.5 % and XTC and mushrooms both by 0.4 % of respondents. In terms of a younger age range (18–39 years), a decline of the last year use of cannabis was reported, compared to 2000 and 2003 surveys. For other substances, only slight variations were noticed. In 2006, last year cannabis use was reported by 9.2 % of respondents, compared to 10.4 % in 2000 and 11.8 % in 2003.
The results of the Drug Affinity Study (DAS) conducted in 2001 and 2004 showed that the difference in drug experience of teenagers between old and new federal Länder is narrowing fast. The 2007 results of the Bundeszentrale für gesundheitliche Aufklärung (BZgA) (12–19 years of age), indicated a strong decline in cannabis use compared to 2004, reflecting that shown by the ESA results. Indeed, in 2007, 13 % of those aged 14–17 years reported cannabis use at least once in their life, compared to 22 % in 2004. The same decrease was observed for the last year prevalence of cannabis use, with 8 % in 2007 reporting cannabis use in the last year, compared with 15 % in 2004. These declining trends might indicate a possible decreasing readiness for experimental use of cannabis among younger age groups.
The latest ESPAD survey (2007) indicated that 20 % of the students, aged between 15–16 years, reported a use of cannabis at least once in their life; while in 2003 it was reported by 27 % of the sample. In 2007, 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 11 %, amphetamines by 5 % and the same lifetime prevalence for cocaine and amphetamines use by 3 % of the sample.
Prevention
The school environment still remains the most important setting for universal drug prevention in Germany, followed by youth work, public health and the family. Prevention activities are primarily focused on three areas; alcohol, tobacco and cannabis. Several large-scale school-based prevention interventions have been implemented and also driving schools are used as a prevention carrier.
Selective prevention is mainly carried out in recreational settings, such as youth centres and sports clubs. Innovative projects for selective prevention are constantly being developed, such as Internet-based counselling, telephone counselling and projects specifically targeted at ethnic minorities. A selective prevention project (FRED) targeting young offenders is now being implemented in 10 additional Member States.
The need for targeting at-risk children is largely acknowledged and more indicated prevention programmes in Germany are mostly targeted at children with attention-deficit/hyperactivity syndrome, children and adolescents with behavioural disorders and children in families with addiction. These prevention programmes are delivered within a therapeutic or counselling context.
Recently, more efforts have been made towards environmental strategies against alcohol and tobacco. Monitoring of prevention interventions is now well developed.
Problem drug use
The most recently available estimate of problem drug use including the users of cocaine and amphetamines refers to the year 2006 and estimates the prevalence to be between 169 000 and 201 000 (3.1–3.6 per 1 000 inhabitants, aged 15–64).
Problem opiate users were estimated using two multiplier methods in 2007 — based on drug-related deaths and police contacts.
Figures collected from treatment police contacts and drug-related deaths led to an estimate of the number of problematic opiate users for Germany at between 1.5 to 2.7 per 1 000 inhabitants, corresponding to a total number of between 82 000 and 149 000 persons. Due to limitations of data, no separate estimate for drug injectors was possible. Compared to estimates based on the same data sources for previous years, the 2007 figure was somewhat lower, with an increased lower limit owing to the increase of the drug-related deaths in the country.
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.
Treatment demand
The treatment demand data in Germany for 2007 were based on 720 outpatient centres out of 934, 147 inpatient centres out of 245 and 29 low-threshold agencies and treatment units in prison.
In 2007, a total of 48 475 clients entered treatment, out of which 19 493 were new treatment clients. 49.8 % of those who sought treatment for the first time were cannabis users and 28.5 % opiate users, while the figures for all persons entering treatment shows a different distribution: 50.3 % were opiate users and 29.9 % were cannabis users.
In 2007, 36 % of all clients entering treatment were aged less than 25 years. On the other hand, first-time treatment clients were considerably younger, with 54 % under the age of 25 years. With regards to gender distribution among all clients entering treatment, 81 % were male and 19 % female. This distribution was also evident among first-time treatment clients with 82 % male and 18 % female.
Drug-related infectious diseases
The HIV/AIDS department of the Robert Koch-Institut (RKI) (http://www.rki.de) 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.
The number of AIDS cases varies considerably between the Federal Länder. Whereas in the new Länder, relatively few people suffer from AIDS, most infections are reported in the city states, Berlin and Frankfurt. According to the Robert Koch-Institut, 5.6 % (2006: 6.1 %) among those diagnosed with HIV for the first time in 2007 were injecting drug users (IDUs). Until the year 2000, this figure was reported at above 10.1 %. The prevalence of HIV infection among clients starting treatment declined from 5 % to 2.1 % in most small-scale studies available in this area. According to the BKS, a positive HIV-status was found in 3.4 % of the drug-related deaths (48 out of 1 384) compared to 2.9 % in 2006.
Basic data on viral hepatitis are available for the general population. According to the Federal Health Report (Robert Koch-Institut, 2007). 5–8 % of the population in Germany in the age between 18–79 years were affected by a hepatitis-B infection, 0.4–0.8 % are virus carriers. A total of 7.7 % in the old and 4.3 % in the new Länder are estimated to carry hepatitis-C antibodies (Thierfelder et al. 2001.).The incidence for hepatitis B in the year 2006 was reported at 1.2 per 100 000 inhabitants (2006: 1.4). Incidence for hepatitis C was reported at 8.3 per 100 000 inhabitants (2006: 9.2); in 2007. Discrimination between acute and chronic hepatitis-C infections in the case reports is not possible with the current reporting system. For 3.7 % of hepatitis-B infections and 35 % of hepatitis-C infections intravenous drug use was reported as the most likely route of infection.
