Treat heroin addicts with heroin: it’s the best option, both for the addicts and society:
In the late 1980s and 1990s a major spike in heroin-related HIV cases occurred in Switzerland. More young people were using heroin, and there was an increase in overdose deaths and heroin-related crime. Large open drug scenes in Swiss cities attracted thousands of addicts daily. A rather repressive and prohibitionist drug policy was unable to cope with these challenges. Health professionals managed to persuade the authorities that continuing with a criminalising, police-based approach would not resolve the problem. Instead a harm-reduction approach to public health programmes was developed, which included such methods as needle-exchange programmes, safe heroin-injection rooms and the treatment of dependency. Switzerland developed a drug policy based on four pillars—policing, prevention of drug use, treatment of drug use, and harm reduction. Much can be learned by this positive and forward rethinking of drug policy.
In 1994 Switzerland became the pioneer of the ‘heroin clinic’, a safe environment where addicts go to be prescribed and inject pure heroin, as opposed to its sometimes ineffective substitute, methadone. Initially, this programme was met with scepticism, but the Swiss public were persuaded of the benefits of heroin-assisted therapy (HAT) and endorsed it twice in nationwide votes . This new-found confidence in HAT was primarily due to a cost-benefit analysis estimating that the rewards of the programme (money saved in law enforcement and health costs) were double that of the cost , tackling areas such as crime, social reform and stopping the spread of HIV & AIDS.
Drugs and crime are inextricably linked. Addicts need money to feed their habit, so they often commit theft. However, by prescribing addicts heroin, analysts have seen a reduction in serious crimes of up to 90% against property committed by drug users . According to estimates, a similar programme being implemented in the United Kingdom has resulted in crime costs falling by £16.1m in the first year, and £11.3m during the second .
Treating an addict rather than just imprisoning them, where they will more likely be exposed to an even deeper criminal lifestyle, allows them to make a positive contribution to society. Upon admission to the HAT, 73% of the addicts were unemployed and 69% were funding their habit via an illegal income. After 18 months of treatment, the figures dropped dramatically, to 45% and 11%, respectively .
Initial concerns about the HAT program, from Swiss citizens and the governments of neighbouring countries, were not confirmed; prescribing heroin did not lessen the perceived risks of heroin use by the young, drug-free treatment did not become obsolete, patieents did not stay forever on HAT but left after 3 years on average, and the positive effects were sustainable after leaving the programme.
HIV & AIDs
Blood-borne diseases plague drug-consuming populations, primarily due to the swapping of used needles. By providing addicts with clean apparatus to inject with, Switzerland has seen a decrease in the spread of HIV and AIDs, an issue that concerns the general public, as well as drug users .
The Swiss experience with heroin and drug policy reform can be generalised to offer a number of important lessons:
i) Programmes must be based on scientific-evidence and research and not ideological statements;
ii) Public education is vital on drugs and drug policy;
iii) All programmes should be open to independent non-governmental review;
iv) Judicial and health approaches must be co-ordinated.
In 2012, despite dogged opposition by conservatives, a proposal was approved to impose a fine on consumers of small amounts of cannabis instead of opening formal criminal proceedings, hence Switzerland has joined a growing number of countries adopting some form of decriminalisation.
Godfrey C., Stewart D., & Gossop, M. (2004) Economic analysis of costs and consequences of the treatment of drug misuse: 2-year outcome data from the National Treatment Outcome Research Study (NTORS) Addiction 99 (6)