Yo no sabia nada de esto hasta hoy a la tarde, que se menciono en toxico. Y bueh, me puse a leer algo. Me parecio ultra-super-interesante para poner aca, abre una nueva perspectiva sobre el rol del Estado, la guerra contra el narcotrafico, y como tratar a los adictos y reducir el "daño colateral" para los no-consumidores.
Switzerland's Heroin Experiment
Nadelmann, Ethan, "Switzerland's Heroin Experiment." National Review. July 10, 1995: pp. 46-47.
The Swiss government is selling heroin to hard-core drug users. But in doing so the government isn't offhandedly facilitating drug abuse: it's conducting a national scientific experiment to determine whether prescribing heroin, morphine, and injectable methadone will save Switzerland both money and misery by reducing crime, disease, and death.
The Swiss deal with drug users much as the U.S. and other countries do--prisons, drug-free residential treatment programs, oral methadone, etc.--but they also know that these approaches are not enough. They first tried establishing a "Needle Park" in Zurich, an open drug scene where people could use drugs without being arrested. Most Zurichers, including the police, initially regarded the congregation of illicit drug injectors in one place as preferable to scattering them throughout the city. But the scene grew unmanageable, and city officials closed it down in February 1992. A second attempt faced similar problems and was shut down in March 1995.
So Needle Park wasn't the solution, but the heroin-prescription program might be. In it, 340 addicts receive a legal supply of heroin each day from one of the nine prescribing programs in eight different cities. In addition, 11 receive morphine, and 33 receive injectable methadone. The programs accept only "hard-core" junkies--people who have been injecting for years and who have attempted and failed to quit. Participants are not allowed to take the drug home with them. They have to inject on site and pay 15 francs at approximately $13 per day for their dose.
The idea of prescribing heroin to junkies in hopes of reducing both their criminal activity and their risk of spreading AIDS and other diseases took off in 1991. Expert scientific and ethical advisory bodies were established to consider the range of issues. The International Narcotics Control Board--a United Nations organization that oversees international antidrug treaties--had to be convinced that the Swiss innovation was an experiment, which is permitted under the treaty, rather than an official shift in policy. In Basel, opponents of the initiative demanded a city-wide referendum--in which 65 per cent of the electorate approved a local heroin-prescription program. The argument that swayed most people was remarkably straightforward: only a controlled scientific experiment could determine whether prescribing heroin to addicts is feasible and beneficial.
The experiment started in January 1994. The various programs differ in some respects, although most provide supplemental doses of oral methadone, psychological counseling, and other assistance. Some are located in cities like Zurich, others in towns like Thun, which sits at the foot of the Bernese Alps. Some provide just one drug, while others offer a choice. Some allow clients to vary their dose each day, while others work with clients to establish a stable dosage level. One of the programs in Zurich is primarily for women. The other Zurich program permits addicts to take home heroin-injected cigarettes known as reefers, or "sugarettes," (since heroin is called "sugar" by Swiss junkies). It also conducted a parallel experiment in which 12 clients were prescribed cocaine reefers for up to 12 weeks. The results were mixed, with many of the participants finding the reefers unsatisfying. However, since more than two-thirds of Swiss junkies use cocaine as well as heroin, the Swiss hope to refine the cocaine experiment in the future.
The national experiment is designed to answer a host of questions that also bubble up in debates over drug policy in the United States, but that our drug-war blinders force us to ignore. Can junkies stabilize their drug use if they are assured of a legal, safe, and stable source of heroin? Can they hold down a job even if they're injecting heroin two or three times a day.? Do they stop using illegal heroin and cut back on use of other illegal drugs? Do they commit fewer crimes? Are they healthier and less likely to contract the HIV virus? Are they less likely to overdose? Is it possible to overcome the "not in my back yard" objections that so often block methadone and other programs for addicts?
The answers to these questions are just beginning to come in. In late 1994, the Social Welfare Department in Zurich held a press conference to issue its preliminary findings: 1) Heroin prescription is feasible, and has produced no black market in diverted heroin. 2) The health of the addicts in the program has clearly improved. 3) Heroin prescription alone cannot solve the problems that led to the heroin addiction in the first place. 4) Heroin prescription is less a medical program than a social-psychological approach to a complex personal and social problem. 5) Heroin per se causes very few, if any, problems when it is used in a controlled fashion and administered in hygienic conditions. Program administrators also found little support for the widespread belief that addicts' cravings for heroin are insatiable. When offered practically unlimited amounts of heroin (up to 300 milligrams three times a day), addicts soon realized that the maximum doses provided less of a "flash" than lower doses, and cut back their dosage levels accordingly.
