We tried an approach of repression and intolerance, treating heroin addicts as criminals, but it simply got us nowhere

Berne public health spokesman

The door opens suddenly and the two people at the head of the line push through.

They look as if they might be collecting unemployment benefit checks or social security payments but they are not. They have come here for a syringe full of heroin.

In the next room, which is incongruously set out like a classroom, 10 heroin addicts are shooting up at tables while doctors look on.

"It's not a cosy atmosphere - it's not meant to be like a coffee house - they shoot up, and they leave," says Dr Christoph Burki, the Director of the Koda heroin prescription scheme in the Swiss capital Berne.

"We don't want them enjoying their euphoria in here - they can do that outside."

Dramatic rethink

Since 1994, Switzerland has been giving hardened drug addicts free heroin on prescription in a bid to stabilise the health of current addicts and to protect the public from the open drug scene.

It was part of a dramatic rethink of the government handling of the drug problem in Switzerland, which by the early 90s had reached epidemic proportions, leaving a country of just seven million with more than 30,000 people addicted to hard drugs.

Patients say the clinic has reduced heroin and other drug use

"We had to do something," says Ueli Loecher from the Department of Public Health in Berne.

"We tried an approach of repression and intolerance, treating heroin addicts as criminals, but it simply got us nowhere.

"We had to recognise that these people had a serious health problem."

The scheme is only open to extreme addicts, with mental and physical health problems, and with a history of at least 10 years of hard drug abuse, and several serious previous attempts to come off heroin.

On the open drug scene the scene was terrible - blood everywhere, people injecting in their heads, neck veins and groins - here it's a clean environment

Director Christoph Burki

The scheme got official federal and public approval when the initiative came before two national referendums in 1997 and 1999, and there are now 20 clinics across the country.

"The results were remarkable. Seventy per cent of addicts remained in the treatment programme and went on to methadone programmes or detox programmes and became drug free," says Mr Loecher.

"While in the programme, their health situation improved, physically and mentally, their social integration improved, their criminal activity decreased significantly and overall the outcome was that they could be stabilised, they could hold jobs and they went back into society."

Katarina sits in the waiting room between her two morning injections. She looks at Dr Burki with admiration.

I'm reintegrated into my own life

Programme user

"I've been in this programme for two years now," she says.

"People criticise this programme but look at me. Before, I got my heroin on the street and I couldn�t handle anything.

"Now I have money, because I only have to pay a little for my habit, I have a job as a cook and they've taken my son out of care and allowed him to live with me again. I'm reintegrated into my own life."

Like most of the addicts on the scheme, Katarina has now cut her heroin consumption by half and no longer uses cocaine.

"This is why we are expanding this programme," says Dr Burki.

'Terrible scene'

"At present we have 160 patients but from early 2002, we'll take on a third more again," he says.

"I used to work as a doctor on the open drug scene and there the scene was terrible - blood everywhere, people injecting in their heads, neck veins and groins.

"Here it's a clean, sterile and professional environment. We no longer see infections, no more abscesses, and the HIV and hepatitis rate is down."

Some addicts have been there now seven years already; it's a good way for them to get cheap heroin and it solves nothing

Programme critic Yves Bichsel

There are those who don't share Dr Burki's positive attitude.

Yves Bichsel from the right-wing UDC party would rather see a police crackdown on the drugs problem rather than what he sees as a softly softly approach.

"The figures are poor for those who leave the scheme and become drug free," he says.

"Some addicts have been there now seven years already; it's a good way for them to get cheap heroin and it solves nothing."

It's not easy being addicted to heroin - but with this programme, I am finally controlling my habit

Programme user

David, a patient at the clinic for two-and-a-half years smiles ruefully when this is suggested to him.

"On the street I was the lowest you can get. I took the dregs from other people's syringes.

"I had holes and sores all over my body and I spent all day and all night searching for drugs. Now I have a job and a house like normal people.

"This is not an easy programme; it's not easy being addicted to heroin - but with this programme, I am finally controlling my habit."