Pictures of drug addicts openly injecting heroin in a Zurich park attracted the world’s attention in the 1980s. Those images still haunt Switzerland today, particularly now that voters are being summoned to consider a new law on drugs. For Otto Schmid, director of the Heroin Substitution Centre, the referendum is of paramount importance: “If it doesn’t pass, it would be a big step backwards – we would be back where we were 20 years ago.”

Amongst other things, the law would make heroin substitution therapy permanent. In a bid to end open-air drug scenes, the government has set up a place where the toughest addicts can inject in clean surroundings. And to make sure it’s clean, the state provides the heroin. Addicts come twice a day, every day. They must take the heroin on the premises, so it can’t be sold on. Sitting side by side, patients inject or swallow the drug.

The state believes if it didn’t offer heroin, the most hard-line addicts would just stay outdoors and out of reach. A heroin consumer gives his account: “On the street I got pneumonia, my hands swelled up with infections from using dirty needles. I still couldn’t give up. But when I got into the heroin programme, I was able to relax because I didn’t have to worry about getting my fix.”

Twelve hundred addicts are currently being treated in this way, trying to wean down the dose. Supporters say it is not a heroine handout, and that most patients have been addicted for a decade before even beginning the programme. “We carried out a study 10 years ago that showed a severe heroin addict costs society about 200 swiss francs a day. When they get into treatment, they cost society about half that,” says René Stam of the Office for Public Health. 

But for many this treatment has turned the state into a drug pusher. And plenty argue that the method is flawed. Jean Henri Dunant, a doctor and member of the opposition, is one of them: “Heroin is the most addictive drug. Giving it to addicts will never make them give up.”

The debate, of course, goes way beyond a matter of costs. It’s about what kind of protection society should guarantee, and how best to help patients combat the scourge of heroin addiction.