Political choices, political crimes: Harm reduction faces pushback around the world

The way Machteld Busz recalls it, people in the Netherlands were overdosing and dying in the 1970s and ’80s. Syringes littered the streets. Some people were getting arrested, others were going to rehab, but all of them seemed to return to the same situation. Police were frustrated. Government officials were frustrated. People who used drugs were frustrated. 

There was a sense of urgency, and that urgency fostered harm reduction in the Netherlands. 

People who use drugs pushed for access to methadone and new syringes. And perhaps the world’s first drug users unions, Amsterdam’s Medisch-sociale Dienst Heroine Gebruikers (MDHG) and the Junkiebond in Rotterdam, emerged. Eventually there were syringe exchanges, easier access to methadone, and safe consumption spaces. 

Busz is director of Mainline, a Dutch harm reduction organization, and has a particularly clear view of the past and future of drug policy in her country. We sat at a conference table in the midst of the busy organization’s headquarters on Frederik Hendrikstraat in Amsterdam. Boxes of old issues of their magazine surround us.

Mainline’s calling card is its magazine, which for more than 30 years has informed people who use drugs and the broader public about substance use and health. They play a central role in the community as a drug monitor – signaling harm reduction approaches to new substances for marginalized communities. 

In the midst of that crisis in the 1970s and early ’80s, Busz said police and politicians could see that harm reduction worked. And they supported it. The country made political choices. 

Today, the landscape in the Netherlands is vastly different from ours. Drug use is decriminalized. They have heroin-assisted treatment. Drug use, in small amounts, is decriminalized. They have safe consumption spaces and ready access to methadone. 

It’s so successful, she said, that she wonders if some people have forgotten what things used to be like, and why the country made a choice to embrace harm reduction. 

Busz told me that recently someone had overdosed and died from a substance that was contaminated with nitazines. They issued a red alert throughout their network and even made sure that the information was broadcast on the national news.

Mainline’s work has been supported, in part, by government dollars because, for decades, the Dutch government understood the importance of their work. But in the last decade or so, Busz said, there has been a shift towards drug control. 

“The ‘tough on crime’ narrative works with voters in the Netherlands, too,” she said. 

This political shift towards drug control and cuts to harm reduction, to mental healthcare and housing programs, worries Busz. With cuts to those programs, there are more people using drugs on the streets, more people unhoused, more people with mental health concerns.

“That is a political choice,” she said. 

We’re making our own political choices in the United States. 

On the one hand, many have been celebrating the recent drop in overdose deaths – a trend that has reversed somewhat. On the other hand, we are on the verge of sweeping cuts to Medicaid.

According to the Health Policy Institute of Ohio, the end of Medicaid expansion will mean 435,000 people without access to healthcare in our state – likely many of whom have a substance use disorder or mental health diagnosis. In 2024, 40 percent of Ohioans enrolled in Medicaid expansion had a primary mental health or SUD diagnosis.

Our present age of recession and reform is also the age of billionaires. We’re told that we must cut government funding for social programs that feed children, while Amazon founder Jeff Bezos and company gallivant at three-day Venetian weddings; B-2 bombers fly from Missouri to Iran to drop bombs; and Ohio legislators float loans to build stadiums for failing professional football teams.

“Political language is designed to make lies sound truthful and murder respectable,” George Orwell wrote, “and to give an appearance of solidity to pure wind.”  

The truth is, there are people making choices for themselves and not for us. 

When I asked Busz directly what she thought of the US approach to substance use in recent years, I got a very direct Dutch reply. “I think it’s a political crime what’s been happening there,” she said. “All these people that died, it’s all preventable.”

She points to a need for better access to syringe exchange programs, proper drug testing, decriminalization, and more opioid-assisted treatment. Busz said these practices are both cheap and proven. “If you’re not doing it, that’s a political choice. And that means it’s a political crime that you’re letting people die like that,” she said. “That’s my opinion. I think it’s a complete disregard for human life.”

“Every overdose is a policy failure,” I added.

“Definitely,” she said. “And someone is responsible for that.”