Country overview: Germany
- Drug use among the general population and young people
- Problem drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-related deaths
- Treatment responses
- Harm reduction responses
- Drug markets and drug-law offences
- National drug laws
- National drug strategy
- Coordination mechanism in the field of drugs
- Public expenditure
- Drug-related research
|Year||Germany||EU (27 countries)||Source|
|Population||2012||81 843 743 p ||503 663 601 b p||Eurostat|
|Population by age classes||15–24||2012||11.0 %||11.7 % b p||Eurostat|
|25–49||34.5 %||35.4 % b p|
|50–64||20.6 %||19.5 % b p|
|GDP per capita in PPS (Purchasing Power Standards) 1||2011||121||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2010||30.7 % p||29.4 % p||Eurostat|
|Unemployment rate 3||2012||5.5 %||10.5 %||Eurostat|
|Unemployment rate of population aged under 25 years||2012||8.1 %||22.8 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2011||86.8||:||Council of Europe, SPACE I-2011|
|At risk of poverty rate 5||2011||15.8 %||16.9 % e||SILC |
p Eurostat provisional value.
b Break in series.
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, 2011.
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).
The latest representative survey, the nationwide Epidemiological Survey on Addiction (ESA), was conducted in Germany in 2009. A total of 8 030 people aged 18–64 responded to a questionnaire via mail, telephone or Internet (response rate: 50.1 %). The survey found that 26.7 % of respondents had used illegal drugs at least once in their life, and, compared to the 2006 ESA, lifetime prevalence of all substances had slightly increased. However, last year and last month prevalence remained stable — last year prevalence was 5.1 % in 2009; 5.0 % in 2006; 7.4 % in 2003, and last month prevalence was 2.6 % in 2009; 2.5 % in 2006; 3.9 % in 2003. Cannabis remained by far the most used drug — last year prevalence was 4.8 % and last month prevalence was 2.4 %. 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. Among respondents aged 18–34 there was a decline in the last year use of most substances, including cannabis.
The latest European School Survey Project on Alcohol and Other Drugs (ESPAD) study in 2011 indicate 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 use by 2 %.
The latest Drug Affinity Study (DAS), conducted in 2011 among a sample aged 12–25, corroborated findings from other studies that cannabis is by far the most frequent illicit substance used by adolescents and young adults in Germany, and that the use of illicit drugs is more common among young males than females. The study, carried out by the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung/BZgA), also confirmed a declining trend in recent cannabis use over time among those aged 12–17, reflecting a decline found in the ESA results. The last month prevalence of cannabis use declined from 2.4 % in 2004 to 1.9 % in 2011, while last year prevalence fell from 10.1 % to 4.6 %. This tendency is not observed among those aged 18–25, although the rates of recent cannabis use remain at or below the record rates observed in 2004.
In summary, the trends observed in all recent studies might indicate a decrease in the experimental use of cannabis among younger age groups in Germany.
Federal agencies, Länder and community administrations share responsibility for the implementation of drug prevention activities in Germany.
The school environment still remains the most important setting for universal drug prevention, while family-oriented and community-based interventions are less available. School prevention activities are primarily focused on three substances: alcohol, tobacco and cannabis. Apart from information, the school-based prevention programmes promote life skills, and encourage students to think critically about drug use and to develop their own values. Klasse2000 is a programme developed in 1991 and is 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 peer education method for addiction prevention is applied in school settings as well as outside school, usually targeted at children in the 7th grade and older. In recent years a new universal prevention programme, Prev@WORK, has been developed for young people in vocational training settings to promote responsible substance use behaviours; it is now implemented in seven Länder. Family Ties is an example of intervention aiming to increase parenting skills, while the programme Strong Parents–Strong Children supports parents in building families’ protective role and strengthening the basic life skills of children. The programme Elterntalk is available at 35 locations in Bavaria and also focuses on enhancing parenting skills. In 2011 a number of universal prevention initiatives focused on children and young people in recreational settings, for example in sports clubs.
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. The federal pilot programme Family Outreach Therapy for Risky Drug Using Adolescents and their Families assists 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 17 other EU Member States.
The need to target 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 to stop 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.
Several instruments have been developed in recent years to monitor drug prevention initiatives. For example, the quality of 40 drug prevention projects was measured using a Quality in Prevention (QIP) instrument. Around 340 facilities recorded prevention activities in the Dot.sys monitoring system in 2011. The system enables researchers to monitor where the activities are conducted and what substances are being addressed.
Green List Prevention compiles prevention programmes with a beneficial evaluation outcome and recommends them for dissemination.
View ‘Prevention profile’ for additional information.