On the basis of these initial findings, the Swiss federal government approved an expansion of the experiment @ne that may offer an opportunity to address the bigger question that small-scale experiments and pilot projects cannot answer: Can the controlled prescription of heroin to addicts take the steam out of the illegal drug markets? Switzerland's prescription experiment fits in with the two-track strategy Switzerland and other Western European countries have been pursuing since the mid-1980s: tough police measures against drug dealers, and a 'harm reduction' approach toward users. The idea behind harm reduction is to stop pretending that a drug-free society is a realistic goal; focus first on curtailing the spread of AIDS-A disease that will have cost the U.S. $15.2 billion by the end of 1995, and the lives of over 125,000 Americans--and later on curtailing drug use.
The effort to make sterile syringes more available through needle-exchange programs and the sale of needles in pharmacies and vending machines epitomizes the harm-reduction philosophy. Swiss physicians and pharmacists-along with their professional associations-are outspoken in their support of these initiatives. Study after study, including one conducted for the U.S. Centers for Disease Control, show that increasing needle availability reduces the spread of AIDS, gets dirty syringes off the streets, and saves money.
The Swiss have also created legal Fixerrdume, or "injection rooms,' where addicts can shoot up in a regulated, sanitary environment. Swiss public-health officials regard this harm-reduction innovation as preferable to the two most likely alternatives: open injection of illicit drugs in public places, which is distasteful and unsettling to most non-addicts; and the more discreet use of drugs in unsanctioned 'shooting galleries" that are frequently dirty, violent, controlled by drug dealers, and conducive to needle sharing. Five Fixerrdume are now open in Switzerland. Initial evaluations indicate that they are effective in reducing HIV transmission and the risk of overdose.
So what does the future hold? Last month, Switzerland's governing body, the Federal Council, voted to expand the number of prescription slots to 1,000: 800 for heroin, 100 each for morphine and injectable methadone. Interior minister Ruth Dreifuss, who initially was skeptical of the experiment, is now a strong supporter. She is backed by the ministers of justice, defense, and finance, who together constitute what has become known as "the drug delegation' of the Federal Council. The three leading political parties have combined to issue a joint report on drug policy that supports the heroin experiment and other harm- reduction initiatives. Outside Switzerland, the Dutch are about to embark on their own modest experiment with heroin prescription. The Australians, who recently conducted an extensive feasibility study, seem likely to start a heroin-prescription i program. In Germany, officials in Frankfurt, Hamburg, Karlsruhe, Stuttgart, and elsewhere are seeking permission from the central government to begin their own heroinprescription projects.
While these countries experiment with more sensible and humane approaches to drug policy, the United States clings to a war not only against drug dealers, but also against drug users. Most scientific researchers studying drug abuse acknowledge that the Swiss experiment makes sense socially, economically, and morally. The point of these innovations i isn't to coddle drug users. It's to reduce the human and economic costs of drug use--costs paid not only by users but also by non-users through increased health, justice, and law-enforcement expenditures.
But no distinguished researcher seems prepared to take on all the forces blocking a heroin-prescription experiment in the United States. Through our reticence, we are shutting our eyes to drug policy options that could reduce crime, death, and disease and ultimately save this country billions of dollars.
Switzerland's Heroin ExperimentThe Dutch heroin experiment has begunThe experiment to supply clients with medically prescribed heroin in the Netherlands has begun at last. It involves the cities of Amsterdam and Rotterdam. To begin with, 25 clients in both cities will receive a dose three times a day which they must inject or smoke on the spot. Eventually, 750 addicts referred to as ‘patients’, spread over seven cities, will take part in the experiment. This is an experiment that is linked to a scientific investigation. From this, it should become clear whether prescribed heroin leads to an improvement in the health and social functioning of addicts - more than conventional methadone treatment does.by Elly Tanis
The Minister of Public Health views prescribing heroin as "a last chance" for long-term addicts who, in spite of the health care programmes and supply of methadone, are in bad shape. The experiment will take one and a half years.
Who will be taking part in the experiment?
