Today we visited the drop-in center for individuals in Lucerne who get heroin as a necessary medical intervention to keep them from over dosing and dying. In 1991, as a continued response to the drug problem occurring in public spaces, Switzerland added a 4th pillar, harm reduction, to their strategies for addressing drug use (the other pillars are prevention, intervention, and law enforcement).
The center can accommodate 100 people in the heroin clinic; about 80 people are currently enrolled. Clients undergo an assessment and medical evaluation to determine if the drop-in clinic is the appropriate intervention for their needs. The assessment process takes two weeks. Some people are turned away. An example given was a man who had a job in banking, a family and significant social support, and had been clean for 10 years. The treatment team thought he had the resources and support to get clean again, and that it was not medically necessary to place him on a heroin maintenance program. As such, they referred him to another program.
Women who are pregnant are eligible to enroll. At first, this policy was the hardest for me to understand. The withdrawal symptoms for babies born addicted to heroin is so hard. However, upon reflection, I came to the conclusion that moms who are using, are going to continue to use with or without the services of the drop in center. At least with the clinic services, the moms have safe and medically appropriate doses of heroin and clean needles, thus protecting the life of the fetus from an overdose or HIV. Either way, the baby is going to have to go through withdrawal when born.
According to the social workers, the clients are typically male and 30 years old. However, one client has been coming for 20+ years as he enrolled when the clinic opened. He is now in his 50’s. The medical complications that the aging heroin population will face are still unknown as users typically die before reaching old age.
Qualified individuals are allowed to come to the center up to three times a day (in the morning from approximately 7-830a, around lunch time from approximately 12-130p, and again from 430-7pm) for a medically approved fix. In the clinic, there are nine stations that people sit at and shoot up. Clients receive their dose of heroin, and must inject it themselves; social workers and other medical staff observe. Clients must pay $5 per day to participate in the program. This is interesting because the methadone clinic is free. This represents a difference in attitudes about the use of heroin and methadone. Clients who have established the trust of staff not to abuse or sell the drugs are able to take home doses of methadone.
This policy is very different from the drug policy in the United States. The majority of our treatment interventions focus on abstinence. It is fairly controversial to teach young substance abusers how to be a social or moderate drinker/user. The expectation is that someone who is 20 years old should never drink (or use) again.
In addition to the focus on abstinence, US drug policy focuses on incarcerating drug offenders. Because we do not see substance abuse as a medical problem, but instead see it as a problem of willpower or individual control, individuals who buy and sell drugs are often dealt with in the criminal justice system. Sentences can be very long (10+ years if someone has committed three drug offenses) for non-violence crimes. One positive thing that US society does is offer support programs in the community to assist families of substance users. Family members do not need the users’ permission to go to these support groups. These groups are free of charge.
I will leave you with two statistics:
- Switzerland has a population of 8 million. It is expected that deaths by overdose will be around 300.
- Ohio has a population of 11 million. In 2016, it is projected that 450 people will die from heroin this year in Montgomery County (population approximately 200,000).
You decide which policy makes more sense.