05/29/19 Christoph Buerki

Cultural Baggage Radio Show
Christoph Buerki

Interview with Dr. Christoph Buerki the designer of the Swiss Heroin injection program that since 1993 has allowed for more than 27,000,000 injections of pure Heroin with zero overdose deaths.

Audio file


MAY 29, 2019


DEAN BECKER: I am Dean Becker, your host. Our goal for this program is to expose the fraud, misdirection, and the liars whose support for drug war empowers our terrorist enemies, enriches barbarous cartels, and gives reason for existence to tens of thousands of violent US gangs who profit by selling contaminated drugs to our children. This is Cultural Baggage.

Hello, my friends, I am Dean Becker, the Reverend Most High. This is Cultural Baggage, and I think it's very important to recap what I learned last year in Switzerland, where they have had twenty-seven million injections of pure heroin with zero overdose deaths.

CHRISTOPH BUERKI, MD: Christoph Buerki, I'm a psychiatrist in Bern, and I've been with heroin prescription from the very beginning, which is, if I recall it right, 1993, we started with that. And, I think you should, if we talk about prescribing heroin in Switzerland, we should also mention the time before, before that.


CHRISTOPH BUERKI, MD: Because, there was a very, very big open drug scene here. We'll walk past the park where the drug scene was. We really had an epidemic of heroin overdose, for a small country, six million people, it was extraordinary, some -- up to five hundred persons a year died of heroin overdose.

Now, I know in the US you have a bigger epidemic right now, but, sizewise, it was still very significant.

DEAN BECKER: And, approximate population of Switzerland at that time?


DEAN BECKER: Six million. Yeah that's --

CHRISTOPH BUERKI, MD: Six and a half million, it was, yeah. Yeah. And so, we just needed to have new ways, and that was one of the new ways. There was different, new ways and initiatives. One was a safe consumption room, that exists also until today in Bern, as well as in many other cities, where people can go consume their own drugs.

DEAN BECKER: Right. With supervision.

CHRISTOPH BUERKI, MD: That they bring with. Under supervision, yeah.

DEAN BECKER: I've been to Insite in Vancouver, which is probably similar.

CHRISTOPH BUERKI, MD: Yeah. Yeah, very much. I visited, like, a week after it was opened, and it's very similar to our injection room.

So, that was really a major initiative from big cities in the mid-'90s to find ways to close down those huge open drug scenes.

DEAN BECKER: Sure. Sure.

CHRISTOPH BUERKI, MD: And, an important element was this -- was the heroin prescription. Of course, we couldn't just do it like that, we needed a legal basis for it, and we did this within a research frame.

So this was a huge, multi-center study, as we call it. It's called PROVE, P-R-O-V-E, where, sort of, we did it under that research -- research umbrella. So, it was --

DEAN BECKER: How large of an undertaking, a project, was that, the PROVE?

CHRISTOPH BUERKI, MD: In the beginning, it was like some 800 patients, and some -- some 16 or 18 centers, all around Switzerland.


CHRISTOPH BUERKI, MD: And, the reason it was important to -- it wasn't a gold standard research in the sense, as you would do it in medical science, for to prove something, like, in the sense of a gold standard where you have two groups --


CHRISTOPH BUERKI, MD: -- that you directly compare with each other.

DEAN BECKER: One placebo group, maybe.

CHRISTOPH BUERKI, MD: Even placebo, which is difficult to prescribe a placebo, if you're heroin dependent you'd immediately realize that it's placebo.

DEAN BECKER: Where's my heroin?

CHRISTOPH BUERKI, MD: Right. So, that sort of methodological -- it's not a flaw, but it's, it can be proved methodologically.

DEAN BECKER: Well, sure. It was the best --

CHRISTOPH BUERKI, MD: At the time --

DEAN BECKER: -- possible, right?

CHRISTOPH BUERKI, MD: At the time, it was what we could do. What we did basically was, we started taking people in. We couldn't take in everyone.


CHRISTOPH BUERKI, MD: We could only take in people who had a certain history of addiction, who had certain -- more than one, several -- several attempts of quitting, with the heroin addiction. Mostly methadone, but also inpatient detox. They'd have to prove, or we would have to prove together with them, that they really tried to stop in other ways.

They needed to have certain social or psychological, somatic complications of their addiction.


