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CHAPTER 4 - SOCIAL RAMIFICATIONS OF DRUG POLICIES AROUND THE WORLD

The Netherlands

Policies to continue

4.1 The policy papers on drugs produced recently by the Dutch Government illustrate that the Dutch policies are a continuing evolution of those policies which have been operating for the past 20 years. Although rumours abound outside the Netherlands that the Dutch are reversing their policies on drugs, the main thrust of their polices are to continue, albeit with some revisions. The European Union has exerted its influence on the Dutch Government and has necessitated a reassessment of its policy. Ten years ago the greatest critic of Dutch policy was the Federal Republic of Germany. Nowadays, however, the German Ministers for Public Health and Justice have appealed to the Dutch Government to continue with their policies as many Germany states wish to emulate them. The French have in recent years become the greatest critics of the Netherlands' drug policies.

4.2 The French Prime Minister, M Chirac, claims that the majority of drugs seized in France come from the Netherlands although the French police have provided evidence that shows only four per cent of the drugs seized in France come from the Netherlands. This is not surprising because most cannabis entering Europe comes from Morocco and enters France via Spain. The street availability of cannabis in France is similar to the street availability in the Netherlands which is similar to most other industrialised countries in the world. The Dutch simply have developed amore pragmatic approach based on the open admission that a cannabis trade exists and it is better to control it than to deny its existence.

Law enforcement focus and training

4.3 Law enforcement in the Netherlands is directed towards reducing the level of international trafficking, production and trade. There is no enforcement on personal use but police try to reduce the public nuisance to other people who do not use drugs. For example, drug users from France, Belgium and Germany come to the Netherlands to buy drugs which can be bought more or less in the open; this creates a nuisance problem for the Dutch population. It is the belief of the Dutch that they could contain their problems better if neighbouring countries did as well.

4.4 When asked what drug education he offers the police in the Netherlands, Dr Fromberg

replied:

" ... I try to teach them what role drug use has had for human beings. The way substances work on your brain, the influence society has, the influence on the individual ... that prohibition creates more problems for society than the drugs, whatever their properties, can do. ... I wish them well in their hopeless job."

The International Treaties

4.5 Dr Buning noted that:

"Holland has signed all the international treaties and the Dutch government believes that our policy is within the possibilities of the international treaties, but this is questioned by other countries and by international bodies."

He further added that:

" ... the police and the public prosecutor can actually discuss priorities with each other and have the whole list of crimes to solve, finding murderers, bank robberies or whatever and then somewhere comes the individual user of soft drugs. This person will be very low on their priority list."

4.6 Recently, Dr Schroeder, President of the International Narcotics Control Board, said on Dutch television in response to an interviewer's statement that Dutch policies were working,:

"I'm not really interested if it's working or not working. What I'm interested in is what you are doing within the lines of the international treaty. That's what we have to check. We're not really interested if it works or not"

According to Dr Buning, President Schroeder took a very bureaucratic stand and added that,

"There were no other countries who question these Treaties." Buning suggested that politicians all over the world ought to question these Treaties and attempt to assess whether or not they minimise the harm resulting from drug use at the societal level as well as for individuals.

Research

4.7 The Netherlands, a small and densely populated country, is well placed to conduct research on the effects of policy changes. The University of Amsterdam carries out a number of household surveys every four years to assess the rate of tobacco, alcohol and illicit drug use. Recently 10,000 residents were selected through a random sample of the population aged between 14 and 65 years and asked, "Have you ever used cannabis?" Lifetime use has increased as the population ages but figures for regular use by young people is surprising, with only six per cent of 14 to 21 year olds reporting cannabis use on a regular basis, ie daily, weekly, monthly and yearly use.

4.8 There is a small group who use soft' drugs in a harmful way, just as there are those who use alcohol in a harmful way. Dr Buning was at pains to point out that the Dutch policy did not play down the effects of soft' drugs and continued to regard such use as a public health issue.

