How the government can steal your stuff: 6 questions about civil asset forfeiture answered

https://kiowacountypress.net/content/how-government-can-steal-your-stuff-6-questions-about-civil-asset-forfeiture-answered

Editor’s note: Should someone wearing a badge have the power to relieve a suspected drug dealer of his Maserati on the spot without giving him an opportunity to flee or liquidate and launder his assets? Known as civil asset forfeiture, this practice might sound like a wise policy.

But lawmakers on both sides of the aisle in Congress and the states are challenging the Trump administration’s embrace of the arrangement, which strips billions of dollars a year from Americans – who often have not been charged with a crime. Law professor and criminal justice expert Nora V. Demleitner explains how this procedure works and why it irks conservatives and progressives alike.

1. What is civil asset forfeiture?

Civil asset forfeiture laws let authorities, such as federal marshals or local sheriffs, seize property – cash, a house, a car, a cellphone – that they suspect is involved in criminal activity. Seizures run the gamut from 12 cans of peas to multi-million-dollar yachts.

The federal government confiscated assets worth a total of about US$28 billion during the decade ending in 2016, Justice Department data indicate.

In contrast to criminal forfeiture, which requires that the property owner be convicted of a crime beforehand, the civil variety doesn’t require that the suspect be charged with breaking the law.

Three Justice Department agencies – the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF), the Drug Enforcement Administration (DEA) and Federal Bureau of Investigation (FBI) – do most of this confiscating. Most states also permit local prosecutors to take personal property from people who haven’t been charged with a crime. However, some states have begun to limit that practice.

Even when there are restrictions on when and how local and state authorities can seize property, they can circumvent those limits if the federal government “adopts” the impounded assets.

For a federal agency to do so requires the alleged misconduct to violate federal law. Local agencies get up to 80% of the shared proceeds back, with the federal agency keeping the rest. The divvying-up is known officially as “equitable sharing.” Crime victims may also get a cut from the proceeds of civil forfeiture.

2. Can people get their stuff back?

Technically, the government must demonstrate that the property has something to do with a crime. In reality, property owners in most states must prove that they legally acquired their confiscated belongings to get them returned. This means the burden is on the owners to dispute these seizures in court. Court challenges tend to arise only when something of great value, like a house, is at stake.

Unless an owner challenges a seizure and effectively proves his innocence in court, the agency that took the property is free to keep the proceeds once the assets are liquidated.

Many low-income people don’t use bank accounts or credit cards. They carry cash instead. If they lose their life savings at a traffic stop, they can’t afford to hire a lawyer to dispute the seizure, the Center for American Progress – a liberal think tank – has observed.

And disputing civil forfeitures is hard everywhere. Some states require a cash bond; others add a penalty payment should the owner lose. The process is expensive, time-consuming and lengthy, deterring even innocent owners.

There’s no comprehensive data regarding how many people get their stuff back. But over the 10 years ending in September 2016, about 8% of all property owners who had cash seized from them by the DEA had it returned, according to a report from the Justice Department’s inspector general.

3. Who opposes the practice?

Many conservatives and progressives dislike civil asset forfeiture. Politicians on the left and right have voiced concerns about the incentives this practice gives law enforcement to abuse its authority.

Critics across the political spectrum also question whether different aspects of civil asset forfeiture violate the Fifth Amendment, which says the government can’t deprive anyone of “life, liberty, or property, without due process of law” or is unconstitutional for other reasons.

Until now, the Supreme Court and lower courts, however, have consistently upheld civil asset forfeitures when ruling on challenges launched under the Fifth Amendment. The same goes for challenges under the Eighth Amendment, which bars “excessive fines” and “cruel and unusual punishments,” and the 14th Amendment, which forbids depriving “any person of life, liberty, or property, without due process of law.”

In 2019, the Supreme Court unanimously found for the first time that these constitutional protections against excessive fines apply not just to the federal authorities but to the states as well.

Some concerns resonate more strongly for different ideological camps. Conservatives object mostly about how this impounding undermines property rights.

Liberals are outraged that the poor and communities of color tend to be disproportionately targeted, often causing great hardship to people accused of minor wrongdoing.

Another common critique: The practice encourages overpolicing intended to pad police budgets or accommodate tax cuts. Revenue from civil asset forfeitures can amount to a substantial percentage of local police budgets, according to a Drug Policy Alliance study of this practice in California. This kind of policing can undermine police-community relations.

