"It shouldn't become the Club Med of drug problems here": Navigating community responses to harm reduction services in four Belgian cities (2026)

While harm reduction has become increasingly embedded in urban drug policy across Europe, its local implementation remains a site of tension and controversy. Despite being backed by strong public health evidence, harm reduction services (e.g., drug consumption rooms, opioid agonist treatment centers) intersect with contested urban dynamics and diverging stakeholder expectations. This study explores how harm reduction services are perceived within the socio-spatial fabric of four cities in Belgium: Brussels, Liège, Ghent, and Antwerp. Twelve focus group discussions were conducted with local residents, social and healthcare professionals, and local authorities (n = 95 participants). Data were thematically analyzed, with attention to how harm reduction is framed in relation to care, safety, and urban governance. Three intersecting themes emerged. First, services were seen as essential infrastructures of care for people who use drugs in highly precarious situations. Second, they also provoked socio-spatial tensions around perceptions of nuisance, neighborhood livability, and the appropriate place of such services in the city. These tensions were shaped by differing stakeholder narratives, emphasizing public safety, health, or human rights. Third, participants underlined the need for cross-sector collaboration and more inclusive community engagement in decision-making. Overall, harm reduction services operate at the intersection of care, control, and contested urban belonging. Moving beyond binary notions of support or resistance, this study points to the importance of context-sensitive strategies that embed harm reduction within broader urban policy, social investment, and participatory governance. [Author's abstract]