Scottish Drugs Forum Glasgow 30th June 2005 Residential Drug Services Where do they fit on the treat

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Scottish Drugs Forum Glasgow30th June
2005Residential Drug Services Where do
they fit on the treatment map?The situation in
Switzerland

• Nicolas Heller
• Gilgamesch House
• Basle, CH
• Tel [phone]
• e-mail nh_at_balcab.ch

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Comparison Switzerland Scotland

• Area 15,940 sq mi 78,782 sq mi
• Population 7,450,867 5,054,800
• IDU 30,000 50,000
• (15-49 years old) 0,9 ?

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Language(s)

• German 60
• French 30
• Italian 10
• Romansh

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Political divisions

• 26 cantons (responsible for health services)
• 2,904 communes
• 26 different drug policies

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Switzerland's drug policy

• 1980s
• HIV-AIDS epidemic
• Open drug scenes
• Miserable state of drug addicts becomes visible
  to everybody (public pressure to act)
• Needle exchange programmes
• Hepatitis vaccinations

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New approach Harm reduction

• 1990s
• Fourfold approach (4 pillars)
• Prevention
• Law enforcement
• Treatment
• Harm reduction
• 300 projects/programs supported by 6,5 millions
  Pounds/year

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Heroin assisted treatment HAT

• Severely dependent heroin addicts, who had failed
  at other treatment programmes, treatment
  non-responders
• Restricted clinical trials
• Strict scientific evaluation
• Begin 1994 End 1996

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Evaluation report (1997)

• Increase of physical and/or psychic health
• Increase of quality of life (housing, work etc.)
• Decrease of illegal use of heroin/cocaine
• Decrease of prostitution and criminality
• Economy benefits
• Since 1999 HAT recognized type of therapy

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Treatment

• Objectives
• Breaking drug addicts of their habit
• Social reintegration
• Better physical an mental health
• 2004
• 1,280 medically prescribed heroin
• 14,588 medically prescribed methadone (1979 728)
• 486 medically prescribed buprenorphin
• 51 medically prescribed morphin

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Residential drug services

• 1999 100 institutions 1,750 spaces
• Thunderclouds
• Lower demand
• Standard Quality Management System
• 80 occupancy at least claimed
• 2005 80 institutions 1,000 spaces

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Costs

• Residential rehabilitation
• 150 Pounds/day
• Social welfare
• Residential detoxification
• 300 Pounds/day
• Health insurance

• Methadone programmes
• 20 Pounds/day
• Health insurance
• Heroin assisted treatment
• 20 Pounds/day
• Health insurance
• Welfare outpatients
• 40 Pounds/day

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Drug-abstinence

• Methadone programme (2 years) 42,4
• Abstinence based therapy (1 year) 50

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Traditional residential services

• Aims
• withdrawal / abstinence / reintegration
• Duration
• short / medium / long
• Interventions
• clinical detoxification / psychosocial support /
  counselling / group therapy / employability
  training

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Main treatment goal

• Empowering to lead a life
• as independent as possible
• as satisfying as possible
• for themselves
• and their social environment

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Combination of residential and substitution
benefits

• 2 residential rehabilitation services specialized
  for addicts in methadone programme and/or heroin
  assisted therapy
• House Gilgamesch, Basle (since 1995) 7-12 beds
• Saurenhorn Community, Berne (since 1998) 10 beds

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Challenges

• Concomitant cocaine and crack cocaine consumption
• Resulting relapses for substituted patients
• Psychiatric co-morbidity
• Flexible, made-to-measure setting
• Training for the staff

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Thank you