SWISS Medication-Assisted Treatment 1994- 2018: SUMMARY


SWISS MAT (Medication Assisted Treatment) APPROACH TO HEROIN ADDICTION
1994 – 2018: SUMMARY

This summary was taken from six published reports and updated every year. The Swiss Federal Office of Public Health reviewed and approved its release. Additional questions should be directed to Catherine Ritter in Bern (41) 58-469-18-13 Email Catherine.Ritter@bag.admin.ch – NOTE: The author toured Swiss clinics in 2001 and 2016 and met with federal health officials in 2008 and 2017 to increase understanding and knowledge. Understanding was enhanced, due to the author’s fluency in French and German. This summary was researched and written by Howard J. Wooldridge, Drug Policy Specialist at Citizens Opposing Prohibition (.org)

Overview: Due to the severe drug problem in Switzerland in the early 1990s, (rising number of injection drug users, visibility of open drug scenes, AIDS epidemic, rising number of drug related deaths, poor physical health, high criminality) the Swiss made a fundamental shift in approaching the problems caused by heroin addiction. The Swiss offer treatment-on-demand and life-time status as a patient. (Like an alcoholic is a lifelong condition) A variety of different treatments is available, in order to treat a broad range of dependent people. Of an estimated 22-24,000 addicts 17,500 are in treatment. 92% are given daily doses of primarily methadone at conventional clinics or via general practitioners (60%). The Swiss treat about 1800 addicts with maintenance doses of heroin or slow-release morphine tablets at 23 special clinics operating in cities and two prisons. Opioid based treatments are part of a broader therapy that includes social, educational and psychological measures. The Swiss approach has resulted in lower rates of crime, death, disease, a slight drop in expected new users as well as an improvement in mental and physical health, employment and housing. Similar programs have been developed in seven countries: Germany, Denmark, Holland, Belgium, England, Spain and Canada.

* To qualify for a heroin or morphine prescription: 1) at least 18 years old; 2) been addicted (daily use) for at least two years; 3) present signs of poor health; 4) two or more failed attempts of conventional treatment (methadone or other); 5) Surrender driver’s license; 6) Heroin/morphine can only be obtained at the clinic and must be consumed on site (oral or injection). (Note: Under strict control and specific criteria [for example full employment] a few are allowed to take away one oral dose daily)

A. Patients can receive up to three doses of heroin per day. 66% take the heroin via needle injection, the rest via pill or liquid heroin mixed with juice.
B. Patients average about three (3) years in this plan. However, they may stay in treatment indefinitely. 20% of original patients are still in the program.
C. Upon relapse, a patient can return to the clinic or doctor and immediately receive a safe dose of heroin.
D. The vast majority of patients are satisfied or very satisfied with the program.
E. Average age of patient: 42 years.
F. The Swiss approach is custom-designed around the patient, not program centered.

*Crime Issues: 60% drop in felony crimes by patients (80% drop after one year in the program). 82% drop in patients selling heroin.
*Death Rates: Millions of doses have been administered. No participant has died from a heroin overdose since the inception of the program
*Disease Rates: New infections of Hepatitis and HIV have been reduced for patients.
*New Use Rates: Slightly lower than expected. 1) As reported in the Lancet June 3, 2006, the medicalisation of using heroin has tarnished the image of heroin and made it less attractive to young people. This is still true in 2017 per Bern. 2) Most new users are introduced to heroin by members of their social group and 50% of users also deal to support their habit. Therefore, with so many users/sellers in treatment, non-users have fewer opportunities to be exposed to heroin, especially in the rural areas.
*Cost Issues: 48 dollars/day: Patient costs are covered by national health insurance agency. Patients pay annually 700 dollars for the compulsory insurance. Note: The Swiss save about 38 dollars per day per patient mostly in lowered costs for court and police time, due to less crime committed by the patients.
*The Swiss purchase about 100 kilos of heroin for treatments ($200,000, black market price: 3.7 million).
** The Swiss approach gives us a glimpse of a context in which drug issues are handled by the medical community.
*** In September 2017, the Swiss govt in Bern confirmed their willingness to send a team to the US Congress to explain their program, if they receive a formal request.
**** The Swiss do not have an opioid-type problem like in the USA, as doctors rarely prescribe pain meds like Oxycontin.

Reader: What the Swiss Program is not:

1. It has not eliminated street sales of heroin. Dealers still exist in cities with clinics.
2. It is not a ‘free’ drugs program. Patients must purchase health care insurance and receive their methadone or heroin as part of their comprehensive drug treatment therapy.
3. A non-heroin using adult cannot walk into a clinic and receive heroin.
4. Simply put, the Swiss are using a comprehensive public health approach (treatment on demand) to heroin addiction whose unique feature is to allow a small minority of patients to receive pure, maintenance doses of heroin or morphine.
5. Heroin is not a legal, regulated and or taxed product in Switzerland.
6. The Swiss have never calculated how many fewer people have taken heroin during the life of the program because of the MAT program. They have calculated there was an annual drop of users of about 1% between 1992 and 2002. The Swiss attribute any progress to their Four Pillar’s Approach, not any isolated component.

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