The Justice Department‘s guidelines state that forfeitures “punish and deter criminal activity by depriving criminals of property used in or acquired through illegal activities.”

However, the Inspector General’s office noted “without evaluating data more systemically, it is impossible for the Department to determine … whether seizures benefit law enforcement efforts, such as advancing criminal investigations and deterring future criminal activity.”

4. What is the scale of this confiscation?

The federal revenue raised through this practice, which emerged in the 1970s, mushroomed from $94 million in 1986 to a high of $4.5 billion in 2014, according to the Justice Department.

The Justice Department says it returned more than $4 billion in forfeited funds to crime victims between 2000 and 2016, while handing state and local law enforcement entities at least $6 billion through “equitable sharing.”

The scale of seizures on the state and local level is less clear.

5. What happened during the Obama and Trump administrations?

Under the leadership of Attorney General Eric Holder, the Obama-era Justice Department determined that civil asset forfeiture was more about making money than public safety. It then changed the guidelines for asset adoption.

Beginning in 2015, joint state-federal task forces could continue to share forfeiture proceeds but state agencies were no longer permitted to ask the federal government to forfeit property they had taken on their own.

“I love that program,” Attorney General Jeff Sessions said in 2017. “We had so much fun doing that, taking drug dealers’ money and passing it out to people trying to put drug dealers in jail. What’s wrong with that?”

Attorney General William Barr, Sessions’ successor in the Trump administration, has also defended this policy.

6. Congress and the states

When Sessions changed the policy, legislative changes seemed possible. Senate Judiciary Committee Chairman Chuck Grassley sent Sessions a memo about how the federal funds obtained from seizures were wasted and misused. In some cases, Grassley wrote, the government provided “misleading details about some of these expenditures.”

The House of Representatives voted in 2017 for an amendment that would restrict civil asset forfeiture adoption.

The House also approved a bipartisan measure restricting civil forfeiture on June 20, 2019. This one goes further though and would substantially curtail the federal government’s powers.

State governments have also tried to discourage this kind of confiscation. New Mexico, Nebraska and North Carolina have banned civil forfeiture. Michigan has made it easier to challenge these seizures. California limited equitable sharing, and other states have increased the burden of proof the government must meet. But in many states, investigative reporting has shown that innocent owners continue to lose their property.

In a Georgia Law Review article, I gave examples of other ways to keep police departments and municipalities funded, such as increasing fines and fees.

Unless the police pursue some alternatives, funding woes will continue to contribute to abusive policing practices that fall most heavily on those who can the least afford them: the poor and communities of color.

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Request for Information: Ensuring Patient Access and Effective Drug Enforcement

https://www.federalregister.gov/documents/2019/07/26/2019-15952/request-for-information-ensuring-patient-access-and-effective-drug-enforcement

This Request for Information (RFI) seeks comment on ensuring Start Printed Page 36112legitimate access to controlled substances, including opioids, while also preventing diversion and abuse, as well as how federal, state, local, and tribal entities can collaborate to address these issues.

DATES:

Comments must be received at one of the addresses provided below, no later than 5 p.m. on August 26, 2019.

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Physician Stories From the Front LInes

https://physicianbalint.home.blog/

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Massachusetts AG probing comp pharmacy over opioid dispensing

https://www.businessinsurance.com/article/20190726/NEWS08/912329833/Massachusetts-AG-probing-comp-pharmacy-over-opioid-dispensing

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https://www.wcpo.com/conquering-addiction/dea-agent-says-recent-indictments-should-be-warning-to-drug-distributors-pharmacists

CINCINNATI — Two top execs from a pharmaceutical wholesaler indicted this month. Two pharmacists indicted.

A federal agent tells WCPO that others passing prescription drugs and adding to the opioid crisis should take it as warning.

“We’re going to come after you. If we can do it, we’re going to do it,” said Mauricio Jimenez, DEA assistant special agent in charge.

Jimenez said the Drug Enforcement Administration is cracking down on pharmaceuticals distributors and pharmacists it believes are breaking the law, like those accused in the Miami-Luken case. The former Springboro wholesaler, two executives and two West Virginia pharmacists were charged in a conspiracy to flood rural Appalachia with millions and millions of painkiller pills, according to the U.S. Attorney’s Office.

