Heroin: from crisis to compromize

The Dutch experiment that made heroin disappear

In the 1970s and 80s, heroin was everywhere in Amsterdam. Blue lamps lit stairwells to keep users from shooting up in the dark. The Zeedijk was a lawless strip of dealers, sex workers, and desperate addicts. By the early 1990s, the Netherlands had some 30,000 heroin users. Junkies crowded stations, slept in doorways, and stole to feed their addiction. The crisis was visible, frightening, and felt unsolvable.

What changed was not the drug, but the policy. Authorities stopped chasing users and started treating them as patients. Needle exchanges reduced HIV and hepatitis. Methadone programs dulled withdrawal. User rooms created safer spaces. But for the most chronic cases — the people who never stabilized, who cycled through police cells, shelters, and emergency rooms — even methadone wasn’t enough.

That’s when the Netherlands tried something almost unthinkable: giving free heroin to addicts.

A radical idea becomes reality

Inspired by a Swiss trial in the 1990s, Dutch researchers launched a large study with 600 patients who had failed every other form of treatment. They were prescribed pharmaceutical-grade heroin to inject or smoke, under strict medical supervision, twice or three times a day. The results were striking: better health, more stability, and far less crime. Families were reunited, neighborhoods became safer, and the burden on police and courts collapsed.

What’s remarkable is how little political resistance there was. After the trials, heroin prescription was quietly made a permanent part of Dutch health care. Left and right agreed: it worked. Today there are 18 clinics across the country, with about 700 patients in treatment. Most are aging men who began using in the 1980s. Almost no one under 40 ever starts.

Life inside the program

Step into one of these clinics and the atmosphere is clinical, even bureaucratic. Patients sign in, receive their dose, and use in supervised rooms with glass walls, cameras, and nurses. Most now smoke the heroin rather than inject it. The routines are rigid: miss your appointment, and you don’t get your dose. There is no take-home supply. The goal is safety, not pleasure.

Patients often describe the program as both a salvation and a trap. They no longer have to steal, hustle, or prostitute themselves. Their health and housing improve, their lives become more predictable. But some complain that the strict structure leaves them feeling written off — dependent on the state for their next hit, without much hope of moving on. “We hang on the teat of the GGD,” one user told me.

The paradox of success

The Dutch heroin program has been so effective that it erased the very problem it was designed to solve. The junkie, once the most visible figure in the drug debate, has all but vanished from public space. A younger generation avoids heroin altogether, terrified of its reputation. Meanwhile, the remaining patients age quietly inside the system, a hidden reminder of a crisis that once defined entire neighborhoods.

Critics argue that the program medicalized heroin to the point of absurdity — treating the drug like plutonium rather than a narcotic. Others say it offered dignity to people who had run out of options, and by extension, dignity to the city itself. Both views are true. The only problem left, as one former user put it, is the addiction itself. “If your only issue is being hooked on heroin, you have to ask yourself: do I even want this anymore?”

A lesson for other drugs?

The paradox is that the Netherlands solved its most feared drug problem not with prohibition, but with regulation. By facing heroin addiction pragmatically — as a health issue rather than a crime — the country dismantled a crisis that once seemed intractable. Today, while the United States is gripped by an opioid epidemic, the Netherlands counts only a few thousand aging users.

The lesson, perhaps, is that rules work better than bans. Legal heroin for a small, chronic group has made Amsterdam’s junkies disappear. If such an approach could succeed with heroin, one of the most stigmatized drugs in the world, the question lingers: what might be possible with cannabis, MDMA, or other substances where taboos still dominate policy?