KHN correspondent Shefali Luthra reported this text from Germany as a 2019 Arthur F. Burns Fellow.
HAMBURG, Germany ― In 2016, 10 occasions as many Americans as Germans died on account of drug overdoses, principally opiates. Three occasions as many Americans as Germans skilled opioid habit.
Even because the charges of habit within the U.S. have risen dramatically up to now decade, Germany’s habit charges have been flat.
That distinction, experts say, highlights a big divergence in how the 2 international locations view ache in addition to distinct coverage approaches to well being care and substance abuse therapy.
Unlike within the United States, the place these drugs are commonly dispensed after surgical procedures and medical procedures, opioids have by no means emerged as a front-line medical therapy in Germany.
“Among the most important reasons we do not face a similar opioid crisis seems to be a more responsible and restrained practice of prescription,” mentioned Dr. Peter Raiser, the deputy managing director on the German Center for Addiction Issues.
Doctors should first strive various therapies, which the nation’s common medical insurance system usually covers. Before prescribing opioids, physicians should get particular permission and display sufferers to ensure they aren’t in danger for habit.
“Here in Germany, they prescribe opiates if all the other drugs don’t work,” mentioned Dr. Dieter Naber, a psychiatrist and researcher on the University of Hamburg. “It’s much, much, much more difficult.”
Analyses present that opioid painkillers in Germany are prescribed considerably greater than they had been 30 years in the past. But that enhance hasn’t fueled abuse.
Research published this spring reveals that the variety of Germans hooked on opioids has modified solely barely up to now 20 years. In 2016, 166,300 Germans skilled opioid habit ― about zero.2% of the inhabitants. In 1995, between 127,000 and 152,000 Germans had been believed to have used heroin, particularly; in 2000, the vary of Germans hooked on opioids was estimated between 127,000 and 190,000.
In the United States, in 2008, the government-administered National Survey on Drug Use and Health discovered that about 10,700 folks took ache relievers or heroin for nonmedical functions (even when they weren’t essentially addicted). By 2016, about 2.1 million Americans ― zero.6% of the inhabitants ― skilled full-on opioid habit.
The distinction speaks to variations in how the 2 international locations strategy medical care. Because of Germany’s well being system ― which emphasizes major care and retains value sharing low ― people who find themselves prescribed opioids usually tend to sustain with their medical doctors’ visits. If they exhibit warning indicators of habit, physicians have a greater probability of noticing.
To make certain, illicit drug use additionally happens in Germany, and opioids are the primary killer in drug-induced deaths. Still, the drug-induced mortality charge has gone down right here, per the newest European figures.
Even when folks right here get addicted, they’re far much less more likely to die in consequence. In 2016, 21 per million Germans died from drug-induced overdoses (of which most had been opioid-induced). That similar yr, 198 per million Americans died from the identical trigger.
Experts mentioned this speaks to variations in how the international locations view the problem of habit.
Because of Germany’s beneficiant public protection, it’s simpler to get therapy ― which, within the United States, might be arduous to search out, and costly when you don’t have a well being plan that covers it.
“Money regarding treatment is really not an issue here,” Naber mentioned.
That mentioned, Canada and Scotland each insure everybody and nonetheless face substantial habit charges.
But, in Germany, drug habit is handled with treatment and “harm reduction” approaches, together with so-called safe-injection websites ― folks experiencing habit take medicine underneath medical supervision, with clear needles to forestall the unfold of illness. These amenities even have protocols in place to forestall overdose. Germany has more than 20 such websites, with 4 in Hamburg. The strategy has “certainly reduced mortality,” Naber mentioned.
Such methods are controversial within the United States. A federal choose ruled early in October in opposition to a Trump administration effort to dam a safe-injection program in Philadelphia. The administration argued that such efforts allow and encourage habit, and pledged to proceed efforts to dam safe-injection websites.
But “harm reduction,” usually, and supervised injection, particularly, have been cited as finest practices by the Organization for Economic Co-Operation and Development, a coalition of developed, principally Western nations.
“We know harm reduction works in terms of dealing with the problem of mortality,” mentioned Dr. Andres Roman-Urrestarazu, a researcher on the University of Cambridge who research habit within the world context.
He added that Germany’s success with its multipronged strategy illustrates that habit is “a more complex problem” than the present American response has acknowledged.