The Amsterdam Methadone Dispensing Circuit: genesis and effectiveness of a public health model for local drug policy

Abstract

During the 1970s, the Methadone Dispensing Circuit (MDC) was initiated by the municipality of Amsterdam in order to cope with the heroin addiction epidemic that afflicted the city. In the MDC, methadone is dispensed to opiate addicts on a maintenance basis in low-threshold public health programmes, as well as in high-threshold treatment programmes. The MDC is an essential part of the local drug policy in the city. It is designed to get in touch with all opiate addicts who are not able to manage their lives in a proper way, and to stimulate them to regulate their addiction. This paper describes the genesis of the MDC as a result of a historical and political process. Determining factors in this process proved to be the urgency of the drug problem, the widespread consensus among local politicians, most of the general practitioners (GPs) and alternative relief institutions about the low-threshold dispensing, and finally its success, particularly the lower rate of drug-related death and less disruption of public order. In the second part of the paper, data on the functioning and effectiveness of the MDC are presented. It is concluded that the effectiveness of the MDC could be improved by better management and the application of more sensible diagnostic methods. The transferability of the 'Amsterdam model' to other places is discussed; besides the burden of the drug problem, it depends on the acceptance of the underlying value orientation.

Towards combination HIV prevention for injection drug users

“…Providing combination HIV-prevention to IDUs under one umbrella, in a point-of-care, one-stop venue that addresses their myriad needs may seem like a Holy Grail, but it is ultimately what substance users need and is likely to be cost-effective. For decades, Amsterdam has offered integrated OST, HIV and primary care services for substance users (40). In the U.S., some early steps have been made to promote a multi-city infrastructure that integrates HIV primary care and substance abuse treatment (41).…”

Multimodal drug addiction treatment: A field comparison of methadone and buprenorphine among heroin- and cocaine-dependent patients

“…Many studies have demonstrated the efficacy of methadone maintenance therapy (MMT) in decreasing illicit drug consumption and criminal behavior, improving the rehabilitation of intravenous opiate-addicted patients, and lowering the prevalence of HIV infection (Newman, 1987;Plomp, Van der Hek, & Ader, 1996;Schottenfeld & Kleber, 1995). However, MMT is associated with several problems, including limited patient and community acceptance, and it appears not to be optimal for all subjects (Kolar, Brown, Weddington, & Ball, 1990;Schoenbaum & Selwyn, 1995 Since 2001, buprenorphine (BUP), an opiate A-receptor partial agonist, has been available for the treatment of heroin addiction, proving to be effective in reducing cravings for opiates and in blocking withdrawal symptoms, thus representing a useful alternative drug to methadone (Cozzolino et al, 2002(Cozzolino et al, , 2003Ling et al, 1998;Pani, Maremmani, Pirastu, Tagliamonte, & Gessa, 2000).…”

The impact of harm-reduction-based methadone treatment on mortality among heroin users

“…17 The Amsterdam methadone maintenance system aims to keep in contact with as many drug users as possible through different types of programs (low, medium, and high threshold) that provide methadone in combination with social-medical care and needle-exchange facilities. 18,19 These programs involve no waiting lists, and it is relatively easy to enter and reenter the programs. Ongoing drug use during treatment is tolerated in low-and mediumthreshold programs.…”