Netherlands Country Drug Report 2019

Treatment

The treatment system

The Dutch national drug treatment strategy places an emphasis on the empowerment of 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 health care agenda. Drug treatment is provided by specialised addiction care organisations. 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 reorganisation of mental health care in 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 generalist primary mental health care and specialised mental health care. Some treatment providers deliver 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 and supported living.

The options for drug treatment interventions in the Netherlands are diverse. Opioid substitution treatment (OST), complemented by psychosocial treatment, is the treatment of choice for opioid dependence, and OST with methadone has been available since 1968. Heroin-assisted treatment (HAT) is provided at 17 outpatient treatment units in 16 cities (668 treatment slots), while methadone-based treatment is available from various treatment providers, including office-based practitioners and mobile units. In case of gamma-hydroxybutyrate (GHB) dependence, treatment with medical GHB is available, and research is being done into relapse prevention by means of baclofen.

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, crack cocaine users and GHB users. In addition, new treatment settings for homeless drug users in several municipalities have been developed.

#

Treatment provision

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 were already in long-term 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 an ageing of the opioid-using population in the Netherlands. According to the latest available data, in 2014, close to 7 500 clients received OST, a large decrease from 2011. It should be noted that the steep decrease after 2011 is probably related to changes in registration. All OST clients were treated in methadone maintenance programmes, some of which also received heroin-assisted treatment.

#

#


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.