đź’Š Substitution treatment
In brief
In opioid dependence, substitution treatment replaces the substance used with a medically prescribed substitution drug (e.g. methadone, buprenorphine). The legal basis is § 5 of the Betäubungsmittel-Verschreibungsverordnung (BtMVV, Narcotics Prescription Ordinance); the funding body is the statutory health insurance.
Only doctors with "addiction medicine qualification" may substitute without restriction; other doctors may treat only a limited number of patients. For handing over the substitution drug to take at home on your own ("take-home"), special periods apply, as a rule limited to 7 days, which can be extended in individual cases.
Step by step
- Find a medical practice offering substitutionAsk via the addiction advice centre, the Kassenärztliche Vereinigung (association of statutory health insurance physicians) or directly at a practice with addiction medicine qualification.
- Start treatmentAfter medical diagnosis and information, the substitution drug is adjusted individually, usually at first with daily dispensing on site.
- Stabilisation and checking take-homeIf things go steadily, the doctor can approve a supply for several days, with regular personal check-up appointments.
Deadlines
- § 35 BtMG "treatment instead of punishment" is something different from substitution treatment – substitution is medical treatment, not a criminal law provision (see "Treatment instead of punishment").
- Not every doctor's practice may substitute without restriction – the qualification requirement under § 5 Abs. 3/4 BtMVV in practice limits free choice of doctor.
- Older leaflets sometimes give narrower take-home limits – this no longer matches the current version of the BtMVV; if in doubt, check the statutory text on gesetze-im-internet.de.
In depth · legal basis, figures and practice – for advisers and professionals
Legal basis
Substitution is regulated in § 5 BtMVV (in conjunction with the BtMG). Professional standards are specified by the Bundesärztekammer guideline on substitution-assisted treatment of opioid dependence (version of 16 July 2026); the funding body is the statutory health insurance (§§ 27, 31 SGB V). Only doctors with "addiction medicine qualification" may substitute without restriction; others at most 10 people, with a duty to coordinate.
Diamorphine (heroin-assisted treatment)
Since an amendment effective 5 December 2024, diamorphine treatment is regulated in its own § 5a BtMVV; the access requirements were relaxed (including reducing the minimum duration of opioid dependence from 5 to 2 years and the minimum age from 23 to 18 years). The exact official designation of this amending ordinance could not be conclusively verified.
Figures
According to the BfArM report on the substitution register (January 2025), around 80,400 people were reported as being in substitution treatment on the reference date of 1 July 2024, with around 2,434 reporting substitution doctors. No newer figures were available at the editorial deadline.
Uncertain/not conclusively clarified
The exact official designation and Bundesgesetzblatt citation of the BtMVV amendment of 5 December 2024, as well as figures more recent than July 2024, could not be reliably verified.
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