How would you describe 2022? A year of war, the aftermath of the pandemic, a protesting earth and increasing inequality. A world where homelessness is on the rise, people are tumbling over the edge, and the most vulnerable are hit the hardest by all the crises.

According to the Global State of Harm Reduction 2022, our field of work faces a funding gap of 95%. Mainline feels the effects. Increasing amounts of time are spent on fundraising and reporting, followed again and again by disappointment when the best-laid plans fail to go ahead. It sometimes seems like you have to explain the value of harm reduction from scratch every day.

2022 was the first year of Mainline's new strategic plan, in which we fully committed to our outreach work and activities that directly benefit people who use drugs. It is a plan in which we reinvented ourselves with relevant educational offerings, practical research and expertise on new topics. With the new plan, 2022 also became a year of hope.

The National Postcode Lottery acknowledged the importance of our work and made a donation. Through the European Commission's Justice Fund, we launched a large project involving migrants using drugs on the streets of Amsterdam, Athens, Berlin and Paris. Internationally, we helped launch harm reduction programmes in various countries and helped improve access to and quality of services. We bid farewell to colleagues and welcomed new Mainliners.

Mainline moves with the waves of the world around us. We carry on, focus on what is important and try to make a big difference with sometimes small gestures.

Machteld Busz, Director of Mainline

Mainline is an expert on drug use in sexual settings. We expanded that expertise in 2022.

In 2022, we started developing the website chemsex.nl, a platform with information about chemsex and a national care map to provide help and care related to chemsex. The official launch will take place in 2023.

Since 2016, Mainline has been organising and facilitating biweekly chemsex meetings for MSM who want to or have quit chemsex. In 2022, 24 meetings were attended by 79 participants—of which 33 were new visitors.

Most participants were from Amsterdam and surrounding areas, but there were participants from all over the country. Particularly notable was the group of refugees (5 men) from Lebanon, Russia, Ukraine and Syria.

Mainline also provides individual chemsex consultations. One hundred thirty-seven people from all over the country had an interview with one of our outreach workers. In addition, more loved ones/family members of users/former users and professionals asked for information, advice and support. The issues are remarkably complex, and the target group has difficulty finding help. There is also still much to be gained in the area of education. In particular, injecting new substances such as 3-MMC and 3-CMC leads to health risks that not everyone is aware of. These and other signals indicate the importance of developing a good informational website with a care map, such as chemsex.nl.

Women who use drugs face many forms of stigma and exclusion. Mainline delved into the situation in Nepal.

Women are even more looked down upon by society for drug use than men. Access to harm reduction programmes is not self-evident for them, which further compounds potential harm from drug use.

In December 2022, Mainline spoke with Nepali women who use drugs and employees of harm reduction services. Their view of their lifestyles is included in this report. We also hope the recommendations will be included in the next round of funding by the Global Fund.

Various groups of migrants who use drugs are becoming increasingly visible on the streets of many European cities. These are often people with significant trauma and limited employment opportunities, mostly undocumented.

What about their access to harm reduction programmes and care? Does the right to care and a dignified existence in Europe not apply to everyone? Mainline is joining forces with six other European organisations to give a voice to people from migrant backgrounds who use drugs. It is high time that the rights of migrants are brought to attention locally, nationally and Europe-wide. The project will run through 2022 and 2023.

Training for professionals working with migrants

Mainline conducted training on dealing with misunderstood behaviour at Barka, an organisation that works with Central and Eastern European migrants in The Netherlands. In their day-to-day work, they may encounter clients with complex issues such as substance dependence and psychiatric disorders. Mainline trained the organisation on the root causes of such behaviour, setting boundaries, resilience and effective communication. A follow-up course is planned, along with a comprehensive e-course around this topic.

Mainline wants to make harm reduction more accessible to people who use stimulants. Unfortunately, many harm reduction projects still focus on people who inject drugs and use opiates.

In 2022, Mainline worked with SCDI to strengthen the stimulant learning hub in Hanoi. This is valuable work, as there is interest throughout the region in harm reduction for people using methamphetamine. In addition to a range of practical interventions to reduce the harm of frequent stimulant use, organisations in Southeast Asia are particularly interested in the community mental health approach we developed with SCDI. Now that the year is over, we are ready to share the knowledge we have accumulated with other harm-reduction organisations. This can be done through a visit to Hanoi, through our blended learning offerings, or simply by contacting us and exchanging knowledge.

We published Mainline magazine four times again in 2022, this time under a new editor-in-chief.

Mainline has produced a lifestyle magazine for drug users for more than 30 years. With a circulation of 10,000, it is widely distributed throughout the Netherlands. Two of the four issues in 2022 were special editions, such as the Sex & Drugs edition. The Sex & Drugs edition was also distributed in the LGBT+ community and nightlife entertainment venues. It focused on why people combine sex with drugs and how to mitigate the risks. This magazine's target audience was broader than the usual chemsex editions as it also targeted straight people who had sex under the influence of drugs. We also made a youth edition about the “new” designer drug 3-MMC. This edition was distributed in the regular places and a variety of places frequented by youth.

We also released other educational materials, including the “stop chemsex” leaflet that was frequently ordered in 2022, and updated the “drug advice” poster.

