Germany

"The German Federal Narcotics Act defines schedules of narcotic substances, the framework and procedure for legal trade and prescription of narcotics, criminal and administrative liability, and alternative measures for drug-dependent offenders. Use of drugs is not mentioned as an offence. Unauthorised personal possession and purchase of drugs are criminal offences punishable by up to 5 years in prison. However, the law affords various possibilities other than prosecution when only small quantities of narcotic drugs for personal use are involved. These depend on the amount and type of the drugs involved, the involvement of others, the personal history of the offender, and whether or not public interest would be served by prosecution.

"Most of the Länder have defined values for ‘small amounts’ of cannabis (usually 6-10 g) and a few have established amounts for heroin, cocaine, amphetamine or MDMA/ecstasy; in the case of methamphetamine, a federal ruling limits a ‘non-small’ amount to 5 g of the active substance. When a sentence is imposed, the principle of ‘treatment instead of punishment’ still allows — under certain circumstances — a postponement or remission of the punishment if the offender enters treatment.

"The illicit supply, cultivation and manufacture of narcotic drugs carry penalties of up to 5 years’ imprisonment. The penalty range increases to 1-, 2- or 5-15 years in defined aggravating circumstances, for example if larger quantities of narcotic drugs, minors, gang membership or weapons are involved.

"From November 2016, a new law has prohibited supply-related actions involving new psychoactive substances (NPS) that belong to groups of amphetamine-type stimulants, including cathinones and synthetic cannabinoids; these offences are punishable by up to 3 years in prison or up to 10 years’ imprisonment in certain aggravating circumstances."

"In Germany, more than a quarter of the adult population have used illicit drugs during their lifetime, while fewer than 1 in 10 have done so in the last 12 months; of these, about half have used illicit drugs in the last 30 days.

"Data on drug use among the adult population are available from the Epidemiological Survey of Substance Abuse (ESA). The Drug Affinity Study (DAS) provides data on the use of licit and illicit substances among adolescents and young people aged 12-25 years. The 2015 studies found that cannabis remained the most common illicit drug in Germany among both adults and adolescents. In general, consumption of illicit drugs is more common among males than females and remains higher among young adults, in particular those aged 18-25 years.

"The most recent ESA results indicate a slight rise in cannabis use among young adults. DAS data for the same time frame (2012–15) also indicate a slight rise in cannabis use among adolescents and young people, although prevalence declined slightly between 2014 and 2015.

"In 2015, for the first time, amphetamine was reported as the most common stimulant used by German adults in the last 12 months, followed by cocaine and MDMA/ecstasy. About 2.8 % of adults in Germany had used some kind of new psychoactive substance (NPS), while about 2.2 % of young adults (aged 18-25 years) indicated use of these substances in the past.

"A number of German cities participate in the Europe-wide annual wastewater campaigns undertaken by the Sewage Analysis Core Group Europe (SCORE). This study provides data on drug use at a municipal level, based on the levels of illicit drugs and their metabolites found in wastewater. In 2018, the study reported an increase in cocaine and MDMA levels in wastewater in almost all the cities for which data for several years were available. Cocaine and MDMA concentrations were higher at the weekends. Methamphetamine metabolites were found in the wastewater of cities in eastern Germany. In contrast, cocaine use was concentrated in Berlin and Dortmund."

"Studies reporting estimates of high-risk drug use can help to identify the extent of the more entrenched drug use problems, while data on first-time entrants to specialised drug treatment centres, when considered alongside other indicators, can inform an understanding of the nature of and trends in high-risk drug use.

"The population of high-risk opioid users in Germany was estimated by means of two multiplier methods using two data sources: drug-induced deaths in 2017 and treatment admissions in 2016. These estimates ranged from 0.94 to 2.96 high-risk opioid users per 1 000 inhabitants aged 15-64 years.

"High-risk stimulant use has become more common in Germany. The latest estimate of high-risk use of amphetamines and/or cocaine, based on 2016 treatment data, was 1.64-1.95 per 1 000 inhabitants aged 15-64 years.

"Data from specialised treatment centres indicate that the number of first-time treatment clients seeking help as a result of use of amphetamines reported in 2016 has increased recently and is higher than the number of first-time clients seeking treatment for opioid use. Among treatment entrants, heroin is increasingly being smoked or snorted. In addition, local data suggest that injecting heroin is becoming less prevalent.

"In the 2015 ESA, approximately 1.2 % of the population aged 18-64 years in Germany (around 612 000 people) reported indications of clinically relevant cannabis use in the 12-month period studied, according to the Severity of Dependence Scale. Moreover, cannabis users constitute the largest proportion of first-time treatment clients of specialised treatment services, although this may be the result of the progressive development of special programmes for this target group."

"Clean needles and syringes and other drug use paraphernalia are provided through a network of low-threshold services, outpatient counselling facilities and vending machines. Data on the number of syringes distributed are not available for the country as a whole, but data from local syringe monitoring are available in the Land North Rhine-Westphalia and some larger cities, including Frankfurt and Berlin.

"The outpatient treatment centres serve as additional contact points for drug users, providing crisis interventions and offering psychosocial and medical help; some also offer outreach services. There are currently 22 DCRs [Drug Consumption Rooms] at fixed locations in Germany, and two drug consumption vehicles operating in Berlin.

"In recent years, the number of programmes providing overdose emergency training and giving out the antidote naloxone to potential bystanders of opioid overdose has increased, and activities are reported from Berlin, Saarbrücken and several cities in North Rhine-Westphalia and Bavaria. Based on an on-going government-funded project, prevention and harm reduction interventions targeting migrants are being developed. To reach people in rural areas for early testing, a pilot project in Bavaria provides online access to order diagnostic tests for HIV, following an initial face-to-face counselling session."

"The German National Strategy on Drug and Addiction Policy focuses on treatment and counselling alongside prevention and early intervention. In Germany, the responsibility for the implementation of drug treatment lies with the federal Länder and the municipalities. Available treatments range from low-threshold contacts and counselling services to intensive treatment and therapy in specialised inpatient facilities. Long-term treatment options exist in the form of opioid substitution treatment (OST), long-term rehabilitative treatment and social reintegration options.

"Special guidelines are available for the treatment of opioid dependency and psychological and behavioural problems related to the use of cannabis, cocaine, amphetamines, MDMA/ecstasy and hallucinogens. In recent years, guidelines for the treatment of methamphetamine-related disorders and recommendations on how to deal with somatic and psychosomatic comorbidity have also been developed. Funding for treatment is provided by many organisations: the Länder, pension and health insurance bodies, the municipalities, communities, charities, private institutions and companies.

