GENEVA –Switzerland’s direct democracy allows citizens who have gathered enough petition signatures to challenge government policies and laws in nationwide referenda. After a spate of AIDS deaths during the 1980’s, the Swiss came face to face with a problem that has destroyed millions of lives in the United States, Russia, Latin America, the European Union, southern Asia, and other regions. Intravenous drug users – especially heroin addicts – had turned public spaces in Zurich and other Swiss cities and towns into needle parks. AIDS proved itself to be blind to affluence.
The Swiss did not respond with the kind of neglect that Russia’s government has shown so far toward its heroin and HIV epidemics – more than two million drug users and an estimated one million people living with HIV, over 60% of them infected while sharing contaminated needles. Nor did the Swiss react with a “war on drugs” and massive funding for more policing, more jails, and mandatory prison sentences.
That war is well and truly lost. The US now incarcerates more people than any other country, largely as a result of soaring drug convictions, with a disproportionate number of African-American and Hispanic prisoners. The war on drugs has enabled drug cartels to reap higher profits than ever and transform entire communities in Latin America into fiefdoms. Drug money is corrupting democratic governments and law-enforcement institutions around the world. Drug-related violence has consumed untold numbers of victims in Afghanistan, Burma, Colombia, the US, and Mexico.
The Swiss re-examined their government’s drug policies with a pragmatic eye. Health professionals took the lead in a campaign to press the government – through the mechanisms of direct democracy – to shift its focus from arresting and punishing drug users toward public-health policies that are based on scientific evidence of what works.
The Swiss implemented methadone programs. and, in order to prevent the spread of HIV, they created needle exchanges, including in prisons, and established safe injection rooms on a large scale. The Swiss Federal Office of Public Health also oversaw an experiment in prescribing heroin to people who had lived with opiate dependency for significant periods.
The Swiss government’s careful evaluation of this approach demonstrated that heroin-assisted therapy is both feasible and cost-effective, and that it can bring patients significant health improvements. Moreover, it contributed to a startling drop in drug-related crime. The Swiss public was so convinced of the benefits of heroin-assisted therapy that, in two nationwide votes, voters endorsed the policy, despite domestic political opposition and criticism from the International Narcotics Control Board.
Switzerland is a conservative country. Trafficking in illicit narcotics remains illegal. In November 2008, the Swiss rejected a proposal for Dutch-style decriminalization of cannabis. And some policymakers question whether the Swiss approach has focused drug policy too much on public health and too little on dealing with the poverty and social exclusion faced by drug users.
Switzerland’s pragmatic approach to drug abuse has nonetheless yielded significant lessons that are applicable to the US, Russia, and the many other drug- and HIV/AIDS-ravaged countries over which they wield significant influence. So have similar approaches in Portugal, which only a decade ago led the EU in drug-related HIV/AIDS cases. Portugal’s decision in 2001 to decriminalize possession of illegal drugs led not only to more drug users in treatment (rather than in prison), but also a significant decrease in the number of drug users newly infected with HIV.
One lesson is the crucial importance of using scientifically rigorous investigation of new programs – rather than populist rhetoric, religious moralizing, and urban myth – to guide policymaking. This requires coordinating policing and health programs within a coherent policy framework, investing in research and public education on drug policy, opening new programs to independent review, and standing up to ideological criticism, both domestic and international, with evidence and pragmatism.
To convey these and other significant lessons, and to advocate worldwide for effective harm-reduction policies – and for broader public debate about more efficient and humane drug policies – we and other world leaders have initiated the Global Commission on Drug Policy, which held its inaugural meeting in Geneva in January. Our aim is to show that the war on drugs is lost. Switzerland, Portugal, and other countries have demonstrated that there is a better way forward, combining pragmatism and cost effectiveness with compassion and respect for human rights.