Switzerland

Switzerland - Data

(2007 - Switzerland - deaths from heroin and HIV) "Drug-related deaths, most of which are a consequence of heroin dependence, have declined since the early 1990s, from 350-400 per annum to 150-200 per annum in this decade. HIV infections related to injecting drug use have also declined. This may reflect a modest decline in injecting, as opposed to smoking or snorting, of heroin, a decline in needle sharing among users because of Syringe Exchange Programs and the lower population of heroin dependent users."

(2006 - Switzerland - drug arrests) "Total drug arrests increased substantially in the 1990s and rose slightly in this decade. There was a large decline in heroin arrests (from 18,000 in 1997 to 6500 in 2006), compensated for by an increase in cannabis arrests. About 80 percent of arrests are for possession rather than dealing. Switzerland makes more arrests (per capita) for simple possession of cannabis than even the United States; comparative figures for a number of countries are provided in Figure S2. However at the other end of the criminal justice system, small numbers are sentenced to incarceration; out of roughly 40,000 persons arrested each year for drug violations, fewer than 2,000 receive terms of incarceration. Moreover the total number of convictions and incarcerations for drug offenses has hardly changed over the period 1990-2006, Fewer than one quarter of those sentenced receive terms as long as eighteen months. The majority of arrests are for possession of cannabis and result in fines of 250-300 CHF; these are not even recorded as convictions."

(2002-2006 - Switzerland - heroin use) "Heroin has been, at least until very recently, the principal drug problem for Switzerland, as for most Western European nations. In the mid-1990s Switzerland had a heroin addiction prevalence that may have been the highest in Europe. Switzerland’s heroin problem has been declining steadily over the last decade. The estimates of the size of the group are crude but show a reduction from about 29, 000 in 1994 to 23,000 in 2002, the most recent year for which an estimate is available. The aging of the population in treatment is a reassuring indicator that initiation rates have been low since the mid-1990s; whereas in 1994 the median age of those in treatment was 26.5 years, that had risen to 30.5 by 2006. The health of the heroin dependent population has been improving."

(1975-2002 - Switzerland - incidence of heroin use) "The incidence of regular heroin use in the canton of Zurich started with about 80 new users in 1975, increased to 850 in 1990, and declined to 150 in 2002, and was thus reduced by 82%. Incidence peaked in 1990 at a similar high level to that ever reported in New South Wales, Australia, or in Italy. But only in Zurich has a decline by a factor of four in the number of new users of heroin been observed within a decade. This decline in incidence probably pertains to the whole of Switzerland because the number of patients in substitution treatment is stable, the age of the substituted population is rising, the mortality caused by drugs is declining, and confiscation of heroin is falling. Furthermore, incidence trends did not differ between urban and rural regions of Zurich. This finding is suggestive of a more similar spatial dynamic of heroin use for Switzerland than for other countries."

(2000 - Switzerland - heroin-assisted treatment) "It has emerged that heroin-assisted treatment is a suitable option only for a small proportion (currently 4%) of the 30,000 severely dependent injecting drug users. Heroin-assisted treatment is not a replacement for other substitution or abstinence-based therapies, but an important addition for those drug users that have so far fallen through the therapeutic net. This is confirmed by the relatively modest increase in patient numbers since the bar on the legally permitted maximum number was lifted."

(2000 - Switzerland - prevalence of illegal drug use) "According to current estimates, about 30,000 of the seven million inhabitants of Switzerland are dependent on illicit narcotics (hard drugs) such as heroin and cocaine. Cannabis, however, is the most frequently used drug, followed by heroin and cocaine. The use of synthetic drugs, especially of Ecstasy/MDMA, seems to be stable. Based on surveys done between 1987 and 1997, one can assume that the numbers of severely dependent drug users have remained relatively stable since the early 1990s among those aged 17 to 30 (Gervasoni et al. 2000). A comparison of the two National Swiss Health Surveys conducted in 1992/1993 and 1997 shows that the number of cases of consumers of hard drugs in the population aged 17 to 45 are too small to be significant (Gmel and Maag 1999). Cannabis is the only illegal drug whose occasional consumption shows an increase from 6 percent in 1986 to 12 percent in 1994 and to over 22 percent in 1998 (SFA, 1999)."

Switzerland - Law and Policy

(Switzerland - "fourfold drug policy") "The “Fourfold Drug Policy” (law enforcement, prevention, treatment, and harm reduction) has proven to be very successful and has put a stop to the increase in new users hard drugs among young people; it has helped a multitude of drug-dependent individuals escape the vicious cycle of addiction and protects the physical and mental wellbeing of drug-dependent individuals. The various forms of treatment are encouraging thousands of drug-dependent individuals who opt for the diffi cult road out of addiction. Drug-dependent individuals have a chance to regain their independence and be reintegrated into society and the crime rate connected with obtaining drugs has been substantially reduced."

