Editor’s Note: This is Part 2 of a three-part series examining the opioid crisis in the United States and the Gulf South, and comparing it to successful drug use harm reduction efforts in the Netherlands. You can read other entries in the series here:
Part 1: Going Dutch: Harm reduction is embraced in the Netherlands but struggles in the US
Zipping his jacket closed, Officer Bob Blankenzee grabs his citation booklet and points to a list of violations that includes using drugs.
“This one. ‘Openlijk gebruik harddrugs,’” he says, tapping the Dutch words for “open use of hard drugs.” In Amsterdam, it’s considered a public nuisance, along with open container, panhandling, and public drunkenness.
The penalty for a first offense is a 24-hour ban from the area.
“And if you don’t know it, here are the sides, the lines are scripted here,” he says, showing a map on the back of the booklet that outlines the city center known locally as De Wallen.
Blankenzee is a police officer with “Policestation Burgwallen,” the precinct that oversees De Wallen. Dating back to the 14th century, the district was a hub for the port city’s sailors. The red lanterns sex workers used to signify their availability became a distinctive feature, giving the area another name: The Red Light District.
Blakenzee steps out into the cold March morning. Joining him on his patrol is Mohamed Bakayan, a social worker with the city’s health department, known as the GGD.
“Hey, Moe!” Blankenzee says, greeting him with a smile.
Dutch police work hand-in-hand with the health department. It’s an approach started during the country’s heroin crisis that began in the 1970s. Around the same time, in 1971, President Richard Nixon declared a “War on Drugs” in the United States.
In the decades since, the U.S. has treated drug use largely as a criminal justice issue — despite the staggering death toll of the opioid crisis. The Netherlands chose a public health model that helped put an end to their crisis.
“We don’t have an office,” Bakayan says. “The street is my office. I approach people and offer them help and try to seduce them to work with me to find a solution for the situation.”
Walking the canal-lined streets, Blakenzee and Bakayan spot a group of people huddled in an alley between the skinny gabled buildings. As they approach, the group scurries away.
“You can see here,” Bakayan says pointing to cigarette butts and torn plastic powdered with white residue left behind on the brick. “These are the silent witnesses.”
During the patrol, the pair stops at safe consumption rooms and shelters. Blankenzee waits outside while Bakayan goes in to check in on people.
Inside a “ziekenboeg,” a shelter for chronically ill people who use drugs, Bakayan sits with Alvin Medema in his small room. The two tease each other in an interaction laced with the minor frustration that exists when one person is trying to help another who is struggling, but stubborn.
“This is a coke pipe, a base coke pipe,” Bakayan says, picking up a small metal pipe from Medema’s desk.
“Who said that is crack pipe? That is one pipe,” Medema says before winking. “I can also smoke hashish and marijuana inside.”
Originally from the former Dutch colony of Curaçao, Medema had one of his feet amputated because of poor circulation caused by his drug use. He was also recently diagnosed with lung cancer. Bakayan helped him get a room at the “ziekenboeg.”
“It’s very nice because I eat on time, sleep on time, I can take a shower,” Medema says.
Bakayan asks him if he’s able to make his doctor’s appointments for his cancer treatments.
“They say I am lucky because they say I only need one, maybe two treatments, but I must stay under control,” he replies.
After the patrol, Blankenzee and Bakayan return to the station and then part ways. Bakayan has other districts to visit and make his rounds — more people to check in on.
Blankenzee returns for a night shift, when The Red Light District wakes up. He’s on patrol in plainclothes, blending into the sea of people bathed in the red glow illuminating the women in the windows.
Through an earpiece, Blankenzee is fed information from the precinct’s command center and other officers. His main targets are pickpockets taking advantage of tourists.
Throughout the night, Blankenzee also comes across a few people using drugs. One man is smoking base coke — crack, as it’s commonly known in the U.S. Blankenzee writes him an order banning him from the area for 24-hours and gives him information about contacting the health department.
In the U.S., he knows he could have arrested him.
“The prisons are more full than here and they do not have a life after the prison,” Blankenzee says of the U.S. “And here, we try to manage it [with] light penalties and offer them help.”
