Evolution of the Harm Reduction Model in Switzerland

[pukingcells]

I know that Canada has Insite which started as a clinical trial and has been successful for heroin addicts with a clean injecting site

I think that they are now opening an inhalation room for coke/crack as well and I want to say it is Vancouver, not sure though.

 

[ghostfreak]

Thanks for the links at the start - very interesting.

 

[jspun]

I going to start opening and pasting the links: some day the may no longer exist and there is a wealth of info and cool stuff. Thanks for your info ZurichSB, I'll hsve to PM you for more insider information.

Needle Parks, whether authorized, overlooked, or underground, have been ubiquitous in many major western cities over the last 40 years. Zurich, Switzerland implemented a needle-exchange program in a main park downtown, and on my first trip to Europe, with Kristy and Tim Brauch, in 1992, we happened upon their Needle Park. It was pretty unbelievable, and pretty shocking. Now, it wouldn't have been anything but interesting, and I probably would simply approach the people and ask if I could shoot some photos. But at the time the longest lens I had was a 105mm, and I shot these photos from the driver's seat of our Renault, across the street. After shooting photos and trying to be inconspicuous for a few minutes, Kristy said "Oh my God, go!" I kept shooting. Tim was laughing, but then said, "shit,go!" I kept shooting until Kristy hit me and said "Someone's coming!" I dropped my camera into my lap as the guy who was crossing the street towards us broke into a full run, and just got the little car going as he approached us from behind and on the driver's side. He'd been holding a syringe and needle, and as we "escaped" he threw it at the back of the car. With the camera to my eye I hadn't even seen him... Looking back it was funny, but Kristy didn't laugh for a while.

Anyway, in these photos, which are grainy and too far away, you can still see a dude shooting up in the back of his hand, and the full-on shoot-up shop set up a block from the financial district in downtown Zurich. As we sat there, men who looked like "normal" business dudes walked up, removed their jackets, paid the guy selling the dope, took the needle, watched him heat it up, borrowed his rubber band, and shot up. They stood there making conversation like it was the most normal thing int he world for a few minutes, put their coats back on, and walked off where they had come from.

It was more than our suburban minds could handle at the time, but the images have always stuck with me. It just seemed like another wild, cool thing that you saw on skateboarding trips.


Check the candle going to heat up bent spoons filled with dope.
The guy on the left is shooting into his hand, and the normal looking woman seems oblivious. The bent dude in the center seems sketchy though.
The guys on the left had already taken care of business like it was just so normal. The dealer dude is setting up the syringe and needle for the next customer. (Needle dangling from his mouth.)
Business is selling heroin, and business is good.Please don't steal my photos. If you do, please credit skatepunk.com

Follow link can't figure out how to paste pix

http://www.skatepunk.com/featured/needle-park-zurich-1992

 

[jspun]

Cocaine Rx a possiblity in Switzerland alongside Rx Heroin

One article out of the bunch that explores the possibility of an Rx cocaine scene being added to the Rx heroin scene that the Swiss have had for the last 15 years. By the way, anyone have any info, from an historical standpoint on the old Zurich needle park scene circa 1986-1992? First hand accounts especially appreciated. But anyway back to the subject of cocaine maintenance (CMT) in the Swiss Confederation. This article is a bit dated @ 2002 but it took the Swiss over 9 years to institute there current Rx Heroin scene after much debate and study.

Doctors consider cocaine prescription

by Imogen Foulkes


Cocaine and crack users have the use of two smoking rooms in Zurich (Keystone Archive)

Switzerland’s policy of harm reduction for drug users could go one step further with a programme of cocaine prescription.

Positive results from Switzerland’s heroin prescription programme, which show patients achieving better health and a more stable life style, have led some doctors to believe that cocaine addicts could be helped in the same way.

Dr Daniel Meili, who is chief medical officer for Zurich’s heroin prescription programme, is pleased with the way patients on the programme have improved, but wants more flexibility in what he can offer them.

“We need more options,“ he said. “We are still too restricted in what we can do and we are not reaching all the people who need our help.“

Meili points out that most heroin addicts continue to use cocaine as well, which they must buy on the illegal drugs scene.

