Neurobiological evidence and clinical experience indicate that opioid dependence is a chronic relapsing disorder. Crisis intervention, abstinence-oriented treatment (including detoxification and relapse prevention), and agonist maintenance treatment are the current treatment options depending on the individually pursued treatment goals. Agonist maintenance therapy is considered the first-line treatment for severe chronic opioid dependence. Numerous studies demonstrated evidence of a growing number of different agonist maintenance agents, such as methadone, buprenorphine and also new options like slow-release morphine, intravenous, inhalable and oral diamorphine. Despite the proven effectiveness of agonist maintenance therapy, the number of comprehensive care facilities nationwide is still not adequate. The growing number of patients in maintenance-treatment has not been accompanied by an increase in the number of specialized German physicians actively taking part in substitution treatment. Further efforts are needed to ensure adequate health care provision for opiate addicts in Germany.