DAILY / MAY 8, 2018  
Psychiatric News Update

Switzerland Halts War on Drugs, Cuts Opioid Deaths by Offering Range of Treatments for Heroin Users

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Switzerland has found an unorthodox method—at least by U.S. standards—of solving its opioid crisis: decriminalizing substance use; offering 24-hour-a-day access to methadone programs; and for treatment-resistant cases, offering pharmaceutical-grade heroin in clinics.

Michael Liebrenz, M.D., a forensic psychiatry professor at the University of Bern’s Institute of Forensic Medicine in Switzerland, told attendees at the Annual Meeting session “Emerging Ethical Considerations in a Globalized Psychiatry” that the country’s overdose deaths have dropped by one-third since instituting these programs.

The U.S. incarceration rate—707 people imprisoned for every 100,000—is more than 10 times that of most European nations, where only 70 people to 80 people are in prison for every 100,000. It is not that U.S. citizens are more violent or engage in more criminal behavior than those in Europe; rather, the difference, Liebrenz said, is the countries’ differing approach to illicit drugs.

Switzerland found that its “war on drugs” and abstinence-based treatment was not living up to the country’s expectations. It had some 30,000 citizens addicted to opioids by the 1980s, and communes of impoverished addicts had taken over several large public parks, with 2,000 to 3,000 people openly injecting heroin in one of these “needle parks” daily. In 1991, paramedics were called in 3,600 times in just one of the needle parks to resuscitate people who had overdosed on heroin. HIV/AIDS and hepatitis C were rampant among the heroin users, and the country was often referred to as a “drug swamp” in popular media.

Starting in 1991, the country began a major paradigm shift: it decriminalized drug consumption and to stop overdose deaths and the spread of HIV/AIDS, it opened clean “reception centers” with needle exchanges where users inject themselves with substances they bring in and receive clean needles. “The offers of help no longer reached just the drug users who wanted to quit, but also those who were still unwilling or not capable of doing so,” Liebrenz said.

Twenty-four-hours a day, heroin users can now call a hotline staffed by psychiatrists and other mental health professionals and begin immediate methadone treatment. Patients in the program do not have to visit every day, which disrupts employment opportunities, Liebrenz said. Rather, they can take home a two- or three-week supply of methadone and then head to their jobs.

Methadone patients who continue to use illegal heroin are offered heroin-assisted treatment in which they pay daily visits to a treatment clinic staffed by medical professionals. Patients may choose to be injected with or to snort or smoke pharmaceutical-grade heroin.

Opioid use prevalence has remained fairly constant, he said. “Those who get addicted, stay addicted,” Liebrenz said. “But new cases of opioid use have fallen to almost zero.”

Other positive results include a huge drop in overdose deaths, crime, and the spread of HIV and hepatitis. Participants have improved social functioning and employment, he added.

The treatments, including heroin-assisted treatment, have been expanded to women in Swiss prisons. Many of the women are migrants who were incarcerated for drug-trafficking crimes, such as carrying drugs into the country for others. The prisons are bright and colorful; they have bars at the entrances and are surrounded by expansive green lawns.

“We have found some solution to the opioid crisis. This is ethics at work. And we have found a way to take care of the migrant women who suffer from substance abuse and mental illness who have been used as mules to bring illicit substances into our country,” Liebrenz said.

(iStock/Minerva Studio)


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