PRESCRIBE HEROIN, COKE TO ADDICTS: MAYOR

Larry Campbell Believes It's An Option When Methadone And Abstinence Fail

ZURICH -- Mayor Larry Campbell wants Vancouver to copy a controversial but
successful Swiss program of prescribing heroin to hard-core addicts.

In fact, if he had his way, they'd get cocaine prescriptions too.

When social workers and drug addiction counsellors talk about the model for
treating the hardest of hard-core addicts, for whom abstinence or methadone
programs do not work, they all look to Switzerland for advice. That's
because for the last eight years the country has operated a prescription
heroin program with relative success.

Under the program, the only one of its kind in the world, addicts who have
failed at other attempts to kick their habit can receive daily doses of
pure heroin, which is produced by a Swiss pharmaceutical company. They can
either inject the drug or take it orally, and in Zurich those on the
program are allowed up to nine injections daily.

The program is only one part of a broad package of addiction treatment
programs available to heroin addicts, and that's what attracted Campbell's
attention most this week as he met addiction treatment specialists in Zurich.

"I can see this kind of a program operating in Vancouver," Campbell said.

"It's an effective way of treating a small but very resistant group of
people addicted to heroin. In fact, by rights we should be offering
prescription cocaine to the hardest addicts, because they often are hooked
on both."

Campbell is on a whirlwind fact-finding tour of several Winter Olympic
sites, including a diplomatic visit to the International Olympic Committee
headquarters in Lausanne where today he will deliver a copy of Vancouver's
bid for the 2010 Winter Games.

In advance of that visit, the mayor took two days to tour supervised drug
injection facilities in Zurich in the hope of learning more about how other
cities treat their drug addicts.

Switzerland's heroin maintenance program is separate from city-based safe
injection programs, and is a response to a small but persistent core of
deeply hooked addicts.

Dr. Jurgen Rehm, director of the Zurich-based Addiction Research Institute,
said the prescription program isn't the be-all, end-all solution to drug
treatment.

In fact, most of Switzerland's estimated 30,000 heroin addicts will never
see the inside of a prescription treatment facility.

"It's not appropriate for most heroin users," Rehm said. "But about five to
10 per cent of the population should be in heroin maintenance."

According to Rehm, two-thirds of Switzerland's opiate users are in some
form of treatment. More than 18,000 are on methadone. Another 1,000 are
prescribed buprenorphine, a drug shown to be more successful in treating
new and young addicts. Another 1,500 are in abstinence-based programs.

Only 1,169 addicts are in the heroin prescription program, which is
administered at 21 centres across Switzerland.

Unlike the safe-injection sites in Zurich, where no scientific trials or
data collection were undertaken before opening the facilities, the heroin
maintenance program has been heavily scrutinized by researchers.

Results published by the Addiction Research Institute and the Swiss Federal
Office of Public Health show that in the first six years of operation, 70
per cent of patients in the program remained in treatment for more than a year.

They also found that the longer the patient remains on the program, the
more likely he or she is to make a successful transition to other treatment
programs such as abstinence.

Other benefits documented were increased physical and mental health of the
addicts and a decline in criminal behaviour.

The addicts have also recognized the value of the program; in the first
four years of operation, an average of one-third would drop out in the
first four months of treatment. That figure has been cut in half. At the
other end of the scale, the number of "treatment terminations" after two or
more years in treatment doubled from 21 per cent to 42 per cent.

That's in part because addicts in the prescription program are forced to
leave if they choose to go into some other form of treatment, Rehm said.

Most of those enrolled do not have jobs and live on federal social
assistance or disability cheques. They live a life scheduled around
multiple daily treatment times. But the longer the addict remains in
treatment, the more likely he or she is to become stable and want to
explore starting a new life, Rehm said. Consequently, those wanting to do
things like go back to work have to use other forms of treatment, such as
abstinence or methadone.

Switzerland's decision to proceed with a heroin maintenance program was not
nearly as controversial as one might imagine. In fact, prescribing heroin
to addicts is less of an issue than a national referendum being
contemplated on the legalization of marijuana, according to Rehm.

"In this country, referenda continually show there is a steady 55 to 60 per
cent support for heroin trials. But on cannabis, most people are in support
of liberal laws, but they vary to different degrees, so one can never know
if a law on that will be passed."

Money also talks when it came to proving the heroin maintenance trial was
worth doing. Studies show the program costs the equivalent of about $60 Cdn
per addict per day, a little more than half what it costs taxpayers to deal
with untreated addicts in terms of health issues, policing, courts and
imprisonment.

The Swiss government recently went one step further, ordering health
insurers to cover 75 per cent of the cost of the program. Switzerland has a
universal health-care system. Rehm said it made sense for health insurers
to cover the equivalent of about $45 Cdn of the daily cost to each addict
because it is directly a health issue.

Under the agreement, addicts are expected to pay the remaining $15 per day,
but local authorities will cover that cost if the patient doesn't have any
money.

Some doctors have said the program's success leads them to believe a
cocaine prescription program should also be started.

In an interview last year with Swissinfo, a national news agency, Dr.
Daniel Meili, chief medical officer for Zurich's heroin prescription
program, said it is difficult to properly treat some hard-core addicts who
are hooked on both drugs.

"We need more options. We are still too restricted in what we can do and we
are not reaching all the people who need our help," he said. "Most addicts
like the combination and can't or don't want to give up cocaine. And since
we don't have many options for treating cocaine addiction, it is difficult
to reach these addicts."

Last year Zurich's city-run drug treatment programs expanded to include
"inhalation" rooms in two of the four supervised injection facilities it
operates. Users can enter the well-ventilated rooms to smoke crack and
heroin. The room at the city's busiest facility on Selnaustrasse gets an
average of 40 "consumptions" a day.

Campbell said he knows he faces an uphill battle in getting a heroin
prescription program running in Vancouver. But it will eventually be
necessary if the city is to provide a broad spectrum of treatment options
for its addict population, he said.

"I estimate five to 10 per cent of our addicts are hooked hard and need to
be on prescription heroin," he said. "It's not hard to see we need that
kind of a program if we believe in treating all addicts."