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EXPLAINED: What is Switzerland’s heroin distribution programme?

For the past 27 years, Switzerland has been dispensing heroin to addicts. How does this innovative project work?

EXPLAINED: What is Switzerland’s heroin distribution programme?
A needle exchange package. Image Wikicommons

A stickler for law, order, and rules, Switzerland can’t be called “unorthodox”. And yet, when it comes to certain aspects of its drug policy, the country has proven to be quite liberal and innovative. 

This description concerns specifically its pioneering heroin-assisted treatment program (HAT), which consists of supplying pure, industrially produced heroin under medical supervision to a limited number of addicts.

Why did Switzerland implement the HAT project?

The origins of the programme go back to the 1980s and early 1990s, when Zurich’s Platzspitz park was a notorious open drug scene. As addicts used to congregate there and inject drugs in full view, the site became known as a ‘Needle Park’.

Drug scene at Platzspitz. Photo by Stadt Zürich

As the number of drug overdose deaths and HIV rates climbed, officials recognised that repression was not effective in stopping the most hardened heroin users.

Instead, they decided to include prescription heroin as a “therapeutic measure for individuals with a severe heroin addiction”, according to the Federal Office of Public Health (FOPH).

Since 1994, HAT consists “of the strictly regulated and controlled administration of diacetylmorphine [heroin], accompanied by medical and psychosocial care. In the light of the positive results obtained, it was adopted as a therapeutic measure”, FOPH said.

André Seidenberg, a Zurich doctor who participated in the government’s heroin trials, told The Local that by adopting this pragmatic approach, “Switzerland has overcome hypocrisy and offered a safe and adequate supply of heroin to addicts, without moralising”.

READ MORE: Cannabis: What are the rules in Switzerland?

What is the goal of the programme?

Originally, it was meant to keep addicts off the streets and reduce crime.

But the programme goes beyond that. The government convened expert scientific and ethical advisory bodies to devise an alternative to “zero-tolerance” drug policies practiced elsewhere, focusing instead on prevention, harm reduction, medical care and counselling for the most severely dependent addicts, and eventually their reintegration into society.

As FOPH explains it, HAT’s goal is “to improve the physical and mental health of those affected and promote their social integration; to facilitate low-risk use and create the conditions for permanent abstinence; to distance those affected from the illegal drug scene and prevent crime associated with the supply of drugs”.

READ MORE: Drugs and alcohol: Just how much do the Swiss consume?

However, since strict supervision is required, the programme is only open to a small number of addicts: in 2019 — the last year for which data is available —1,700 people received this treatment in 22 specialist outpatient centres and one prison.

This covers only about eight percent of addicts, according to FOPH.

Who is eligible for the HAT programme?

The selection criteria is strict: FOPH considers only those with severe heroin dependency for at least two years who have had at least two unsuccessful treatment attempts, and who display physical, mental or social consequences of drug use.

For those who are not part of the HAT programme, several Swiss cities offer safe and clean ‘injection centres’ with sterile material and trained staff.

Has the HAT programme been successful?

FOPH says it has been a success. 

“The results show clearly a constant improvement in the addicted individuals’ mental and physical health, as well as in their social situation. Crime levels have also been reduced”.

The programme has been “the main game changer in Switzerland’s drug policy”, Seidenberg pointed out.

“Since a quarter of a century drug addicts live a normal life in Switzerland, with nearly normal life expectancies, and almost no more deaths from AIDS or overdose”, he added.

How does the public feel about this programme?

As HAT is government-run — that is, funded by taxpayers — it was necessary that Swiss public be on board before the project could get off the ground.

In a 1997 referendum, 70.6 percent of voters turned down proposals from conservative groups to scrap the government’s liberal policy on illegal drug use.

And in 2008, when it was time to renew the heroin distribution program, 68 percent of voters approved its continuation, because they saw it as an effective way to keep addicts off the streets and reduce crime.

Do other countries have similar programmes?

While in the 1990s Switzerland was a trailblazer in heroin distribution, since then a handful of other countries, including the UK, the Netherlands, as well as Canada and Australia, copied the concept, adjusting it to their own requirements.

Last but not least: what happened to Zurich’s Platzspitz?

It morphed from the needle and garbage-strewn drug hub to a clean recreational area popular with Zurich families.

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Reader question: Do people really swim to work in Zurich?

Whether you live in Zurich or not, you may have heard stories of people swimming to work (at least in the summer months). Is it true - and how easy is it?

Reader question: Do people really swim to work in Zurich?

Other than for people who tend swim-up bars or perhaps for police divers, the idea of swimming to work seems ludicrous for most of us. 

This is particularly the case in most major cities. But Zurich, despite having a metro area population of around 1.5 million, is not most major cities – particularly when it comes to the city’s closeness to nature and its waterways. 

Do people swim to work in Zurich? 

Whether you live here or are just visiting, swimming is a popular pastime in Zurich. 

Swimming in the middle of the city on a warm summer's day is certainly possible in Zurich

People swimming at Wasserwerkstrasse 89 in central Zurich. Photo by Teo Zac on Unsplash

The waterways are clean and accessible – and unlike most things in Switzerland they’re either free or very cheap. 

READ MORE: Ten things people take for granted in Zurich

Swimming in rivers and in Lake Zurich is free, while visiting a Badi – a Zurich abbreviation of Swiss swimming bath – will set you back a few francs but will allow you to access basic amenities like changing rooms, toilets and cafeterias. 

Some Zurich residents have even managed to take advantage of the current of the city’s major river, the Limmat, to swim or float to work. 

A story by Germany’s Welt magazine in July 2022 spoke about the phenomenon of people swimming to or from their place of work in Switzerland’s largest city. 

“Some people in Zurich even swim to work (or, depending on the direction, home from their shift). They are easily recognisable from the bank as they have a waterproof, rope-tied swimming bag in tow in which to stow their day clothes and other belongings,” the magazine wrote

Although fewer Zurchers swim to work than claim they do, it does take place – and the fact that it is possible for part of the year is something truly special. 

How can I do it? 

Starting at Lake Zurich, the Limmat flows through the city in a north westerly direction. 

There are points to get in pretty much along the entire river, with some jumping from bridges or pontoons and others climbing in from the banks. 

A photo of Zurich's Limmat river. Image: Wikicommons/CC

A photo of Zurich’s Limmat river. Image: Wikicommons/CC

If you do choose to jump in, make sure the river is deep enough – and never dive in head first. 

Travel: How to save money while visiting Switzerland

One of the major advantages is the current, which strongly flows out of the lake and northwest towards the cantonal border with Aargau. 

The strong current means you can float along the river without needing to put in too much effort swimming. 

The disadvantage however is that the current – which continues in the same direction consistently – means even strong swimmers will be unable to swim back. 

So if you do swim to work, there’s a fair chance you won’t be swimming home. 

What about keeping my stuff dry?

Anyone swimming to work may want to take dry clothes and perhaps their phone or laptop with them. 

One option is to use a waterproof swimming bag, which not only allows you to keep your stuff dry but acts as a buoyant inflatable pillow to help you float down the river. 

There are several companies which make waterproof bags and bladders which are designed specifically for the purpose, including the Basel-based Wickelfisch. 

There are several videos available online which show people swimming the Limmat, including for work.