Europe's Drug Prescription
Innovative Approaches to the Drug Problem from Over There
by Ethan Nadelmann
Rolling Stone Issue 700 January 25 1995
Last month the University of Michigan and the federal government released the results of its annual survey of high school drug use. To the surprise of no one, more seniors say they've smoked marijuana during the last year - 30.7 percent in 1994, compared with 26 ,percent in 1993. There has also been an increase in the number of students who've tried LSD and other hallucinogens. Overall, 45.6 percent of seniors say they've tried illegal drugs.
What these young outlaws should keep in mind, however, is that the war on drugs, though less visible of late and less effective than ever, continues to claim plenty of casualties. Almost 30 percent of the l million inmates in federal and state prisons in the United States (two-thirds of the 93,708 in federal prisons) are serving time for drug-law violations. In some states mandatory sentencing means a lengthy prison term for simple possession. There are many powerful reactionaries like Texas Sen. Phil Gramm who continue to think the answer to our nation's drug problem lies in doubling a prison population that has tripled in the last 15 years.
Remarkably, there are a few reasons to be hopeful in 1995. Republican Sen. Arlen Specter of Pennsylvania has declared himself to be in favor of shifting funds for law enforcement to drug treatment and prevention. The new chairman of the House judiciary Committee, Henry Hyde, about as conservative as they come, says mandatory minimum sentences and drug-related asset forfeitures have gone too far, and the latter may be unconstitutional. And around the country, an eclectic assortment of mayors, from Baltimore's Kurt Schmoke, a Democrat, to Los Angeles' Republican mayor Richard Riordan, are looking for alternatives to the failed policies of the past.
They are looking to Europe and to some extent Australia where governments are also struggling with tough drug problems. But many of these countries have come to rely on common-sense policies and a spirit of experimentation that's absent in the U.S. The approach used abroad, generally described as harm reduction, is based on the simple notion that a drug-free society is impossible. Harm reduction means leaving casual drug users alone and treating addicts like they're still human beings. It means providing a variety of treatment options - without requiring prison time benefit from one - and for those not ready for treatment, it seeks to find a way to minimize harm to themselves and to society. Almost 20 years ago the Dutch government adopted a policy of separating soft-drug and hard drug markets. Criminal penalties and police efforts against heroin traffickers were increased, while, those against cannabis consumers were relaxed. Marijuana and hashish can be bought in hundreds of "coffee shops" throughout the country. No advertising or open displays are allowed, and sales to minors are prohibited. Coffee shops caught selling hard drugs are quickly closed down.
What has been the result? Cannabis consumption among Dutch teenagers has increased - but to levels slightly below those in the U.S. Dutch parents care at least as much about their kids as American parents do, but almost no one sees marijuana as a huge problem. As Eddy Engelsman, the former Dutch drug czar, explained, "We succeeded in making pot boring."
