Over the past two decades many have come to favour tackling heroin abuse through “harm reduction” policies, rather than tougher policing. Many governments have decriminalised personal use and provided free therapy programmes, using drugs such as methadone and buprenorphine that block heroin’s high. Two other proven ways to reduce harm, however, are more politically controversial: setting up safe sites where users can inject while monitored by health-care staff, and—for registered addicts who cannot or will not comply with treatment regimes—providing heroin itself free.
Switzerland and the Netherlands pioneered this “Heroin Assisted Treatment” (HAT) approach in the 1990s, and both countries later adopted it as national policy. HAT trials have also been run in Spain, Britain, Germany and Canada. The evidence suggests that HAT slashes heroin-related deaths and HIV infection, since users are shooting up under medical supervision. It also drastically reduces heroin-related crime, since addicts have no need to steal or sell their bodies to get money for their fix. Some studies find that HAT actually works better than methadone or buprenorphine. Heroin use is falling steadily in both Switzerland and the Netherlands; by the late 2000s the Dutch incidence of new heroin users had fallen close to zero, and the ageing population of addicts from the 1970s and 1980s continues to shrink.