"Family doctors play a special role, as they are often the first point of contact for drug users and at-risk individuals. At the core of the dependency support system lie addiction counselling and treatment centres, psychiatric outpatient institutes, facilities for integration support and therapy facilities. Psychiatric clinics are also important in the drug treatment system. Most treatment facilities are provided by charitable bodies. State and commercial organisations are involved mainly in the provision of inpatient treatment. Most drug treatment takes place in centres and institutions that deal with dependence in general, although there are some treatment units specifically for illicit drug users.

"Outpatient counselling centres provide psychosocial care and psychotherapy and are often an entry point for clients. These centres provide treatment either directly using their own resources or in collaboration with general practitioners who are specifically qualified in addiction medicine.

"Psychiatric facilities for dependency represent the second major pillar of drug treatment in Germany. A wide range of services are provided in these facilities, including low-threshold, detoxification treatment, crisis interventions, complex treatments for comorbidity and planning for reintegration. Detoxification can also be administered in therapeutic communities. In the integration and aftercare phase, a varied range of services relating to employment, housing and reintegration into society are provided. A number of new treatment programmes addressing cannabis users specifically are offered by treatment providers. OST with methadone was introduced in 1992, buprenorphine in 2000 and heroin-assisted treatment in 2010. OST is offered mainly by the primary healthcare system, with about 10 % of inpatient facilities providing this treatment."

"The lifetime prevalence is not suitable as an indicator for current changes since it does not give any valuable clues to the current use behaviour of the interviewees. In literature, the 12-month prevalence is generally used as a reference value since, on the one hand, it is referred to a reasonably limited time window of past use and, on the other, it provides interpretable prevalence values (whereas the 30-day prevalence of the use of illicit drugs with the exception of cannabis often only gives extremely low figures) (details on the population surveys are also contained in the online standard table 1).
"While the lifetime prevalence of the use of illicit drugs among adults in the age group 18-64 years (ESA [Epidemiological Survey on Addiction]) slightly increased between 2006 and 2009 (2006: 23.7%; 2009: 26.7%), the figures for the use of illicit drugs in the 12-month category remained practically unchanged between the two data collection years 2006 and 2009 (2006: 5.0%; 2009: 5.1%). The situation is similar for the use within the last 30 days prior to the survey (2006: 2.5%; 2009: 2.6%) (Pabst et al. 2010).

"As the prevalence of the use of illicit drugs (total) significantly depends on the use experience with cannabis (and is nearly the same), the findings of the ESA 2006 indicate a stabilisation of the decline of the current use of cannabis in the general population, which had already been observed by the ESA 2006. Within the framework of the ESA 2009, only 7.4% of the interviewees (2006: 5.8%) report experience with other illicit drugs in the lifetime category. Even lower are the values for the 12-month (1.3%) and 30-day prevalence (0.6%), which have remained practically unchanged in comparison with the survey carried out in 2006 (1.2% and 0.7% respectively) (cf. also Table 2.2)."

Click here for complete datatable of Prevalence of Past-Year Illicit Drug Use in Germany, by Gender and Age

"In total 17.6% of 12-17 year old adolescents in Germany have been offered an illegal drug at some point, according to the findings of the DAS [Drug Affinity Study] 2011 (BZgA 2012a). The proportion of adolescents who have also tried an illegal drug at some point in their lives is significantly lower, at 7.2%. This means that less than half of those who have ever been offered drugs also accepted them. In total, 4.9% of adolescents between 12 and 17 years old had also used an illegal drug within the 12 month period prior to the survey (12-month prevalence), while less than half of them (2.0%) reported that this use was less than 30 days previously (30-day prevalence). Regular use of illegal drugs was seen in the case of approximately every hundredth adolescent. In total 0.9% of 12-17 year olds reported having taken an illegal drug more than ten times in the previous 12 months."

"Use of illicit drugs is a phenomenon occurring primarily in younger age groups. The portion of the 12-month-users among the below-30-year olds lies on average around 14%, among older users however, it is only about 2%. For many substances (except cannabis), the current (i.e. 12-month) consumption prevelances are already low among younger age groups, among the above-30-year olds they lie for all older age groups consistently below 1%. Apart from cannabis, only amphetamines and cocaine play a major role among the 20-29-year olds, although consumption experience with ecstasy, LSD and hallucinogenic mushrooms in the age groups above 30 years is quite common in the lifetime category. Looking at the relation between lifetime prevalences and current consumption, it is to be assumed that use of these substances is only of a transitional nature in the majority of users."

Click here for complete datatable of Prevalence of Illicit Drug Use in Germany

Click here for the complete datatable of Prevalence of Illegal Drug Use in Germany, 2006, 2008, and 2009

"In 2011, Germany took part in the European School Survey Project on Alcohol and other Drugs (ESPAD) for the third time, after also taking part in 2003 and 2007. The aim of the study is to examine the extent of, attitudes to and risks of alcohol, tobacco and drug consumption amongst adolescents (see 2.1).
"With a lifetime prevalence of 22.2%, cannabis remained the most commonly consumed illegal substance (Table 2.3). In the year prior to the survey, 17.4% of adolescents had tried cannabis at least once. For the 30 days prior, this figure was 8.1%. More boys than girls reported having used cannabis at least once in their life (28.2% vs. 16.8%), in the 12 months prior to the survey (22.8% vs. 12.6%) and in the 30 days prior to the survey (11.7% vs. 4.8%). The lifetime prevalence was highest in respect of secondary general schools (26.8%).
"However, use within the last 30 days was reported by significantly more comprehensive school pupils (11.5%).
"A frequent consumption of cannabis was rare. In the 30 days 2.5% of adolescents reported having used cannabis more than five times in the last 30 days. As a proportion of cannabis users, 13.3% registered a frequent consumption of at least 20 times in the last month. This pattern of use was particularly common in secondary general schools (Hauptschule) (26.8%)."

