FIRST, REDUCE HARM

In 1990, leaders from the Netherlands, Germany, and Switzerland realized
that scores of young people were dying from overdoses of potent street
drugs. These countries' governments decided that their priority would be to
keep people alive. In a document called the "Frankfurt Resolution," they
started an international movement called "harm reduction."

Since then, the three countries have adopted variations on the
harm-reduction theme-a belief that the risks to society and public health
associated with illegal drugs are so great that those risks must be reduced
by whatever methods are necessary, even if they run counter to traditional
approaches to controlling illegal behavior.

"Over the last 10 years in most European countries, there has been a shift
away from law enforcement and a punitive approach [and] toward prevention
and treatment," explains Benedikt T. Fischer, an assistant professor of
public health at the University of Toronto and an expert on drug addiction.

Germany's policy changes include providing IV drug users with clean needles
and safe injection rooms. "Most of the harms related to illicit drugs were
reversed," says Fischer. HIV infection rates dropped, he adds, "and in
Frankfurt, the overdose deaths and property crimes dropped significantly."

The harm-reduction approach also spurred a rethinking of conventional drug
abuse treatment, including the use of opiate pharmacology. In the early
1990s, the Swiss started prescribing heroin to addicts. Experts from the
Vienna-based International Narcotics Control Board and the World Health
Organization have concluded that the Swiss prescription experiment produced
positive results:

Heroin addicts' health improved. Many were able to work. And crime went
down. But the same group of experts cautioned that other countries might
not be able to duplicate the experiment's results.

Former U.S. drug czar Barry McCaffrey sees a larger problem with the Swiss
approach. "Once you start issuing heroin and doing harm reduction, it makes
it harder to maintain the political will to establish effective drug
treatment and hook it into the criminal justice system," he says. In other
words, it becomes difficult to lock up addicts for breaking drug laws.

Fischer says that the Swiss harm-reduction campaign gradually eliminated
the drug scene that had been visible in Zurich in the 1980s. "There are
hardly any addicts on the streets, and many are in treatment," he says.

McCaffrey is not impressed. "They took a typically Swiss approach: Get the
problem out of sight. They tell the chronic addicts, 'If you want to
destroy yourself in shooting galleries, we'll provide them.' "

The Netherlands has become the model for countries that support harm
reduction and decriminalizing drugs. McCaffrey, who has visited the
Netherlands, calls that nation's efforts a "well-organized, compassionate,
nonjudgmental way to minimize the terrible self-destructive pathology of
drug addiction."

Nevertheless, McCaffrey thinks the overall result is a "disaster." The
Dutch, he says, "have the worst drug-education program on the face of the
Earth. In schools, they are teaching kids how to use drugs safely! There's
a real problem, in my view." .