Managing Drugs to Do the Least Harm

Huddled in the shadow of Rotterdam's huge Centraal Station transportation hub, the crowd on Platform Zero paces impatiently under the glare of a spring afternoon sun. Platform Zero is not a train track, but its passengers are always on a trip to nowhere -- hence the name.

Platform Zero is an officially tolerated safety zone where drugs can be openly bought and used. It stands near the local police barracks, and several times a day the police discreetly pass by the tiny patch of concrete. But it is decidedly a low-key surveillance. Except the outreach teams of local universities and the Health Department's social workers, the authorities leave the area pretty much alone,


Rotterdam -- Baltimore's "sister city" in the Netherlands -- was the site earlier this year of the International Conference on Reducing Drug Related Harm. The name describes the drug policy followed by Dutch cities. Harm reduction accepts that some levels of drug use are an inevitable result of living in a fast-paced changing urban society. Rather than isolate and marginalize those who choose to use drugs, the Dutch decided it was far more important (and cheaper) to keep drug use -- and drug users themselves -- integrated into society.

Soft drugs such as marijuana and hashish were effectively decriminalized several years ago. Today, you can buy grass in special state-licensed coffee houses set up in the inner cities. Zones like Platform Zero are allowed to exist. Needle exchanges already were in place in many major cities at the onset of AIDS, started by drug-users' organizations in the late '80s as a response to a major hepatitis outbreak. As a result, AIDS statistics among intravenous drug users are a fraction of the numbers found in comparable U.S. cities.


The ECHO Project is a low-profile experiment located in one of Rotterdam's older working-class neighborhoods. The Dutch acronym signifies "Honest Contact Address for Assistance and Reconstruction." Here is a first, even by Dutch standards: a project promoting safer drug use.

On the first floor, people wander amiably in from the street, gathering in the living room to smoke heroin and cocaine on small wooden tables. Upstairs, ECHO maintains a separate room for injectors. As I watch, a young couple nonchalantly shoot up, soon drifting into dreamy reverie.

Lloyd Valles, the project's director, explains ECHO's philosophy: one is ever a 24-hour dope fiend. This place offers people a chance to build their self-respect. We offer an environment for the authorities to come down from their high horses and talk to us like human beings."

The rules are simple. Drug deals inside the premises are not tolerated. Clean syringes are freely available. Several times a week, a social worker stops by to offer connections with social services. Local beat cops will often drop in for a cup of coffee. Privately, the police express unqualified support for ECHO; they say it gives them a neutral bridge to people they normally would have only antagonistic contact with. Through ECHO, the police are able to pass on messages, such as telling runaways to call home or for certain local addicts to stop leaving used syringes in the neighborhood park where the neighborhood children play.

Dutch drug policy is often misinterpreted as liberal. On the contrary, the Dutch have opted for a strict, if softer method of social control over a so-called problem population. Whether behavior deemed anti-social is best fought by exclusion from society or by monitored inclusion is an age-old debate stretching back to Ancient Greece

I am struck by how relaxed and low key all this is, especially when you compare ECHO with the shooting galleries of Baltimore. In this relatively intimate scene, everyone knows one another; hassles and rip-offs are kept to a bare minimum by self-policing.

Later that afternoon, a local dealer takes our party to one of the illegal "addresses" in the neighborhood. Here, the houseman openly sells drugs from his living room to a steady flow of customers. Some take their purchases out and others line up at a partition separating the living room from the kitchen to "chase the dragon." Posted on the wall on a yellowed piece of paper are the five house rules: "Don't Expect Anything Out of Anyone Else," "You Must Have Your Own Lighter," "QUIET: Think of the Neighbors," "No Dirty Syringes" and finally, "If You Don't Agree With the Rules, Stay Out!"

People at this "address" frown on the scene at Platform Zero -- "Too hard," they say. And indeed you don't see any of the vacant, numbed stares or menacing posing found at Platform Zero, especially at night when the area fills up with the shadowy outlines of dozens of bodies pushing and shoving one another in the dark. All trying to carve out some small space to smoke or inject in peace.


Back at the Harm Reduction Conference, a more mixed picture emerges. Privately, a Health Department official concedes that "accountants and bookkeepers and not doctors are beginning to decide drug policy." Circulating petitions, members of the European Interest Group of Drug Users protest the impending shut-down of nearly 30 methadone programs due to cuts in the federal budget. In Amsterdam, the most consistently liberal area of the country, the police have cracked down on previously tolerated drug-using areas, and known "troublemakers" are being barred.

Off the record, several workers in the drug-treatment programs complain that drug policy is slowly beginning to revert to a repressive stance. Zero-tolerance guidelines are found in nearby France and Germany. Others say that current drug policy is experiencing a backlash from the public, who now associate drugs (and rising crime rates) as being a "foreign" problem due to the numbers of non-Dutch drug users said to be flooding the streets. Already in Amsterdam's steamy red-light districts, most street prostitutes are Germans with cocaine and heroin habits reputedly lured by the city's anything-goes reputation.

Some cautionary lessons are beginning to emerge as the country's drug policy becomes strained by forces outside policy makers' control.

Even the staunchest American advocates of drug-policy reform rarely talk of social context. Much of the focus instead has been on whether drugs should be controlled by the free market or by government regulation, by doctors or by police. The Dutch placed drug use squarely in its social context. Contented citizens with most of their basic needs met make unlikely recruits to the life of a junkie. So, as the dikes were constructed to hold back the North Sea, the Dutch built a welfare-state bulwark against being flooded with the social problems of other countries.

Because of economic stagnation, this welfare state is now being gutted, producing a ripple effect on the way the country manages its drug problems. If the protective barriers of high social benefits are dismantled at a time of double-digit unemployment, especially among young people and those of foreign origin, critics warn of a growing "underclass." Whether the Netherlands will remain so special in its treatment of drug issues in five years time is a question now sorely up for grabs.

Curtis Price is coordinator of Street Voice Outreach in Baltimore.