The most recent estimate of problem drug use, including opiate, cocaine and amphetamine use, is based on treatment data for 2010. According to the data, the prevalence is estimated at between 200 402 and 237 977 (3.7–4.4 per 1 000 inhabitants aged 15–64).
Problem opiate users were estimated using three sources — treatment, drug-related deaths and police contacts. Based on treatment demand, in 2010 there were an estimated 2.9–3.4 problem opiate users per 1 000 inhabitants aged 15–64, which corresponds to between 156 164 and 185 445 people, a slightly increasing trend from 2009. This increase is assumed to be mainly due to a rise in the number of treatment request in 2010.
Up to 2012 the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) defined problem drug use as injecting drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis were not included in this category. Details are available here.
The treatment demand data in Germany for 2011 were based on 778 outpatient centres, 166 inpatient centres and 39 low-threshold agencies and treatment units in prison.
In 2011 an estimated 75 532 clients entered treatment, of which 20 519 were new treatment clients. Among new treatment clients, 54.9 % sought treatment for cannabis use, 19.2 % for opioid use and 15.2 % for stimulant use. Among all treatment clients the distribution is different: 44.3 % were opioid users, 33.0 % were cannabis users and 11.0 % were stimulant users. In recent years, clients entering treatment have frequently reported using two or more psychoactive substances.
In 2011 some 30 % of all clients entering treatment were under the age of 25. New treatment clients were considerably younger, with 48 % under 25. With regard to gender, 79.2 % of all clients entering treatment were male and 20.8 % were female; among new treatment clients 80.8 % were male and 19.2 % were female.
The HIV/AIDS 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. Changes to the collection of data on new HIV cases have made the exclusion of multiple reporting more effective.
According to the Robert Koch-Institut, 4.0 % of those newly diagnosed with HIV in 2011 (2 889) were injecting drug users (IDUs) (3.7 % in 2010; 3.5 % in 2009; 5.0 % in 2008; 6.3 % in 2007). In 2000 some 12.4 % of those newly diagnosed with HIV were IDUs, so a clear downward trend can be observed between 2000–09, with some signs of stabilisation in recent years. Around two-thirds of newly diagnosed HIV infections amongst IDUs originated in Germany, and most of the remaining originated in other European countries (24 %), in particular in Eastern European countries (17 %). The HIV incidence study that was carried out from 2008 to 2010 indicated that the proportion of recently contracted HIV infections is highest among IDUs compared to other transmission groups.
The incidence of reported cases of hepatitis B virus (HBV) in 2011 was reported at 1.0 per 100 000 inhabitants (0.9 in 2010; 0.9 in 2009; 1.0 in 2008). Incidence of newly diagnosed cases of hepatitis C virus (HCV) in 2011 was reported at 6.1 per 100 000 inhabitants (6.5 in 2010; 6.6 in 2009; 7.5 in 2008). For HCV, a downward trend in incidence is observed. It is not possible to differentiate between acute and chronic HCV infections with the current reporting system. In 2011 injecting drug use was reported as the most likely route of infection for 17.2 % of HBV infections and 69.6 % of HCV infections with a known transmission route. According to the 2012 National report, in 2011 HBV and HCV prevalence among tested opioid clients in outpatient treatment was 9 % and 52 % respectively.
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, in 1999 the BKA specified the categories for drug-related deaths. Data from the General Mortality Register are available as drug-related death standards, using 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 overdose).
The most recent data according to the national definition (BKA) show that in 2011 a total of 986 people died in connection with illicit drugs, which is less than in 2009 and 2010 (1 331 and 1 237 respectively), and is the lowest number of drug-related deaths recorded since 1988. According to the General Mortality Register, there were 1 205 drug-related deaths in 2010 (1 276 in 2009; 1 326 in 2008). These additional data also confirm the declining trend in drug-related deaths.
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 therapy and 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. 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 substitution, and drug dependence problems are treated by outpatient counselling centres, which provide psychosocial care and psychotherapy. 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. Funding for treatment is provided by many actors: the Länder, pension and health insurance bodies, municipalities, communities, charities, private institutions and companies.
There are approximately 1 507 outpatient treatment centres offering contact, motivation and outpatient care, as well as psychosocial care for patients in substitution treatment. Furthermore, there are approximately 430 inpatient facilities providing long-term withdrawal and abstinence-based treatment as a precondition for further treatment in inpatient or outpatient settings. With regard to substitution treatment provided by licensed doctors, in 2011 a total of 2 703 doctors reported provision of the treatment through the special register.