“You’re breaking the law, you’re killing people, you’re putting this out on the street, we’re going to do everything we can to get you,” said Jimenez.

Jimenez said these investigations can take years, but they are happening. The DEA looks at the size of companies, ratio of pills to population, how payment is accepted and more.

“When it comes to these distributors … that are doing this to gain as much money as they can, and not caring about the public, that’s a significant issue that we all must face,” Jimenez said.

Speaking for pharmacists, Mimi Hart, owner of Hart Pharmacy in West Price Hill, said most take great care to avoid overfilling. She said every prescription comes with a checklist and pharmacists look for red flags before deciding to fill it.

“If it’s from a doctor out of the area, if it’s from a very large quantity,” Hart said for example.

“I don’t know a pharmacist that hasn’t said, ‘No, I cannot fill this prescription,’ that hasn’t called the doctor and said, ‘We’re really worried about this.’ “

Today’s opioid crisis makes that scrutiny even more important. But it’s not always cut and dried, Hart said.

“You know it’s a high dose, but it’s not necessarily a high dose for this patient,” Hart said.

“Everybody is trying really hard to make sure that people are getting the pain medication that they need, that they’re not getting too much, that it’s not diverted,” Hart said.

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Senator Portman Presumes To Know How Many Days Of Pain Relief All 328 Million Americans Need

https://www.cato.org/blog/senator-portman-presumes-know-how-many-days-pain-relief-all-328-million-americans-need

With clear evidence that restricting the number of prescriptions increased the death rate by driving non-medical users to heroin and fentanyl, the last thing one wants to hear about is a politician planning to double down on this deadly policy by calling for further prescription limits for patients in pain.

Yet Senator Robert Portman (R-OH) is proposing legislation that would impose a national 3-day limit on opioid prescriptions following surgeries. He will be kind enough to allow exceptions for people dealing with cancer, chronic pain, and “other serious matters”—whatever that means.

Government data show there is no correlation between the number of opioids prescribed and their non-medical use or the development of opioid use disorder. Overdose rates skyrocketed during the last 10 years while high-dose opioid prescriptions dropped more than 58 percent and total volume of dispensed opioids dropped more than 29 percent. Seventy-five percent of opioid-related deaths in 2017 involved fentanyl and heroin, and fewer than 10 percent involved prescription pain pills without also involving heroin, fentanyl, cocaine, tranquilizers, or alcohol. 

The senator has determined that, “After the second or third [postoperative] day, other pain medications work just as effective (sic).” In my more than 35 years as a practicing general surgeon, I usually find that my patients recovering from major surgery require prescription opioids to control their pain for more than 2 or 3 days. It is bad enough that many states have imposed 5 or 7 day limits on opioid prescriptions, forcing many patients in severe pain to make multiple trips to the doctors office for refills. Imposing a national 3-day limit lacks an understanding of the science. It would be an unfounded and callous government intrusion into the practice of medicine.

Senator Portman, like so many other politicians untrained in medicine or pharmacology, is guilty of misinterpreting and misapplying the guidelines on opioid prescribing published in 2016 by the Centers for Disease Control and Prevention. He must still believe that today’s non-medical users are yesterday’s pain patients, even though, as mentioned above, there is no evidence of any correlation between the two. 

He also seems to think there is a high risk of addiction in patients prescribed opioids for acute post-surgical pain. Yet a well-publicized study in the medical journal BMJ by researchers at Harvard and Johns Hopkins looked at 568,000 opioid “naïve” patients in the Aetna health insurance data base given prescription opioids for acute postoperative pain over the period of 2008-2016. The researchers found the “total misuse rate,” i.e., rate of all opioid misuse diagnoses among the 568,000 patients prescribed the opioids, was 0.6 percent.

Senator Portman told Ohio reporters, “After day four, five or six, the chances of becoming addicted are higher.” Maybe he is reacting to the statement by the researchers in the BMJ report that each refill and additional week of opioid use was “associated with an adjusted increase in the rate of misuse of 44%.” But a deeper look at their data shows the incidence of opioid misuse rose from 145 cases per 100,000 person years, or 0.15 percent per year, in patients who had no refills, to 293 cases per 100,000 person years, or 0.29 percent per year, for persons who had one refill. Indeed, that is nearly double. But if you nearly double a very low number, you still get a low number.