Click here for the complete datatable for Prevalence of Cannabis Use Among Youth in Germany, by Gender and Age Group, 2003-2011

"According to the findings of the current DAS (BZgA 2012a) the proportion of 12-17 year old adolescents who have drunk alcohol within the 30 days prior to the survey is 42.0% (30-day prevalence), 14.2% of this age group drink alcohol regularly (i.e. at least once a week), 15.2% of adolescents have drunk five glasses of alcohol one after the other at a drinking occasion at least once in the last 30 days (binge drinking) and 3.7% at least four times (frequent binge drinking). In the case of young adults in the age of 18-25, the 30-day prevalence of alcohol consumption is 81.9%, 39.8% regularly consume alcohol. The 30-day prevalence rate for binge drinking is 41.9% and the prevalence of frequent binge drinking is 12.9%. The alcohol consumption levels for male adolescents and young adults are higher than that of their female counterparts in all the described consumption indicators. Alcohol consumption amongst adolescents from 12-17 years old has declined in the last few years. The 30-day prevalence of alcohol consumption as well as the regular consumption of alcohol, binge drinking in the last 30 days and frequent binge drinking were not as common in 2011 as they were still in 2004. Trends amongst 18-25 year old young adults since 2004 have varied. In addition to downward trends, increases have also been observed so that no clear trends can be ascertained for this age group."

"Current data on tobacco consumption amongst adolescents and young adults is also available from the DAS (BZgA 2012a). In 2011, 70.8% of 12-17 year old adolescents in Germany have never smoked, 11.7% smoke. 4.8% smoke on a daily basis, 2.0% smoke 10 cigarettes or more per day and 0.3% smoke more than 20 cigarettes per day. 17.5% have tried smoking at least once but are currently non-smokers. In the case of young adults between the ages of 18-25, 27.6% have never smoked; the smoker quota is 36.8%. 23.1% smoke every day, 16.5% consume at least 10 cigarettes per day and 4.8% smoke at least 20 cigarettes per day. Amongst adolescents and young adults, no differences in smoking behaviour between the sexes can be seen. Smoking is declining amongst males and females between the ages of 12 and 17 as well as between 18 and 25. Amongst adolescents, the rate has more than halved over the last decade from 27.5% (2001) to 11.7% (2011). Trend analysis of the existing HBSC studies on tobacco consumption is also available. This shows that regular smoking in the period 2002 to 2010 decreased significantly overall, whereby the stronger reduction was in the period 2002 to 2006. The rate of smoking amongst 13 year olds fell from 14.1% in 2002 to 3.0% in 2010; amongst 15 year-olds from 33% to 14.9%. This decline was observed for girls as well as boys to the same extent (Richter et al. 2012)."

"To conclude, it must be stated that heroin treatment involves a somewhat higher safety risk than methadone treatment. This is mainly due to the intravenous form of application. The rather frequently occurring respiratory depressions and cerebral convulsions are not unexpected and can easily be clinically controlled. Overall, the mortality rate was low during the first study phase, and no death occurred with a causal relationship with the study medication. Compared to much higher health risks related to the i.v. application of street heroin, the safety risk of medically controlled heroin prescription has to be considered as low."

Crime, Courts, and Prisons

"In 2011 in Germany, a total of 236,478 narcotics offences were recorded (2010: 231,007), of which 170,297 were general offences against the German Narcotics Act (BtMG) and almost 50,000 were dealing/trafficking offences. Drug related crime has thus increased overall by 2.4% compared to the previous year (BMI 2012)."

"Direct economic compulsive crimes are understood to refer to all criminal offences committed in order to obtain narcotic drugs, substitute or alternative drugs. In 2011, 3,013 cases (2010: 2,556) of direct economic compulsive crimes were recorded by the Police Criminal Statistics (Polizeiliche Kriminalstatistik, PKS), which corresponds to an increase of 17.9% compared to the previous year. With this, the number of this type of offence has, after four years (2007-10) in which there were only minor changes, risen markedly from 2010 to 2011. Almost three quarters (72.9%) of these offences are related to prescription forgery or theft for the purpose of obtaining narcotics (BMI 2012)."

"These crimes are related to offences committed in connection with commercial/professional dealing in narcotic drugs or smuggling of larger quantities of narcotic drugs. All drug dealing/trafficking crimes recorded by police are - just as consumption-related crimes - taken account of in this report irrespective of the outcome of later legal proceedings. Both in terms of proportion and absolute figures, cannabis played the most important role in drug dealing/trafficking crimes (30,765 crimes, 60.6% of all crimes; 2010: 29,306 crimes, 59.1%), followed at a large distance by heroin (4,980, 9.8 %; 2010: 6,403, 12.9 %; 2009: 7,205, 14.1 %) (Figure 9.1). Similar to heroin, the number and proportion of trafficking crimes related to cocaine (3,731, 7.6%; 2010: 3,763, 7.6%; 2009: 4,522, 8.9%) have slightly decreased in recent years. Since 2000, the proportion of trafficking crimes involving amphetamines has been on a continual rise and the case figure too slightly increased again after a slight decline in 2008 and 2009. In 2011, amphetamines accounted for 14.8% (7,497 crimes; 2010: 6372, 12.8%) of all dealing/trafficking crimes and thus overtook heroin for the first time, ranking third on this list (BMI 2012)."

"This section is about narcotics offences that are - due to the related conditions (quantity, persons involved) - classified by police as 'general offences' and are therefore taken as referring to consumption-related offences (Figure 9.2). The police criminal statistics (BMI 2012) show that cannabis plays a predominant role also in the case of consumption-related offences: 59.4% of all respective cases in 2011 are related to cannabis. Heroin (8.0%), amphetamines (18.4%) and cocaine (6.0%) together account for 32.4% of the recorded cases. The remaining proportion is split between ecstasy, LSD and other drugs. In 2011, the total number (170,297) increased by 2.7% in comparison with the previous year (2010: 165,880). The number of consumption-related offences in connection with amphetamines increased by 21.9% from 2010 (25,695) to 2011 (31,330) and thus continued the trend which began in the mid 1990s. In addition to the number of consumption related offences in connection with amphetamine, an increase was seen in the number in connection with ecstasy (+12.3%) and other substances (+18.3%). Aside from these, there were minimal changes in respect of cannabis (+1.6%), cocaine (-2.8%) and LSD (+6.8%) as well as a significant reduction in the case of heroin (-25.1%)."

"The overall figure for first-offence hard drug users increased from 2010 to 2011 by 14.5% to a total of 21,315 (2010: 18,621). As in the previous years, pronounced declines were found for heroin (2011: 2,742; 2010: 3,201; -14.3%). The number of first-offence hard drug users remained unchanged where the offence was in connection with cocaine (2011: 3,343; 2010: 3,211; +4.1%) and LSD (2011: 135; 2010: 141; -4.3%). For the first time since 2004, the number of first-offence users of ecstasy rose (2011: 942; 2010: 840; +12.1%).
"As in the previous years, the number of amphetamines users who came to the attention of the police for the first time115 increased (+11.5%) and reached a new peak in 2011 (12,709 cases; 2010: 11,401).
"At respectively low overall figures, the figures for first-offence methamphetamine users increased dramatically (2011: 1,693; 2010: 642; +163.7%) as did those for other hard drugs (2011: 897; 2010: 333; +169.4%). The figures for crack (2011: 438; 2010: 311; 40.8%) also increased considerably.
"First-time offenders in connection with amphetamines and methamphetamines accounted for a little less than 2/3 (62.9%) of the total of first-time offenders (heroin: 12.0%; cocaine: 1.6%, ecstasy: 4.1%, crack: 1.9% and others including LSD: 4.5%)116 in 2011. In this statistical documentation cannabis users are not taken account of since only so-called hard drugs are recorded (BKA 2012a)."

