Swiss Weigh Fate of Clinics Offering Legal Heroin

By ELIZABETH OLSON

THUN, Switzerland Several years ago, Thomas sold himself on Zurich's
streets, burgled houses and sold drugs at the city's notorious needle
park to finance his heroin habit.

"You are constantly looking for more because there's never enough," said
Thomas, 29, a lean man with bleached hair and a welltrimmed goatee, who
spoke on condition of anonymity.

In those earlier days, he racked up a modest criminal record. He tried
to quit drugs five or six times but failed. Eventually he lost his job
as a counter clerk at the national airline, Swissair.

Now, he no longer worries about money; he has a parttime construction
job. And he still takes heroin, twice a day. But he no longer needs to
steal or to traffic in it to obtain his fix. The heroin is provided by
the Swiss government, through a modest clinic across from Thun's
hospital.

Thomas is part of a controversial Swiss experiment in which addicts are
allowed to receive heroin injections.

The program, begun in 1994, was pronounced a resounding success this
summer by government officials, who said that some participants had
gotten off drugs completely, while others no longer needed to commit
crimes to pay for their habit.

But the government's declaration of success is being challenged. Critics
say the program is deeply flawed because there is no reliable way to
assess improvement in the lives of heroin addicts short of abstinence.

A measure to shut down the program is being promoted by those who
believe that government distribution of heroin is a major step toward a
general legalization of hard drugs. It comes before voters on Sunday.

On the ballot is a constitutional amendment that stiffens national drug
policy by forbidding the use of heroin, cocaine, opium and marijuana,
even for medical reasons. If the measure is approved, the government's
program would become illegal immediately. Because of ambiguities in its
wording, some fear that the measure, sponsored by a group called Youth
Without Drugs, could also bar methadone programs for addicts.

The vote is expected to be close. The most recent opinion poll showed 43
percent supporting the measure and 49 percent against, the Youth Without
Drugs committee said. The Swiss Medical Association is among the
opponents of the measure.

At the core of the debate is Switzerland's pervasive drug problem. A
federally sponsored study, released in June, found that use of
dependenceinducing substances in the country is among the highest in
western Europe.

Switzerland, which has a population of about 7 million, has 30,000 drug
addicts, according to the Swiss Institute for Prevention of Alcoholism
and Drug Use, which conducted the study. The report found that 22
percent of Swiss men and 12 percent of women had taken illegal drugs at
least once.

In the early 1990s when the sordid needle park in Zurich, the Letten
district of the city where drugs were sold openly, drew worldwide
attention federal officials began seeking new ways to tackle the
problem. Hard drugs are illegal in Switzerland, but lax law enforcement
had allowed their use to flourish.

In 1992, government officials decided to start a new hazardreduction
strategy, which included needle exchanges and making heroin available to
addicts under certain conditions.

The heroindistribution project begun in 1994 under the guidance of
Ambros Uchtenhagen, head of the Addiction Research Institute in Zurich
was designed as a scientific trial in which participants were to be
closely monitored.

Unlike Britain's effort in the 1970s to provide heroin, here the drugs
are not given out by individual doctors, but as part of a tightly
controlled project with a small group of addicts, whom some call "the
hopeless and helpless." Participants are at least 20 years old, have
been addicted to heroin for two or more years, have criminal records or
health problems, and have failed several times to shake their
dependence.

Beginning with 750 addicts in 1994, the project grew to 1,146 addicts
over time. To conduct the project which costs $4 million a year
Switzerland needed permission from the International Narcotics Control
Board in Vienna to import heroin. Only a few people in the federal
health agency know the source of the heroin, said Renate Gurtner, the
program director.

Treatment centers were initially set up in 18 locations, including a
prison. Currently seven are in operation. In Thun, 50 addicts come to
the clinic as often as three times a day. They pay $10, walk in, no more
than four at a time, sit at antiseptic white tables in a small room and
inject the drugs themselves.

"We don't do it for them. They must know they are doing it to
themselves," said Ariane Schweitzer, a nurse who directs the program in
Thun.

When the program began, addicts were assessed and divided into three
groups, to receive morphine, methadone or heroin. It soon became clear
that heroin kept far more addicts in the program.

"You don't have the rush without it," Thomas said. "With methadone you
don't feel anything."

At the same time, the addicts were receiving their daily fix, they were
also enrolled in health, social and psychological services, Ms. Gurtner
said. "Heroin was the cookie to get them inside. Then we try to work
with them in a comprehensive way."

As a result, program officials said, crime decreased 90 percent among
participants, who are mostly around 30. New HIV and hepatitis infections
dropped markedly, the number capable of working doubled, and individual
heroin doses decreased. About 80 people including five in Thun
chose to enter abstinence programs. However, program officials said
about 350 addicts dropped out.

The World Health Organization, which is monitoring the Swiss program,
generally opposes such heroin treatment, in part because many countries
would find it difficult to run such a controlled program. However, the
organization has not yet taken a position on the Swiss experiment.

Despite the controversy in Switzerland, Denmark has been watching the
program with interest. (And Dutch authorities have approved a similar
heroindistribution plan on a threemonth trial, Reuters reported on
Wednesday.)

If the measure passes on Sunday, officials say that it will end not only
government distribution of heroin under this program but methadone
programs as well.

This, they warn, would leave 14,000 addicts with no alternative but
shortterm abstinence treatment.

And there are not enough treatment programs available for all of them,
said Dr. Franz Gutzwiller, who helped organize the heroin program.

Whatever the outcome of the vote, the national debate over drug policy
is likely to continue. Next year, another measure goes before voters,
calling for the legalization of all drugs.

Copyright 1997 The New York Times Company