Germany Doesn’t Have An Opioid Crisis. Here’s Why. 

By Kelly Burch 10/22/19

One German doctor believes the country's hesitance to prescribe opioids plays a major role in helping avert a crisis.

German doctor
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With recent stories warning about addiction taking hold in India and Australia, it can seem like the opioid epidemic is much larger than North America. However, Germany has largely avoided the crisis, in part because of its approach to pain management and in part because when addiction does arise, it is treated more quickly and effectively. 

While opioid prescription rates in the United States have been rising exponentially, they’ve only increased slightly in Germany, NBC News reported.

Dr. Peter Raiser is the deputy managing director at the German Center for Addiction Issues. He said that healthcare providers in the country take a much more controlled approach to opioid pain pills. That’s kept prescription rates relatively stable, even while they skyrocketed in other Western countries. 

Raiser said, “Among the most important reasons we do not face a similar opioid crisis seems to be a more responsible and restrained practice of prescription.”

Doctors Need Special Permission To Prescribe Opioids

A major difference is that opioids are not a first-line option for pain management in Germany, as they often are in the United States. Doctors need special permission to prescribe opioids to a patient. In order to be granted that permission, they need to show that they’ve trial alternative treatments and medications, and that those have been unsuccessful. Then, patients need to be screened for addiction risk. 

University of Hamburg psychiatrist Dr. Dieter Naber said those precautions lower the number of opioid prescriptions that are written. 

He said, “Here in Germany, they prescribe opiates if all the other drugs don’t work. It’s much, much, much more difficult.”

Affordable Healthcare Means More Doctor Visits

In part because opioids are less prevalent, opioid use disorder is also less common in Germany. About 0.2% of Germans live with opioid use disorder, compared with 0.6% of Americans. 

One reason may be because Germans are more likely to keep in touch with the doctors that prescribed their opioids, since healthcare is cheaper than it is in the United States. Since they’re seeing patients more frequently, doctors are better able to spot signs of opioid abuse. 

When Germans do become addicted to opioids, they’re much less likely to die than their American counterparts with substance use disorder, since treatment is more affordable and widely available.

Naber explained, “Money regarding treatment is really not an issue here.” 

In 2016, 198 Americans per one million died of drug overdoses, compared to just 21 Germans per million

Harm Reduction In Action

For people who are not willing to go into treatment, Germany has harm reduction programs, including more than 20 safe injection sites. The United States has none (although some cities are considering plans). 

Dr. Andres Roman-Urrestarazu, a University of Cambridge researcher, said the German approach recognizes addiction as a more complicated and nuanced problem that requires a variety of solutions. 

“We know harm reduction works in terms of dealing with the problem of mortality,” he said. 

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.