Belgium Country Drug Report 2019

Harm reduction

In Belgium, the Federal Drug Policy Note of 2001 and the Common Declaration of 2010 endorse harm reduction as one of three pillars of the national drug response. Harm reduction programmes include peer support and needle and syringe programmes (NSPs). NSPs are available at low-threshold harm reduction projects and pharmacies in the French and Flemish Communities. The different Communities and regions in Belgium address the issue of drugs as part of a global health action plan, highlighting health promotion and harm reduction activities in recreational settings.

In general, harm reduction projects are set up and run by non-governmental organisations; some integrate peer support initiatives; and some are managed by city authorities. These projects are funded by the Communities and by the regions. Nine medical and social care centres (MSCCs) across Belgium play a key role in delivering harm reduction services. These low-threshold centres often deliver substitution treatment as well. In both Wallonia and Brussels regions, harm reduction services are mostly provided by non-governmental organisations.

Harm reduction interventions

NSPs (in facilities, through mobile services or in pharmacies) are available across the country, except in the German-speaking community. Fixed sites offer this service in 20 cities in the Flemish community and in nine cities in the French community. There are nine specialised low-threshold MSCC offering this service. All harm reduction projects offer various sterile injecting materials and they collect used syringes and needles. In addition, they facilitate the referral of people who inject drugs (PWID) to other prevention and treatment services. Only services in Brussels and Wallonia offer non-injecting paraphernalia as well as HIV home-testing kits.

From 2014 to 2017, the number of distributed syringes increased in both the Flemish and the French Communities, with over 1.2 million syringes distributed in 2017. In the French community, syringes are distributed through pharmacies. The annual survey of NSP clients in the Flemish community indicated that about one in six clients were new to the service in 2017, most of them having learned about the service through drug treatment services or friends. In total, 68 % of respondents claimed to know PWID who do not make use of NSPs. Since 2016, at least one ‘drop-box’ to collect used injection materials in public places has been available in every Flemish province. Syringe collection policies vary considerably within the French community, with Brussels also providing syringes to users who do not return used materials and Wallonia requesting one-to-one exchange.

In the prevention and control of infectious diseases among PWID, special emphasis in recent years has been given to counselling and testing for the hepatitis C virus. A peer support project about hepatitis — the hepatitis C buddy project — aims to generate interest among people who use drugs in getting tested and treated for hepatitis C and to provide tailored peer support to assist with navigating the health system.

Several services distribute overdose prevention information material and engage in overdose prevention assessment with their clients. The first supervised drug consumption facility was opened in the city of Liège in September 2018.

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

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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.