“Most addicts like the combination,“ he explained, “and can’t or don’t want to give up cocaine. And since we don’t have many options for treating cocaine addiction it is difficult to reach these addicts.”

Smokers’ rooms

In an attempt to reach those who use both heroin and cocaine, Zurich opened two smokers’ rooms at the start of this year. They share premises with the injection rooms, and allow addicts to smoke cocaine or heroin in peace.

Robert Reithauer, the social worker in charge of the Selnau drug users centre, admits he was sceptical at first about having a smokers’ room, but says it is working very well.

“The reputation of crack cocaine smokers is very bad,“ Reithauer explained. “They are prone to aggression. But here they can consume the drugs they have bought illegally – cocaine or heroin – under hygienic conditions.“

“We have maybe 20 or 30 people a day coming to use the smokers’ room; some people come two or three times a day, and really we are surprised at how well it is going.”

Good ventilation

The room itself has enough space for three people, and a powerful air conditioning system to ensure that staff at the centre do not inhale the fumes.

There is even a large roll of aluminium foil on the wall, which addicts need to cook up their fix.

One user, who wanted to remain anonymous, said he was pleased with the new room.

“It’s a positive thing,“ he told swissinfo. “If this room wasn’t here we’d be on the streets, or hiding in the public toilets trying to smoke, and we’d be picked up by the police.“

It’s a shocking sight to those more familiar with drug addiction programmes which encourage patients to give up their habit.

But for many medical staff and social workers, the smokers’ rooms are simply a logical extension of the harm reduction policies which began with the needle exchanges and injection rooms.

Ruth Vogt, who is head of drugs policy at Zurich’s social work department, says maintaining contact with as many addicts as possible is crucial.

“There’s no point closing our eyes and hoping they’ll just stop taking drugs,” she told swissinfo. “They won’t stop. And many of these addicts are ill; they are infected with Hepatitis C for example, so it’s much better if we can have the contact with them and provide them with medical and social help.”

Cocaine on prescription

For Ruth Vogt and Daniel Meili, the next step should be to introduce a cocaine prescription programme.

“I think we should try it,“ said Vogt. “Obviously we need to start with a medical trial - a lot of research needs to be done - but I think we should try.“

Meili himself is increasingly impatient with what he sees as a lack of options for treating people addicted to both cocaine and heroin.

“It’s only half a treatment if I can only prescribe them with heroin,“ Meili said. “It means they stay in the illegal drugs scene. They spend a lot of money, they stay in contact with all those people in the scene, and so it is very difficult to change their life and their social situation.”

Meili says he would start prescribing cocaine tomorrow if he was permitted to do so, but agrees that more research is needed.

“The point is that we won’t know if it will work unless we try,“ he explained. “And I don’t want to argue about cocaine prescription on an emotional or idealogical level. I want to discuss it on a medical and scientific basis, and for that we need proper research.”

Scepticism

But at the Federal Health Department in Bern officials are sceptical about cocaine prescription. Ueli Locher, head of drugs policy at the department, says he doubts that many doctors would support such a programme.

“The prescription of cocaine has a lot of problems,“ Locher told swissinfo. “It’s a much more difficult drug to control than heroin, and there are risks associated with it. Users can become psychotic, or aggressive, and there is a risk of heart attack.

“Many doctors have told us that they don’t want to take the responsibility of prescribing it.“

Nevertheless Locher admits that there is a problem over how to treat cocaine addicts.

“Medical professionals have told us they feel helpless, not just in Switzerland but all over the world it’s the same. No one really knows what to do about this.“

Later this year the Federal Health Department will be holding consultation meetings with doctors and social workers to discuss new ways of treating cocaine addiction.

“I really don’t see cocaine prescription as a viable option at the moment,“ said Locher. “But still we should be ready to listen, and be open to new proposals.“

Swiss Doctors Consider Rx Cocaine

 

[jspun]

Funny, I started this thread to gain info about the "Needle Park" Scene at Platzpitz Park, in Zurich, 1986-1991 or 1992 were the city made the buying, selling, and using of hard drugs in this park legal. It evolved into a thread about legal heroin and harm reduction in Switzerland after Lacey K prompted me to change the name. Found an article, not too much info but alitlle smidge about needle park and how it lead to the establishment of a swiss safe injection, Rx heroin scheme, and hopefully Rx cocaine to come although that hasn't been discussed much recently. This is one of my favorite threads that I started for the wealth of info on harm reduction, the main point of this website.

