04/26/18 Christoph Buerki

Cultural Baggage Radio Show
Christoph Buerki

Dr. Christoph Buerki the Swiss designer of their decades old, very successful heroin injection program, Prof William Martin of James A Baker Institute, Asha Bandale of DPA re Prince OD, Dr. Sanjay Gupta re cannabis relieving heroin addiction.

Audio file


APRIL 26, 2018


DEAN BECKER: Broadcasting on the Drug Truth Network, this is Cultural Baggage.

Hi folks, this is the Reverend Dean Becker. I'm glad you can be with us this week. Last week, we had Major Neill Franklin. He was the executive director of Law Enforcement Action Partnership, talking about our alignment, the Drug Truth Network and their outfit.

And today, I want to talk about another outfit, more local, here in Houston, that deems to grant me the -- as a contributing expert to their efforts. They're based at Rice University, the James A. Baker III Institute, and I want to welcome the director of that drug policy group, Professor William Martin. Hello, sir.

WILLIAM MARTIN, PHD: Hi Dean, good to talk with you again.

DEAN BECKER: Professor, you know, the truth about the drug war is slowly being recognized. I think it's been available to people if they just wanted to absorb it, but it's beginning to be recognized as valid, and needing, or creating need for change. Your thought there, sir.

WILLIAM MARTIN, PHD: Oh, that's absolutely true, and the media picked up on this now for -- for the last three, four or five years, and people are -- people can't help but see it, they can't help but be exposed to it. When they are exposed to it, it's so clear that it's been such a mistake that I've run into people, it doesn't matter whether it's at a church, or at a gathering of soft Republicans, and they'll just say, you know, we've got to change this, this doesn't work. We've got to try something else.

So, yes. The drug war is on the run.

DEAN BECKER: And, you know, I mean, I've been preaching this for, you know, nearly 20 years, we're empowering terrorists, enriching barbarous cartels, we give reasons for these gangs to exist, and we have created this situation where we're leading the world in overdose rates of our children because nobody knows what in the hell they're buying. Am I right, sir?

WILLIAM MARTIN, PHD: That's true, and when you're -- when you buy an unregulated product, sold to you by a criminal with no incentive whatever to be concerned about purity or quality or strength, then you are taking much more of a risk than if it were in the hands of a regulated industry that had to follow rules regarding quality and strength and purity.

DEAN BECKER: Now, Bill, we've had a couple of events within the last month at Rice University, two events looking at cannabis, cannabis laws, the future of cannabis, if you will. It's become a very mainstream topic, has it not?

WILLIAM MARTIN, PHD: Oh, it has, and there it was -- my colleague Katie Neill, who you know, attended a conference last week, I'm attend -- may attend one tomorrow, I haven't yet decided. I'm going to attend a harm reduction meeting in San Antonio that's going to have some high level leaders of that at that, to talk about syringe exchange and other harm reduction measures, that's recognizing that we've got to do -- we've got to do things differently.

DEAN BECKER: Yes, sir, and you know, I just returned from Switzerland and Portugal, and over there, I was able to talk to, and I'll just be, you know, rough with it, the top dogs, the drug czar, the guy who designed the heroin injection program, the head of the European Monitoring Centre, the top scientist there.

They're willing to talk to me, and here in the US, for twenty years, I've tried to get the drug czar, you know, the head of the ONDCP, the DEA, all of these guys whose opinion matters, if you will, it certainly matters in the legislators' opinions, in forming or continuing these laws, and I guess I want to get your thought there, sir. It's time for everybody to face down this lion. Every official. Am I right?

WILLIAM MARTIN, PHD: Well, that is true, and I appreciate so much the way you have gone after this for so many years, and although you haven't gotten all the people that you wanted to get, you have gotten a tremendous number of people of substance, and you're the -- I'm happy to have a new audience for you to reach. I'm sure there will be a lot of people following you from your old time, but I'm happy that you'll also pick up some new people to see what a unique contribution you have made.