The biggest problems with the pot policy in the Netherlands have been the complaints of its neighbors. In October 1994, members of the French Communist Party demonstrated in The Hague to protest Dutch cannabis policy - although two of the protesters were, later found having a smoke in a nearby coffee shop. German-Dutch relations have also become strained over this issue. Some Germans don't like a legal cannabis Source SO close, and Dutch citizens living in border cities like Arnhem are tired of unruly German youth flocking over the border to party. The mayor of Arnhem suggested setting up a coffee shop outside town right next to the border so Germans could buy their product without disturbing the good people of Arnhem
In May 1994 the German Supreme Court removed criminal penalties for possession of small amounts of cannabis. Local officials have reacted indifferent ways: In Frankfurt and Hamburg, cannabis smokers are left alone, and in the northern state of Schleswig-Holstein, it's legal to possess up to an ounce of marijuana or hash. But in Bavaria, that much weed can lead to a prison term
More important in many respects have been changes in policies regarding hard drugs. In the 1970s most countries in Europe were slow to follow in the States' footsteps in providing the synthetic drug methadone to heroin addicts trying to quit their habits. (Methadone is to heroin what nicotine chewing gum is to cigarettes: It doesn't produce the rush of the real thing, but it keeps the user from feeling sick or getting agitated - with almost no bad side effects.) There have been hundreds of studies on the effectiveness of methadone since its introduction in 1965, and all but a few show that it reduces disease and death, cuts addict involvement in crime, stems the spread of AIDS and helps addicts get their lives together. While the number of methadone programs grew quickly in the United States during the 1970s - to more than 100,000 treatment slots - they've stayed at that level, hamstrung by state and federal regulations. Strict rules about dose levels, pickup times and other medical matters are set by bureaucrats, so few good doctors want to work in such programs, and many addicts seeking treatment don't s see the benefit of exchanging the hassles of the street for the hassles of the clinic. The Europeans - and the Australians as well - are taking a different tack. If addicts want methadone, it's available in clinics as well as from general practitioners that provide medical assistance and counseling. In many European cities, more than a quarter of all GPs count methadone users among their clients. People pick up the drug from pharmacies just like anyone else picking up their medicine. Amsterdam, Netherlands, Frankfurt and Barcelona, Spain, among other cities, send out methadone buses - mobile clinics.
In late November 1994 researchers at Beth Israel Medical Center, in New York, released the results of a two-year study: They found that drug users in needle exchange programs showed a new HIV-infection rate of 2 percent per year, as compared with 4 to 8 percent among those who don't frequent the programs. "This proves," said study co- - author (and the world's leading expert on needle exchange) Dr. Don Des Jarlais, "that critics who claim that the availability of clean needles can only exacerbate the drug problem are clearly wrong." Yet Congress continues to refuse to fund needle exchange, drug czar Lee Brown won't take a position, cities and states keep talking about trial programs, and the few dozen programs that do exist are harassed by cops and budget cutters.
In Europe public-health officials and, political leaders didn't wait for all the evidence to come in on needle exchange. The Dutch didn't even wait for AIDS. They started needle exchange in the early 1980s in response to an outbreak of hepatitis B among addicts in Amsterdam. In Britain it took an HIV epidemic among junkies in Edinburgh, Scotland, to get needle exchange going - but the government responded rapidly by setting up hundreds of exchanges around the country. Now one finds needle exchange vending machines in about two dozen European cities. And in Amsterdam it's possible for an addict to exchange a dirty needle for a dean one at the local police station - with no questions asked.
Like other European nations, Switzerland confronted a growing heroin problem during the late 1980s. Efforts in Zurich to concentrate the open heroin scene in one place - what became known as Needle Park - briefly attracted international attention until the park was shut down in February 1992. Today, the junkies gather on the site of an abandoned railway station no more than had a mile from Needle Park, and the Swiss can't agree on what to do about it.
No one in Switzerland likes the open drug scene. It's unsightly, embarrassing and a constant reminder of the nation's inability to solve its drug-abuse problem. Zurich officials plan to shut the site down again - in February - but there is little confidence this will fix the problem. There's support for building new prisons but not much reason to believe that more jails will make a difference. Other cities sweep their hard-core drug problems under the rug by pushing their drug scenes into ghettos where good citizens and foreign tourists dare not venture. Zurich, however, like other Swiss cities, has a problem: There are no ghettos and no stretches of abandoned buildings like those that host most of America's drug addicts. "Every square meter is settled, developed, controlled," Dr. André Seidenberg, a leading addiction doctor, points out. "In a way, Zurich is a big village."
What the Swiss decided to do is experiment. Methadone and needle exchange were easy. The first Swiss innovation was to set up legal fixerraume (injection rooms") so that junkies could inject their drugs in relatively safe and hygienic environments. Few Swiss were keen on making life easier for junkies, but even fewer wanted to deal with the sight of junkies shooting up in public parks and alleyways. The fast fixerraum ran into the expected problems from neighbors, but they've now been accepted in the main cities -, Bern, Basel and Zurich - and one small city, Schaffhausen, recently voted to set up its own.
