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Swiss decree on therapy for addiction to illicit drugs
POLICY AND PEOPLE
Report reveals extent of abuse in Romania’s psychiatric hospitals the care of 19 doctors, including six etails of “disastrous” conditions psychiatrists, none of the nursing staff in Romanian jails and psychihad any psychiatric training. A psyatric hospitals discovered by experts chiatric nursing training school has from the 40-nation Council of since been set up. Treatment was preEurope (CoE) were published in dominantly by drugs, with no other Strasbourg on Feb 19. The findings, forms of therapy offered. The experts from visits in late 1995, were comfound women lying on plastic matpiled under the terms of Romania’s tresses, wearing soiled nightdresses accession to the CoE Convention on which had clearly not been changed the Prevention of Torture and for days. One ill Inhuman or Degrading patient had simply Treatment (CPT) and been “abandoned” published belatedly by nursing staff in an under provisions giving “isolation room” states time to lodge a lying in his own faeformal response, ces and entirely accompanied by a dependent on fellow report on remedial patients. Such isolaaction. tion rooms were used Conditions at the not, as the authorities Poinana Mare psychimaintained, for “agiatric hospital prompted tated” patients, but the experts to invoke as punishment, the emergency CPT proexperts concluded. cedures to demand an Suffering in Romania The experts also immediate inquiry and heard claims of rough treatment—in a report on remedial action to be particular for recaptured runaways. returned within 3 months. There had Almost the only acceptable aspect been no running water for weeks, of the regime was the amount of electricity supplies were erratic, and space and freedom of circulation for there was no heating. The hospital patients, said the report. Otherwise, director explained that even the minibuildings were dilapidated to the mal funding had been suspended and verge of collapse. The diet was mainly the hospital depended on credit or potato or cabbage soup to which bartering. morsels of meat were added twice a Although 500 patients were under Panos Pictures/Mark Makansson
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week, plus bread. The patients were hungry because only 20 litres of soup was shared by 100 patients twice a day. Hospital records confirmed that “severe malnutrition” had been listed as cause of death in 25 out of 61 cases over the previous 6 months. In a jail for long-term prisoners, the experts found “outrageous” overcrowding in which bunks covered almost the totality of floor space, “deplorable” hygiene conditions in which dozens of prisoners shared a single toilet in a dormitory area and a “foul, unbeathable” atmosphere. Again, meals consisted mainly of soup. Conditions were better for women prisoners who were nevertheless housed four to a cell of 9 m2. At Jilava, Romania’s only prison hospital (unheated at the time of the autumn visit), the experts found severe understaffing in relation to the 942 inmates, with perhaps only 50% of the 40 medical posts actually filled, and “disastrous” hygiene standards. The CPT report acknowledged that its experts had been given unhindered access to establishments by authorities which had reacted “constructively” to criticisms. The authorities had warned the experts on arrival that they would find poor conditions because of lack of money. Arthur Rogers
French government steps up plan to reduce drug bill
F
rench Health Minister, Bernard Kouchner, has announced an initiative to reduce drug consumption and costs. Prescription of psychotropics will be reduced by 10% within the next 18 months, as well as the prescription of certain antibiotics. The drug industry will have to reduce its promotion and advertising costs by 10%. Most of all, the government wants to boost prescription of
generic drugs, currently only 4% of all prescribed drugs. The government’s aim is to double this amount during the next 2 years. Kouchner envisages that 50% of all prescribed drugs could be replaced by generic equivalents. Many drugs should be re-evaluated, and, if not considered to be “medically justified”, might have to be paid for by patients instead of being paid by the health insurance,
but no list of the affected drugs has been published until now. Kouchner noted that drugs expenses still increase faster than all other health expenses, and announced that the prices of further classes of drugs could be dropped if their prescription and consumption does not significantly decrease within the next 18 months. Denis Durand de Bousingen
Swiss decree on therapy for addiction to illicit drugs ollowing voters’ rejection in last year’s national referendum of proposals aimed at forcing rapid abstinence on drug users, the Swiss government has issued a decree regarding treatment. This is accompanied by indications of the approximate total of addicts currently eligible for treatment under medical supervision: 800 on heroin, 100 on mor-
F
656
phine, and about 100 on methadone. The decree does not set limits on the number of addicts who may receive treatment. Experimental administration of heroin, started in 1994, shows that between 2000 and 3000 people (about one in 10 of those believed to be on “hard” drugs) are “heavily dependent” addicts, most have tried repeatedly to break the habit.
