Bergen tackles the heroin crisis

With treatment options, social workers, and safe injection sites, Norway’s second city is getting addiction off the streets and breaking the generational cycle of drug abuse

Lori Ann Reinhall
The Norwegian American

It was a rainy Saturday afternoon in September, but rain never keeps the citizens of Bergen away from a celebration, especially not when one of the most beautiful parks in the city is being dedicated. There was free coffee and traditional Bergen “skillingsboller” (cinnamon buns), a drum brigade set the mood, and lively musical performances added to the festive atmosphere. Hundreds were on hand, old and young alike, to watch Mayor Marte Mjøs Persen cut the red, white, and blue ribbon. After three years of refurbishment at the cost of NOK 25 million, Nygårdsparken was officially re-opened.

Five decades ago, things looked much different in Nygårdsparken. In the late 1960s the residents of Bergen could see drugs being bought and sold in the city’s largest urban green space. Ten years later, it was common to see hash traded openly, and the park was becoming a regular hangout for users. An attempt was made to shut down the drug scene there in 1989, but as users made their way to the city center, there were concerns about the negative impact on tourism and the overall safety of Bergen’s citizens.

With time, police surveillance of the park eased up. The situation degenerated, and Nygårdsparken achieved notoriety as the largest open drug scene in all of Europe. By the mid-1990s, heroin had found its way to Norway, and the park lawns were filled with needles and syringes. But while addicts were dying of overdoses, law enforcement turned its focus away from them and directed its attention to drug cartels, dealers, and smugglers. Public health and safety concerns mounted, and eventually the drug scene in the park became intolerable for the surrounding neighborhood. Finally, in August 2014, the park was shut down once and for all. Bergen’s heroin addicts suddenly had nowhere to go.

But Bergen is not a city that leaves its citizens in the lurch. A comprehensive program was put in place to build an infrastructure of drug-treatment facilities, as well as housing for those being displaced from Nygårdsparken. Special residences for heroin addicts are now subsidized by the municipality, with 24-hour on-site supervision by qualified social workers. Furthermore, two new rehabilitation sites were opened with plans for a third in the making, and a safe injection site was added to the municipality’s existing heroin-treatment facility. All this was done to help Bergen’s addicts, reducing their health risks and offering settings that encouraged them to receive further treatment.

Coming from Seattle, a city with its own heroin crisis, I wanted to learn more about the drug-treatment initiatives in our sister city. I reached out to officials at Bergen City Hall and was put in contact with Marit Sagen Grung from the Department of Social Services, a health-care professional and social worker with 18 years of experience working with drug abuse. Grung and I set off together to visit two of three Bergen facilities specializing in the care of heroin addicts.

Our first stop was Nesttun, a half-hour tram trip from the city center, the home of a day rehab center. The facility is strategically situated near the main shopping area—easy to access from public transportation, yet quietly tucked away in a cul-de-sac, offering privacy and repose.

When you enter the house, you are struck by its cleanliness and lightness. Colorful artwork and the smell of fresh coffee welcome you. We were greeted by Rasmus Litland, the center’s director, who is assisted by a staff of committed professionals: nurses, social workers, and a cook.

The staff wears ordinary street clothes in order to mix in with the clients, yet one can immediately recognize who is who. The faces of the addicts show the wear and tear of years of drug abuse and personal neglect; even a smile cannot hide it. Some look tired from a night on the streets, others are ready for a shower or a hot meal. All of this is available to them at the center. They can also lie down on a comfortable sofa for a rest. While all clients have subsidized apartments in buildings supervised by certified social workers, they don’t always find their way home.

Hygiene and nutrition are major concerns at the center; heroin addicts have their own special needs. Injection by needle carries the risk of infection, but having the proper equipment and a sterile environment provides some protection. Clients may consult with the nurse on duty for advice and assistance with wounds, and they receive instruction on how to safely inject and avoid overdosing. While medications are not distributed, natural remedies are sometimes administered. The Nalokson nasal spray program to reduce the effects of overdose is also a key part of the services offered. Finally, three solid meals a day with healthy snacks are available. Clients can also wash their clothes, or even get new clothes donated by volunteers.

The staff at Nesttun believes that maintaining a sense of dignity is key to recovery. While most addicts never find their way, there are some success stories. The next step is treatment at a methadone clinic. Some may never return to productive working life, but there may be hope for the next generation. Litland tells of a female client who still struggles with addiction but is proud that both her daughters are studying at the university with bright futures ahead.

