In Belgium, the Federal Drug Policy Note of 2001 and the Communal Declaration of 2010 endorse harm reduction as one of three pillars of national drug response. The range of officially endorsed harm reduction programmes includes, among others, peer support, needle exchange programmes, drug consumption rooms and heroin-assisted treatment. Nevertheless, the two last programmes are not presently available in Belgium. In addition, the Belgian Early Warning on Drugs system can also be considered as a harm reduction approach. Needle and syringe programmes (NSPs) at low-threshold harm reduction projects have existed in the French community since 1994. In 1998, a law was adopted allowing needle exchange in pharmacies. In 2000, the Flemish community made the necessary legislative adaptations, and from 2001 such programmes have also officially been implemented there.
Availability of selected harm reduction responses
NBYear of data 2016.
NSPs (stationary, mobile or in pharmacies) are now available across the country, except in the German community. In general, harm reduction projects are set up and run by non-governmental organisations, and some are managed by city authorities. These projects are funded by the community and by the regions.
Between 2011 and 2013, an open-label randomised controlled trial was carried out comparing heroin-assisted treatment and methadone maintenance treatment in the city of Liège. The study concluded that the use of heroin-assisted treatment should remain a second-line treatment in patients who have resistance to methadone and recommendations were provided for setting up such a programme. Since then, discussions have been undertaken in order to proceed with this project.
The introduction of drug consumption rooms has been brought up and was also discussed at a political level. A working group of the General Drugs Policy Cell has been mandated to assess the necessary conditions for the introduction of drug consumption rooms.
The harm reduction projects offer, among other things, sterile injecting material (syringes, filters, ascorbic acid, spoons, alcohol swabs and injectable sterile water), foil, bicarbonate and containers, as well as collecting used syringes and needles. In addition, they facilitate the referral of PWID to other prevention and treatment services.
Over the years, the number of distributed syringes has increased in both the Flemish and the French communities, with over 1 million syringes distributed in 2015 across the country. In addition to syringe provision by low-threshold harm reduction projects, pharmacies in the French and the Flemish communities distribute a substantial number of
syringes. In the French community, syringes are distributed mainly as part of the subsidised ‘Sterifix’ kit. In 2015, 11 077 kits were dispatched to pharmacies, in addition to the syringes that were distributed. Annual evaluations of the NSPs in the Flemish community indicate that pharmacies can play an important role in the provision of injecting materials, as 9 out of 10 NSP clients report purchasing injecting material from pharmacies. It is important to note that not every province has a good geographical spread of NSPs.
In the prevention and control of infectious diseases among PWID, special emphasis in recent years has been given to HCV counselling and testing.