Inside Switzerland's Addiction Treatment Experiment

By Maggie Ethridge 11/16/18

One Swiss organization is finding success with a treatment model centered around medical-grade heroin. 

doctors inside a classroom examining the addiction treatment experiment in Switzerland

With some treatment models still offering fairly dismal success rates, specialists are broadening the parameters of what successful treatment looks like. In Switzerland, an injection center attached to the Geneva University Hospitals is operating an experimental heroin-prescription program (PEPS). Patients addicted to heroin check in daily for their Swiss laboratory-manufactured diacetylmorphine, or prescription-grade heroin.

Switzerland’s 1,500 patients at 22 PEPS centers have all failed previous attempts to end their heroin addiction with drug-replacement therapy.

Patient Marco, aged 44, was quoted in The Nation: “Methadone didn’t work for me. 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%. Eventually, I want to get clean.”

Here is a new model for success: instead of complete and immediate sobriety, the goal is to slowly wean the patient off of heroin, while also providing treatment for the underlying issues of addiction during the course of the program.

Meanwhile, the patient is receiving medical-grade heroin at highly controlled doses and is in much less risk of dying from an overdose, and at no risk of contracting a disease (such as HIV) or dying from tainted drugs or dirty needles. The patients are also much less likely to be involved in criminal activity around their drug addiction. The program offers “an easier, softer way” toward sobriety.

Yves Saget, an addiction nurse, told The Nation, “Addiction happens when taking drugs becomes the only strategy for dealing with difficult situations. 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.”

Switzerland had a crisis in the 1980s when heroin use suddenly rose dramatically. The Swiss police tried to limit the criminal issues arising around this drug use by confining heroin uses to areas that soon became known as “needle parks.”

The Swiss government decided they must act. Ruth Dreifuss is a Social Democratic former president of the Swiss Confederation. She told The Nation that at the time of the peak crisis, “We created a forum that brought together the federal state, the cantons, and the affected cities to allow the different actors to get to know each other’s viewpoints. Open drug scenes couldn’t be allowed to continue, but shutting them down would mean finding other solutions. Everything we’d tried had failed. The doctors prescribing methadone suggested allowing them to prescribe heroin. Methadone has been prescribed in Switzerland since the 1960s, so we were mentally prepared.”

So began Switzerland’s program of prescribing heroin to people with addiction for whom replacement therapy had failed. A four-pillars policy was created, including prevention, therapy, risk reduction, and repression. The first injection centers for prescription heroin opened in 1994, most of them in Switzerland.

Today, public hospitals as well as private, state-funded centers run the injection centers.

The program has been a success. Drug-related crime has seen an “exceptional reduction,” according to a study by the University of Lausanne’s Institute of Forensic Science and Criminology. The number of people with addiction involved with police interaction has fallen by two-thirds.

“Crime linked to heroin has almost disappeared because the drug is now available for free,” Regula Müller, social-affairs counselor for the city of Bern, told The Nation.

In addition, heroin dealers have lost their customer base, and prices of the drug are low, making selling heroin a less attractive gamble. The personal gain for those addicted to heroin and those who love them have been enormous, with HIV positive rates at less than 10%, from 50% in the '90s. And numbers impossible to argue with: drug-related deaths of those under 35 years old fell from 305 in 1995 to 25 in 2015.

Please read our comment policy. - The Fix

Maggie May Ethridge is the author of Atmospheric Disturbances: Scenes From a Marriage (Shebooks, 2014) and the recently completed novel, Agitate My Heart. She is a freelance writer published in Rolling Stone, VOX, Washington Post, The Guardian and many others. Find her at her blog Flux Capacitor or on LinkedIn or Twitter.