The fact is the overdose rate from the non-medical use of licit and illicit drugs has been on a steady exponential increase since the 1970s and shows no signs of slowing down. The only thing that has changed over the years is the particular drug in popular use at any given time. The reasons behind this are complex and multifactorial, and likely sociocultural and psychosocial. In the early part of this century the popular drugs for non-medical users were diverted prescription opioids. Next it became heroin. For the past several years it has been heroin and fentanyl. Methamphetamine related deaths are now surging to all-time high levels, and preliminary estimates from the CDC place the number of meth-related deaths at nearly 13,000 in 2018—eclipsing the number for prescription opioid-involved deaths.

Senator Portman is two or three drugs behind in his prosecution of the drug war. 

To bring the death rate down, Senator Portman should learn a lesson from his home state of Ohio, where a recent embrace of harm reduction measures—expanding needle exchange programs, distributing the overdose antidote naloxone, and increasing access to Medication Assisted Treatment—has led to a 23.3 percent drop in overdose deaths in 2018 according preliminary CDC data. Harm reduction is a proven strategy for saving lives.

If Senator Portman wishes to craft legislation that can truly save lives, he should propose a repeal of the federal “Crack House Statute.” This law stands in the way of many of the country’s largest cities that wish to establish Safe Injection Facilities, which are preventing overdoses and saving lives in more than 120 cities throughout Europe, Canada, and Australia.

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Pharmacy error left golf ball-sized hole in Leander woman’s arm

https://www.kvue.com/article/news/investigations/defenders/pharmacy-error-left-golf-ball-sized-hole-in-leander-womans-arm/269-03e58e22-40ca-4dfc-9888-ec0548484433

Josselyn Stevens called the KVUE Defenders after the medicine she received left her with a hole in her arm.

AUSTIN, Texas — Another pharmacy failure has a Leander woman wondering how long it will take the state and the federal government to investigate.

“I saw your previous story and it hit home that people don’t deserve to be hurt,” Josselyn Stevens said. “People deserve to be heard. And I don’t want anyone else hurt.”

Compounding pharmacies tailor medicine for patients. They’re needed for people who can’t take a standard manufactured drug.

There’s no FDA testing and approval for each tailored prescription. So, when things go wrong, patients can be scarred for life.

Now, Stevens’ health requires frequent visits to a doctor.

“I’d be like, ‘Where am I? What am I doing?’” Josselyn said.

She has a genetic disorder causing seizures. The seizures stopped in 2014 when doctors prescribed a specific B-12 shot, tailored at a compounding pharmacy. She can count more than 250 rounds over the years.

Everything was going fine until last month.

WARNING: This gallery contains graphic images some might find disturbing.

Josselyn Stevens – pharmacy errors

“It was excruciating. It was burning,” Josselyn said. “I asked if something was trickling down my arm.”

Nothing was. 

She said headaches came shortly after. Then dizziness and disorientation.

“I looked into the mirror and was like, ‘Whoa,’” she said.

The shot burned her skin and was going deeper.

“The dermatologist said it was a chemical burn and it had completely necrosed, and that I needed to go to the emergency room,” she said.

Lab records show the B-12 had a pH level of 13.2, similar to the pH of bleach.

Josselyn Stevens Lawsuit | Damages | Negligence

Velva L. Price District Clerk Travis County D-1-GN-19-004106 D-1-GN-19-004106 CAUSE NO. _______________ Ruben Tamez TREVOR STEVENS § §V. § TRAVIS COUNTY, TEXAS §STONEGATE PHARMACY, LP., §RENE GARZA, PHARM.D. and § 200THANDRES RUIZ, PHARM.D. § ____ JUDICIAL DISTRICT PLAINTIFFS’ PETITION CONTAINING REQUESTS FOR DISCLOSURE PHARM.

Scribd

A surgeon performed a debridement to remove the damaged skin.

Josselyn also has Stage 3 breast cancer. So going under anesthesia for surgery for the chemical burn could contaminate her central line needed for receiving chemotherapy drugs – an infection could kill her.

“So, I did the procedure awake in the surgeon’s office,” Josselyn said.

The chemo rounds continue, and so do the debridement sessions.

“It was devastating,” she said. “It was devastating to have another hurdle to have to overcome. It’s devasting to worry.”

RELATED: Pure tissue repair: A hernia mesh alternative

When moms go through this much pain, the family feels it, too.

