In The Netherlands, harm reduction has been one of the pillars of national drug policy since decades. Harm reduction focuses on the reduction of (health and social) harms as a consequence of drug use. Acceptance of drug use is paramount, and to receive care or support, it is not a requirement to discontinue the use of drugs.
While the Netherlands has seen a decline in the ‘traditional’ group of people who use harm reduction services for many years, there appear to be newly emerging target groups and new types of drugs and/or drug use that post novel challenges to harm reduction services. Read all about the current state of affairs among Dutch harm reduction services in the report below.
The Dutch Harm Reduction Network (HRN):
goals and main activities
The Harm Reduction Network aims to gather, interpret and spread knowledge and the systematic monitoring of the availability of harm reduction intervention in The Netherlands. The focus lies with interventions for people who (problematically) use heroin and (base)cocaine. The network also initiates network meetings, webinars and congresses, and supports addiction care in the area of harm reduction in a broad sense. The Harm Reduction Network is financed by the Dutch Ministry for Health, Welfare and Sports and coordinated through the Trimbos Institute – Netherlands Institute for Mental Health and Addiction by Daan van der Gouwe (project leader) and, Nadine van Gelder (scientific associate).
What is harm reduction?
In The Netherlands, harm reduction has been one of the pillars of national drug policy since decades. Harm reduction focuses on the reduction of (health) harms as a consequence of drug use. Acceptance of drug use is paramount, and to receive care or support, it is not a requirement to discontinue the use of drugs. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) describes harm reduction as follows: “Harm reduction encompasses interventions, programmes and policies that seek to reduce the health, social and economic harms of drug use to individuals, communities and societies“. Harm Reduction International (HRI) gives a similar description: “Harm reduction refers to policies, programmes and practices that aim to minimise negative health, social and legal impacts associated with drug use, drug policies and drug laws.” The Dutch Harm Reduction Network defines harm reduction as “Reducing (health) harm from drug use, firstly to users, but also for their (social) environment and society as a whole”.
Harm reduction measures deployed in The Netherlands are needle and syringe programmes (NSP), drug consumption rooms (DRC), opioid replacement therapy (ORT), and heroin assisted treatment (HAT). These intervention have made an important contribution to the improvement of the living condition, health and quality of life of people who use drugs, as well as to public nuisances and acquisition crime (De Gee & Van der Gouwe, 2020). The number of drug-related deaths is relatively low in The Netherlands (EMCDDA, 2020 (p.68)), and the incidence of infectious diseases has decreased among people who use. In general, harm reduction measures have been proven to be cost-efficient (Wilson, Donald, Shattock, Wilson & Fraser-Hunt, 2015).
'Traditional' harm reduction
The first harm reduction initiatives focused on users of heroin and (base) cocaine who mostly became dependent on (usually both) drugs in the 1980s and 1990s. Initially, mainstream addiction care did not have adequate support and care to offer for this group. This was because existing support and care was mainly aimed at abstinence, and for many users of these substances this proved unfeasible, and relapse occued often. Low-threshold facilities were therefore created, with fewer demands on their visitors, at least not the requirement to stop using drugs. The harm reduction facilities developed in this context, such as living rooms (low-threshold shelters), needle- and syringe exchange projects and methadone dispensing, are also known as 'traditional' o 'classic' harm reduction. The starting point of these facilities is harm reduction for the user and his/her environment. Staying in touch with the target group is considered very important, and where possible, referrals to care are initiated.
Harm reduction in recreational settings
With the emergence of recreational and less addictive substances such as ecstasy in the late 1980s, combined with the rise of the dance culture, -parties and -festivals, prevention workers, social workers and the target group itself felt the need to introduce harm reduction measures in this setting as well. These included offering the possibility of drug testing, gradually setting up peer projects in which (former) users educating other users of recreational drugs about the effects and risks of drug use, and introducing first aid posts at parties, events and festivals. For more information on initiatives in recreational settings, see the websites of the Drug Information and Monitoring System (DIMS), Celebrate Safe, and Unity. While these are also very valuable harm reduction interventions, the Dutch Harm Reduction Network focuses primarily on the vulnerable group of users dependent on heroin and (base) cocaine and the harm reduction facilities and interventions for this target group.
History of the network
In the 1980s – as a result of the aids epidemic which also spread among people who used drugs – several initiatives for (regional) cooperation were set up to curb the epidemic. In 1988, the national network on aids and drug use was established. About a decade later, interest in the theme had dropped among addiction care facilities, among others due to the vanishing of allocated funding. The topic of infectious diseases among people who use drugs would be accommodated at the national support centre for prevention as of 1998. National network meetings were revived, and (training)tools were developed with co-financing from the Aids Fund. Later, a cooperation on har reduction developed between Trimbos Institute and the Mainline Foundation. From 2012 until 2019, the focus of the network’s activities has securing of prevention and care for infectious diseases within the (social) addiction care setting.
