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Background  Open drug scenes are gatherings of drug users who publicly consume and deal drugs. The authors conducted a study of five European cities that have met such scenes constructively. The aim was to investigate shared and non-shared interventions and strategies in order to increase the understanding of this type of problem.    Methods  First a description was made for the cities of Amsterdam, Frankfurt, Vienna, Zürich and Lisbon. These descriptions were sent to contact persons in each city prior to visit by the researchers. The methods and strategies in each city were discussed and core choices and efforts extracted. A report was sent to the contact group for corrections and clarifications. The paper analyses shared and non-shared traits and strategies.    Results  All of the cities had initially a period with conflict between liberal and restrictive policies. A political consensus seems to be a prerequisite for effective action. A core shared characteristic was that drug dependence was met as a health problem and drug use behaviour as a public nuisance problem. Low threshold health services including opioid maintenance treatment were combined with outreach social work and effective policing.    Conclusion  Prevention, harm reduction and treatment should be combined with law enforcement based on cooperation between police, health care and social services. The aim should be “coexistence” between society and users of illegal substances and the strategy based on several years planning and conjoint efforts. The solutions are found in appropriate combinations of harm reduction and restrictive measures.

Open drug scenes: responses of five European cities