SWITZERLAND'S HEROIN PROGRAM FACES THE VOTERS

Searching For A Solution

Proponents say providing the drug to addicts is working; opponents call it
'a subterfuge to legalize drugs.'

Zurich -- Since the early 1990s, the world has been watching a Swiss
program that supplies heroin free, or at cheap prescription prices, to
about a thousand addicts at special clinics.

It is described by its supporters as a successful harm-reduction program,
and a referendum on Sunday will decide whether the experiment is wound up
or will be expanded to double the number of addicts taking part.

No government in the world has devised a fully successful way to handle the
drug problem, with most of them waffling between increasingly tough methods
of prohibition and enforcement and a more permissive approach that hopes to
reduce the problem by making drug taking at least partly legal and
respectable.

In Switzerland, while most elected politicians seem to favour the liberal
approach, there are plenty of opponents.

This month's referendum has been initiated by such groups as Swiss Doctors
Against Drugs, who oppose the program and have collected the 50,000
signatures needed to put the issue on the ballot paper.

But it is predicted that fewer than 50 per cent of eligible voters in the
Swiss population of more than six million will vote, and a majority will
agree to expand the legal distribution of heroin as a better option than
outright prohibition.

"I think there is no doubt we will lose," conceded Zurich psychiatrist
Ernst Aeschbach, one of the leading members of Swiss Doctors Against Drugs.

A report by the independent Swiss Addiction Research Institute in Zurich
gave the program a thumbs-up on the basis of an analysis of in-depth
interviews carried out by the clinics every few months with all
participating addicts.

But Dr. Aeschbach said the report fails to acknowledge the suspect nature
of the methods and results, citing the lack of a control group, no check on
whether the addicts' testimony about their habits was true and the risk
that addicts gave the answers experimenters wanted in order to ensure a
continued supply of heroin.

"The experimental program and the unreliability of the results claimed for
it by proponents are just a subterfuge to legalize drugs," Dr. Aeschbach
warned.

In the 1980s, the Swiss set up several so-called open drug scenes. The most
famous, a needle park in Zurich, Switzerland's largest city, allowed open
dealing and use of drugs such as heroin in a downtown park.

While passing citizens and the police watched, crowds of druggies bought
and used hard drugs, often lying around all day. Diseases such as
hepatitis and AIDS were common and sirens too often signalled the removal
of the sick and the dead.

In the early 1990s, the Swiss voted in one of their regular referendums to
shut down drug parks and allow a limited trial of a scheme to supply
quality heroin in safe doses to hard-core addicts who had tried to kick the
habit through approved therapy.

The heroin-distribution program has run over its legal time limit and is
currently being funded on the basis of an "urgent decree" passed by
parliament last year, an arrangement that must be ratified.

Erica Zuger, administrator of the ZokL2 Clinic -- currently distributing
heroin to nearly 100 addicts in downtown Zurich, not far from the old
free-drug park -- draws a distinction between the goal of an addiction-free
society and a drug-free society. The latter she sees as "Utopian."

Both sides agree the ultimate goal would be a drug-free society and getting
addicts off the expensive, dangerous street heroin and onto cheap, less
harmful, less addictive methadone.

"But methadone won't work if others in the neighbourhood are providing
heroin," Dr. Aeschbach said. "The liberal drug policy in Zurich has
failed. However . . . we are not monsters. No one should sit in jail for
consuming drugs. But we should arrest dealers. Prohibition, treatment and
prevention should be the three pillars of a drug policy."

"We are not a society without drugs," Ms. Zuger said. "This is facing
reality. How can you ignore something that is there? We have to deal with
it, talk about it. It's important people are aware of what's going on.

"If we want a free economic system with less controls, with people free to
do what they want, some will be curious about drugs and want to test them.

"Not all people can handle drugs in the same way, so they need some
knowledge of what can happen. We don't have to preach to our patients, but
we encourage them to face reality and take the consequences of their
actions. This is the social part of therapy."

Ms. Zuger sees the heroin-distribution clinics as halfway houses for
hard-core addicts who have genuinely tried and failed to kick their habit.

Clinics such as ZokL2 offer an environment that is within their
comprehension. If they are pushed toward treatment, even with methadone,
they'll simply disappear and go back on the streets, she said.

Addicts enter an unmarked door in an unpretentious building and are offered
heroin as a powder, suitable to prepare for injecting with a clean needle,
or as a tablet, which is a small step toward methadone.

"One aim is to switch them from injection to tablets," Ms. Zuger said. "For
addicts who like the rush they get from injection it is not easy to change."

She said the distribution of safe doses of clean heroin has had a
demonstrably good effect on many of the addicts: "Three-quarters of the
people coming here are doing well.

"They come to the clinic every day; they're no longer going to places where
you can buy drugs; they're healthier; they don't steal or do criminal acts
any more; many of them have jobs and places to live; often they have
children and are able to care for them."

Another clinic in Zurich not very far from ZokL2 is ZokL1, which
administers methadone only, once a day, to about 450 strictly selected
hard-core addicts, exchanging needles at about $1 each.

Dr. Milo Huber, one of ZokL1's founders and a former general practitioner
who treated many AIDS patients, said the methadone treatment is helping to
reduce the bad social effects of heroin addiction.

"There are 30 to 40 thousand people in Switzerland taking heroin," Dr.
Huber said, "and about eight thousand are in Zurich.

"If we judge ZokL1 on the basis of the abstinence level, it is not a
success. But if we judge it on the basis of reducing harm, then it is a
success.

"In 1986, the number of new cases in Switzerland testing positive to HIV
was 3,200. In 1998, it had dropped to 650. Ten years ago about 30 per
cent of addicts had HIV and now it's down to 13 per cent or less.

"However, hepatitis C is still going up and up."

Dr. Huber said regular detailed questionnaires show "a reduced crime rate,
less mortality, illness, prostitution and homelessness. . . . More are at
least in part-time work. Some make a lot more than I do."

The much more controversial ZokL2 Clinic has an annual budget of about
$1.1-million, three full-time staff and 17 part-time counter people,
equivalent in total to 10 full-time positions.

"We really have to fight for the money with the government, health
insurance, the social departments of the cities and the communities," Ms.
Zuger said. "It's hard work. If we lose the referendum, we will have to
close down heroin distribution by the end of the year and switch to
methadone."

To Swiss Doctors Against Drugs, this would be great news, but with a
majority in parliament in favour of the program, and public support
seemingly high, Switzerland's heroin distribution seems -- for the moment
at least -- to be safe.