Switzerland has responded to the open drug scenes of the 1980s and 1990s with pragmatic and highly effective solutions to prevent further impoverishment of those affected and to curb the rampant spread of infectious diseases such as HIV and hepatitis. Damage-reducing and preventive measures include the distribution of sterile syringes and needles, the establishment of hygienic consumption rooms and the establishment of opioid therapy (substitution).
This approach led to the development of today's four-pillar policy, consisting of prevention, harm reduction, therapy and prosecution. The Arud, founded in 1991 by committed doctors as a reaction to the untenable conditions of the time, strongly influenced this development from the very beginning.
Prevention policy highly effective and cost-efficient
In a new study of the University Hospital Zurich in cooperation with the Swiss HIV Cohort Study, the effectiveness of the local HIV prevention policy in intravenous drug users has now been comprehensively analysed. The HIV cohort study, in which Arud is also involved, has been collecting epidemiological and clinical data on people with HIV infection for 30 years. Using this data set and a mathematical virus transmission model, the researchers were able to calculate how many infections have been prevented since 1988 thanks to preventive measures.
The results are clear and impressive: over 15,000 additional HIV infections among drug users and over 5,000 additional AIDS deaths have been prevented. The prevention measures have also indirectly protected the entire population by preventing more than 2,500 HIV infections that would have been transmitted through sexual contact. And the prevention measures are also paying off financially: In the last ten years alone, the sum of the treatment costs saved amounts to a considerable CHF 3.4 billion.
The fact that bans and pure repression are of no use was shown most clearly during the Platzspitz period - with fatal consequences: If Switzerland had implemented prevention measures two years earlier, 1400 fewer people would have died. This is also shown by the study of the University Hospital.
Further progress in addiction policy is imperative
With its harm reduction and preventive measures, Switzerland has become an international role model in addiction policy. The almost stagnant HIV infection rate in Switzerland impressively reflects the success of this policy. In contrast, the continuing increase in the number of HIV infections and AIDS deaths in Eastern European and Asian countries shows how devastating the spread of the virus is in the absence of preventive measures.
Nevertheless, Switzerland must not rest. Because the repressive approach also dominates in Switzerland continues to dominate addiction policy: around 65 percent of all expenditure is spent on criminal prosecution (police, judiciary, prison), while a total of only one third is spent on therapy (26 percent), harm reduction (5 percent) and prevention (4 percent).
It is time to fundamentally question our handling of psychoactive substances: instead of sticking to the costly and ineffective drug prohibition policy, the health and safety of the population should be given priority. This requires, on the one hand, more comprehensive prevention measures and education - and, on the other, state regulation of the market for psychoactive substances such as cannabis, cocaine and ecstasy. For as long as the production and trafficking of drugs is left to criminal organisations, public safety and health also suffer. By regulating drugs, on the other hand, the harmful effects of the black market could be avoided - to the benefit of both users and society as a whole!