Authority for the existing programme expires in 2000; the decree extends it until a new law comes into force, expected not later than 2004. In it, heroin may be categorised as a medication, possibly prescribed by specially trained family doctors and paid for by sickness insurance. Alan McGregor
THE LANCET • Vol 351 • February 28, 1998
Report reveals extent of abuse in Romania’s psychiatric hospitals the care of 19 doctors, including six etails of “disastrous” conditions psychiatrists, none of the nursing staff in Romanian jails and psychihad any psychiatric training. A psyatric hospitals discovered by experts chiatric nursing training school has from the 40-nation Council of since been set up. Treatment was preEurope (CoE) were published in dominantly by drugs, with no other Strasbourg on Feb 19. The findings, forms of therapy offered. The experts from visits in late 1995, were comfound women lying on plastic matpiled under the terms of Romania’s tresses, wearing soiled nightdresses accession to the CoE Convention on which had clearly not been changed the Prevention of Torture and for days. One ill Inhuman or Degrading patient had simply Treatment (CPT) and been “abandoned” published belatedly by nursing staff in an under provisions giving “isolation room” states time to lodge a lying in his own faeformal response, ces and entirely accompanied by a dependent on fellow report on remedial patients. Such isolaaction. tion rooms were used Conditions at the not, as the authorities Poinana Mare psychimaintained, for “agiatric hospital prompted tated” patients, but the experts to invoke as punishment, the emergency CPT proexperts concluded. cedures to demand an Suffering in Romania The experts also immediate inquiry and heard claims of rough treatment—in a report on remedial action to be particular for recaptured runaways. returned within 3 months. There had Almost the only acceptable aspect been no running water for weeks, of the regime was the amount of electricity supplies were erratic, and space and freedom of circulation for there was no heating. The hospital patients, said the report. Otherwise, director explained that even the minibuildings were dilapidated to the mal funding had been suspended and verge of collapse. The diet was mainly the hospital depended on credit or potato or cabbage soup to which bartering. morsels of meat were added twice a Although 500 patients were under Panos Pictures/Mark Makansson
D
week, plus bread. The patients were hungry because only 20 litres of soup was shared by 100 patients twice a day. Hospital records confirmed that “severe malnutrition” had been listed as cause of death in 25 out of 61 cases over the previous 6 months. In a jail for long-term prisoners, the experts found “outrageous” overcrowding in which bunks covered almost the totality of floor space, “deplorable” hygiene conditions in which dozens of prisoners shared a single toilet in a dormitory area and a “foul, unbeathable” atmosphere. Again, meals consisted mainly of soup. Conditions were better for women prisoners who were nevertheless housed four to a cell of 9 m2. At Jilava, Romania’s only prison hospital (unheated at the time of the autumn visit), the experts found severe understaffing in relation to the 942 inmates, with perhaps only 50% of the 40 medical posts actually filled, and “disastrous” hygiene standards. The CPT report acknowledged that its experts had been given unhindered access to establishments by authorities which had reacted “constructively” to criticisms. The authorities had warned the experts on arrival that they would find poor conditions because of lack of money. Arthur Rogers
French government steps up plan to reduce drug bill
F
rench Health Minister, Bernard Kouchner, has announced an initiative to reduce drug consumption and costs. Prescription of psychotropics will be reduced by 10% within the next 18 months, as well as the prescription of certain antibiotics. The drug industry will have to reduce its promotion and advertising costs by 10%. Most of all, the government wants to boost prescription of
generic drugs, currently only 4% of all prescribed drugs. The government’s aim is to double this amount during the next 2 years. Kouchner envisages that 50% of all prescribed drugs could be replaced by generic equivalents. Many drugs should be re-evaluated, and, if not considered to be “medically justified”, might have to be paid for by patients instead of being paid by the health insurance,
but no list of the affected drugs has been published until now. Kouchner noted that drugs expenses still increase faster than all other health expenses, and announced that the prices of further classes of drugs could be dropped if their prescription and consumption does not significantly decrease within the next 18 months. Denis Durand de Bousingen
Swiss decree on therapy for addiction to illicit drugs ollowing voters’ rejection in last year’s national referendum of proposals aimed at forcing rapid abstinence on drug users, the Swiss government has issued a decree regarding treatment. This is accompanied by indications of the approximate total of addicts currently eligible for treatment under medical supervision: 800 on heroin, 100 on mor-
F
656
phine, and about 100 on methadone. The decree does not set limits on the number of addicts who may receive treatment. Experimental administration of heroin, started in 1994, shows that between 2000 and 3000 people (about one in 10 of those believed to be on “hard” drugs) are “heavily dependent” addicts, most have tried repeatedly to break the habit.
Authority for the existing programme expires in 2000; the decree extends it until a new law comes into force, expected not later than 2004. In it, heroin may be categorised as a medication, possibly prescribed by specially trained family doctors and paid for by sickness insurance. Alan McGregor
THE LANCET • Vol 351 • February 28, 1998