Swiss refendum material on heroin prescription

Translation from:
Suisse, Office fédéral de la santé publique, Traitment avec prescription d'héroïne: Argumentaire concernant la votation populaire sur l'arrêté fédéral urgent sur la prescription médicale d'héroïne (traitment avec prescription médicale d'héroïne) du 13 juin 1999 (GEWA, Zollikafen, avril 1999). This and a German language version are at http://www.admin.ch/bag/sucht/drog-pol/abstimmg/f/index.htm.

Treatment with prescription heroin
Arguments concerning the popular vote on the Urgent Federal Ordinance on the medical prescription of heroin (treatment with medically prescribed heroin) on 13 June 1999

On 13 June 1999 the vote will take place on the Urgent Federal Ordinance on the medical prescription of heroin, an ordinance that was approved on 9 October by the National Council and the Council of States and against which a committee, placed under the auspices of the Federal Democratic Union (UDF), has initiated a referendum. We set out herein treatment with medically prescribed heroin as a therapeutic possibility within a total therapeutic framework. The arguments [in this paper] respond to the false claims of the [UDF] referendum committee and the chapter "some facts and figures" presents data concerning the treatment with prescription heroin.

Having regard to the message of the Federal Council of 18 February 1998, orders:

Various types of treatment and therapeutic possibilities exist for people dependent on drugs, just as there exist for those suffering other dependencies.

What ambulatory care offers is most suitable for occasional drug consumers. Multiple ambulatory and in-patient institutions exist for physical detoxification, notably cold turkey detoxification, in which the consumption of drugs and medications is drastically reduced, medical detoxification which consists of the administration of reducing doses of substitution medications such as methadone, and rapid detoxification (sevrage éclair) under anaesthetics which is suitable only for people consuming exclusively heroin.

After having physically detoxed, the majority of patients have need of support to prevent relapses. A number of possibilities also exist here: extending ambulatory care, semi-residential or residential therapy, and a still larger number of institutions which helps professional reintegration.

Drug dependent people have a right to treatment, even if this does not permit them to improve their health or to abstain rapidly from narcotics. Prescription of heroin for medical reasons is a treatment directed towards gravely dependent people who seek to stop the negative effects of drug consumption on health and social welfare. This treatment equally envisages the creation of conditions appropriate for later treatment, an objective that substitution programmes (such as treatments with methadone) envisage.

Therapies that envisage abstinence at the first attempt are not suitable for all drug consumers, in particular not for people gravely dependent for several years who are in need of a therapy able to permit them first to stabilise their physical and psychological situation. It is only when their situation is improved that a detoxification can be envisaged. Nevertheless, there also exist well integrated drug consumers who choose to have recourse to a substitution product in order not to be excluded from their professional or social milieu. In general, therapies submitted to under compulsion and without a particular motivation are ineffective.

With the development, at the end of the 1980s, of open drug scenes in certain towns, opinion suddenly became aware of the problem of drug addiction. The suffering of addicts had become visible, the cantons and communes found themselves faced with a major social and public health challenge. Crime, linked to the acquisition and consumption of drugs brought with it security problems in the towns concerned.

Given this situation, the Confederation reacted by adopting a set of "drug" measures (1991), which is reflected in the four pillars policy. These measures envisaged not only prevention but equally took account of the needs of addicts and their near ones (assistance, therapy), as well as those of the general population (security and public order). As for heroin prescription treatment, it was introduced in 1994, in the framework of a trial of medically prescribed narcotics.

It is the destitution into which certain addicts fall, the spread of HIV and hepatitis in the addicted population as well as the failure of classical therapies for people gravely dependent that led the Confederation to take these measures.

Very soon it was noticed that this new form of treatment was of assistance to gravely dependent people who it was difficult to reach otherwise. Health and social integration of these people has perceptibly improved. The risk of infection by HIV and hepatitis B and C has been able to be reduced considerably. Thanks to various measures, including heroin prescription treatment, open scenes of drug use were able to be closed in the spring of 1995 and no new ones have formed. An important decline in crime was observed among participants in the programmes of heroin prescription, which contributed to the improvement of public security in the regions concerned.

The final report of the trials of medical prescription of narcotics, published in June 1997 by the Institute of Social and Preventative Medicine of the University of Zurich, recommended the continuation of treatments of heroin prescription, but only for the specific group of people gravely dependent on heroin.