The cultural context

4.9 The coffee shop outlets for cannabis have to be seen in the Dutch cultural context. The Dutch culture places a lot of emphasis on individual responsibility. From a very young age, Dutch children are taught that every person is responsible for their own life. The Dutch are a people who feel they have internal control; they do not need the state to tell them what is and is not allowed as they internalise these norms of society. The availability of alcohol and drugs in Dutch society is different than in countries where people are used to being told by the state what is good and what is harmful. Perhaps in a state where the controls are external, the availability of cannabis in coffee shops would signal that these drugs are condoned. But this does not happen in the Netherlands.

Heroin use among the young declining

4.10 Dr Buning claims that "heroin is totally out of fashion in Holland" but this is not necessarily the direct result of specific Dutch policies "[t]his is a normal thing, something comes in and goes away." Dr Buning believes, however, that policies in other countries have the unintended effect of making heroin more attractive through stricter control. There seem to be a number of reasons for the decline in popularity of heroin. Firstly, the obvious visibility of heroin addiction in the streets has had a deterrent effect on the younger population. The younger generation do not want to identify with that scene. Secondly, the methadone programs have broken the nexus between heroin recruiting and the young. Many heroin users, after the first two years of using heroin, (the honeymoon period), used to sell to young people to supplement their income to maintain their habit. Now, they are more likely to attend a methadone clinic to supplement their heroin habit. This makes it unnecessary for them to recruit young people. Thirdly, the coffee shops have allowed young people to experiment with soft drugs in an environment where hard drugs are not available. In other countries, dealers will deal in a whole range of drugs and increase their profits by enticing a person from soft drugs which are less expensive to harder drugs. In the Dutch setting, people who run coffee shops have an interest in their patrons not being introduced to heroin for simple economic reasons

.

4.11 Since its amendment in 1976, the Dutch Narcotics Act distinguishes between two kinds of drugs; drugs that pose an acceptable, less heavy risk ( soft drugs', including marijuana and hashish) and those that pose an unacceptable risk ( hard drugs', including Ecstasy). The underlying idea of segregating the two markets was to prevent people who wanted marijuana from getting into unintended contact with illicit hard drugs. The intended segregation between markets has been successful.

Government support of policies

4.12 When the harm reduction policies were instituted in Holland, the left wing of the Government supported it because it protected the rights of the individual and the right wing supported it because they wanted to cut down criminality. The debate currently raging in Holland is about the solutions to heroin addiction in neighbourhoods. Holland is now considering whether it will embark on providing heroin and shooting galleries to get these dependent users off the streets as well as providing compulsory treatment for those who insist on operating outside the law. Both of these options may be implemented very soon.

4.13 Dr Buning strongly supports the legalisation of soft drugs' but argued that controlled availability of hard drugs' was preferable to legalisation. In his view, it is the illegality of certain drugs which makes them dangerous and endangers democracy. Perhaps, he concluded, the best answer is to alleviate the need for these drugs in the first place.

Conclusions

4.14 The Inquiry reached the following conclusions in connection with The Netherlands:

1. The harm reduction policies in the Netherlands have resulted in a measure of success. The nexus between soft drugs' (marijuana and hashish) and hard drugs' (heroin and cocaine) has largely been broken through the availability of soft drugs' in a controlled manner in some coffee shops.

2. Marijuana use on a regular basis by 14 - 21 year olds is now only six per cent, but in 1988 in Australia it was approximately 14% in the same age group.

3. Police training focuses on harm minimisation.

4. Heroin use by the young is decreasing.

The United States of America

The Bronx, New York: a neglected and persecuted region

4.15 Professor Drucker described the Bronx in the following terms:

"The Bronx, where I've worked for almost 30 years is not typical of the US. It is a very dense, very poor urban area. The county has 1.2 million people with about 35% living below the poverty level, crowded conditions similar to the great depression, levels of tuberculosis are now the same as in the great depression in the 1930's. We have had 12,000 cases of HIV diagnosed as of this year which is more than a number of countries in Europe. Drug use levels are very, very high and have been the for the last 20 years, principally the IV use of heroin and cocaine."

