Head of Drug Department, Frankfurt a.M., July 1993.

The Frankfurt open "drug scene" began to emerge in the 70's. About 100 300 drug users started living in the so called Haschwiese (hash meadow) near the heart of the city. Illegal drugs were bought, sold and consumed there-mainly hashish, but also heroin. The scene developed soon into a source of threat for the inner city area communities.

In February 1980 it was decided to clear out the "drug scene" by police action: addicted people were forced to choose between abstinence and jail. As a consequence, there was a 10 years migration of both dealers and addicts from place to place downtown Frankfurt. Every moving provoked distrust, rejection and fear in people living in the area, with great quantities of waste and used syringes left behind.

In 1989, when junkies began to return to their starting point, the Haschwiese, it became evident that the attempt to eliminate drug related problems solely by law enforcement had fundamentally failed.

After nearly ten years, the "open scene" had grown more than five times, becoming also very differentiated. In the parks called Gallusanlage and Taunusanlage up to 1.000 heroin addicts and dealers used to meet daily. The area surrounding the main train station was the so called pill scene, with about 200 300 speed users. The Konstabler Wache became the focal point for up to 100 dealers who sold marijuana and hashish to an unknown number of cannabis users.

The threat for the population living downtown Frankfurt had increased considerably: between January '91 and September '92 the Municipal Drug Department received more than 650 written complaints. Also, more than 80.000 commuters had to cross the open "drug scene" nearby the main train station - two times a day, five days a week. The addicts themselves were in a miserable state of health, living in a perfect ghetto within their respective drug scenes - their only human contacts being dealers and policemen.

The spread of HIV and AIDS among IV drug users increased dramatically from zero to 19% within a few years and since 1985 the death toll had risen by 50% yearly. During the hot summertime and the very cold winter, there was hardly a day without at least one junkie dying for overdose or intoxication from a combination of drugs.

In 1991 in Frankfurt 148 addicts died - most of them in streets, parks and toilets of the one square mile area in the heart of the city.

In 1988 the first Institution demanding strongly a fundamental change in drug policy was the Frankfurt Police Department.

In order to reduce suffering and limit drug related harm was first necessary to secure the addicts' survival.

Three crisis centers were set up in the immediate vicinity of the respective scenes - in close cooperation with the City of Zurich.

In the Taunusanlage Park, a mobile ambulance was stationed -for the exchange of disposable syringes and the provision of emergency assistance for overdose and intoxication. During the winter of 1991 the Junkie Corner in the same park was partly roofed, to provide shelter from cold and snow. The Mobile Survival Help and the Rescue Services organized first aid courses for the junkies living in the area and another bus was provided for drug addicted prostitutes, with distribution of disposable syringes and condoms as well as emergency assistance.

The "drug scene" in the Taunusanlage Park was tolerated within clearly restricted borders that were redefined every week by the so called Monday Group [Every Monday city officials and administrators, doctors, drug coordinators and police officials use to meet to verify the entire program].

For the first time, the police refrained from disbanding the heroin users' meeting place and its activity was limited to define the limits of the "drug scene", with a constant presence of policemen in the area.

The first step of this new drug policy included also a close observation and analysis of the situation. The picture we found was a large scale "drug supermarket", which existed outside any State or medical control.

The results showed that many addicts were in a very poor state of health and most of them were not able to give up their addiction. Also, the illegal "drug scene" was an impenetrable web of crime and disease that was necessary to disentangle in order to help addicts and to fight traffickers.

With this experience in mind, a second phase of the new drug policy started in November 1992.

Its main elements were a new massive expansion of assistance to drug users and an increased presence of policemen in the area.

The HELP PROGRAM developed during that time was designed to meet three basic requirements:

to reach primarily long term addicts:

to develop long term program to end their addiction;

to provide them a concrete and alternative place where to live in.

Accordingly, the following facilities were provided - in decentralized areas and away from the "scene":

more than 900 places for dispensation of methadone in 7 methadone treatment centers;

194 night lodgings for homeless;

300 places for daytime residence.

Regarding AIDS prevention, a mobile syringe dispensation center was set up in the main train station area and pharmacies all over the city were invited to sell syringes to IV drug users.

The police action against dealers was stepped up strongly. Since November 1992 one hundred more policemen patrolled daily the area and the Taunusanlage Park became off limits for drug users and dealers.

Nine months after the beginning of the new Frankfurt drug policy's second step, the situation has greatly changed.

