Can the Netherlands keep their leading role in harm reduction programmes?
Last week, the European Harm Reduction Conference 2014 was hosted in Amsterdam, the Netherlands. As a leading country for harm reduction policy, it is a good time to critically assess the effectiveness of harm reduction programmes in the Netherlands. It begs the question: Can the Netherlands still be used as an example for the rest of the world?
The Netherlands has a long and extensive history of implementing harm reduction programmes. During the 1980’s, programmes provided a combination of care and shelter to people who used drugs. These became widely implemented - starting with methadone provision and syringe exchange programmes, expanding to include drug consumption rooms. More recent developments include the provision of alcohol user spaces and the introduction of Assertive Community Treatment (ACT) teams - multi-disciplinary teams who build intensive relationships with drugs users, so that they prevent harm to themselves and others. Through this mixed approach in care provision, a large proportion of long-term drugs users are reached.
After evaluating different harm reduction programmes in the Netherlands, it turns out that harm reduction has been understood differently by the various implementers of these types of programmes in the country. As such, it is hard to determine the effectiveness of harm reduction in the Netherlands. August de Loor (Stichting Advies Buro Drugs) stated: “The gap between drugs users, policy makers and institutes has never been so big, making it more and more difficult to bridge the gap”. He argues that harm reduction programmes should not only be focused on the health of the users and the reduction of social inconvenience, but should be focused on all aspects of drug use, also including production and trade. Harm reduction should also be available to extensive alcohol and tobacco users.
Normalising harm reduction programmes and regulating drug use is necessary in order for the Netherlands to remain a leader in the field. Drugs users should not be punished for drugs use. Instead, the complex needs of drug users and what ultimately drives them to use drugs should be understood and addressed.
Current drug programmes are plighted by long waiting times, despite persistent calls for help from users. The overuse of protocols is also a major issue. At the conference, cases were presented where care providers would stick to set protocols, leading to situations where drug users were forced to take higher doses of methadone than what they would normally take of heroin. Another major issue is the fact that insurance companies decide how treatment is provided and for how long. They have the power to decide how and when programmes are provided, yet they are hardly involved in the discussions regarding the effectiveness of these regulations. Regulations create boundaries to the inclusion of harm reduction programmes, but also for access to health care, as care is often refused or made inaccessible through the need of referral statements from providers.
It is evident that harm reduction is in need of an update in the Netherlands, if it is to keep its status as a leader in the field. The role of insurance companies and care providers has to be evaluated, and their voices need to be included in policy-making and implementation. Policies regarding the provision of methadone and their inclusion in programmes need to be reviewed, and where necessary, be made more flexible. There should be a call for awareness regarding the groups who are hard to reach, mainly home-users and/or recreational users. New developments in the drugs markets needs to be monitored, and any shifts in the types of users and drugs – including the increased number of party users and availability of drugs from the internet. By keeping up with this changing market, the Netherlands can reform it guiding position as a policy export country.
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