4.16 Expansion of arrests and imprisonments follows on the strict enforcement of prohibition. There has been a criminalisation not just of drug use, but, since drug use is so prevalent amongst Afro-Americans, essentially of the entire non-white population of the Borough. Not all of those prosecuted go to prison but virtually every family network has members who are imprisoned or are under the control of the criminal justice system at any given time. As the state government does not depend on this Borough for its election, because less than 25% of eligible voters go to the polls, it is a community that has been disenfranchised and neglected.

Harm maximised through fear

4.17 In the United States, about 40 million people have ever used cocaine in their lifetime. Professor Drucker estimated that a tenth of that number would have used cocaine in the last year. One quarter of current users get arrested each year. About 20 million have used heroin in their lifetime and a million are problematic current users. The problem with a policy that does not discriminate is that it drives the non-problematic user to be a problematic user. Because a drug is clandestine, users can never know what they are buying, what the purity is or what its been cut with. These conditions maximise the risk and lead to users hiding in a closet trying to keep their drug use secret.

4.18 Alcohol use, by comparison, is really out in the open. Society is learning to recognise someone who has a drinking problem. Even the terminology is important because the whole system is skewed now to seeing something as a medical problem, whereas in the case of illicit drugs, the whole system is skewed to concealing it to a point where it is very difficult to manage. Drug treatment is not a simple matter once someone has become a compulsive user.

Proportion of New York budget spent on law enforcement

4.19 According to Professor Drucker:

"We have to really cost out a social policy such as drug prohibition very fully. Even in the short term in a city like New York, we have a $30 billion annual budget and ... $2 to $3 billion of that year is spent on prosecuting, chasing down, incarcerating. paroling, rearresting drug users right now."

4.20 In New York 120,000 people are arrested each year, of whom about 60% are on drug charges. That amounts to about two or three hundred arrests a day. This means that it costs $10,000 per arrest. This money could be used to ameliorate the conditions in the Bronx that would lower the prevalence of drug use. When arrested, a person is set up for a lifetime, basically becoming unemployable, tainted as far as their ability to make a respectable marriage and have a stable household. The likelihood of recidivism is about 60%.

4.21 Thus, according to Professor Drucker:

"[Y]ou begin a process which for a 16 year old who gets arrested on a crack offence, may mean that over his lifetime, we'll spend a million and a half dollars on keeping him and us miserable. Multiply that by 2 or 3 thousand times in New York and you've committed yourself to a huge expenditure for the rest of that generation."

4.22 Professor Drucker went on to argue further that if the money was spent on alleviating the pain and reducing the harm, then we may be getting somewhere.

"Miserable conditions create the need to escape , to salver the pain in some and if the thing you use to do that takes on a life of its own as addictive drugs do, there you are."

4.23 It is well know that some of the drugs that are illegal now were legal 90 years ago and there are large parts of the world where the drugs that are legal in the west are totally proscribed. We now know enough and have the monitoring systems available to see the effects of what we do. According to Professor Drucker, Australia's drink driving laws have been quite effective and that this is a model which should now apply to illicit drugs. If you remove the barrier and the distinction, the prognosis is much better.

Drug policy: Race discrimination policy?

4.24 In the United States, drug policy has for decades been inextricably intertwined with the nation's difficult race relations. One in three Afro-American males in their twenties is in prison. Concern over incarceration, although substantial, has yet to translate into support for harm reduction as an alternative means of combating drug-related harm, even amongst the black communities.

4.25 Afro-Americans represent 12% of the population in the United States, 13% of illicit drug users, 35% of those arrested for drug possession, 55% of those convicted for drug possession and 74% of those sent to prison for drug possession. There is an urgent need for examination of these polices from a human rights perspective, let alone a health perspective.

