Ever since it was founded in November 1991, Arud has been committed to helping people whose addictive behaviour has become problematic. Over the years, it has continuously expanded and further established its services and fields of action. Today, Arud is a leading institution in the field of addiction medicine. Through its work, it has played a substantial role in shaping Swiss drugs policy.
First aid on the Platzspitz
On 30 November, a handful of committed physicians and specialists found the Working Group for Low-Risk Use of Drugs (Arbeitsgemeinschaft für risikoarmen Umgang mit Drogen) – shortend to ARUD. A few weeks later, in February 1992, the largest open drug scene worldwide, the Zurich Platzspitz, is closed rashly by the authorities.
The aim of Arud is to use medical measures to counter the repressive drugs policy, in order to prevent further misery for the people affected.
The 1980s and 1990s mark a turning point and an awakening in Switzerland’s drugs policy. Important developments are no longer driven by legislative proposals, but by the forces in the field – one of them being Arud.
(Picture: Gertrud Vogler)
First low-threshold methadone supported treatment
The opening of the Arud centre Aussersihl (formerly Poliklinik Zokl1) marks the first Swiss institution to offer easily accessible methadone-assisted treatments to heroin addicts.
At the time, official stringent conditions make the dispensing of methadone difficult. Arud finds them to be inadequate to deal with the current situation. By offering easily accessible treatments, they challenge the authorities. Many GPs support this controversial approach.
In the first year only, 700 heavily addicted persons seek treatment at Arud. To make it easier to treat that many patients, Arud invents a computer-controlled methadone dispensing apparatus.
Heroin-assisted treatment starts as a scientific project
In January 1994, Arud opens its second facility, the Stampfenbach centre (formerly Poliklinik Zokl2), where heroin-assisted treatments (HAT) are offered – as part of a scientific project (“PROVE”), because there is no legal basis for it yet.
It is GP André Seidenberg who has initiated the project. For ten years, the co-founder of Arud has been speaking out in specialist circles, politics and the public for medically prescribing heroin and other opioid-based substances, such as methadone and morphine, to severely addicted people. 17 other treatment facilities are part of this scientific evaluation of opioid-assisted treatment, initiated by Ruth Dreifuss, acting health minister at the time, and designed to be re-assessed after three years. By introducing HAT, Switzerland takes a pioneering role in the treatment of opioid dependence.
Evaluating the project shows that HAT improves survival rates as well as the general health of severely addicted people, reduces the chances of newly-acquired infectious diseases and decreases drug-related crime.
In 2008, an amendment of the Narcotics Drugs Act introduces HAT into Swiss law and makes it part of the mandatory basic insurance policy of health insurance providers.
Establishment of an own research department
Arud establishes its own evaluation and research programme in order to evaluate treatment data systematically. This contributes to quality control and the development of an evidence-based, innovative range of services.
For instance, Arud is working on expanding the range of available opioid agonists used in treating opiate dependence in order to be able to provide each patient with the most suitable substance. Arud takes part in various research studies and examinations to promote understanding for individualised opioid agonist treatments. For example, the clinical trial for slow-release oral morphine, conducted between 2007 and 2011 in Switzerland and Germany was initiated and supported by Arud.
With its research, Arud has contributed to a paradigm shift in the field of hepatitis C. Until ten years ago, national and international guidelines had advised against hepatitis C treatments for people who use drugs. Research studies –some of them carried out in Switzerland and conducted by Arud – were able to show that this is no longer scientifically tenable. Today, hepatitis C guidelines give particular priority to the treatment of drug users.
Research has also played an important role in the political process. Unbiased scientific studies contribute significantly to evidence-based policy development. Since their beginnings, heroin and opioid-assisted treatments have constantly been evaluated, making it possible to demonstrate their benefits for individual patients as well as for the whole of society. This managed to convince the majority, as was demonstrated impressively in 2008, when in a vote on the amendment of the Narcotics Drugs Act, 68 per cent voted in favour of embedding heroin-assisted treatment (HAT) into Swiss law.
Clear rejection of the "Youth without Drugs" initiative
In 1997, the popular initiative "Youth without Drugs" was put to the vote. Its aim is to stop - and reverse - the practical developments of recent years. The initiators - advocates of abstinence with links to the SVP - are particularly interested in heroin-assisted treatment, which they want to abolish.
Arud is intensively involved in the voting campaign and, as a member of the board of the National Working Group on Addiction Policy (NAS-CPA), coordinates the voting campaign in the Canton of Zurich. Arud employees take part in numerous podium events and media events to inform the public about the importance of the HeGeBe and how important its continuation is.
