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Will Godfrey Will Godfrey

Heroin Maintenance and More: Switzerland’s Great Drug Policy Experiment

Former Swiss president Ruth Dreifuss talks about the radical policy changes that helped to mitigate her country's AIDS crisis.

4 Substance

In the 1980s, Switzerland suffered from the highest HIV rate in Western Europe, thanks largely to soaring levels of intravenous heroin use. How the country successfully mitigated this problem—with harm reduction approaches including prescribed heroin, or Heroin Assisted Treatment (HAT)—is instructive.

Last night, at an event hosted by the Open Society Foundations (OSF) in New York, former Swiss president Ruth Dreifuss—who became her country’s first female leader in 1999—related Switzerland’s journey to some of the radical changes that she oversaw.

“We were confronted in the ’80s with the peak of the AIDS epidemic,” she said. “We were also touched by the presence of a great number of people being injecting consumers of heroin, consumers of other substances, in a really marginalized way.” Swiss law enforcement reacted by keeping some neighborhoods of cities clear of open drug use, while allowing other areas—most famously Zurich’s “needle park”—to become de facto decriminalized zones.

But concentrating public drug use into certain areas wasn’t enough, said Dreifuss: “It was very clear that we couldn’t abandon the people in this open scene. We had to give them the means to protect themselves. We had to develop a public health policy.”

She explained the need to ”enlarge the spectrum of treatment,” to include abstinence-based programs alongside harm reduction provisions like clean needles, supervised drug consumption rooms, expanded methadone programs and the headline-grabber: HAT—which prescribes heroin to long-term users in order to bring them into contact with the health system, keep them safer and cut associated crime.

“Everything can be a treatment if we help people take one step forward,” said Dreifuss. “So why not prescribe heroin to people who failed at every step before, who even failed in methadone programs because they couldn’t comply?”

Switzerland’s highly scrutinized five-year “experiment” with HAT, involving 1,000 long-term heroin users for whom other approaches had failed, was a resounding success, despite some international opposition. The OSF’s report, From the Mountaintops, summarizes some of the findings:

It was possible to stabilize dosages of heroin, usually in two or three months, without a continuing increase of dosages, which some had feared.

There was significant and measurable improvement in health outcomes for patients, including significantly reduced consumption of illicit heroin and even illicit cocaine.

There was a significant reduction in criminal acts among the patients, to the point where the estimated benefits of this effect well exceeded the cost of the treatment.

Heroin from the trials did not find its way into illicit markets.

Initiation of new heroin use did not increase.

Utilization of treatments other than HAT, especially methadone, increased after the advent of HAT rather then declining as some had feared.

“Generally people are really satisfied with this new policy,” said Dreifuss last night, “including people who fought against it that now accept the good results.”

In 1988, 64% of Swiss people thought that drugs were one of their country’s five biggest problems—in 2002, only 12% did. After several votes—including a 68% “yes” in a 2008 referendum—HAT has now been legally endorsed as one element of Switzerland’s broader drug strategy. Interestingly, this happened even though Switzerland is a relatively conservative country in some ways: Voters in that 2008 referendum rejected marijuana decriminalization, although it’s back on the political agenda now.

Political realities have prevented the adoption of HAT in all but a handful of other European countries, and despite further positive study outcomes, it still seems a long way from happening in the US.

Switzerland’s former president believes that rather than pursuing what she calls “the myth of a drug-free world,” policy should focus on doing all of the things that help people to stay safer: ”The only good addicted person is a living person. She is the only one who has the chance to become free and to live a normal life.”