Heroin-Assisted Treatment

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Page last updated June 9, 2020 by Doug McVay, Editor/Senior Policy Analyst.

26. Swiss Heroin-Assisted Treatment

"It has emerged that heroin-assisted treatment is a suitable option only for a small proportion (currently 4%) of the 30,000 severely dependent injecting drug users. Heroin-assisted treatment is not a replacement for other substitution or abstinence-based therapies, but an important addition for those drug users that have so far fallen through the therapeutic net. This is confirmed by the relatively modest increase in patient numbers since the bar on the legally permitted maximum number was lifted."

"Heroin-Assisted Treatment (HeGeBe) in 2000," Swiss Federal Office of Public Health (Bern, Switzerland: SFOPH, August 28, 2001), p. 2.

27. Treatment Description

"Despite the availability of a wide range of treatment programs, including methadone substitution, not all drug addicts with serious health and social problems could be motivated to enter treatment. A core group remained, which was characterized by numerous social and physical deficiencies. In an attempt to reach this group, Heroin on prescription was launched in 1994 as part of a nationally-based research project. Admission criteria were a minimum age of 20 years, at least a two-year duration of daily intravenous heroin consumption, a negative outcome of at least two previous treatments, and documented social and health deficits as a consequence of their heroin dependence. The treatment consisted of between one to three injections of heroin a day, and medical, psychiatric, and social monitoring.
"After three years, the results showed, amongst numerous other findings, that:
"• The program is able, to a greater extent than other treatments, to reach its designated target group.
"• The improvements in physical health proved to be stable over the whole period.
"• Illicit heroin and cocaine use regressed rapidly and markedly, whereas benzodiazepine use decreased only slowly and alcohol and cannabis consumption hardly declined at all.
"• The participants' housing situation and fitness for work improved considerably.
"• The income from illegal and semi-illegal activities decreased dramatically (10% as opposed to 69% originally).
"• Both the number of offenders and the number of criminal offenses decreased by about 60% during the first six months of treatment."

van der Linde, Francois, "Moving Beyond the 'War on Drugs': The Swiss Drug Policy," James A. Baker III Institute for Public Policy (Houston, Texas: Rice University, April 11, 2002), p. 4.

28. Medicalization of Heroin

"The harm reduction policy of Switzerland and its emphasis on the medicalisation of the heroin problem seems to have contributed to the image of heroin as unattractive for young people."

Nordt, Carlos, and Rudolf Stohler, "Incidence of Heroin Use in Zurich, Switzerland: A Treatment Case Register Analysis," The Lancet, Vol. 367, June 3, 2006, p. 1830.

29. Heroin-Assisted Treatment and Decline in Problematic Heroin Use

"Heroin misuse in Switzerland was characterised by a substantial decline in heroin incidence and by heroin users entering substitution treatment after a short time, but with a low cessation rate. There are different explanations for the sharp decline in incidence of problematic heroin use. According to Ditton and Frischer, such a steep decline in incidence of heroin use is caused by the quick slow down of the number of non-using friends who are prepared to become users in friendship chains. Musto's generational theory regards the decline in incidence more as a social learning effect whereby the next generation will not use heroin because they have seen the former generation go from pleasant early experiences to devastating circumstances for addicts, families, and communities later on."

Nordt, Carlos, and Rudolf Stohler, "Incidence of Heroin Use in Zurich, Switzerland: A Treatment Case Register Analysis," The Lancet, Vol. 367, June 3, 2006, p. 1833.

30. Crime Reduction

"With respect to the group of those treated uninterruptedly during four years, a strong decrease in the incidence and prevalence rates of overall criminal implication for both intense and moderate offenders was found. As to the type of offense, similar diminutions were observed for all types of offenses related to the use or acquisition of drugs. Not surprisingly, the most pronounced drop was found for use/possession of heroin. In accordance with self-reported and clinical data (Blaettler, Dobler-Mikola, Steffen, & Uchtenhagen, 2002; Uchtenhagen et al., 1999), the analysis of police records suggests that program participants also tend strongly to reduce cocaine and cannabis use probably because program participants dramatically reduced their contacts with the drug scene when entering the program (Uchtenhagen et al., 1999) and were thus less exposed to opportunities to buy drugs. Consequently, their need for money is not only reduced with regard to heroin but also to other substances. Accordingly, the drop in acquisitive crime, such as drug selling or property crime, is also remarkable and related to all kinds of thefts like shoplifting, vehicle theft, burglary, etc. Detailed analyses indicated that the drop found is related to a true diminution in criminal activity rather than a more lenient recording practice of police officers towards program participants.

"On average, males had higher overall rates than females in the pretreatment period. However, no marked gender differences were found with regard to intreatment rates. Taken as a whole, this suggests that the treatment had a somewhat more beneficial effect on men than women. This result is corroborated by selfreport data (Killias et al., 2002). With respect to age and cocaine use, no relevant in-treatment differences were observed. As to program dropout, after one year, about a quarter of the patients had left the program, and after four years, about 50% had left. Considering the high-risk profile of the treated addicts, this retention rate is, at least, promising."

Ribeaud, Denis, "Long-term Impacts of the Swiss Heroin Prescription Trials on Crime of Treated Heroin Users," Journal of Drug Issues (Talahassee, FL: University of Florida, Winter 2004), p. 187.