In 1971, Robert Gorter set up the very first Methadone Detox and Maintenance Program in the European continent in the Amsterdam Vondelpark. The Vondelpark is the largest city park in the center of Amsterdam and can be compared with Hyde Park in London.
Robert Gorter received the full support by the city of Amsterdam and the Municipal Public Health Department (“Gemeentelijke Gezondheids Dienst”, or GGD) for the delivery of methadone tablets. (Later on, methadone was delivered to patients in liquid form to prevent that clients would sell the tablets). In addition, 1) clean syringes with needles where dispersed to halt the spread of Hepatitis B virus infection and b) under medical supervision, contraceptive medication and condoms where handed out. He quickly got the nick name as the “Clean Doctor” as he was a strict vegetarian, did not smoke or drink, nor do any form of drugs (except coffee and chocolate…).
When it became clear that hard drugs would become a definite part of various subgroups and on request of Robert Gorter, a more formal program was installed that was eventually called “HUK” (het huiskamer project; living room project) what stood for a (very) low-threshold program for intravenous drug users IVDUs (and their dogs and other beloved ones) in a building in the Spuistraat 96 in the center of Amsterdam (see pictures).
Here, with a few volunteering colleagues like Nanda Wittebrood, Robert Gorter and his team with nurses (especially Trudy) and social workers (some of them had been addicted themselves) and through trial and error, set up and developed a program where IVDUs could stay essentially all day in a “living-room-like low-threshold program where seven days a week, the clients could have a warm lunch, social- and medical assistance, needles and methadone seven days per week.
in the Vondelpark of Amsterdam
Already at that time, Robert Gorter was a licensed acupuncturist and treated many more regular medical conditions but also very successfully withdrawal symptoms with electro-acupuncture. During this period, and with the support of the psychiatrist Thijs Bos, who also had interest in the application of acupuncture in this population, the idea was developed to start a low-threshold clinic where IVDUs would be treated with acupuncture. This clinic came and with a generous grant by the City of Amsterdam, for several years this clinic was established and successfully run by Thijs Bos and Robert Gorter.
Robert Gorter was also instrumental in setting up the “Methadone by Bus” where staff members would deliver methadone and counseling and free needles to IVDUs “to their doors”, so to speak.
Currently, the Amsterdam Municipal Health Service runs the ‘methadone by bus’ project. Two mobile clinics cruise the city, stopping at six different locations daily. The liquid methadone is consumed on the spot and clean needles, condoms and counseling are available. This project is based on the principles of ‘harm-reduction’, i.e. if it is not (yet) possible to ‘cure’ a hard drug user, one should at least try to minimize the harm they cause to themselves and their environment. As soon as a client refrains from the use of illegal drugs, the client can ‘graduate’ to other methadone programs with a higher threshold. To prevent double prescription, all Amsterdam methadone programs participate in the central methadone registration. The Amsterdam Municipal Health Service has contact with over 50% of the drug users. The estimated number of hard drug users has remained stable over the last 5 years, whilst the average age of drug users has increased to 32 years. In the future, increasing the average dosage and the provision of injectable drug users will be discussed to assess their role in further harm reduction.
In addition, at Robert Gorter’s initiative, a farm in the city of Purmerend was erected with a rained staff to assist IVDUs in their re-socialization process.
Three (four?) years later, HUK was closed and became part of the formal program of the Jellinek Kliniek in Amsterdam. Robert Gorter joined then part-time the staff of the Jellinek Kliniek; still at the Keizersgracht at that time.
The Jellinek Kliniek is a center in Amsterdam and surrounding regions and the largest center for addiction in the Netherlands. In 2013, the total number of clients was more than 5.000. It serves clients with addiction problems (alcohol and drugs) but also recently, those addicted to gambling, etc.