Read more about Harm Reduction in the Netherlands (in Dutch) >
Improvements in health and quality of life
In the 1980s, the inner cities of many Dutch municipalities were characterised by groups of problem users of heroin and cocaine, causing nuisances on the streets and in public areas such as public transport and shopping centres. Dealing and drug use mostly took place on the streets, and use was mostly paid for through shoplifting, bicycle theft and other petty crime. Since the gradual introduction of harm reduction facilities such as methadone dispensing, but certainly also (later) of drug consumption rooms, the living conditions, health and quality of life of drug users have greatly improved, and drug nuisance and acquisition crime have decreased significantly (De Gee & Van der Gouwe, 2020). The number of drug-related deaths in the Netherlands is relatively low. The incidence of infectious diseases within this group has also decreased: harm reduction measures such as syringe exchange programmes and methadone maintenance programmes have successfully contributed to the prevention of an HIV epidemic among injecting drug users. Harm reduction interventions have also proved cost-effective.
Harm reduction facilities
HRN is currently working on an overview of harm reduction facilities in The Netherlands: drug consumption rooms, methadone and heroin dispensing, syringe exchange programmes, low-threshold facilities such as drop-in centres and living rooms, and other facilities. As of 2023, we will update data by harm reduction facility type via this webpage.
Drug consumption rooms
The most recent inventory on drug consumption rooms (DCRs) in The Netherland showed that there were 24 DCRs available (De Gee, Woods, Charvet & Van der Poel, 2018), as well as 18 alcohol consumption rooms rooms in 2015 (Zijlstra-Vlasveld & Van der Poel, 2015). Interesting developments are taking place around DCRs in the Netherlands. 'Drug consumption rooms in the Netherlands' (2018) updates the handbook (from 2003) on the organisation and design of DCRs and provides an overview of these facilities in the Netherlands. An older inventory can be found in the article 'Organisation and design of use rooms in the Netherlands (2003-2010)' (Tijdschrift Verslaving, 2012), which describes developments between 2003 and 2010. In 2015, a similar survey was conducted on the organisation and design of alcohol consumption rooms in the Netherlands.
Needle- and syringe exchange
Over the past years, injecting heroin and cocaine has become less and less common in The Netherlands; most users now smoke these drugs. For this reason, exchanging used needles and syringes has to some extent become an afterthought at many institutions: it still takes place, but on a smaller scale than in the 1980s and 1990s. Nationwide figures around numbers of exchanged syringes are not available. The most recent local data are from 2018: in that year, 90,000 syringes were exchanged in Amsterdam, half of that in Rotterdam (internal communication Trimbos Institute).
Methadone and heroin provision
The most recent data on numbers of clients in methadone substitution treatment (MST) are from 2014, and for clients in heroin -assisted treatment (HAT) from 2018. In 2014, there were 7,569 clients in MST; the average dosage was 80mg/day. In 2013, there were 82 locations where people dependent on opiates could go for MST (Trimbos Institute, 2013). When it comes to HAT, there were 602 spots available at 17 locations in 16 cities in 2018. There are 18 locations where people dependent on opiates can go for treatment with medical heroin. At 10 of these locations, both methadone-only and medical heroin treatment in combination with methadone take place.
Civil society involvement is increasingly regarded as an important and effective element to prepare, adjust and/or evaluate drug policies. This happens at local, national and international level. Where drug and infectious disease policies are concerned, all supranational institutions such as the European Commission, the World Health Organisation (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Office on Drugs and Crime (UNODC) have mechanisms to structurally involve civil society in discussions. At the national level, several countries have established mechanisms ranging from information sharing to actively involving civil society in policy. What is particularly important is to involve the people the policy is about and give them a voice. The aim here is to achieve optimal and effective drug policies.
National Civil Society dialogues
Civil society meetings in The Netherlands aim to promote a direct and transparent dialogue on (the elaboration of) drug policy between civil society and the Dutch government. To provide a platform to signal the (desired and undesired) effects of current drug policies on actual users of illicit substances or to propose and discuss policy changes. The organisation of these meetings in The Netherlands is currently in preparation by the Ministry of Health, Welfare and Sports.
Harm reduction organisations
Australia Harm Reduction Australia
Belgium Modus Vivendi
Netherlands Mainline Foundation
Netherlands Regenboog Groep / Correlation
United Kingdom UK Harm Reduction Alliance
United States National Harm Reduction Coalition
Europe Correlation | European Harm Reduction Network
Eurasia Eurasian Harm Reduction Association
Middle-East Middle East and North Africa Harm Reduction Association
International Harm Reduction International
International Women and Harm Reduction International Network
Daan van der Gouwe (project leader)
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