Pubdate: Thu, 28 Mar 2002
Source:  Frankfurter Allgemeine Zeitung (Germany)
Copyright: 2002 Frankfurter Allgemeine Zeitung
Author: Brigitte Roth
Bookmark: (Heroin)
Bookmark: (Heroin Maintenance)
Bookmark: (Methadone)
Bookmark: (Cocaine)
Bookmark: (Treatment)


FRANKFURT -- A new era is about to dawn for heroin addicts in Germany.

Instead of having to scrape together an average of around Euro 4,000 
($3,500) a month to buy the drug on the streets, some people addicted to 
heroin will soon able to receive the drug at no charge from the government.

Already, the city of Bonn has begun giving heroin to a select group of 
addicts at a special university clinic.

Hamburg, Hannover, Frankfurt, Cologne, Munich and Karlsruhe are to begin 
distributing the drug by July, but are still in the preparation phase.

The three-year nationwide experiment will involve 1,120 of the estimated 
120,000 heroin addicts in Germany. The study aims to establish whether 
successful therapy depends on the scope of care or on the type of drug 
handed out, but its ultimate goal is to find new ways of stabilizing the 
well-being of heroin addicts who do not benefit from conventional treatments.

Half of the test subjects will be given a dose of heroin individually 
prescribed by a doctor. The other half, a control group, will get methadone 

The German government has committed a total of Euro 9.9 million to the 
experiment, even though there is data available from similar projects in 
Switzerland, Denmark and Britain. Martin Kohler, director of the Drugs and 
Addiction working group at the German Health Ministry, said the investment 
was still justified because of the limitations of the other projects. The 
Swiss, for example did not have a control group on methadone.

Furthermore, Mr. Kohler pointed out, the World Health Organization 
criticized the Swiss report, saying claims there was a decline in 
consumption for drugs such as cocaine were based only on statements by 
addicts. Mr. Kohler expects the German project to be more objective and to 
make greater use of blood, urine and hair tests.

Test persons are selected under the auspices of the Center for 
Interdisciplinary Addiction Research at the University of Hamburg using 
fixed criteria, including a minimum age of 23, a heroin addiction at least 
five years old and proof of permanent residence or registration at a 
supervised accommodation for at least a year in a city participating in the 

The experiment is also limited to addicts who have not responded to treatment.

Those who meet the basic prerequisites are subjected to interviews and 
medical examinations. A poor bill of health requires at least 13 physical 
symptoms on a scale, such as prolonged bronchitis, respiratory problems, 
ulcers, weight loss or infections.

Another set of criteria will help measure whether addicts are mentally fit. 
According to Wilfried Kohler, the director of heroin projects in Frankfurt 
and chairman of the department for dependencies at a local hospital, many 
from the drug scene suffer from depression, anxiety, insecurity in social 
interaction and psychosomatic "illnesses." If, however, these illnesses are 
so serious that the medical experiment could potentially be fatal, the 
addict will be excluded. This applies, for example, in cases of serious 
cardiac irregularities, insulin-dependent diabetic disorders, certain liver 
diseases and serious psychological illnesses.

The inhabitants of the seven participating cities, meanwhile, are most 
concerned with where to house the special clinics. Most people do not want 
to see them in their neighborhoods, even if they essentially agree with the 

The biggest disputes centered on the selection of locations for Hamburg and 
Frankfurt, which have the largest numbers of participants for the 
administration of heroin, 230 and 100 respectively.

The local uproar in Hamburg ultimately led to the shelving of plans to use 
a building situated near some nurseries, schools and swimming pools. 
Instead, the drug is to be distributed in portable cabins in the downtown area.

In Frankfurt, however, the head of the local health authorities presented 
what he considered a suitable building in the city's Ostend district at the 
start of this year, leaving little time for any opposition.

For this reason and a lack of suitable alternatives, the city stuck to its 
decision. A local residents' group now plans to take legal action, arguing 
that the property is surrounded by a number of schools and nurseries. If 
100 drug addicts visit the planned site three times a day, they say, this 
will attract dealers and other drug users.

Concerns here are centered on addicts' secondary habits. Although the 
clinic provides heroin free of charge, it does not have any cocaine or the 
highly-addictive crack. The money for these drugs would still have to be 
found, and dealers would have 100 potential customers on a single spot.

Relatively few drug addicts these days are, in fact, heroin users. Most 
take whatever is available on the illegal market, above all cocaine and its 
derivative, crack.

Swiss reports indicate that cocaine abuse among project participants 
declines in the long term. It does not completely disappear, however -- and 
certainly not right away. Those caught dealing are to be excluded from the 

Hamburg and Frankfurt are themselves seeing a rise in the consumption of 
crack, a powerful stimulant that also triggers aggression. Researchers are 
interested in seeing whether crack addiction diminishes during the 
experiment. Residents near the planned clinic in Frankfurt are more 
concerned, however, about the possibility of seeing a rise in violence due 
to crack, a tough challenge even for experienced social workers. Many 
locals also want to know what project participants do with their time 
between fixes -- whether they work or hang out in parks.

The addicts, says Dr. Kohler, are not just different in character but also 
in behavior. In his estimation, some will do some sort of work at least for 
a few hours, while others run errands at home. He stresses that the 
research project is not limited to the allocation of heroin and that the 
major focus is on individual counseling with doctors and social workers.

Evaluation of the completed project will again involve the criteria used to 
select the participants. This is to allow a comparison with the physical 
and mental condition of each individual before the experiment. If results 
are positive, this could pave the way for the official approval of new 
treatments for heroin addiction.


Heroin addicts in several German cities will soon start receiving heroin 
administered under a government-run project to find new ways to help 
difficult-to-treat users of the narcotic. But in some cities residents are 
worried about distribution centers being set up too close to schools and 
day-care centers. (Photo: Wonge Bergmann).
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