01.03.2012 Success in managing the problem of drug abuse
MaPaDro lll. The Federal Government’s Third Package of Measures to Reduce Drug-related Problems (MaPaDro III 2006–2011) has been effective. An evaluation of the project has confirmed this. The following is an overview of the most important areas of progress in managing drug use and its consequences.
Gone are the days of open drug scenes like those of the 1980s. For the general public and politicians alike, their disappearance seems to indicate that the problem of drug abuse is under control. But drug use continues to be a social problem. About half of today’s 15–16 year olds have already had experience of cannabis. Some 26,000 adults regularly use heroin and/or cocaine. Approximately 250 people die each year as a result of abusing hard drugs. In addition, there has been a rise in the use of new psychoactive substances (designer drugs, medicines) in recent years. The cost to the economy of treating, combating and preventing the use of illicit drugs amounts to about 4.1 billion francs a year. MaPaDro III is designed to counter these trends. Its main goals are to
– reduce drug use
– reduce the negative consequences for drug users
– reduce the negative consequences for society.
MaPaDro III (2006–2011) is being implemented by the Drug Section of the Federal Office of Public Health (FOPH) in cooperation with the Federal Office of Police (fedpol) and the Federal Office of Justice in accordance with an action plan drawn up by the FOPH. Below is an overview of the key activities and events of the last few years:
Revision of the Narcotics Act
The most important development in Swiss drug policy was the approval by parliament of the revised Narcotics Act (BetmG) in 2008, which created a legal framework for Swiss drug policy and its four pillars of prevention, therapy, harm reduction and repression. The four-pillar (or “fourfold”) model had already been developed for MaPaDro I (1991–1996), while MaPaDro II (1998–2002) institutionalised it at the cantonal and municipal levels. The four-pillar model has now been consolidated and further developed in MaPaDro III.
Early identification and early intervention
The development, dissemination and institutionalisation of early identification and early intervention (E+E) were and continue to be of great importance in the prevention of substance abuse. This approach is designed to identify children and young people at risk and institute supportive measures at an early stage. Among other measures, the E+E pilot programme was launched in schools and municipalities. It requires them to develop an E+E management system with which to define, for instance, the processes, tasks and responsibilities of the different players involved. In conjunction with specialist institutions, work tools are developed, examples of good practice disseminated and exchanges of experience organised for this purpose.
In addition, the Fachverband Sucht (an association of addiction experts and organisations) and GREA (Groupement romand d’études des addictions/association of addiction management professionals in French-speaking Switzerland), supported by the FOPH, have published E+E brochures presenting a model for addressing early identification and early intervention in children and young people, along with recommendations and examples of good practice. And in 2012, Lucerne University of Applied Sciences and Arts will issue a publication on the legal framework of such activities for schools and municipalities.
Consolidation of therapy
Improving the quality of substance abuse management
The quality standard, QuaTheDA (quality, therapy, drugs, alcohol), had originally been confined to residential facilities in the field of substance abuse, but is now applied to outpatient measures as well. This step has greatly improved the quality of low-threshold addiction-management services. Currently, 88 sponsor organisations running a total of 180 facilities are certified to the QuaTheDA quality standard.
Regular surveys of client satisfaction now also include outpatient services. Client satisfaction is a key indicator of the improvement potential of any quality management system. QuaTheDA had previously been limited to the quality of structures and processes. Now an approach that measures the quality of outcomes has also been developed. This means that the QuaTheDA project can be extended to include the third dimension of quality, i.e. that of outcomes (QuaTheDA-E).
Methadone- and buprenorphine-assisted treatment: this form of therapy involves substituting a legal medicine prescribed by a physician, e.g. methadone or diacetylmorphine, for an illegal opiate. The treatment is supplemented by psychosocial measures. The approach is used in about two thirds of dependent heroin users (approx. 17,000 in Switzerland). Sixty percent of substitution therapies are prescribed by primary healthcare providers. With a view to improving the quality of treatment, the Swiss Society for Addiction Medicine drew up recommendations on the medical aspects of substitution treatment. The FOPH then supplemented the recommendations with legal and structural considerations. These recommendations have been recognised by the professional federations and the Association of Cantonal Medical Officers and thereby provide the conditions necessary for harmonising the practice of substitution treatment in Switzerland (further information available at http://www.bag.admin.ch/themen/drogen/00042/00629/00798/index.html?lang=en). In a further step, the recommendations were rounded out with practical instructions for family doctors (www.praxis-suchtmedizin.ch).
Heroin-assisted treatment (HAT) is intended to help seriously dependent heroin users who cannot be reached with other therapeutic measures. It involves the regulated and monitored prescription of pharmaceutical-quality heroin and is underpinned by psychosocial care and medical treatment. Following on many years of experience and scientific support, the revised Narcotics Act (BetmG) and the Narcotics Addiction Ordinance (BetmSV) created the legal framework for heroin-assisted treatment. HAT is now provided in 23 centres throughout Switzerland. The number of patients receiving it has been stable for years and now totals about 1,300.
Harm reduction breaks new ground
The FOPH has a mandate to support the cantons, municipalities and institutions in their efforts to implement harm reduction measures. The focus of such support (contact points, needle exchange facilities, etc.) had previously been on ensuring the survival of dependent heroin users. However, changed user habits meant that the scope of harm reduction measures had to be extended (for instance to nightlife and leisure activities). The FOPH, together with experts in addiction management and prevention, therefore compiled examples of good practice in the implementation of harm reduction measures. Work on a publication designed to make this knowledge available to a broader specialist public is currently in progress.
MaPaDro III was evaluated in 2011. The evaluators came to the conclusion that significant progress had been made in relation to all three main goals in the implementation of MaPaDro III. Against this backdrop, the MaPaDro III action plan is now being adapted to address the changes in the problem situation. The measures are being brought into line with the revised Narcotics Act, current trends in practice and new forms of drug use and addiction (e.g. poly-drug use). The new action plan, supplemented by fedpol measures, will be published on the FOPH website, probably towards the middle of this year.
Markus Jann, Head, Drug Section, email@example.com