Swiss drugs policy bearing fruit

Inside the new injection centre in Geneva Keystone Archive

Switzerland's liberal drugs policies, epitomised by a new injection centre in Geneva, continue to win converts and provoke criticism.

Swiss drugs policy has come a long way since the early 1990s and the images of hundreds of heroin addicts shooting up in “needle park” in the middle of Zurich. Tolerance has given way to an integrated strategy where harm reduction and therapy is just as important as prevention and repression.

While some still regard injection centres and heroin with horror and bewilderment, the Swiss authorities would contend that it is working. So much so, that their approach is being copied.

“It is a policy based on pragmatism, and, as far as possible, on scientific evidence,” says Ueli Locher, head of federal drugs policy.

Last resort

Heroin prescription, approved in a referendum in June 1999, is restricted to those drug-users for whom other treatments have failed – a “last resort for the hardest cases” as Locher puts it. The scheme has been copied in a number of countries, including Germany, Spain and the Netherlands.

Injection rooms are aimed at minimising the health risks associated with drug-abuse, increasing social contact for marginalized addicts, and offering the chance to direct them into therapy programmes.

These facilities – often known as shooting galleries – have been used in German-speaking Switzerland for over a decade. But the first such centre in a French-speaking canton has just opened in Geneva. Another is being planned in Lausanne.

“If this place had existed 15 years ago, I would not be HIV-positive today,” says Bianca Maria Infante, president of the Geneva AIDS Group, which runs the new “welcome centre”. Launching the project, she painted a picture of a life shooting up in filthy public toilets, car parks and cold shop doorways.

Damage limitation

The centre is located in a prefabricated building behind Geneva’s railway station, a regular haunt for many heroin addicts. A needle-exchange scheme has been operating in Geneva for a number of years, but here they can take their drugs in a clean, hygienic environment, with medical assistance close at hand.

“You cannot completely eradicate drug use,” says Christophe Mani, head of the Geneva AIDS Groups harm reduction section.

“But you can accept that it exists and try to limit the damage as much as possible. And the best way of doing that is to ensure that people are not driven underground. If you stay close to people, you can help them,” he told swissinfo.

The centre is staffed by trained social workers and nurses. The large reception area leads to a clean, spartan injection room, where a nurse provides clients with a clean spoon and needle. The addicts must provide their own drugs. No dealing or violence is allowed in the centre or in the vicinity.

The staff reject accusations that they are encouraging drug use. They argue that the people who use the centre are taking a big step towards confronting their addiction and their social responsibilities.

Step towards legalisation?

Despite its apparent success, the Swiss strategy continues to provoke the ire of the International Narcotics Control Board (INCB), the independent agency responsible for implementing United Nations drug conventions. It believes “shooting galleries” are a step away from the legalisation of hard drugs.

“This is not in line with the conventions. This is clearly non-medical use of heroin under the supervision of the authorities,” says Herbert Schaepe, secretary of the Vienna-based INCB.

“If you see it only in terms of harm-reduction, then it seems a good thing. But drug control is not only about harm-reduction. We want to significantly reduce demand, and injection rooms have no impact on demand,” Schaepe told swissinfo.

Nevertheless, a number of countries are drifting away from this absolutist stance. The record of countries like Britain, which has some of the most stringent drugs legislation in Europe, has convinced them that adopting a hard line is not necessarily the most effective approach.

International debate

“The international view has definitely become more informed. Other countries have realised that what we’re doing is not so terrible,” Locher says.

“When you look at the other countries that are opening injection rooms and prescribing heroin, we can say that Switzerland has made a contribution to the international debate,” he told swissinfo.

Switzerland can point to the figures to show that its policy works. Deaths from overdoses are half what they were in 1992; AIDS-related deaths among drug users have fallen by over a third since 1994; HIV infections have stabilised; the number of people in treatment has doubled in the past decade.

The four-pronged Swiss strategy – law-enforcement, prevention, therapy and harm-reduction – is enshrined in a new draft drugs law being considered by parliament.

Public opinion

The government’s pragmatic approach would seem to have the backing of the Swiss people, judging by the results of a series of federal and regional votes in recent years.

“The stereotype of the drug user still persists. But the attitude of the public has evolved, and they’re now much more tolerant,” Mani says.

The Swiss approach does not come cheap. Well over SFr 1 billion francs is spent on law-enforcement, rehabilitation, harm-reduction, prevention, and research. But this is only a fraction of what it would cost if a more hardline approach were adopted.

“The more people who are in therapy, the less needs to spent on repressive measures. This is the cost-effective way of dealing with the problem,” Locher explains.

by Roy Probert