THE WHO REPORT ON THE SWISS HEROIN TRIAL

Since the Swiss themselves started distributing their own evaluations on the heroin distribution experiment, Hassela Nordic Network has claimed that there is no scientific evidence that heroin distribution per se has resulted in any improvements among heroin addicts who have taken part in the experiment. This is now verified through the WHO report.

Here follows the full text of the Executive Summary of the report:

"This document presents the report of the external evaluation of the Swiss Scientific Studies of Medically Prescribed Narcotics to Drug Addicts that were conducted in three phases between 1995 and 1998. The Swiss Scientific Studies are hereinafter referred to as the Swiss studies.

The Swiss studies were designed and initiated in the early 1990s as a response to difficult local problems of populations of addicts who appeared to be refractory to, and unable to engage with, the treatments then currently available.

The Swiss Federal Office of Public Health (SFOPH) and the research team chose to conduct a direct observational study to assess the feasibility of heroin and other opioid prescription, to assess the suitability of treatment method for heroin addicts who had failed at other treatments, and to assess the impact of such treatment on health and social outcomes.

Unlike drug treatment systems in most other countries, the Swiss drug treatment system is highly resourced with high levels of drug-free residential and drug-free community treatment as well as high levels of oral methadone treatment.

The Swiss studies had a very high degree of oversight involving local Canton authorities, federal authorities and researchers from the Institute for Social Research. Reports of all deaths were reviewed and none found to be related to the nature or quality of treatment. However, these reports have not been reviewed independently by the external evaluators.

The questions and priorities for the Swiss authorities at the beginning of the project were different from those subsequently raised at en international level. The final study design was a prospective outcome study that was intended to measure the impact of the intervention but could not determine the efficacy of one intervention compared to other interventions.

The Swiss studies were not able to examine whether improvements in health status or social functioning in the individuals treated were causally related to heroin prescription per se or a result of the impact of the overall treatment programme. Hence, from a rigorous methodological viewpoint, it was not possible to obtain internally valid results with respect to the research question of heroin prescription being causally responsible for improvements in health status or social functioning in the individual treated.

The external evaluation supported the study conclusions that: (1) it is feasible to provide an intravenous heroin treatment programme under highly controlled conditions where the prescribed drug is injected on site, in a manner that is safe, clinically responsible and acceptable to the community; (2) participants reported improvements in health and social functioning and a decrease in criminal behaviour and in reported use of illicit heroin.

There is a need for continued scepticism about the specific benefits of one short acting opioid over others and there is a need for further studies to establish objectively the differences in the effect of these different opioids."