Needle Park, Switzerland
Often when talking about drug legalization I hear about how the Swiss tried it and in what was nicknamed “needle park” and what a mess it was. Junkies shooting up in public… fighting, throwing up… even dying in the park. They cite it as evidence that we need to continue our policy of prohibition.

What the pragmatic Swiss did was this: They realized that heroin addicts were a problem in Zurich and other Swiss cities. The Swiss like order and cleanliness and junkies nodding off in shop doorways and urinating on the steps of Swiss banks was a problem. They designated a park near the railroad station as a place where these IV drug users could go and do what they did unmolested by police.

Well it got them away from the downtown shops and banks but every IV drug user in Switzerland went there to score their drugs. Then it attracted junkies from other European countries as well. It became an uncontrollable mess in short order. Imagine if we had alcohol prohibition again and there was one park in your city designated as the only place where you could legally drink alcohol. How long would it take for every alcoholic in town to go there? Can you imagine what that park would be like in a month?

So realizing that the needle park idea was a dumb one but still understanding that arresting drug users hasn’t worked elsewhere in the world the Swiss tried another plan…heroin maintenance. They took the most addicted drug users they could find, people that had repeatedly failed treatment programs, and brought them to a clinic where they met with a doctor who examined them and gave them their dose of heroin. Soon a dose was found that satisfied their cravings but allowed them to function. They came to the clinic once or twice a day and shot up. After a year they evaluated the program. The results, according to World Health Organization* concluded:

(a) The health of participants improved.

(b) Illicit cocaine and heroin use declined greatly.

(c) Housing situation improved and stabilized- most importantly there were no longer any more homeless participants.

(d) Fitness for work improved considerably, those with permanent employment more than doubled from 14% to 32%.

(e) The number of unemployed fell by half (from 44% to 20%)

(f) A third of the patients that were on welfare, left the welfare rolls. But, others went on to welfare to compensate for their lost income from sales of drugs.

(g) Income from illegal and semi-legal activities decreased significantly, from 69% of participants to 10%.

(h) The number of offenders and offenses decreased by about 60% during the first 6 months of treatment.

(i) The retention rate was average for treatment programs. 89% over 6 months, and 69% over 18 months.

(j) More than half of the dropouts did so to switch to another form of treatment. 83 of the participants did so to switch to an abstinence-based treatment, and it is expected that this number will grow as the duration of individual treatment increases.

(k) There were no overdoses from drugs prescribed by the program.

There are currently some 1300 addicts in these programs around the country and, in addition to pharmaceutical heroin or cocaine they get therapy with a psychiatrist and counseling by social workers.

The aim is that the patients learn how to function in society. After two to three years in the program, one-third of the patients start abstinence-programs and one-third change to methadone treatment.

I remember talking to the chief of police for Zurich at that time and he told me that he spoke around the country against this program until he saw it in action. Now he speaks in favor of it and why not? Crimes committed by heroin addicts have dropped 60 percent since the program began in 1994.

Next Sunday the Swiss will have a referendum on whether or not to make the program permanent. Polling shows a 3 to 1 majority in favor.

Also on the ballot will be a law to make it legal to own and cultivate cannabis. According to official surveys, 28% of the Swiss aged between 15 and 39 have smoked cannabis.

“Out of a population of 7 million we have 600,000 users. The level of social acceptance is very high” said Sergio Savoia, president of the ‘Verdi Ticinesi’ and one of the political parties in favor of the new law.

The big Swiss cities and the German part of Switzerland are in favor while more rural and traditional areas are less enthusiastic. The majority of political parties are in favor of this law and it too is expected to pass.

Check back here after the voting and I’ll tell you the results.