What's the number now, is it above 1,500 people you have interviewed?

DEAN BECKER: Oh, I haven't actually tallied it. Once I got above a thousand I kind of quit, and that was about six years ago. So ---

WILLIAM MARTIN, PHD: It's way on up there, but, and we at the Baker Institute, we are so pleased now for several years to have, to serve as an archive for that resource, and just as, you know, your book, To End The War On Drugs, which we helped to -- helped to publish and also to distribute, helped with financing of that to some extent.


WILLIAM MARTIN, PHD: And, which is in itself, which you did, based on the interviews that you've done over the years, sort of topic by topic of the drug war, and then much more even really quite currently, we have on the first page of our website, you can go to -- you can google Baker Institute Drug Policy, and you'll come up on the front page, and there's an article there that I put together about law enforcement in Houston favoring drug policy reform.

Even though I put it together, it came from your interviews with the past and present chiefs of police, the sheriff, the DA, and with other people who have minor roles in that article, but not minor roles in -- all of these people agree that the drug war has been a failure, and we need to do something else besides lock people up.

DEAN BECKER: Well, Bill, I appreciate that endorsement, and you know I send it right back to you guys for standing so tall and so honest in this regard. Please point them to that website one more time, Bill.

WILLIAM MARTIN, PHD: Okeh, you can just go to drug -- Baker Institute Drug Policy, and it will pop up.

DEAN BECKER: The following segment comes to us courtesy of MIC.com.

ASHA BANDALE: On the anniversary of Prince's death, what I want people to think about, more than anything, is that we don't have to lose another life. We don't have to have people dying of overdose. My name is Asha Bandale, I'm a senior director at the Drug Policy Alliance.

Prince meant so much to me, because he was black excellence and because he was free. Gave me the ability to claim my own freedom, and be who I was. I'm here talking about addiction and talking about drug use, because I loved Prince.

When I think about Prince, I think about a man who probably felt a lot of stigma because he was in pain, and because he didn't feel like he could ask for help. And so when we use terms like crackhead, junkie, addict, and we just dismiss the humanity of people, they don't feel like they can come to us and ask for help, they feel shame.

Each year in America, somewhere around 64,000 people die needlessly of drug overdoses, about 42,000 of those deaths are driven by opioid use. From marijuana to heroin, 75 to 90 percent of the people who use them never become addicted.

So we need to begin to look at what are those things that are present in the lives of people who do become addicted, and often what you find are things like lack of access to healthcare, loss of hope, loss of jobs, loss of family structures, and so we have to not think about addiction as this isolated sort of craziness that some person who's a freak lives in. We have to think about our social responsibility and what we're not providing people.

There are nations like Portugal that once had an overdose epidemic, much like the one we're having here in the United States. Portugal took drugs to the maximum extent possible out of the criminal justice system, and put it inside their public health system, and so when they've done that, what they've actually seen is a reduction in young people who use drugs. They've ended their overdose epidemic. They've almost exclusively curtailed, almost entirely, the transmission of HIV through shared needles.

So Trump's approach about killing the drug dealer is his lazy, scientifically unsound, and morally unethical approach to, actually, what we need to have a leader of this nation do, which is figure out how to save lives.

donald trump: If we don't get tough on the drug dealers who are wasting our time, and that toughness includes the death penalty.

ASHA BANDALE: The war on drugs has been an abject failure and we've known it. People are going to use drugs. Our job as a society should be to save lives, but we're more concerned about morality than we are with saving lives, and my plea to anybody who's within reach of my voice, is choose life first. Wouldn't we want Prince still here? Wouldn't we want Whitney Houston still here? Wouldn't we want our own loved ones, who we've buried to drug use, still here?

They could be, if we actually let go of our morality and chose their lives first. That is the true morality, to me.

DEAN BECKER: All right, folks, that was Asha Bandale from the Drug Policy Alliance. I toured Portugal with her, Lisbon, we interviewed the drug czar over there, each of us.