“I can’t even pump soap without it hurting,” Josselyn said.

“Having three kids running around the house, bumping into everything, bumping into her,” said her husband, Trevor.

“Bumping into me is hard,” Josselyn added.

Josselyn’s specialized B-12 came from Stonegate Pharmacy, the same pharmacy the KVUE Defenders told you about in May when a specially mixed thyroid medicine nearly killed Lorena Lopez-Gonzalez. Records show it was 54,000% percent higher than her prescribed dosage.

RELATED: 54,000% higher: Austin woman almost dies after pharmacy’s dosage mistake

“It’s a miracle that I did not die,” Lorena said in May.

Last year, the Texas State Board of Pharmacy fined Stonegate for several mistakes from 2014 through 2016. The board required the pharmacy to implement a corrective action plan and put Stonegate on probation for five years.

“I think just one person, one person with an injury to my extent should at least call for a recall,” Josselyn said.

The pharmacy board director, Allison Benz, said it’s mandatory.

“We require pharmacies to institute recalls on their compounded medications if they become aware of a problem with one of their products,” Benz said.

The KVUE Defenders tried asking Stonegate if they recalled the B-12. They quickly referred KVUE to their attorney, who is out of the country until August.

“My purpose for contacting you was to help people, even if there is just one person,” Josselyn said.

RELATED: Critical care doctor warns of vibrio symptoms and who’s at risk

Josselyn filed complaints with the FDA and the State Board of Pharmacy.

As evidenced by Lorena’s case, it can take years for the state to investigate and take enforcement action.

“I couldn’t believe it,” attorney Sean Breen said.

Breen represents Josselyn in a lawsuit filed last week against Stonegate claiming negligence.

“They’re not going to wait around for the pharmacy board for two years,” Breen said. “They’re not going to wait around for the FDA. They’re going to exercise their rights in court, to have 12 people in Travis County say enough is enough.”

RELATED: Medical Device Dangers: A KVUE Special Broadcast

Josselyn has two more rounds of chemo left and eight more wound-scraping visits.

“Everything that I’ve had to go through over the last eight months has been devastating,” she said. “It just felt like the odds were against me.”

To top it all off, Josselyn had her gall bladder removed a month before her mastectomy. That’s three different surgeries this year.

The pharmacy board wants compounding pharmacies inspected every two years. 

The legislature recently provided money to hire more people and bring the total to 14 compliance inspectors for the entire state – eight field investigators.

If you have a complaint about a pharmacy or medication, click here for the Texas State Board of Pharmacy and click here for the FDA.a

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Two House members  (Foster& Kelly) have added an amendment to HR 2470 #20 amendment – which would assign a “unique number” to every person getting chronic pain meds

Two Senate members ( Manchin & Braun) has a bill S. 2089: FDA Opioid Labeling Accuracy Act  that would prohibit the FDA from labeling any opiate for long term pain use – with a few exceptions – until studies have been done to “prove” that they work for treating long term pain.   I guess the  couple of millenium that they have been used to treat pain in insufficient ?

They claim that global warning is caused by an excessive amount of CO2 and our increasing national debt is caused by the cost of supporting our Social Security, Medicare & Medicaid programs. A part of the solution to this problem can be brought by using the carbon footprint calculator which helps in calculating the consistency of damage to the environment over millions of years. 

The proposed House bill – as I remember – has been tried before by a dictator of a country that in the late 1930’s – early 1940’s – assigned a “unique number” to a subset of the country’s population.  In fact they wanted the unique number to be “permanent” so they tattooed them to the inside of their forearms…   As I remember, that numbering system did not work out so well and a lot of people died

The Senate bill would deny most chronic pain pts long term pain management, and we all know that chronic pain pts that get denied adequate pain management… some end up committing suicide and others will end of dying of “natural causes” because under/untreated pain will cause their other co-morbidity issues to become life threatening. Maybe even a premature… see chart below

How would all of this help solve global warning and our national debt problem ?  If these proposed bills make it to law and cause more chronic painers to commit suicide or die prematurely… there would be less CO2 being generated … since every time that one of us exhales.. we exhale CO2.

Most of the chronic painers consume a lot of healthcare dollars in treating their numerous medical issues and many are on Medicare disability or Medicaid or maybe both..

Many talk about a “covert genocide” and perhaps there is a “end game” to help address global warming and our growing national debt.