* Source: Robert Ali, et al, (April 1999), Report of the External Panel on the Evaluation of the Swiss Scientific Studies of Medically Prescribed Narcotics to Drug Addicts, The World Health Organization.

http://www.reconsider.org/wordpress/?p=73

 

[jspun]

It was cool to see fotage on the old Needle Park and other out door scenes in Switzerland as well as a discussion on the success of the Swiss Heroin Maintenance Program in the Nat Geo special on heroin. My question had been what happened to the expansion of the program to include Rx cocaine, which had been discussed. According to one source, discussing the paucity of harm reduction alternatives for cocaine abusers,

For example, we discussed the Swiss heroin maintenance program, which has explicitly ruled out cocaine. I asked one of the managers of this program why not include cocaine, and he said that acute reactions to the drug are too dangerous. But, of course, given that people are using the drug, its dangers are not a reason for excluding it from safety programs, but rather are a reason for including it.

This is from Stanton Peale.

http://www.peele.net/faq/harmred.html

So no coke maintenance for the time being

However, in several places, including Vancouver, Australia, and the UK, was investigated d- amphetamine oral substitute for harm reduction relating to other stimulants.

An interesting study was recently (apr 2010) published in the Journal of Psychopharmacology:

Cocaine Choice in Humans During d-Amphetamine Maintenance
Rush, Craig R. PhD; Stoops, William W. PhD; Sevak, Rajkamur J. PhD; Hays, Lon R. MD
AbstractThe results of preclinical laboratory experiments and clinical trials indicate that agonist replacements such as d-amphetamine may be a viable option for managing cocaine dependence. This study determined the effects of d-amphetamine maintenance on cocaine choice behavior in human participants. We predicted that d-amphetamine maintenance would reduce cocaine choice. Nine cocaine-dependent participants completed the study. Two d-amphetamine maintenance conditions were completed in a counterbalanced order (0 and 40 mg/d). After 3 to 5 days of placebo or d-amphetamine maintenance, the participants completed 5 experimental sessions. During these sessions, the participants first sampled the placebo (ie, 4 mg of intranasal cocaine) identified as drug A. The participants then sampled a second intranasal drug dose (4, 10, 20, or 30 mg of cocaine) identified as drug B. The participants then made 6 discrete choices between drugs A and B. Drug choices were separated by 45 minutes. The primary outcome measure was the number of cocaine choices. All doses of cocaine were chosen significantly more than placebo during both maintenance conditions (ie, placebo and d-amphetamine). Choice of the 20-mg dose of cocaine was significantly lower during d-amphetamine maintenance relative to when this cocaine dose was tested during placebo-d-amphetamine maintenance. Cocaine produced prototypical subject-rated drug effects (eg, good effects, like drug, willing to take again). These effects were not altered to a significant degree by d-amphetamine maintenance. Cocaine was well tolerated during d-amphetamine maintenance, and no unexpected or serious adverse events occurred. These results are concordant with those of previous preclinical experiments, human laboratory studies, and clinical trials that suggest that agonist replacement therapy may be a viable strategy for managing cocaine dependence.

http://journals.lww.com/psychopharm..._Choice_in_Humans_During_d_Amphetamine.8.aspx

The Swiss should cosider these results which have been conducted in the past investigating treatments for meth abusers.

In the Swiss clinics, people are probably mixing coke in with their pharmaceutical heroin doses anyway.

I know it was a long time ago, but anybody out their involved in the old Needle Park scene in Zurich (or the Leiten abandoned train station scene that it moved to), or is currently undergoing maintenance treatment in Switzerland. Your stories and insights would be most appreciated.

Atleast somewhere in the world sensibility prevails!

 

[Coolio]

toobad i cant even leave the state of newjersey for more than 24 hours and cant get a passport. felony record FTL

You can get a passport even if you're convicted of murder, lacey. Unless you're a fugitive and have an active warrant, your criminal history doesn't bar you from getting a passport. Now, it's illegal to enter Canada if you have a felony, but there are plenty of countries that don't care. Also Canada never bothered to figure out that I'd been sneaking in and out of their country with active felony warrants as well as felony convictions in my past.

