Switzerland\'s policy of offering heroin addicts substitution treatment with methadone or buprenorphine has led to a decline in the number of new heroin users in Zurich, according to a paper published in this week\'s issue of The Lancet.

Switzerland has implemented various policies to try and reduce harm to dependent heroin users, including needle-exchange services, low-threshold methadone programmes, and heroin-assisted treatments. However, critics say that these policies may lead to a growing number of new drug users and lengthen the period of heroin addiction.

To investigate, Carlos Nordt and Rudolf Stohler from the Psychiatric University Hospital, Zurich, Switzerland analysed data from over 7250 patients in Zurich who presented for substitution treatments with methadone or buprenorphine over 13 years from 1991. From this data they estimated trends in the number of new heroin users. They found that the incidence of heroin use dropped from 850 new users in 1990 to 150 in 2002. The authors contrast the situation with heroin use in the UK, Italy, and Australia, which has continued to rise. They also found a low cessation (quit) rate and therefore, the overall number of heroin dependents, whether in treatment or not, only declined by 4% per year.

Dr Nordt states: \"As the Swiss population supported this drug policy, this medicalisation of opiate dependence changed the image of heroin use as a rebellious act to an illness that needs therapy. Finally, heroin seems to have become a \'loser drug\', with its attractiveness fading for young people. Nevertheless, whether drug policy had a positive effect on the number of new heroin users or not, our data could not confirm an increase of heroin incidence as expected by the critics of the liberal Swiss drug policy.\"

Joe Santangelo