CHRISTOPH BUERKI, MD: So, in the end, we -- we could only take them off and -- take them in and get permission if we could prove all those things.

DEAN BECKER: Yes, sir.

CHRISTOPH BUERKI, MD: And, then we -- we started, and you will find -- you will find how it works in detail.

DEAN BECKER: Well, Christoph, what you're saying about, you know, these, the patients, more or less having to prove the need, or the mental framework, that would allow them to go ahead and use the heroin.

Doctor Goulão there in Portugal was talking about, they have the dissuasion committees that try to convince people to quit using drugs, but some people say, no, I'm a heroin user, I will keep using it, and therefore they're allowed to continue, you know, without interference.

CHRISTOPH BUERKI, MD: It's nicely put, the dissuasion committee. Actually this is just part, of course, of everyday -- of our everyday work, it was at the time. And that's, I think, is the most important aspect of heroin prescription.

You treat the patients, of course you give them out heroin, and that's why they come to you. But, it provides a whole opportunity to treat, to talk, to provide social -- social support, housing, finance, and so on, to provide medical support, to provide psychiatric support.

Many of those people have a dual diagnosis, in the psychiatric sense. They have maybe psychosis or depression, or anxiety disorders.

DEAN BECKER: May I ask you a question?


DEAN BECKER: I would surmise, I have no proof of this, but I would surmise that many of these people who use drugs, and wind up on heroin, have suffered a penalty, or ostracized by either law enforcement or family, or whomever, for their drug use, which may lead them even further in that direction. Is there -- ?

CHRISTOPH BUERKI, MD: Of course. Many, many of the people who entered the program had a previous history of -- of court problems, of prison stays, of delinquency of some sort, of course.


CHRISTOPH BUERKI, MD: And that was also one of the findings, one of the most important findings, also, besides, that people simply survive their addiction, another important finding was that rates of criminalization, of delinquent behavior, decreased massively once patients have entered the program.

DEAN BECKER: Now, is that -- I would guestimate a couple of reasons why, one is, they're no longer having to devote time looking for heroin, and perhaps no longer having to scrape up money with which to buy it.

CHRISTOPH BUERKI, MD: Of course. Of course, yeah. That's a very important thing, to have a structure during the day.

They get up and they go to bed, at some time, two times when they need to appear in the distribution center, in the clinic, and they get their heroin, and they don't need to run around, they don't need to prostitute themselves, or rob old ladies of their handbags, or do worse things, or, by the way, deal with drugs. They don't need to do that, as well.


CHRISTOPH BUERKI, MD: So, that's a massive, massive improvement over the life of an addict before he or she enters a program.

DEAN BECKER: Hi, this is Dean Becker, I wanted to remind you, you're listening to Cultural Baggage on Pacifica Radio and the Drug Truth Network. This interview was recorded in Bern, Switzerland, in the office of Doctor Christoph Buerki. He's the designer of the long-term, very successful, Swiss heroin injection program.

We talked briefly out there on the street about the US having a major problem.


DEAN BECKER: Sixty thousand dead last year, they say, and I close my radio program with this thought, okeh? Because of prohibition, you don't know what's in that bag, please be careful.

And it's -- I think that's, at its worst in the United States, best I understand it, with the fentanyl, carfentanyl, the mixture, that's being sold, and people just don't know what they're taking. I wonder how often it even contains heroin. Your response, please.

CHRISTOPH BUERKI, MD: Of course, that's one of the major issues, if you're a drug addict on the street, you just have to consume or take whatever your dealer sells you as being heroin, and that can be, especially -- we also do street surveys of street drugs, up to today in the canton of Bern, regular samples are taken in the low-threshold street agency, and it's really a problem, because it contains between two or three percent of heroin, up to forty or sixty percent of heroin.


CHRISTOPH BUERKI, MD: That's a very, very dangerous situation. Many people might -- can overdose in those situations. If you're used to heroin of five percent and then you suddenly get heroin, street heroin, of sixty percent, it can be a death penalty.

DEAN BECKER: There you go.

CHRISTOPH BUERKI, MD: It could be really, really dangerous. So, of course, that's one of the things that, even up to today, where we've done it twenty-five years now, almost. I'm not aware of a single patient who has died of an overdose in a heroin injection -- of a heroin injection in a heroin prescription clinic. Not a single overdose death.

