Heroin-assisted treatment (HAT) in Switzerland: by successfully regulating the supply and use of the high-risk injectable drug, the epidemic — one of the world’s worst in the 1990s — has virtually disappeared.
Why Swiss Doctors Are Giving Heroin to Heroin Addicts
Treating heroin addicts by giving them heroin might seem counterintuitive, yet for some of the most hardened addicts, administering heroin in supervised clinics may just do the trick where the traditional approach of detox and methadone have failed. Switzerland has been pioneering this new approach with gratifying results, and other countries have been quick to follow suit. Perhaps other countries still could learn from the success of the Swiss and their counterintuitive assault on the heroin epidemic.
The staggering stats of Switzerland’s unorthodox approach to their heroin epidemic
Due to the severe drug problem in Switzerland in the early 1990s — the rising number of injection drug users, visibility of open drug scenes, AIDS epidemic, rising number of drug related deaths, poor physical health, high criminality — the Swiss made a fundamental shift in approaching the problems caused by heroin addiction. The Swiss offer treatment-on-demand and life-time status as a patient. (Like an alcoholic is considered a lifelong condition)
A variety of different treatments are available, in order to treat a broad range of dependent people. Of an estimated 22-24,000 addicts 17,500 are in treatment. 92% are given daily doses of primarily methadone at conventional clinics or via general practitioners (60%).
The Swiss treat about 1600 dependent people with maintenance doses of heroin or slow-release morphine tablets at 23 special clinics operating in cities and two prisons. Opioid based treatments are part of a broader therapy that includes social, educational and psychological measures.
The Swiss approach has resulted in lower rates of crime, death, disease, a slight drop in expected new users as well as an improvement in mental and physical health, employment and housing.
Similar programs have been developed in seven countries: Germany, Denmark, Holland, Belgium, England, Spain and Canada.
To qualify for a heroin or morphine prescription the patient must meet certain criteria:
- at least 18 years old
- been addicted (daily use) for at least two years
- present signs of poor health
- two or more failed attempts of conventional treatment (methadone or other)
- Heroin/morphine can only be obtained at the clinic and must be consumed on site (oral or injection). (Note: Under strict control and specific criteria [for example full employment] a few are allowed to take away one oral dose daily)
- Patients can receive up to three doses of heroin per day. 66% take the heroin via needle injection, the rest a pill or mixed with juice.
- Patients average about three (3) years in this plan. However, they may stay in treatment indefinitely. 20% of original patients are still in the program.
- Upon relapse, a patient can return to the clinic and re-start the treatment.
- The vast majority of patients are satisfied or very satisfied with the program.
- Average age of patient: 42 years.
- The Swiss approach is custom-designed, according to the medical needs of the patient.
Crime Issues:
- 60% drop in felony crimes by patients (80% drop after one year in the program)
- 82% drop in patients selling heroin.
- Death Rates: Millions of doses have been administered, yet no participant has died from a heroin overdose since the inception of the program.
- Disease Rates: New infections of Hepatitis and HIV have been reduced for patients.
- New Use Rates: Slightly lower than expected.
- As reported in the Lancet June 3, 2006, the medicalisation of using heroin has tarnished the image of heroin and made it less attractive to young people. This is still true in 2018 per Bern.
- Most new users are introduced to heroin by members of their social group and 50% of users also deal to support their habit. Therefore, with so many users/sellers in treatment, non-users have fewer opportunities to be exposed to heroin, especially in the rural areas.
Cost Issues: 48 dollars/day: Patient costs are covered by national health insurance agency. Patients pay annually 700 dollars for the compulsory insurance.
What is HAT and how does it work?
HAT — Heroin assisted treatment, or diamorphine assisted treatment, refers to the prescribing of synthetic, injectable heroin to opiate addicts who do not benefit from or cannot tolerate treatment with one of the established drugs used in opiate replacement therapy like methadone or buprenorphine (brand name Suboxone).
For this group of patients, heroin assisted treatment has proven superior in improving their social and health situation. It has also been shown to save money, as it significantly reduces costs incurred by trials, incarceration, health interventions and delinquency.
It has also drastically reduced overdose deaths in the countries utilising it, as patients take their dose in a controlled, professionally supervised setting, and Narcan (naloxone) is on hand in the case of an accidental overdose. Opiate related overdoses in the US currently kill around 20,000 people per year.
HAT is significantly less common than opioid substitution treatment (OST). This is because HAT is typically reserved for opioid users who have proven unresponsive to other forms of treatment, and because it is considered more politically controversial.
But despite its relatively limited availability, there is now a substantial body of evidence demonstrating the effectiveness of HAT. This evidence provides useful lessons for managing one of the most risky and problematic forms of drug use as a public health challenge, rather than a criminal justice one.
Legally recognised as a medical intervention and therefore not prohibited by the UN drug conventions, HAT shows the wider potential benefits – locally, nationally and internationally – of moving the supply and use of an illicit drug into a completely legal, strictly regulated market.
The experience of Switzerland, which became a pioneer of HAT in the 1990s, represents the most comprehensive source of empirical evidence on the outcomes of such a transition. It suggests that if this form of treatment were rolled out widely – particularly in major consumer countries – it could have major benefits for many people dependent on heroin, and a significant impact on the scale of illicit drug markets.
Source: tdpf.org.uk
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