Mr Bruggmann, the Arud Centre for Addiction Medicine treats around 4,000 addicts, including young people. How old are they?
They are a small proportion of our patients. Most are older, around 18. It's not that there is no need among younger people. We have tried several times to recruit specialists from child and adolescent psychiatry, but found that they are often unfamiliar with addiction issues. There is a gap in care here.
What substances do the young people you treat consume?
There must be serious problems before someone comes to our facility. On the one hand, we see young people who come to us on their parents' initiative because they are struggling at school or have problems at home, usually due to cannabis use. On the other hand, we also treat 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 addiction manifests itself less physically, but through consequences such as expulsion from school or apprenticeships and serious family crises.
What is the deal with opioids?
The term is a collective term for substances that bind to opioid receptors and have strong analgesic, sedative and euphoric effects. The group of natural opioids consists of opiates, which are active substances such as codeine or morphine extracted directly from the opium poppy plant. Then there are semi-synthetic opioids such as heroin, which is a chemical derivative of morphine, and synthetic opioids, i.e. those produced entirely artificially, such as oxycodone, tramadol and tilidine. These are found in medium-strength to strong prescription painkillers.
What opioids do addicted young people use?
The situation has changed fundamentally. It is no longer about heroin from the street; the focus is now on synthetic opioids that are traded as medicines. Young people often consume goods from the darknet. For some, the path to addiction began with an opened box of medicines from their parents' medicine cabinet. I'm not talking about fever reducers here, but very strong painkillers that are taken after surgery. 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 encountering more and more frequently.
And minors order them themselves via the darknet?
I suspect that the majority obtain the substances through intermediaries. There are many indications that synthetic opioids are less commonly traded on the traditional black market and are increasingly coming from the darknet. There is an increased risk that preparations contain something much stronger than the stated active ingredient. We have had cases where Oxycontin, which is actually a moderate painkiller, ordered from the darknet contained nitazene. These are synthetic opioids that can be fatal in very small doses for someone who is not used to them.
Serious incidents involving synthetic opioids are on the rise abroad, and an epidemic is even underway in the United States. How do you assess the situation in Switzerland?
It is likely that addiction and deaths caused by synthetic opioids will become more common in our country. As I said, the problem is their distribution via the darknet, where highly potent opioids such as nitazene and fentanyl are offered. However, the situation is not comparable to that in the USA. There, a pharmaceutical company promoted an Oxycontin preparation and sold it as harmless, causing thousands of people to become addicted. When the drug was taken off the market, these people switched to heroin – and where this was in short supply, to fentanyl. This cannot happen in Switzerland. We have much stricter approval and prescription criteria for drugs and are very well positioned when it comes to caring for opioid addicts.
How severely are young people affected by this problem?
It's a small minority. Nevertheless, education is extremely important – and we need to make young people aware of the drug-checking services that offer free chemical analysis of psychoactive substances and also warn them about particularly dangerous combinations. Mixed consumption is a problem we are seeing more and more often, especially among young people.
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 medications such as benzodiazepines. Benzodiazepines have anxiolytic, sedative, muscle relaxant and sleep-inducing effects. They are used to treat anxiety and other mental health conditions, under trade names such as Xanax, Valium and Temesta.
I wish drug checking would be established everywhere. It saves lives.
How does this phenomenon occur?
Music and social media play an important role. Rappers sing about consuming Xanax, and on TikTok there are challenges involving «drinks» such as lean or purple drank. These are mixed from lemonade, sweets, prescription cough syrup and medication – instructions are included. What looks cool can be deadly when substances are combined that would not necessarily be dangerous on their own but can have fatal effects when mixed, 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 consumption. The fear that this will tempt them is a misconception. It is much more dangerous to treat things as taboo and let young people try things without any background knowledge. When it comes to medication in particular, many are more willing to experiment because they think medicines are harmless.
I would also like to see drug checking established everywhere. Some regions are reluctant to do so because they fear it will encourage drug use. The fact is, drug checking saves lives. We should accept that a certain amount of drug use occurs, especially among young people, and work to ensure that as few people as possible come to harm as a result.
