Source: New York Times Contact: September 28, 1997 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