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Drug treatment overview for Netherlands

Map of Netherlands

1. National context

Responsibility for the organisation, implementation and coordination of addiction care in the Netherlands is delegated to regional and local authorities, and is part of the broader mental healthcare agenda. Addiction care is provided by 13 regular addiction care and treatment institutes, of which seven have merged with a mental health institute and one with an institute for social support. Municipal public health services, general psychiatric hospitals, several religious organisations and 10 private clinics also offer care for people with addiction problems. Addiction care is also available in the criminal justice sector, and within the probation services.

In the past decade, however, the number of addiction service providers has reduced considerably due to the many mergers that took place for economic reasons in the Dutch mental healthcare and addiction care services. In 2012, further agreements were reached among main stakeholders and funding institutions in mental health to gradually reduce the number of beds in long-term residential mental healthcare settings, including addiction services, and to expand outpatient services, services through general practitioners and e-health interventions (e.g. Drugsondercontrole). This shift supports an overall vision that puts addiction clients in charge of their own addiction treatment, by shifting the care towards empowerment, reintegration and self-regulation of the clients. Since the start of 2014, addiction care has been provided in a three-stepped approach: with frontline support from a general practitioner or a general practice mental health worker, followed by the primary mental healthcare and secondary mental healthcare. However, there have been some challenges related to co-payment for the primary mental healthcare services.

In general, funding for drug treatment is mainly provided by health insurance, while the public budget for social support at the national and local levels is mainly provided for special projects, such as heroin-assisted therapy. In 2012 out-of-pocket payments for addiction treatment were increased, which reduced the number of outpatient treatment clients and created resistance from care providers. As a result, in October 2012 the measure was cancelled. Some measures are taken by the Council for Care Insurance and the National Health Care Institute to further determine reimbursement criteria for addiction care.

The options for drug treatment interventions in the Netherlands are diverse. Outpatient opioid substitution treatment (OST) is dominant for opiate dependence. Psychosocial interventions are more frequently provided to complement OST in order to achieve longer-term effectiveness, reduce relapses and promote social reintegration. In recent years, however, new treatment options have been introduced for young cannabis users, people with multiple (addiction and mental health) problems, and crack and GHB users. In addition, new treatment settings for homeless drug users in several municipalities have been opened.

The psychosocial treatments that are frequently used in drug treatment centres include motivational interviewing, relapse prevention techniques, cognitive behavioural therapies, and family, community and home-based treatment therapies.

Methadone has been the most commonly prescribed substitution substance since 1968. Heroin-assisted treatment (HAT, introduced in 1998) and high-dosage buprenorphine treatment (introduced in 1999) are also available. HAT is provided at 18 municipality treatment units and is used with a restricted and controlled group of treatment-resistant opiate users. Methadone, on the other hand, is available via various outpatient treatment providers, including office-based practitioners and mobile units.

According to the latest available data (2013), a total of 8 185 clients were in methadone maintenance treatment. The number of people receiving buprenorphine-based maintenance treatment is not available.

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2. Treatment registries and monitoring systems

The Dutch Alcohol and Drug Information System (LADIS) has been operational since 1986 and covers 95% of all alcohol and drug treatment out-patient services in the Netherlands. From 1994 it has been operating as a population-based register in which contact episodes of individual clients can be linked over time with a unique code made anonymous by encryption. With the acceptance of the welfare law in 1998, the flow of various categories of data (diagnostic, demographic, treatment and evaluation) and the continuity of LADIS have been secured. Data capture, processing and quality control are highly automated. The information from LADIS concerns annual reports as well as numerous profiles of various groups of clients (Ouwehand and van Alem, 1999). A National Centre for Substance Registration (LCMR) is being formed and should deliver data on clients in pharmacologically-assisted treatment from 2006 onwards. So far, no data from the LCMR have been made. There were plans for a new registration system Zorgis but these plans have been replaced by plans for a new registration system called ALI, but these are still plans for the future. ALI will be the registration systems for the forthcoming Diagnosis Treatment Combinations. 

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3. Treatment demand

Table 1: Number of clients entering treatment in Netherlands by year
Clients in treatment 2010 2011 2012 2013
Number of all clients entering treatment 12919 13109 10801 11129
Number of all clients entering treatment with known primary drug 12919 13109 10801 11129
% of which for opioid use 15.8 12.8 12 10.3
% of which for cocaine use 26.0 24.6 27 26.3
% of which for cannabis use 44.6 48.3 48 48.6
% of which for stimulants use (other than cocaine) 6.3 6.7 6 7.3
Number of new clients entering treatment 6938 7671 6129 6460
Number of all clients entering treatment with known primary drug 6938 7671 6129 6460
% of which for opioid use 6.7 6.0 6 4.8
% of which for cocaine use 20.8 20.3 22 22.2
% of which for cannabis use 57.0 58.0 58 57.7
% of which for stimulants use (other than cocaine) 6.6 7.3 6 7.7
Notes:
The variation across time, in particular with regard to the absolute numbers of clients in treatment, should be interpreted with caution as coverage data may have changed over time. For further information on coverage details please refer to the relevant EMCDDA Statistical Bulletin.
For an explanation of terms used, see the definitions of terms.
Sources:

Reitox national reports 2014 and TDI tables.
EMCDDA Statistical Bulletin 2015.

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4. Treatment provision

Table 2: Opioid substitution treatment provision in Netherlands
Opioid substitution treatment 2010 2011 2012 2013
Number of clients in opioid substitution treatment N.Av. N.Av. 9556 8185
of which with methadone 10085   9556 8185
of which with buprenorphine N. Av.      
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
‘N. Av.’ stands for ‘No information available’.
For an explanation of terms used, see the definitions of terms.
Sources:
Standard Table 24 (ST24) on 'Treatment availability' submitted in 2014.
Table 3: Year of official introduction of opioid substitution treatment substances in Netherlands
Applied substances in opioid substitution treatment Officially introduced in
Methadone (MMT) 1968
Buprenorphine (HDBT) 1999
Heroin assisted treatment,including as trials 1998
Slow-release morphine N. Av.
Buprenorphine/naloxone combination N. Av.
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
‘N. Av.’ stands for ‘No information available’.
For an explanation of terms used, see the definitions of terms.
Sources:
Reitox national reports.
Table 4: Legal framework of opioid substitution treatment in Netherlands
Legal framework of opioid substitution treatment Methadone Buprenorphine
Do office-based medical doctors have the right to initiate the prescription of substitution treatment? Yes Yes
Do office-based specialised medical doctors have the right to initiate the prescription of substitution treatment? Yes Yes
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
For an explanation of terms used, see the definitions of terms.
'Specialised medical doctors' refers to specifically trained or accredited office-based medical doctors.
Sources:
Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2014.

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5. References and links

Related EMCDDA resources

 

External links

Please note that the EMCDDA is not responsible for the content of external sites.

  • Ouwehand AW and van Alem VCM (1999). The Dutch National Alcohol and Drugs Database: Progress in Monitoring, Monitoring in Progress, European Addiction Research 1999;5:173-178

Treatment inventories

Treatment research centres

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Page last updated: Thursday, 28 May 2015