This approach has worked.
Heroin arrived in the Netherlands in the 1970s. After the infamous "French Connection" smuggling scheme was shut down, the opiate slipped in through the city’s ports and Amsterdam became the new center for the European heroin trade.
Chinese communities traditionally smoked opium. American GIs brought the habit they’d picked up in Vietnam with them as expatriates. Thousands from Suriname and other former Dutch colonies — including Curaçao, where Medema is from — flocked to the country, many without money or opportunity.
Soon, the native Dutch youth began using it, and heroin became a public health crisis. The Red Light District resembled parts of U.S. cities like Portland and Los Angeles today, with open drug use and people sleeping on the streets. By the 1980s, there were more than 30,000 people using heroin in the country.
Activists called “street corner workers” started harm reduction efforts like syringe exchanges and safe consumption rooms. Local medical providers made methadone easier to access with walk-in clinics and mobile units.
But police were initially against the efforts. In her office at the Dutch National Police headquarters in The Hague, Margot Coenraads remembered the failures of the old approach.
"We arrested constantly the heroin addicts, and a few hours later, or a day later, they were again on the street using heroin again, so it was a little hopeless situation," she said.
Coenraads is deputy manager of the country’s national narcotics program. Eventually, the government and the police embraced a new, integrated approach that emphasized harm reduction and accessible treatment — including in jails and prisons.
The police shifted focus away from drug use to stopping drug trafficking and production. Public health-focused policies helped end the crisis.
"I think the harm reduction approach helps the police in solving the problem, because we couldn’t do it ourselves in the heroin crisis," Coenraads said. The approach led to a reduction in heroin use and addiction, overdoses and disease transmission, as well as an increase in successful addiction treatment rates.
"We needed the extra effort of health. So, in the Netherlands, we don’t have a heroin problem anymore."
Today, selling or making drugs is a criminal offense. Local ordinances may classify public drug use as a nuisance, but using drugs is legal, Coenraads said.
But the Dutch criminal justice system isn’t perfect. In interviews, several people who use drugs said they contend with harassment from the police.
"Sometimes they arrest me and I haven’t done nothing. They don’t find nothing. Sometimes they lock me up," said Dwight, a dealer in the Red Light District.
Dwight is Surinamese and said white Dutch police officers can have racist attitudes towards people of color.
In the Oosterpark, a park in Amsterdam notorious for open drug use, Alex, who did not give his last name, described being forced to detox from cocaine and heroin.
"They are arresting you, bring you there, and for the first 15-20 days you are being treated like in a jail," he said.
The Netherlands also has a legal process for repeat offenders called “Inrichting voor Stelselmatige Daders,” or ISD. Courts can incarcerate people for two years. Advocates described incidents where people were sentenced to ISD for minor crimes, like vagrancy or using drugs in public, as well as for the very Dutch crime of stealing a bike, or, in one case, stealing a fish.
Still, people with mental health and substance use disorders in ISD receive counseling and treatment. In the U.S., less than half of the country’s jails provide medications for substance use disorder.
The Dutch criminal justice system’s views on drugs, harm reduction and the availability and access of treatment with medication are only a few of the differences between police in the Netherlands and in the U.S.
Juan Cloy, chief of the McComb Police Department in Mississippi — a state where even a first-time drug possession charge can result in a years-long sentence — said there are also vast cultural differences.
"Our culture right now can’t stand anything within reason," he said.
Cloy spent years working as a street-level narcotics officer in Jackson, Mississippi, in the late ‘90s as part of a small unit who wore military camouflage uniforms and called themselves the “jump out boys” because of the speed in which they swooped in and chased down drug dealers and people using drugs.
Once, he and his narcotics unit of six officers arrested more people in a week than the entire Jackson Police Department, Cloy said. But after arresting what he described as the "same kids, different names," Cloy said his views changed.
"It hasn’t worked," he said. "All it does is take people from their family and friends."
One incident in 2016 stands out. Cloy said he was sent to a boy's house in Jackson to see why he had stopped going to school — discovering that the boy lived in a home with no running water and only had one set of clothes.
