Swiss Approve Prescription Heroin Policy

By Jeralyn, Section Foreign Affairs
Posted on Sun Nov 30, 2008 at 09:45:00 PM EST
Tags: drug reform (all tags)

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Bump and Update: The Swiss voted to make permanent the experimental plan of providing heroin to addicts through doctor's prescriptions. The measure passed by 68%. (But they rejected an initiative to decriminalize pot):

****

Swiss to Vote on Prescription Heroin Policy Sunday

Tomorrow, the Swiss head to the polls. On the ballot: whether to make an experimental program allowing doctors to prescribe heroin permanent.

In 1998 Switzerland introduced an experimental 10-year heroin prescription programme. Today around 1,300 patients across the country are on the programme.

[More...]

Dr Christoph Buerki says his clinic in Bern serves 210 such patients. "Their average age is 40 now, and they have an average of 13 years of heroin addiction before they enter this programme. Basically we are aiming at a group of people where everything else has failed," he says.

The Swiss were early participants in needle exchange and clean injection room programs. This is the next step, for those who haven't been able to kick the habit. Who is against it? A Swiss group called Parents Against Drugs. This comment says it all:

I would never, never, put my children into a heroin prescription programme. What kind of freedom is that? I'd rather they were dead.

A parent who would prefer death for a sick child (and drug addiction is a disease) is truly pathetic, and I hope, in the minority among Swiss voters. This program should be made permanent.

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Swiss Approve Prescription Heroin Policy | 36 comments (36 topical)

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There are people (5.00 / 2) (#2)
by JamesTX on Sat Nov 29, 2008 at 02:08:53 PM EST

in the world who need these drugs in the same way diabetics need insulin. For many of them, that is how they get attracted to and addicted to heroin. Most people will not go to the trouble of maintaining a supply in an atmosphere of violent contraband, which shows that the drug is not universally "addictive" in the sense that the law enforcement model claims.

The way the brain and body manages pain, and the wide differences in those processes between people, is something that is far from understood. It is imbecilic to assume that everyone is the same, and that nobody benefits from or deserves pain killing drugs based on their brain chemistry. They will hand out powerful drugs of other sorts based on the most unsubstantiated brain chemistry theories, and they will use them until they hurt somebody. But this? No.

The history of the anti-opioid movement in the U.S. is a tragic comedy of politics and racism, and the truth is there for anyone to see. The efforts beginning with the 1914 Harrison Act were the first in a long string of mistakes, and we will pay the price for decades to come.

: I'm not sure that I agree with all you (5.00 / 1) (#22)
by sj on Sun Nov 30, 2008 at 12:09:25 PM EST

say. Or even most of it. (I don't know that I don't, either) But I do respect that your opinion is thoughtful and reasoned. You have clearly given this a great deal of thought and research.

[ Parent ]

How heroin got its name (5.00 / 3) (#9)
by Jeralyn on Sat Nov 29, 2008 at 05:15:18 PM EST

In 1969, I got to go to a World Health Organization conference in Toronto (with my father who was a biochemist in drug research.) I remember the session on treating narcotics addiction. The speaker said heroin was developed after the civil war as a cure for morphine addiction. It worked so well they called it the "hero drug" and then heroin.

As to the commenter above who said the only danger is OD'ing, there's one other: sudden withdrawal.

Also at that conference I learned that the test of whether something really is a narcotic, and therefore physically addictive, is whether you go through withdrawal (DT's, sweats, vomiting, etc) if you stop abruptly. Withdrawal is not just uncomfortable but dangerous. Our laws have mischaracterized marijuana and cocaine as narcotics for decades. Neither one is a narcotic.

