Harm reduction is a central feature in the Dutch drug policy and is aimed at reducing drug-induced deaths and drug-related infectious diseases, as well as at preventing drug-related emergencies.
In the Netherlands, harm reduction activities are implemented through outreach work, low-threshold facilities, and centres for ‘social addiction care’, the main goal of which is to establish and maintain contact with difficult-to-reach drug users. All services attempt to motivate difficult-to-reach drug users to participate in some kind of treatment to prevent their individual and/ or social situation from worsening. However, if this is not feasible, support is given to drug users to reduce the harmful consequences of drug use.
Most outreach work is carried out by low-threshold services in outpatient care facilities, targeting street-based problem drug users and drug-using sex workers. Drug consumption rooms offer the possibility of supervised consumption to chronic hard drug users. Other target groups are PWID, high-risk drug users and drug users from foreign countries. Outreach activities also feature in programmes for reducing drug-related public nuisance, which are a collaborative venture between treatment and care facilities, police and civil groups.
Needle and syringe programmes have been established in the Netherlands for more than 20 years and are available in all major cities. These programmes are mainly implemented by street drug workers and at treatment centres. In some cities, pharmacies are involved in needle and syringe programmes, and in Rotterdam needle and syringe exchange is available at several police stations. There is no national monitoring of the number of syringes and needles distributed. Available local data indicate a significant decline in syringe provision since the 1990s, which can be attributed to a reduction in heroin use and injecting in general as a result of increasing coverage of opioid substitution treatment (OST), and an increase in the inhalant use of other substances, such as crack cocaine. Therefore, it is assumed that the current level of syringe provision meets the needs for clean injecting equipment among the majority of people who inject drugs.
The first drug consumption room was established in 1994; currently there are 31 drug consumption rooms across 25 cities, servicing people who inject drugs and those who smoke or inhale drugs.
Availability of selected harm reduction responses
NB Year of data 2016.
In 2015, HCV treatment availability expanded and the new oral interferon-free direct-acting antiretroviral treatments became reimbursable. A comprehensive hepatitis plan was launched in 2016, and the Health Council advised that drug users should actively be offered HBV and HCV testing. Addiction care institutions were identified as the main players responsible for case finding.
In 2015, more than 31 000 people received drug treatment in the Netherlands, mainly in outpatient settings