(Switzerland - harm reduction policy) "There are many elements of the Swiss drug policy experience that can be generalized to diverse social and political contexts. Most significant among these would be the importance of scientifically rigorous investigation of new programs, and letting science speak to policymakers; bringing policing and health programs together under a coherent policy rubric; investing in the education of the general public on drug policy issues; opening new experiences to independent review; and facing down ideological criticisms from other countries and international bodies with evidence and pragmatism. The Swiss experience shows that harm reduction measures, inevitably controversial when they are new, can emerge from a relatively conservative political base."

(Switzerland - Four Pillars drug strategy) "Switzerland’s progressive implementation of the Four Pillars policy resulted in a significant decrease in problems related to drug consumption. The rise in heroin consumption, by far the greatest problem in the late 1980s, was halted and has steadily declined since the early 1990s. According to The Lancet, the The introduction of the Four Pillars strategy also brought about a significant reduction of deaths directly attributable to drug use, such as overdose (OD), and of deaths indirectly related, such as HIV and Hepatitis. Between 1991 and 2004, the drug related death toll fell by more than 50% (See figure 3). Additionally, levels of drug-related HIV infection were divided by eight within ten years."

(Switzerland - cannabis decriminalization) The Manchester Guardian reported in October 2000, "Switzerland is preparing to introduce legislation that effectively would allow the consumption of cannabis, adding to the country's pioneering but controversial record on drugs policy. The Swiss government said it would draw up legislation next year after consultation among local authorities and community associations revealed that there was widespread support for decriminalising cannabis. "'Two-thirds of the organisations consulted said they were in favour of this move,' the interior minister, Ruth Dreifuss said yesterday. "But the same groups opposed any such move on hard drugs, and officials ruled out softer laws on possessing or using such substances. "Switzerland has the most liberal approach in Europe towards the treatment of heroin addicts. Since 1998 it has been providing clean needles and allowing the distribution of heroin to addicts under strict medical supervision."

(Switzerland - 'needle park') "Increasingly desperate to find a way to control crime and social and health harms associated with injection drug use, in 1987 the Zürich authorities allowed people who used illicit drugs to gather in a defined space near the main train station—the Platzspitz park, which sat on a small spit of land surrounded by the water of two converging rivers (Grob 1995). This space came to be known as the 'needle park.' Up to 1,000 drug users per day would come to the park at its peak (Grob 2010). Surveys conducted in the Platzspitz showed that by 1990 these included not only young people but significant numbers of older working and professional adults among whom heroin use had spread (Grob 1995)."

(Switzerland - methadone treatment) "The federal government also provides recommendations from experts concerning oral methadone treatment and supports the evaluation of this type of treatment. About 15,000 drug-addicts follow a methadone maintenance program, about half of them at private doctors, the rest in specialized clinics."

(Switzerland - policies to prevent the spread of HIV) "For the last 15 years, the federal government has therefore been supporting a variety of measures (e.g. needle-exchange programs, injection rooms, housing and employment programs) in order to improve the health and the lifestyle of drug addicts and to prevent the spread of HIV and other infectious diseases. Compared with the late 1980s, the incidence of new HIV infections among drug addicts has decreased significantly."

Switzerland - Research

(Switzerland - decline in heroin use) "Heroin misuse in Switzerland was characterised by a substantial decline in heroin incidence and by heroin users entering substitution treatment after a short time, but with a low cessation rate. There are different explanations for the sharp decline in incidence of problematic heroin use. According to Ditton and Frischer, such a steep decline in incidence of heroin use is caused by the quick slow down of the number of non-using friends who are prepared to become users in friendship chains. Musto's generational theory regards the decline in incidence more as a social learning effect whereby the next generation will not use heroin because they have seen the former generation go from pleasant early experiences to devastating circumstances for addicts, families, and communities later on."

(Switzerland - medicalization of heroin) "The harm reduction policy of Switzerland and its emphasis on the medicalisation of the heroin problem seems to have contributed to the image of heroin as unattractive for young people."

Switzerland - Heroin Maintenance

(heroin assisted trials in Switzerland) "... hundreds of peer-reviewed journal articles on the trials, as well as a book produced by FOPH (Rihs-Middel et al. 2005), attest to the care taken to document a wide range of health and social outcomes from the HAT experience. In brief, some of these results are as follows (See esp. Uchtenhagen 2009, 34 and Bammer et al. 2003, 365):

"• It was possible to stabilize dosages of heroin, usually in two or three months, without a continuing increase of dosages, which some had feared.

"• There was significant and measurable improvement in health outcomes for patients, including significantly reduced consumption of illicit heroin and even illicit cocaine.

"• There was a significant reduction in criminal acts among the patients, to the point where the estimated benefits of this effect well exceeded the cost of the treatment (See also Killias et al. 2005).

"• Heroin from the trials did not find its way into illicit markets.

"• Initiation of new heroin use did not increase.

"• Utilization of treatments other than HAT, especially methadone, increased after the advent of HAT rather than declining as some had feared.

In short, the fears of opponents of HAT were largely refuted by solid evidence, though, of course, political debate would continue."

