Success, ladies and gentlemen, is fluid, not solid. It has an upflow, and a downflow. It can create a new set of problems. The same goes for the success of the Dutch and Amsterdam policy on drugs. The addicts grow older and sicker. They need more care. And new groups spring up who seem beyond the reach of care agencies. In my opinion this creates a need for a fundamentally new approach.

Instead of treating the older addicts with legal remedies, we should be applying medical ones. Or, to use the Amsterdam term, a «social approach». We should be increasing methadone, palfium and heroin programmes for them — under strict conditions.

Self-evidently, before there is a chicken, there has to be an egg. So before we go any further, let us take a look back into the recent history of the drugs problem and drugs policy in Amsterdam.

Back in the 1970s we had a group of «problem» addicts. It was small at first but it soon grew — and grew into a real problem. It started at around 2000 in 1975, and by 1984 it had mushroomed to 8500. This increase did not go unnoticed in certain neighbourhoods — and that is a massive understatement! Within four years the Zeedijk neighbourhood — a traditional area for a night out — had become «junky heaven». The place for addicts to meet and deal. But Amsterdammers are famous for their determination — dare I say stubbornness? And the local people never gave up. It is a tribute to their spirit that now, eight years later, the Zeedijk seems to have had a face-lift — in the positive sense.

City Hall was not sitting on its hands all this time. Lessons were learned from the Zeedijk. And to give reclamation a practical boost the city purchased nearly all the buildings in the area. Owning the real-estate is the best defence against crooked owners welcoming the dealers and users. The approach we took here was the «three Ps»: a Public Private Partnership, with bona fide private investors.

There is one key player I have not mentioned yet — the police. Without the imaginative support of the local men and women in blue, the campaign would never have succeeded. But it did succeed! — because one of the city’s oldest streets has begun a fresh episode in its history. Zeedijk has risen like the phoenix.

As anyone involved in caring for drug addicts will tell you — learning is crucial. I would describe the policy we implemented back in the 1970s as «search and experiment». As the funding resources grew, so did the number of agencies and institutions willing to provide help. There was a colourful mosaic of organisations all dedicated to getting addicts off drugs and back into society. Slowly but surely it became clear that this objective was not feasible. This whole adjustment of reality came under the «circuit model» as it was called. It centred around harm reduction and acceptance of addiction. There were two aspects in harm reduction: care for the health of the individual user, plus limitation of the nuisance factor suffered by the ordinary, non-using, members of the public.

In early 1979 the city health department was tasked with providing methadone to addicts via three neighbourhood posts and a specially converted bus, which moved from location to location. And so, in 1997, with this programme the health department reached 1900 addicts, five times a week. Since 1981, general practitioners have also been prescribing methadone. In the European context, it is unique that 75% of Amsterdam general practitioners issue 40% of methadone in Amsterdam.

In the second half of the 1980s we developed an integration model. The starting point here was the need for all parties to work together. Amsterdam saw establishment of new joint efforts, like the central methadone register. And by the early 1990s, the drugs epidemic had stabilised.

As I said, our medical/social care approach for addicts has been a success. It gives them the prospect of a normal life, a «normal» old age.

But what about Amsterdam three years from the millennium? The graphs certainly show a steady drop in the number of our addicts, and a steady rise in their average age. In 1986 there were 7290 addicts with an average age of 29.6. In 1996 the figures were 5769 and 37.

When I became Alderman for public health in 1994, I met with a group of 170 addicts at City Hall. We had a very deep, very frank talk about their hopes and expectations. They wanted day activities to be organised; also on their wish-list was some place to «use»; and — indeed — they wanted heroin to be issued.

In fact, addicts are not the only ones who want places to «use», and free issue of heroin. Many ordinary people who live in the city centre feel the same way; they believe this would cut down the nuisance factor. All the same, with all respect, I have to say that action has been taken against this.

The weather is beautiful in Amsterdam at this time of the year, and the European Summit is over, so you can get a seat in a restaurant again! And if you care to come over next week, you will hear us presenting the City Council with a proposal on «user» facilities. Specifically my proposal deals with an adoption model whereby the existing care organisations look after 150 addicts. Spread over between ten and fifteen facilities across the city, that will give us a regular, manageable user group for each.

My proposal also covers the estimated 200 to 300 homeless chronic addicts — specifically it deals with putting a roof over their heads. To realise that I want to expand the capacity of social lodging-houses by 125 beds.

If the powers-that-be in government and parliament agree, 750 addicts across a half-dozen Dutch cities will be able to take part in a test provision of heroin. I can reveal that this experiment has caused a few political sparks, I can also reveal that this Alderman thinks the fuss is unjustified! Improving the behaviour and physical condition of top problem addicts means more than a major saving on the social bill.

To my mind, provision of heroin is the logical outcome of our success in keeping so many of the target group alive for so long.

While waiting for the OK to start the heroin experiment, I have started one using palfium. Two years ago I asked the city health department to set up a test project with this drug — which is legally available in the Netherlands. The project has now been rounded-off, and, as part of the learning process - this is another «first» in Europe — we can agree that it was worth the effort. Palfium is an «upper» which works for a short period of time. In pharmacological terms the effect is analogous to heroin; it is a strong, addictive painkiller administered in tablet form. But hold on! It is similar to heroin but not the same. To quote one of the people in the project: «Nothing is like heroin, heroin is on its own».

Fifty-three people started the test programme, and 30 made it to the end. Most — 68% — reduced their use of heroin. And 24% stopped, or very nearly stopped. To put it in technical terms: their urine tests showed negative for heroin. I think this is an encouraging result, and on this basis I will be providing palfium on a wider scale.

Did we get where we wanted with user facilities, heroin and palfium?

The answer is no. But, with these provisions we have improved the situation for older addicts and people in their immediate neighbourhood. At least that is what I hope and trust.

That frees more energy and thought-power to be targeted on groups which are often left out. The clear demand for designer drugs and drinks, linked to kids» tendency to experiment, justifies this focus. But that is a story for another day and another gathering.

Obrigado.