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In , the United Nations adopted the Single Convention on Narcotic Drugs , a treaty aimed at combatting drug abuse through coordinated international action. The accord seeks to prohibit the use, trade, and production of certain drugs except for medical and scientific purposes, and to combat drug trafficking. Yet despite efforts like this, failed interventions and policies, as well as human rights violations related to drug use, have continued to stand in the way of progress at the local, national, and global levels. We have much more to do to confront the many harms that drugs inflict on health, development, peace, and security, in all regions of the world. Still, there have been some wins along the way— including in Switzerland. Between and , overdose deaths in the country decreased by 50 percent, HIV infections decreased by 65 percent, and new heroin users decreased by 80 percent. Yet while scholars and practitioners have drawn lessons on public health, public order, and public policy from this partial success, few have considered how it might inform the process of social innovation. In the process, we identified five main factors that drove success, and that may help other leaders of social change think about and improve their own innovation processes. The starting point for rethinking the narcotic drug problem in Switzerland was not the will to innovate, but rather the visible, undeniable failure of existing approaches. Starting in the s, the eyes of the world turned to Zurich. Zurich registered the first death from heroin overdose in , and narcotic drug consumption in the city continued to steadily rise. In the early 80s, as a response to the increasingly widespread use of narcotics, the Swiss government revised federal law, and defined rigorous criminal sanctions for the possession, consumption, and sale of illegal drugs. By the late 80s, thousands of people around the country were openly selling, buying, and consuming drugs. Are you enjoying this article? Read more like this, plus SSIR's full archive of content, when you subscribe. This created a nexus of problems, and public health and public order were at stake. It was clear that existing approaches to solving the problem were dramatically failing, and the severity of the situation forced policy makers, police, health officials, and the public to consider alternative ways of approaching the problem. The city administration of Zurich began contracting with direct-service organizations, but many of them initially engaged in conflicting or poorly coordinated activities. Public agencies and nonprofits in the city and beyond provoked controversy by introducing needle-exchange programs, safe injection rooms , and shelters. And although authorities often looked the other way, doctors supplying clean syringes to drug users to decrease and control the risk of infection were threatened with sanctions. But over time, these groups formed coalitions and became more coordinated. Police, social workers, and medical staff started to cooperate, and churches and civil society organized to help drug users living on the streets. City representatives demanded more decision-making power in the field of drug policy and advocated for new measures, including harm reduction. Health officials, for instance, began lobbying for syringe exchange schemes that made it possible, when prohibition failed, to use drugs without irreversible physical damage like HIV infection. Coalitions emerged around these practices, shaping up an alternative to the prohibitionist policy model. Social workers, police, policy makers, health professionals, and researchers increasingly brought together policing, social, and health programs under a coherent policy. And as initial successes became visible , the public, policy makers, and public funds increasingly supported these collaborative efforts. As the process became more coordinated and gained public support, officials emphasized the need for—and the willingness to invest in—evidence building, monitoring, and documentation. Given the urgency of the problem, policy makers readily supported plausible innovations in protected spaces so that they could collect data about their effects and make decisions based on those data. For example, although consumption of narcotic drugs was still formally illegal, the Federal Office of Public Health authorized Heroine Assisted Treatment HAT trials , prescribing heroin for controlled consumption to addicts in Zurich, Bern, Basel, and Geneva. And in , the government created a Federal Commission for Drug Issues, composed of 14 mainly academic experts in the field of narcotic drugs, to advise on drug policy issues. These efforts quickly produced an impressive body of evidence that became the basis for program and policy decision-making and public discussion, both nationally and internationally. Given that Switzerland is a federal republic and direct democracy, Swiss policy is strongly localized and emerges from public opinion. So, as with any other social problem, having small coalitions develop solutions behind closed doors and implement them from the top down was not viable. At the same time, each canton, or state, could test their own solutions and thus avoid the need for a national consensus. This local orientation potentially helped overcome one of the primary challenges of drug policy implementation: Policies are often set at the national level, while the pressure to act emerges locally. For