Chasing the Scream: The First and Last Days of the War on Drugs (44 page)

It had been discovered a few years before in Switzerland that there was a clause in Swiss law that allowed heroin to be given to citizens, provided it was part of a scientific experiment. So far that had been done with only a tiny handful of people.

So Ruth said—Okay, we are going to have a really large experiment.
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We are going to make it much easier for any addict who wants it to get methadone, and for the people who can’t cope with that, we will prescribe them heroin. Switzerland has a political system built on consensus. No one official can drive a policy on her own. She needed to persuade her colleagues, and the cantons. So Ruth fought for it. This is an emergency, she explained, and in emergencies, you take dramatic steps.

Twenty years later, Ruth Dreifuss lives across the street from one of the heroin-prescribing clinics in Geneva that were made possible by her political battle. At seven in the morning, I hurry past the seagulls squawking on Lake Geneva. It is as dark as midnight, and in the neat little Swiss cafés, men and women in suits are reading newspapers and drinking coffee. Nobody seems bleary-eyed. The Swiss go to bed early, and they wake in the darkness without complaining.

In the white corridor of the heroin clinic, I find a young man with big headphones and an old man in a tweed suit with leather elbow patches sitting in chairs next to each other. They are waiting patiently to shoot up.

The older man follows a nurse into the injecting room, and he emerges a little while later to sit for twenty minutes alone, and then he agrees to talk to me, in a room, to one side. He looks like the secretary of state for a minor Central European nation, with his carefully polished shoes and lined, distinguished face. After we are introduced by the doctors, he says he will tell me his story provided I do not use his real name, because he was admitting to criminal offenses he had carried out before the drug laws were changed. I will call him Jean.
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“I was sick, I was dirty,” when he first came here, he says. “I was really quite a typical addict.” He couldn’t concentrate to watch a film for more than a few minutes; he couldn’t eat fruit or anything even vaguely greasy, because his digestive system was so curdled by the street contaminants. He had been shooting up for thirty-five years. “When you are using on the street, you feel death already hiding inside you. You can feel it and you can see it,” he says. “You have death inside yourself, and death is progressing.”

He tried methadone, but it did nothing for him. He still craved heroin all the time. He would wake each morning in a flop-sweat of panic, asking himself: How am I going to get the money I need to buy my smack today? He was trapped in the constant misery-go-round of get money, buy heroin, inject, get money, buy heroin, inject, all day, every day.

“It’s not just an addiction. It’s a job,” he says. He survived only by being involved in drug trafficking—he doesn’t want to give the details, except to say that he was a “middleman”—until one day, he heard about the prescription program established by Ruth Dreifuss.

This is the last option in the system for people who cannot be helped any other way. To be eligible, you need to meet three conditions: you have to be over eighteen, you have to have gone through at least two other treatment programs without success, and you have to hand in your driver’s license.

“It wasn’t easy to accept and see at first,” he says. “All addicts are in a total confusion.” Suddenly, his constant scrambling for his drugs was taken away, and he had a day ahead of him he had to fill. He tells me patients here “have to reinvent our lives. We have to reinvent the imagination.” The heroin program is built around helping the patients to slowly rebuild: to get therapy, to get a home, and to get a job. One of Jean’s fellow patients, for example, owns a gas station, while another works in a bank. He discovered that “once you have stability, the speed of events decreases, and you come back into a normal life, and you say—okay, what am I going to do now?”

It’s hard to do this, after being addicted for so long, but Jean says “the pain I have now isn’t the pain of a sickness. It’s the pain of being reborn.” For the first time in decades, “I feel well and happy, to have recovered things I had completely forgotten.” He has started to eat fruit and watch films and listen to music again. “You can come back,” he says, “to reality.”

Harry Anslinger believed he had spotted the crucial flaw in heroin prescription programs like this. Addicts’ bodies gradually develop a tolerance for their drug, so he said they would need higher and higher doses over time to achieve the same effect. “The addict is never satisfied
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with his dose; he always tries to get more,” he explained. He praised two of his officers who laid out what they called the First Law of Addiction: “A person in the condition of
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opiate addiction, with free access to opiates, will continue in that condition at an accelerated rate of consumption unless the course of addiction is deterred by some extraneous force.”

That observation seems to make sense. Yet at this clinic, they tell me, they have discovered something that contradicts it.

