Switzerland is comprised of 26 states (cantons), each with its own constitution, parliament, government and court system as provided by the Federal Constitution. Switzerland has several ethnic and religious communities. German, French, Italian and Romansh are the four official languages. A majority of the roughly 7 million Swiss citizens speak German. Referenda are an integral part of Swiss democracy. A federal law can be put to a referendum if 50,000 citizens ask for one within 100 days of its publication. Understanding Switzerland’s political structure helps to understand its drug policy. It can be argued that Switzerland has 26 different drug polices, one for each canton and half-canton. This diversity is often overlooked. Likewise, the lessons learned from Swiss drug policy are often taken out of context. Drug war bureaucrats point to the failure of the short-lived “needle park” experiment in Zurich; reform advocates tout the proven benefits of the prescription heroin maintenance trials that replaced it.

The recent history of Switzerland’s drug policy began in the late the 1960s with the increase in psychoactive drug use. The cantons developed a drug policy based on three approaches, namely:

• the repression of drug use and trafficking;
• prevention measures aimed at young people;
• abstinence-based treatment (methadone maintenance, however, was already in use)

During the early 1980s, the HIV-AIDS epidemic hit many countries, including Switzerland. Public and social services were created to help protect injection drug users against HIV and AIDS. Needle exchange programs were set up and users were offered and encouraged to be vaccinated against hepatitis. The Swiss Federal Office of Public Health (SFOPH) supported many of these services and still does, arguing that they help prevent the spread of AIDS. However, the main focuses of Switzerland’s official drug policy remained prevention, therapy and law enforcement.

In the 1990s, Switzerland introduced additional harm reduction measures to reduce the problems associated with drug use and enforcement as part of a new national drug strategy. This new strategy led to the creation of a fourfold approach. The role of the Confederation became more defined. Harm reduction reference materials, scientific data and training for professionals are provided to cantons, cities and private organizations. In 1991 the Swiss government adopted a program of federal measures to reduce the problems related to drug use, currently known as “ProMeDro” and based on the concept of harm reduction. The objectives of the program were as follows:

• to decrease the number of new drug users and to prevent people from becoming drug dependent;
• to help users overcome their addiction (through therapy and social reintegration);
• to improve the living conditions and the health of drug users, to reduce harm and to maintain their social integration.

To achieve these goals, the following measures were introduced:

• primary and secondary prevention measures aimed at young people and awareness campaigns to prevent them from experimenting with drugs;
• patient management and treatment to help users overcome their addiction;
• harm reduction, AIDS prevention and social reintegration measures to help addicts cope with their dependency in the best possible health conditions and to ensure that the door to a drug-free life remains open;
• ongoing training and development programs for professionals (including those working in the areas of sentencing, programs and social services, as well as hospital workers, pharmacists and family doctors) and for people acting as mediators (such as teachers, youth group facilitators, business personnel and parents);
• the development, co-ordination and regular publication of scientific research on drugs;
• the evaluation of projects and measures in the fields of prevention, patient management and treatment to help identify any gaps or shortcomings, but also to pinpoint and highlight any progress achieved;
• the development of new documentation and information services normally provided by the Swiss Confederation; and
• the co-ordination of measures adopted by the Confederation.

These measures mark the beginning of Switzerland’s current drug policy, based on a fourfold approach: prevention, law enforcement, treatment and harm reduction. Among other activities, the Federal Council asked for a study on heroin assisted treatment for chronic heroin addicts who had failed at other treatment programs. In 1992, the Council passed an order authorizing clinical trials involving the medical prescription of heroin, along with a strict scientific evaluation of the trials. A 1997 evaluation of the trials concluded that:

• heroin assisted treatment for severely dependent heroin addicts improved their physical and/or psychic health, as well as their quality of life (in terms of housing, work and other areas);
• participants’ illegal use of heroin and cocaine decreased;
• the users involved in the program committed fewer crimes (the incidence of theft and property and drug trafficking offences fell sharply).

The Federal Council followed the report’s recommendations, and on March 8, 1999 authorized heroin maintenance treatment, setting objectives, eligibility criteria, administrative measures and providing for such treatment.

Marijuana

The Federal Commission for Drug Issues was tasked with evaluating marijuana law in Switzerland and released the Cannabis Report in 1999. Although technically illegal as a drug, marijuana production (agricultural and private) and distribution in the form of stores specializing in the sale of “hemp” products are found throughout the country. The report pointed out that marijuana cultivation in Switzerland had greatly increased during the 1990s and that most of the crop was destined for the illegal market rather than the legal one (e.g. as a renewable raw material for textile production). According to an investigation in all cantons, hashish was mainly sold on the street while marijuana was being sold more and more through hemp shops as “aromatic pillows.”

Following are some of the conclusions of the Cannabis Report:

• It is considered that the effect of marijuana does not depend only on its composition, dosage or mode of consumption but also on the user’s state of mind, expectations and the atmosphere at the time.
• Acute toxicity of marijuana is generally considered to be rare. A psychotic state may appear after use of high doses of marijuana. Reassurance is often enough to calm the person down.
• The ability to drive a motor vehicle is impaired for two to four hours (maximum eight hours) after using marijuana. Users often over-estimate the effect of marijuana on their ability to drive a motor vehicle and therefore concentrate more intensely and drive more slowly. It was also proven that in 80% of accidents where THC was found in the plasma of the responsible parties, their alcohol level was also positive.
• The “amotivational” syndrome, which entails personality change, neglect of one’s appearance and general disinterest displayed by habitual marijuana users, was never confirmed.
• The use of marijuana may lead to psychological dependence. The tendency towards physical dependence is, however, very low.
• It is advisable to abstain from marijuana, tobacco and alcohol use during pregnancy.
• The human immune system is relatively resistant to the immunosuppressive effects of cannabinoids and research results support the therapeutic use of delta 9 THC in patients whose immune system has already been weakened by other diseases (AIDS, cancer).

The Federal Commission noted that the drug policies of the different cantons varied with respect to minor offenses of marijuana dealing and use. The general trend in the courts, however, was to soften penalties involving personal use. In 10 of the 26 cantons police had adopted a differentiated practice, in that marijuana users were tolerated as opposed to users of other illegal substances. Following detailed consideration of the different options, the Federal Commission unanimously recommended the elaboration of a model which not only removes the prohibition of consumption and possession but also makes it possible for marijuana to be purchased lawfully. This model was approved by Swiss Senate in December 2001, without opposition. Approval by the House of Representatives is pending. A majority of Swiss citizens support ending marijuana prohibition. Should the issue be put to a national referendum it would likely pass.