The addicts who will take part in the scientific experiment have been selected using strict criteria. There are around five thousand hard drug users in Amsterdam. Of these, about one thousand addicts have many physical, psychological and social problems. The clients chosen to receive prescribed heroin have been using hard drugs for over fifteen years and have been involved in a methadone programme for more than five years (without success). For these chronic addicts, whose average age is 38, kicking the habit is not a major concern. Their treatment focuses on creating peace and order in their lives. There is then enough time left over for them to eat well and to get sufficient sleep. It is expected that the client will appear three times a day, that he is registered in the city and that he has given his written consent.
The background to this experiment
The Netherlands has been trying to get this experiment off the ground for around twenty years. Earlier attempts foundered. However, the Dutch government has finally changed tack to follow the Swiss example. Supplying prescribed heroin to 1100 chronic addicts was begun four years ago in Switzerland. A year ago, following an evaluation of this experiment it appeared that the mental health of the participants had improved, the number of crimes in this group had decreased and that some of the addicts had a permanent address and had found employment. The result of this experiment has led the Swiss Minister of Public Health to amend the law so that the supply of heroin has a legal basis. However, the Swiss experiment has not made it clear whether the supply of heroin was the sole cause of the improvement of the clients’ physical and mental condition. It so happens that psychosocial assistance was being given and work and accommodation were being offered while the experiment was running.
The CCBH (Central Commission for the Treatment of Heroin Addicts) was set up in 1996 in the Netherlands. This commission developed a proposal for a scientific experiment. The aim of this experiment is to demonstrate 20% improvement in the clients’ physical and mental health, social integration and reduced criminal activity by the end of the trial period. In addition, other research topics will be addressed such as:
- What is the difference between addicts who are supplied with heroin for 6 months and those who receive it for 12 months?
- What happens when the supply is stopped?
- How great is the satisfaction?
In the end, a number of scenarios is possible:
- 1st scenario: no improvement means no further supply of heroin
- 2nd scenario: permanent improvement noticeable means no further supply of heroin
- 3rd scenario: improvement, but demonstrable deterioration when supply is terminated means that the doctor in question has the possibility to resume the supply on medical grounds.
The aim of the Dutch experiment is not for the clients to kick their habit. The intention is that they will improve, that they will become more approachable and be less of a nuisance.
The CCBH will report to the Minister of Public Health on the possible trouble the supply of heroin causes the neighbourhood. People living in the neighbourhood of the clinics can lodge complaints at a special centre or at the local police station. It is not expected that there will be many complaints as the local residents are already familiar with methadone clinics.
It is known that many addicts use cocaine as well as heroin. However, it is thought that, by supplying heroin, the addicts will become calmer and, as a result, will be better able to tackle their problems.
During the experiment it will be emphasised that it is not just about handing out heroin. The participant will also receive intensive counselling and other medical and psychological help.
Amsterdam and Rotterdam
The project will first take place in Amsterdam and Rotterdam. After an evaluation of the first 3 months the number of clients could be increased in both cities. For the time being, the practical problems that the experiment may pose will be looked into. To obtain more insight into this, a possibly more definite decision to supply medically prescribed heroin will be made only after a year and a half.
It is expected that the heroin experiment will yield a number of important advantages for the client as well as his surroundings. Noticeable improvement of the clients’ physical and mental condition is expected. He will become more stable, whereby he will be better able to tackle his other problems. The neighbourhoods will experience less trouble from the client. The doctor will be able to administer treatment better targeted to the patient and he will also have the opportunity to put the treatment that is the most desirable for an individual patient into effect.
The Dutch heroin experiment has begunSwitzerland's Liberal Drug Policy Seems To Work, Study Says
Main Category: Alcohol / Addiction / Illegal Drugs
Article Date: 02 Jun 2006 - 9:00 PDT
Switzerland's policy of offering heroin addicts substitution treatment with methadone or buprenorphine has led to a decline in the number of new heroin users in Zurich, according to a paper published in this week's issue of The Lancet.
Switzerland has implemented various policies to try and reduce harm to dependent heroin users, including needle-exchange services, low-threshold methadone programmes, and heroin-assisted treatments. However, critics say that these policies may lead to a growing number of new drug users and lengthen the period of heroin addiction.