The positive results obtained from the trials has led the Federal Council to include heroin prescription treatment in the "therapy" pillar of its policy, by Urgent Federal Ordinance of 9 October 1998. Heroin prescription treatment certainly does not replace other therapies which are directly based on abstinence or have recourse to other substances (for example methadone).

Today, some heroin prescription treatments are dispensed at Basel, Saint-Gall, Zurich, Horgen, Winterthour, Zoug, Lucern, Olten, Soleure, Bienne, Thoune, Berne, Geneva and at Oberschöngrün (canton of Soleure). Other cantons and regions have already planned new treatment centres.

Numerous patients have seen their level of health improve, their housing situation markedly stabilise and little by little have been reintegrated into professional life. Many have been able to reduce their debt and no longer have recourse to social security. The number of those having part time or full time work increases with the length of treatment. The majority have reduced their contacts with addicts and with the drug scene. The results for the years from 1994 to 1996 are confirmed by the figures for 1997.

As far as crime is concerned, the situation has radically changed. Although at the time of their entry to the programme, 70% of patients had an income from illegal or semi-legal activities, there were only 10% who had recourse to these activities after 18 months of treatment. These results, which relate to the period of treatment from 1994 to 1996, have been confirmed by the information from 1997.

From 1994, 1522 people have commenced a heroin prescription treatment (up to March 1999). These people have been in treatment for more or less a long time; some for 5 years, others for some days only. Up to this point, information on 443 people who left treatment after a variable lapse of time has been analysed; 30% of them moved to an abstinence based treatment, 37% to a methadone based treatment. The longer the length of treatment, the greater is the number who turn to an abstinence based treatment and there are fewer who interrupt their treatment prematurely.

The trials have also been evaluated from an economic point of view. The average cost in the ambulatory treatment centres is estimated at 51 francs per patient per day. The general economic benefit flowing from saving realised in criminal prosecutions and prison sentences and from the improvement in the level of health is estimated at 96 francs. After deduction of the costs, an average benefit of 45 francs per patient per day is obtained.

The state of health of patients has clearly improved and stabilised at a good level. The consumption of non-prescribed substances has diminished to a significant degree during treatment, the number of patients in employment has markedly increased and crime has considerably diminished. 30% of the 443 people who have left the treatment up to March 1999 have chosen an abstinence based treatment, 37% have opted for a methadone prescription treatment.

Comparison between prescription heroin and prescription methadone treatments

From a study undertaken in 1998 to compare heroin prescription treatment with methadone prescription treatment it appeared that patients having followed the first had markedly reduced their consumption of illegal heroin, cocaine and benzodiazapines and considerably limited their contacts with the drug scene. The number of people having interrupted treatment is also fewer in this group. This shows that heroin prescription treatment for a well defined target group produces better results than methadone prescription treatment and thus represents a relevant complement to the therapeutic palette.

These good results have also been largely confirmed by recent results. Although no new patients were possible between June 1996 and February 1998, patients admitted from March 1998 also comply with all the very strict admission criteria and among these also very encouraging progress has been observed. The data relating to observations made among the patients who have left treatment shows that the improvements obtained within the framework of heroin prescription treatment are, in most cases, still observable one or two years after the end of treatment. The best results are observed among those who followed a later treatment (therapy based on abstinence or on methadone).

With the Federal Ordinance that is submitted to the vote, the Federal Council and Parliament has created a legal basis for the introduction of medical prescription of heroin as a recognised therapy. The National Council and Council of States has approved the federal ordinance. The last laid down that heroin may be prescribed only to people

The limit of 800 people able to be admitted to treatments with prescribed heroin is replaced by these criteria. In the short term, a need for about 1,500 treatment places is provided for. According to specialists, their number should be somewhere between 1,500 and 3,000 long term places. At present, nearly 1,000 people are in treatment.

The referendum committee, placed under the auspices of the Federal Democratic Union (UDF), wishes to prevent the prescription of heroin to gravely dependent people. It forgets that heroin prescription treatment does not consist simply in the provision of a drug, but that it is a matter of fairly much a total therapy that represents the last hope for people dependent for several years and, whose state of health has seriously deteriorated, and who have already made without success several therapeutic attempts.