these reasons, local communities are the most likely to develop and test possible solutions. In Zurich, city administrators set up regular public meetings to counter neighborhood resistance to harm reduction facilities. National drug policy conferences in and helped generate intensive debate among politicians and drug policy professionals, and the conference reports opened up the debate to the media and the public, ultimately increasing public support for the pragmatic policy approach. Initially, conservative groups within Switzerland, neighboring countries, and the United Nations were critical of the new drug policies, claiming that actions like HAT testing were in violation of the prohibitionist UN drug conventions. But over time, and with increasing evidence that harm reduction measures worked, critics began to recognize the Swiss approach as valid. It took more than a decade before the World Health Organization in and the European Union in recognized the role of harm-reduction measures. Some scholars suggest that heroin use declined not only because of successful public policy, but also because the generation that used heroin during peak years was aging and younger generations were attracted to other kinds of drugs. While this is a single case that played out in the unique context of Switzerland, we nevertheless believe it provides important food for thought about social innovation processes:. Our hope is that other innovators can increase the scope and scale of their work by transferring some of these insights to other contexts and social issues. Help us further the reach of innovative ideas. Donate today. By closing this banner, scrolling this page, clicking a link or continuing to otherwise browse this site, you agree to the use of cookies. Near Zurich's old town, hundreds of heroin addicts gathered in the 80s and 90s. During the heroin epidemic, police officers in Zurich struggled to keep control of the city. Stanford Social Innovation Review. Download RIS File. X SSIR. I Agree.

The US can learn a lot from Zurich about how to fight its heroin crisis

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Official websites use. Share sensitive information only on official, secure websites. Over half a million heroin misusers receive oral methadone maintenance treatment world-wide 1 but the maintenance prescription of injectable opioid drugs, like heroin, remains controversial. In Switzerland began a large scale evaluation of heroin and other injectable opiate prescribing that eventually involved misusers. This was done while maintaining good drug control, good order, client safety, and staff morale. The self reported use of non-prescribed heroin fell signifianctly, but other drug use was minimally affected. There were limited reports of problems in the local neighbourhood, despite the high frequency of daily attendance. Heroin diversion was not a major problem, although some trial participants were expelled for attempting to remove heroin from the clinic or to smuggle cocaine into the clinic. The Swiss trials have encouraged proposals for similar trials in other countries, including Australia, 5 and, more recently, Denmark, Luxemburg, and the Netherlands. Any country that contemplates a trial of heroin prescription will need to address several problems that arose in the Swiss trials. Secondly, in the Swiss trials heroin was prescribed as part of a comprehensive social and psychological intervention. In the absence of any comparison treatment it was impossible to disentangle the pharmacological effects of heroin from the effects of providing treatment in well resourced clinics with highly motivated staff. An assessment of this issue requires an appropriate comparison treatment. Thirdly, the unique social and political context of the Swiss trials makes it uncertain how to generalise their findings to other countries. Switzerland is a wealthy society that has a comprehensive healthcare system that includes a well developed drug treatment system whose staff have substantial experience with opioid substitution treatment. Given this limited role, the controversy surrounding heroin prescription in Switzerland and elsewhere has been out of all proportion to its likely role as a treatment option. A recent debate about heroin prescription in Australia, for example, dominated public discussion of drug policy for nearly a month before the government decided against proceeding with the trial. The debate also had other untoward effects: supporters of the trial argued that something radical was needed, thereby encouraging the view that Australia was in the midst of a national heroin crisis. Their opponents agreed but countered that this was evidence that the national policy of harm minimisation, which sanctions methadone maintenance and needle and syringe exchange, had failed. These issues have not been resolved by the Swiss trial. There are clearly still questions that remain unanswered. The most important is what is the comparative usefulness and cost effectiveness of injectable heroin and oral methadone maintenance? A convincing answer to this question would substantially improve our understanding of the role of this controversial treatment. As a library, NLM provides access to scientific literature. Find articles by Michael Farrell. Find articles by Wayne Hall. Michael Farrell : Senior lecturer. Wayne Hall : Executive director. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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