THE AMSTERDAM METHADONE-DISPENSING-CIRCUIT - GENESIS AND EFFECTIVENESS OF A PUBLIC-HEALTH MODEL FOR LOCAL-DRUG POLICY

During the 1970s, the Methadone Dispensing Circuit (MDC) was initiated by the municipality of Amsterdam in order to cope with the heroin add iction epidemic that afflicted the city. In the MDC, methadone is disp ensed 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 regula te their addiction. This paper describes the genesis of the MDC as a r esult of a historical and political process. Determining factors in th is process proved to be the urgency of the drug problem, the widesprea d consensus among local politicians, most of the general practitioners (GPs) and alternative relief institutions about the low-threshold dis pensing, 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 di agnostic methods. The transferability of the 'Amsterdam model' to othe r places is discussed; besides the burden of the drug problem, it depe nds on the acceptance of the underlying value orientation.