"Because the percentage of addicts and consumers of illegal drugs in German penal institutions cannot be clearly quantified, the number of persons incarcerated as a result of violations of the Federal Narcotics Act (Betäubungsmittelgesetz) is frequently used. This estimate is relatively imprecise, however, because first of all it counts people who, although they have violated the law in connection with drugs, may not themselves have consumed any illicit substances, as could be the case, for example, with some dealers. Secondly, a large percentage of drug consumers are not taken into account because for example persons who are sentenced as a result of offences in connection with procurement of drugs are listed under other categories of violations against the Federal Narcotics Act in the statistics.
"As of 31 March 2010, there were a total of 8,841 persons (14.7% of all inmates) serving time in prison institutions as a result of violations of the Federal Narcotics Act (BtMG). Of these, 5.5% (511) were female, while 3.3% (294) were serving sentences as juvenile offenders. From 2006 (total: 64,512; BtMG: 9,579) to 2011, the total number of inmates increased by 6.9% whilst the number of inmates serving sentences due to BtMG offences decreased by 7.7% (Table 9.2). The number of inmates convicted for BtMG offences as a percentage of all inmates has remained constant for adults since 2006. For juveniles and young adults (in particular males) it is slightly decreasing (Statistisches Bundesamt 2011d)."

"In 2011, in 1,804 cases (2010: 1,517), 133,650 cannabis plants (2010: 101,549) were seized (Table 10.6) which in both instances represents a market increase (+18.9% cases; +31.6% plants seized). The quantity seized thus reached the level of 2009 once more, the number of cases is the highest since 2003 (BKA 2012a). The increased number and quantity of plants seized as well as the doubling of the seized small plantations (see 10.2.2) imply on the one hand an increased (own) cultivation of cannabis in Germany and on the other, if one considers the increasing seizure numbers for marijuana and the falling numbers for hashish (see 10.3.1), an increased preference for marijuana and a diminished preference for hashish."

"In comparison to the years 2010 and 2011, the seized quantities of heroin (+5.0%) amphetamine (+16.3 %), crystalline methamphetamine (Crystal; +48.8 %), khat (+51.1 %), ecstasy (+110.5 %) and LSD (507.1 %) all increased, whilst the seized quantities of crack (-11.9 %), psychoactive mushrooms (-17.0 %), hashish (-18.5 %) and marijuana (-188 %) declined. Whilst the seized quantities of khat and crystal (for comparatively low total quantities) has been steadily rising for some years, a development which seems to be a 'real' trend, the hugely increased quantities of ecstasy and LSD seized in comparison to the previous year seem to have been caused by the lower values in 2010. The main reason for these fluctuation are large individual seizures which greatly increase the numbers or, if such seizures a lacking in comparison to the previous year, reduce the numbers. For example, the increase in quantity of cocaine seized from 2009 to 2010 (+77%) was largely down to a few major seizures (1.3t, 351 kg and 341 kg). As such large seizures did not occur in 2011, the amount of cocaine secured, the quantity of cocaine seized remained in 2011 on a similar level to 2009 (BKA 2012a). In contrast to that, the quantity of methamphetamine seized (for a comparatively small total amount) almost tripled."

"In 2011, 19 illegal drug laboratories were uncovered, which corresponds to a slight increase in comparison with the previous year (16 laboratories). As in the previous year, the detected production sites were mainly (15 sites) small laboratories that produced ATS to meet the operators’ personal demand or to supply a limited circle of local buyers. One laboratory was set up to produce GHB (BKA 2012a).
"Overall, in the laboratories, 16.8 kg amphetamine, 0.14 kg methamphetamine and 12ml GHB were seized in the detected laboratories. In addition, basic material found included acetic anhydride (2.7 kg), phenyl acetic acid (0.25 kg), hydrochloric and sulphuric acid (76.8 l and 7.6 l respectively), acetone (16.6 l), ethyl ether (4.6 l), benzyl methyl ketone (BMK; 24.2 kg), toluol (8.6 l), pseudoephedrine (0.01 kg) and pills containing pseudoephedrine (1,236 consumption units) (BKA 2012a)."

"As far as the average drug prices (Table 10.7) are concerned, there were hardly any changes of any significance observed from 2010 to 2011.
"At retail level, the prices for cocaine (+-0%), ecstasy (+-0%), hashish (+1%), marijuana (+2%), amphetamine (+5%) and LSD (+9%) either stayed constant or rose slightly. The prices for heroin (+17%), crystal (+17%) and crack (+18%), however, rose on a nationwide to a noticeable degree.
"Prices at wholesale level are difficult to compare to the previous years: an international expert group led by the EMCDDA initiated a harmonisation of the data collection procedures for wholesale drug processes in Europe which led, in a first step, to a clearer differentiation of large quantities in the categories from 0.5 to < 1.5 kg (or respectively 500 to < 1,500 consumption units), 1.5 to < 10 kg (1,500 to < 10,000 consumption units) and 10 kg to < 100 kg (10,000 to < 100,000 consumption units) and larger127. This differentiation was also implemented by the BKA.
"Whilst the prices for wholesale volumes of heroin rose slightly and for cocaine more starkly at the 0.5 to <1.5kg level, the other wholesale prices either remained stable or fell."

