A man in a Rotterdam clinic placed a large dose of pharmaceutical-grade heroin on a piece of foil, heated it from underneath and inhaled the vapour through a tube. I stood a few feet away, behind a glass wall, watching.
He was 65 years old and had been using opioids since he was 15. I was visiting the clinic with a group of addiction physicians. About 60 patients attend the program, usually once or twice a day, to receive prescribed heroin under the supervision of nurses. He told us he had no plan to stop, he said he had seen too many friends quit treatment, relapse, lose their tolerance, overdose and die.
At first glance, the scene seemed to confirm every stereotype about Dutch drug policy: this was the country of cannabis coffeeshops and permissive attitudes toward drugs taken to their logical extreme. But the more I learned, the less that description seemed to fit. The striking thing about Dutch drug policy is not how permissive it is. It is how controlled it is.
That is particularly apparent when comparing opioids. Canada recorded 7,146 opioid-toxicity deaths in 2024, while in the Netherlands roughly 161 deaths that year involved opioids, in a population about half the size of Canada’s. The statistics are not perfectly comparable, but the difference in scale is unmistakable. What’s going on here?
North America first went through an era of extraordinarily high prescription-opioid use. Canada became one of the world’s highest per-capita consumers of prescription opioids. Large numbers of people were exposed to drugs such as oxycodone and hydromorphone before the illicit opioid market was transformed by fentanyl. The Netherlands never experienced the same sequence on the same scale. Opioid use remains relatively rare.
Cannabis tells a similar story. The Netherlands has long been known for legal cannabis. Except cannabis is not actually legal there in the way it is in Canada. For decades the Dutch have tolerated the sale of small quantities through coffeeshops operating under strict rules while cultivating cannabis technically remains illegal. The goal of the fudge was to separate the cannabis market from markets selling more dangerous drugs.
What surprised me most in Amsterdam was how discreet those coffeeshops were. At times I genuinely had trouble deciding whether a place sold cannabis or cappuccinos. By contrast, in many Canadian cities, cannabis stores are ubiquitous, with prominent branding and storefronts competing for customers. I often tell my students that we have more cannabis stores than Tim Hortons. I’m not sure what the Dutch equivalent would be. Perhaps stroopwafel shops. And this is, after all, a country that loves to indulge in cheese, coffee and chocolate, and where prostitution is legal. But tolerance does not mean anything goes.
In fact, the image of the Netherlands as an ever-more-liberal cannabis haven is increasingly out of date. The number of coffeeshops has fallen substantially over the past two decades, and municipalities have considerable power to limit or exclude them altogether. Amsterdam has progressively tightened its approach to drug tourism and public nuisance, including banning cannabis smoking in parts of the city centre. The direction has been toward greater regulation and clearer limits.
Walking beside a canal in Delft, I encountered a sign showing crossed-out images of cannabis, pills and a syringe. DRUGSGEBRUIK VERBODEN. Drug use prohibited. That sign may say more about Dutch drug policy than the neon cannabis imagery tourists have historically associated with Amsterdam. The same country that tolerates cannabis sales and provides extensive harm-reduction services is perfectly willing to prohibit drug use in a public space.
I also saw no open illicit drug use and virtually no visible homelessness in Dutch cities. That is an observation, not a statistic, and the Netherlands certainly has homelessness. But homelessness does not translate into the same degree of visible street disorder. Dutch municipalities fund emergency shelters, supported accommodation and housing-led services, while homelessness policy also employs more controlling measures aimed at regulating the use of public space and reducing visible street homelessness. The system is far from perfect, but people with severe illness or addiction are less likely to have their entire care delivered on a sidewalk or in an encampment.
In Canada, debates about addiction increasingly force policies into opposing sides: treatment versus harm reduction, abstinence versus safer supply, enforcement versus decriminalization. The Dutch approach seems less interested in choosing a side. Someone who wants to stop using drugs can be offered treatment. Someone who is homeless may need shelter and supported housing as much as addiction treatment. And someone smoking cannabis in a place where it is prohibited can be fined and told to leave.
The Dutch system has plenty of problems. Homelessness is rising. Drug trafficking through Rotterdam and other European ports has fuelled violence and powerful criminal networks, including efforts to corrupt port and customs workers. Their cannabis system contains the odd contradiction of tolerating retail sales while historically leaving much of the wholesale supply illegal. Treatment is not always immediately available. And Canada cannot simply import the Dutch model: our history of exceptionally high opioid prescribing and our fentanyl-dominated illicit supply created a fundamentally different drug landscape.
But standing in that Rotterdam clinic, I initially thought I was seeing the most liberal imaginable approach to drugs. By the end of my visit, I had almost the opposite impression. The Netherlands tolerates drug use where tolerance seems to reduce harm, offers treatment to those who want it and draws firm lines around behaviour that disrupts public space. The Dutch may have become famous for their permissiveness, but their modern approach is built just as much around limits.