DEAN BECKER: That's wonderful. The best outcome you could hope for, right?

CHRISTOPH BUERKI, MD: I think it's, for the individual patient, it's the best outcome one can hope for. Yeah, it is. And, also many people, they -- I mean, one big criticism of heroin prescription is that you keep patients forever, sort of, for the rest of their life.

Which, for some patients, it's true, one has to say, it's true, they are so heavily addicted, and they can't, despite all the motivational efforts by staff and psychotherapists, doctors, social workers, they cannot be motivated, they cannot be pushed into trying to quit or doing something different, which is one of the issues, of course.

But then again, those people, would they find a way out if they lived just on the street, on street heroin? Probably not. Most of them would be dead by now.

DEAN BECKER: Yeah. Well, right, because of the impurities, the -- and again --

CHRISTOPH BUERKI, MD: Yeah. Lifestyle.

DEAN BECKER: -- and not knowing what is in that bag.


DEAN BECKER: Like I say. There was a gentleman, one of the founding members of Johns Hopkins University, very prestigious outfit over there in the US.


DEAN BECKER: He was known as a lifelong morphine addict. He was, and I'm trying to remember his name [sic: Dr. William Stewart Halsted], but he was declared to be the father of modern surgery, he was that good.


DEAN BECKER: And, I often like to ask folks, if he were your surgeon, would you want him to have his fix before or after he cut you open? And my thought is, I think he should have it before he cuts me open, but, he had a very productive life just the same, and do you find some of your patients nonetheless have very productive lives despite -- ?

CHRISTOPH BUERKI, MD: Of course. That's, I mean, that's the ultimate goal of the program, to have, yeah, a fulfilling or productive life, somehow. That meant -- might mean totally different things for different people.

It might mean that you have a job, that you have a family, for others it might mean that you don't die of suicide or you don't die of a major mental illness. So that's a -- that's an individual thing, what is a fulfilling life.

But that's the ultimate goal, of course, in all the treatments that we do as doctors, as institutions.

DEAN BECKER: Right. Well, and, that's very admirable, I, that's why I'm here, you know, to learn about it.

We'll be back shortly after this quick break.

It's time to play Name That Drug By Its Side Effects! Blistering or peeling skin, swelling of eyelids, throat, and lips, blurred vision and yellowing of eyes, black tarry stools, vomit that looks like coffee grounds. Time's up! The answer: Celebrex.

Again, we're speaking with Doctor Christoph Buerki, the inventor of the Swiss heroin injection program.

My hope, my goal, and again, I'm a former cop, I want to legalize all drugs.


DEAN BECKER: I want them to be made by Merck and Pfizer.


DEAN BECKER: Not some Mexican farmer who's mixing cartel --


DEAN BECKER: -- fentanyl all together.

CHRISTOPH BUERKI, MD: Yeah. And, may I say something?


CHRISTOPH BUERKI, MD: Because I have been to the US as well, like, last year, and I, with a big smile, I drove through Colorado and listened to the radio ads of marijuana.

DEAN BECKER: How good this one is, that [unintelligible] the other, yes.

CHRISTOPH BUERKI, MD: I think it's great, that tendency, that marijuana is taken out of, I mean, to punish somebody because he consumes marijuana, it's frankly quite a stupid thing to do.

And, however, I think it's a bit problematic, as a psychiatrist, I'm of course aware that marijuana is not without risks.


CHRISTOPH BUERKI, MD: And, if we talk about legalization, I would very strongly think we should prohibit commercial advertising --


CHRISTOPH BUERKI, MD: -- for those [unintelligible]

DEAN BECKER: I'm with you. I'm with you.

CHRISTOPH BUERKI, MD: Basically, same with cigarettes and alcohol, it shouldn't be advertised, on TV and cinemas, on billboards somewhere. It shouldn't --

DEAN BECKER: That's just glamorizing it.

CHRISTOPH BUERKI, MD: Yeah. And the same thing, we shouldn't do with drugs, be it marijuana, be it whatever psychoactive substance.


CHRISTOPH BUERKI, MD: Bit of a criticism to the legalization movement in the US. It goes like from one extreme, the total demonization of relatively, a relatively harmless substance called marijuana, to a consumer product that even needs advertising and --

DEAN BECKER: It doesn't need much advertising at all.

