Comprehensive Treatment for Problematic Opioid Users: The Dutch Experience
Until 1972, widespread heroin dependence did not exist in The Netherlands. There was a level of morphine dependence, mainly among pain patients and medical doctors. Following the introduction of methadone in the US in 1964, morphine-dependent patients in Amsterdam began treatment with methadone in 1968. This meant that a comprehensive methadone treatment system was established prior to the emergence of illicit heroin dependence.
This lecture explores the development of The Netherland’s comprehensive treatment system for problematic drug use over the last 50 years, including key challenges, such as the AIDS epidemic, the heroin glut of the 1990s, and the emerging horizons of ADHD and SUD
Evaluating and updating the treatment system to respond to these challenges, as well as the introduction of new substances and use patterns, is a constant challenge. For example, we have conducted two recent trials of (i) a sustained release dexamphetamine and (ii) a cocaine-directed contingency management for hydromorphone assisted treatment (‘HAT’) patients with comorbid cocaine use disorder.
While The Netherlands is often celebrated for its evidence-based drug policies, we are not without challenges. The Netherlands was late to introduce Needle and Syringe Programs and the Dutch Government have recently decided not to subsidise long-acting injectable buprenorphine. The Dutch treatment system also experiences more mundane challenges, such as a lack of nurses within the HAT-system to supervise the self-administration of heroin after-hours.
The Netherlands’ comprehensive treatment system is not unique. Evidence-based policies also exist in Europe, North America, and Australia, which now has two safe injections rooms. While developments with Hydromorphone Assisted Treatment (HAT) are being trialed or implemented in different jurisdictions, despite strong scientific evidence for its cost-effectiveness, HAT has only been implemented in a few countries. Further, substitution therapies for stimulant use has been met with very little enthusiasm so far despite the potential for substantial benefits.
It seems, therefore, that the lives of problematic substance users are not worth the money that is needed to improve their future and that this is not so much a scientific issue as it is a human rights issue. To move forwards, it is critical that, these issues are not solely reserved for social/scientific conferences but debated in human rights tribunals.
This talk will also cover recent research into the link between ADHD and SUD, and sustained-release dexamphetamine to treat cocaine use disorder, and the implications of these new treatments for service systems.
Wim van den Brink, MD PhD, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
Wim van den Brink is a Professor of Addiction Psychiatry at the Amsterdam University Medical Centre. He first received his medical degree in 1981 and trained as a Psychiatric Epidemiologist in Groningen and New York (1983 – 1987), completing his PhD in 1989.
In 2014 he received the lifetime achievement award from the Netherlands Association of Psychiatry, and in 2015 he became an honourable member of the Spanish Society for Dual disorders. In 2017 he received the European Addiction Research Award from the European Federation of Addiction Societies (EUFAS), and in 2020 he became Professor Honoris Causa at the Eötvös Loránd University in Budapest, Hungary.
He is a (co)author of more than 600 international peer-reviewed scientific papers (HIWoS=80; HIGoogle Scholar=113). He has been a thesis advisor to more than 75 PhD students. He has been the chair of the Workgroups that developed the Dutch Treatment Guidelines on Alcohol Use Disorders, Opiate Addiction and Drugs other than opioids. He is one of the founders and president of the International Collaboration of ADHD and Substance Abuse (ICASA). His main scientific interests are related to the neurobiology of addiction and the pharmacological treatment of substance use disorders and related comorbidities.