Netherlands Country Drug Report 2019

Harm reduction

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.

Harm reduction interventions

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.

Availablity of selected harm reduction responses in Europe
Country Needle and syringe programmes Take-home naloxone programmes Drug consumption rooms Heroin-assisted treatment
Austria Yes No No No
Belgium Yes No Yes No
Bulgaria Yes No No No
Croatia Yes No No No
Cyprus Yes No No No
Czechia Yes No No No
Denmark Yes Yes Yes Yes
Estonia Yes Yes No No
Finland Yes No No No
France Yes Yes Yes No
Germany Yes Yes Yes Yes
Greece Yes No No No
Hungary Yes No No No
Ireland Yes Yes No No
Italy Yes Yes No No
Latvia Yes No No No
Lithuania Yes Yes No No
Luxembourg Yes No Yes Yes
Malta Yes No No No
Netherlands Yes No Yes Yes
Norway Yes Yes Yes No
Poland Yes No No No
Portugal Yes No No No
Romania Yes No No No
Slovakia Yes No No No
Slovenia Yes No No No
Spain Yes Yes Yes No
Sweden Yes No No No
Turkey No No No No
United Kingdom Yes Yes No Yes

Netherlands main page

Methodological note: Analysis of trends is based only on those countries providing sufficient data to describe changes over the period specified. The reader should also be aware that monitoring patterns and trends in a hidden and stigmatised behaviour like drug use is both practically and methodologically challenging. For this reason, multiple sources of data are used for the purposes of analysis in this report. Caution is therefore required in interpretation, in particular when countries are compared on any single measure. Detailed information on methodology and caveats and comments on the limitations in the information set available can be found in the EMCDDA Statistical Bulletin.

Additional note for the Netherlands: Data on number and quantity of seizures do not include all relevant law enforcement units and should be considered partial, minimum figures. Data for amphetamines, heroin and MDMA include seizures by Dutch Customs and the Royal Military Police, but do not include seizures by national or regional police forces. Cocaine seizures represent the majority of large seizures, comprising data from Dutch Customs (including Rotterdam and Vlissingen harbours), the Royal Military Police and the National Police Force, but regional police force data are not included. Cannabis data are limited to police seizures of plants, cuttings and tops seized during dismantlement of cultivation sites. Data on precursors (scheduled and non-scheduled substances) are based exclusively on reports of suspicious transactions of such substances to the Fiscal Intelligence and Investigation Unit.