A no to heroin prescription treatment would signify the end of a therapy that had the chance to succeed for about a thousand addicts. Most of them would once again have to procure the drug in the street — with the consequences that one knows for their health and for the population in the neighbourhood new open drug scenes could be expected to form. In addition, other gravely dependent addicts meeting the criteria for treatment with heroin prescription treatment would not be able to benefit from the therapy.

In the case of a no to the federal ordinance, one would run the risk of seeing open drug scenes reforming and of being faced with the distress to which they give rise. The images of shameful living conditions, of deplorable hygiene conditions and of profound despair are still vivid in our memories. Numerous seriously ill addicts would see themselves deprived of the last possible escape from a life of despair and increasing destitution. To say no to heroin prescription treatment would signify that our society abandons the feeblest and most deprived to their fate.

Heroin prescription treatment clearly carries the following messages: The needs of drug dependent people (assistance) are taken into account but also the security needs of the general population; and this, which is not to the detriment of one or the other, is for the good of all. The therapy is necessary because dependency is a serious illness. Therapy is possible, also for gravely dependent people. Besides, there is nothing to indicate that heroin use has increased among young people since the introduction of prescription heroin.

The provision of narcotics by the State does not allow us to fight organised crime or criminality.

The strong reduction in criminality among patients who undergo heroin prescription treatment has been confirmed by the trials. Thus not only have some dealers in the black market been removed but also the market's best clients. For the rest, the law enforcement authorities fight with more effective means against organised crime within the framework of the "repression" pillar.

The costs of heroin prescription are in part recouped from health funds. The provision of poison is thus financed by insurance premiums.

Addicts are exposed to greater risks than the average of the general population. They are more often ill and hospitalised. Heroin prescription treatment, which is partially financed by health funds, leads to an improvement notably in the psychological and physical situation of addicts, which makes them the ones less often hospitalised in an emergency and other interventions are less frequent. The public health system being less called on, costs are reduced, which produces a benefit for the insured.

The cantons and communes are also obliged to pass on costs to the [health insurance] fund. New tasks result and this consequently means a supplementary charge on contributors.

Thanks to heroin prescription treatment, contributors save money. Treatment cost Fr. 51.- per patient and per day. At the same time, the same treatment reaps an economic benefit of Fr. 96.- per patient and per day. The greatest part of this sum consists of savings in the areas of law enforcement and public health. This type of treatment consequently generates a net economic benefit of Fr. 45.- per day per patient, an amount that represents a saving for the contributor.

The number of treatment places of heroin prescription treatment is unlimited, a large number of toxic substances can be administered for pseudo therapy. The Confederation will soon distribute poison to 30,000 addicts.

The strict admission conditions for treatment firmly limit the number of potential patients. A patient is admitted only if he satisfies the criteria fixed by the Confederation. The Federal Office of Public Health oversees that treatment is carried out in accordance with the determined conditions and correctly. The Confederation also controls the heroin prescription treatment centres in collaboration with the cantonal services. To date, the cantons and towns have announced a need for 1,430 treatment places. In the medium term, it is necessary to count on a need for between 1,500 and 3,000 treatment places. The available substances for substitution treatment are exclusively methadone, morphine and heroin. Out of 1,522 of the first patients — independent of the duration of treatment — 134 have already moved on to abstinence based treatment and 162 to methadone treatment.

Rather than motivating addicts to get off the drug, it is attempted only to reduce the negative effects of use and in doing so one forgets that the motivational assistance that matters is eliminated.

It is true that in some circumstances a certain pressure can reinforce motivation to get off drugs. However, the motivational assistance that matters is the desire to change one's life and the hope of doing so. The one and the other are often difficult to show themselves in a life entirely oriented towards the search for drugs and their use. This is why heroin prescription treatment is able to create conditions favourable to the motivation to get off the drug and gives back to people who have been dependent for years and, because of that, do not believe themselves able to escape, the hope of a life in which they have succeeded.

Heroin provision programmes have failed. The number of addicts has increased, at the same time there has been a massive reduction in the number who have stopped using drugs, seduced as they are by the pernicious signal that the provision of the drug sends out, and the number of abstinence based treatment places has been reduced.

The number of addicts has been relatively stable for some years. The number of those entering residential institutions providing abstinence based treatment has grown by 200 between 1993 and 1996, passing from 1,900 to 2,100, and it continues to increase. In 1993, addicts who wished to quit drugs had 1,250 detoxification and rehabilitation places available to them. In 1997, this number was 1,750.

