Opioid crisis in Germany? Insights from a cross-sectional nationwide survey within the German drug scene
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Introduction
Synthetic opioids cause tens of thousands of deaths annually in North America and appear to be increasing in Europe. This study examined high-risk substance use in the German drug-using community with a particular focus on the synthetic opioids fentanyl and nitazenes.
Methods
A cross-sectional online survey was conducted in the drug-using community in Germany (August–September 2025). The sample included 235 individuals aged ≥14 years (mean age=43.4 years; 57.9% male), recruited by peers in open drug-use scenes (79.6%) and in addiction clinics and opioid substitution services. The primary outcome was past 12-month substance use. Additional measures included opioid sources, forms, routes of administration, perceived changes in availability and price, risk perceptions, overdose experiences, and harm-reduction behavior.
Results
227 respondents reported substance use (mean: 6.2 substances). 73.1% (95% CI=67.0– 78.5%) had used at least one opioid in the past year. Synthetic opioids were reported across regions and all age and gender groups. Among participants reporting a shortage of their primary opioid, 25.0% (95% CI=15.8–37.2%) used fentanyl as a substitute. 56.5% (95% CI=36.8–74.3%) of synthetic opioid users reported an overdose in the past 12 months. Most respondents perceived synthetic opioids as highly risky and feared contamination, but only 9.9% (95% CI=6.6–14.7%) use drug-checking services.
Conclusions
Synthetic opioids have entered the German drug scene and are associated with high overdose rates and limited access to harm-reduction measures. These findings indicate an emerging synthetic opioid transition in Germany and highlight the need for expanded surveillance, naloxone distribution, and drug-checking services.