4.26 A recent report released by the Sentencing Project reveals shocking racial disparities in the criminal justice system. Young Black Americans and the Criminal Justice System: Five Years Later, a follow-up to the 1990 study, found that one in four Afro-American males in the age group of 20 - 29 was under some form of criminal justice supervision - either in prison (one or more years sentence) or in prison (less than one years sentence), on probation or on parole. Nearly one in three young Afro-American men is under criminal justice supervision on any given day.

4.27 Of all demographic groups, Afro-American women have experienced the greatest increase in criminal justice control - with their rate of criminal justice supervision rising by 78% between 1989 and 1994.

4.28 While current political rhetoric might suggest that rising crime rates among Afro-Americans are responsible for this situation, the data provide little support for this. Although Afro- American arrest rates for violent crimes - 45% of all arrests - are disproportionate to their share of the population, this proportion has not changed substantially in 20 years. Arrests for drug related offences reveal a different rate altogether. Between 1983 and 1993, the number of incarcerated drug offenders nationally increased from 57,000 to 353,000. One in four inmates is either awaiting trial or serving time for a drug offence. Drug arrests in the Afro-American population in this same period rose from 24% in 1980 to 39% in 1993.

4.29 In the words of Reverend Jesse Jackson, commenting on President Clinton's Bill to maintain the crack cocaine sentencing disparity:

In the absence of a real war on drugs and an urban policy ... we have a war on the young, vulnerable and black."

Conclusions

4.30 The Inquiry reached the following conclusions with respect to overwhelming drug problem in the United States:

1. Law enforcement policies in the United States have resulted in massive numbers of people being incarcerated for drug use, with the vast majority (74%) being Afro- American even though only 13% of illicit drug users are Afro-Americans.

2. Law enforcement has not deterred drug use. The health and social dangers associated with drug use have increased.

3. Law enforcement costs represent a disproportionate amount of funds needed to ameliorate the declining social and health problems of the very community it polices.

Canada

Law enforcement and police powers

4.31 Canada's Drug Strategy is officially one of harm reduction, but in practice the policy is one of prohibition and criminalisation of drug users.

4.32 In response to a question regarding the stringency of law enforcement measures and their relationship to the reduction of drug use, Dr Erickson replied:

"We've given our Canadian police some of the most extreme powers in any democracy and yet even with them, they are still only arresting a tiny fraction of all users."

4.33 Until quite recently, police in Canada could search someone without any reason other than the very general suspicion that they had drugs on them. If the police found drugs, that became a justifiable reason for the search and the evidence was admissible in court, so there was virtually no recourse. The police have the right of warrantless search. According to Dr Erickson, although they go a long ways in Canada to make it easy for police to wage a drug war and to maximise arrests, there appears to be -

" .. no correlation between fluctuation in penalties and resources and use levels. I think that the impact of the law on decision of users is vastly overestimated."

4.34 There are many other factors that impact on drug related decisions made by people, beside the severity of penalties and the likelihood of being arrested. If authorities really want to make an impact on the decisions made by individuals, they have to do more than just throw resources into enforcement. In the last five years there has been an 800% increase in arrests and incarceration of black males in Toronto and a 100% increase in arrests and incarceration of whites. Additional stress is encountered in Canadian ethnic communities, making the job of regular policing more difficult.

HIV/AIDS and needle exchange

4.35 Professor Riley indicated that Canada had suffered severe cuts (70%) to research and analysis. It is estimated that health and welfare will suffer a 50% cut back over the next year. Canada currently spends $250 million a year on imprisonment for cannabis possession and

administration alone.

4.36 Canada has had needle and syringe exchanges in pharmacies since the 1980's. Needle exchange was always understood as a health issue. These exchanges are under some threat as the Canadian Government considers laws against syringe containers. Having needle exchanges, however, does not mean that Canada does not have a problem with HIV/AIDS. The rate of HIV infection is not decreasing in homosexual and bisexual people. While only seven per cent of AIDS cases are IDU related in Canada, as many as 10% and 20% of injecting drug users are HIV infected. It is know from research conducted for the World Health Organisation that when the prevalence of HIV infection in injecting drug users increases above 10%, more rapid spread often occurs. In Montreal, the prevalence level of HIV infection is 20%. In a number of other Canadian cities, the level is 10% and over. Hepatitis levels are also of major concern.