One of the aims of heroin prescription treatment is improvement in the physical and psychological health and social integration of patients. Prescription heroin has shown itself effective in these areas. However, the prescription of heroin is an intermediate step towards abstinence. Among patients having commenced this treatment before March 1999, 134 have opted, after more or less a long time, for an abstinence based treatment and 162 for a methadone treatment. What is remarkable to know is that all the patients are people who have been seriously dependent on heroin and who have already failed other therapies several times.

The provision of the drug is a strategic step towards liberalisation of drugs.

Heroin prescription treatment is not a step in the direction of general drug liberalisation. It is a question of a strictly regulated therapy, under which the patient is subject to a number of obligations (by the way just as at the commencement of abstinence based treatment), obligations that he undertakes to respect. The vote of 13 June 1999 concerns only heroin prescription treatment and is not in the least about a liberalisation of drug policy.

The synthesis report on the medical prescription of narcotics is scientifically debatable.

An international group of experts, instituted by the WHO, has made a searching analysis of three phases of the Swiss trials of the prescription of heroin. Its report, which has just been published, recognised as valid on essential points the results presented by the Swiss researchers, notably in the improvements of health and the social circumstances of the participants in the trial, the reduction in crime as well as the feasibility of heroin prescription, and furthermore it recognised the care and precision with which the programme was carried out.

Two points were the subject of criticism: The first concerns the absence of a control group. To that it can be responded that, in accordance with the research plan, the evaluation concerned a clearly defined group of gravely dependent addicts (the cohort), which is fairly much a usual procedure in the evaluation of therapeutic programmes for addicts. Some sub-groups were provided for by the research plan, to which different substances were prescribed (heroin, morphine, intravenous methadone), but it was observed that morphine and intravenous methadone were very poorly accepted and that a very small proportion of the treatment places provided for this were taken. It was because of that barely possible to make weak comparisons between the groups.

The second criticism brought up the fact that it is not clearly established whether the therapeutic success was the result of the prescription of heroin or the therapeutic framework by which the participants benefited. This observation is relevant, but it is known, in methadone treatments, that the accompaniments and the therapy are the factors determining the success of the treatment. It ought therefore to be the same for heroin prescription treatment. For the rest, the prescription of heroin offers the guarantee that the group of gravely dependent people, of whom most have not been able to complete a treatment or have not been able to embark on one, can be treated. A later study should make it possible to determine the contribution of different factors in the success of the treatment.

In authorising heroin prescription treatment, Switzerland is breaking international law.

Heroin prescription treatment is in conformity with all international conventions which Switzerland has signed. Heroin prescription for gravely dependent users is a new therapeutic approach which has been experimented with for the first time in Switzerland and which has produced important new information on the treatment of dependent people in general. This appreciation is still being worked through [? – "est encore confortée"] in the debate underway at the international level in a number of European countries and across the Atlantic. Thanks to research carried out in Switzerland, this treatment is seen as more and more scientifically justified. It is not only in Switzerland that gravely dependent people receive medical and psychological assistance within the framework of heroin prescription, it is also the case in The Netherlands and in Great Britain. In these countries wide ranging scientific studies are accompanying this type of treatment. Everywhere, but more particularly in countries where the introduction of heroin prescription is envisaged, this new form of therapy is the subject of discussion; this is the case in Germany, Spain, Denmark, Australia and Canada.

The 4 pillar policy has been endorsed in several popular votes. On 28 September 1997, the people voted on the "Youth without drugs" initiative that envisaged the elimination pure and simple of the "harm reduction" pillar and, in the therapy pillar, to stop substitution treatments and, more particularly, heroin prescription. The initiative was rejected by 70.6% of voters. The "Droleg – for a reasonable drug policy" initiative, which advocated an extended liberalisation of drug use and trade was rejected on 29 November 1998 by 73.9% of voters.

The electors of Zurich have passed judgement twice, namely on 1 December 1996 and 29 November 1998, in favour of pursuing heroin prescription treatment. At Winterthour the citizens passed judgement, on 25 June 1995, on the participation of the town in a trial of the controlled provision of heroin and methadone, and, on 1 December 1996, on the continuation of this trial. On each occasion, heroin prescription treatment was approved.

A vote took place in the canton of Bâle-Ville on 2 June 1994, a vote concerning the decision of the Great Council concerning an appropriation for various medical prescriptions of drugs. The appropriation was largely approved.