THE SOCIAL ISOLATION OF LONG TERM ADDICTS HAS BEEN SUCCESSFULLY OPENED UP.

685 of them were admitted to clinical detoxification, 485 started a clinical withdrawal treatment, 190 participated to a flat sharing scheme to promote abstinence.

Today (July 1993) there are slightly more than 600 long term drug users involved in methadone treatment with daily dispensation of methadone and daily medical and psycho social care.

Also, we have several hundred of contacts with long term drug users through our night lodgings, daytime residences, syringe distribution points and women related facilities.

THE PROBLEMS FOR THE FRANKFURT POPULATION HAD BEEN GREATLY REDUCED.

The addicts living permanently in the streets of the main train station area decreased from more than 1.000 to 100 150 people.

The number of street robberies in the inner city was drastically reduced and the addicts involved in robbery activities decreased from 35% to less than 20%.

And most important, now most of non addicted traffickers are separated from the junkies - thus they are more under control of police.

THE SEPARATION OF CANNABIS USERS FROM HEROIN USERS.

The Attorney General of the State [Land] of Hessen sent a raccomandation to prosecutors and judges to stop the prosecution of people found with a maximum of 30 grams of cannabis - and police also followed these directions. With a clear division of "soft drugs" market from heroin and cocaine dealers, cannabis users (most of them young people) avoided the risks to be involved in "hard drugs" use.

HEALTH CARE FOR LONG TERM DRUG USERS HAS BEEN GREATLY IMPROVED.

The number of emergency intervention was drastically reduced and clinical treatment for addicts was clearly improved. The number of emergency admissions to hospitals was considerably decreased and in general there are no more problems for the availability of hospital beds for addicts. Admission to clinical withdrawal treatment has become much easier.

THE PROGRAM FOR AIDS PREVENTION THROUGH NEEDLE EXCHANGE PROGRAMS WAS ASSURED, EXPANDED AND MAINTAINED.

On a daily basis, between 3.400 and 4:500 syringes are exchanged on several different places:

mobile dispensation points in the main train station area, catering also to addicts outside Frankfurt;

bus for distribution of condoms and syringes to prostitutes;

dispensation at 4 contact shops, 3 overnight places for homeless, 5 drug help centers;

sale of syringes by all pharmacies in the city.

A DRAMATIC DECLINE IN DEATH TOLL WAS SHOWN.

In the first half of this year 53% fewer addicts died - compared with the same period of 1992. This development is accompanied by a decline of death toll in the entire Frankfurt area as well as in the State of Hessen.

These results suggest that we have been able to improve the situation of the long term addicts and that we have prepared the ground for more effective action against illegal drugs trafficking. We also realized that this approach is effective in limiting harm, reducing suffering and minimizing drug related risks for individuals as well as for communities.

But there are still two particular problems with no solution.

First, we couldn't reach about 100 150 long term addicts still living in the streets of the central train station district. They are in an extremely poor health condition and are still causing problems to neighbors, passers by and business people: most of them need more time to accept involvement in a methadone scheme.

Several categories of addicts cannot even be reached with methadone programs - such as people with psychiatric afflictions or advanced AlDS infection conditions, addicts too close to dealers explicitly refusing any help and people that cannot even contemplate a perspective for their life without heroin consumption.

In order to reduce harm for those addicts and to limit the problems they cause to communities, we plan to create conditions that allow them to legally consume heroin by intravenous injection in a medically tolerable way. The organization of health centers is currently underway - the HEROIN DISPENSATION PROJECT.

Second problem: how help the addicts that are relatively well socially integrated and have not yet suffered health defects to not slide further down into the "scene"? To avoid this development, we have still to consider the use of methadone as a health and social tool able to stop the process of social isolation and of health degeneration.

Also, the City of Frankfurt provides a large scale Drug Prevention Program, with the involvement of teachers, students and parents in every school. Similar programs exist also in several City Youth Centers.

Finally, since the new policy was started - 4 years ago - the average age of the addicts who are registered by police in the main train station area does not decrease any more. Year by year the average age of known addicts rose about one year. On a long term scale, we hope that this sign will be confirmed: it means that the number of young people falling into addiction do not increase anymore.

The above reported statistics clearly show that a policy of harm reduction is a reasonable and effective way to minimize the problems related to drug addiction in our modern societies. And the results of this pragmatic drug policy adopted from the City of Frankfurt are very encouraging on the way toward a solution to drug related problems.