Addiction to a narcotic drug is a disease. We should treat it as such rather than with criminal penalties.

on the hero drug (5.00 / 1) (#10)
by Jeralyn on Sat Nov 29, 2008 at 05:27:08 PM EST

Just found this:

During the Civil War the numbers of people exposed to morphine in the course of being treated for their war related injuries sky rocketed. Tens of thousands of Northern and Confederate soldiers became morphine addicts. In just over 10 years time from its arrival into this country the United States was plagued with a major morphine epidemic.
Even though no actual statistics were kept on addiction at this time, the problem had grown to large enough proportions to raise serious concerns from the medical profession. Doctors became perplexed and were completely in the dark as to how to treat this new epidemic.
By 1874 the answer to this increasing problem was thought to be found in the invention of a new drug in Germany. This new wonder drug was called Heroin, after its German trademarked name. Heroin was imported into the United States shortly after it was invented. The sales pitch that created an instant market to American doctors and their morphine addicted patients was that Heroin was a "safe, non addictive" substitute for morphine. Hence, the heroin addict was born and has been present in American culture ever since.

[ Parent ]

: Regarding rates (5.00 / 1) (#13)
by JamesTX on Sat Nov 29, 2008 at 07:54:00 PM EST

of habitual use under conditions of no control, Jeralyn, I read something early in my research on this topic some twenty years ago. Not realizing how important it would turn out to be, I didn't note the reference. It was a book, and it had to be published prior to 1985.

Even though no actual statistics were kept on addiction at this time...
There was a record found from the 18th century in New England, I believe, where a store owner sold an opium tincture as a tonic. He recorded the number of "regular customers" he had for the tonic. When this number was compared to the population, the estimate came out at a little less than 10%. The point here is that even when here is no control, the drug isn't universally "addictive".
The "epidemics" are often manufactured through the way in which "addiction" is measured and defined, much in the same way that "crime rates" can be adjusted by the definition of crime and the amount of enforcement. For example, Nixon, as the basis for his War on Drugs and the eventual founding of the DEA, changed the definition of heroin addiction over the five years he measured it. This actually created a sort of statistical "skyrocketing epidemic", while the actual rate of use was constant. Poor Dick. He had to resort to drug wars after he tried to base his presidency on getting "tuff on crime". His advisors eventually explained to him that crime was pretty much a state issue!

[ Parent ]

Yes, I sometimes (5.00 / 1) (#18)
by JamesTX on Sat Nov 29, 2008 at 08:41:08 PM EST

get carried away with my "harmless" rhetoric, but most of the experts I work with note that withdrawal is overrated. For most people, it is no worse than a bad cold or maybe the flu. Yes, it can kill because it stresses the heart, but usually the heart has to be sick already. It can also be avoided by gradually reducing dose, which is also required for many other medicines used today.

I also failed to mentioned another very real medical danger, and that is the masking of pain. For instance, a person taking high doses of narcotics may not recognize or react to important pain signals, like appendicitis, until it is too late. That is, they can have a very painful condition which signals a need for medical attention and it will go ignored.

[ Parent ]

That's why induced detox (none / 0) (#30)
by Fabian on Mon Dec 01, 2008 at 08:04:27 AM EST

needs to be done under medical care. Take an opiate addict, add naltrexone and get instant detox plus the possibility of serious physical consequences.

[ Parent ]

in their defense (and yes, i have children), (none / 0) (#1)
by cpinva on Sat Nov 29, 2008 at 01:58:55 PM EST

i suspect (and this is strictly speculation!) they see addiction to heroin as death by the long road. better it be clean and quick, than slow and agonizing.

not saying i necessarily agree with them, just that i kind of see where they're coming from.

Contrary to the (5.00 / 2) (#3)
by JamesTX on Sat Nov 29, 2008 at 02:17:23 PM EST

unspoken assumption which the anti-drug warriors have planted in the public psyche (without ever actually saying it, because they know it isn't true), heroin is harmless. The only hazard is the so-called "addiction", and the possibility of overdose from having supplies that vary in strength (they get a "strong" batch and OD). Heroin does not do any tissue damage. It is not toxic. It can be consumed without health hazards for a lifetime. Use of heroin is not a "road to death" under medical supervision. Absolutely, demonstrably, and unambiguously false. Ask any physician.

