Harm Reduction Drug Project Uzbekistan - Contact Netz

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3. Switzerland-Uzbekistan Harm Reduction Project 3.1 Background: Switzerland’s drug policy Switzerland cannot claim, any more than any other country, to have “solved” or “eliminated” the drug problem, and is therefore in no position to lecture others. However, since we are convinced that an exchange of experiences can help all concerned to make progress in this onerous struggle we would like to take this opportunity to explain our drug policy to a wider audience. Despite being a prosperous nation with a reputation for health and order Switzerland has been shaken to the core by the misery and desperation of those of its citizens who have become drug dependent. The problem grew out of all proportion with the spread of the deadly HIV virus, making it necessary for a fundamental rethink of the situation as a whole. One of the major factors that had to be considered was the extent of organised, drug-related crime. The political authorities of our cities and those involved at the grass-roots level were the first to realise that a new policy reflecting the reality of the drug problem was urgently needed. They developed an “outreach” strategy, i.e. reaching out to the most seriously addicted individuals. Since 1991 the Swiss federal government has provided support for this realignment of policy by adopting a strategy based on the “four-pillar model”: prevention, therapy and rehabilitation, harm reduction, and law enforcement. Figure 1 Swiss drug policy is based on a four-pillar model Prevention Treatment and therapy Harm reduction Law enforcement Prevention: prevention must be an everyday activity. Intervention therefore has to be directed at the “settings” in which people live, i.e. the family, school, workplace, community or neighbourhood. The primary aim of prevention is to avoid damage to health, rather than focusing solely on drug abuse. Therapy and rehabilitation: a wide range of options are available, including both hospital and outpatient treatment. About half the opiate addicts in Switzerland are receiving methadone treatment. Heroin-assisted therapy has been recognised since 1999. Harm reduction: this means providing medical help in an effort to prevent the spread of Aids and Hepatitis, including substitution therapy and centres in which drugs can be injected under hygienic conditions. It also means helping subjects to 7 Drug policy in Switzerland A policy reflecting the drug problem The four-pillar model: Prevention Treatment and therapy Harm reduction
find employment and accommodation, and helping to structure their daily routine and their leisure activities. Maintaining and promoting health The fundamental objective in working with addicts is to reintegrate them into society. This means maintaining and improving their physical heath as well as their social situation, helping with employment, training and housing needs. The direct action of the substances drug users take is often a serious threat to their health. They are, for instance, exposed to the risk of overdose and to the side effects of the many substances used to “cut” or dilute the drugs. Many are also at risk from the conditions in which they live including inadequate food, poor hygiene, homelessness and a high risk of HIV infection. Low-threshold assistance The pioneering institutions in this field offered drug addicts shelters, and continue to do so. These shelters provide a refuge from the stress of the streets. The focal point is often a cafeteria. Many centres also offer laundry and shower facilities, as well as a sympathetic ear. The Swiss Federal Office of Public Health (SFOPH) provided support for a large number of harm reduction projects in the framework of the first national drugs programme. These included the following measures: - distribution of syringes to addicts at large - distribution of syringes in prisons - drug injecting facilities - employment and housing projects - projects for drug-dependent women engaged in prostitution - an advisory centre for children with drug-dependent parents Since 1991 harm reduction services have also been provided by the cantons, local authorities and private organisations. Medical services Fortunately the incidence of HIV infection among drug users has declined in recent years. This is partly due to a widespread campaign of awareness resulting in a significant decline in needle sharing. There has also been a vast improvement in the distribution of syringes and the means of obtaining them in recent years in Switzerland. Social care In 1995 the SFOPH created a central agency for facilities and services designed to foster social stabilisation. This agency provides support for low-threshold social facilities, particularly employment and housing schemes, as well as for day centres. Acceptance and the legal situation Addicts often resort to criminal behaviour such as illegal drug dealing to finance their habit. This worsens their social situation and increases the burden on society. Though harm reduction measures are well accepted by the general public they regularly meet with initial criticism in the immediate neighbourhood. This can put harm reduction projects at risk, or at least delay their implementation. It is therefore important to provide the public directly affected with the necessary information. The legal situation of each project also needs to be checked. Before injecting rooms were set up for example, expert legal opinion was sought to ensure that this would not violate Swiss law. Law enforcement: the primary objectives of drug-related law enforcement are to restrict the drug supply, combat illegal dealing and the associated illegal financial transactions, and eliminate organised crime from the circle. 8 Reintegration in society Low-threshold facilities are important Support from SFPOH Decline in incidence of HIV Agency for social stabilisation Harm Reduction: Acceptance and legal situation Law enforcement against organized crime
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Page 41 and 42: C Bibliography Analyses of Internat

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