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. Harm reduction services for users of traditional drugs (mainly heroin) consist of a combination of care and support, while services for recreational users focus on the prevention of drug-related health emergencies, including drug-related deaths. Methadone and heroin programmes, needle and syringe programmes (NSPs), supervised drug consumption rooms, sheltered living projects and treatment of drug-related infectious diseases are widely available for people with problem drug use patterns.
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.
Most outreach work is carried out by low-threshold services in outpatient care facilities. Drug consumption rooms offer the possibility of hygienic and supervised consumption. In 2018, there were 24 drug consumption rooms across 19 Dutch cities servicing people who inject drugs and those who smoke or inhale. At some Regional Institutes for Protected Living, the use of drugs is also tolerated. Outreach activities also feature in programmes for reducing drug-related public nuisance, which are a collaborative venture between treatment and care facilities, the police and civil groups.
NSPs were established in the Netherlands over 30 years ago and are available in all major cities. These programmes are mainly implemented by addiction care and some municipal health services, and syringes are available through street drug workers and at treatment centres. There is no national monitoring of the number of syringes and needles distributed. Available local data from Amsterdam and Rotterdam indicate a continuous decline in syringe provision between 2002 and 2017 to one fifth of the original number; the decline is attributed to a reduction in heroin use and injecting in general and an increase in the inhalant use of other substances such as crack cocaine.
In 2015, the new oral interferon-free direct-acting antiretroviral treatments for hepatitis C virus (HCV) infection became reimbursable. Such treatment is offered to all HCV patients, irrespective of the level of fibrosis. A comprehensive hepatitis plan was launched in 2016, and the Health Council advised that people who use drugs should actively be offered hepatitis B virus and HCV testing. Addiction care institutions were identified as the main players responsible for case finding in this risk group. Several projects implement chain of care pathways to lead HCV-positive drug users into treatment in hospital centres. In addition, retrieval projects in several parts of the country aim to find patients previously diagnosed with chronic HCV, including people who use drugs, to offer them treatment with direct-acting antiretroviral drugs.
|Country||Needle and syringe programmes||Take-home naloxone programmes||Drug consumption rooms||Heroin-assisted treatment|