Transcript Victor Everhardt

Drug Consumption rooms in The
Netherlands
History, Efficacy and Results
Victor Everhardt, Trimbos-instituut ©
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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.
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Target group
•
•
•
•
long term addicts
multiple problems
street drug use
poor physical state
*Bransen, van t‘ Land and Wolf, 2004
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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)
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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.
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Support of DCR’s increased
2001
Number of DCR’s
Communities with DCR
Addiction care with DCR
Daily visitors DCR’s (mean)
20
9
7
29
2003
32
15
10
36
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Objectives
• Reduction of public nuisance
• Reduction of health risks
• Improvement quality of life
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Three perspectives on harddrug users and
DCR’s
• Public order
• Social integration
• Medical care
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Principal criteria for admission
100
80
60
40
20
0
2001
2003
Minimaal 18 jaar
Dakloos
Cliënt bij instelling
Ingeschreven gemeente
Overlast geven
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Types of areas in DCR’s
•
•
•
•
Both smoking and injecting
Injecting only
Smoking only
Common room
(2003)
%
30
52
62
46
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Services of DCR’s
‘Old’
(n=18)
%
(2003)
‘New’
(n=12)
%
Provision of accessories
84
100
Needle exchange
74
100*
Medical aid
63
77
Sandwiches
89
69
Recreational activities
79
69
Work programmes
79
69
Counseling and referral
79
61
Hygiene services
84
61
Lockers
63
61
Warm meals
68
38
Practical help
68
38
Doctors’ consults
42
38
Health education
47*
8
*differences are statistically significant (p<0.05)
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House Rules
2003
(N=32)
Social rules
No agression or theft
No dealing of drugs
No alcohol
No sharing of drugs
Rules for save use
No injecting in high risk parts of the body
No helping with injecting by staff members
Basic hygiene rules
No sharing of accessories
No helping one another with injecting
No use of drugs when too far out of it
97%
87%
78%
34%
66%
56%
56%
44%
31%
16%
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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’
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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
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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’
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Challenges
• Admission criteria
• Opening hours
• Distance between drug market and DCR
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Discrepancy
Chief activities of staff
Maintain order
Distribution food/drinks
Housekeeping
Surveillance on save use
Giving emotional support
94%
90%
87%
77%
77%
Facilities for personal care
Medical aid by nurse
Dentist care
Food and drink
Health education
(Selling of harddrugs 87%)
94%
93%
89%
89%
87%
Most reported needs by cliënts
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Conditions for succes
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•
•
•
•
•
•
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
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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
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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
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