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Medication abuse a growing concern in Germany

Tobacco and alcohol consumption is falling, but a graying Germany is at risk of becoming more dependent on pharmaceuticals.

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German addiction experts warn of a growing dependency on pharmaceuticals among older adults

Tobacco and alcohol consumption are down across Germany, the use of e-cigarettes is up and the abuse of sleeping aids, painkillers and anxiety medication is poised to grow among older adults, addiction experts reported in Berlin on Tuesday. 

The newly released "Addiction Almanac 2017" draws on data from health insurers, tax receipts and treatment centers over the previous year to catalogue trends in substance use, abuse and addiction - as well as addictive behaviors like gambling - across Germany's roughly 82 million residents.

Published by the German Center for Addiction Issues, the findings range from the trivial (nasal spray is the most purchased over-the-counter medication) to the curious (beer drinking is falling as wine consumption stays flat) and the concerning (women are more commonly addicted to pharmaceuticals like sleep aids than men).

Tobacco and Alcohol

Germans on average drank 105.9 liters of beer in 2015, the latest year for data, down from 109.3 liters four years earlier. Wine consumption remains roughly steady at 20.5 liters per year, almost the same as four years earlier. Both figures represent high consumption rates, researchers said, although in line with other Western nations. Binge drinking from age 15 is especially high for Europe, the study shows.

The past decade's steady decline in cigarette use continued in 2016, with sales 7.7 percent lower than the previous year and down 20 percent from a decade ago. Cigarette smoking is also down among children and teenagers, researchers said, and surveys show exposure to secondhand smoke has dropped as its dangers become better known.

Yet tobacco use has become more expensive for those who are addicted, and it should and could be further curbed, researchers said. The German government could further raise the price of a pack of cigarettes, for example, or do something that every other EU member has already done and prohibit tobacco advertisements and sponsorships, German Cancer Research Center researcher Dr. Martina Pötschke-Langer told reporters. 

"A law has been crafted, two ministers and (Germany's) Drug Commission stands behind it, but it's not moving forward in the respective committee," she said. "That's a dilemma for Germany."

Use of e-cigarettes continue to grow, the study showed. Most users are also tobacco smokers, researchers said, with many using the devices as a tool to quit cigarettes. The long-term health-effects of the devices remain unclear, however.

Illegal drugs

Consumption of narcotics among teenagers between 12 and 17 has ticked upward in recent years after steady declines between 2004 and 2011. Marijuana is most common, with harder drugs like cocaine and ecstasy remaining rare. Adult use of marijuana is also rising again.

The number of drug offenses pursued by police reached a 10-year high in 2016, Center director Peter Raiser said, a reflection of stepped-up investigations more than drug consumption. Yet the overwhelming majority of their cases, some 80 percent, still targeted drug users rather than dealers, Raiser said.  

"That means it's preponderantly, overwhelmingly - that is, 80 percent - users," Raiser said. "Sick people, people who are suffering from an addiction, suffering from a chronic biosocial sickness, and are threatened with punishment." he said. "It would be better if the investigations focused more on the dealer level."

Legal drugs

Dependency on legal drugs - prescription or over-the-counter - is easily overlooked, said Dr. Gerd Gläske, a pharmaceuticals researcher with the University of Bremen told reporters Tuesday. Yet after tobacco, legal drug use is the most common dependency in Germany, affecting an estimated 1.5 to 1.9 million people.

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Dependent users are more frequently older and female. Having reduced alcohol and tobacco consumption for health reasons, they turn to sleep aids, pain medication and anti-anxiety medication to solve personal problems or discomfort stemming from joint or back problems, he said. Benzenes, a drug class that includes Valium and other anti-anxiety medications, and sleep aids that rely on so-called "Z-drugs" Zolpidem and Zopiclon as active ingredients, account for three-fourths of all medication dependency in Germany, Gläske said. Side-effects range from lack of focus to mood swings and a greater risk of falls, followed by slow-healing injuries. 

Complicating the issue is that doctors and pharmacists aren't monitoring their patients as closely as they should. In some cases, addictive medications like sleep aids can be obtained through "private prescriptions" that are good for longer durations and may prompt fewer questions from doctors or pharmacists.

"This kind of dependency is easily overlooked, and the problems caused by these pharmaceuticals often underestimated," Gläske said.

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