Problem Drug Use and Its Correlates

"Calculations based on figures collected from treatment, police contacts and drug-related deaths lead to an estimated figure of problem heroin users ranging between 63,000 and 185,000 persons (with the estimates of the year 2010 serving as a calculation basis). This corresponds to a quota of 1.2 to 3.4 persons per 1,000 population in the age group of 15 to 64 year olds (Table 4.1).
"In comparison to 2009, the estimate for the year 2010 is higher as a result of the multiplier 'therapy demand'. This is presumably attributable mainly to the fact that the number of therapy admissions increased in 2010 compared to 2009. For the year 2010, the methodological basis for the calculation of the estimate of the total number of outpatient facilities and thus the extrapolation was partially adjusted. The estimates since then have been undertaken on the basis of the total number of outpatient facilities, taken from the facilities register (Süss & Pfeiffer-Gerschel 2011). A more detailed presentation of the methods used can be found in the REITOX Report 2010.
"The number of heroin users who have come to the attention of the police for the first time has been on a strong decline for some years (2000: 7,914; 2011: 2,742). At the same time, the portion of drug-related deaths that had been recorded before as users who had come to the attention of the police for the first time, remained constant between 2005 and 2008 (n=40). After a slight reduction in 2009 (n=38) and an unchanged value in 2010, this value fell sharply once more (n=34). Therefore, one can say that the estimates based on this indicator have been on a continual decline.
"The estimates based on the multiplier 'drug-related deaths' are based on the mortality rate amongst clients in outpatient treatment and the number of drug-related deaths. The former remained relatively constant in comparison to the previous year (2010: 0.9%-1.5%; 2011: 1.1%-1.6%), the latter fell sharply in 2011 compared to 2010 (2010: 1,237; 2011: 986). The estimates based on the multiplier 'drug-related deaths' thus declined sharply for 2011 in comparison to 2010.
"The estimates for the multiplier 'police contacts' have been falling since 2005. The same applies for the multiplier 'drug-related deaths' for the years since 2008. The estimates based on the multiplier 'treatment demand' fell from 2008 to 2009 before rising slightly again in 2010. One can, therefore, not observe any clear tendency."

Click here for complete datatable of Prevalence of Problem Opioid Use in Germany 2005 to 2011

"A total of 2,889 HIV infections were reported to the RKI [Robert Koch Institute] for the year 2011. This translates to a nationwide incidence of 3.5 cases per 100,000 population. The total number of newly diagnosed HIV infections thus hardly declined in comparison to 2010 (2,939). Information about the route of transmission was available for 77% of newly diagnosed HIV infections. The group of persons (n=90) who likely contracted their HIV infection through intravenous drug use represented the third largest group (4%).
"Amongst those intravenous drug users newly diagnosed with HIV, information on their origin was lacking on 19% of the reports. 43% of persons newly diagnosed with HIV originated from Germany, 38% from abroad. Of the intravenous drug users from other countries, probably around 38% had contracted the infection in Germany, the same number in Eastern Europe. At least two thirds of the newly diagnosed HIV infections amongst intravenous drug users occurred in Germany, most of the others in other European countries (24%) – in particular Eastern Europe (17%) (RKI 2012a, b)."

"Between 1.1.2008 and 31.12.2010, a total of 1,337 cases of new AIDS infections were reported to the RKI [Robert Koch Institute] (notifications until 1.3.2011). With this, the total number of persons with full blown AIDS has increased to 28,027 since the start of the epidemic. There are however considerable divergences between regions to be found with regard to completeness of the reported AIDS-cases.
"Among the new AIDS cases registered between 1.1.2008 and 31.12.2010, 82% were men and 18% women. With 7% of the infected men and 14% of the infected women, injecting drug use was for both genders in third place on the list of known infection risks. For 22% of the reported AIDS cases among men and 18% of the AIDS cases among women, there was no information given on the infection risk (RKI 2011a)."

"The reliability of information on drug-induced deaths strongly depends on the question as to whether autopsies and toxicological examinations have been used to validate the initial classification as drug-induced death or not (cf. chapter 6.1). The autopsy rate of all drug-induced deaths in the reporting year 2011 was on average at 65% (2010: 66%; 2009: 66%), whereby individual Laender considerably diverged from this value either upwards or downwards (minimum: 35%; maximum 100%).
"In the year 2011, a total of 986 people died because of the use of illicit drugs which corresponds to a decline of 20 percent in comparison with the previous year (1,237) and the lowest level for the number of drug-related deaths since 1988. Overdose of heroin (including use of heroin in connection with other drugs) remains with 569 cases the most common cause of death (58%; 2010: 69%; 2009: 70%). The portion of drug-related deaths in which substitution substances alone or in combination with other drugs were detected, was at 22% (2010: 14%; 2009: 13%) and thus slightly up in comparison with recent years, however it is still lower than 2002, as this proportion was at 40%. Since 2006, the statistics of the federal criminal police office discriminate in the detected substitution substances between methadone/polamidone and Subutex® (buprenorphine). According to the BKA data, the majority of death cases that were attributable to one substitution substance alone happened in connection with methadone/polamidone (N=51; 96%). Among the 160 cases of death, in which substitution drugs in combination with other drugs were found, there were also two cases in which buprenorphine was detected¹⁰⁸ (see also Table 6.2) (BKA [Bundeskriminalamt (Federal Criminal Police Office)] 2012b).
"Generally, it is however to be assumed that in the presentation of the involvement of substances in the recorded deaths, the number of mixed intoxications (combination categories) but also the involvement of substitution substances is underestimated due to frequently missing exact toxicological data on a death case."

Treatment

"In the year 2011, data of a total of 313,604 therapies (without one-off contacts) carried out in N=778 outpatient facilities were collected within the framework of the DSHS. For this REITOX Report only data from clients primarily treated for illicit substance use (including sedatives/hypnotics and volatile solvents) were taken into account (patients treated primarily for alcohol-induced disorders accounted alone for 54% of all recorded cases in 2011).
"Diagnostic data
"For the year 2011, the German Statistical Report on Treatment Centres for Substance Use Disorders contains data on the main diagnoses of a total of 60,169 treatments from N=778 facilities that were started or completed in outpatient psychosocial addiction support centres because of problems with illicit drugs. The main diagnoses are based on the diagnostic categories of the international classification system of the World Health Organisation (WHO), the ICD 10, for disorders caused by psychotropic substances (harmful use or dependence).
"When looking at the DSHS data and confining oneself to illicit substances, one finds that less than half of the clients (44.9%; 2010: 46.3%) sought treatment or counselling primarily for dependence on or harmful use of opioids90. The proportion of persons primarily treated for disorders in connection with the use of opioids has been on a continual decline since 2007. In more than a third of the cases (34.7%; 2010: 35.6%), clients were treated for primary cannabis problems. After having increased over the last years, this portion has stabilised. On the rise is the proportion of clients who receive counselling and treatment because of problems connected to the use of stimulants (10.5%; 2010: 8.2%). The comparative values for cocaine (5.8%; 2010: 5.9%) and other substances remained practically unchanged in comparison with the previous year."

