HOOKED ON DOGMA; U.S. DRUG WARRIORS IGNORE SWITZERLAND'S SUCCESS WITH
HEROIN ADDICTS

In 1986, the Swiss city of Zurich designated its Platzspitz park as a
refuge for drug users, a place where they would be tolerated by police and
even offered sterile needles and medical care. The goal wasn't to condone
drug use, but to control its side effects mainly the diseases contracted
by users and spread to the population at large. But, by the early 1990s,
"Needle Park" bulged with Europe's outcasts. As crime rose in the area and
a oncecharming garden became an eyesore, Zurich ended the experiment.

The shapers of American drug policy from former czar Bill Bennett to
Drug Enforcement Agency chief Thomas Constantine often cite Needle Park
as an argument against changing America's hardline drug policies. But the
Swiss, aware that dispersing the Needle Park junkies did not eliminate the
serious harm they were doing to themselves and to society, have continued
to pursue novel approaches toward solving their country's drug problem. For
the heroin addicts who would not respond to conventional treatment, the
government decided to take the radical step of offering heroin itself.

From 1994 to 1997, in 18 treatment centers around Switzerland, 1,146 male
and female addicts received injections of pure heroin three times a day.
Led by Ambros Uchtenhagen, an internationally renowned social scientist,
the Addiction Research Institute in Zurich kept careful tabs over the
experiment. The goal was not to offer the drug, in perpetuity, to all
comers. Rather, the researchers hoped to mitigate the injurious behavior of
a small group of addicts for whom repeated treatment regimens had failed.

The success was striking. Heroin maintenance, Uchtenhagen and his
researchers found, not only improved the lives of addicts but benefited
society in tangible ways. Before going on heroin maintenance, 59 percent of
the Swiss addicts in the program were involved in criminal activity.
Because they no longer needed cash to pay exorbitant prices on the black
market, by the end of the experiment that number dropped to 10 percent. For
the same reason and also because participants in the program were
required to undergo counseling many addicts climbed out of the
underworld, found housing and began to work in mainstream jobs. The rate of
homelessness in the group dropped from 12 percent to near zero.

The health benefits were also unambiguous: HIV and hepatitis infections
dropped sharply, and the annual death rate fell by half. Day to day, many
fewer addicts contracted skin infections and other diseases. A small but
significant portion of the group even left the program for abstinence
treatment.

If the Swiss experiment had failed, you can be sure that American officials
would trumpet the news, just as they so regularly refer to Needle Park. But
the actual results are less convenient for advocates of the status quo. And
so the response has been to ignore it.

For example, in the past four months, the National Institute on Drug Abuse
(NIDA), which controls a $ 520 million budget and 85 percent of all
research on the health effects of drug abuse and addiction, has organized
two major conferences on heroin without considering the Swiss research.

The lesson is not that heroin maintainence ought to be embraced here. The
episode illustrates, however, how discussion of America's drug policy has
been constricted by the dogma of the drug war. While vigorous research and
debate is taken for granted in public policy debates about, say, welfare
policy or affirmative action, such discussion is largely absent from the
study of drugs. To ignore innovative ideas and approaches especially
complicated, unsettling ones is at best unsound. At worst, it will lead
to outright failure.

While it is a legitimate social policy goal to eliminate heroin use
entirely, the American approach of zerotolerance has proven remarkably
ineffective. About 600,000 Americans are addicted to the drug. That number
has increased over the past several decades, despite billions of dollars
and hundreds of thousands of arrests.

Meanwhile, these addicts are causing a great deal of harm to themselves
and to the rest of us. Intravenous drug users are now the single biggest
factor in the spread of HIV. Eightyfive percent of addicts commit some
kind of crime, ranging from petty burglary to homicide. The financial costs
of untreated heroin addiction is an estimated $ 20 billion a year,
according to a National Institutes of Health (NIH) panel.

