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The opioid epidemic has become one of the nation’s most pressing public health concerns.
As it claims more and more lives every year, the strategy in mitigating the challenge, addressing the symptoms, and finding the root cause of substance abuse has grown more efficient. Yet the prevailing question of finding the most effective solution remains elusive.
While traditional approaches relying on heavy criminalization have been implemented, they have done little to prevent overdoses—leaving room for innovative, evidence-based alternatives.
One such model originates from Zurich, Switzerland, which faced a massive drug crisis in the 1980s and 1990s. To place the disastrous effects of drugs in the country in perspective, the people of Zurich suffered from open-air heroin (a type of opioid) markets, rising HIV infections, and increased overdose deaths. In response, policy-makers established what is known as the Four Pillar Program, which has been hailed as one of the most successful public health models of its time.
The program is built on a foundation of four key elements: prevention, therapy, harm reduction, and repression. All these elements work together to reduce the harm of opioids and other substances along with paving a long-term pathway toward liberation from addiction.
The Four Pillars:
- Prevention: Preventing drug use through educational mediums, and informing the public about the risks and consequences associated with drugs
- Therapy: Treatment options for those struggling with addiction such as rehabilitation, counseling, or medication
- Harm Reduction: Developing safe injection sites to prevent other sorts of diseases (HIV/AIDS) and opening consumption sites
- Repression: Enforcing penalties on drug possession and use
This program ultimately becomes effective, not by each individual element, but rather the sequence and combination of all of them applied to the population.
The United States, with around 80,000 yearly opioid overdose deaths, reportedly has three total supervised safe consumption sites (SCS) to combat the opioid crisis—two in New York, and one in Rhode Island. On the contrary, the city of Zurich only contains three SCS, supported by its four-pillar program integrated in its public health system. This contrast highlights a growing disparity that we as a nation must address.
Starting from local levels, cities such as San Francisco—with most of its deaths a result of opioid abuse—must address the epidemic in a permanent way.
As seen in a 2024 policy report from the City and County of San Francisco Board of Supervisors, the Zurich Four Pillar Program is being assessed as a potential framework to address the opioid crisis. The report acknowledges that the current temporary incarceration and displacement systems are inefficient, while Zurich’s program may provide more beneficial outcomes.
If the Four Pillar Program is adopted, this would allow for the investment into more treatment options, consumption sites (SCS), and a more balanced approach to mitigate the opioid epidemic through removing the stigma of criminality associated with it and replacing that with the notion of coming together to find an equitable solution.
This article was written as part of a program to educate youth and others about Alameda County’s opioid crisis, prevention and treatment options. The program is funded by the Alameda County Behavioral Health Department and the grant is administered by Three Valleys Community Foundation.
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