"Among the persons who underwent addiction therapy for the first time, cannabis clearly led the league with a nearly unchanged share in all substances (56.6 %; 2010: 59.8 % of all clients) and was followed at a clear distance by the portion of clients treated for opioids for the first time. Their portion remained nearly unchanged (18.1 %; 2010: 17.7 %) whereas the portion of users of stimulants (15.0 %; 2010: 12.5 %) increased (Table 5.1). The proportion of persons with cocaine-related disorders declined even further also among the patients treated for the first time in comparison with the previous year (6.6 %; 2010: 6.6 %). The proportions of all other substance groups practically remained unchanged in respect of the previous year.
"Secondary addiction diagnoses made in addition to the main diagnosis are relatively common. Out of the clients with primary opioid-related problems⁹¹ about one in four clients (26.5 %) also displayed an alcohol-related disorder (dependence or harmful use) or a disorder in connection with the use of cocaine (21.9 %) (Table 5.2). Dependence on or harmful use of cannabis continued to represent the most common non-opioid secondary diagnosis in this patient group (32.2 %).
"Among clients with primary cocaine-related problems⁹² cannabis, alcohol, amphetamines and ecstasy played a dominant role as substance-related secondary diagnoses. As in previous years, almost one client in ten with a primary cocaine diagnosis additionally fulfilled the diagnostic criteria of a heroin-related disorder (8.9 %).
"Almost one in five of the clients with primary cannabis-related problems93 also displayed harmful use of or dependence on amphetamines (18.8 %). Almost one client in ten with a cannabis-related main diagnosis showed also harmful use of or dependence on cocaine (9.1%). More than a quarter of the clients with a primary disorder caused by the use of cannabinoids also fulfilled the diagnostic criteria of an alcohol-related disorder (27.4 %). Seen across the board of all substances, approximately more than a quarter of the clients had a disorder caused by the use of alcohol in addition to the primary reason for treatment admission (Pfeiffer-Gerschel et al. 2012d)."

"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)."

Click here for complete datatable of Opiate Substitution Treatment, by Drug Type in Germany, 2003-2011

"A total of N=11,627 persons receiving supervision/assistance or undergoing treatment live in the same household with at least one child. The largest group of clients (principal diagnosis opioids) are the group living with at least one child in a household (n=7,465, 17.4%) (see Table 12.3). Clients with a principal diagnosis of cannabis compose the second largest group of clients and also the second largest group living with children in the same household (n=2,340). With other principal diagnoses the figure is 17.1% (n=781) for persons with a principal diagnosis of cocaine, 15.3% (n=713) for persons with a principal diagnosis of stimulants and 20.5% (n=317) for persons with a principal diagnosis of sedatives/hypnotics. With all main diagnoses, more than half of the clients living in a household with children live with one child and more than one-fourth with two children in the same household. (see Table 12.3).
"The majority of clients at ambulatory facilities do not live alone. Out of the total principal diagnosis, the persons not living alone account for between 58.5% (principal diagnosis opioids) and 62.1% (principal diagnosis stimulants). Among these the percentage of persons who live with children varies considerably. While somewhat more than one in every ten clients not living alone with a principal diagnosis of cannabis lives with children (11.0%), among persons with a principal diagnosis of stimulants this figure is almost one in every five (18.2%). The figure for persons with a principal diagnosis of cocaine is 22.8% and a principal diagnosis of opioids is 25.0%. The share among persons with a principal diagnosis of sedatives/hypnotics is even more than one in every three at 36.9% (see Table 12.5)."

"The central result of the German model project shows a significant superiority of heroin over methadone treatment for both primary outcome measures. Heroin treatment has significantly higher response rates both in the field of health and the reduction of illicit drug use. According to the study protocol, evidence of the greater efficacy of heroin treatment compared to methadone maintenance treatment has thus been produced. Heroin treatment is also clearly superior to methadone treatment when focusing on patients, who fulfill the two primary outcome measures."

Harm Reduction

"Following on from the findings of the project, presented in the last REITOX Report, to produce a situational report on existing syringe exchange programmes in Germany (Flöter et al. 2011), internet research was once more carried out to confirm facilities identified in the last report and possibly to identify further facilities offering syringe exchange. This research reveals in total 223 facilities with syringe exchange programmes (mainly contact sites of drug help facilities and the German AIDS Service Organisation (Deutsche AIDS Hilfe, DAH)) as well as 167 syringe dispensing machines. One should note that these figures possibly represent an underestimation of syringe exchange programmes actually available in Germany as they only include facilities that have either taken part in the syringe exchange project of the IFT or specifically mention their syringe exchange programme on their website.
"Further information on syringe exchange programmes can be found in Standard Table 10.
"The only Land in which a regular survey is conducted on a local level on the distribution of single use syringes by the DAH (AIDS-Hilfe), is North-Rhine Westphalia. In 2011, the DAH NRW reported 1,927,626 (2010: 2,113,242) loose syringes were handed into drug facilities as well as 228,262 (210: 251, 072) syringes handed in via automatic machines (AIDS Hilfe NRW e.V. 2012)."

"Especially syringe dispensing machines can provide 24h supply for sterile drug use equipment for drug users. With approximately 160 syringe dispensing machines, Germany has the largest number of syringe dispensing machines worldwide. In the year 2009, approximately 380,000 boxes with syringes, needles and accessories were dispensed in this way. Nevertheless, the syringe exchange programme is far from covering the whole of Germany – there are still no locations in six Laender. Only North Rhine-Westphalia (with about 100 dispensing machines) and Berlin (17 dispensing machines) have a well developed network."

"As at June 2012, there are a total of 24 stationary drug consumption rooms in six German Laender (Berlin, Hamburg, Hesse, Lower Saxony, North-Rhine Westphalia and Saarland) across 15 cities and two mobile drug consumption stations in Berlin. A consumption room in Aachen was closed at the beginning of the year¹⁰⁹.
"More precise data on use and clientele of consumption rooms are at present only available for individual facilities who publish their annual reports on the internet. In addition, the DBDD sent a request by email in 2012 to those consumption rooms that do not make data available on their websites. From this request, together with internet research, data from 20 consumption rooms is available¹¹⁰. This data shows that in 2010, a total of 630,649 consumptions took place in these facilities in 2010 (although one should note that the definition of a 'consumption' varies considerably from facility to facility – in some consumption rooms, each visit is recorded as one consumption, irrespective of whether substances are consumed multiple times or if multiple substances are consumed during that one visit; in other facilities each 'consumption unit' is reported as its own consumption). Furthermore, in 2010 17 consumption rooms reported a total of 944 drug emergencies which could be treated in the facility directly or which could be transferred for further medical treatment."

