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The Swiss have given the world many notable things - the Swiss Army knife, the cuckoo clock and, of course, the Swiss Roll. What they gave us on Sunday last (30 November 2008) was, however, quite extraordinary. Despite the disapproval of the USA and the UN drugs authority, they voted ‘Yes' in a referendum in which they were asked to approve the continuation of a regime under which the State supplies heroin to long-term heroin users. Throughout the 1980s and early 1990s Switzerland had one of the highest rates of heroin addiction in Europe. In cities such as Zurich, Basel and Bern it was common to find addicts injecting and dealers selling publicly in the streets and parks. Users often shared needles, leading to high HIV infection rates, and in the spread of Hepatitis. In an attempt to reduce the spread of such diseases, the Swiss health department began introducing needle exchanges, followed by clean injection rooms where addicts could take their illegally-bought heroin in a safe environment, supervised by a nurse. For many, the next logical step was to start prescribing heroin to those addicts, many of them already ill, who really did not seem able to get off drugs. And so in 1998 following a referendum the law in Switzerland was changed to allow a ten year experiment in the state supply of heroin. The prescription of heroin was allowed to junkies who had tried everything else, but had been unable to give up the drug. Its prescription was though part of an overall strategy involving help from psychiatrists and social workers as well, in an attempt to help the addicts to normalise their lives. Under the scheme, patients can take heroin several times each day but, to have the supply, they must go to a clinic where they inject themselves as a nurse watches. There is no chance therefore of the heroin being taken away for sale on a black market. Although the dose is not in practice limited by the state, the amount mostly chosen for injection by addicts themselves is just enough to satisfy their cravings but not enough to cause a big high. This means that after a relatively short period of time, they are fit to leave and get on with their day. Those who have jobs go back to work. For those who have families, it is possible to have something approaching a relatively normal life. The permanent change in the law had already been approved by Parliament earlier this year, but the (mainly religious) right wing in Switzerland demanded a referendum on the basis that it was morally wrong to supply heroin to people who were never likely to become abstinent. In their view, it was only right to supply heroin where the ‘treatment' had as its likely outcome that the addicts would give up their habit entirely. Otherwise, how could it be regarded as ‘treatment'? So why did the Swiss decide last week by a majority of over two-thirds to adopt the more pragmatic view? Well, the previous ten years were an experiment and the results are now in:
And there is another, unforseen, result: the incidence of heroin use has dropped from 850 new users in the year 1990 to only 150 new users in the year 2002 and has continued at this lower level since. This contrasts with the situation regarding the number of users in the UK, Italy, and Australia, which has continued to rise. It seems that the supply of heroin by state-run clinics has changed the image of heroin use from being the rebellious act of rock stars to being an illness which needs therapy. Finally, for the Swiss, heroin seems to have become a 'loser drug', with its attractiveness fading for young people. Switzerland is now looking at extending the idea to other drugs, notably cocaine. Other countries, such as Australia, Germany, Denmark and Holland are seriously looking into the adoption of the policy for their heroin addicts. To give state help to people to continue to take heroin for the rest of their lives may seem shocking to those with absolutist moral views. For those of those of us who are not so hide-bound, however, it makes simple humanitarian sense to help people who have little real prospect of overcoming what is a dreadful disability and, at the same time, to relieve society of the consequences of the criminality which would otherwise inevitably accompany their sad lives. Maybe one day, even in this country, we shall benefit not only from Swiss Rolls, but Swiss pragmatism.
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