Effects on racial minorities

4.37 Like the United States, there are a disproportionate number of the coloured community who are arrested, prosecuted and incarcerated. Although the majority of drug users are white, the majority of those incarcerated are from the non-white communities.

4.38 Should it seek to move against prohibitionist drug policies, Canada risks incurring the wrath of the United States. For economic reasons, Canada cannot afford to do that.

Conclusions

4.39 The Inquiry reached the following conclusions regarding Canada:

1. Stringent law enforcement, broader police powers and increasing erosion of civil rights have not stemmed the flow of drug use. Instead, these changes have fostered a series of major public health problems with drug users at the centre.

2. There are a disproportionate amount of non-white males represented in the arrest and incarceration rates.

3. Canada's policies seem to be heavily influenced by the threat of economic retaliation by the United States.

Nepal

Prohibition imposed in exchange for aid

4.40 The war on drugs has had a major impact on Nepal. The 1976 Narcotics Act outlawed the possession of drugs and paraphernalia. It was not until 1981 that cannabis cultivation was banned. This was done at the behest of the United States Drug Enforcement Agency. Foreign aid is definitely linked to these programs.

4.41 Cannabis use in Nepal is however sanctioned by the Hindu religion. Cannabis was used regularly by the people in public and private religious ceremonies. Holy men or Sadhus, are the only people now who can gain access to cannabis legally. The United States is trying to put a stop to that as well. This prohibition of a drug that was used so commonly with the Nepalese people has created an enormous problem for the old and young alike. As Mr Rana pointed out in Nepal "[i]t's become an illegal habit now instead of something that we just used to do".

4.42 According to Mr Rana, Nepal had a history:

" ... where there was socially sanctioned drug use, the governments have been too influenced by outside forces like the US and the UN organisations, and are in denial really, to a large extent. That's an uphill struggle for groups like us. They're denying that drug use was ever socially sanctioned. If there's a problem they see it as something the hippies brought into Nepal in the 60's, part of Western influence, western corruption."

4.43 Nepal is the only Hindu Kingdom in the world. It is not part of the Commonwealth. Nepal is dominated by United States aid policy. Australian policies are very important to Nepal as they give Nepal alternatives to United States policies.

Harm reduction endorsed

4.44 The Nepalese Parliament recently passed a resolution that harm reduction is to be part of the National AIDS Policy. One of the greatest supporters of harm reduction is the Chief of Narcotics. He endorsed the harm reduction program over the objections of the Health Ministry. These programs generally receive more support from the Home Ministry, responsible for drugs, than they do from the Health Ministry. One result of this policy change is that, although Nepalese drug laws are based on punishment, the police are not interested in arresting drug users.

4.45 According to Mr Rana:

" ... harm reduction is trying to help to bring a more holistic view to the problem and to what has gone before and what should happen in the future. The answer is in harm reduction for all countries."

Conclusions

4.46 The Inquiry reached the following conclusions with regards to drug policies in Nepal:

1. Following direct intervention by the United States, Nepal has adopted a policy of prohibition in dealing with the problems associated with illicit drug use. This has created enormous health and social problems which did not exist to the same degree prior to prohibition.

2. Drugs that were used traditionally for religious and recreational purposes in the past have now been outlawed.

3. Endorsement for harm reduction programs has come mainly from the areas responsible for drug control than from health agencies.