 

[jspun]

In my not so humble opinion, there is a wealth of information regarding the swiss experience including the experience with heroin maintenance and other modalities of harm reduction considered unorthodox by a majority of this world's nations and considered absurd and incomprehensible by a sizable fraction- running contrary to what 100 years of brainwashing in the world wide war against drug users has established as 'common sense" and rational thinking.

Post #16 an # 18 provide some of the best historical information and most pervasive arguments for heroin maintenance, safe injection rooms, ect... as effective strategies at managing the disease of drug addiction.

Lacey K, it goes without saying, has been a prolific and invaluable contributor on bluelight. I know she's from Jersey but I don't know what her felony involed. But wild guess, it was some how related to illegal drugs and the policies of the state of NJ and the US federal gov as well. I often wonder if the proposal made by the AMA and Bar Association of the state of NY to initiate heroin maintenance trials (HMT) had succeded and expanded along the lines of this nations MMT program (which was a step in the right direction, non the less), if an innability to leave the state would even be an issue. In that world maybe the discussion would be along the lines of visiting Bermuda, or the Bahamas, or the hated Left Coast with all the money she saved having enroled in her local HMT program- which enough deregulation wouldn' cost that much even if it was private run.

The question is why has HMT been such a success in Switzerland, why has the Dutch experiment with harm reduction and soft drug decriminalization been widely decried in the international community while the swiss experiment and british experience before that hadn't garnered so much noteriety. And why did it take root in the swiss confederation of all places.

This is my theory- the dutch were a victim of their own success, their policies on soft drugs were widely publicized leading to international condemnation and drug tourism, the press never mentioning that the dutch have one of the lowest abuse rates of hard drugs, or cannabis for that manner in Europe.

The Swiss, in the 1800s copied some of the best parts of the US constitution according to one of those articles. They had one of the highest drug prohibition budgets in the 70s. However, its a country of only 7 million people, and they were very prosperous through banking, staying out of wars, ect... I think that having ones sister or cousin thrown in jail for using humanized the problem. They were already prosperous- there wasn't huge amounts of money to be made increasing the war on drugs and making new jails. The Swiss are known to be pragmatic and they experimented with many solutions until they arived at their current one. They were smart enough to keep it on the down low. It was so successful, that the people passed a referendum (analogous to CA prop 215) making HMT the law of the land. They are blessed to live in a country were the feds respect the will of the People. The bigest irony and greatest hope is that the Swiss are conidered tobe one of the most conservative people, as a whole, in Europe.

So what went wrong in the USA. This is a great country, don't get me wrong and its a patriots duty to speak up while we still can. In the final analysis, and this is no suprise, the Drug War is Big Bussiness. If all of Europe, Russia, and Iran set up HMT programs, the Aphgan heroin trade would go belly up. The Taliban would lose major gun funding -although many would lose their livelyhood, the enemy would be dealt a serious blow.

Then they would look towards America as a market for their drugs. This would probably precipitate a war against the mexi cartels and the Colombian paramilitary forces. If all went well hopefully they would end up killing each other off and the world would be a better place. But in this depressed economy, illegal drugs are they only sure money cow for the politicians, law enforcement, cartels, banks, prisons, ect...

Our rights and voice are being taken away one policy at a time, and our voice stifled...What pisses me off is that we can't afford this war, a war that can never possibly be won.

The good news is that people are getting tired of Bullshit, even the least likely, most apathetic. Now its time to get the message out- even 1 person, 1 square at a time.

Anyway, another good harm reduction story envolves Frankfurt, used to have some stuff on Foreign Drug Scenes I think, but its interesting to see how that evolved.

 

[qwe]

a cocaine program would be pushin it IMO considering that cocaine aint a physically addictive drug that your body is dependent on...thats why dope is so much more of a problem, i aint saying coke or crack aint a problem or nothin like that....but just that the whole reason for this program is the ppl NEEDED the dope to function....i am too high to be thinkin about this right now tho. I am changing the title,tho, to make it clearer since to me ''needle park'' is either asbury park nj in the 70s n 80s or the place in the movie panic in needle park. definately never heard of no switzerland needle park before.

