They say that it's the best way to reduce the harm the drug does to its users and to society. Paul Cullen reports from Geneva.
Children are playing on the street, the shops are busy and the millionaires' lakeside palaces are just down the road. There is nothing to indicate that this quiet residential road in downtown Geneva is home to a remarkable scheme for giving heroin to drug addicts.
Three times a day, 365 days a year, the addicts come into a centre on the street to get their state-supplied fixes. They enter through a back door to preserve their anonymity, then queue up to inject themselves in a private room in the presence of a nurse.
The heroin they use is pure and strong, and the needles are clean. The drug has been manufactured to the highest standards, not in some Colombian drug factory but in a hospital laboratory in Switzerland.
Addicts are prohibited from bringing in heroin from the street, but if they want to buy more drugs outside that's their business. "They are allowed to use illegal heroin, but invariably they're disappointed with the effect," says Naima Bockstael, a nurse at the centre. "What they get here is better, and it doesn't cost anything."
Once a fortnight they see a doctor; they can also avail of psychiatric and psychological treatment and even legal advice as part of the programme.
A handful are working and combine their drug use with a seemingly normal existence. "They come here in the morning for their fix, take a substitute such as methadone at lunchtime and come back for heroin in the evening," says the director of the centre, Dr Miguel Marset.
The programme can boast one indisputable success: since it started, in 1995, not one participant has died from an overdose. "That's because the heroin is taken on its own and is a pure product," he says.
The patients pay nothing; funding comes from the medical insurance fund, which is universal in Switzerland, as heroin addiction is considered a sickness.
But this is no free-for-all for making heroin available to all comers. The scheme is available only to those with the strongest addictions who haven't responded to other treatments. Participants must also be over 18 and have been shooting up for at least two years. They must have tried at least two other treatments and failed and have specific psychiatric, psychological, medical or legal problems. Most importantly, they must want help.
Perhaps because of these qualifying hoops, the 50 or so addicts on the scheme tend to be older than we are used to in Ireland, although they share the appalling medical problems of all addicts.
Four out of five have psychological problems and one in four is HIV positive (overall, 11 per cent of Swiss addicts have HIV, compared with 1 per cent in the general population). The average age is almost 39, and three-quarters are male.
The addicts in the scheme use many drugs - heroin, cocaine, tranquillisers, alcohol and cannabis. But one of the first effects of the scheme is a drop in "parallel consumption", according to Dr Marset. "They stick to heroin and drop the other drugs."
He says the programme has been a big success, with participants committing 80 per cent fewer crimes. In 1997, a study estimated the cost of the scheme at €36 a participant a day, compared with a social cost of €65 a day if the programme didn't exist and the addicts were sourcing their heroin on the streets.
"Pierre" is one of the centre's oldest clients. A 52-year-old Swiss-German, he has been coming here to feed his habit since 1995.
"I was a family man, with a good job at the United Nations and two kids. But I was always a hippy, and in that scene I started using heroin. Like the doctors and the dentists and other respectable users I had my sources, but I could never get enough. Then my health went into decline, and I lost my job."
Pierre tried to get treatment, unsuccessfully. "The bad things really started happening when I went on methadone, and my body got used to a daily dose of opiates. Now I would die if you were to cut me off from my heroin."
The scheme is a natural development of Switzerland's traditionally liberal drugs policy. Methadone has been distributed here since the mid-1970s, and drug use is tolerated in the big cities.
When I lived in Zurich in the 1980s, I made a habit of taking horrified visitors to the Platzspitz, a small area of riverside land behind the main train station that functioned as an open drugs market. Here you could buy and sell virtually every type of illegal drug, undisturbed by the police, then consume your purchases on the spot.
By the early 1990s, however, the scene had turned ugly, with an increasing number of drug-related murders and more than 400 overdoses a year. Confronted with the results of their liberalism, the Swiss opted for a balanced approach. While the police cracked down on Platzspitz, which today is as placid as it was in the days when James Joyce posed there for photographs, the authorities put a new emphasis on treatment for addicts. The number of overdose deaths halved.
For all its claimed success, Dr Marset's scheme is only a drop in the ocean in relation to Switzerland's overall drug problem. Its 50 places pale beside Geneva's 3,000 addicts - and the 30,000 of Switzerland as a whole. Zurich and Basle run similar schemes, but local resistance has impeded the spread of the programme to other areas.
"Of course there is opposition. Everyone agrees we need to take action to reduce the problems associated with drug addiction, but not everyone agrees on how to do this," says Dr Marset.
The scheme has had little success in weaning addicts off their habit; a quarter of those on the programme have been attending since it started. Demand for places has also been surprisingly low.
"Some addicts think it's a trap and that the police are involved," says Pierre. "Others just can't take a regular lifestyle."
Other countries have been slow to follow the Swiss example; so far, the Netherlands is the only EU state to try a similar approach. Yet Dr Marset is hopeful the scheme will expand to other Swiss towns and other countries.
"It's not that Switzerland's drug problem is any worse than other countries'," he says. "It's just that this country has looked for - and found - new ways of dealing with the issue."
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Could it work here?
The idea of handing out heroin to Ireland's drug addicts might stick in the craw of many, but it has strong support in the drug-treatment community.
"It should be seen as one more tool in the tool kit to treat addiction," says Tony Geoghegan of the Merchant's Quay Ireland centre, in Dublin. "If people are fixated on one particular drug and substitutes are not working, then why not make it available to reduce the harm involved in heroin use?"
Geoghegan says Ireland is in a minority in relying on methadone as the sole alternative opiate for weaning addicts off heroin. But he admits that doling out heroin to addicts, even in a medical setting, is probably "a bridge too far" for Irish society at the moment. The liberalisation of alcohol licensing laws in recent years has had mixed results at best, he points out.
Tommy Larkin of UISCE, a group representing drug users in Dublin's north inner city, also supports the prescription of heroin. "There are people who just use heroin and don't want to use methadone, because it has its own problems. I see no reason why heroin shouldn't be made available on prescription." Not only is methadone more addictive than heroin, but there is plenty of evidence to show that many of those getting methadone are continuing to take heroin, he says.
Two years ago, Merchant's Quay Ireland drew up an application for a research programme similar to those in Switzerland and the Netherlands, but it failed to win approval even locally.
Yet with the number of addicts continuing to increase, the associated social and criminal problems greater than ever and continuing disquiet about the use of methadone as a substitute, the pressure to find new ways of treating heroin addiction will remain.
Although official circles are slow to take a stance - several declined to be quoted for this article - that may change. The State's drug advisory committee has commissioned a review of the literature on harm-reduction measures in place internationally. It is expected to deal with the Swiss and Dutch programmes to prescribe heroin.