[ Parent ]

that's true james, i didn't mean to (none / 0) (#4)
by cpinva on Sat Nov 29, 2008 at 03:17:27 PM EST

suggest otherwise. however, most people, having been weaned on a diet of "harry anslinger-like" false data about, well, pretty much all drugs (except those sold by drug companies, of course), assume all addicts to be wild-eyed, crazed lunatics, arms lacerated by pus leaking, old needle wounds, slowly dying from their addiction.

where do you think the impetus for most of our drug laws came from, anyway?

[ Parent ]

As you can see, (5.00 / 1) (#6)
by JamesTX on Sat Nov 29, 2008 at 04:34:59 PM EST

I rant on this is a topic, particularly opioids. The fact of the matter is that I don't know where the motivation came from, but I have some ideas.

Interpreting things like Anslinger and the birth of the drug war movement today invites presentist bias. It is very important to remember that medicine didn't have the status then it has now. They didn't really have antibiotics, and most people still died of infections that would be cured with a short order of oral antibiotics today. Although medicine was advancing scientifically, simple infections were still a daunting enemy. There were other political forces acting then that are hard to understand now, and saying where and why it all started is something I am still not sure about.

I think it had something to do then with the promotion and building of the medical profession, although it is important to understand it was not in a conscious and deliberate way. Just like today, those in the BigPharma industry don't realize they are actually denying people good medicine to promote the market for their products. They actually believe their own propaganda.

In the early years, the medical profession understood the power of narcotics, as it was basically the only fast-acting tool they had (who wouldn't want exclusive rights to distribute their only valuable product). They could reliably kill pain with this stuff, and at least people died quietly and with minimal agony. They also had the emerging insight that pain-free didn't mean disease-free, and there was a truly progressive political motive fighting the exploitation of poor people by those who sold them morphine when they were sick and needed some other treatment. The point is, there probably wasn't a lot that could be done for most of them at that time anyway, but it kept them from seeking further medical attention, and the medical profession didn't like that. How can you create a strong and profitable profession if the public is ambivalent about your product? If there were alternatives available, folks just wouldn't (or couldn't) worry with doctors.

The racist tactics were simply the political tool for a larger economic purpose, which is still open to interpretation. But that is my best guess. This motive and style of market-building then morphed slowly from the medical profession to the pharmaceutical industry, because they didn't want any unpatentable natural products interfering with their new markets for synthetic compounds. Thus, they had to either discredit or demonize drugs they couldn't patent. It may be easy to discredit vitamins, but you can't discredit morphine with someone who is in pain! The only solution they had to get the effective drugs off the market was to demonize them.

[ Parent ]

I agree about heroin, but other (none / 0) (#7)
by ThatOneVoter on Sat Nov 29, 2008 at 05:02:02 PM EST

drugs available since the drug war began are a different story. For example, no one can use crystal meth for an extended period of time and not have serious health effects, mental and physical.
I think a rational approach to reforming drug laws has to included harsh penalties for dealing some substances. I also think dealing to children should be a very serious crime.

[ Parent ]

I have deep (5.00 / 1) (#12)
by JamesTX on Sat Nov 29, 2008 at 07:26:12 PM EST

concerns about my opinion on that. I agree with you on amphetamine, but I can't hold together my reasoning unless I take a very libertarian kind of position on drugs (I am not a libertarian, but their drug theory is most sensible). Amphetamine and related stimulants are poison and dangerous. It ruins the lives of children and adults. Nonetheless, if we are going to undo this tangled mess we have woven with drug laws, we have to accept the fact that no solution will be a panacea. In the larger picture, legalizing makes for less harm than contraband laws of the type we have. It will just be more reasonable and better than what we have. Education about the dangers of some synthetic drugs is needed, but prohibition isn't the answer. It doesn't work for three reasons:

