Moana Mika, medical scientist and science journalist

When is a drug a drug? Many people probably first think of heroin, injected into a vein in a dark corner of the park. But not of nicotine, which carries you through the office routine between deadlines and video calls. According to the World Health Organization (WHO), drugs are substances with psychoactive effects. These are substances that, for example, can elevate mood, trigger strong emotions, or even slow down memory.

The glass of red wine in the evening that gently lulls you to sleep? The after-work beer that lets you briefly forget the daily grind? Or the cigarette for that necessary energy boost? From a medical standpoint, we all consume drugs.

The fact remains: drugs have always been defined not only by medical criteria but also by societal ones. As recently as the early 20th century, alcohol fell into disrepute here: The "poison" was said to harm society in the long run. And when cannabis products emerged around 1960, there were concerns about the degeneration of youth. Today, neither alcohol nor cannabis causes an outcry. However, the record-high cocaine consumption in Zurich or the devastating crack epidemic in Geneva do.

One thing is clear: psychoactive substances have always been consumed and will continue to be consumed. But it is society's engagement with them that determines how they are dealt with. It decides whether a substance is labeled as a drug, whether it is seen as a narcotic or a recreational substance, whether it is stigmatized or becomes socially acceptable, whether users are driven into illegality or allowed to consume with reduced risks. And this engagement can take a long time. A very long time.

Crisis Years, Heroin, and HIV

Flashback: As late as the 1980s, unmarried couples were not allowed to live together in parts of Switzerland. Repression was high, and there were hardly any spaces for the youth. The English punk band Sex Pistols screamed an angry "There's no future!" in their song "God Save the Queen." The lyric became the motto of an entire generation – no future. To make matters worse, at the beginning of the 1990s, Switzerland also faced an unusually high unemployment rate. It was called the years of crisis. The disillusioned Swiss youth responded with a carefree attitude and contempt for everything conventional. And then came the drugs: They hit the thirsty generation like long-awaited rain. Heroin and cocaine met with curiosity, tolerance, and a sense of adventure – who wanted to be square? And there was nothing to lose anyway.

By the mid-1980s, the number of people injecting drugs rapidly increased. Zurich's Platzspitz became known worldwide as "Needle Park." At times, around 3,000 users frequented the park, many even stayed overnight. There were days when paramedics revived up to 25 people in the park.

The shock of the drug crisis was immediately followed by the next: HIV and AIDS. And this terror shook the country like a devastating aftershock: Again, people had to witness – helpless and overwhelmed – how people were now dying not only from drugs but also from a horrific, previously unknown disease. Between 1983, when Switzerland officially recorded the first HIV infection, and 2016, more than 4,800 people contracted HIV through needle-sharing. Until the early 1990s, intravenous drug use was the most common route of transmission. The peak occurred in 1990, when there were 553 new infections among users. For comparison: in 2023, there were only four. What happened in between?

Four Pillars to Address Societal Failure

The misery of the open drug scenes caused great shock among the public and heated debates in politics. The Aargau cantonal doctor Hans Pfisterer stated in an interview on Swiss television in 1973: "In my opinion, drug addiction is a symptom of societal failure." This failure was finally addressed in the early 1990s: After much back-and-forth, the four-pillar model was established nationwide. The model stipulated that, in addition to prevention, treatment, and law enforcement, the urgently needed harm reduction should be introduced. Thanks to this model, drug outreach centers were legally established, methadone was provided, and clean syringes were distributed.

The aim of harm reduction is simple: to minimize the negative consequences of drug use as much as possible. Users should be able to lead as comfortable and self-determined a life as possible.

And yet, the measures implemented during the drug crisis were lagging behind: Hundreds died from drugs, thousands contracted HIV and viral hepatitis. And whether drug-dependent, HIV-infected, or neither: the whole country was shaped by the crisis.

Drugs are cunning: they hijack circuits in our brain, specifically the ones responsible for the reward system. Our brain craves the rush of reward and cannot get enough of it. But, like everything that feels good, the effect diminishes over time. To trigger the same reward feeling, more frequent and larger doses are needed. Gradually, drugs can change the brain to the point where it cannot function properly without them. On the contrary, abstinence causes symptoms – anxiety, tremors, sweating, nausea, restlessness.

Today, it is believed that around 20 percent of drug users become addicted to substances like heroin, cocaine, and amphetamines. It is still being researched why some people develop an addiction while others do not.

What Have We Learned From It?

So why do we consume drugs? If they harm us and make us suffer? There are probably as many answers to this question as there are people who use drugs. Drugs can be pure enjoyment. But they can also be a way to cope with pain – physical or psychological. For some, drugs are a way to deal with themselves and the world. For others, they are the gateway to the next adventure – the forbidden, the kick, the fun. And yet others seek connection and community in collective consumption.

One thing became clear starting in the 2000s and is now undisputed: the harm reduction measures were effective as a response to the drug crisis. The Swiss HIV Cohort Study (SHCS) calculated a few years ago the extent of HIV infections in a model – with a clear result: More than 15,000 additional HIV cases among drug users were prevented, and more than 5,000 deaths from AIDS were avoided.

Since the crisis in the 1980s and 1990s, drug use in Switzerland has changed significantly: The open drug scenes have disappeared, and intravenous drug use has decreased. However, the consumption of so-called recreational drugs has increased, as shown by the Swiss Health Survey by the Federal Statistical Office. These include substances like Ecstasy at Dayraves, which releases happiness hormones synchronized with techno beats, or cocaine lines on the way out, to feel strong as a lion in the crowd. Or methamphetamine at a Chemsex session, as the game of love is meant to become a true powerplay.

Drugs are part of our society. What should not be part of it, however, are crises like those that Switzerland went through in the 1980s and 1990s. With all the misery that the time brought with it in mind: The country has learned, grown, and forged new paths. Today, an informed and enlightened consumption is possible – because knowing the effects and consequences of drugs is the key to managing them. And with this knowledge, it doesn't matter whether a substance is labeled a drug or not.