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 (BKA) and the General Mortality Register of the Federal Statistical Office (StBA). 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 (Bundeskriminalamt, 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 from the General Mortality Register in 2007 show that a total of 1 394 persons died in connection with illicit drugs which represents an increase by 7.6 % from 2006 to 2007. In 2006, the Police Registry of the Federal Criminal Police Office (BKA) recorded a total of 1 296 drug-related deaths, a decrease of 2.3 % compared with 2005.
Treatment responses
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 drug-free 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 2006, there was a total 934 outpatient treatment centres offering contact, motivation and outpatient care as well as psychosocial care for patients in substitution treatment. Furthermore, in 2006 there were 160 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 2007, there were a total of 2 786 doctors. An additional 500 GPs provided substitution treatment without a specialised qualification but under the supervision of a consultant.
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 and a model-project on heroin-assisted treatment started in the year 2003.
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 2007, the total number of clients in substitution treatment amounted to 68 800 clients, 55 315 of whom were on methadone and 12 797 on buprenorphine. Codeine and diamorphine are also used in substitution treatment, yet only in special cases with 413 and 275 clients respectively.
Harm reduction responses
Harm reduction activities are part of the Social Welfare Act. In addition to treatment services, projects have been implemented with the aim to reduce or minimise drug-related harm for chronic drug users. Such projects include, for example, outreach street plan work, drop-in centres, syringe exchange programmes and social support at home. Syringe exchange schemes have been established in Denmark since 1986. In most cases, pharmacies administer the scheme either through dispensing and sales at pharmacies or through dispensing machines with clean needles in public sites. Some municipalities also dispense needles and syringes through shelters and boarding houses. The latest estimates (2005) indicates that about 910 000 syringes were distributed through needle exchange programmes.
Using social reserve funds for 2006, the Government and the parties behind the reserve fund decided to launch activities against hepatitis C on a national scale. As a result, the National Board of Health prepared an action plan in 2007, in which it is recommended to the municipalities to take a number of specific actions with regard to coordination and interventions (e.g. information, screening, vaccination and treatment referral). The results will be evaluated on an annual basis.
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 Balkan route being importation routes. In addition, the route through the central Asian countries — Uzbekistan, Turkmenistan, Tajikistan, Kirghizstan and Kazakhstan — towards Europe is gaining more and more importance. Cocaine is smuggled directly from Columbia, Peru, Venezuela and Argentina. The Netherlands and, to a much smaller extent, Poland are the two main countries of origin for synthetic drugs such as amphetamines, amphetamine derivatives and LSD and cannabis products. However, cannabis resin often comes directly from Morocco.
In 2007, a total of 235 296 drug law offences were reported, out of which 60 % were cannabis law offences followed by 12.6 % heroin law offences and 11.4 % amphetamine law offences.
In 2007, seized quantities of cocaine and amphetamines increased slightly with a total of 1 717 kg of seized cocaine in 2006 to 1 878 kg in 2007 and a total of 723 kg of seized amphetamines in 2006 to a total of 810 kg in 2007. Whereas heroin, herbal cannabis and cocaine increased considerably in 2007 as compared to 2006. With a total of 1 074 kg of seized heroin in 2007 as compared to 879 kg in 2006, a total of 3 770 kg of seized herbal cannabis in 2007 as compared to 2 954 kg in 2006 and a total of 1 878 kg of seized cocaine in 2007 as compared to 1 717 kg in 2006. On the other hand, the seized quantities of ecstasy and LSD decreased in 2007 as compared to the last seven years, with a total of 985 218 seized ecstasy tablets in 2007 and a total of 10 525 units of seized LSD in 2007.
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) and the prerequisites for the establishment of drug injecting rooms at the discretion of the Federal Länder (2000). 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.
Since 2007, legal changes have been discussed but not finalised to continue the results of a pilot project to treat addicts with diamorphine (heroin).
National drug strategy
Germany’s Action Plan on Drugs and Addiction was adopted in June 2003 and replaced the plan to combat drugs, developed in 1990. The current action plan has a timeframe of five to ten years. It is comprehensive and covers four pillars: prevention, counselling and treatment; survival aid and harm reduction; controls (repression); and supply reduction. It focuses on all psychotropic substances and on some special groups (children of addicted parents, high-risk groups, car drivers, consumers of different drugs) which have been identified and should be targeted specifically.
Coordination mechanism in the field of drugs
The office of the Federal Drug Commissioner has belonged since 1998 to the Federal Ministry for Health and Social Security (BMGS). The Federal Drug Commissioner is responsible for the addiction policy of the Federal Ministry for Health and Social Security 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.
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. Under the supervision of the Institute for Clinical Psychology and Psychotherapy of the University of Applied Sciences Dresden, a curriculum for doctoral candidates will be tested and evaluated to promote addiction research. 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. Recent drug-related studies mentioned in the 2008 German National report mainly focused on aspects related to responses and interventions.