Initial studies show that fixerraume have proven effective in reducing drug overdoses and the spread of AIDS. Now the Germans have followed suit, with Frankfurt opening a fixerraum in December - although they call it a Gesundheitsraum ("health room"). "If you sit in a garden or behind a truck, you have neither light nor dean water, and you can't find your veins because they contract in the cold," says Horst Burghardt, who supervises the Frankfurt Gesundheitsraum "That's when: overdoses happen."
The big news, however, is Switzerland's national experiment with prescribing heroin to addicts. The rationale for the experiment was simple. Needle exchange helped reduce the spread of AIDS, but the heroin that was injected with legal needles, sometimes in legal injection rooms, was illegally purchased, often financed by criminal activity, and typically it was impure and of unknown potency. Could a program of prescribing heroin legally to junkies reduce both addicts' criminal activity and their risk of contracting and spreading AIDS and other diseases? The Swiss sought advice from the few British doctors experienced in prescribing heroin to addicts and then set out to create the largest, most scientific study of heroin maintenance ever attempted.
The first Swiss heroin-prescription program started in January 1994. There are now two in Zurich, one of which is specifically designed for women. Others, with up to 50 addicts in each, are in Bern; the little town of Thun; and the one most recently set up is in Basel Some programs started off by giving some addicts heroin and others morphine or injectable methadone. Researchers soon found, however, that almost everyone opted for the "sugar" (as junkies refer to heroin), which is provided up to three times a day - for a daily fee of 10 Swiss francs (about $7.50). Two programs allow clients to take a few heroin reefers - known as sugarettes - home each night, and one program briefly experimented with giving clients . cocaine reefers - since most of the addicts also use cocaine.
In late September, Swiss officials released their preliminary report: Heroin maintenance seems to work (although the evidence on cocaine maintenance was too scanty to draw any conclusions). When addicts can control their dose and take it in a safe, clean place, the drug causes few health problems. The programs have not resulted in a black market of diverted heroin, and the health of addicts in the program has dearly improved. But the officials also noted that heroin maintenance cannot solve the problems that led to heroin addiction in the first place. Based on these findings, the Swiss federal government decided in October to expand the experiment to include up to 1,000 addicts in 1995. Now it appears that the Dutch will also initiate heroin-maintenance experiments this year. And in Germany city officials in Frankfurt, Hamburg and elsewhere want to do likewise but are blocked by the federal government. Not every country in Europe supports harm reduction. Sweden has its own version of Singapore's drug laws; Belgium and France tilt in the direction of US. policies and rhetoric. Even in Zurich some police officials such as Peter Wepfer, head of the drug squad, complain that "it's too easy for the junkies here. They can get everything too easily." But Wepfer's solution is to legalize drugs completely. That would solve most of the problems, he observes, but only if everyone - not just the Swiss - did it.
During the last decade, the U.S. Congress convened hundreds of hearings on almost every aspect of the drug problem - but not a single one focused on the harm reduction approaches used abroad. The Swiss set up their heroin-prescription programs because they wanted . answers to questions that many Americans also ask - but have never been able to answer. There's not a single valid, legal, scientific, financial or ethical reason why heroin maintenance programs or fixer rooms can't be tried in the US. - only bad political reasons.
So far these reasons have prevented all but the arrest-and-imprisonment approach to the nation's drug problem. This is a tragedy. The failure to set up needle exchange programs in the United States during the mid-19806 is probably responsible for the deaths of tens of thousands of men, women and children. Even today, public officials bicker over the moral messages" of such programs and talk of pilot projects. Hundreds of thousands of young lives have been ruined by imprisonment for what are essentially victimless crimes.
Former' Surgeon General Joycelyn Elders dared to call for the 'study of alternative drug policies, and she ultimately paid the price. Politicians now have a choice to make: escalate the drug war tactics of the past decade despite overwhelming evidence that they've failed or open their eyes and see what can be done.
ETHAN À. NADELMANN is the director of the Lindesmith Center, a project of George Soros' Open Society Institute.