Last week, the cities of Hamburg and Frankfurt warned that injection clinics where severe heroin addicts are administered free doses of the drug under medical supervision are in danger of closure by the middle of the year if the German government doesn’t extend their lifetime.

A failure to do so wouldn’t just threaten the future of the clinics in Hamburg and Frankfurt, but also hit heroin injection centers in five other German cities where hard-core addicts can inject themselves with diamorphine, a chemically pure form of heroin. In addition to providing clean needles, the clinics also offer crucial psychiatric support.

Heroin versus methadone

They were all set up in 2002 under the previous German government of Social Democrats and Greens as part of a project modeled on similar experiments in Switzerland and the Netherlands to find the most effective way to treat hard-core heroin addicts, help them build a relatively normal life and eventually get them to kick the habit.

The project compared results between a group of patients who were put on heroin maintenance therapy and another on methadone, a heroin substitute.

The findings, which were published in a study last year, found that the heroin group fared much better.

"Those on heroin stayed in treatment longer and the drop out is much less than the methadone group. They had much less illicit drug use, using street heroin and cocaine, and so have better health records,” said Christian Haase, a Hamburg-based researcher who carried out the study.

Lower drug crime and better health

The study’s conclusions in favor of heroin maintenance therapy to treat the country’s worst addicts has been boosted by the fact that Germany’s heroin-overdose death rate has continually plunged in the past years and is currently at its lowest level since 1989. In addition, cities such as Hamburg, long notorious for its open drug scene near the main railway station, have managed to stem illicit drug use and lower drug crime.

“Our clinic’s priority has been to improve the health of patients and we have made good progress with that,” said Peter Heine, a spokesman for the Frankfurt mayor’s office. The city’s heroin injection clinic has seen its patients dwindle to 59 from 93. “And importantly, the clinic has helped to keep addicts off the street and prevent them from resorting to illegal means to obtain the drug,” Heine added.”

Karin Bonorden-Kleij, head of the heroin injection clinic in Hamburg said patient numbers had dropped to 70 from an original 200 who started therapy. Most turned clean with fewer health problems, a few dropped out while some went back to the streets.

Bonorden-Kleij said that thanks to twice daily injections of diamorphine, more than 40 of her patients now had regular jobs --which was unthinkable when they first approached the center.

Conservatives resist heroin maintenance

Despite the therapy’s success, heroin maintenance treatment remains highly controversial. The injection clinics initially sparked angry protests among residents living near them, particularly in Hamburg and Frankfurt. But most have since dropped their resistance.

However, politicians in Germany remain split on whether the project -- which has already been extended once -- should be renewed beyond June 2007.

In particular, the conservatives in Germany’s current grand coalition government are against the project.

Though members of the Christian Democratic Party (CDU) and its sister party, the Christian Social Union, (CSU) declined requests for interviews; their resistance to the project on ideological and financial grounds is well known.

Last year, they reacted furiously to a proposal to make heroin available by prescription.

"These plans aren't acceptable. The CSU won't approve any legislation that will make the state a drug dealer," Markus Söder, general secretary of the CSU told daily Die Welt, adding there was no way "the state will pay for the junkies' fix" when citizens were paying ever more for their health. The heroin maintenance project has so far cost over 12 million euros.

"A big chance for Germany"

Experts however rebuff the too-expensive argument, saying that though heroin maintenance is admittedly more expensive than methadone therapy; the benefits far outweigh the costs.

"You have to look at the bigger picture. Heroin therapy isn't expensive if you take into account the indirect costs that you save in terms of improved quality of life, productivity and improved health," Hamburg researcher Haase said. He says the therapy will cost just around 10,000 euros per patient every year for the estimated small group of Germany's 1,500 severe heroin addicts.

"This is a big chance for Germany to take a step forward and create a modern therapy to tackle drug dependency," Haase said.

Legalizing heroin a sticking point

The conservatives -- who control the upper house of parliament and can thus block legislation -- are also against changing Germany’s drug laws to legalize heroin and approve it for medical use, a point that experts say is absolutely essential.

"It's really annoying that a medical discussion has been hijacked by politics," said Ralf Hüllinghorst, head of the German Head Office for Dependency Matters (DHS) who stressed that heroin administration had to made part of regular health care in Germany.

"If heroin maintenance has proved to be effective, we have to be able to make use of it. Heroin has to be legalized and doctors should be allowed to prescribe it like in the Netherlands and in

Switzerland."

The matter however is far from decided. Conservative members of Germany's parliament face a challenge from their own party members on the issue at the state level.

Hamburg which is ruled by a CDU government said last week it was kicking off a campaign to lobby support in the upper house of parliament to amend German drug laws to legalize heroin. Frankfurt too saw a rare show of support across party lines for extending its heroin injection clinic.

Patients stand to lose everything

As the debate rumbles on, advocates of the project warn that if the German government doesn’t extend the project and legalize heroin it would spell disaster for hundreds of patients.

"If the clinic closes and we stop the diamorphine doses, it will make everything worse for the patients who have managed to stabilize their lives," said Karin Bonorden-Kleij who pointed out that most of her patients had managed to break away from a life of criminality and abuse and painstakingly build a normal life.

"If you take this away from them, I fear that some will not see the point of living anymore and commit suicide."