Heroin for Addicts Works as Swiss Fix

Heroin for Addicts Works as Swiss Fix
Posted by FoM on July 31, 2001 at 08:35:44 PT
By Susan Taylor Martin, Times Senior Correspondent
Source: St. Petersburg Times 
In an old house near Switzerland's capital city, heroin addicts are getting ready for their midday fix. A young man with pierced ears cinches a piece of rubber tubing tightly around his arm. The brachial vein bulges out, making it easier to stick in the needle. The men with him have been shooting up for so many years, the veins in their arms have hardened. One man yanks down his pants and injects himself in the fleshy inner thigh. Another works a syringe into the thin skin on the back of his hand. 
They are among the 30,000 or so heroin addicts in Switzerland. There is nothing unusual about their craving for such a highly addictive drug or their methods of taking it. What is unusual, though, is the setting. This is a Swiss prison and it is the Swiss government -- not a fellow junkie or illegal dealer -- that is supplying the heroin. Since the mid '90s, Switzerland has provided pure heroin to a small group of addicted prisoners and hundreds of other addicts who have been unable to kick their habits through more common forms of treatment. Though controversial even in Switzerland, the heroin prescription program has helped reduce drug-related crime, improve addicts' health and slow the spread of AIDS and hepatitis. It is part of what experts consider the world's most innovative approach to dealing with opiate addictions. The Swiss government also sanctions methadone treatment for heroin addicts and "safe injection rooms," where intravenous drug users can get fresh syringes and shoot up in clean surroundings under medical supervision. It's all based on a philosophy of "harm reduction" -- reducing the harm that illegal drugs cause to the users themselves as well as to society as a whole. "We don't waste our energies on drug wars and things we can't change," says Anita Marxer, who runs the injection center in Bern. "There are people who are addicted, you find them in every corner of the world. ... It's better to accept a problem and deal with it in a pragmatic way than strive for a goal that is impossible." Switzerland's lead is being followed by a small but growing number of countries disillusioned with "zero-tolerance" U.S. drug polices. That has put the Swiss at odds with the U.S. government, which criticizes the Swiss approach and maintains that "drug use is widespread" among the country's 7.1-million people. However, the United States' own figures belie that claim. According to the State Department's latest report on global drug trends, marijuana is by far the most commonly used drug here yet is smoked by less than 8 percent of all Swiss -- a rate not out of line with other Western European countries and the United States. Based on recommendations from a panel of experts, the Swiss government expects to legalize the personal use of marijuana by mid 2003. The proposed revision of Swiss narcotic laws would also legalize the heroin prescription program, a radical approach that has been used in clinical trials since 1994. The idea was born out of revulsion with the "open" drug scenes that sprang up in the early 1980s. Hundreds of addicts congregated in public areas, including Bern's Kochar Park, near a pleasant residential area, and Zurich's notorious "Needle Park," next to the main train station. "It's not so easy to be a junkie in a little town so they came to the bigger towns and the scenes starting growing," says Barbara Muehlheim, who heads Bern's heroin prescription center. At Kochar Park, "there was crime, there was noise, all the dealers were on the scene, they were very aggressive. The police tried to control it, but it was so big. You would see about 50 people in the morning, by evening there would be 500. The whole park was filled up with people sleeping there." Among other steps to control the drug crisis, the government gave the go-ahead to prescribing heroin for hard-core users as part of a comprehensive program that included counseling and medical care. Participants had to meet strict criteria: age 20 or older; addicted to heroin for at least two years; a history of failure with other types of treatment; adverse effects of drug use on health and social relationships. "These people are in an absolutely desperate condition, so you can't put them immediately into abstinence-oriented treatment," says Georg Amstutz of the Swiss Federal Office of Public Health. "The first thing is to stabilize them and treat their diseases and get them in a condition that they can face another therapy that might lead to abstinence." The program began with centers in Bern, Zurich and several other cities. A year later, in 1995, it expanded to the minimum-security prison in Solothurn, about a half-hour's train ride from Bern. The decision to include inmates in the clinical trials was based on a reality of prison life the world over: Despite efforts to keep them out, illegal drugs will get in. "In every prison you will find drugs, some more, some less," says Heinz Stutz, a social worker at Solothurn. "They tried to find out where drugs were coming from, but it's not possible to block everything." Still, the idea of abetting a prisoner's addiction stunned the guards. "We felt a little overrun by the system," says Yeli Schleup, the guard supervisor. "(The inmates) were being punished for drugs, that's why they were here and now the state of Switzerland is giving them heroin." Although the simple possession of drugs is rarely prosecuted, Switzerland has cracked down on drug traffickers. Most of Solothurn's 76 inmates are doing time for drug dealing, and 12 are so seriously addicted themselves that they qualified for the heroin prescription program. Three times a day, they head to the prison offices, in a 17th century house, to get their fixes. The injection room is clean and bright, with a big bouquet of fresh flowers. A nurse removes the heroin from a wall safe and gives each prisoner a premeasured, individualized dose. With brusque efficiency, the first three men take small squares of disinfectant-soaked gauze and swab the areas where they will inject themselves. They find a vein, shoot up, wipe away little trickles of blood and leave. The whole process takes no more than five minutes. A fourth prisoner, Otto Krummenacher, mixes his heroin with water and drinks it. His veins are "too hard" to inject, he says. Now 44, Krummenacher started drinking beer at 14 or 15 and moved on to heroin, whose relaxing effect helped his chronic insomnia. Although he occasionally smoked marijuana, he scoffs at the argument that it is a "gateway" drug that inevitably leads to heroin addiction: "In the beginning it can be alcohol or marijuana or TV -- it can be anything." Krummenacher held jobs for a time but found "it was too much to organize heroin and keep working." To support his habit, he bought heroin in Zurich and sold it in his native Lucerne. Twice he was arrested and put on probation; the third time he was sentenced to 39 months, but will have to serve only 24. A half-hour after taking the drug, Krummenacher acts no differently than before. He has been using heroin so long "it doesn't change my mind," it only gives him what he describes as a warm, relaxed feeling. Like other inmates in the heroin program, he is not allowed to drive prison vehicles or use heavy machinery. However, he can work in the prison garden, tend its small herd of cows and assemble lamps, which the prison makes under contract with a private company. On his furloughs, Krummenacher visits friends in Lucerne and gets his heroin from the prescription center there. After he is released from prison, he plans to move to Morocco, where, he says, he can live well on his monthly disability check from the Swiss government. "Maybe," Krummenacher says, "it's a way of life to take drugs." Despite initial skepticism, the prison guards have come to believe the heroin program makes sense for hard-core addicts like Krummenacher. "In time we saw that their health was getting better, they were pretty calm afterward," says Schleup, the guard supervisor. "They have different behavior, they are interested in different things instead of thinking only about drugs and where they would get them." In 1997, three years after the clinical trials began, a panel of experts concluded that Switzerland's heroin-assisted treatment "is useful ... and can be carried out with sufficient safety." Specifically, the study found: In the first six months of treatment, the number of crimes committed by participants dropped about 60 percent. The percentage of those with permanent employment more than doubled, from 14 to 32 percent. Participants saw improvements in physical health and a decrease in psychiatric problems, including depression. Babies born to addicted mothers were normal and healthy. After withdrawal from the program, addicts' use of illegal drugs increased somewhat "but remained clearly below the initial level." By the end of the first two years, 83 people had decided to give up heroin and switch to abstinence