Cannabis use, health problems, and criminal offences in Germany: national and state-level trends between 2009 and 2021

Abstract

The German federal government plans to decriminalise cannabis. The impact of this policy on use prevalence, cannabis-related health and legal problems cannot be fully anticipated and should be viewed in context with current trends. We used routine data on (a) cannabis use (population-based surveys), (b) cannabis-related diagnoses (ICD-10 code F12) in outpatient medical settings and (c) minor law offences (registered violations against the narcotics law for possessing small amounts) to analyse age and sex-specific trends by federal state between 2009 and 2021. To enable comparisons across time and federal state besides crude prevalence rates, age-standardised rates were calculated. Between 2009 and 2021, the age-standardised prevalence of cannabis use (5.7–10.6%), rate of diagnoses (1.1–3.7 per 1,000), and legal offences (1.8–3.1 per 1,000) increased, with the largest increase noted for cannabis-related diagnoses. Relatively, increases were most pronounced for older users (40-to-59-year-olds: use and offences; 35-to-44-year-olds: cannabis-related diagnoses) and rather stagnant for minors. Cannabis use and health problems appear to be more pronounced in Northern and city states, while no clear geographic trend was observed for law offences. Cannabis-related outpatient treatment demand has risen more steeply than use prevalence suggesting an increasing challenge for the health care system. Despite rising rates for documented offences, the long-term implications of law violations on social and occupational life are poorly understood but may be considered for evaluations of the proposed law changes.

Germany's cannabis act: a catalyst for European drug policy reform?

“…In 2021, about 150,000 people were registered as having violated the narcotics law by possessing minor amounts of cannabis for personal possession—a 65% increase compared to 2009. 33 Drawing on experiences from other legalising jurisdictions, we hope for a reduction in these legal consequences, and for a minimisation of possible racial disparities noted in those charged with such offenses. 34 With their focus on quality control, prevention and treatment referral, cannabis clubs may provide additional health benefits.…”