Congress doesn’t seem to be capable of directly dealing with these two issues… so … maybe there is a hidden agenda here… because if they tried to create a direct solution… probably HALF of the country would not be happy… and maybe many in Congress would not get re-elected ?

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Switzerland couldn’t stop drug users. So it started supporting them.

www.northcarolinahealthnews.org/2019/01/21/switzerland-couldnt-stop-drug-users-so-it-started-supporting-them/

By Taylor Knopf

ZURICH and GENEVA, Switzerland — Today, Platzspitz Park serves as a peaceful respite for those meandering along the Limmat River and past the Swiss National Museum. But it’s best known by the nickname “Needle Park.”

That’s because in the 1980s the park was hijacked by thousands of heroin users and dealers. The space, despite being in the heart of downtown Zurich, became one of the most famous examples of Switzerland’s “open drug” scenes.

Local police were tired of trying to control and disperse large groups of users, so Needle Park became one of the spots law enforcement left alone.

Rates of HIV infection soared from the sharing of needles. And the number of drug overdose deaths climbed.

People were injecting and dying outside one of the most beautiful hotels in Zurich. The same thing happened near political buildings in Bern, the nation’s capital, said Rita Annoni Manghi, director of the opioid substitution and heroin-assisted treatment programs at Hôpitaux Universitaires Genève.

It was the equivalent of people dying on the White House lawn, she said.

“So you are obliged to see the problem,” she said. “And Switzerland is not so modern, but it’s very pragmatic. And Swiss politics is very pragmatic.”

The rise in HIV infections, drug overdose deaths and the public nature of the drug problem led the Swiss to make major changes in how they approached illegal drugs and treated people who use drugs.

And in 1994, Switzerland went on to pass one of the most progressive and controversial drug policies in the world, which included the dispensing of heroin.

“Switzerland is no one’s idea of a leftist country,” Joanne Csete wrote in her paper “From the Mountaintops: What the World Can Learn from Drug Policy Change in Switzerland.”

“Its famous tradition of protecting bank secrets, its having granted women the right to vote only in the 1970s, and its referendum-based rejections of minarets on mosques and decriminalization of cannabis illustrate its quirky conservatism,” Csete wrote.

But the Swiss are pragmatic. Instead of endlessly fighting drugs, they took a new approach and began supporting drug users through new treatment options.

The majority of Swiss citizens supported the measures, despite some pushback inside and outside the country.

The nation cut its drug overdose deaths significantly. HIV and Hepatitis C infection rates dropped. And crime rates also dropped.

The Four Pillars

To address the Swiss drug problem, elected officials, community members, law enforcement and medical experts all worked together to create the “four pillars” drug policy.

Those four pillars of the Swiss law are harm reduction, treatment, prevention and repression (or law enforcement).

“The goal was not to fight drugs anymore. It’s completely ridiculous to fight drugs,” said Jean-Félix Savary, secretary general of the Romand Group of Addiction Studies in Geneva. “We came to this conclusion and decided to change.”

“It was a big revolution. We don’t try to ask people not to take drugs, but take care of problems generated by the situations around people being addicted to drugs.”

The policies became as much about public order as public health, Savary said.

There was some resistance among some Swiss civil groups. Their push ultimately forced a national referendum in 1997 challenging the four pillars policy. But 70 percent of Swiss citizens voted in favor of the law. The four pillars have withstood other challenges as well, as the majority of Swiss voters continue to support it.

The multi-pronged approach included some controversial measures — such as legalized drug consumption rooms and heroin-assisted treatment facilities — but ultimately, the statistics show it has been successful.

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Over the past two decades, the number of opioid-related deaths in Switzerland has decreased by 64 percent.

The number of new HIV infections also dropped significantly. In 1986, more than 3,000 people tested positive for HIV in Switzerland. In 2017, there were fewer than 500 new positive tests in a country of 8.4 million.

Switzerland began mandatory Hepatitis C reporting in 1988. The number of reported cases peaked between 1999 and 2002, declining since then.

Harm reduction

Harm reduction strategies aim to lessen the damage caused to a person by their use of drugs. Needles exchange programs fall under this category, as do legalized drug consumption rooms.

Offering drug users clean needles and other supplies reduces their use of dirty needles, therefore reducing the spread of HIV and Hepatitis C infections.Drug consumption rooms go one step further by providing users with a safe place to use under medical supervision, which reduces the chance of an overdose.

