A fix but no cure for addicts

Ten years after Switzerland began offering prescription heroin, for many addicts a daily trip to the heroin clinic has become a lifeline. It keeps them off the streets; away from disease and crime, ridding them of so many of the negative aspects of an addict’s life. Except it seems, the addiction itself.

Ten years after Switzerland began offering prescription heroin, for many addicts a daily trip to the heroin clinic has become a lifeline. It keeps them off the streets; away from disease and crime, ridding them of so many of the negative aspects of an addict’s life. Except it seems, the addiction itself. Eliane Rentsch is 36-years-old, and lives alone in a quiet suburb of Bern. She gets up every morning at 0630, washes, dresses, and puts on her make-up. She has a cup of coffee, tidies her already spotless kitchen, and then she goes out. A not unusual routine. Millions of people everywhere do the same thing. But when Eliane goes out, she is not going to work. Instead she is going to Bern’s heroin prescription clinic. She has an appointment there every morning, and she has kept that appointment every single day for the past 10 years.”Before I went to the clinic I was on the streets,” she told me. “I did everything to get money for drugs. I stole, I worked as a prostitute. Now I do not have to.” Eliane is from a broken home, and spent a lot of time in care. She started taking heroin when she was only 15-years-old. A girl she was friendly with put her on to it. The first time she took it she paid someone to inject it directly into her veins. He gave her too much and she collapsed from the overdose. But when she came round, she took heroin again. No escape Now, her arms are so scarred that when she goes to the clinic, a nurse has to inject the prescription heroin into her ankles, 200 mg in each. Every day, 150 patients come to Bern’s heroin prescription clinic. The youngest is in his early 20s, the oldest is 66. The morning I go there with Eliane it is rather hectic. There is a queue of people at the door; while another group drinks coffee and smokes, unwinding after their fix. In a corner there is a children’s play area with toys and colourful cushions. A couple with a toddler in a pushchair arrives to join the queue, so too does a young man in painter’s overalls. He is angry and sweating, shouting that since he has to get to work he ought to get served first. These are the addicts that just do not seem to be able to escape from their drug. “On average our patients have tried 10 times to get off heroin and failed,” explained Christoph Byrki, the doctor in charge. “Their average length of addiction is more than 13 years. This is a chronic situation, and for that you need a chronic treatment.” Cleaning up I have known Dr Burki for a few years now. I went to visit his clinic went it first opened. Heroin prescription was very controversial back then, but Switzerland’s open drugs scene seemed worse. Emaciated addicts, many of them with dreadful open sores on their arms and legs, used to congregate in parks to take their heroin. They injected in full view of passers-by. They left their needles lying around. They also shared them. Rates of HIV infection and hepatitis were high. That has largely stopped now. There are not any fewer addicts, but they are not really visible any more. Switzerland is a clean and organised country, and it has taken the same approach to its heroin addicts: they have been cleaned up and organised too. To be fair, heroin prescription is not Switzerland’s only answer to drug addiction. There are prevention campaigns and therapies aimed at coming off the drug, but the option of getting heroin officially from the state is there for the minority that just cannot succeed in giving up. Widespread support Supporters of the scheme point to the improved health and more stable lifestyles of the patients who are on it. “Heroin prescription was never about trying to get people off drugs,” one doctor told me. “It is harm reduction. Many of these patients would probably be dead without it.” But there are some Swiss doctors who still disapprove. Sabena Bergmann for example, who works with addicts herself. “If you give them heroin,” she said, “you remove their last hope of getting free of it. “It is completely the wrong solution. You might as well offer a bathing suit to someone who is drowning.” But after 10 years in operation, heroin prescription has widespread support in Switzerland. It even got the backing of voters in a nationwide referendum a few years ago. Still, watching Eliane take her heroin in the clinic was a depressing experience. She winced when the needle entered her ankle. A few moments later, the effect of the heroin had made her flushed and shaky. It did not seem to make her feel better. “No it does not,” she agreed. “It is not taking it that makes me feel bad.” No incentive? Eliane – who is quite tall – weighed only 50 kilos when she started coming to the clinic 10 years ago. Now she is rather plump. She has got a flat, but she has got no job, and no idea of what she might like to do with the rest of her life. The heroin appointment is the only thing that provides any sort of rhythm to her day. In a way I am addicted to the clinic now too,” she admitted. “Of course it is easier when you get the drugs for free. You do not have to hustle on the streets for them. What more could you want? “But it almost makes it harder to give up. You think, why bother trying?” Her doctor Christoph Byrki said he always hopes his patients will reach a point where they want to try to get off heroin. “But,” he added, “we have to be prepared for patients who will be with us for life.” Appointment over, Eliane swabs down her ankles, puts her socks and shoes back on and leaves the clinic. That is it, the rest of the day stretches before her, empty. I asked if she believed she would be doing this forever. She looked away. “I do not know,” she said. “Part of me wants to give it up, part of me does not. I suppose I could accept it if I came to the clinic for the rest of my life.” She went off to catch her tram back home, just an ordinary looking woman in the city streets. That is the success of heroin prescription, it returns people to a certain social normality.(Source: BBC News: June 2004)