I asked the staff at Nesttun if they have a vision for the future. Their answer was without hesitation and unanimous: to see heroin use decriminalized. Beyond that, it is their dream that even more centers will be built to reach out to more of those in need and that they will want to come get help. They understand that their clients are “social cases”—victims of broken homes, violence, and child abuse. Many are in a third generation of drug abuse, and the staff’s goal is to break this cycle. The staff sees itself as part of a humanitarian effort to help those who have fallen victim to unfortunate circumstances in life, including criminal drug cartels. They view their work as vitally important, and they like their jobs.

Much closer to the city center is Strax-huset, the largest center for heroin addicts in Bergen. The facility opened in 1995, dating back to the earlier days of the HIV epidemic. Here the atmosphere is considerably more institutional, due to its size and sheer volume of visits. Located next to a bridge and tunnel where addicts displaced from Nygårds­parken now congregate, it has a reputation as a rough environment. But I learn from the facility’s director, Hugo Torjussen, that the approach at the treatment center is much the same as at Nesttun.

“Strax-huset” roughly means “the straightaway house” in the sense of immediacy or urgency. It is a place where heroin addicts can drop in and get help on an “on demand” basis, providing they meet certain criteria. When the center opened two decades ago, clean needles were distributed to curb the rising HIV epidemic. In December 2016, a safe-injection room was added, the second in Norway coming online more than 10 years after the first in Oslo.

In 2017, the staff of 100 saw more than 5,000 visits, servicing approximately 1,500 unique users. To receive treatment, you must be addicted to heroin; other addicts are sent to facilities with programs designed to meet their needs. Torjussen explains that different addictions require different protocols. The staff at Strax-huset is trained in dealing with the heroin addict specifically.

Incoming clients are carefully vetted before the staff oversees their safe injections. Many of them overdose in the immediate surroundings by the bridge, and there is an urgent need to teach them how to correctly use heroin. Torjussen underlines that this by no means constitutes an effort to encourage drug abuse, rather it is an attempt to save lives. Last year, more than 5,000 nasal-spray antidotes were administered to prevent death by overdose.

At both Strax-huset and the Nesttun facility, approximately 75 percent of the clients are men. More than women, they suffer from loneliness and alienation, which may predispose them to drug abuse. Approximately 50 percent of those vetted suffer serious mental-health issues, and the staff is careful to screen for psychotic behavior that may put others at risk. Psychiatric treatment or psychological counseling is not provided at the center, but those at risk are referred to other programs.

Like at Nesttun, once admitted, the clients can shower and wash their clothes. Strax-huset also functions as an overnight facility for those who don’t have a residence or who are unable to stay at their homes. The rooms are simple, clean, and quiet. Meals are also available. The clients may consult with medical assistants in the health room, get a flu shot, or receive instruction on how to safely inject or what to do in the case of overdose. They may learn about the benefits of smoking heroin as opposed to injecting it, although, paradoxically, smoking must take place outside the premises, which by law are operated only for safe injections.

Currently, the facility is engaged in a research project on hepatitis C, a major cause of death among heroin addicts. New drugs have been developed, and the goal of the three-year study is to find a way to eradicate it within the next 10 years. The drugs are expensive and normally a stable condition is required for full efficacy, but all addicts nonetheless receive treatment.

Another innovative program at Strax-huset is an effort to clean up the facility’s immediate environment. When we arrived, a group of clients was busy cleaning up debris left there the night before, and some were painting over graffiti on the concrete walls under the nearby bridge. They are allowed to work four hours a day and receive NOK 50 (about $6.15) an hour in tax-free money. In the life of an addict, it is a very small amount of money, with habits costing up to NOK 3,000 (about $370) a day. This leads to prostitution for women and criminal activity for men, and many addicts steal from each other to survive.

The program at Strax-huset has not been without critics. There are “moral” arguments against drugs, with the reasoning that the Norwegian state should not embrace drug addicts. The media have also put a negative spin on safe injection sites in Bergen, reporting of the dangers of working there—yet no cases of serious violence against employees have ever been reported.

Without hard data and statistics, my visits to the heroin treatment sites at Nesttun and Strax-huset left me with the impression that something positive was happening in Bergen. Grappling with heroin addiction is a difficult, perhaps unsolvable, challenge, but it was encouraging to meet highly trained, committed professionals dedicated to helping their fellow citizens. Nygårdsparken is now a place for families to gather, the streets of Bergen are safer, and help is coming to those in dire need. There is a general consensus about the necessity to decriminalize heroin to focus instead on saving lives — and they feel certain that the work they are doing is making a difference.

This article originally appeared in the Jan. 12, 2018, issue of The Norwegian American. To subscribe, visit SUBSCRIBE or call us at (206) 784-4617.