I want to say this. I have a local minister, he's here in studio with me, he's going to be anonymous for today, but he just wants to see what's going on. He's thinking of joining forces with us, and I'm hoping he's the first of many local officials, ministers, you know, county commissioners, and whomever, police chiefs maybe. It's time to challenge the logic of the drug war. It has no reason to exist.

You know, after I left Lisbon, I went to Bern, Switzerland. There, I got a chance to interview Doctor Buerki, Christoph Buerki. He's the inventor of the, how do you call it, the heroin injection program, which has saved a lot of lives. We're going to hear half of that discussion today. This is Doctor Christoph Buerki.

It's time to play Name That Drug By Its Side Effects! Agitation, paranoia, hallucinations, face chomping, lip eating, heart devouring, brain slurping, ecstasy, suicidality, zombie-ism. Time's up! The answer, according to law enforcement, from some crazy-ass chemist somewhere: mephedrone, otherwise known as bath salts.

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. Dr. Goul?├║o 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 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 their 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 [sic: that's all drug overdose deaths], 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 pay -- 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: All right. Once again, that was Doctor Christoph Buerki, the Swiss scientist who came up with the Swiss heroin injection program, as he says, almost 25 years in existence now. Nobody's ever died of heroin there in Bern, Switzerland, since they came up with that program. I got to tour the facility, a six story building. I got to see how they store the heroin, how they dispense it, how they control, you know, who gets what.

Twice a day, people come in, get their heroin fix, then they go back to work or tending their children or whatever it might be. But, it is a much better way than we have, where people are buying crap on the street, they've got no idea what's in that bag. And yet, you know, they keep buying it just the same, because, well, that's the way America likes their drug war, deadly and dangerous, I suppose.

I've got a track I want to share with you about something that's fixing to happen, and I hope you will tune in, because I'm certainly going to.

donald trump: We're going to work with the people who are so addicted, and we're going to try like hell to get them off that addiction.

SANJAY GUPTA, MD: A national epidemic. Trump campaigned to end it. As president, he promised to fix it.

donald trump: The scourge of drug addiction in America will stop. It will stop.

SANJAY GUPTA, MD: But one year later, it hasn't stopped. People are still dying. A hundred and fifteen Americans die every day from an opioid overdose. More than car accidents, breast cancer, or guns.

VOICE ONE: Literally everyone we know knows somebody who has died of an overdose.

SANJAY GUPTA, MD: And two and a half million Americans are currently struggling with opioid addiction.

VOICE TWO: I was completely helpless, where I just was like suicide is a constant thought.

jefferson beauregard sessions III: People need to take some aspirin sometimes, and tough it out.

SANJAY GUPTA, MD: A solution some believe is this: cannabis. It's controversial to many. Is cannabis a gateway drug? But a gateway to recovery for others.

Did it help you get off of the opiates?

VOICE TWO: Absolutely.

VOICE THREE: Cannabis has given me a reason to live.

SANJAY GUPTA, MD: Join us as we investigate, search for answers, and meet potential pioneers and outspoken critics. Whether you struggle with opioids, or know one of the millions who do, decide for yourself.

DEAN BECKER: It shall air Sunday, April 29, at 8pm eastern on CNN.

I hope you tune in. It's going to be, I think, very instrumental in changing America's perspectives on this. It was Doctor Sanjay Gupta about four or five years ago who came forward, talking about the benefits of medical marijuana, for all those little kids with epilepsy, and how it made them able to have a fairly normal life, how a small dose of cannabis was able to twerk or tweak their brain to where they were able to, you know, lead a more productive life, go to school, learn to walk, talk, all those good things we want our children to do.

I got to wrap it up. Once again though friends, I want to invite you to contact me, especially if you're a minister, a commissioner, or whoever out there. Our number, our email is Dean@drugtruth.net, and again I remind because of prohibition you don't know what's in that bag. I urge you to 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 an abyss.