Mr Bruggmann, the Arud Centre for Addiction Medicine cares for around 4,000 people with addictions, including young people. How old are they?
They make up a small proportion of our patients. Most are older, around 18. It's not that there's no need amongst younger people. We have tried several times to recruit specialists from the field of child and adolescent psychiatry, but found that they are often unfamiliar with issues relating to addiction. There is a gap in care here.
What substances do the young people you treat use?
There must be serious problems for someone to come to our centre. Among young people, on the one hand, we see those who come to us at their parents’ instigation because they are struggling at school or there are problems at home, usually due to cannabis use. On the other hand, we support young people who have lost their footing because they are addicted to opioids or consume cannabis to such an extent that they can no longer cope with everyday life. Severe cannabis dependence manifests itself less in physical symptoms and more through consequences such as expulsion from school or apprenticeship programmes and serious family crises.
What's the deal with opioids?
The term is a collective name for substances that bind to opioid receptors and have strong analgesic, sedative and euphoric effects. The group of natural opioids comprises opiates; these are active substances extracted directly from the opium poppy, such as codeine or morphine. Then there are semi-synthetic opioids such as heroin, which is a chemically modified form of morphine, as well as synthetic opioids – that is, those produced entirely artificially – such as oxycodone, tramadol or tilidine. These are found in moderate- to strong-strength prescription painkillers.
Which opioids do young people with drug addictions use?
The situation has changed fundamentally. It is no longer about heroin bought on the street; the focus is now on synthetic opioids that are sold as medicines. Young people often buy drugs from the dark web. For some, the path to addiction began with an opened box of medicines from their parents’ medicine cabinet. I'm not talking about paracetamol here, but about very strong painkillers taken after operations. Young people wanted to experiment and eventually lost control. Opioids have a high potential for addiction.
Among young people, poly-drug use is a problem we are facing with increasing frequency.
And minors order them themselves via the dark web?
I suspect that the majority obtain these substances through middlemen. There is much to suggest that synthetic opioids are traded less on the conventional black market and are increasingly sourced from the dark web. There is a heightened risk that products sold there contain substances that are considerably stronger than the stated active ingredient. We have had cases where OxyContin ordered from the dark web – which is actually a moderately strong painkiller – contained nitazene. These are synthetic opioids which, even in the smallest doses, can be fatal to someone who is not used to them.
There has been a rise in serious incidents involving synthetic opioids abroad, and in the US there is even an epidemic underway. How do you assess the situation in Switzerland?
It is likely that cases of addiction and deaths caused by synthetic opioids will increase here. As mentioned, the problem lies in their distribution via the dark web, where highly potent opioids such as nitazene or fentanyl are being sold. However, the situation is not comparable to that in the US. There, a pharmaceutical company promoted an OxyContin-based product and marketed it as harmless, leading thousands of people to become addicted to it. When the drug was withdrawn from the market, these people switched to heroin – and where heroin was in short supply, to fentanyl. This cannot happen in Switzerland. We have much stricter approval and prescribing criteria for medicines and are very well equipped when it comes to treating people addicted to opioids.
To what extent are young people affected by this issue?
We're talking about a small minority. Nevertheless, raising awareness is hugely important – and we need to make young people aware of the services offered by drug-checking centres, which carry out chemical analyses of psychoactive substances free of charge and also highlight particularly dangerous combinations. This is because, amongst young people in particular, the mixed use of substances is a problem we are encountering with increasing frequency.
Mixed consumption of what?
In recent years, there have been several deaths in Switzerland among young people who had taken multiple psychoactive substances at the same time. They mixed codeine-containing cough syrup and synthetic opioids with alcohol and other medicines such as benzodiazepines. «Benzos» have anxiolytic, sedative, muscle-relaxing and sleep-inducing effects. They are used to treat anxiety and other mental health conditions, and are available under brand names such as Xanax, Valium and Temesta.
I wish drug testing were introduced everywhere. It saves lives.
What causes this phenomenon?
Music and social media play an important role. For example, rappers sing about taking Xanax, whilst on TikTok there are challenges involving «drinks» such as Lean or Purple Drank. These are mixed from fizzy drinks, sweets, prescription cough syrup and medicines – complete with instructions. What looks cool can prove fatal when substances are combined which, taken individually, would not necessarily be dangerous, but which, when mixed, can have a fatal effect – such as causing respiratory paralysis.
Where do you see a need for action?
We must not leave education to social media. We should talk openly with young people about substances, their effects and their use. The fear that this might lead them astray is a misconception. It is far more dangerous if we treat certain topics as taboo and young people try things out without any background knowledge. When it comes to medicines in particular, many are more inclined to experiment because they think medicines are harmless.
I, too, would like to see drug testing become established everywhere. Some regions are reluctant to introduce it because they fear it will encourage drug use. The fact is: drug testing saves lives. We should accept that a certain amount of drug use does take place, particularly amongst young people, and work to ensure that as few people as possible come to harm as a result.
