German Drug and Addiction Policy Panel: Charting Drug Policy around the World Speaker: Mechthild Dyckmans, Federal Drug Commissioner, Germany 12 November 2013

German Drug and Addiction Policy Overview German Drug and Addiction Policy – The National Strategy – understanding the German system The success of our policy – some data on consumption, treatment and drug related death

German Drug and Addiction Policy Licit substances (tobacco, alcohol, prescription drugs) Illicit drugs (cannabis, cocaine, ecstasy, heroine, amphetamine and others) Non-substance related addictions (computer and internet, gambling)

German Drug and Addiction Policy “The human being at the center stage” Four pillars: Prevention Counseling, Treatment and Rehabilitation Harm Reduction Measures Repression and Supply Reduction Basis: National Strategy on Drug and Addiction Policy (2012)

Harm reduction Opioid substitution treatment Needle exchange At least one syringe distribution offer is made (including dispensing machines) in 114 out of a total of 429 rural and urban districts (26.6%) Drug consumption rooms in seven Laender and in bigger cities only Low-threshold services providing/offering: social counseling HIV- and Hepatitis-testing knowledge on infection risks, safer use and safer sex

Supply reduction Decriminalization of consumers - § 31a Drug Act the prosecutor can close proceedings if a consumer is charged with possession of a small amount Treatment instead of prison - § 35 Drug Act a person will be sent to treatment if a criminal offence was committed due to drug addiction

Federal Organisation Governmental Levels of the Drug and Addiction Policy FEDERAL GOVERNMENT Legislation, External Representation Narcotic Drugs Act, national models and programms; prevention campaigns; international cooperation FEDERAL LAENDER and COMMUNITIES Execution, Administration addict support system; public health care

Principle of Subsidiarity Non-Governmental Stakeholders Communities Churches and Charitable Associations Other Non-Governmental Organisations Principle of Subsidiarity The Government (Federation, Laender) will only act, if non-governmental organisations are not active.

German Drug and Addiction Policy Social Security System German Drug and Addiction Policy covered by state budget (federal, Laender or municipalities), health insurance or pension fund Social Security in Germany – Social Book Code II III V VI VIII IX XII Social Integration into Labour Prevention Treatment Opioid substitu-tion Self-Help Rehabilita-tion Aftercare Youth Welfare Service Regula-tion of Interface Manage-ment Social Integration

German Drug and Addiction Policy 2. Are we successful in what we are doing?

Prevelance of drug use in the general population

Opiate consumption Estimated number of opiate users (injectors and non-injectors) 130.000 Patients in OST: 75.400 (of those 500 in heroine substitution)

Changes in admission to outpatient therapy by main diagnosis every 2nd person seeking treatment for the first time shows up because of cannabis

Drug related deaths

HIV Prevalence/Incidence 3.400 newly diagnosed HIV infections in 2012 IDU accounted for 3% of new infections Number of new HIV diagnoses in IDUs dropped with 89 reported cases in 2012 to the lowest level since the start of differentiated data collection in 1993 HIV incidence (by mode of infection):

Hepatitis C Incidence 32.6% of all newly HCV positive persons reported IDU as possible exposition - new HCV cases with indication of IDU:

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