Trimbos-instituut Drug Consumption rooms in The Netherlands History, Efficacy and Results Victor Everhardt, Trimbos-instituut ©

Trimbos-instituut The Dutch definition of DCR A facility under the administration of an official organisation where drug users can administer their pre obtained drugs in relative peace and quiet under supervision of (trained) staff.

Trimbos-instituut Target group long term addicts multiple problems street drug use poor physical state * Bransen, van t‘ Land and Wolf, 2004

Trimbos-instituut At a certain moment there were [in Maastricht] 3000 drug tourists a day. […]Dealers from Rotterdam and other cities moved in, because they were much more used to working on this scale than the local drug dealers. The place was littered with syringes. There was no health care facility in the area, nothing. It wasn’t easy to find a suitable location for this. The first place designated by the local council, was set fire to by the local community. When the local authorities didn’t succeed in finding a suitable location, they opened up the City Hall for the hard drug users. This was in the basement of the City Hall. (Consumption room worker Maastricht)

Trimbos-instituut Policy document Ministry of Health (2002) Two reasons Benefits for public health (reduced risk of infectious diseases and overdose) Decrease of public nuisance If formal DCR’s are not allowed the use of illegal ‘shooting galleries’ will increase and this is a threat for public health.

Trimbos-instituut Support of DCR’s increased Number of DCR’s Communities with DCR 9 15 Addiction care with DCR 7 10 Daily visitors DCR’s (mean) 29 36

Trimbos-instituut Objectives Reduction of public nuisance Reduction of health risks Improvement quality of life

Trimbos-instituut Three perspectives on harddrug users and DCR’s Public order Social integration Medical care

Trimbos-instituut Principal criteria for admission

Trimbos-instituut Types of areas in DCR’s (2003) % Both smoking and injecting 30 Injecting only 52 Smoking only 62 Common room 46

Trimbos-instituut Services of DCR’s (2003)

Trimbos-instituut House Rules 2003 (N=32) Social rules No agression or theft97% No dealing of drugs87% No alcohol78% No sharing of drugs34% Rules for save use No injecting in high risk parts of the body 66% No helping with injecting by staff members56% Basic hygiene rules56% No sharing of accessories44% No helping one another with injecting31% No use of drugs when too far out of it16%

Trimbos-instituut Is the target group reached? YES Specific admission criteria Mean number of visitors increased Utrecht (2004): 410 homeless drug users 300 passholders (75%) 220 active visitor of dcr’s (75%) Rotterdam (2003): 4000 heroin and cocaine dep 500 passholders (12,5%) ‘frequent use by passholders’

Trimbos-instituut Challenges Admission criteria more stringent Residence permit necessary Interview on admission to addiction care facility obligatory Opening hours can cause pass holders to use drugs outdoors or in public places

Trimbos-instituut Contribution to nuisance reduction? Linssen (2001) In 5 Dutch cities DCR’s reduced levels of drug use in public Rotterdam (Van der Poel et al, 2003) 80% of pass holders less drug use in public Utrecht (Hulsbosch et al, 2004) 84% of pass holders reported less loitering about because of DCR’s 20% ‘I still prefer use of drugs in the streets’

Trimbos-instituut Challenges Admission criteria Opening hours Distance between drug market and DCR

Trimbos-instituut Discrepancy Chief activities of staff Maintain order 94% Distribution food/drinks90% Housekeeping 87% Surveillance on save use 77% Giving emotional support 77% Most reported needs by cliënts Facilities for personal care 94% Medical aid by nurse 93% Dentist care 89% Food and drink 89% Health education 87% (Selling of harddrugs 87%)

Trimbos-instituut Conditions for succes Successful contact with target group Consensus about objectives, function & target group DCR is embedded in local policy with regard to long-term addicts and harm reduction Agreement with police and public prosecutor Availability and accessibility of health care and welfare facilities for long-term addicts Availability of trained staff Cooperation with interest groups/target group

Trimbos-instituut Legal conditions I Principle of discretionary powers The Public Prosecutions Department (OM) may waive prosecution of offences if this serves the general public interest. The guidelines for investigation and prosecution of violations of the Opium Act state the following priorities

Trimbos-instituut Legal conditions II UN Conventions (1961, 1971 & 1988) Harm reduction is part of Demand reduction (terminolgy of the UN conventions) Use of drugs is not covered by UN Conventions Possession for Personal Use is not covered by UN Conventions A d.c. Room is a sound medical practice D.C. Rooms are not contrary to UN Conventions Germany, Norway, Switzerland, Portugal, Spain and The Netherlands