CHRISTOPH BUERKI, MD: It's a bit extreme, those pendulum swings.

DEAN BECKER: I like to look back, the United States had a 1906 Pure Food and Drug Act --


DEAN BECKER: -- which said -- up til then, it had been snake oil salesmen, and, you know, buy this, it will --


DEAN BECKER: -- give you a [unintelligible], or whatever, but, the truth was, the 1906 Act required that the manufacturer label very specifically what was in the product.


DEAN BECKER: And I think that's -- we could stop right there, because, like I told Doctor Goulão, that, you know, if somebody, if there's kerosene and foot fungus in the cocaine, which there is, coming out of Colombia, because of the manufacturing process, maybe small amounts, but if somebody likes kerosene and foot fungus and they're willing to buy it, seeing it there on the label, then we ought to let them buy it.

And, I guess the point I'm getting at is, you know, people are going to do brave things. I think that's a lot of what drug use is, is bravado, thinking I can face down this lion. I can do it on a daily basis.


DEAN BECKER: I don't know. I'm drifting off here, but I think the point I'm getting at is that there are a lot of factors that lead people to take drugs. I'm not saying that kerosene and foot fungus is one, but I'm just saying, through labeling the product, people would know exactly what they're buying, and they would be liable for that.

Then, we could judge people by their actions, like we used to, rather than the baggy in their pocket. Your response to that, please.

CHRISTOPH BUERKI, MD: Well, it's a philosophical question, because we're in both our societies very far away from such things, and our compromise in Switzerland, and I think it's not a bad compromise, is --

DEAN BECKER: Oh, no, I admire it.

CHRISTOPH BUERKI, MD: -- is starting prescribing it through doctors, the heroin. Yeah, I mean, heroin is strong stuff, one must admit, and it is, you can get over it, of course, but it doesn't go easily. It does have side effects, it also restricts your life at the moment, the way you -- the way it's prescribed in the clinic. There's no take home doses of heroin. It's no fun to be a patient in a heroin prescription clinic.

But it's a compromise, it's medicalized through that, it's made sure that what patients get and take is clean and pure. And maybe also one aspect, I think it's important to realize, it's also, the heroin prescription, giving out the heroin every day, is only a means to get into touch with people.


CHRISTOPH BUERKI, MD: And to really get them into treatment. I think that's the biggest value of this type of program, that you can get in touch with people. You see them every day twice, you can intervene, when they have a pneumonia, when they -- many of them are HIV positive. I mean, we started at a time when we didn't have anti-retroviral substances yet.

DEAN BECKER: And, the -- it was taking off, the --

CHRISTOPH BUERKI, MD: And it was exploding. The numbers were exploding. And, or they have hepatitis C, or all those things. And you can, you see them, you can intervene, you can -- when, when somebody gets psychotic because of their underlying psychoses, you can medicalize them with an anti-psychotic medication.

You can give them out anti-depressants if they're depressed, and so on, you can do psychotherapy for certain situations, in order for them to find -- find a way to be with their problems in life.

So, there's a lot of things you can do in that accompanying --


CHRISTOPH BUERKI, MD: -- treatment, and they're only possible because your patients come to you.

DEAN BECKER: Once again, a reminder, you're listening to Cultural Baggage on Pacifica Radio. This interview was recorded in the office of Doctor Christoph Buerki in Bern, Switzerland. Got a lot smarter.

Now, in the US, we've, there's talk of legalizing marijuana at the federal level.


DEAN BECKER: But then there's this roadblock that's always put up, that, oh, we can't do that, we're party to the UN treaties and it wouldn't allow for, and it brings me to my next question to you. How did you get through, or work around, that situation?

CHRISTOPH BUERKI, MD: You're asking me something that you should ask somebody from the federal government. I'm sorry, I'm not quite aware -- if I remember it right, the -- what's clear is that members of the United Nations Narcotics Control Bureau [sic: Board], they have been here several times, have visited, and overall, were absolutely impressed, and -- impressed by the quality of the treatment, by the seriousity -- how it was done.

They didn't have to complain about anything with the -- in that regard. So, it is possible, within UN framework, to do something like that, there's no doubt.

DEAN BECKER: Hard to chastise you for success and keeping people alive, right?