"The German aids help organization Deutsche AIDS-Hilfe conducted a national survey on drug emergencies that occurred in 2009 in drug consumption rooms in order to be better able to assess what contribution consumption rooms can make to avoiding drug-related deaths. With 13 facilities from eleven cities, half of all consumption rooms in Germany took part. During the six-month period of enquiry, a total of 266 drug-related emergencies were documented, out of which 263 could be evaluated. 139 cases (53%) were classified as ”light“ or “moderately severe“, 124 (47%) as “severe“ or ”life threatening“. According to the author, it can be assumed that 47% of the people affected would in all probability not have survived the emergency in a different setting (e.g. in their own flat or in public space) and thank their lives to the competent intervention of the consumption room staff (Schaeffer & Stoever 2011)."

Economics

"Adding the identified and calculated expenditures, one gets a range between 5.2 and 6.1 billion EUR spent in 2006 for the area of illicit drugs which breaks down as follows: the portion of the German National Statutory Pension Insurance in the funding for medical rehabilitation, participation in working life and benefits granted for the reduction in earning capacity amounted to about 172 million EUR. The extrapolation of the expenditures of the medical health insurance institutions for medication, hospital treatment, rehabilitation etc. came to 1.4 billion EUR. At the institutional level, an amount of 3.6 to 4.5 billion EUR was provided for the prevention and reduction of the consequences of drug-related problems in the form of prevention, intervention and repression measures."

Laws & Policy

"In Germany, the term ‘drug policy’ is undergoing a gradual change of meaning. Until the end of the last century, it was exclusively related to illegal drugs that were at the centre of the political interest. There was no comparable conception either for an alcohol or tobacco policy or for an ‘addiction‘³ policy, comprising the whole range of addictive substances. In recent years however, (1) disorders resulting from legal psychotropic substances and (2) common aspects of all substances (e.g. in universal prevention or in patients with multiple abuse) as well as non-substance-related forms of addiction4 (e.g. pathological gambling) have increasingly moved into the focus of the political interest. This is the reason why the terms ‘drug and addiction policy’ or ‘addiction policy’ find more frequent use, gradually replacing the term ‘drug policy’. As a result of the differences in the policy aims pursued and strategies deployed in the area of legal and illegal substances, the term ‘drug and addiction policy’ finds preferred usage in the German language.
"Moreover, the range of vision is expanding from the original main focus on substance-related addiction to risky and harmful use and thus to a comprehensive understanding of health policy for substance-related disorders and risks. However, in the German language there is no appropriate term reflecting this expansion of the concept, so the (insufficient) term of ‘addiction policy’ continues to be used. As a consequence, legal substances and common strategies for both legal and illegal substances have to be taken into account in the annual reports of the German Reference Centre for the European Monitoring Centre for Drugs and Drug Addiction DBDD. In many cases, it is no longer possible to set the two categories apart due to technical and political developments. Nevertheless, in line with the guidelines given for the topic of this report, exclusively illicit substances will be taken into consideration, where possible. Non-substance-related addiction is currently of no relevance for this report."

"On 15 February 2012, the 'National Strategy on Drug and Addiction Policy', as announced in the last REITOX report, was passed by the Federal Cabinet (Bundeskabinett) (see also REITOX Report 2011). This policy replaces the 'Action Plan Drug and Addiction' from 2003 (Die Drogenbeauftragte der Bundesregierung 2012b)6. According to the National Strategy, the aim of the drug and addiction policy remains the reduction of consumption of legal and illegal addictive substances as well as the prevention of drug and addiction related problems in society. The National Strategy sees itself as a health political guideline for a modern drug and addiction policy in Germany. It formulates the areas of focus and addiction political challenges with drug and addiction policy taking into account current developments, the existing addiction support system, the surrounding legal framework and proven concepts in addiction prevention. The Strategy also draws on international initiatives and activities on a European level as well as on the level of the WHO and the United Nations. The National Strategy on drug and addiction policy is, in terms of its targets and intentions, a part of the Federal Government’s general prevention strategy in the area of drug and addiction policy which is currently being prepared. Both strategies stress the central importance of health promotion and prevention in the overall health politics. In this context, Germany has at its disposal many years’ experience with successful measures of universal, selective and indicated prevention and sets its focus on children and adolescents, in order to promote healthy development at an early stage, as well as on adults, to preserve their health.
"Within these strategies, quality and efficiency assured measures are designed enduringly to secure or improve health and quality of life and meet current challenges resulting, amongst other things, from the demographic changes in an aging population. In this, prevention is given central importance alongside existing offers of counselling and treatment, cessation assistance, measures to reduce ill effects as well as law enforcement."

"The Federal Government continues to follow an integrative approach in its addiction policy. Unlike in other European countries, legal and illegal addictive substances are addressed together. Particular consideration is given, due to their wide popularity, to the legal addictive substances alcohol, tobacco and psychotropic pharmaceuticals when further developing addiction prevention and the assistance system. The National Strategy directs particular attention to new challenges in drug and addiction politics which arise from, amongst other things, demographic change, societal changes, old and new addiction forms and addictive substances and the resulting consumption trends. Now, more than in the past, it is not only addiction which is focused on but also risky use behaviour, which is harmful to health and limits personal development even if it does not necessarily lead to an addiction."

"Prevention of drug-related infectious diseases by low-threshold drug help facilities consists mainly of providing information on infectious diseases and risks as well as distributing safer use articles. Distribution of needles and needle exchange is explicitly permitted by the Narcotics Act and is also practised by many facilities."

"With the 'Act on diamorphine-assisted substitution therapy which came into effect on 21 July 2009 (German Federal Law Gazette, BGBl., I of 20 July 2009, p. 1801) the legal preconditions were created for a transfer of the diamorphine-assisted therapy from the German national model project into regular care by changing the Narcotics Act (BtMG), the Medical Products Act (AMG) and the Regulation on the Prescription of Narcotic Drugs (BtMVV). The act stipulates primarily that diamorphine (pharmaceutically produced heroin, provided it is approved as a medicinal product for substitution purposes under pharmaceuticals law) becomes eligible to prescription – on very narrow criteria – for the substitution treatment of heavily dependent opioid addicts (c.f. REITOX reports 2007 and 2008).
"Government funding for the Laender and municipalities which originally participated in the clinical pharmaceuticals study funded by the Ministry for Health (“Heroin Study”) expired at the end of February 2008. The Federal Government funded the documentation and monitoring of the diamorphine assisted therapy in Germany until 2011 in order to ensure continuous monitoring was undertaken for the purpose of quality assurance, which included the therapy standards and effects."