He bought new clothes and gifted them to the boy, who was grateful for the gesture. The next time he saw him, Cloy said the boy was selling drugs with other kids in his neighborhood.
He knew he could have arrested him, but he said it would do nothing to change his conditions.
“Those kinds of moments helped me realize wholeheartedly that I damaged society in a certain way,” Cloy said. “But consciously, I can say that, since I know better, if I don't do better, then I have an issue. So I do better.”
When Cloy became police chief in McComb in 2023, he implemented tactics that resemble the approach of Dutch police.
He disbanded the department’s narcotics unit. He told officers to stop arresting people for possession of small amounts of drugs, including what he called a “user’s amount” of heroin and fentanyl. He also recently assigned an officer to drive a vehicle bought with opioid settlement funds that distributes naloxone, or Narcan.
He’s in favor of wider accessibility to addiction treatment with medications for substance use disorder. And he is open to more harm reduction initiatives, like syringe exchange programs and safe consumption rooms — both of which are illegal under Mississippi state law.
But while police chiefs hold a lot of power over how their department enforces laws, they can’t create funding for public health initiatives.
“We have to put our money where our mouth is when it comes to those things,” said Brandon del Pozo, a public health and justice expert at Brown University and a former police chief. He pointed to the "failure" of Oregon’s attempt to decriminalize drugs in 2021.
The law removed criminal penalties and aimed to connect people to voluntary treatment. But few sought help, overdose deaths soared and public disorder worsened.
The state has since reversed course, reinstating criminal penalties. Del Pozo said effective drug policy has to balance public health and criminal justice.
“It's not just about a change in the law. It's about properly funding meaningful public health alternatives, which they've done in a lot of Europe,” del Pozo said. “We haven't put the funding and those resources in place here. And then when it fails, we say it was a terrible idea, and we don't want to try it again.”
Police in the Netherlands also don’t have to contend with guns like American police do. They’re illegal in the Netherlands without a special permit for shooting sports and hunting. In the U.S., there are more guns than people.
“Every time the police have an encounter with an unknown person who may be acting a little erratic, the worry that they have a gun is top of mind,” del Pozo said. “And that is not paranoia. That is working as a cop in a country with 400 million guns. So that is a big difference.”
Local context also matters. Cloy said he recognizes the pushback harm reduction and a public health approach faces in states like Mississippi.
But the broader, American cultural view of drugs is part of the problem, too. Cloy describes an “it’s not me that’s hurt, it’s you” mindset that positions drug addiction as an individual, moral failure rather than a medical problem that impacts the entire community.
Unless that changes, “We’re going to always have opioid epidemics,” he said. “And it’s still going to fall on law enforcement.”
Cloy is comfortable sharing his views on harm reduction with other departments in training sessions, but he stops short of suggesting drug use be legal.
"We're not like the Netherlands. The Netherlands are the Netherlands," Cloy said. “Just being able to really consume that and get my mind wrapped around that thought process totally, it’s a very difficult thing to do.”
One of Cloy’s officers, Tyler Harvey, who volunteered to drive the mobile unit distributing naloxone, echoed this sentiment in a thick, Southern Mississippi accent.
"This is harder to wrap your head around from our eyes... the families it ruins, the lives it affects, the lives it takes," Harvey said. "To see it legalized. It's just hard to grasp."
Cloy, Harvey, and del Pozo said most police feel the criminal justice approach is ineffective and damaging. But every year, nearly a million people are arrested for drugs across the country. And despite recent reductions in overdose deaths, the number of people dying in the opioid crisis is still at “catastrophic” levels.
“What we're doing, I haven't noticed it work. Nothing's really stopped it,” Harvey said. “A radical shift might work, it might not work. Like the chief just said, we're a different culture.”
This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.
This story was produced by the Gulf States Newsroom, a collaboration between Mississippi Public Broadcasting, WBHM in Alabama, WWNO and WRKF in Louisiana and NPR. Support for public health coverage comes from The Commonwealth Fund.