India

Traditional use of drugs

4.47 India did not have a restrictive drug policy until the mid 1970's. Until then, cannabis and opium were legal in many of the states. There were few arrests related to cannabis or opium use as these substances were used in a traditional and ritualistic way, linked to religious ceremonies. They were also used for medicinal purposes. The development of the war on drugs' led to the destruction of cannabis plants and opium poppies in India. By and large traditional users of cannabis became users of heroin when both these drugs were made illegal. Heroin was more available on the market, physically and economically. Many people became addicted to heroin in India and when prices increased, they sought substitutes and began to inject a wide variety of illegal substances. India now has a substantial problem with large numbers of injecting drug users although until quite recent times, there was virtually no illicit drug problem. Traditional and ritual use of drugs was associated with very few problems.

Pressure from the United States

4.48 According to Mr Samson:

" ... now we have a very difficult situation where we have a lot of injecting drug users in India where we had virtually no drug problem. We had just traditional and ritual use of drugs. And that's still fairly recent. All the UNDCP pressure on the government and US policy on our government have led to a most unenlightened and unresearched approach to the management of drug supply."

4.49 At the time when international policy on drug control was being developed, India was more aligned to the Soviet policy. When foreign aid dried up, the United States Government offered India aid in return for a just say no' drugs policy. This was too difficult for India to refuse. India, however, still produces opium for licit medicinal use. Not all of it finds its way out through legal channels.

A breeding ground for corruption and increased production

4.50 India, Pakistan and Afghanistan have developed ingenious ways of escaping the controls of heroin production by scapegoating marijuana. Huge quantities of heroin are shipped through Manipur every day but only truckloads of marijuana, which is even more abundant, would be seized. Officials proclaim that they have seized 20 tonnes of marijuana and 250 grams of heroin while a much larger quantity of heroin is allowed through. Thus, according to Mr Samson:

"All we've done is succeeded in breeding new production centres. The more illegal it is the higher the prices and the more value it has as a cash crop."

Implementation of drug policy

4.51 Australia has helped India develop needle exchange programs. India is slowly developing a harm reduction policy. The Government believes that there is a more enlightened approach to the dugs problem by the Australian government.

4.52 India has been influenced by the South Asian and South East Asian policies. The drug policy, therefore, is formulated on a very stringent, punitive approach. India does not go as far as Singapore or Thailand, but it believes in rigorous incarceration. Not all police agree with the law. They are very poorly paid and very susceptible to bribery to supplement their income.

4.53 According to Mr Samson the following story sums up the dilemma of the police. While running a detoxification camp where the police were involved and very supportive, one of the clients had his bicycle rickshaw stolen. The thief was brought back to the detoxification camp and the police asked Sharan to look after him for the night as he was so upset. The police asked if he could be given some medication and they would get him in the morning and sort the problem out. The police are not really interested in arresting what are obviously poor victims.

4.54 Manipur and other places in India have had a very poor response from the law to their problems. That situation really needs to change. In Manipur, 50% - 70% of the injecting population are HIV positive. A large number of them are in prison and, because legislation is so strict, any person on drug charges cannot be bailed. Prisoners who are very sick cannot gain access to treatment. This is a human rights problem.

Conclusions

4.55 The Inquiry reached the following conclusions with respect to India:

1. Pressure by the United States on India in the 1970's lead to the adoption of prohibitionist policies which have maximised the harm created by drug use in India. Prior to this India had virtually no drug problem Many cannabis smokers have now begun to inject heroin.

2. India now has a sizeable problem with heroin injection.

3. Since prohibition, heroin has become much more readily available, even though the laws are extremely punitive.

4. Huge amounts of heroin are shipped through India as corruption is endemic.

5. Fifty to seventy per cent of the injecting population in Manipur are HIV positive.

Britain

Policy by default

4.56 The "British System" of drug policy has developed mainly by default. Policy has often developed because a decision was not made to stop a development rather than a decision being made to promote a measure. Needle and syringe programs are a good example. A small number of projects began and hence a decision needed to be made whether to stop that development or to embrace it as a pilot venture. There was no decision made to establish needle exchanges; just an absence of a decision to stop them. Structured methadone programs, on the other hand, were set up in response to evidence - based research.

