Should heroin be prescribed by medical doctors?
While many countries have experimented with methadone clinics aimed at weaning people off of heroin and other addictive opiates, there is little doubt that the problem has been getting worse. One alternative that continues to be advocated in countries such as Canada involves making heroin available by prescription, something that continues to be vehemently opposed by conservative politicians and anti-drug activists. Despite promised changes by many governments, this continues to be an uphill battle in most places.
But Switzerland is not most places....
Due to the sharp rise of heroin use throughout the 1980s, "needle parks" sprang up in Swiss cantons across the country. Intended to limit the spread of intravenous drug use, the parks basically meant forcing users to congregate in small areas where users could shoot up without too much fear of arrest. That one of these parks sprang up just across from the seat of the Swiss Federal Assembly in Bern demonstrated to the politicians meeting there just how out of control the problem had become.
To combat the widespread drug use, not to mention the risk of HIV and other diseases spread by the sharing of needles, the Swiss Federal Council decided to take action. In 1992, they approved the first five-year experimental program for dealing with the heroin epidemic. Based on the "four pillars policy" (prevention, therapy, risk reduction, and repression), the first injection centre for prescribed heroin opened up soon afterward. Despite opposition from conservative politicians, medical prescription for heroin is currently available in all of Switzerland's cantons. In all there are 22 injection centers at present- including on in a prison- are managed by public hospitals or private care clinics supported by the state. There are currently 1500 patients at these centers, all of whom receive regular injections of diacetylmorphine - a form of heroin much stronger and safer than anything they might purchase on the streets.
As to how successful the program has been to date, the patients themselves remain candid on how their lives have changed for the better. In a recent article, several of these patients shared their experiences. “Methadone didn’t work for me," said 44-year-old Marco. "The side effects were terrible, and I didn’t get any tranquilizing effect. So I was taking other drugs on top of it. I’ve been registered here for the last six months. I’ve put on weight, and cut my heroin use by 80 percent. Eventually, I want to get clean.” Chantal, 54, an addict for 30 years, said: “The treatment gives me structure. I don’t have to chase after my dealer any more.” Jeff, 54, had just injected his daily dose; his pupils were dilated, and he spoke in a loud voice: “My quality of life has definitely improved. It’s stabilized my day. Before I got into the program, I was a dealer. I was cunning, I found ways to get money, I did stuff.”
In the same article, Yves Saget, an addictions nurse described how heroin treatment can be so effective. “Addiction happens when taking drugs becomes the only strategy for dealing with difficult situations," he said. "We don’t say ‘fix’ here, we say ‘treatment. The brain becomes dependent, and needs heroin to maintain its balance. At this center, we are treating 63 patients with diacetylmorphine. Medical heroin is pure, unlike the drug you buy in the street, which is cut with caffeine, paracetamol, and other substances. Street heroin isn’t satisfying, so addicts often take other narcotics with it, or alcohol, or psychotropic drugs such as benzodiazepine. Our dosage, which is individually tailored, allows patients to live as normal a life as possible.” He added: “We emphasize good citizenship—patients must treat our staff and the neighborhood with respect. This is their treatment center, so it’s up to them to protect it.”
For now, the experimental program remains popular in Switzerland. Whether or not the success of the current program will inspire other countries to establish similar programs elsewhere remains to be seen.
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