Within a global context, Germany was relatively late in its acceptance of substitution treatment, having first introduced methadone maintenance treatment (MMT) in the late 1980s. Since the early 1990s, Germany has taken a number of legal steps which favor harm reduction, assistance and treatment, rather than the law enforcement approach that was dominant before. As a result of this new commitment, Germany now also allows the use of non-methadone substitutes, such as buprenorphine, LAAM, dihydrocodeine (DHC) and codeine. A heroin maintenance trial has been scheduled to begin in early 2002. Despite the fact that the overall number of participants in drug-substitution treatment has risen over the past decade from about 1,000 in the early 1990s to more than 55,000 in 2001 and that MMT has been comprehensively evaluated in Germany with favorable outcomes, there remains a lack of availability of and accessibility to substitution treatment, due to rigid entry and treatment criteria imposed by the social health insurers (SHI).
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