IMO, if a drug has people stealing/using violence to obtain it, spending money on giving them clinic access (to not have to deal with the financial problems with their drug of choice so that they can lose some of the psychological addiction and also get their life back in order, financially first, which is really important; and giving them, through the clinic access, opportunities that could help them lift themselves up in life) would be a net benefit, to our society, financially

 

[jspun]

to make it clearer since to me ''needle park'' is either asbury park nj in the 70s n 80s or the place in the movie panic in needle park. definately never heard of no switzerland needle park before.

Thats were the swiss probably coopted the name from. "Needle park", Zurich is historic in that it is probably the first place in the world since the world wide prohibition of drugs came into fruition that a part of the world officially allowed "hard drugs." Unlike its US counterpart in NJ, drugs were fully tolerated. This occured in a park in central Zurich called Platzpitz between 1986-1991 or 1992. A little snipit was featured on nat geo's drug's inc. The sissy ass dutch scene that tolerates "soft drugs" but cracks down on hard drugs (until recently- softening their stance on hard drugs and injection rooms while taking a more hard line approach to the cannabis cafes.) In the US, in the 80s in alphabet city, Lower East Side/ East Village, NY and parts of harlem, they had a prety vibrant open scene but it wasn't officially sanctioned and was subject to periodic police crackdown. In Zurich, there were instances were the cops would check people's ids or visa as an excuse to confiscate coke or heroin but had to hand them back if their papers were in order and/or they weren't commiting a real crime. Thousands of dope fiends came from all over Europe and other countries.

1986 was the year that Bearn, the capital experimented with a safe injection room/ and I believe Rx heroin. That clinic exists to this day, It is different than other clinics in that the age limit is 16 as opposed to 18 @ all the other injection rooms currently throughout Switzerland.

These days countries like Portugal, Mexico, to name a few have decriminalized drug possession of small amounts.

Another city that had a large open scene, but one that was not candoned was Frankfurt. I dug up some info from a FDS post I made:

The open drug scene has an interesting history there. The first open air scene was established at a park nick named "Haschweise" in the inner city belt of parks at which, as the name suggests, cannabis was the drug with highest availability. A hard drug scene evolved through the 70s centered on heroin. This scene was chased around the city during this period until it finally settled in the area in and around the main station in 1981. The drug scene became centered on a park in this area, where it was to remain through the 80s. The scene grew through assimilation of narco refugees fleeing repressive policies in other parts of Germany at the time. In 1990 the Frankfurt Resolution was formulated in Frankfurt which was a significant development in harm reduction in Europe- serious students of harm reduction have probably heard of this. It is around this time, i believe, that crack, long a peculiarity of the Frankfurt scene, first began to make an apperance. In 92' the open scene was again closed down by authorities and this time spread to and took root in various parts of the city and its suburbs simutaneously, akin to smacking a behive with a stick- oops. At this point harm reduction, as opposed to Gestapo style crackdowns, began to seem like a seriously good strategy to authorities.

For students of harm reduction, the Frankfurt Resolution was huge, historic.

http://www.bluelight.ru/vb/showthread.php?t=373156&page=7

post # 162.

Currently their are safe injection, safe crack smoking, and needle vending machines, but no Rx to my knowledge, yet. Maybe someone knows more about the situation there or in Hamburg, but that is off topic.

FYI, in the 80s, unlike Zurich, getting hard drugs off the street in Amsterdam was often a huge rip off.

In the 80s, in East Village, people would get dope from tenement buildings from behind steel doors or using buckets. They used to say that avenue C was for coke and Avenue D was for dope. After coping, people would go to shooting galleries to fix. I believe the scene their is a far cry from back then but I ventured to Avenue D and it was still alittle sketchy- this was back in 2000 during the Guliani era.