Powerful, no-tolerance contraband laws create black markets which lead to corruption in enforcement, and it creates laws which authorities can use to violate the civil rights of any citizen at any time. This is because the laws are reactionary and not based in reason.
Users are impoverished and pressured into activities which are much more dangerous than the simple act of using the drug. More harm results to both the society and the user than would be caused by a laissez faire policy.
Black markets drive prices of essentially worthless substances beyond the price of gold, and the profits go solely to criminal enterprise. Often those enterprises are based outside the United States. This creates gangland dynasties more powerful than legitimate social forces. These gangs corrupt government officials with blackmail and bribery, and take the money drug users spend out of the U.S. economy. We should at least keep the money drug users spend at home.

No one will except a hands-off attitude (none / 0) (#15)
by ThatOneVoter on Sat Nov 29, 2008 at 08:04:54 PM EST

towards drugs which are harmful. That is not the way to a solution.

[ Parent ]

That is very (5.00 / 1) (#19)
by JamesTX on Sat Nov 29, 2008 at 09:06:43 PM EST

interesting given that we have just come off of a twenty year binge based on an economic theory which very much leaves people alone to make bad decisions and suffer the consequences. Nobody seems to think that most harmful things should be outlawed, nor that people should be protected from themselves in any other area. This reasoning is peculiar to drugs. As always, I somehow just can't muster a real warm feeling when told that the government deeply cares about me and is protecting me. I don't think they are in that business.

[ Parent ]

Now here you are off base. (5.00 / 1) (#20)
by ThatOneVoter on Sat Nov 29, 2008 at 09:37:10 PM EST

The last 20 years, in the sector you speak of, is an aberration. The last 100 years have shown that the public wants consumer product safety of all kinds regulated by the government.
It wasn't the public that was crying for deregulation of the financial sector---that happened as a result of the legalized bribery of Congress which we call lobbying.

[ Parent ]

: Opium, like hemp (5.00 / 1) (#23)
by JamesTX on Sun Nov 30, 2008 at 12:32:39 PM EST

is a natural product that can easily be produced in gardens. Thomas Jefferson grew it on a large scale at Monticello. It is interesting that those poppies still existed as he planted them until the 1980's, when drug warriors found out about it and forced them to carelessly rip that irreplaceable piece of American history out by the roots and burn it. Talk about desecration of an incredibly important piece of American history! The poppy is as old as time. People may favor product safety, but this is no newfangled, synthetic, "product" that could harbor unknown dangers (like, say, Vioxx or even acetominophen). Humans have had such an intimate relationship with the poppy for so long that we pretty much know what it does and doesn't do.

[ Parent ]

Why not a naltrexone prescription? (none / 0) (#5)
by Fabian on Sat Nov 29, 2008 at 03:26:09 PM EST

Naltrexone is a fairly effective drug - it's an opiate antagonist but they probably already use it.

I particularly liked one delivery system, an implant. Helps with the patients who don't take their meds reliably. Some people just need more help than others. Hey. That would be a great idea for prescription heroin! Plug and play. No resale value either.

Because it's no fun? (none / 0) (#8)
by ThatOneVoter on Sat Nov 29, 2008 at 05:02:39 PM EST

Addiction is no fun either. (none / 0) (#11)
by Fabian on Sat Nov 29, 2008 at 05:34:55 PM EST

Just ask the family and friends of an addict.

Reminds me of a story a friend of mine told me. He was finally diagnosed as with bipolar disorder, but before that he was just some guy who had a problem with binge drinking. When he woke up from a black out two states away and over 24 hours from his last memory and broke, he decided he had to stop one way or another.

[ Parent ]

Oh i agree. But I'm right, aren't I? (none / 0) (#14)
by ThatOneVoter on Sat Nov 29, 2008 at 08:03:24 PM EST

The addict wants to get the high.

