Agonist opioid treatment for opioid dependents in Germany 2019

Background. After a long and controversial debate Agonist Opioid Treatment (AOT) was first introduced in Germany in 1987. The number of patients in AOT - first low because of strict admission criteria - increased considerably since the 1990s up to 79,700 at the end of 2019. Currently 2,600 GPs are prescribing AOT medications. Psychosocial care should be made available to all AOT patients. Results. Patients benefit substantially from AOT with improvements in physical and psychological health. AOT proves successful in attaining high retention rates (65 % to 85 % in the first years, up to 50 % after more than seven years) and plays a major role in accessing and maintaining ongoing medical treatment for HIV and hepatitis. AOT is also seen as a vital factor in the process of social reintegration and it contributes to the reduction of drug related harms such as mortality and morbidity and to the prevention of infectious diseases. Conclusion. AOT plays a substantial role in the health care system provided to drug users in Germany. In 30 years of AOT in Germany a wealth of experiences has been accumulated, e.g. in the development of research on health care services, guidelines and the implementation of quality assurance measures. However, substantial problems need to be solved in the near future in order to maintain high quality provision of AOT in Germany. Most urgent is the lack of doctors who are willing to provide AOT. The average age of GPs prescribing is about 62 years and soon a substantial part of them will retire. Furthermore access to AOT in rural areas and in closed settings (prisons, forensic psychiatry, etc.) is still very limited and constitutes massive problems. Heroin-assisted treatment needs to be expanded in order to support those patients who do not benefit from other AOT medications.