Pubdate: Fri, 19 Sep 2003
Source: Lancet, The (UK)
Volume: 362
Copyright: 2003 The Lancet Ltd
Contact:  http://www.thelancet.com/
Details: http://www.mapinc.org/media/231
Author: Clare Kapp

SWISS DEBATE WHETHER TO LEGALISE CANNABIS

Alcohol And Tobacco Pose Far Greater Danger, Way Advocates Of Cannabis 
Legalisation

The Swiss government, which already has one of the most liberal drug 
policies in the world, wants to decriminalise consumption of cannabis and 
put state provision of heroin to addicts on a permanent legal footing.

The ruling four-party coalition hopes the proposed revision of its drug law 
will close loopholes and establish a constitutional basis for Switzerland's 
four-pillar policy of repression, prevention, treatment, and harm 
reduction--including heroin prescription--which is widely credited with 
bringing down the mortality rate, crime, and deprivation associated with 
severe addiction.

Ahead of a scheduled parliamentary vote at the end of September, passions 
are running particularly high about the proposal to legalise consumption 
and--under certain circumstances-- production and sale of cannabis.

An estimated 500 000 people--the Swiss population is 7 million--are 
occasional or regular consumers of cannabis, and "joints" are openly smoked 
in parks, outside schools, and on trains. The government argues that its 
police resources are too stretched to enforce outdated laws.

"For the sake of our own credibility we cannot allow that alcohol and 
tobacco, which kill 10000 people a year in Switzerland, are sold with all 
kinds of marketing wizardry, while consumption of cannabis, a less 
dangerous product, is a legal offence", said the Swiss Institute for 
Prevention of Alcoholism and Drug Abuse, an independent research and 
counselling organisation.

Ahead of general elections scheduled for Oct 24, drug policy has become a 
political football. The right-wing Swiss People's Party is expected to make 
considerable gains, and this has led to a more conservative tone in the 
drug law debate--with a strong chance that the government package may be 
thrown out.

"The whole issue has become too emotional and politicised", said Felix 
Gutzwiller of Zurich University's Institute for Social and Preventive 
Medicines, and one of the pioneering forces behind Swiss drug policy.

Regardless of the outcome of the cannabis vote, Gutzwiller told The Lancet 
that this would not change Switzerland's four-pillar policy or undermine 
its injectable heroin prescription programme. This currently benefits about 
1300 addicts--all of whom have longstanding, chronic heroin dependency, 
have made several unsuccessful therapy attempts, and have clear health and 
social problems.

Gutzwiller and other advocates say there is growing international 
recognition of the positive effect of the heroin provision, as shown by a 
spectacular fall in the number of overdose-related fatalities. Last year 
there were a reported 167 deaths, down 15 2% on 2002 and the lowest level 
for 16 years. (In 1994, one of the peak years, 399 people died of drug abuse.)

"The programme is not a perfect solution, but it's better than nothing", 
Health Minister Pascal Couchepin told parliament earlier this year.

The cost is covered by Swiss health insurance to the tune of SwF11-14 5 
million (US$8-10 5 million) per year because--according to Couchepin-- 
"heroin addiction is an illness and controlled provision is a therapy".

Critics disagree, with the UN International Narcotics Control Board saying 
that Switzerland and like-minded countries are "aiding and abetting drug 
abuse and possibly illicit drug trafficking, through drug-injection rooms 
and similar outlets."

Continuing the pioneering approach, the cities of Basel and Bern are due to 
begin a 3-month pilot project this autumn to prescribe the attention 
deficit hyperactivity disorder drug methylphenidate (Ritalin) to 60 cocaine 
addicts in recognition of the trend towards consumption of heroin and 
cocaine cocktails and the fact that standard heroin treatment is not 
effective for cocaine addicts.

The health ministry rejected a request by Zurich's social department to 
test controlled prescription of cocaine itself.

Gutzwiller also said he found cocaine prescription was premature and that 
the methylphenidate experiments were a more reasonable approach.

"Switzerland is a small country and so we can't go too fast", he said. "Our 
drug policy has to be based on evidence rather than adventure."
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