The DCRs are now accepted and supported by most political parties in the country. The latest federal vote in 2008 concerning the revision of the national narcotics law showed a clear acceptance by the public of harm reduction, as the term is now included in the Swiss federal Drug Policy system. Indeed, the Swiss drug policy is based on four pillars – repression, therapy, prevention and harm reduction.
There are 13 DCRs in 8 cities in Switzerland, most of them in the German part of the country. DCRs reach out to, and are accepted by, their target population.
The world’s first DCR was opened in 1986 by Contact Netz in Bern, Switzerland. It was becoming clear that the strategies to deal with the issue of drug use at the time focused exclusively on repressive measures and abstinence, could not cope with the high level of new HIV infections, the increasing numbers of drug-related deaths and the open drug scene in the city. The creation of the DCR was a paradigm shift in drug policy, creating radical new approaches to the drug epidemic at the political, health and social level. Indeed, Contact Netz provides medical and social services for users without obligations, including needle and syringe exchange, warm meals and shelter. DCRs were subsequently set up in several other cities in Switzerland and the so-called open drug scenes disappeared.
The fundamental objectives of DCRs are to provide people who use drugs social and healthcare services, improve the health of people dependent on drugs and reintegrate them into society, and reduce public disturbance created by drug use in public areas.
In 2011, national standards were developed for all DCRs in Switzerland. These new standards provide guidelines on the provision of services, including HIV and hepatitis prevention and care, general medicine, health problems caused by drug consumption (abscesses, drug dependence treatment, voluntary counselling, and services to improve hygiene) and the good functioning of the DCRs, such as the admission criteria and rules.
With the introduction of DCRs, the number of drug-related deaths has decreased. Several studies have shown the effectiveness of DCRs in reducing HIV or hepatitis C virus infections among people who use drugs. Positive changes were also observed in injecting behaviours and hygiene for many clients. This has been confirmed by a decrease in syringe sharing in several surveys in Switzerland.
The services are provided by nurses and social workers. They provide services including booths for intravenous use, smoking and sniffing, a cafeteria providing food and non-alcoholic beverages, healthcare services, consultations for social problems, hygiene services (such as showers and the provision of clothes), NSPs, and referrals to drug dependence treatment programmes and clinics for those clients who request it.