If you are an addict here and you want a higher dose of heroin, you can ask for it, and they’ll give it to you. So at first, most addicts demand more and more, just as Anslinger and his agents predicted. But within a few months, most addicts stop asking for more and choose, of their own free will, to stabilize their doses.
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After that, “most of them want to go always down,” explains the psychiatrist here, Dr. Rita Manghi. Jean, for example, started at the clinic taking heroin three times a day—80 mg in the morning, 60 mg in the afternoon, and 80 mg in the evening. Now, he takes only 30 mg in the morning and 40 mg in the evening, and he says, “I’m on the brink of saying to my doctor I don’t want any more.” He is a typical user here.

Suddenly, the slightly depressing debate at the start of the drug war between Harry Anslinger and Henry Smith Williams—prohibition forever versus prescription forever—seems bogus. But in this clinic, they have discovered that that isn’t the real choice. If you give hard-core addicts the option of a safe legal prescription and allow them to control the dose, the vast majority will stabilize and then slowly reduce their drug consumption over time. Prescription isn’t an alternative to stopping your drug use. It is—for many people—a path to it.
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“This program,” Jean says, “gives you the chance to recover the control you have lost,” step by step, day by day. A Portuguese psychiatrist who treats people here, Dr. Daniel Martin, tries to explain it to me by giving me a visual image.

Most addicts here, he says, come with an empty glass inside them;
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when they take heroin, the glass becomes full, but only for a few hours, and then it drains down to nothing again. The purpose of this program is to gradually build a life for the addict so they can put something else into that empty glass: a social network, a job, some daily pleasures. If you can do that, it will mean that even as the heroin drains, you are not left totally empty. Over time, as your life has more in it, the glass will contain more and more, so it will take less and less heroin to fill it up. And in the end, there may be enough within you that you feel full without any heroin at all.

Users can stay on this program for as long as they want, but the average patient will come here for three years, and at the end of that time, only 15 percent
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are still using every day.

Before, being a heroin addict was violent and thrilling—you were chasing and charging around. In Switzerland today, it is rather dull. It involves sitting in clinics, and being offered cups of tea. The subculture is gone.

After the clinics opened, the people of Switzerland started to notice something. The parks and railway stations that were filled with addicts emptied. Today, children play there once again. The streets became safer. The people on heroin prescriptions carry out 55 percent fewer vehicle thefts and 80 percent
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fewer muggings and burglaries. This fall in crime was “almost immediate,”
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the most detailed academic study found. The HIV epidemic among drug users stopped. In 1985, some 68 percent of new HIV infections in Switzerland were caused by injection drug use, but by 2009, it was down to approximately 5 percent.
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The number of addicts dying every year fell dramatically,
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the proportion with permanent jobs tripled, and every single one had a home.
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A third of all
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addicts who had been on welfare came off it altogether. And just as in Liverpool, the pyramid selling by addicts crumbled to sand: people on the heroin prescription program for a sustained period were 94.7 percent
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less likely to sell drugs than before their treatment. Jean tells me the drug dealers he used to work for are “completely against this program. They can control people in weak states and make money from them. If I was still in the criminal milieu, they could make me a killer, I would do anything.” As he said this, I thought of Chino and Rosalio. “But now? No. I am lost for them.”

The program costs thirty-five Swiss francs
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per patient per day, but it spares the taxpayer from having to spend forty-four francs a day
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arresting, trying, and convicting the drug user. So when people ask “Why should I pay for this?” the pragmatic Swiss answer is: This doesn’t cost you money. It saves you money.

But I was still wondering all the time—how did Ruth manage to sell these policies in such a conservative country? My Swiss relatives are often way to the right of the Tea Party—and they are regarded as moderates. This isn’t like people opting for drug reform in San Francisco—it’s like people opting for drug reform in Lubbock, Texas.

I knew she couldn’t have gone over the people’s heads, because Switzerland has a system of deep democracy. If you are a Swiss citizen and you don’t like a law passed by the parliament, all you have to do is gather fifty thousand signatures,
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and you will trigger a national referendum on whether it should be struck down entirely. In the late 1990s, a conservative group triggered a national referendum on heroin prescription, and there was a rowdy national debate—or as rowdy as Switzerland ever gets.

Ruth and the many people who agreed with her introduced something to the drug debate that nobody had ever tried anywhere else in the world. Ever since Anslinger, the drug warriors had presented themselves as the forces of order ranged against the chaos that would inevitably be brought by any relaxation in the drug laws. But, in a political jujitsu move, Ruth reversed that argument. Swiss citizens could see now that U.S.-style drug crackdowns had brought chaos to their streets—and after the government provided a legal route to heroin, the chaos vanished. So they argued that the drug war means disorder, while ending the drug war means slowly restoring order.