The great commitment is rewarded: 70 percent of the electorate reject the initiative.
Hepatitis C epidemic: The Arud strikes alarm
Arud informs that hepatitis C is spreading among drug addicts at an alarming rate. Up to 90 per cent of injecting drug users are hepatitis C positive. The virus was first detected in 1989. It is mainly transmitted through sharing injection utensils.
Arud began early to sensitise affected people and to treat them in clinical trials. At national level, Arud is involved in improving therapy measures as part of a hepatitis C cohort study supported by the Swiss National Science Foundation. Arud is honoured to be the first non-academic organisation to take part in this project.
Launch of a Stop Hepatitis C Campaign
Pressured by Arud, the City and Canton of Zurich launch a major hepatitis C awareness campaign. The campaign is later copied by the Federal Office of Public Health.
In response to the findings on the alarming hepatitis C transmission rates among drug users, made public by Arud the previous year, a multicentre study of treatment of hepatitis C with interferon and ribavirin is initiated.
8. Buprenorphine newly approved as a drug for opioid-assisted treatment
Up until now, only two substances had been authorised for the treatment of opioid dependence: methadone and, subject to stringent conditions, heroin. Now, the opioid buprenorphine (Subutex®) can be administered as well. Treatment can thus be better adapted to the individual needs of the patient, since tolerability of the various opioids differs from person to person.
Arud is one of the first institutions to introduce buprenorphine after its authorisation and to evaluate it in a clinical trial.
New location in Horgen
Arud receives another facility: The "Foundation for Integration and Prevention" (SIP Horgen) hands over the ownership of the Horgen Clinic (formerly DBB - Poliklinik für Diagnostik, Behandlung, Beratung) to Arud.
The DBB Polyclinic was founded in 1995 as a result of the dissolution of the open drug scene in Zurich and the associated repatriation of people with a severe drug addiction to their original municipalities. In order to be able to offer an adequate treatment, the authorities in Horgen commissioned SIP to open a polyclinic for heroin- and methadone-assisted treatment. The planning was carried out with the expertise of Arud.
Six years later, SIP decides to concentrate on its core business in socio-educational projects. With this change from a socio-educational to a medical ownership, there is a great increase in medical and addiction-specific know-how and exchange.
New reception for the centre Aussersihl
Over ten years after it first opened in 1992, the Aussersihl centre renovates its medical counter and reception area. Thanks to these improvements, workflow can be organized more efficiently and ergonomically and patients are given more space. Additionally, these modifications create a more agreeable atmosphere. In the same building at Sihlhallenstrasse, additional rooms are converted into therapy rooms.
Relocation of the centre of Horgen
In December, the Horgen centre (formerly Poliklinik DBB) relocates. The new facility at Seestrasse in Horgen is centrally located and easily accessible by public transport. Its rooms are arranged in a modern, functional and patient and employee-friendly way.
Voting success to continue heroin-assisted treatment
Arud is involved in the successful voting campaign in Zurich to continue the work of the outpatient clinics offering heroin-assisted treatment (HAT): 75.1 per cent voted in favour of the bill. For the first time, HAT can be continued indefinitely in the city of Zurich, whereas under Swiss law it is still only provisionally approved. It takes another four years until HAT is incorporated into Swiss law for good in 2008.
(Photographer: Beat Jordi, ADP Architekten AG)
Relocation of the main office
Arud is planning a new service, targeting consumers of cocaine, cannabis and party drugs. The facilities of the main offices right next to Zurich main station are ideally suited for this purpose. In November, the main offices move 100 metres down the road to Konradstrasse 32, where new premises are rented.
Patients from the canton of Schwyz
Since the autumn, the Horgen centre treats patients from the canton of Schwyz. This allows them access to heroin-assisted treatment, which is not available in their home canton
New services and cooperations: GAIN, Checkpoint and DIZ
Arud launches a series of new services, which are all located under one roof at Konradstrasse 1 near Zurich main station – an ideal prerequisite for an interdisciplinary and straightforward collaboration.
The new service GAIN, short for Health Services and Information, offers treatments specifically for problems with cocaine, cannabis and designer drugs. Horgen, too, extends its range of services accordingly. It is Arud’s response to changed consumer behaviour: there are fewer heroin users, and far more consumers of psychotropic substances such as cannabis, cocaine or designer drugs now. Especially in Zurich, where each weekend, thousands of partygoers look for excitement. A small but growing number of users experiences serious health problems or social issues.
