Harm Reduction Initiatives in the Netherlands
A major element which has provoked the opioid epidemic is the increase in the prescription of opioids. Additionally, this provocation is combined with false beliefs that opioids are safe when they are used for chronic non-cancer pain, and that the development of an addiction is rare (1). What separates Canada and the United States from the Netherlands is the fact that public marketing by pharmaceutical companies is not allowed in the Netherland’s(1). Another factor may be that the Netherlands had the warning example of the enormous opioid epidemic in Canada and the United States (1).
With the warning signs in place through the examples of other countries, and with the epidemic increasing dramatically over the past ten years, the Netherlands has programs and policies in place which have contributed to keeping fatalities much lower than in Canada and the USA (1). In the Netherlands, harm reduction is implemented through social programs such as outreach work, low-threshold facilities, and centres for “social addiction care”, where the main goal is to maintain contact with difficult-to-reach drug users (2). Other avenues of health care support include the thirty one drug testing centres, the harm reduction model, and free addiction treatment programs (3). Despite drugs being illegal under the Netherlands legislation, the Dutch Opium Act includes amendments and policy considerations which take harm reduction initiatives into account. This act first makes a distinction between “hard drugs” (eg. heroine, cocaine) and “soft drugs'' (eg. cannabis products). Sales of less than five grams of “soft drugs'' are tolerated by this Act in regulated establishments known as Coffee Shops (4). The police and public prosecutors additionally give low priority to investigating possessions of small amounts of drugs for a person's own use (2). The Opium Act Directive of the Public Prosecutor states that if the offence concerns a small possession of a hard drug, the drugs will be taken, but there will be no custody or prosecution (2). In cases of possession of hard drugs, diversion to care such as referring people to social programs and support is the primary aim of the prosecutors in these cases (2).
The systems in place in the Netherlands are not perfect, since between 2008 and 2017 the number of prescription opioid users have nearly doubled, and the hospitalizations caused by opioid intoxication has tripled (1). Additionally, addiction care for opioids and substitution therapy nearly doubled, and opioid related mortality also doubled (1). The increase of the hospitalizations was greater than other proxies of misuse and greater than the relative increase in opioid prescriptions (1). This ultimately shows that the increase in opioid prescriptions are being paralleled by an increase in multiple proxies for opioid misuse (1).
There are two ideas Canadians can recognize and further implement in our society based on the Netherlands actions concerning the opioid epidemic. The first is that finding ways to inform and educate people on the risks and uncertain effects of taking prescribed opioids, and also lessening the pressure on physicians to prescribe opioid medications may be beneficial. The second is to acknowledge and consider adopting social support programs, since health, policy, and legislation are interconnected entities.
References
Kalkman GA, Kramers C, van Dongen RT, van den Brink W, Schellekens A. Trends in use and misuse of opioids in the Netherlands: a retrospective, multi-source database study. The Lancet Public Health. 2019;4(10).
McVay D. The Opioid Overdose Crisis [Internet]. Drug Policy Facts. Real Reporting Foundation; 2021 [cited 2021Mar30]. Available from: https://www.drugpolicyfacts.org/chapter/opioid_crisis
Smit‐Rigter LA, Van der Gouwe D. The neglected benefits of drug checking for harm reduction. Internal Medicine Journal. 2020;50(8):1024–.
Veiligheid Mvan Jen. Why are coffee shops allowed to sell soft drugs in the Netherlands? [Internet]. Drugs | Government.nl. Ministerie van Algemene Zaken; 2016 [cited 2021Mar30]. Available from: https://www.government.nl/topics/drugs/why-are-coffee-shops-allowed-to-sell-soft-drugs-in-the-netherlands