"Section 31a of the German Narcotics Act (Betäubungsmittelgesetz, BtMG) provides for the possibility to discontinue prosecution for possession of drugs under certain circumstances, namely when the offender has grown, produced, imported, exported, bought or received and possessed in any other way narcotic substances in small amounts exclusively for personal use and when his guilt is deemed as minor and there is no public interest in prosecution. This provides the public prosecutor with an instrument to stop proceedings for consumption-related offences without court approval. All Federal Laender have regulated details of the application of § 31a BtMG through recommendations or guidelines. These guidelines considerably diverged from each other in the individual Laender a few years ago, but have meanwhile largely converged. Some divergences in the Laender regulations do however persist (Schäfer & Paoli 2006)."

"Most of the Laender have introduced comparable threshold values for 'small amounts' (upper/lower limit) of cannabis. The limits set by the individual Laender are guideline values from which public prosecutors and judges may diverge in individual cases. It is important to note that there exists, also in respect of these regulations, no legal claim whereby in the relevant cases the prosecution of the possession of small quantities of drugs shall be discontinued. If a sentence is not handed down, this does not automatically mean that the crime has no consequences. Public prosecutors have the right to stop proceedings under certain conditions (e.g. community service, fines or counselling in a social institution).

"On 3 December 2008, the Federal German Court of Justice (Bundesgerichtshof, BGH) lowered the 'non-small' amount for methamphetamine from 30 grams methamphetamine base to 5 grams in a principle-establishing ruling. In view of the scientific findings gathered on the toxicity of methamphetamine over the last ten years, the Senate considered it necessary to change the existing law and lower the threshold value. Contrary to a Land Court, the BGH fixed the threshold value not to five gram methamphetamine hydrochloride but to methamphetamine base (for more details see also Patzak 2009). With its ruling of 17 November 2011, the BGH stipulated the non-small amount of racemic methamphetamine as 10g of the effect inducing base. Upwards of this amount, the offender is no longer merely committing a misdemeanour as per Sec. 29 Par. 1 BtMG which provides as possible sanctions monetary fines or imprisonment up to five years, rather he would be facing imprisonment of no less than one or two years.

"Already in April 2007, the Federal Court of Justice (BGH) rendered a ruling defining the 'non-small amount' of buprenorphine. With that, the Federal High Court of Justice added another decision to the series of landmark rulings on 'non-small amounts' in which it dealt for the first time with a substance used in substitution therapy that has also made its appearance on the illicit market causing some concern (Winkler 2007). The 'non-small amount' in the wording of the BtMG does not refer to – contrary to the term 'small amount' – the weight of the seized substance but to the active ingredient contained in the substance.

"Only a few federal states have explicitly defined regulations for discontinuing prosecution in connection with other narcotic drugs. They provide for the possibility to discontinue prosecution in the case of heroin (1 g), cocaine (depending on the federal state: 0.5 – 3 g), amphetamines (0.5 – 3 g) and ecstasy (between 3 and less than 20 tablets) (Patzak & Bohnen 2011)."

"According to §63 and §64 of the Penal Code (Strafgesetzbuch, StGB) it is possible under certain circumstances to order the placement of mentally ill or addicted offenders in special closed correctional facilities (like psychiatric facilities or withdrawal clinics).
"The Narcotics Act (Betäubungsmittelgesetz, BtMG) allows the suspension of proceedings in cases of minor guilt or lack of public interest in prosecution (§31a BtMG). This applies mainly to consumption-related offences, in particular when they occur for the first time and third parties are not involved. These regulations are subject to different regional application as shown by a study carried out by Schäfer & Paoli (2006). With regard to the prosecution of consumption-related offences involving cannabis, there has recently been a move to greater convergence of the definitions of limit values for 'small quantities' in the Laender in line with the guidelines passed by the Federal Constitutional Court. Further details can be found in chapter 1.2.2.
"It is moreover possible to defer a prison sentence of up to two years to provide the drug addict with the chance to undergo therapy ('therapy not punishment', §35 BtMG)."

"With regard to the preparation of the release of detainees from prison, the legal framework establishes that detainees are to receive assistance upon prison release (§ 74 Prison Law in connection with § 15 Prison Law) with a view to promote societal integration after prison. In order to reach this goal prison services are to cooperate at inter-departmental level (§ 154 Prison Law). Moreover, providers of social security services are to form networks and cooperate with the competent agencies to complement each other in the pursuit of the same goal (§ 68 paragraph 3 Social Code XII and § 16 paragraph 2 Social Code II). Corresponding strategies and measures are developed and implemented under the term transition management. On the one hand, it is tried to facilitate a smooth transition from prison to freedom with integration into training, work and employment, on the other, to tackle problems linked with detention and criminal careers. The main task of transition management is to improve the situation of the clients by offering them counselling and care but also possibilities of professional qualification and training as well as job placement.
"Although from an historic viewpoint there have been corresponding efforts undertaken already 150 years ago with the introduction of the assistance for offenders and the introduction of the probation service in the 1950s, the discussion and the implementation of a transition management still require further development."

"The anyway tense situation on the labour market makes it difficult for substance dependent people to reintegrate after therapy into professional and social life. The unemployment quota among drug addicts is extremely high – depending on the severity of the problem up to more than 80%. Studies show that social and professional integration is a crucial factor for sustained abstinence.
"The integrative approach adopted by the Social Security Codes II (SGB II) enables socio-integrative services to be provided in addition to the instruments of employment promotion. An integral part of these supporting integration services is addiction counselling (§ 16a SGB II).
"Addiction counselling, as a service to be provided in respect of SGB II, falls – like the other socio-integrative integration services - under the organisational and financial responsibility of the municipalities. The Federal Ministry for Employment and Social Affairs assumes supervisory functions defined by SGB II insofar as the Federal Employment Agency is the service provider but not with regard to services provided by the municipalities. These are placed under the supervision of the Laender. This is the reason why the Federal Government currently does not have any computed data at hand on specific measures or activities carried out with regard to drugs and addiction in the field of basic social care for people in search of work."

"The German model project for heroin-assisted treatment of opioid dependent patients is so far the largest randomised control group study that investigated the effects of heroin treatment. This fact alone lends particular importance to the results in the (meanwhile worldwide) discussion of effects and benefits of heroin treatment. For the group of so-called most severely dependent patients, heroin treatment proves to be superior to the goals of methadone maintenance based on pharmacological maintenance treatment. This result should not be left without consequences. In accordance with the research results from other countries, it has to be investigated to what extent heroin-assisted treatment can be integrated into the regular treatment offers for severely ill i.v. opioid addicts."