To investigate, Carlos Nordt and Rudolf Stohler from the Psychiatric University Hospital, Zurich, Switzerland analysed data from over 7250 patients in Zurich who presented for substitution treatments with methadone or buprenorphine over 13 years from 1991. From this data they estimated trends in the number of new heroin users. They found that the incidence of heroin use dropped from 850 new users in 1990 to 150 in 2002. The authors contrast the situation with heroin use in the UK, Italy, and Australia, which has continued to rise. They also found a low cessation (quit) rate and therefore, the overall number of heroin dependents, whether in treatment or not, only declined by 4% per year.
Dr Nordt states: "As the Swiss population supported this drug policy, this medicalisation of opiate dependence changed the image of heroin use as a rebellious act to an illness that needs therapy. Finally, heroin seems to have become a 'loser drug', with its attractiveness fading for young people. Nevertheless, whether drug policy had a positive effect on the number of new heroin users or not, our data could not confirm an increase of heroin incidence as expected by the critics of the liberal Swiss drug policy."
http://www.medicalnewstoday.com/articles/44417.phpHeroin Legalization Program Approved By Swiss Voters
ALEXANDER G. HIGGINS | November 30, 2008 05:10 PM EST
GENEVA — The world's most comprehensive legalized heroin program became permanent Sunday with overwhelming approval from Swiss voters who simultaneously rejected the decriminalization of marijuana.
The heroin program, started in 1994, is offered in 23 centers across Switzerland. It has helped eliminate scenes of large groups of drug users shooting up openly in parks that marred Swiss cities in the 1980s and 1990s and is credited with reducing crime and improving the health and daily lives of addicts.
The nearly 1,300 selected addicts, who have been unhelped by other therapies, visit one of the centers twice a day to receive the carefully measured dose of heroin produced by a government-approved laboratory.
They keep their paraphernalia in cups labeled with their names and use the equipment and clean needles to inject themselves _ four at a time _ under the supervision of a nurse, and also receive counseling from psychiatrists and social workers.
The aim is to help the addicts learn how to function in society.
The United States and the U.N. narcotics board have criticized the program as potentially fueling drug abuse, but it has attracted attention from governments as far away as Australia and Canada, which in recent years have started or are considering their own programs modeled on the system.
The Netherlands started a smaller program in 2006, and it serves nearly 600 patients. Britain has allowed individual doctors to prescribe heroin since the 1920s, but it has been running trials similar to the Swiss approach in recent years. Belgium, Germany, Spain and Canada have been running trial programs too.
Sixty-eight percent of the 2.26 million Swiss voters casting ballots approved making the heroin program permanent.
By contrast, around 63.2 percent of voters voted against the marijuana proposal, which was based on a separate citizens' initiative to decriminalize the consumption of marijuana and growing the plant for personal use.
Olivier Borer, 35, a musician from the northern town of Solothurn, said he welcomed the outcome in part because state action was required to help heroin addicts, but he said legalizing marijuana was a bad idea.
"I think it's very important to help these people, but not to facilitate the using of drugs," Borer said. "You can just see in the Netherlands how it's going. People just go there to smoke."
Sabina Geissbuehler-Strupler of the right-wing Swiss People's Party, which led the campaign against the heroin program, said she was disappointed in the vote.
"That is only damage limitation," she said. "Ninety-five percent of the addicts are not healed from the addiction."
Health insurance pays for the bulk of the program, which costs 26 million Swiss francs ($22 million) a year. All residents in Switzerland, which has a population of 7.5 million, are required to have health insurance, with the government paying insurance premiums for those who cannot afford it.
Parliament approved the heroin measure in a revision of Switzerland's narcotics law in March, but conservatives challenged the decision and forced a national referendum under Switzerland's system of direct democracy.
Jo Lang, a Green Party member of parliament from the central city of Zug, said he was disappointed in the failure of the marijuana measure because it means 600,000 people in Switzerland will be treated as criminals because they use cannabis.
"People have died from alcohol and heroin, but not from cannabis," Lang said.
The government, which opposed the marijuana proposal, said it feared that liberalizing cannabis could cause problems with neighboring countries.
On a separate issue, 52 percent of voters approved an initiative to eliminate the statute of limitations on pornographic crimes against children before the age of puberty.
The current Swiss statute of limitations on prosecuting pedophile pornography is 15 years. The initiative will result in a change in the constitution to remove that time limit.
Heroin Legalization Program Approved By Swiss Voters