The policy of the Federal Council envisaging the reduction of problems linked to drugs has as objectives:

To achieve these goals, the Federal Council has defined a policy comprised of four aspects (the so-called 4 pillar policy). We recall as follows the strategic elements:

It is a matter of persuading (young) people not to use drugs and to choose a healthy life-style (primary prevention). As well, it is a matter of protecting occasional users in order that they do not develop an addictive habit and to prevent them leaving their social environment, namely their family, school and apprenticeship (secondary prevention).

In the therapeutic domain it is necessary to distinguish (in accordance with available resources and the life-style of the patients) two objectives: On the one part, it is a matter of stabilising the condition of the patient and having done that to improve his state of general health. On the other part, it is a matter of healing the dependency, which is to say to do so in such a manner as the addict will be able to live without drugs and without relapses. Stabilisation is necessary particularly for gravely dependent people in order for them to regain their strength and the hope of quitting their life of addiction. It is here that heroin prescription treatment fits in.

Harm reduction measures envisage the maintenance as well as is possible of the health of dependent people in their active addictive phase. The state of health and life-style of dependent people should be improved, the spread of HIV and other infectious diseases should be prevented. These measures can consist of needle exchanges, injection facilities and housing programmes and employment.

The Federal Council's drug policy is founded on the strict regulation of prohibition of certain substances and preparations that can lead to dependency. The Confederation has provided itself in recent years with legislative instruments to fight against money laundering and organised crime. The law on money laundering that entered into force on 1 April 1998, obliges banks to inform the federal authorities of suspicious accounts and to freeze the funds concerned.

The following data is drawn from the synthesis report of June 1997 and recent evaluations and inquiries of the Institute of Addiction Research at Zurich and of the Institute of Forensic Science and Criminology of the University of Lausanne.

Tables of figures 1, 2.1, 2.2 and 3.1 are based on information furnished by 632 people who undertook heroin prescription treatment in the second half of 1997. To take into account differences that may exist between the groups of patients in treatment for different periods, three sub-groups have been established for the evaluation:

Housing situation	Patients in treatment for less than 2 years (n=269)		Patients in treatment from 2 to 3 years (n=291)		Patients in treatment for more than 3 years (n=144)
	on entry	1997	on entry	1997	on entry	1997
stable	53%	81%	47%	74%	59%	82%
unstable	47%	19%	53%	26%	41%	18%

The housing situation is considered stable when there is long term assurance of psychologically and physically tolerable conditions. On this basis a positive change was observed in the three groups of patients. The patients succeed in stabilising notably their housing conditions.

Employment situation	Patients in treatment for less than 2 years (n=269)		Patients in treatment from 2 to 3 years (n=291)		Patients in treatment for more than 3 years (n=144)
	on entry	1997	on entry	1997	on entry	1997
full time employment	9%	10%	7%	13%	9%	16%
part time employment	5%	9%	3%	6%	6%	15%
temporary training housework	10%	38%	8%	40%	17%	31%
unemployment benefits	44%	36%	45%	31%	30%	30%
unable to work	16%	6%	17%	7%	17%	8%
street crime prostitution	16%	1%	19%	2%	20%	1%

A significant growth in forms of legal employment in the three sub-groups was ascertained. In particular temporary employment clearly increased, but one also observes this tendency in full time employment and part time employment. On the other hand, those who gravitate to the neighbourhood of the drug scene had clearly diminished.

Circle of friends	Patients in treatment for less than 2 years (n=269)		Patients in treatment from 2 to 3 years (n=291)			Patients in treatment for more than 3 years (n=144)
	on entry	1997		on entry	1997		on entry	1997
no friends	28%	29%		30%	26%		26%	23%
drug dependent friends	29%	18%		30%	22%		31%	16%
friends not on drugs	43%	54%		40%	53%		44%	61%

People interviewed who had no friends at the start of treatment had barely changed in the course of treatment. On the other hand, among people interviewed who had friends, a displacement towards friends outside the drug milieu is observed. The longer treatment lasts, the greater the number of friendships established outside the drug scene increases.

