Heroin prescription is no quick fix

Ten years after the government launched its controversial heroin prescription programme, drug experts say the scheme has saved hundreds of lives.

Thursday is the 100th anniversary of the Swiss Institute for Alcohol and Drug Prevention, and experts say the country has plenty to celebrate, not least its success in tackling heroin addiction.

Today more than 1,100 heroin addicts, who have failed other attempts to shake off their addiction, receive daily doses of the drug – under strict supervision – at one of 22 injection centres across the country.

Addicts either inject heroin, which is legally produced by a Swiss pharmaceutical firm, or take it orally. At the drug dispensary unit in Zurich, those on the programme are allowed to inject themselves up to nine times a day.

Those who have been on the programme for several months – and are viewed as “stable” – are eventually allowed “take home” doses of the oral form of heroin or methadone to counter withdrawal symptoms.

Critics of the scheme have long maintained that the heroin prescription programme fails to wean addicts off drugs. But Dr Daniel Meili, a leading member of the association for the reduction in the risks of drug abuse, insists they are missing the point.

Primary Goal

Meili stresses the primary goal is to reduce people’s heroin consumption and to stabilise their physical and mental health by removing them from the drug scene.

“The final goal is abstinence, but there are a lot of people who never reach that goal,” he told swissinfo. “If you measure success only by the rate of abstinence you are on the wrong track because that’s not the primary goal – first people have to survive.”

Meili points out that statistics show that those outside the treatment programme die at a rate of two to three per cent a year. After ten years that means a death rate of 20-30 per cent – “maybe more”, he says.

“For me the programme has been a success because, from a medical point of view, the main aim is to reduce mortality”, he adds.

Drug-related deaths, mostly from heroin overdoses, have dropped by half since 1992 – the year the heroin prescription programme was introduced. Aids-related deaths among drug users have fallen by a third since 1994.

Dr Jürgen Rehm, director of the Addiction Research Institute in Zurich, says other important factors also need to be taken on board when assessing the merits of the programme.

Drug consumption

He says by reducing the prevalence of illicit drug consumption some indicators of social integration – most notably criminality – have also improved.

This is supported by statistics from the Federal Office of Public Health which show that at the start of their treatment, 70 per cent of addicts are involved in some kind of criminal activity. This figure drops to just ten per cent after 18 months on the programme.

Other studies reveal that the economy also benefits since the cost of treating a patient amounts to SFr51 daily, whereas those not on the programme cost the government SFr96 a day in terms of policing, imprisonment and poor health.

Rehm says the alternative of trying to withdraw addicts from heroin through rapid detoxification does not achieve the same results.

“Of course you can get them clean for a day or two but then what? Then they have to go back to their own place of living with their old environment, with their old subculture and nothing is gained,” he says. “This is a long-term intervention and you can only judge it by its long-term results.”

He adds that further proof of the success of Switzerland’s heroin prescription programme lies in the fact that other countries such as the Netherlands and Australia have adopted similar schemes.

“We know from a randomised clinical trial in the Netherlands, using the same methods, that they have achieved results and the Dutch government wants to prescribe heroin on a long-term basis for some drug addicts and they want to legalise heroin as a medication for drug addiction within the European Union,” he explains.

Heroin prescription

A report by Britain’s House of Commons home affairs committee, published this week, called on the government to radically extend heroin prescription and immediately introduce “safe injecting rooms”.

Over at the Federal Office of Public Health, Markus Jann, who heads up the drugs unit, says there have been no indications that the heroin prescription programme has had the effect of increasing the number of addicts. In fact, he adds, the number of heroin addicts in Switzerland – estimated at 30,000 – is “decreasing slightly”.

The average age of those entering into drug treatment programmes in Switzerland is increasing, giving rise to the hope that the number of addicts will eventually start to drop.

“Switzerland has not forgotten the overall goal of getting addicts off drugs,” says Jann. “We are convinced that heroin prescription can be, or is, the first step to abstinence for addicts who have dropped out of all other treatments including substitution with methadone.”

“We believe that even if the treatment takes a very long time, over five or six years, there will always be the chance that these people can get off drugs. This programme helps to stabilise these people and to make sure that whenever they want to take another step out of drugs they are still alive to get this treatment.”

by Adam Beaumont and Ramsey Zarifeh