therapy. "The economic benefit of heroin-assisted treatment is considerable," the study said, noting the reduced costs of treating disease and imprisoning addicts. The program remains highly controversial. Even those who acknowledge its successes say it might not work nearly as well in other countries. "The positive developments (in Switzerland) are the result of complex measures, supported by a sophisticated social and health care system and impressive financial resources, and not the result of any isolated element of the drug control policy," says a report from the International Narcotics Control Board, the United Nations' drug-control arm. "The Board therefore encourages other countries examining the Swiss experience to consider its complexity." Opposition continues in Switzerland itself. Most of the 21 heroin prescription centers are in German-speaking parts of the country, where the "open" drug scenes became such a blight on Zurich and other big cities. Heroin treatment remains controversial in the French- and Italian-speaking cantons, which are more conservative and had less of a visible drug problem. But most Swiss endorse what they see as their government's middle-of-the-road approach. In the past few years, voters have soundly rejected extreme proposals, one that would have legalized all drugs, another that would have adopted a policy aimed at total abstinence. "Swiss drug policy was made with doctors, social workers, police, cantons, everybody sitting at the same table," says Amstutz of the Office of Public Health. "That's one of the very important points -- everybody was involved. We reached a national consensus on drug policy that successfully passed the test of national popular votes. "We've heard many criticisms for many years and we can only say we're convinced our policy is a good one for Switzerland." -- Susan Taylor Martin can be contacted at: susan sptimes.comTreat or Get Tough? Britain Tries AgainBy David AdamsBrighton, England -- This windy seaside town, once known as an elegant summer retreat for well-heeled holidaymakers, has lost its gloss. With the highest level of heroin-related deaths in Britain, Brighton has an unseemly reputation as the country's drug mecca. "Brighton is top of the league when it comes to drugs," says Ray Jenkins, a 38-year-old reformed heroin addict who manages a substance misuse program for a local charity called Crime Reduction Initiative. "It's not something we are proud of." Like their counterparts in the United States, Jenkins and other drug charity workers are critical of the lack of government money for drug treatment programs. They say that proper treatment services could reduce the spiraling crime and health costs associated with drug addiction. But unlike their counterparts in the United States, they are growing more optimistic about winning the debate. "The government is just beginning to realize that we need to have better treatment services," Jenkins says. "It's a time of great expansion and great activity." After experimenting with repressive U.S.-style criminal justice measures to crack down on drug abuse, the government has come under increasing pressure to adopt a softer approach more in line with its European neighbors. With one foot in each camp, the British drug debate provides a useful barometer on where international drug policy is headed. For years Britain was at the forefront of the "harm reduction" approach to the drug problem, which advocates treating addiction as a public health issue and not a criminal one. Britain led the world in the 1980s by adopting a government-paid needle exchange. Today, the program distributes about 3-million syringes a year to addicts from 2,000 centers around the country. But cocaine and heroin use, as well as drug-related crime, have risen in recent years, the rise a product of high unemployment in parts of Britain coupled with the greater availability of drugs. Advocates of better treatment for addicts have lost ground to political pressure for more repressive criminal justice measures. In the late 1990s, Prime Minister Tony Blair's government began to incorporate drug policy into a "get tough on crime" strategy that even proposed mandatory drug testing for all criminals. "We have gone through several stages and gone through them very quickly. We might look as though we have a foot in every continent," says Gerry Stimson, a professor who heads the drug research center at Imperial College, one of London's top medical schools. The tide is turning again. After a top British Cabinet minister suggested the government might consider relaxing its stance on drugs, a national newspaper poll found 37 percent of Brits favored legalizing marijuana -- a dramatic increase over previous surveys. The outgoing chief inspector of prisons called for the legalization of all drugs, and leaders across the political spectrum have since chimed in. The left-wing mayor of London, Ken Livingstone (known as "Red Ken"), described the war on drugs as a failure and called for greater emphasis on treatment. The former deputy leader of the opposition Conservative Party, Peter Lilley, also broke ranks to advocate the sale of marijuana in licensed outlets. Marijuana possession carries a maximum five-year jail sentence and a $7,000 fine. Police complain that dealing with marijuana drains their ability to police more dangerous Class A drugs. An independent inquiry last year, the first in 30 years, was set up to examine marijuana laws. Headed by a member of the government's advisory council on the misuse of drugs, the inquiry recommended substantial reductions in penalties for marijuana possession. But the report was largely dismissed by the Blair government. This month, police in the London borough of Lambeth took matters into their own hands, announcing a radical six-month experiment. Instead of arresting pot smokers, officers will confiscate their drugs and issue only a caution. Robert Broadhurst, head of the Brixton police, one of Lambeth's toughest neighborhoods, says the experiment has helped his officers devote more resources to the area's crack cocaine problem, which has dealers selling crack right from the train station platform. "We are overwhelmed by it," he says. "It's an open drug market." In the last year, Lambeth police spent about 5,000 hours processing 680 arrests for marijuana possession, only to see most offenders let off with small fines. "The courts don't use the powers they have," Broadhurst says. "When we know there's no tangible results some of the PCs (police constables) are saying, "Why are we doing this?' " Critics of government policy hail the Lambeth experiment. "Legalizing cannabis would be a sensible step, but what is more urgently required is a fundamental overhaul of the prohibitionist policies on drugs such as heroin and cocaine that successive British governments have imported from the United States," says John Gray, a professor at the London School of Economics. "When drug use is commonplace and widely seen as normal it makes no sense to prohibit it. The result can only be to make criminals of otherwise perfectly ordinary people." But policymakers are wary of any march toward legalization, arguing that removing the ban would likely lead to wider drug use. "Quite frankly we don't know enough about these drugs when they are used in an unsupervised manner," says Detective Geoff Monaghan, a drug policy expert with the Association of Chief Police Officers, which advises the government. About 1,800 criminally active drug users are in the Brighton area, which has a population of about 350,000. Social workers estimate that every cocaine or heroin addict enrolled in a needle exchange saves more than $100,000 in health costs. Dirty needles are what cause most drug-related infections, including AIDS and hepatitis C. In recent years, Britain has succeeded in dramatically reducing the AIDS infection rate among intravenous drug users, down to 130 new cases last year. "I'm glad as a country we are moving away from "Just Say No,' " says Jenkins, the Brighton substance misuse worker. "It's about taking the lid off it. We have to get to grips with the fact that kids are going to try this." Legal Drugs CheaperBy Times Staff WriterBern, Switzerland -- One argument for legalizing drugs is that it would eliminate the black market and sharply reduce prices. Drug users wouldn't be as likely to turn to crime to pay for their habits. Switzerland's heroin prescription program gives some support to the theory. The prescription center in Bern last year distributed about 55 pounds of pure heroin obtained on the legal market. Total cost: $128,000. The same amount on the black market? An estimated $3.7-million. Source: St. Petersburg Times (FL)Author: Susan Taylor Martin, David Adams and Times StaffPublished: July 31, 2001Copyright: 2001 St. Petersburg TimesContact: letters sptimes.comWebsite: Versus Them - St. Petersburg Times SeriesMarijuana Loses Its Appeal In Coffee Shop Culture of Ecstasy Experiencing 'Fatigue' With It Approach To Education: Just Lay Out Facts Policy Not Limited To Borders's Pot Feeds U.S. Habit
Home Comment Email Register Recent Comments Help