(heroin maintenance in Switzerland) "Despite the availability of a wide range of treatment programs, including methadone substitution, not all drug addicts with serious health and social problems could be motivated to enter treatment. A core group remained, which was characterized by numerous social and physical deficiencies. In an attempt to reach this group, Heroin on prescription was launched in 1994 as part of a nationally-based research project. Admission criteria were a minimum age of 20 years, at least a two-year duration of daily intravenous heroin consumption, a negative outcome of at least two previous treatments, and documented social and health deficits as a consequence of their heroin dependence. The treatment consisted of between one to three injections of heroin a day, and medical, psychiatric, and social monitoring.

"After three years, the results showed, amongst numerous other findings, that:

"• The program is able, to a greater extent than other treatments, to reach its designated target group.

"• The improvements in physical health proved to be stable over the whole period.

"• Illicit heroin and cocaine use regressed rapidly and markedly, whereas benzodiazepine use decreased only slowly and alcohol and cannabis consumption hardly declined at all.

"• The participants' housing situation and fitness for work improved considerably.

"• The income from illegal and semi-illegal activities decreased dramatically (10% as opposed to 69% originally).

"• Both the number of offenders and the number of criminal offenses decreased by about 60% during the first six months of treatment.

(heroin maintenance in Switzerland) "The harm reduction policy of Switzerland and its emphasis on the medicalisation of the heroin problem seems to have contributed to the image of heroin as unattractive for young people."

(heroin maintenance in Switzerland) "Heroin misuse in Switzerland was characterised by a substantial decline in heroin incidence and by heroin users entering substitution treatment after a short time, but with a low cessation rate. There are different explanations for the sharp decline in incidence of problematic heroin use. According to Ditton and Frischer, such a steep decline in incidence of heroin use is caused by the quick slow down of the number of non-using friends who are prepared to become users in friendship chains. Musto's generational theory regards the decline in incidence more as a social learning effect whereby the next generation will not use heroin because they have seen the former generation go from pleasant early experiences to devastating circumstances for addicts, families, and communities later on."

(Swiss heroin prescription program) "Finally, the analysis of the reasons for interrupting treatment revealed that, even in the group of those treated for less than one year, the majority did not actually drop out of the program but rather changed the type of treatment, mostly either methadone maintenance or abstinence treatment. Knowing that methadone maintenance treatment – and a fortiori abstinence treatment – is able to substantially reduce acquisitive crime, the redirection of heroin maintenance patients toward alternative treatments is probably the main cause for the ongoing reduction or at least stabilization of criminal involvement of most patients after treatment interruption. Thus the principal post-treatment benefit of heroin maintenance seems to be its ability to redirect even briefly treated high-risk patients towards alternative treatments rather than back “on the street”."

(Swiss heroin prescription program) "With respect to the group of those treated uninterruptedly during four years, a strong decrease in the incidence and prevalence rates of overall criminal implication for both intense and moderate offenders was found. As to the type of offense, similar diminutions were observed for all types of offenses related to the use or acquisition of drugs. Not surprisingly, the most pronounced drop was found for use/possession of heroin. In accordance with self-reported and clinical data (Blaettler, Dobler-Mikola, Steffen, & Uchtenhagen, 2002; Uchtenhagen et al., 1999), the analysis of police records suggests that program participants also tend strongly to reduce cocaine and cannabis use probably because program participants dramatically reduced their contacts with the drug scene when entering the program (Uchtenhagen et al., 1999) and were thus less exposed to opportunities to buy drugs. Consequently, their need for money is not only reduced with regard to heroin but also to other substances. Accordingly, the drop in acquisitive crime, such as drug selling or property crime, is also remarkable and related to all kinds of thefts like shoplifting, vehicle theft, burglary, etc. Detailed analyses indicated that the drop found is related to a true diminution in criminal activity rather than a more lenient recording practice of police officers towards program participants.

"On average, males had higher overall rates than females in the pretreatment period. However, no marked gender differences were found with regard to intreatment rates. Taken as a whole, this suggests that the treatment had a somewhat more beneficial effect on men than women. This result is corroborated by selfreport data (Killias et al., 2002). With respect to age and cocaine use, no relevant in-treatment differences were observed. As to program dropout, after one year, about a quarter of the patients had left the program, and after four years, about 50% had left. Considering the high-risk profile of the treated addicts, this retention rate is, at least, promising."

(Swiss heroin prescription program) "Overall, results indicate that heroin prescription is a very promising approach in reducing any type of drug related crime across all relevant groups analyzed. It affects property crime as well as drug dealing and even use/possession of drugs other than heroin. These results suggest that heroin maintenance does not only have an impact by reducing the acquisitive pressure of treated patients, but also seems to have a broader effect on their entire life-style by stabilizing their daily routine through the commitment to attend the prescription center twice or three times a day, by giving them the opportunity for psychosocial support, and by keeping them away from open drug scenes."

(Swiss heroin prescription program) "As one of the responses to dramatically increasing drug scenes, heroin maintenance trials were implemented in Switzerland from 1994 onwards. The target population for this new treatment consists of heroin users who did not comply with other forms of treatment and who presented serious health and/or social problems."