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Health insurers to foot bill for heroin

Some 1,169 heroin addicts receive daily doses of the drug Keystone Archive

Heroin addicts enrolled on Switzerland's drug treatment programme will in future have their fixes paid for by health insurance companies.

Under the new system announced by the government, health insurers will be required to fork out 75 per cent of the cost of heroin prescriptions. That works out SFr16.5 million ($10 million) a year, or SFr40 per addict per day.

Health insurers already foot a quarter of the bill.

Currently 1,169 addicts are given daily doses of the drug as part of the government’s Heroin Assisted Treatment (HAT) programme at a cost of SFr55 per addict per day.

The addicts themselves are expected to foot the balance – SFr15 a day – but for those without the means to do so the local authorities will pick up the rest of the bill.

“This scheme has nothing to do with legalising heroin and nothing to do with heroin becoming more accepted,” Martin Hosek, deputy coordinator of HAT at the Federal Office of Public Health, told swissinfo.

No legal recourse

The Office added that health insurance companies would have no legal recourse to fight the decision.

Health insurer, Swica, told swissinfo that, in its view, addicts were a public responsibility and that it was not up to health insurers to see to their needs.

“I was surprised to hear of the government’s decision because it doesn’t make any sense,” said Swica spokeswoman, Nicole Graf. “All it does is change who has to pay for heroin medication.”

She said ultimately it would be the public who footed the bill, through their health premiums, adding that it would take at least six months to see whether premiums would be raised to cover the additional costs.

Strict supervision

Under the HAT programme, addicts receive daily doses of Diaphine (soluable heroin) – 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. 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.

Hosek told swissinfo that the HAT scheme was attracting increasing interest from other European countries.

“We see some interest from countries like Britain and the Netherlands [which] want to see whether they can adopt or emulate some of the principles. A German trial started in February [and] Spain wants to start trials in November.”

Lives saved

In the ten years since the heroin prescription programme was introduced, drug experts say it has saved hundreds of lives.

Drug-related deaths, mostly from heroin overdoses, have dropped by half since 1992, while Aids-related deaths among drug users have fallen by a third since 1994.

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.

“The final goal is abstinence, but there are a lot of people who never reach that goal,” he told swissinfo in a recent interview. “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 said.

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

Reducing crime

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

He said that 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 SFr55 daily, whereas those not on the programme cost the government SFr96 a day in terms of policing, imprisonment and poor health.

Rehm said 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 said. “This is a long-term intervention and you can only judge it by its long-term results.”

by Samantha Tonkin

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SWI - a branch of Swiss Broadcasting Corporation SRG SSR

SWI - a branch of Swiss Broadcasting Corporation SRG SSR