Early trends in outpatient addiction care for cannabis use disorder following cannabis legalization in Germany: Evidence from National Monitoring Data

BACKGROUND AND AIMS: With the introduction of the German Cannabis Act (CanG) in April 2024, cannabis use was partially legalized in Germany. This study investigated immediate trends following this policy shift in treatment-seeking for cannabis use disorders (CUD) in the German outpatient addiction care system. METHOD: Data were obtained from the German Addiction Statistical Service (DSHS), Germany's national monitoring system for addiction-related treatment demand. We analyzed meta-aggregated datasets for two pre-legalization years (2022, 20 223) and one post- legalization year (April-December 2024), focusing on care episodes with a primary CUD diagnosis (International Classification of Diseases 10th Revision codes F12.1/F12.2). Annual facility-level rates were calculated for admissions and key treatment characteristics. Year-to-year differences were assessed using rate ratios (RR) with 95% confidence intervals (CI), adjusting for multiple testing. RESULTS: CUD-related admissions per facility increased from 29.0 cases in 2022 to 30.0 cases in 2023 (RR = 1.03, 95% CI: 1.02-1.05) followed by a decline to 25.6 cases in 2024 (RR = 0.85, 95% CI: 0.84-0.87). The number of female clients remained stable (≈5.5 cases per facility), whereas male admissions declined from 23.9 in 2023 to 19.8 in 2024 (RR = 0.83, 95% CI: 0.81-0.84). Admissions among clients aged under 25 years decreased from 15.1 to 11.4 per facility between 2023 and 2024 (RR = 0.76, 95% CI: 0.0.74-0.78). Similar downward trends were observed for first-time admissions, referrals through the legal system and legal obligations to admissions. CONCLUSIONS: First nation-wide monitoring data in Germany demonstrate a decline in cannabis use disorder-related outpatient addiction care seeking following the introduction of the German Cannabis Act, which may indicate that established ways of reaching young at-risk populations is no longer functioning effectively.