Access to Substitution Treatment in Germany, 2011

"The most recent census carried out within the framework of the substitution register permits making inferences about the number of persons reached on a set day but not over the course of the year.
"The number of reported substitution patients since the beginning of the reporting obligation (2002) has risen continuously until 2010 up to 77,400 patients as of 1 July 2010. In 2011, the number dropped for the first time on 1 July 2011 to 76,200 (BOPST 2012). It should be noted that in 2011 an above-average number of doctors had their databases updated by 'inventory reports' as part of corrective action, so that missed cancellations could be registered later, for example.
"Approximately 150 double treatments (in 2010: approx. 190) could be detected in the year 2011 through the substitution register and were subsequently terminated after notifying the corresponding physician.
"A total of 2,703 substitution doctors have reported patients. The medical associations report approximately 8,100 physicians who are qualified for addiction therapy, far more than those who actually provide substitution treatment. About 19 percent or 513 substituting doctors have used the supervision of a colleague in 2011: based on this, doctors without addiction therapy qualification can also substitute up to three patients simultaneously if they involve an accordingly qualified physician. The average number of registered substitution patients per substitution doctor varies considerably between the individual states and its nationwide average is 28 (Die Drogenbeauftragte der Bundesregierung 2012a).
"Access to substitution treatment is subject to strong regional divergences: firstly, the proportion of substitution patients in the total population is much higher in the city-states (especially Bremen and Hamburg), than in the large-surface states possibly because of surrounding countryside effects (Die Drogenbeauftragte der Bundesregierung 2012a), secondly it is significantly higher in the western Laender than in the eastern Laender. Still only 3.0% (N=2,266; 2010: 3.0%; N=2,195) of the patients reported to the register (cut-off date: 01.10.2011) and 5.3% (N=140; 2010: 5.2%, N=130) of the substituting doctors are from the eastern Laender (excluding Berlin) (BOPST 2012)."