(What’s a drug consumption room like? More on that later in our series.)

Swiss drug experts said the public also benefits: passersby no longer see people injecting in the streets or come in contact with many used syringes.

Harm reduction staff workers make a point not to judge people who come through their doors. And many build relationships with frequent visitors. Resources are available to drug users at these facilities as well to connect them to anything they might need, from a place to sleep, eat, do laundry, or find addiction treatment.

The Swiss are also very deliberate when it comes to placing their drug consumption rooms.

For example, in Geneva, a lot of people gathered and injected near the main train station. So now, around the corner, a drug consumption room is housed in a modern green building that stands out among the backdrop of the traditional Swiss architecture.

Lowering barriers to treatment

“The goal in this field is to get as many users as possible into treatment,” said Thilo Beck, addiction psychiatrist and medical director of the heroin-assisted treatment program in Zurich.

He said that 75 percent of active users in Switzerland are in treatment on a given day, and about 95 percent have been in treatment at some point.

This is medication-assisted treatment, using methadone or buprenorphine. It also includes slow-release morphine or heroin, which aren’t used to treat people with substance use disorder in the United States.

“Treatment is available and accessible,” Beck said. “I think that’s how it should be in every country.”

There are circumstances in Switzerland that make treatment so accessible. First, the country has universal health care, so everyone has health insurance.

The four pillars law also expanded opioid substitution therapy (or medication-assisted treatment) and lowered the threshold for entry. Someone can walk into a clinic for the first time and start treatment 20 minutes later, Beck said.

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Before the 1990s, this type of treatment was viewed as the first step toward abstinence. Beck said that people were supposed to stay on the treatment for six months to stabilize them, then taper off and stop.

“But this was not happening. Some people might do that, but the majority will not,” he said. “What we learned is you have to be pragmatic and take the problems as they are and think of the most feasible solution.

“It doesn’t help to think of goals that are not achievable.”

People in drug treatment programs no longer need to visit a treatment center every day to receive methadone, buprenorphine or morphine. Stable patients receive take-home doses. Physicians can also write prescriptions for these same treatments. And there’s no expectation of abstinence from street drugs and no mandatory drug-screening tests.

“By offering opioid substitution therapy almost unconditionally to virtually anyone willing to change their consumption from heroin to another product, the health care system became a viable competitor among those supplying people addicted to opioids in Switzerland,” wrote Christian Schneider, a drug analyst who works at the Swiss Federal Office of Police.

The treatments are safer than street drugs because the consumer knows exactly what’s in it. Switzerland doesn’t have the same fentanyl problem as the United States, but there are other unwanted substances in their street drugs. Drug check sites help with this problem. These are places a user can take their drug to be checked, and it’s given back to them with a list of what is inside it.

And because a person in treatment is spending less time and money finding and buying drugs, they can focus on other things in their life, such as housing, work or family.

“Prescribed in a way tailored to fit the needs of consumers, opioid substitution therapy not only offered a much safer and much cheaper substitute but also ensured availability and access to products in a way that street dealers could never match,” Schneider concluded.

Law enforcement

The role of law enforcement changed under the four pillars approach. As more and more users went into treatment, the demand for opioids on the black market fell, as did the purity of the products.

The purity of heroin taken by Swiss police over the last decade or so is poor, averaging between 15 and 20 percent purity. The purity and price were much higher before the four pillars law.

The police are focusing less on the users and more on big time dealers.

“You have to help the consumer and fight the criminal,” Manghi said. “And the consumer may deal a little, but they are not organized enough to do high-level crime.”

Savary, a Swiss drug and harm reduction expert, explained that getting law enforcement support was essential to gaining public support for the four pillars law. From what Savary has seen, one supportive police officer has more influence than 100 medical experts.

The Swiss are prosecuting fewer opioid-related crimes. In 1993, the country had about 20,000 cases a year. Today, the Swiss average about 5,000 opioid-related cases annually.

Prior to the four pillars law, house break-ins were common in Switzerland, Savary said. After the law was adopted, there was a huge drop in burglaries.

“We reduced theft by 98 percent. We never had a security figure like this,” he said, referring to crime statistics. “With health measures, you can have a very big security impact… You can do both. It’s cheap and effective. It sounds like a miracle, but you can do it.”

Coming next: Switzerland fights heroin with heroin

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