[ Parent ]

"The high" (5.00 / 3) (#16)
by JamesTX on Sat Nov 29, 2008 at 08:25:22 PM EST

is always hard to define because we are referring to a phenomenological experience (something subjective). In opioid use, it is particularly troublesome. It is not clear that there is any difference between "the high" and the pain killing properties of the drugs. Decades of pharmaceutical chemistry has been focused on separating the two (making a narcotic that kills pain but doesn't cause a "high"). It turned out to not be very productive.

Somewhere in the way we are wired neurologically, there exists something called pain. Pain is nature's way of telling you something is wrong, and we tend to do whatever causes pain to stop. Psychologists call it avoidance learning. Opioids do their work at the very level of the pain "signal system", mimicking the actual chemicals our bodies produce to control the experience of pain. The mechanism is one of a molecule "fitting" into a receptor site, like a key fits a keyhole.

The way in which pain is experienced is not well understood. That is, not a lot is known about the mapping between nerve activity and subjective experience. That is not surprising, because there hardly ever is such an understanding about how nerve acticity relates to subjective experience. Philosophers and psychologists call it the "mind-body problem". There is a fairly good theory, called gate control theory, which seems to account for how pain is transmitted through the nervous system and how opioids and endorphins control the signals. It is actually controlled by the brain, which, when the "keyholes" are filled, sends messages to the spine to "turn off" the pain signals.

There is every reason to believe that there is wide individual variation in the experience of pain, and some people have much less or more of it than others. This is not any more surprising than the fact that some people have more or less fat, hair, fingernails, earwax, or whatever, than others do. It is not unreasonable to suspect that some people, due to their wiring, really have a deficiency in their ability to control the experience of pain. In essentially every other physical system that is understood, sometimes natural substances have to be replaced or augmented for health purposes. I suspect this accounts for the fact that about 10% of the population will eat opium habitually, given the opportunity. Most habitual users will tell you they do not experience a "high" under normal circumstances. They feel (and act) "normal" when they take the drug, and they are literally sick when they do not.

[ Parent ]

Thank you for the excellent (5.00 / 1) (#26)
by Radiowalla on Sun Nov 30, 2008 at 10:24:52 PM EST

discussion you are leading here and for your many thoughtful posts.

[ Parent ]

: Thank you! n/t (none / 0) (#35)
by JamesTX on Tue Dec 02, 2008 at 10:40:27 AM EST

[ Parent ]

Very interesting about the 10%. (none / 0) (#17)
by ThatOneVoter on Sat Nov 29, 2008 at 08:35:30 PM EST

I'm not sure what you' are saying here, (none / 0) (#32)
by sarcastic unnamed one on Mon Dec 01, 2008 at 11:58:54 AM EST

are you saying that some 10% of humankind perceives "pain" sufficiently differently from the rest of us such that they need the "pain masking" effects of heroin, in contrast to the "pain masking" benefits of, say, ibuprofen or NyQuil?

Personally, experiencing for myself the effects of heroin and some other drugs have always been attractive to me, they just haven't been attractive enough for me to act on that attraction.

Lotsa things in this world like that...

[ Parent ]

: Yes, I think that is what I mean. (none / 0) (#33)
by JamesTX on Tue Dec 02, 2008 at 10:33:34 AM EST

If by "perceive" you mean that subjective experience is different (or more intense), yes, that is what I am saying. It isn't such a far fetched hypothesis. There are many other examples where we have individual differences in sensitivity.
Precisely as I have mentioned, I might think your own sensitivity is not intolerable enough to justify you seeking out the drugs, especially in the atmosphere of contraband laws.
Of course, this doesn't mean opioids are a panacea for those people. They can still be misused and be dangerous. People can misuse insulin and that can be dangerous. Anytime one's own natural biochemistry is being altered or augmented by pharmaceuticals, there is always risk and it is never as good as "the real thing". My primary point is that the opioid attitude is based on the assumption that everyone is the same with regard to something that there is every reason to believe is affected by normal human variation.

[ Parent ]

You're not necessarily right (5.00 / 1) (#21)
by sj on Sun Nov 30, 2008 at 12:09:02 PM EST

...But I'm right, aren't I?
The addict wants to get the high.