Physical health	Patients in treatment for less than 2 years (n=269)		Patients in treatment from 2 to 3 years (n=291)		Patients in treatment for more than 3 years (n=144)
	on entry	1997	on entry	1997	on entry	1997
very good	6%	11%	3%	8%	1%	6%
good	74%	82%	76%	81%	74%	86%
bad	19%	8%	20%	11%	24%	8%
very bad	1%	0%	1%	1%	1%	0%

Psychological health	Patients in treatment for less than 2 years (n=269)		Patients in treatment from 2 to 3 years (n=291)		Patients in treatment for more than 3 years (n=144)
	on entry	1997	on entry	1997	on entry	1997
very good	3%	4%	3%	6%	1%	9%
good	58%	77%	61%	74%	53%	76%
bad	36%	18%	34%	17%	45%	15%
very bad	2%	1%	3%	3%	1%	1%

Re 2.1 and 2.2: Heroin prescription treatment has a positive influence on the evolution of the physical and psychological health of the patients. Already after a short time, nearly 90% are in good physical health and more than 80% in good psychological health. It should be noted, though, that the state of health of these people should always be evaluated taking account of the fact that one is dealing with people who are seriously heroin dependent.

Acute illnesses	during the first month after entry	after 18 months of treatment
skin illnesses	49%	6%
digestive troubles	10%	3%
anaemia	5%	1%
epileptic attacks	5%	0.5%
intoxication	4%	1%

Psychological health	Patients in treatment for less than 2 years (n=269)		Patients in treatment from 2 to 3 years (n=291)		Patients in treatment for more than 3 years (n=144)
	on entry	1997	on entry	1997	on entry	1997
no illegal income	33%	89%	28%	86%	35%	83%
only petty dealing	20%	3%	17%	8%	17%	8%
only illegal income	20%	7%	21%	4%	23%	6%
petty dealing and illegal income	27%	0%	35%	2%	25%	4%

The results show clearly that all forms of illegal and semi-illegal income have reduced during treatment.

3.2 Patients having committed crimes registered by the police (data drawn from police registers)

Observation period	Before commencement of treatment	After commencement of treatment	Reduction
6 months (n=604)	45.4%	25.8%	43.2%
12 months (n=336)	53.6%	32.1%	40.1%
18 months (n=153)	66.7%	39.2%	41.2%
24 months (n=108)	73.1%	44.4%	39.3%

The number of patients having committed crimes registered by the police has reduced by about 40% during treatment, independently of the period of observation.

3.3 Average number of crimes per patient registered by the police (data drawn from police registers)

Observation period	Before commencement of treatment	After commencement of treatment	Reduction
6 months (n=604)	1.92	0.61	68.2%
12 months (n=336)	3.16	1.00	68.4%
18 months (n=153)	4.56	1.38	69.7%
24 months (n=108)	5.84	1.69	71.1%

Motives	Left during the 1st semester		Left during the 2nd semester		Left during the second year		Left after the 2nd year		Total
	Number	%	Number	%	Number	%	Number	%	Number	%
Abstinence based treatment	34	27.0	26	27.1	29	34.5	45	32.8	134	30.2
Prescription methadone treatment	43	34.1	43	44.8	22	26.2	54	39.4	162	36.6
Hospitalisation	3	2.4			4	4.8	1	0.7	8	1.8
Exclusion	8	6.3	4	4.2	5	6.0	10	7.3	27	6.1
Put in detention	7	5.6			1	1.2	3	2.2	11	2.5
Moved from the area	1	0.8	1	1.0	1	1.2	2	1.5	5	1.1
Died	4	3.2	6	6.3	2	2.4	5	3.6	17	3.8
Left without explanation	24	19.0	15	15.6	11	13.1	16	11.7	66	14.9
Other reasons	2	1.6	1	1.0	9	10.7	1	0.7	13	2.9
Total	126	28.4	96	21.7	84	19.0	137	30.9	443	100

A total of 456 people left treatment from the start of the trials of heroin prescription treatment up to March 1999. Data on 443 people whose length of treatment varied, is able to be analysed: 27% to 34% have opted for abstinence based treatment, 26% to 45% have chosen prescription methadone treatment.

I. –Therapeutic approaches for different target groups and different phases of their life	*
II. – Treatment with prescription heroin	*
III — Consequences of rejection of the urgent federal ordinance	*
IV — False understandings about heroin prescription treatment	*
V — Earlier voting bearing on drug policy	*
VI — The 4 pillar policy	*
VII — Some facts and figures concerning treatment with prescription heroin	*