And yet, for the same reasons that they wouldn't contemplate heroin
maintenance, American officials have kept tight restrictions on the medical
treatment with the best track record: methadone maintenance. Only 20
percent of heroin addicts have access to methadone, a synthetic opiate that
often removes the craving for heroin. In November, a panel of scientists
convened by NIH and NIDA urged expanded use of methadone maintenance. This
treatment regimen, the panel concluded, "is effective in reducing illicit
opiate drug use, in crime reduction, in enhancing social productivity, and
in reducing the spread of viral diseases such as AIDS and hepatitis."

The problem, the panel reported, is a public that refuses to consider
heroin addiction in a medical context. Drug therapy for addiction is viewed
with suspicion because it's seen as just another addiction. "It's not the
zero tolerance option and so it's unpopular," says David C. Lewis, a
professor of medicine and community health at Brown University. The irony
is that Americans embrace pharmaceutical treatments for every conceivable
human ailment, from impotence to depression to hyperactivity to stage
fright. But drug addicts are regarded as castoffs.

Even discussing heroin maintenance is strictly taboo as was evident at
the same NIH conference that concluded by lamenting the stigma attached to
methadone treatment. Before the conference, NIDA assembled a bibliography
that was supposed to contain every known study of the medical treatment of
heroin addiction. The Swiss study was not among them. When Lewis made brief
mention of the study, he was criticized by his colleagues for doing so.

"Scientists and clinicians people I regard as leaders and look to with
respect are concerned that just bringing it up will cause difficulty,"
Lewis said. "You can't talk about these things in this country without
causing controversy, which is a great sadness."

NIDA is a perfect example of the paralysis that permeates the discussion
about American drug policy. In 1992, the institute was put under the aegis
of NIH specifically to insulate it from the prejudices of public opinion
to evaluate and commission drugrelated research based on science, not
politics. Nevertheless, NIDA gives priority to studies that are likely to
support government positions and regularly interpret science with obvious
political intent.

That makes debate around scientific questions concerning drug issues
difficult. "If you were at NIDA," says Peter Reuter, the director of the
University of Maryland's Drug Policy Research Center, "you would say, 'How
can I seriously argue that [discussing heroin maintenance] would make a
difference to programs here?' " Worse than not making a difference, it
could do a great deal of harm, if outraged congressmen moved to slash the
institute's research budget.

So public opinion keeps researchers from considering new ideas. But the
public can't reconsider its biases without being presented with new ideas.

The cycle is difficult to break, but not impossible. Consider the case of
medical marijuana. For years, NIDA has stonewalled researchers trying to
conduct largescale trials of the plant's utility in treating diseases such
as glaucoma and chemotherapyrelated nausea. Then, California passed an
initiative legalizing marijuana for medical use and the Clinton
administration finally instructed NIDA to conduct studies. "It's a case
where popular politics has really driven science," says Reuter.

By contrast, Swiss scientists who, like their American counterparts, depend
on government support, seem more free to conduct research in the addiction
field, which citizens can then judge on the merits. Indeed, after the
results of the heroin maintenance experiment were published this summer,
Swiss voters were asked in a referendum whether the program should
continue. More than 70 percent said "yes."

What Swiss voters seem to have realized is that there is a middle ground
between condoning heroin use and insisting all addicts kick their habits
immediately. As with nicotine, a drug with a similar addiction profile,
heroin use is not a simple matter of exercising free will. Dependence is
fierce and allconsuming; withdrawal wreaks havoc on both the body and
mind. The pleasure of heroin, writes David Lenson in his book, "On Drugs,"
takes over the body, "so that in withdrawal, ordinary consciousness is
received as pain."

Anja DoblerMicola, a member of the Swiss research team, says, "We always
get this question: 'Shouldn't therapy be drugfree?' But is drug freedom
the first step, or is it the last step?" Addicts in the program, she says,
"realize how dependent they really are." Freed from the consuming street
life and required to undergo counseling, they are able to reflect and make
more rational choices about their future.

Now, if only Americans could start making rational choices about their drug
policy.

Copyright 1997 The Washington Post