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 | 2010 | 81 802 257 p | 501 105 661 p | Eurostat | |
| Population by age classes | 15–24 | 2010 | 11.3 % | 12.1 % p | Eurostat |
| 25–49 | 35.3 % | 35.8 % p | |||
| 50–64 | 19.3 % | 19.1 % p | |||
| GDP per capita in PPS (Purchasing Power Standards) 1 | 2009 | 116 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 2 | 2008 | 27.8 % | 26.4 % p | Eurostat | |
| Unemployment rate 3 | 2010 | 6.8 % | 9.6 % | Eurostat | |
| Unemployment rate of population aged under 25 years | 2010 | 9.9 % | 20.9 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 4 | 2009 | 89.3 | Council of Europe, SPACE I-2009 | ||
| At risk of poverty rate 5 | 2009 | 15.5 % | 16.3 % | SILC | |
p Eurostat provisional value.
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, 2009.
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).
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; 5.4 % in 2006; 7.3 % in 2003 and last month 2.5 % in 2009; 2.7 % 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), stabilisation of the last year use of most substances, including cannabis, is reported.
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 2008 results of the Federal Centre for Health Education (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 2008, 16.7 % reported cannabis use at least once in their life, compared to 21.3 % in 2004. Decrease was also observed for the last year prevalence of cannabis use, with 9.1 % in 2008 reporting cannabis use in the last year, compared with 12.1 % 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
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, followed by the family, community and youth sports settings. Prevention activities are primarily focused on three areas; alcohol, tobacco and cannabis. Several large-scale school-based prevention interventions have been implemented.
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 and migrants. A selective prevention project (FReD goes net) targeting young offenders is now being implemented in 17 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.
Several instruments and practices were developed in 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. More than 320 facilities has recorded their prevention activities in Dot.sys monitoring system in 2008–09, which allows to monitor where the activities are conducted and what substances are addressed through these activities.
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 2008. According to the data, the prevalence is estimated to be between 196 836 and 233 743 (3.6–4.3 per 1 000 inhabitants, aged 15–64).
Problem opiate users were estimated using two multiplier methods in 2009 — 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 1.6 to 2.3 per 1 000 inhabitants, corresponding to a total number of between 89 014 and 126 609 persons and the estimated trend of problem opiate use is rather stable in the country. Due to limitations of data, no separate estimate for drug injectors was possible.
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 2009 were based on 779 outpatient centres, 157 inpatient centres and 29 low-threshold agencies and treatment units in prison.
In 2009, an estimated total of 67 500 clients entered treatment, out of which 15 600 were estimated as new treatment clients. 58.6 % of those who sought treatment for the first time were cannabis users, 19.6 % opioid users and 10.3 % amphetamine users, while the figures for all persons entering treatment shows a different distribution: 47.2 % were opioid users and 33.5 % were cannabis users.
In 2009, 33 % of estimated clients entering treatment were aged less than 25 years. On the other hand, first-time treatment clients were considerably younger, with 53 % under the age of 25 years. With regards to gender distribution among all clients entering treatment, 80 % were estimated to be male and 20 % female. Likewise distribution was also estimated 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) 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, 3.5 % (2008: 5.0 % and 2007: 5.5 %) among those diagnosed with HIV for the first time in 2009 (2 843) were injecting drug users (IDUs). Until the year 2000, this figure was reported at above 10.1 %. The ongoing HIV incidence study indicates that slightly more than a third of all new HIV cases (37 %) are diagnosed among injecting drug users and it is regarded as relatively high rate for Germany.
The prevalence of HIV infection among opioid clients in outpatient treatment tested for HIV antibodies is 4.1 %. According to the Federal Criminal Police Office in 2008, a positive HIV-status was found in 3.1 % of the 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 2009 was reported at 0.9 per 100 000 inhabitants (2008: 1.0). Incidence of symptomatic hepatitis C cases was reported at 6.6 per 100 000 inhabitants (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. For 1.6 % of hepatitis B infections and 34.1 % of hepatitis C infections, intravenous drug use was reported as the most likely route of infection. According to the 2010 National report, in 2009, HBV and HCV prevalence among tested opioid clients in outpatient treatment was 8.7 % and 51.8 % respectively.
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 1 331 persons died in connection with illicit drugs, which is less than in 2008 (1 449). In addition, in 2008, according to the General Mortality Register there were 1 326 deaths.
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 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.
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. Germany has the highest number of needle and syringe vending machines in the World. Around 161 vending machines are installed in 9 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 in 2004 and currently there are 27 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.
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. Cocaine is smuggled within drug runs from the Netherlands and Belgium or directly by air from South America. The Netherlands and, to a much smaller extent, Poland, Belgium and also the Czech Republic are the main countries of origin for synthetic drugs such as amphetamines, amphetamine derivatives and LSD. As in previous years, the Netherlands was also in 2009 by far the most important country of origin and departure for cannabis products seized in Germany. Larger quantities of cannabis resin entered Germany also via Belgium and France. Furthermore, herbal cannabis is smuggled mostly in smaller quantities but higher frequency from Austria Switzerland and the Czech Republic into Germany.
In 2009, seized quantities of heroin, cocaine, amphetamines, methamphetamines and LSD increased with a total of 503 kg in 2008 to 758 kg in 2009; 1 069 kg in 2008 to 1 707 kg in 2009; 1 279 kg in 2008 to 1 376 kg in 2009; 4 kg in 2008 to 7 kg in 2009; and 12 875 units in 2008 to 20 705 units in 2009 respectively. The number of seized cannabis plants increased with a total of 121 663 plants in 2008 and 127 718 plants in 2009, and has stabilised at high levels since 2006. Whereas quantities of seized other cannabis products and ecstasy decreased considerably in 2009 compared to 2008.
In 2009, 24 illicit laboratories producing mostly methamphetamine were uncovered, however the detected sites were rather small and intended to meet its operators personal demand.
In 2009, a total of 235 842 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 72.0 % of all drugs related offences were general offences committed against the Narcotic Act (unauthorised possession, purchase and distribution of narcotic substances).
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.
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.
In 2010, the Federal Government Commissioner on Narcotic Drugs called for development of a new national strategy on drug and addiction policy. The draft strategy is currently under review by the relevant governmental departments.
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.
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 2010 German National report mainly focused on aspects related to responses and interventions, but also cover drug use prevalence issues and research on consequences of drug use.