In June, Checkpoint, a health centre for men who have sex with men, opens its doors. In a collaboration with Zurich Aids-Help (now Specialist Office for Sexual Health Zurich, SeGZ), Checkpoint offers consultations and advice. Arud provides medical services. The main focus of the service is HIV and other sexually transmitted diseases (STIs).
In September, the Drugs Information Centre (DIZ) is opened. Street workers of the Social Department of the City of Zurich provide an important contribution to harm reduction by offering advice to consumers of party drugs and drug checking services. If required, an appointment can be made for subsequent treatment at GAIN.
Multi-center study on the use of retarded morphine in opioid agonist therapy
In order to treat opioid dependence, apart from heroin, which is subject to stringent conditions, only methadone and buprenorphine are authorised as opioid agonists (substitutes).
This makes a fine-tuned choice of treatment medication difficult. Morphine, clinically established in pain management, is used only occasionally in so-called “off label” use, as it is not licensed.
In the largest multicentre study ever conducted in this field, Arud shows that slow-release morphine is for many patients an important and effective alternative to methadone. The findings of this research study lead to slow-release morphine being licensed for treatment of opioid dependence.
Vote on the revision of the Narcotics Drug Act
In the autumn of 2008, the public is set to decide on the amendment of the Narcotics Drugs Act (Betäubungsmittelgesetz BetmG). As part of harm reduction, it would make heroin-assisted treatments (HAT) part of Swiss law.
Arud is involved heavily in the pre-voting activities, organising the campaign for the Canton of Zurich and providing key arguments in the debate at national level.
The result is clear: almost 70 per cent of voters are in favour of the amendment, in Zurich almost 80 per cent. This proves that Arud’s short-term tour de force before the vote had paid off, but also that after 15 years of continuous commitment to a pragmatic drugs policy, the campaign slogan “because it works” was convincing and credible.
Working with ada-zh
Often, it is not just the consumers of substances themselves who suffer from their problematic behaviour, their families and friends are troubled by it as well. In order to doing both sides justice and supporting them both individually, Arud starts a collaboration with the counselling service ada-zh (Angehörigenvereinigung Drogenabhängiger Zürich).
All partnerships such as this one are located under one roof at the “Health centre Konradstrasse 1”.
Hepatitis symposium and establishment of a hepatitis network
Organised by Arud, the “1st International Symposium on Hepatitis Care in Substance Users” takes place in Zurich. The presentations and debates address how to best treat the many chronic hepatitis C sufferers who are dependent on substances. Around 200 experts from over 30 nations take part.
The symposium lays the foundations for INHSU, a network, which brings together specialists in the area of hepatitis C care for drug users from all over the world at annually held congresses. It coordinates international multicentre studies and commits itself to improving the global care situation.
Furthermore, with Hepnet Zurich, Arud is building a local network of dedicated people involved in hepatitis C care. Every three months, the platform brings together specialists from different professions and subject areas to promote and share specialist knowledge.
Specialised treatment for alcohol dependence
Arud expands its services. People with an alcohol problem are getting personal and comprehensive support. Treatment is based on an accepting, open-minded and individualised therapeutic approach.
Controlled drinking, reduced consumption, abstinence and relapse prevention are all possible treatment goals. Outpatient alcohol detoxifications accompanied by a specialist are also an option. Arud builds on its extensive experience in the treatment of complex addiction disorders.
World's first online self-help tool for cocaine users
“Snow Control” offers people whose cocaine consumption has become problematic the chance to assess their behaviour anonymously, wherever they are and whenever they want. The goal of the tool is to recognise risk situations in time, learn to cope with pressure and strengthen intrinsic control. In eight modules, common problems are addressed and tried and tested psychological strategies, which help reduce consumption, are reinforced. Participants can make use of a consumption tracking tool and access information on cocaine.
New concept of communication
Since its beginnings, Arud has continuously grown in size and expanded and adjusted its services according to the changing needs and circumstances. It recognised early that additional mental and physical illnesses and, most of all, infectious diseases also needed professional medical attention.
A new concept of communication and a new corporate design reflect the extended and more flexible range of services. The names are adjusted too: ARUD Zürich (Working Group for Low-Risk Use of Drugs) becomes Arud, Centres for Addiction Medicine. The outpatient clinics Zokl1, Zokl2, DBB and GAIN are now called Aussersihl, Stampfenbach, Horgen and Hauptbahnhof centres.
