Buying Heroin Geneva

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Buying Heroin Geneva

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.

Geneva struggles with crack-cocaine epidemic

Buying Heroin Geneva

By most accounts, Sarah lives a normal life. Twice a day, Sarah also walks down the street from her apartment to a clinic where she takes a treatment to stabilize her chronic disease. Sarah is one of 1, people who are part of a heroin-assisted treatment HAT program in Switzerland. One of those four pillars includes new and expanded treatment options for opioid users, including heroin-assisted treatment. The heroin provision was the most controversial part of the multi-prong Swiss drug policy. The Swiss, in keeping with their national stereotype, kept meticulous records. They found data to support the program through years of scientific study and strict randomized controlled trials before incorporating HAT into the law. Since then, the number of new heroin users in Switzerland has declined. Drug overdose deaths dropped by 64 percent. HIV infections dropped by 84 percent. Home thefts dropped by 98 percent. And the Swiss prosecute 75 percent fewer opioid-related drug cases each year. Meanwhile, in the United States, drug overdoses kill more Americans than car crashes, according to the Centers for Disease Control and Prevention. The number of overdose deaths in North Carolina went up in , and an average of four people overdose and die each day. The Swiss law requires that HAT patients must have at least two years of opioid dependence before starting treatment. They must have tried and failed two other addiction treatments and be at least 18 years old. The program was designed to treat the small percentage of people with substance use disorder who do not benefit from more traditional opioid substitution therapies, such as oral methadone or buprenorphine. Another substance being used to pad street drugs in Switzerland is an animal dewormer. In , more than 1, overdose deaths in North Carolina involved fentanyl, which is often cut into heroin or other street drugs. It also frees up the time previously spent finding the street product, enabling users to focus on things like housing, family and employment. There are hardly any young newcomers. When HAT programs started, 85 percent of participants were younger than Today, 80 percent are over the age of As the sun set outside, an increased flow of people arrived at the clinic for their second daily dose of heroin. They were polite, but not interested in making small talk in the waiting area outside the injection room. In Geneva, patients only have two time frames — the morning and the evening — to get their treatment. An older woman named Flor agreed to a short interview as she waited. Here, it helps me to have another life and do other things. When she was young, she studied theater in school. Now, Flor says she been able to get back into acting. The program also gives her peace of mind, because unlike in the streets, the product is always the same, she said. Sarah, the English woman, came in after Flor, looking equally jittery. Her eyes appeared slightly glazed, but she was more upbeat and ready to walk with her dog to a cafe across the street and chat with a reporter. Over coffee she explained her erratic journey with drugs — both heroin and cocaine — and how she found stability and comfort in the HAT program. Sarah tried heroin for the first time at age 18 but said it was too expensive. Her heroin use became consistent in the late s, when she was in her 30s and heroin was cheap. For the first six months, she used heroin off and on. For the next five years, she divided up her weekly stash into daily packets and managed to keep her full-time job and care for her small children. So she went to rehab and stayed four months. She tried rehab again, this time for a whole year. Sarah says she was lucky to have supportive friends, family and an apartment to come back to after. She found another job, but after a few months went back to using. Sarah set boundaries and rules for herself while using heroin. She would not use at work or in a public bathroom. Instead, she used the drug consumption room during her lunch break. But all the self-discipline went away with cocaine. But had I spent another two months on the street, that would have been it. And if I had done that, I felt like I could never get up again. She said it acts as an antidepressant for her. She frequently goes back to England to visit her mother for holidays and takes oral morphine instead. The randomized controlled trials included 1, participants in 17 places, including new and existing opioid substitution clinics and prisons across Switzerland. The European Monitoring Centre review found some promising trends. HAT program participants use less street heroin and illegal drugs than in the control groups treated with oral methadone. The annual cost per HAT patient ranges from 12, euros a year in Switzerland to 20, euros in the Netherlands. These are much higher than the annual cost of oral methadone treatment, which is 3, euros per patient in Germany and 1, a person in the Netherlands. The increased cost is due to the high staffing need at heroin treatment facilities. Most HAT programs require multiple staff members present at all times. And most programs do not allow the same take-home dosages allowed with other opioid substitution programs. So clinics must be open days a year for extended morning and evening hours. However, Switzerland changed the law in to allow two days of oral heroin take-home doses for stabilized patients. The European Monitoring Centre determined that HAT programs result in significant savings to society, particularly in the reduction of costs from criminal justice proceedings and incarceration of drug users. Beck, the medical director of the heroin-assisted treatment program in Zurich, said that when he goes to conferences in North America, his U. There will always be moral objection to these kinds of programs, Beck said. There are people in Switzerland who hear all the evidence and data for HAT but will not support it. Rita Annoni Manghi, medical director of the the HAT program in Geneva, said she, her colleagues and patients met with community members at coffee shops to explain what they were doing. Neighbors around the HAT facility were scared of the program and thought it would lead to more drug use, she said. This work is very important to change the minds of people. So these countries created spaces for them. Republish This Story. Taylor Knopf writes about mental health, including addiction and harm reduction. Knopf has a bachelor's degree in sociology with a minor in journalism. Been trying to contact you to voice several issues having to do with different manifestations and problematic dynamics, all having to do with what appears to be an endless slew of government tactics that will never positively influence our horrific addiction epidemic and number of associated deaths. Sadly, those sanctioned to make a difference are few and operate exclusively from self-derived, ill-informed understanding. By continued reliance upon inexperienced paradigms, the collective closed mind of an empowered few will sustain or worsen the nightmare. Change will come from minds that become open to acknowledge and accept the truth, best-told by experienced addicts and their families. Yep, I fully agree with the sentiment that harm reduction has been overwhelmingly proven as the most sensible and effective treatment for long term chronic opiate addiction. Skip to content Read all of our joint coverage with The Charlotte Ledger here. Staff worker at the heroin-assisted treatment facility in Geneva prepares injectable heroin before the patients arrive. She has a substance use disorder, and her treatment includes injectable heroin. So it started supporting them. Thilo Beck, psychiatrist and medical director of the heroin assisted treatment facility in Zurich, holds a bottle of medical-grade heroin as patients go into the glass doors on the left to inject. Photo credit: Andy Specht. People walking to work one early November morning in Geneva, Switzerland. An injection space inside the heroin-assisted treatment facility in Geneva. Photo credit: Taylor Knopf. Republish our articles for free, online or in print, under a Creative Commons license. Taylor Knopf. Next Proposed rule would require licensed daycares to test for lead in their water. Excellent article, thanks for expanding our vision of new treatments to try. This is excellent reporting on important steps being taken elsewhere. Thank you, Ms Knopf. 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Buying Heroin Geneva