FDS Insight Newsletter Oct-Dec 2020

50 Today, the majority of opioid- dependent people in Switzerland receive methadone treatment. Very few have entirely stopped taking illicit drugs, but most can lead entirely normal lives. Twenty-five years ago, a thousand people died each year of drug-related causes in Switzerland – about four hundred of them died of heroin overdoses, the rest primarily of AIDS, hepatitis and purulent infections. Drug- related causes were the major factor in deaths of people in their 30s and 40s. Today, not only are overdoses increasingly rare, but HIV, since 1996- 97, can be effectively treated. Hepatitis C can not only be cured, there is hope it can be eradicated completely. The Swiss ‘Four-Pillar’ policy – prevention, therapy, repression and harm reduction – was an imperfect but workable national compromise. The only truly new element was harm reduction, and the efficacy of the other elements must still be viewed critically. Long-term prevention and abstinence- oriented therapy have yet to prove their worth in scientific studies. After detoxification cures, relapses are par for the course, often ending in fatal overdoses. Thus, the abstinence ideal, as opposed to long-term methadone treatment, at least doubles excessive mortality, today as much as back then. An adequately controlled agonist treatment best meets the needs of dependent people and of society as a whole. In 1994, I became medical director of the first heroin dispensary at Zurich’s Arud polyclinic on the Stampfenbachstrasse. During the grand opening media circus, we proudly presented diacetyl morphia vials altogether containing a half-kilogram of pure, federally produced, Swiss- quality heroin. Since then, I have privately called myself the biggest small-time heroin dealer in town. The heroin pilots were highly successful. Even the most long-term, criminally involved heroin users would see their lifestyles transform nearly immediately – demonstrating that the inherent properties of the drug were not the salient issue. And most importantly, nearly all of them survived. Switzerland’s failure to capitalize fully on this opportunity is a continuing source of regret, however. Heroin treatment never officially went beyond the test phase, and less than 3 percent of dependent people have received heroin treatment to date. For many years, my anger was more powerful than my fear. I exposed myself and my family to considerable unpleasantness. We were subjected to telephone harassment. I was spat on, beaten and received death threats. More than once, I hurt myself with HIV- infected materials. Each time, my wife and I anxiously sat out the three-month waiting period until the laboratory results came. Was it worth it? I’d say yes. My patients could so easily have been me. They were people just like me, struggling in life, just like I do. When I was able to help them, it meant everything. A. Seidenberg, talkingdrugs.org (10/9/20)