Instant Hepatitis C tests
In a collaboration with the Drop-In Centres for Drug Users of the City of Zurich, Arud started to raise awareness of hepatitis C through instant hepatitis C tests on-site. Thanks to simple and quick diagnoses, counselling sessions and treatment offers, substance users are provided with an uncomplicated way of preventing the consequences of a hepatitis C infection.
In 2012, the project is awarded first prize by the Health Network 2025 of the City of Zurich. Today it is a standard annual procedure in all of Zurich’s drop-in centres.
Panel event on the future of Swiss addiction policy
Together with the Specialist Association for Addiction (Fachverband Sucht), Arud organises a panel discussion to revive the debate on how drugs policy could and should be developed further in Switzerland. The event marks the beginning of an ongoing collaboration with the Global Commission on Drug Policy.
The Global Commission was founded in 2011 by former presidents of Latin American and European countries – among them Ruth Dreifuss, former president of Switzerland. As health minister in the 1990s, Dreifuss managed to push through the groundbreaking Four Pillars Policy, which consists of prevention, therapy, harm reduction and repression – a model that has since been copied by other countries. Together with other members of the Global Commission, she is dedicated to ending the global war on drugs and to bringing about a paradigm shift in global drugs policies, towards legalisation and regulation of psychoactive substances.
Report on the Global Hepatitis C Epidemic
Arud is substantially involved in the development of the Hepatitis C Report by the Global Commission on Drug Policy, which is published in 2013. The report shows that criminalisation of drugs and repressive drugs policies are fuelling the spread of hepatitis C and hinder adequate health care and prevention.
Launch of a basic principles document on market regulation
Arud participates in the development of the basic principles document by NAS-CPA on market regulation. The document is launched in 2014. Instead of the current, historically grown practice of dividing drugs into legal and illegal substances, it demands a continuing development of Swiss drugs policy, taking into account the actual harm of a substance. For each psychoactive substance, a model should be introduced that does not encourage consumption unnecessarily and that does not harm those unnecessarily who consume it anyway – a model, that ensures the best possible protection for children and young people and best guarantees safety in public places.
The paper shows clearly that black markets, as they currently exist for psychoactive substances, pose a greater risk to consumers and society than a regulated market.
Network for a Hepatitis C Strategy for Switzerland
Unlike HIV, hepatitis C receives little attention from the public and politicians. However, chronic hepatitis infections represent a huge problem for public health. As part of the Network for a Hepatitis C Strategy for Switzerland, Arud is dedicated to improving the care for people with hepatitis C.
The goal of the network is to coordinate the activities of all participants in the field of hepatitis and to enable goal-oriented measures, which will benefit affected individuals and public health. It also has an ambitious vision: to eliminate hepatitis B and C in Switzerland by 2030.
A milestone is reached in 2017: the Federal Office of Public Health (FOPH) ends the limitation on hepatitis C medicines, allowing all affected people to access the new and highly effective medication as opposed to just those with advanced liver damage. At the same time, prices for the expensive hepatitis C medication are lowered.
Consumption diary app
Arud’s approach is not abstinence-oriented, but open-minded. Everyone decides for themselves what their treatment goal is: reduced consumption, improved control or abstinence. A consumption diary often helps to define realistic weekly consumption goals (daily allowances, consumption-free days).
Arud has an app developed, which allows easy recording of the consumption of psychoactive substances. It is a practical tool for setting consumption goals and planning and continuously reviewing changes.
On 30 November, Arud celebrates its 25th anniversary. Since its beginnings, it has contributed substantially to the development of the Four Pillars Policy in Switzerland and has played a pioneering role in shaping drugs policies all around the world. Since then, further reforms have been difficult to achieve. Other countries are testing out new ways to deal with addictive substances, leaving Switzerland behind.
This is why Arud celebrates its 25th anniversary by publishing facts and demanding action from society and politics: Ten statements by Swiss drugs policy makers show just how much Arud has achieved – and where it still needs to persevere.
Merger of the four locations in Zurich
After up to 25 years, the three facilities in Zurich have become outdated. Their layout and their apparatuses no longer meet the requirements. The centres are reaching their capacities and are not wheelchair accessible. Furthermore, interdisciplinarity cannot be guaranteed in all of them.
This is why Arud is bundling its forces in two locations: Zurich and Horgen. In December, its three centres in Zurich and the main offices move to Schützengasse 31 – right next to Zurich main station.
At the same time, Arud’s appearance is modernised by renewing its corporate design and its website.