DEAN BECKER: All right. Well, I was just going to say, Doctor Buerki, if you would, tell me what I'm leaving out. What should be let my listeners know about the success of your project?

CHRISTOPH BUERKI, MD: Basically, walk around Bern. Have a look around. You can -- there's no corner in Bern that you cannot walk around.

DEAN BECKER: The criminality is down.

CHRISTOPH BUERKI, MD: Criminality is so much down. Drug related crime, delinquency, petty crimes, stealing, all those things, so much better nowadays than it was 25 years ago. That alone is a huge success for it.

And, on the individual level, you have many, many lives who are saved. You have --

DEAN BECKER: Prolonged.

CHRISTOPH BUERKI, MD: Many people who are still dependent on drugs, somehow, some of them, for some of them it's a phase in their life, for some of them it's a phase that never ends, or for some of them, still it is a phase that ends their life. But, overall, many, many people have survived or even survived in good health, basically, unfortunate addiction.

DEAN BECKER: Right. Well, you know, I -- I grew up in the '60s. I tried heroin, I never did like downers, it just didn't appeal to me. Got into speed for a while, and, you know, and noticed that I was going to have a son, kind of caused that to end, you know, that affection for the speed.


DEAN BECKER: And, I think, in many cases, that tends to be the case, that a job or a wife or a kid, or some other happening to your life, tends to help many people, you know, walk away from the dangerous part of their habit, at least.


DEAN BECKER: Has that proven to be true for many of these addicts, or is -- or were you dealing more with the more serious, committed addicts, I guess is what I'm --

CHRISTOPH BUERKI, MD: Basically, from epidemiological research we know that this is very true, that a lot of people use drugs, maybe even have an addiction over a certain time in their late teens, in their twenties, and once in their thirties they start thinking about families, about career, and so on, and they stop.


CHRISTOPH BUERKI, MD: It's the same with cigarettes, it's the same with excessive alcohol drinking. It's the same with drugs, generally. And, however in the heroin prescription program, as I lined out before --

DEAN BECKER: These were serious people.

CHRISTOPH BUERKI, MD: -- we have that, we have serious people, with serious addictions, with a lot of co-morbidities, of a psychological nature. So, they tend not to be that easy --


CHRISTOPH BUERKI, MD: -- a population that can sort of, at the blink of an eye, quit their habit and go on with their lives.

DEAN BECKER: Time's up, I'm done.

CHRISTOPH BUERKI, MD: Yes. This is more something I do nowadays, I have a lot of, still a lot of patients in, with some sort of drug problem. For example, nowadays, young people, they tend to take more MDMA.

DEAN BECKER: Doctor Buerki, I want to thank you for your candid -- for being so candid with us, and for sharing your thoughts. The last question I want to present here is that, our president is talking about people who sell drugs, they need to be killed.

That's what he's been saying, consistently, for the last few weeks, that their lives are just not worth prolonging another moment. We're not talking -- you were not talking about selling drugs, but it just seems such a, I don't know how to phrase this without trying to drag you into something political.

CHRISTOPH BUERKI, MD: Don't worry about it. I have my opinions. It's a war on drug -- it's a typical statement of a war on drugs person. I mean, we as a society, we have tried war on drugs for countless years. I think the war on drugs was formally declared by Richard Nixon, if I recall it right.

It has not proven to work. It has not proven to work. Let's look at the situation in the US. It's worse than ever, despite all the law enforcement efforts going into, into combating drugs, into having that war on drugs, so, all we can say is, more of the same, or even inhumane approaches to that war on drugs.

DEAN BECKER: He says we have to get tough, as if we haven't been.

CHRISTOPH BUERKI, MD: I can't understand it. It's just not understandable, how somebody can say something like that, and how, I mean, there is -- he's also supported by many religious people, in your country, I know. How can somebody support a person who says such crazy things? With such disrespect for life? It's incredible.

DEAN BECKER: Again, that was Doctor Christoph Buerki, the inventor of the Swiss heroin injection program. Just enough time to remind you that because of prohibition you don't know what's in that bag. Please, be careful.

To the Drug Truth Network listeners around the world, this is Dean Becker for Cultural Baggage and the unvarnished truth. Cultural Baggage is a production of the Pacifica Radio Network. Archives are permanently stored at the James A. Baker III Institute for Public Policy. And we are all still tap dancing on the edge of an abyss.