DCRs are an integral part of the harm reduction response in the Netherlands. In the last decade, the profile of people who use drugs has changed with an increase in smokers, cocaine users and alcohol consumption. There has also been a shift in focus of public health policies – the approach towards drug use is now embedded in general healthcare provision and is multidisciplinary, taking into account the social, legal and health situation of a person.
Overall there are two different kinds of DCRs in the Netherlands: integrated and specialised. They are almost evenly represented throughout the country. A remarkable fact is that only 10 % of PWUD in the Netherlands is still injecting drugs by 2010. This lead to an average of 14 smoking and 5 injecting places per facility in 2010 and several 'smoking only' DCRs. In 2014, 30 DCRs were offering their services in 26 municipalities.
Already in the 70's and early 80's small initiatives started tolerating drug use in their facilities like the Princehof and HUK in Amsterdam, de Pauluskerk and Perron Nul in Rotterdam. Their main focus was establishing contact, preventing disintegration and stabilising drug users.
But it wasn't till the 1990's the political momentum was there to open consumption rooms in the Netherlands. The establishment of official DCRs became possible with the development of legal guidelines by the College van Procureur-generaal in 1996. These guidelines clarified that the possession of controlled drugs in DCRs was tolerated provided that the facilities fit into the local drug policy framework as defined by the mayor, the police and the public prosecutor. Municipalities usually outsource the management and organisation of a DCR to health / addiction care organisations.
In the year 2000 a legal 'instruction' (Aanwijzing Opiumwet) was issued by the governement, which states that addicts can consume drugs under professional supervision in DCRs. It also states the premise that providing or selling drugs in the rooms is strictly forbidden in order to prevent a 'honeypot effect'.
DCRs in the Netherlands have a limited number of registered clients from a well-defined target group – mainly homeless people. However, some DCRs have wider access criteria or target specific vulnerable population groups, such as immigrants or sex workers. The aim is to provide a safety net for these vulnerable groups, to reduce public nuisance, and to improve the welfare and health status of the individual.
There has been no rigorous evaluation regarding the impact of DCRs over a certain time period . However the overall results are generally regarded as positive:
- Public disturbance related to drug use, such as dealing and using in the streets, decreased significantly.
- There was an important shift from injecting to smoking – only 10% of DCR clients are injecting drugs. This has led to a significant decrease in needle sharing. There was, however, an increase in smoking.
- Recent research shows that acceptance of the DCRs by social and health care providers, the neighbourhood and the police is very high in certain areas where DCRs are established (more than 80%)
- There are very low infection rates of HIV and hepatitis C.
Most rooms have staff comprising medical and/or social workers and a third of the facilities have ex-drug users working as staff. 75% of the rooms have some form of client participation, involving them in the daily routine and in decision making processes.