We provided plenty of training again in 2022. Our customer base continues to grow.

In 2022, Mainline's team of educational experts worked hard to further develop our educational offering. In addition to the training courses we provide independently (at home and abroad), we ensure that our educational offering matches our clients' needs and can be fully customised. We are investing more in longer relationships and mentoring professionals or organisations who want to try a new approach for a longer period. This gives the education a more profound impact.

In countries such as Vietnam and South Africa, we continued our work with partners on topics such as community-based mental health interventions, harm reduction for people who use stimulants, chemsex, behavioural change and outreach strategies. We worked with partner organisations to increase their capacity to provide services based on these topics. This included mentoring, on-the-job coaching, trainer training programmes and the development of intervention packages.

Training courses in the Netherlands

In 2022, we organised 66 training courses for care professionals from 26 organisations in the Netherlands.

The organisations included social shelters, addiction treatment facilities, municipal authorities, mental health authorities and mental health institutions. The topics ranged from GHB in shelters to chemsex and from substances & addiction to making contact. Some of our regular clients included us in their standard educational offerings. This shows that organisations trust our expertise! In 2022, 253 professionals from 26 locations in the Salvation Army's Northwest Region attended Mainline training.

Our training focuses on increasing the quality of life for people who use drugs. Connecting with users is the most important part of that. Basic knowledge about drugs, addiction and psychiatry is essential for good contact. Only then does confused behaviour become understood behaviour. Our training also touches on how you and the organisation think about drug use and how that can affect contact. Last but not least—because that is Mainline's core premise—we focus on how we can integrate harm reduction within the work of professionals.

Mainline worked hard to create an online educational offering in 2022. We are particularly proud of the e-course we developed with IDPC and Health[E]Foundation. The comprehensive course on decriminalising drug use is available for free. Seven hundred seventy people from 96 countries have already followed it. It is available in four languages.

We have developed fully-fledged educational offerings in seven themes in cooperation with various partners. These can be combined with a live session (online or in-person). Mainline will launch the Harm Reduction School in 2023. We hope this will contribute to the broad spread of harm reduction and give partners around the world tools to make a difference in the lives of people who use drugs.

Mainline conducted research in Iran and Zimbabwe. Our previous studies have been published in reputable international journals.

The drug scene in Iran has changed in recent years. There has been an increase in drug use, including methamphetamine, and more people have become homeless. Mainline investigated whether Tehran's current harm reduction programmes still adequately meet the needs of the various people who use drugs. Depending on developments in the country, we hope to play a role in implementing the recommendations resulting from the study.

Mainline also surveyed drug scenes in five regions of Zimbabwe. The goal was to gain insight into which drugs are mostly used and what health interventions are appropriate. The report can be read here. The great news: the first steps to launch harm reduction interventions have now been taken in Zimbabwe!

Academic publications

Mainline's work is increasingly recognised internationally and in academia. Our 2021 slam survey was published in the Dutch Journal of Sexology and Sexual Health. The study on anabolic steroid use was published in European Addiction Research, and the study on sex and drugs among women was published in the popular science magazine Vlam.

Poppi Drug Museum was hard at work again in 2022, organising two exhibitions (World of Opiates and XTC store) and collaborating on the exhibition House of HIV, which looked back at 40 years of HIV initiatives. At the XTC store, we received 1,600 paying visitors, including many politicians, a.o. Minister Kuipers. We also received frequent media coverage, including an article in The Guardian!

World of Opiates

Opium as a “date rape drug” in the 17th century, as a sedative and soporific for the pope in the 18th century and as a “party drug” for pirates. Different times, different worlds. The World of Opiates expo informed visitors of the extensive history of opiates. From 3 December 2021 to 29 March 2022, the exhibition was on display in the heart of Amsterdam. It was a collaboration between Poppi, Utrecht University, the Inventor’s Guild and Corné van der Stelt.

XTC shop

Suppose the government were to regulate the production and sale of ecstasy. Would it be available to the public to buy anywhere? Or would there be an age limit and strict supervision? In the XTC store, visitors could determine that for themselves. The store was open in downtown Utrecht from 15 July to 29 September. Political lobbying was part of the exhibit. City council members from several cities visited the store, and an after-dinner session was held at the Tivoli. The XTC store was built in collaboration with creative makers Vincent Schoutsen and Corné van der Stelt. Together with Utrecht University, we paired an audience survey with the store. The report can be found here.

At the time of writing this annual report, 2023 is well underway. It will be an exciting year.

Among other things, we are expanding our work with vulnerable migrants who use drugs to include former unaccompanied foreign minors. We will collaborate with the Trimbos Institute on a large study among users of heroin and crack cocaine, and we are involved in a large study in Pakistan.

We will participate in the International Harm Reduction Conference in Melbourne in April. We are launching our Harm Reduction School there and will get to talk about our work with several partners. If you are also going to Melbourne, send us a message at info@mainline.nl. We would love to see you there!

We also have big plans with Poppi. We are committed to a project with young people who work or have worked in drug crime, are further developing Tales from the Drug Closet and hope to host a significant experience around psychedelics. To support Poppi or help out, please get in touch at info@poppi.amsterdam.

In 2023, we are once again fully committed to improving the health and rights of people who use drugs.