A look at how Switzerland radically and successfully changed its approach to drug policy following a heroin epidemic in the late 1980s and 90s, and what the effort teaches us about the social innovation process.
Near Zurich's old town, hundreds of heroin addicts gathered in the 80s and 90s. (Photo by iStock/mikeinlondon)
In 1961, the United Nations adopted the Single Convention on Narcotic Drugs, a treaty aimed at combatting drug abuse through coordinated international action. The accord seeks to prohibit the use, trade, and production of certain drugs except for medical and scientific purposes, and to combat drug trafficking. Yet despite efforts like this, failed interventions and policies, as well as human rights violations related to drug use, have continued to stand in the way of progress at the local, national, and global levels. We have much more to do to confront the many harms that drugs inflict on health, development, peace, and security, in all regions of the world.
Still, there have been some wins along the way—including in Switzerland. Between 1991 and 2010, overdose deaths in the country decreased by 50 percent, HIV infections decreased by 65 percent, and new heroin users decreased by 80 percent. Today, the so-called “four-pillar model” that guides Swiss drug policy—prevention, treatment, harm reduction, and law enforcement—is internationally recognized as a major step in redefining how to tackle narcotic drugs.
The starting point for rethinking the narcotic drug problem in Switzerland was not the will to innovate, but rather the visible, undeniable failure of existing approaches. Starting in the 1970s, the eyes of the world turned to Zurich. One of the wealthiest cities in the world, Zurich had become, as one New York Times article later called it, a “bazaar of the bizarre.” Heavy drug users regularly gathered in the city center without shelter, toilets, or showers—just a few meters away from flourishing businesses, banks, and hotels. Zurich registered the first death from heroin overdose in 1972, and narcotic drug consumption in the city continued to steadily rise. In the early 80s, as a response to the increasingly widespread use of narcotics, the Swiss government revised federal law, and defined rigorous criminal sanctions for the possession, consumption, and sale of illegal drugs. However, in the years that followed, police struggled with enforcement, and in an effort to regain control, local authorities started to tolerate consumption in “controlled areas,” such as certain parks where police did not make arrests. By the late 80s, thousands of people around the country were openly selling, buying, and consuming drugs.
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At the same time, HIV/AIDS was on the rise. In 1986—one of the first years that countries reported HIV data—Switzerland’s estimated prevalence was the highest in Western Europe. This created a nexus of problems, and public health and public order were at stake. It was clear that existing approaches to solving the problem were dramatically failing, and the severity of the situation forced policy makers, police, health officials, and the public to consider alternative ways of approaching the problem.
The city administration of Zurich began contracting with direct-service organizations, but many of them initially engaged in conflicting or poorly coordinated activities. Public agencies and nonprofits in the city and beyond provoked controversy by introducing needle-exchange programs, safe injection rooms, and shelters. And although authorities often looked the other way, doctors supplying clean syringes to drug users to decrease and control the risk of infection were threatened with sanctions. But over time, these groups formed coalitions and became more coordinated. Police, social workers, and medical staff started to cooperate, and churches and civil society organized to help drug users living on the streets. City representatives demanded more decision-making power in the field of drug policy and advocated for new measures, including harm reduction. Health officials, for instance, began lobbying for syringe exchange schemes that made it possible, when prohibition failed, to use drugs without irreversible physical damage like HIV infection. Coalitions emerged around these practices, shaping up an alternative to the prohibitionist policy model. Social workers, police, policy makers, health professionals, and researchers increasingly brought together policing, social, and health programs under a coherent policy. And as initial successes became visible, the public, policy makers, and public funds increasingly supported these collaborative efforts.
As the process became more coordinated and gained public support, officials emphasized the need for—and the willingness to invest in—evidence building, monitoring, and documentation. Given the urgency of the problem, policy makers readily supported plausible innovations in protected spaces so that they could collect data about their effects and make decisions based on those data. For example, although consumption of narcotic drugs was still formally illegal, the Federal Office of Public Health authorized Heroine Assisted Treatment (HAT) trials, prescribing heroin for controlled consumption to addicts in Zurich, Bern, Basel, and Geneva. Between 1991 and 1999, the Federal Office of Public Health supported the development of more than 300 programs, many of which also received cantonal (state-level) or municipal support, amounting to a federal expenditure of more than 15 million Swiss francs (about $15 million) annually. And in 1997, the government created a Federal Commission for Drug Issues, composed of 14 mainly academic experts in the field of narcotic drugs, to advise on drug policy issues. These efforts quickly produced an impressive body of evidence that became the basis for program and policy decision-making and public discussion, both nationally and internationally.
Given that Switzerland is a federal republic and direct democracy, Swiss policy is strongly localized and emerges from public opinion. So, as with any other social problem, having small coalitions develop solutions behind closed doors and implement them from the top down was not viable. At the same time, each canton, or state, could test their own solutions and thus avoid the need for a national consensus.
During the heroin epidemic, police officers in Zurich struggled to keep control of the city. (Photo by iStock/Denis Linine)
This local orientation potentially helped overcome one of the primary challenges of drug policy implementation: Policies are often set at the national level, while the pressure to act emerges locally. Cities, particularly those in direct democracies, can’t afford to lose the support of the people who depend on social services or the middle class that supports generous welfare policies. For these reasons, local communities are the most likely to develop and test possible solutions. In Zurich, city administrators set up regular public meetings to counter neighborhood resistance to harm reduction facilities. National drug policy conferences in 1991 and 1995 helped generate intensive debate among politicians and drug policy professionals, and the conference reports opened up the debate to the media and the public, ultimately increasing public support for the pragmatic policy approach.
Initially, conservative groups within Switzerland, neighboring countries, and the United Nations were critical of the new drug policies, claiming that actions like HAT testing were in violation of the prohibitionist UN drug conventions. But over time, and with increasing evidence that harm reduction measures worked, critics began to recognize the Swiss approach as valid. It took more than a decade before the World Health Organization (in 2003) and the European Union (in 2008) recognized the role of harm-reduction measures. And while Switzerland has practiced the four-pillar model and the prescription of heroin for decades, it didn’t revise its narcotic law until 2008, when the problem had already diminished. Some scholars suggest that heroin use declined not only because of successful public policy, but also because the generation that used heroin during peak years was aging and younger generations were attracted to other kinds of drugs.
Switzerland’s drug policy innovation process took more than two decades and involved all levels of society, but it has achieved notable success. Our hope is that other innovators can increase the scope and scale of their work by transferring some of these insights to other contexts and social issues.
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Miriam Wolf is a scientific project manager at the Humboldt Institute for Internet and Society in Berlin (@hiig_berlin). Her work is concerned with social transformation processes and organizations creating social and/or environmental value.
Michael Herzig is a lecturer at the Institute for Social Policy and Management at the ZHAW Zurich University of Applied Sciences (@ZHAW). His work is concerned with addiction, drug policy, harm reduction, and social work with drug users, alcoholics, and sex workers.
