Psychosocially assisted pharmacological treatment of opioid dependence in Germany: problems and perspectives

Background: Since its introduction in Germany, agonist opioid treatment (AOT) has been deemed an established type of therapy for the treatment of opioid dependence. In this connection, psychosocial services are both a recognized and an obligatory component of AOT. This type of care, which is mainly provided by clinical social workers, is being provided in very heterogeneous settings and in accordance with diverse standards. In addition, it is still not based on strong scientific evidence. Methods: Our analysis included the exploration of the political regime, as well as the different practices of psychosocial care for substituted opioid-dependent patients in Germany. On the basis of this exploration, we have put forward suggestions to help further develop this treatment approach. Results: We note sharp differences between the guidelines for AOT laid down by the WHO and treatment practices in Germany. This was particularly evident with regard to the provisional regional structure, funding of psychosocial services, and the situation of imprisoned opioid-dependent individuals, as well as the conceptual focus set by providers of psychosocial services. Conclusion: Compared with other European countries, the drug policy regimen established in Germany constitutes a novelty with regard to the AOT of opioid-dependent persons. What is now urgently required is to further develop existing conceptions and practices. In addition, readjustments should be implemented by taking into consideration differences in the needs of patients and in regional care practices. Also, a stronger orientation towards scientific evidence is crucial. Further, it is critical to place the current drug policy regimen on a new footing.