Comment #5 posted by Dan B on August 01, 2001 at 03:54:19 PT:
A Nation of Alcoholics
Patrick argues, "When prohibition ended did we become a nation of alcoholics?" and I have to say that is a good argument. Still, many would say that we did, in fact, become a nation of alcoholics, and I would tend to agree. The question, then, is why?The answer: people turned to alcohol as the principal method of intoxication because it has been, since 1937, the only legal intoxicant widely available without a prescription. If the other drugs were never illegal, I predict that drug abuse (not use, I'm talking about abuse) would never have become a big societal factor. In fact, it really is not a major societal factor right now, aside from the mass hysteria surrounding drug use. Consider this: By the government's oft-cited estimate, we have about 5 million "drug addicts" in this country (in actuality, the number of addicts is significantly lower than this: about 2.7 million, or about 1% of the population). Even if we accept the larger estimate, that is less than two percent of the U.S. population--hardly a significant problem. Further, if cannabis were legalized, we'd have a less harmful drug than alcohol to legally use. I predict that many would switch from alcohol to cannabis after discovering that it produces many of the positive effects without causing the disorientation, digestive disturbance, or hangover produced by alcohol. If more people switched from alcohol to cannabis, we would predictably have fewer highway accidents and less overall violence in our communities. More importantly, police could then be in a position to actually serve the community, rather than simply arresting as many citizens as possible in the name of the war on (some) drugs.I hope this makes sense. I'm tired.Dan B
[ Post Comment ]

