In the 1990s, Switzerland decided to fight one of the worst drug epidemics in Europe by testing a radical and controversial policy — which included offering pure heroin and consumption rooms to addicts.
The new strategy has dramatically reduced the number of overdoses, HIV infections, AIDS-causing viruses, and new users. In an interview with journalist Zak Brophy, from the BBC radio program Witness, Swiss doctor Andre Seidenberg, who has worked with drug addicts for decades, and former president Ruth Dreifuss, who campaigned for change in public policy in the country, report how Switzerland defeated the uncontrolled use of heroin by facilitating access to the drug in the 1990s.
“I tried almost every drug, my friends had serious drug problems. Fortunately I escaped… I started studying medicine, and my patients sometimes ended up being old friends.”
The speech is from Seidenberg, now retired, who has worked helping users in Switzerland since the 1970s.
At that time, the country was experiencing a major heroin epidemic. The government responded with police repression and treatments focused only on abstinence. But the strategy wasn’t working.
The situation got so out of control that, in the late 1980s, some local governments decided to tolerate drug use in certain public spaces, such as parks, in an attempt to regain some sort of control. These places became known as “needle parks”—and Zurich’s Platzspitz Park was one of the most famous.
“First it was a few hundred, then a few thousand every day, drugging, wandering around, dealing all kinds of drugs. It became a horrible scene, with a lot of HIV, and people dying right there. They died in the park or nearby , on any corner. It was a disgrace,” says the doctor.
Seidenberg was part of the growing community of healthcare professionals that challenged official policy. They began offering addicts access to shelter and medical services in addition to sterile needles, which was particularly vital when HIV began to spread in the 1980s.
In the late 1980s and early 1990s, Switzerland had the highest HIV infection rate in Western Europe, in part due to needle sharing. It was the dark side of one of the richest societies in the world — plunged into a crisis that was apparently classless.
“No ‘needle park’, you could meet any kind of people, rich people and poor people, people completely desperate and almost dying or actually dying. And you also saw healthy, rich people who worked in a bank during the day but bought heroin.”
For Seidenberg, it was clear that the current policy was not working. “The son of a friend of mine died of an overdose after two years of struggling to become abstinent,” he recalls. “So this is my personal experience, we really failed, we failed in treatment, we failed in prevention. And we were powerless in the face of the damage produced by consumption.”
When former Swiss President Ruth Dreifuss became Health Minister in the early 1990s, the voices of reformers like Seidenberg were increasingly drawing the attention of policymakers. And she herself supported the new approach. “It was clear that I, as federal minister of health and responsible for implementing the narcotics law, had to facilitate innovation in practice,” she says in an interview with the Witness program.
“Those who had a really strong connection with the population said that we had to try new ways. It wasn’t possible to continue as we did in the past.”
In 1991, the Swiss government then drafted a new national policy, which combined a hard line on crime and a public health approach for addicts — it became known as the “four-pillar strategy.” One of the pillars was law enforcement. But the other three — prevention, harm reduction and treatment — were based on treating drug users more humanely.
However, Switzerland is a highly decentralized federation, in which decisions are often taken through referendums. Each region or city then had to be persuaded to try out some of the new public policy ideas. “I was active throughout this campaign, going from north to south, east to west, to explain why we were doing this, what were the results and the population’s responsibility to overcome the stigmatization of drug users and consider those who are addicted as people with a disease that needs to be taken care of,” recalls Dreifuss.
One of the most controversial elements of the plan was to test what became known as heroin assisted treatment (HAT). It consisted of offering addicts pure heroin on prescription, to be safely injected in specialized clinics. In this way, they would stop buying contaminated drugs in the underground market.
The first clinic of its kind opened in Switzerland in 1994. Patients had to meet strict criteria. In addition to therapy, they also received help with employment and housing.
The HAT program was conceived as a scientific investigation, and preliminary results looked promising. But opposition remained strong in some parts of Switzerland. Critics of the proposal claimed that prescribing heroin to addicts could influence young people, as well as harm the drug addicts themselves. Over time, however, the data began to show conclusiveness.
Thanks to trials of heroin-assisted treatment and other programs—such as the increased use of methadone (used in heroin detoxification)—the number of fatal overdoses in the country fell by half between 1991 and 2010. At the same time, infections HIV infections were reduced by 65%, and the number of new heroin users dropped 80%.
“In a way, it’s something to be proud of when you get something after several years of struggle and work,” says Seidenberg. “But the main thing is that people got back to health, started to think about normalizing their lives and managed — at least more than half did — a really normal life. And people weren’t dying,” he says.
But the final test of the project was political. In 2008, Switzerland held a national referendum, in which 68% of the population voted to permanently incorporate the four-pillar policy into federal law.
It was a long journey of building political consensus, but for Dreifuss it was worth it. “The most positive experience a political leader can have is saying that he helped save lives. And that was the case.”
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