Since the end of the 1980s, metropolitan communities in Northern and Central Germany have been concerned by the emergence of open drug use, increased HIV and mortality rates among drug users, and drug-related property crimes and have come to favor survival-oriented help for drug users. While the Federal Government still favors repression and law enforcement, officials have made needle exchange programs legal. At the local level, authorities provide a variety of services, such as housing, crisis intervention, primary medical care, maintenance with substitute drugs, and needle exchange programs. The creation of pilot heroin maintenance programs is planned for Frankfurt and Hamburg. Established needle exchange programs are successfully functioning in large cities, but the demand for sterile needles and syringes remains unmet in smaller cities. Another major problem continues to be the drug use situation in prisons. Although intravenous drug use is common in prisons, injection equipment is not legally available for the 10,000 IDUs imprisoned at any given time. Even so, 2 of Germany's 220 prisons started an experimental needle exchange program in 1996. An appendix contains the Frankfurt Resolution, an agreement for cooperation in the formulation of drug policies. 61 references and 1 table