[Drug addiction and anaesthesia: most popular recreational drugs in Germany and anaesthesiological management of drug addicts].

Drug addicts need special anesthesiological care due to their co-morbidities, their modified need for analgesics and anesthetics and/or their specific substitution therapies. In spite of the high incidence of addiction worldwide controlled studies and evidence based recommendations for the anaesthesiological management of the patients are missing. The perioperative care is not the treatment of addiction, on the contrary the specific aspects of a chronic disease have to be accepted. Equally important perioperative treatment strategies for the management of drug addicts include: 1. stabilisation of the physical dependence by substitution therapies. 2. avoidance of distress or craving. 3. perioperative stress relief. 4. strict avoidance of inadequate analgesic treatment. 5. postoperative optimization with regional or systemic analgesia with non-opioids, opiods and co-analgesics. 6. consideration of specific physical or psychological comorbidities. Inadequate analgesic treatment is known to be responsible for relapses into addiction and has strictly to be avoided. This holds true even for people with long term drug abstinence.