"Real tolerance would come from within"

Arjan Nuijten earned a doctorate on the history of the Dutch drug policy 

Arjan Nuijten recently earned his doctorate on the history of Dutch drug policy, with a focus on Amsterdam, Arnhem, and Heerlen. Nuijten argues that drug policy essentially originated locally and was only later adopted nationally. Spuit 11 spoke with him. “I am somewhat resistant towards the portrayal of the Dutch policy as tolerant.”

Arjan: When we look at the long history of harm reduction in the Netherlands, we often see that new measures only come into place during crises. The ideas are already out there, but they are only implemented by large organizations and municipalities when the problem has been around for a while. Take needle exchange programs, for example: the MDHG already had the idea to introduce needle exchange services, but the concept only gained momentum from the GGD when there was a crisis on the streets, when there were needles everywhere, and AIDS emerged. Harm reduction thus begins with ideas like those of the MDHG. Only once significant public nuisance arises does national policy come into play: they see what works at the city level and consider executing it more broadly.

Spuit 11: Are governments not interested in the health of drug users?

Arjan: It’s not very high on their agenda. The primary responsibility for care lies with the general practitioner. The problem also remains invisible for long, until addiction increases significantly. Only then does the municipality realize that there’s a whole group they need to serve, that they need to remove the nuisance from the GP, the pharmacist, and the streets. There are, of course, specialized addiction clinics like Jellinek, but certainly in the 1970s, Jellinek was very conservative. If someone used heroin and wanted to quit, it was very difficult to get help there, and maintenance treatment was certainly out of the question.

That’s the paradox, at least if you see harm reduction as tolerant, that these measures only arise once we recognize it as a problem.

Spuit 11: How do you interpret tolerance, then?

Arjan: For me, the word has acquired a negative connotation, especially since our top officials started selling the Dutch policy abroad as tolerant. But if you look at drug consumption rooms, they remain extremely clinical settings. On one hand, you want to help people, but you’re also placing them in a system with a significant degree of control and suppression. I somewhat resist the portrayal of Dutch policy as tolerant: there’s a strong component of medicalization involved. Historically, you do see that we introduce “tolerant” measures, but they’re aimed at combating disturbances. Real tolerance, for me, would come from within.

Spuit 11: It’s not tolerant because it’s not intrinsically felt.

Arjan: Some people do feel it intrinsically. In my book, I show many people who genuinely care about their fellow humans, who are open to a different world where heroin use is normalized and regulated through social rituals. You do see that certain organizations, like the MDHG, or highly involved doctors or aldermen, see the pain and set up initiatives. The initial idea thus originates very strongly bottom-up. But especially in the last two decades, you see an increasingly conservative attitude: it’s always those neighbors who complain.

Spuit 11: But where’s the difference with abroad? They must have had complaining neighbors too.

Arjan: It starts with a few fundamental differences in the Netherlands. Since the early 1960s, addiction has been seen as a medical problem, rather than a judicial one. Additionally, Dutch drug legislation changed later than other countries. For instance, Germany introduced strict legislation in 1972, but around that time, many studies emerged suggesting this approach might not be the best. The Netherlands was able to incorporate these insights into its legislation almost five years later. Perhaps there is also more of a culture of consultation and deliberation in the Netherlands, so a municipal government is more likely to talk to doctors or to a drug users’ union. There’s more openness and discussion, and a less strong taboo.

Spuit 11: And yet a significant part of the population doesn’t have such an open attitude towards drug use at all. Many former base-coke or heroin users who have been stable on methadone for years are still required to get their methadone from the GGD, as many GPs won’t prescribe it.

Arjan: That’s also reflected in the history of the MDHG, that you’ve long advocated for methadone distribution to return to the GP. Some GPs would do it, but there was always a fear of “shopping” and that too much would be obtained. Around 1977, the Gezondheidsraad (Health Council) stated that methadone distribution should only take place in specialized clinics aimed at detoxification.

Spuit 11: So you actually see national policy trying to counter local policy.

Arjan: That same ambivalent attitude also comes back with the coffeeshop. On one hand, the separation of markets was appreciated, but there was also talk of getting rid of coffeeshops altogether because heroin was also being dealt there. However, there isn’t necessarily evidence of that in the sources. At the same time, more and more coffeeshops were appearing, which again led to disturbance. So, the coffeeshop is somewhat useful, but is it useful to have 30 on one street? Hence, the question arose on how to limit them. The policies thus did not emerge from a mindset of simply accepting everything.

Spuit 11: Can you also explain why a tolerant policy works?

Arjan: Because it removes the issue from the streets and provides a place for people. And that is always better than no place, even if it’s a very medicalized place. National government documents reflect that in the 1990s, we started patting ourselves on the back for our approach because we were supposedly so tolerant. But they should have given much more economic arguments; harm reduction should not be moralistic or ideological. If you keep talking about tolerance, a conservative person will say that they don’t want tolerance – they want something that works. Then you especially need to show that it works to provide a place where people can use, to offer people housing.

Spuit 11: In the field of people who work with drug users, there is quite a broad consensus that you need to regulate drugs, and that regulating starts with legalizing. If that sentiment already exists, and the nuisance from drug chains is growing, you’d almost say that there should be a massive legalization and regulation movement by now.

Arjan: You do see it emerging again, for example with Mayor Halsema saying we need to regulate the cocaine trade. That actually stems from the abuses we see weekly on the streets. But I think in some ways we suffer from some things going too well. Ecstasy is already freely used at festivals, with the only frustration surrounding it being drug waste. Cocaine is seen as an international problem and thus not something you can solve locally. The coffeeshops are similar: only the backdoor is a problem. Maybe things are actually going much too well. The politician needs to see it around the corner; when he travels from Enschede to The Hague in the morning, he needs to encounter it.

Spuit 11: So the members of the MDHG should cause much more nuisance on the streets, so that drug policy finally changes?

Arjan: Without severe disturbances, you won’t reach the last step; that’s not going to happen.


By: Dennis Lahey, Teake Damstra en Sofia Uleman