Drug overdose deaths in the United States have tripled since 2010. And so it makes sense that President Obama has announced, as he did late last month, new initiatives to fight the epidemic of prescription drug and heroin abuse in the United States.
As the former head of state of Switzerland, where innovations in drug policy have been front and center for years, I have learned much about how to prevent heroin overdoses, improve the lives of people who use drugs and create a safer environment for their communities. It is a complex puzzle, but there are key pieces that, when used together, create a public health approach with long-lasting positive effects.
The United States could take some important lessons from Switzerland’s success.
In the past 20 years, Switzerland and other countries, such as Portugal and Uruguay, have implemented policies that are people-centered, focused on health and most importantly, keeping people alive — all while respecting human rights. Switzerland’s federal government focused on reducing the harms of drug use among people who inject drugs, creating supervised injection sites and offering substance analysis services and access to opiate substitution therapy, mainly through methadone and even medical heroin.
The country also complemented these harm-reduction interventions with prevention programs. To ensure these policies had citizen acceptance, the Swiss government created forums aimed at overcoming the stigma and marginalization of people who use drugs.
Our success with these policies is not only reflected in the stories that we hear from people who use drugs, but also from the rigorous evaluation we have undertaken. According to government officials, in the first decade alone, drug-related deaths have been reduced by 50%, and approximately 1,300 dependent users are now given maintenance doses of heroin via 23 specialized clinics, which has resulted in an 82% drop in patients selling heroin on the streets.
We have succeeded in keeping more people alive, while respecting their human rights and increasing their access to health services.
So why are we discussing this now?
The United Nations General Assembly Special Session on drugs is taking place in New York on Tuesday, Wednesday and Thursday. It is a historic opportunity to share our experiences. Repressive policies in the fight against the drug epidemic have led to death and disease. There is a better way. It is imperative that the United States join with like-minded countries to advocate for policies that put health first, decriminalize users, and seek to reduce the harms of both drugs and drug policies.
I have learned that the single goal of the puzzle I mentioned earlier is keeping people alive, and that can be attained when governments provide comprehensive services. Needle and syringe programs in countries such as Portugal, the Netherlands and the Czech Republic, among others, have dramatically reduced the transmission of HIV and other blood-borne viruses caused by the sharing of injection equipment.
In the last decade, HIV rates in Portugal fell by 17%, while drug-related deaths have been halved. The United States took a step in the right direction in January by lifting the ban on federal funding for needle exchange programs. However, despite the wealth of evidence on their effectiveness, it is prohibited for federal funds to be used to buy needles; rather, funding is for salaries and counseling.
Another key intervention is reversing overdoses, and although naloxone has been used, with prescription, for decades in Australia and Canada and can provide a crucial step in saving lives, until recently it was not made widely available or accessible to others besides health professionals.
When an overdose occurs, first responders on the scene can use naloxone as a means to neutralize the opioids in the nervous system and allow the person to breathe again. In the past year, New York state, for example, has allowed naloxone to be purchased without a prescription, thus easing legal barriers that might impede its use.
As the United States addresses the current epidemic, it should also consider including substance analysis to determine the chemical composition of the drugs people are using. In many cases, they may not find heroin, but rather its more fatal relative, fentanyl. If federal health agencies would assist both state and county level institutions, as well as nonprofit organizations, in testing substances, it would empower users to make informed, responsible decisions about their consumption. It would also help health authorities target public safety announcements to the risks of current drugs found on the market.
The World Health Organization has been clear that other services must also be available to people who are injecting drugs. These include safe injection facilities, such as Insite in Vancouver, British Columbia, which opened its doors in 2003.
In addition to offering a safe, hygienic environment for people to inject drugs under a nurse’s supervision, Insite provides primary care to treat disease and infection, as well as addiction counseling and treatment, and housing and community support. Insite has been saving lives, with overdose deaths declining by 35% in the area it serves.
The United States can and should begin considering safe injection facilities to keep people alive and provide them with comprehensive services.
Finally, opiate substitution treatment, including heroin assisted therapy, or HAT, is an effective medical treatment for problematic drug users. For the needs of such users who do not respond medically to opioid substitution, Switzerland implemented HAT, provided in day clinics, which allows for “closely supervised administration of injected heroin,” thus bringing users closer to health institutions and providing them with an adapted therapy.
Methadone and buprenophine have both been shown to substantially reduce illicit opiate use, HIV risk behaviors and overdose deaths.
If the goal is to keep people alive, as I believe it to be, these treatments must be available on demand for people who are injecting drugs and/or using opiates, including people in prison.
Public policies related to drugs should focus on a few crucial components: keeping people alive, building in a public health approach and ensuring that people who use drugs have access to services that do not criminalize their behavior, but rather provide them with comprehensive care.
We can do more to keep people alive and the United States can lead that effort. Not only on a national level, but also by advocating for these evidence-based policies at the historic U.N. meeting on drugs this week.
