From trialling pill-testing to piloting cannabis regulation, cities across the world are increasingly taking the lead in drug policy reform, testing out local harm reduction initiatives to serve their populations. However, while these city-led initiatives show promise, their success depends on overcoming national regulatory challenges and collaborating across and between cities. The question remains: can cities (or regionally defined places) pioneer drug policy reforms, tackling global challenges through local innovations?
Victoria’s pill testing initiative
Victoria’s pill-testing trial, which began in December 2024 and will last for 12 months, is an example of a localised harm-reduction strategy, focused on reducing overdoses across the state, and educating its citizens on safer drug-using behaviours. Early results from this trial are promising: in one festival, they tested over 600 samples. For 70% of their service users, it was the first time they had ever had their drugs tested; 40% said they would adjust their dosages after speaking with the staff.
Drug checking is a tried and tested intervention that educates people about the contents of their drugs and their potential effects. However, the fact that the trial was limited to the state of Victoria underscores the broader challenge of scaling local successes to national levels: opposition to drug policy reform is always on the horizon.
Critics argued that while pill testing promotes harm reduction, it does not address the root causes of drug-related harms. This included Emma Kealy, Shadow Minister for Mental Health from the centre-right National Party, who argued that pill-testing alone cannot prevent overdoses or fatalities. While this is true, there’s evidence that drug checking can reduce drug using risks: a 2024 study found that many drug-related deaths at Australian music festivals resulted from young people mixing illicit substances with alcohol, unaware of the heightened risks from poly-drug use. The study underscored that harm reduction interventions like drug checking could reduce harms while simultaneously improve people’s drug education.
While Victoria’s pill-testing initiative is an important step towards better harm reduction services, its effectiveness as a driver for broader drug policy reform remains unclear. The initiative demonstrates how localised interventions can provide immediate public health benefits; but the temporary nature of the trial means there may be no clear pathway to broader national implementation. Its impact may also be limited due to operating in a legal environment where drug possession remains a crime, meaning people may still face legal repercussions if caught with substances.
Despite these limitations, city-driven initiatives like Victoria’s pill-testing could still serve as stepping stones toward national reform. If multiple states implement similar programmes, they would hopefully generate enough evidence to support broader legislative change. What remains to be seen is whether politicians like Kealy remain against such interventions if they prove to reduce harms and festival drug-related deaths.
If all goes well this year, Victoria may come to be a successful example of how a place-based reforms can positively impact people’s behaviours and health around drugs. The long-term plan – of highlighting additional benefits from scaling up Victoria’s pilot to the nation – requires not only local evidence, but sustained advocacy and political will from national actors.
The Dutch cannabis city project
Amsterdam is another example of a city that has pushed forward with localised drug policy reform efforts. While the Netherlands has been a pioneer of tolerant drug policies, with 570 coffeeshops operating across 102 municipalities, its capital stands out as a “cultural” drug destination due to its grey market of cannabis coffeeshop industry.
Crucially, cannabis cultivation and sale remains illegal in the Netherlands; cannabis somehow appears for sale in coffeeshops, a glaring failure of the current system to address its illegal supply.
In light of this, a new cannabis pilot programme begun in 2023, seeking to regulate the entire supply chain, from cultivation to sale. This initiative, supported by an estimated 60% of Dutch citizens, involves legal supply from three domestic producers. It was expanded to two other cities in December 2023, and to eight more throughout 2024. The pilot is expected to run for four years, with the state measuring its effect on crime, safety, public nuisance and public health.
The risk of city-based pilots is that they may create inconsistencies that could clash with national strategies – in this case, the continued criminalisation of cannabis supply. While only ten cities will benefit from the four-year pilot (which may have led to more people visiting them to purchase cannabis), with other places remaining reliant on the grey market arrangement, this disparity can create enforcement challenges and complicate broader efforts to standardise cannabis policy across the country. Additionally, the lack of national coordination has contributed to unintended consequences such as drug tourism, where individuals travel to cities with looser regulations, potentially overburdening local infrastructures and law enforcement.
However, a stepped expansion of the pilot programme seems like a measured approach to address many of these concerns: it creates space for gradual progress, staggered evaluations and local adaptations where needed. Deploying to multiple cities also means that the pilot will demonstrate whether cannabis supply regulation would truly work at the national scale, an issue that city-specific or region-specific pilots may fail to address. Without national or inter-city cooperation, local initiatives risk being seen as exceptions rather than scalable models for systemic reform.
The potential of city-based policies for drug regulation
According to the Organisation for Economic Co-operation and Development (OECD), place-based approaches offer a unique way to address complex societal issues, prioritising local decision-making and community engagement. Local governments are often better positioned to pilot harm reduction measures, allocate resources effectively, and build trust with communities. The examples of the state of Victoria and Dutch cities are evidence of this.
To build on these localised successes, collaboration plays a crucial role. Events like the Dealing with Drugs conference from January 2024 brought together mayors and policymakers from around the world to share strategies for systemic drug policy reform through cities or regions. The Amsterdam Manifesto, the conference’s outcome document, called for the implementation of progressive health-based drug policies that prioritise regulation, safety, and harm reduction. The Manifesto promotes the idea that cities can pursue new approaches to drug control while minimising organised crime involvement in drug markets.
In June 2024, the Global Commission on Drug Policy co-organised an event with UN Habitat at the Global Cities Hub, bringing together global health and social policy advocates. In it, cities were recognised as important units to “drive innovative initiatives that can inspire national change”. Creating common strategies and joint manifestos like the Amsterdam Manifesto is one way of committing to collaborating on cities can learn from each other’s successes and challenges, empowering local governments to push for progress that may come to influence their national drug policies.
This city-led model however, is not without its flaws. While the Netherlands has long prioritised a health-focused approach to drugs, it has not been able to resist the influence of global drug trafficking: Amsterdam has had recent spikes in drug-trafficking related violence as the city (and others) have become major transiting hubs for European cocaine trafficking and money laundering. Femke Halsema, Amsterdam’s Mayor from the left political party Green Left, has acknowledged the Netherlands’ shortcomings in dealing with these issues, which is the result of the global drug prohibition system. Halsema has called for other nations to adopt innovative, health-centred drug policies that move away from prohibition and towards regulation and harm reduction. Cities, she argued, can lead by implementing policies that ensure public safety and societal stability.
A useful test pilot
In sum, city- or place-led drug policies have significant potential in challenging outdated national approaches and illustrating a new way forward. As seen in Victoria’s pill-testing trial and the Netherlands’ cannabis pilot, bounded regions can act as policy laboratories, testing innovative strategies tailored to local needs. However, these efforts remain constrained by national legal frameworks, jurisdictional conflicts, and the challenge of ensuring consistency across different regions.
For city-based policies to have a lasting impact, they must be supported by broader legislative change, inter-city cooperation, and evidence-based advocacy. The success of such initiatives relies not only on their immediate harm reduction outcomes but also on their ability to influence national and international policy landscapes. Without a pathway to legal recognition and expansion, these localised successes risk remaining isolated experiments rather than catalysts for systemic reform.
