ABSTRACT

Background Switzerland introduced a pragmatic national drug policy when the former conservative abstinenceorientated politics proved unable to cope with an escalating number of users and related negative consequences for
public health and public order. The high visibility of ‘needle parks’ and the size of the acquired immune deficiency
disorder (AIDS) epidemic called for a new approach and for national leadership. Aims To describe the intentions, the
process and the results of setting up the new treatment approach of prescribing heroin to treatment resistant heroin
addicts, as an example of drug policy change. Materials and Methods A systematic collection of relevant documents
is analysed and used as evidence for describing the process of policy change. Results Measures to reduce the negative
consequences of continued use and to prevent the spread of AIDS were started mainly by private initiatives and soon
taken up officially in the ‘four-pillar’ drug policy (including harm reduction, prevention, treatment and law enforcement). Medical prescription of heroin to chronic, treatment-resistant heroin addicts was one of the innovations, based
on extensive scientific and political preparation. Detailed documentation and evaluation, ample communication of
results, adaptations made on the basis of results and extensive public debate helped to consolidate the new policy and
heroin-assisted treatment, in spite of its limitations as an observational cohort study. All necessary steps were taken to
proceed from a scientific experiment to a routine procedure. Discussion Comparable policy changes have been
observed in a few other countries, such as The Netherlands and Germany, based on the Swiss experience, with equally
positive results of heroin-assisted treatment. These experiments were designed as randomised controlled trials, comparing intravenous heroin against oral methadone, thereby demonstrating the specific value of pharmaceutical
diamorphine for maintenance treatment in opiate dependence. The positive impact of policy change and the positive
outcomes of heroin-assisted treatment were acknowledged increasingly nationally and internationally, but made it
difficult to continue the process of adapting policy to new challenges, due to the low visibility of present drug problems
and to changing political priorities. Conclusion A major change in drug policy was effectively realised under typical
conditions of a federalist country with a longstanding tradition of democratic consensus building. Facilitating factors
were the size and visibility of the heroin problem, the rise of the Aids epidemic, and a pragmatic attitude of tolerating
private initiatives opening the way to official policy change.