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 substitution treatment 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. In 2011 there were 76 200 clients in substitution treatment, of whom 61 112 were on methadone (or levomethadone) and 14 630 on buprenorphine. Codeine, dihydrocodeine and diamorphine are also occasionally used in substitution treatment (0.1 %, 0.2 % and 0.4 % of all clients in substitution treatment, respectively). Access to opioid substitution treatment differs between Länder, with the eastern Länder contributing 3 % of the total number clients and 5.3 % of the total number of registered physicians providing opioid substitution therapy. Offers of opioid substitution treatment outside larger cities are considered insufficient by experts as well as by people eligible for the treatment.
View ‘Treatment profile’ for additional information.
Harm reduction is one of the four pillars of the German 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 constructed that has an important function, in particular, in the drug scenes of cities.
Outreach work is one method used to support harm reduction. 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. Needle and syringe exchange programmes have existed nationwide since 1984, although data on the number of distribution points or the number of syringes distributed are not available for the country as a whole. The latest reviews of 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 facility). 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 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 24 stationary drug consumption rooms in Germany and two mobile drug consumption stations in Berlin.
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, with Turkey and the Balkans as the primary importation routes and the Netherlands as a destination country. Cocaine seized in Germany in 2010 mainly originated from Colombia, Peru and Bolivia, and entered Germany via ports or directly by air. 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, and 717 cannabis plantations were seized in 2011. The Netherlands and Morocco are the most important countries of origin and departure for cannabis products seized in Germany.
Cannabis remains the most frequently seized substance in Germany. However, in 2011 the quantities of seized cannabis resin and herbal cannabis fell when compared with 2010. Although there was a reduction in the number of cannabis plants seized in 2010 to 101 500, this was not sustained in 2011, when 133 700 plants were seized. The quantity of heroin seized fell considerably in 2010 compared to 2009 (474 kg and 758 kg respectively). Although the number of seizures involving heroin also continued to decline in 2011 and the lowest number of seizures of heroin were reported since 1995, a total of 498 kg of the substance was seized during the year.
In 2011 further expansion of the stimulants market was noted, apart from cocaine. A total of 1 941 kg of cocaine were seized, which is 1 000 kg less than in 2010. However, there was an increase in the quantity seized for ecstasy (230 367 tablets in 2010; 484 992 tablets in 2011), methamphetamine (26.8 kg in 2010; 40 kg in 2011) and amphetamine (1 177 kg in 2010; 1 368 kg in 2011).
In 2011 some 19 illicit laboratories, producing mostly amphetamine and methamphetamine, were uncovered. However, the sites that were found were fairly small and were intended to meet their operator’s personal demand. For the first time, an illicit laboratory manufacturing synthetic GHB was detected.
In 2011 a total of 236 478 drug-law offences were reported, which is a slight increase on 2010. More than half of the offences were related to cannabis, followed by amphetamine and heroin. Around 72 % of all drug-law offences were use-related offences committed against the Narcotic Act (unauthorised possession, purchase and distribution of narcotic substances).
Under German law, unauthorised possession of drugs is a criminal offence. Nevertheless, 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. 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 increase in the 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 Länder (2000) and diamorphine-assisted substitution treatment (2009). The illicit trafficking, cultivation and manufacture of narcotic drugs carry penalties of one to 15 years’ imprisonment. Aggravating circumstances include ‘not insignificant’ quantities of narcotic drugs; an adult supplying narcotics to a person under the age of 18; someone trafficking narcotics ‘professionally’ or as a member of a gang; or carrying a weapon when committing a serious drug-related offence.
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 for prescription — on very narrow criteria — as a narcotic drug used 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 among 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 the 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).
View ‘Legal profile’ for additional information.
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 (alcohol, tobacco and psychotropic pharmaceuticals) and illegal addictive substances. The overall goals of the strategy are reflected in its four levels: (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 of focus: (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.
View ‘National drug strategies’ for additional information.
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 that 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 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.
In Germany, the drug action plans do not have associated budgets and there is no review of executed expenditures. However, a 2008 study estimated the total drug-related public expenditure in 2006. (1)(2)
In 2006 total drug-related expenditure ranged from 0.23 % to 0.26 % of gross domestic product. Expenditure on public order and safety represented more than 60 %, health and social protection less than 35 % and general coordination activities less than 1 %.
The available information is insufficient to allow trends in drug-related public expenditure in Germany to be reported.
(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.
View ‘Public expenditure profile’ for additional information.
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, but clinical guidelines and transfer processes through which initiatives with a positive evaluation are implemented more widely are also used. Recent drug-related studies mentioned in the 2012 German National report mainly focused on aspects related to responses and interventions, but also covered drug use prevalence and research on the consequences of drug use.
View ‘Drug-related research’ for additional information.