Harm minimisation policies

4.57 Harm minimisation has been fairly well embraced by the health profession in Britain. The Department of Health regard harm minimisation as a perfectly straight forward, standard public health strategy to deal with a public health problem.

4.58 The development of recent interventions for illicit drug injectors has focussed on strategies designed to inhibit behaviour associated with HIV infection. Evidence exists to suggest that such strategies may have been effective. Injecting drug users however, are exposed to a very high risk of overdose. This overdose rate is probably the greatest cause of avoidable death amongst injecting drug users in the UK. Some intervention programs are being investigated to reduce the risk of these overdoses.

Conclusions

4.59 The Inquiry reached the following conclusions with respect to British drug policies:

1. Harm reduction programs have evolved in Britain largely by default than through policy implementation.

2. Because of unpredictable concentrations of street drugs, fatal and non-fatal overdoses are very common.

3. Recent programs have been developed to minimise the spread of HIV.

Switzerland

Heroin dosage declines over time on treatment program

4.60 Dr Haemmig conducts a heroin program in Berne. He was surprised by comments from opponents of the ACT Heroin Trial that if dependent users were offered heroin that was freely available to them, they would demand more and more. Dr Haemmig dismissed this as nonsense and explained that the effect of heroin, morphine and every other opioid is quite limited. Subjects on the Swiss heroin trial found that there was no benefit by consuming more than one gram a day. Dependent users do not get any greater psychotropic effect from taking larger doses. Subjects now know that it is just a waste as, in order to get a "rush", they have to have free receptors in their brain. If they have a high dose in their blood at all times, they do not experience any rush. When a dependent user begins the program, they want more as that's part of their addiction, but their intake of heroin decreases by some 24% in the first one and a half years from 440 mg a day to 331 mg a day. They have had the opportunity of attending a clinic three times a day.

4.61 This heroin program, where heroin is prescribed, is only available for those who have failed every other sort of program. It has been a last chance program. The criteria for admission have been the same as those that were used for methadone maintenance.

Health and social benefits to dependent users and the general community

4.62 Switzerland conducts its policies under the existing Convention on Psychotropic Drugs and its own national narcotic laws. The social benefits of the heroin programs to dependent users are obvious. One third of the applicants were homeless at admission but none of the participants are homeless now. Most of them were unemployed at the start but 40% of the participants are now working in Zurich. They have stabilised their health. Many do not want to leave the drug scene as their only social network exists there. This is the problem that Switzerland is now addressing.

4.63 The myth that dependent users flock to a heroin trial is untrue. The challenge is to get them to attend and keep attending. Many do not want to give up their freedom such as surrendering their driving licence or having to attend a clinic three times a day. Some simply prefer the illicit drug scene. Many dependent users are very conservative people who are sceptical of any program and need to be convinced about any possible advantages. Another deterrent is that they cannot guarantee drugs beyond the end of the trial. This means that if someone starts on the trial, they can have a legal supply of heroin for one year. After that the heroin may be stopped and they will be offered methadone or detoxification. The retention rate on these trials is 90%. The way it is currently structured suggests that it is not the program for the future, but it is a start in the right direction.

4.64 The programs began as a response to pressure from the community in the larger cities of Switzerland. These communities were suffering from the activities of the illegal drug users. At first, there was an uproar in response to the clinics but now there is no opposition.

Conclusions

4.65 The Inquiry reached the following conclusions with respect to the Swiss Heroin trials:

1. The heroin trials in Switzerland already show some positive harm minimisation results:

(a) decrease in heroin use;

(b) stabilisation of drug users' health;

(c) forty per cent of the participants have found employment;

(d) All of the previously homeless are no longer homeless.

2. Some negative aspects to the clinical program include:

(a) only those who have failed all other programs can participate;

(b) clinical program is uninviting to many who do not want to change lifestyle or lose their social networks;

(c) no guarantee of heroin maintenance after the trial and the threat of enforced rehabilitation deters many who are in most need of assistance. Previous Section | Next Section | Table of Contents