 

[jspun]

Here's an artcicle translated from Norwegian. it portrays the swiss HMT scene There are 23 heroin clinics throughout the country where people can get heroin on the national health care. There are 23 clinics that one has to be over 18. In Bern the legal age is 16. Of note, the US thretened the Tazmanian manufacturer of heroin for swiss use, US companies were getting morphine and dervatives from the same fields (owned by Johnson & Johnson). The Swiss success in plumetimg crime and decrease in dose over time as well an embarrasment to ther countries that have vested interests on the drug law. The max dise you ab gwt per injection is 750. This is usually worked up too but the average dose drops after 18 months and average dose drops to 300 mg/ pop of pharm diacytelmorphine (Heroin). Read the last 2 or 3 articles on the previous page if you have the time. Anyway, here is the article:

[QUOTE http://translate.google.com/transla...oft:*:IE-SearchBox&rlz=1I7SUNA&sa=N&start=150
[/QUOTE]

Tranlated from Normegian. Tried to cut and paaste but didn't work. Translated link should. Really good read.

Another interesting fact is that there has been a decline of 92 % in new heroin addicys in Zurich= in 850 in 1990 to 150 in 2002, this is in contrast to much of the rest of countries with heroin scenes were use is on the upswing. People suffering from Euro heroin drought might take an extended vacarion in the Swiss Confederation and stay there to wait this problem out. Probably come back with less of a heroin problem, maybe even off it entirely, the cycle of waking up sick, waiting for the connect, and getting right reiforves the cycle and gets people stuck in the sick, hustle, score, get right, get sick, ect... thus better outcomes with the Swiss. The British could probably do better if they didn't impose so many restrictions on their contemporary HMT programs (this is also discussed on the previous page of this thread.) Sorry I couldn't post the above article post google translated. Will translate but doesn't let cytting and pasting.

 

[jspun]

Wondering how the current situation is with heroin Rx Scheme. Has Cocaine Rx ever materialized? Have any budget cuts or new poilitical climate threatened the program?

Wondering of the curent state of affairs, above articles and other are cool and worth reading if your serious about harm reduction. Know they have safe crack and heroin smoking room as well as safe injection rooms if I'm not mistaken.

I know there is an outdoor scene/illicit schene- why is this if you can get heroin by Rx? With a max cap of 750 mg (unless that has changed, per injection if I'm not mistaken).

Off topic but Rotterdam had a progressive program with "house approved dealers" but that country has changed politically in the last couple of years.

How is Europe in general as far as harm reduction? Is it moving forward or slipping backwards taking into account recent problems, economical and political?

 

[adder]

I'm amazed how western countries handle the case with needles and syringes. In the countries of Central and Eastern Europe both syringes and needles may be bought in any pharmacy OTC and the amount doesn't matter. Nobody asks what you need it for and these are cheap. Besides you can buy syringes of various volume (1ml insulin syringe with deattachable and non-deattachable needles, 2ml, 5ml, 10ml, 20ml, and even larger are available but these are for veterinarians) and needles of different gauge (0.3mm are the thinnest and come with some brands insulin syringes, 0.4mm, 0.45mm, 0.5mm, 0.6mm, 0.7mm, 0.8mm and the bigger gauge but as with syringes these aren't found in all pharmacies and they're for veterinarians). Also, as many drugs are in a form of powder in ampules, sterile water is sold OTC because these drugs need sterile water to dissolve the powder from the ampule before the i.v./i.m. injection.

In my opinion OTC syringes, needles, and sterile water are the means to lower viral and bacterial infections. It's inevitable to introduce it anywhere where people want to lower the number of patients in detox wards, with damaged blood vessels, suffering from HIV or HCV infection, suffering from AIDS, and more. It all should be available in as many places as possible so pharmacies are the best bet. And as I know some (but not all!) pharmacies take used syringes and needles for safe disposal and give/sell new equipment in exchange, this is not enough. If there's a low number of such places in big municipalities, a risk of all harm connected with i.v. drug abuse arises greatly.

The solution is at hand and it's not refined, sophisticated... The only thing to be done is to let drug abusers be able to buy syringes, needles, and sterile water in whatever quantity they want just as any person who needs syringes and needles for other purposes (yes, buy not be given, because if they can afford expensive drugs, they can afford cheap syringes and needles - the production of this equipment is not expensive and the price shouldn't be high anywhere).

Just be civilized here because now countries a lot call regimes are more civilized here.

I can't understand really how a country can hold so many programs with enough places for addicts but not foresee that the difficulty in obtaining syringes and needles by addicts leads to more and more patients in detox wards and eventually at maintenance programs.