There's a difference between wanting and needing.

[ Parent ]

: I dont think that it is the need to get high (none / 0) (#28)
by Amiss on Sun Nov 30, 2008 at 11:45:04 PM EST

when one is in the throes of addiction, it is the NEED to not feel SICK, of course after so many days without the drug of choice, the SICK feeling gradually goes away. I am not saying that the first few times one experiments with a drug, that there is not a high, but gradually a tolerance builds and that high feeling goes away when the drug is used.

[ Parent ]

Good News (none / 0) (#24)
by squeaky on Sun Nov 30, 2008 at 04:17:07 PM EST

ZURICH (Reuters) - Swiss voters on Sunday backed a scheme allowing heroin addicts to obtain the drug under prescription, angering conservatives who believe crime will rise as result.
Some 68 percent voted in favor of the prescription program that was already approved by parliament, making permanent an experiment that has been in place since 1994.

Reuters

Too bad the US is too provincial to follow suit. Maybe in another few hundred years of civilizing we will catch up.

: Oh Well (none / 0) (#25)
by squeaky on Sun Nov 30, 2008 at 04:19:17 PM EST

Can't have everything:

In another referendum on Sunday, the Swiss rejected the decriminalization of cannabis, with 63 percent voting against an initiative that was supported by the Social Democrats and the Green party.

[ Parent ]

JamesTX, Thank You (none / 0) (#27)
by befuddledvoter on Sun Nov 30, 2008 at 11:43:24 PM EST

for your very informative posts on this topic. Your time was well spent and your words show real compassion and understanding.

: Thank you! n/t (none / 0) (#34)
by JamesTX on Tue Dec 02, 2008 at 10:35:18 AM EST

[ Parent ]

Truly heartbreaking (none / 0) (#29)
by NYShooter on Mon Dec 01, 2008 at 12:33:03 AM EST

When will we Americans learn to govern using logic, intellect, experience, morality, and our innate, cognitive abilities? Why must so many things we know should, and could, be done to improve our lives and our futures be held hostage to mouth breathing, knuckle dragging politicians, and their superstitious, low information, easily swayed constituents?

A poster here on TL commented (only slightly tongue-in-cheek) that most diseases could be eradicated in a "nano second" if the media focused on them as much as they do on their CDS.

Take any subject that needs fixing: health care, education, alternative energy, etc; none are so complicated that solutions couldn't be found reasonably soon. So, why isn't it done? We all know the answer, but the conclusion may be a little harder to accept; maybe Democracy just doesn't work so well.

The fact that we elected GWB for two terms pretty much says it all, and unfortunately, proves my point.

Please don't flame ball me; I don't mean my comments to be the definitive, all inclusive statement on this subject. I just think that this topic; "We know the problem, we have the solution, yet we have institutionalized paralysis," should be THE subject for the 21'st. Century.

: It is a tall order! (none / 0) (#36)
by JamesTX on Tue Dec 02, 2008 at 10:48:50 AM EST

The seeds of opioid prejudice, and all the initial myths that were propagated to demonize this class of natural products, came long enough ago to be considered real history. Reefer madness is recent enough for people to know and understand the truth, and recognize propaganda. The opioid propaganda of the turn of the 20th century is so old it is accepted as fact, like Aristotle was taken as fact for so many years in the Western world. The forces behind prohibition have all but eradicated any basis for public support of critical thought on the issue. They encourage, for example, using opioids as a reference for evil in drug legalization discussion with rhetoric like "if you legalize marijuana, then what next? Heroin? Surely not!". Notice what the Swiss did with that argument! It is pure propaganda. Opioids are the single biggest threat to a huge portion of the pharmaceutical industry.

[ Parent ]

Anyone done a study (none / 0) (#31)
by nellre on Mon Dec 01, 2008 at 10:34:29 AM EST

I suspect that this sort of intolerance is coming from a person whose heart has been hardened by organized religion.