The Dutch national drug treatment strategy places an emphasis on the empowerment of treatment clients, and their reintegration and self-regulation.
Responsibility for the organisation, implementation and coordination of addiction care in the Netherlands has been delegated to regional and local authorities, and is part of the broader mental healthcare agenda. Drug treatment is provided by 14 regular addiction care and treatment institutes, of which seven have merged with a mental health institutes and one with an institute for social support. Municipal public health services, general psychiatric hospitals, several religious organisations and some private clinics also offer care for people with substance use problems. Since the start of 2014, drug treatment has been provided in a three-step approach: frontline support from a general practitioner or a general practice mental health worker, followed by primary mental healthcare and secondary mental healthcare. Some treatment providers may have inpatient treatment programmes.
In general, funding for drug treatment is provided by health insurance, while the public budget for social support at the national and local levels funds specific programmes, such as heroin-assisted treatment.
The options for drug treatment interventions in the Netherlands are diverse. OST, complemented by psychosocial treatment, is the treatment of choice for opioid dependence. Available psychosocial treatments in drug treatment centres include motivational interviewing, relapse prevention techniques, cognitive-behavioural therapies, and family, community and home-based therapies. New treatment options have been introduced for young cannabis users, people with multiple (dependencies and mental health) problems and crack cocaine and GHB users. In addition, new treatment settings for homeless drug users in several municipalities have been opened.
OST with methadone has been available since 1968. Heroinassisted treatment (HAT) was introduced in 1998 and highdosage buprenorphine treatment in 1999. HAT is provided at 18 outpatient treatment units, while methadone-based treatment is available from various treatment providers, including office-based practitioners and mobile units.
Trends in percentage of clients entering specialised drug treatment, by primary drug in the Netherlands
NB Year of data 2015.
Opioid substitution treatment in the Netherlands: proportions of clients in OST by medication and trends of the total number of clients
NB Year of data 2014.
In 2015, more than 31 000 people received drug treatment in the Netherlands, mainly in outpatient settings. Around one third of them were treated for primary cannabis use, while opioid users constituted the second largest group of treatment clients, followed by cocaine users.
Cannabis users also formed the largest group among those who entered treatment in 2015. Primary cocaine users were the second largest group, followed by primary opioid users.
Fewer than 2 out of 10 treated opioid users entered treatment in 2015, and most of them were already in longterm treatment programmes, such as OST. Moreover, the number of new treatment entries attributable to opioid use has reduced and the mean age of opioid treatment clients has increased, indicating ageing of the opioid-using population in the Netherlands.
According to the latest available data (2014), 7 421 clients received OST, a large majority of whom were treated in methadone maintenance programmes.