Comment #4 posted by J.R. Bob Dobbs on July 31, 2001 at 12:14:56 PT
  Sounds perfectly reasonable - and a lot similar to the way heroin use was treated in the 19th century. People did it in private with a slight sense of shame, to be sure, but they didn't have anyone actively waging war against them.   For examples, look at the movie Topsy Turvy, and the way some characters' opiate use affects the group as a whole, but not in the same way it would today. Also, the first few chapters of Sperber's biography of Humphrey Bogart give insights as to how his parents were able to live while both were frequent opiate injectors in the early 20th century.
[ Post Comment ]

Comment #3 posted by Ethan Russo, MD on July 31, 2001 at 11:05:58 PT:
The Truth Hurts
If you are a lying Amerikan bureaucrat. The answers are so obvious once these innovative European approaches are described. Too bad the ostriches will continue their postures and do nothing on this side of the pond.
[ Post Comment ]

Comment #2 posted by E. Johnson on July 31, 2001 at 10:28:21 PT
Lying is still a SIN, right?
All these Sunday morning Christians in the US government forget that lying is still a sin when you leave church.And lying doesn't stop being a sin when you go to work for the federal government, either.
[ Post Comment ]

Comment #1 posted by Patrick on July 31, 2001 at 08:57:01 PT
Making Drug Sense
The U.S policy of zero-tolerance is looking weaker every time the truth gets published. One of the fears of legalizing drugs is that that drug use will rise dramatically. I don't know for sure, but I doubt it based on the numbers being generated from Europe's programs compared to U.S. numbers with "the deterrent of jail" for drug use hanging over ones head. When prohibition ended did we become a nation of alcoholics? Once again, I ask congress to explain to the public why a weed that grows everywhere has more value than an ounce of gold? Me thinks it has something to do with your silly little war on drugs. You want to prevent drug use and abuse? Educate the children with the truth not scare tactics. 
[ Post Comment ]

Post Comment