Reimbursed Care Access in Bonaire, Sint Eustatius and Saba

Currently classified as a strictly controlled substance under the Opiumwet 1960 BES and enforced by local authorities and Customs; there is no authorised medical or reimbursed use on the BES islands outside of approved clinical research. #.

Currently classified as a strictly controlled substance under the Opiumwet 1960 BES with no authorised medical or reimbursed access outside approved clinical trials; enforcement actions for MDMA are recorded by Customs on the BES islands. #, #.

Esketamine nasal spray (Spravato®) has been assessed and recommended for inclusion in the Dutch basic health insurance package for treatment‑resistant major depressive disorder and the Minister adopted the advice: esketamine is placed in the reimbursement pathway (with conditions) and therefore is available to patients whose care is managed under Dutch healthcare reimbursement rules; national implementation, prior‑authorisation and clinic‑level REMS‑style safeguards are required. The Netherlands’ National Health Care Institute published a formal pakketadvies recommending inclusion and the Minister implemented reimbursement starting 1 September 2021 (with subsequent administrative updates extending temporary arrangements into 2025–2028 timeframes). #, #.

Practical implications for the BES islands: because the islands form part of the Caribbean Netherlands legal framework (Opiumwet BES and national ministries retain responsibility), esketamine reimbursement policy decided at the national level applies to the BES context administratively; however, local availability depends on whether a certified centre/clinic on the island or in the region can deliver the REMS‑style supervised administration required for Spravato and whether insurers operating for BES residents have local arrangements—patients may need referral to mainland Netherlands or to regional providers. For provider coverage and prior‑authorisation processes insurers (and specialist psychiatric centres) apply national eligibility criteria (treatment‑resistant depression after multiple failed prior lines) and facility certification processes. #, #.

Ketamine is listed on the WHO Model List of Essential Medicines for use as an anaesthetic and is a recognised, authorised medicinal product used in clinical practice for anaesthesia and limited off‑label psychiatric interventions in many health systems; in the BES islands ketamine is available for clinical/anaesthetic use under prescription and hospital oversight per national medical regulation and Opiumwet BES controls on distribution. #, #.

Reimbursement and psychiatric use nuance: ketamine used for anaesthesia is procured and reimbursed through standard hospital/pharmacy supply chains and national health financing arrangements applying to the Caribbean Netherlands; ketamine given specifically as a psychiatric intervention (e.g., IV ketamine for depression) would typically be off‑label and billed as a specialist clinical service rather than as a covered, labelled psychiatric drug in a standardized mental‑health drug formulary. Availability of ketamine for psychiatric infusions requires local specialist services and is therefore variable; patients may need referral off‑island for structured ketamine psychiatric programmes. (No BES‑specific national guidance listing routine reimbursed psychiatric ketamine programmes was identified in public sources.) #.

Currently classified as a strictly controlled substance under the Opiumwet 1960 BES and international scheduling; there is no authorised medical or reimbursed access on the BES islands outside of approved clinical research. Enforcement of DMT falls under the Opiumwet BES and island customs/judicial authorities. #.

Currently classified as a strictly controlled/forbidden substance under the Opiumwet 1960 BES with no authorised medical or reimbursed use on the BES islands outside of approved clinical research. Local enforcement and customs treat 5‑MeO‑DMT as illicit. #.

Currently classified as a strictly controlled substance under the Opiumwet 1960 BES with no authorised medical or reimbursed access on the BES islands outside of approved clinical research. There is no publicly published regulatory pathway for clinical ibogaine in the BES context. #.

Because its primary psychoactive constituent (DMT) is controlled, ayahuasca use, possession and distribution are treated as illegal under the Opiumwet 1960 BES; there is no authorised or reimbursed medical programme for ayahuasca on the BES islands outside approved research or tightly constrained religious exemptions (none publicly documented for BES). #.

Currently classified as a strictly controlled substance under the Opiumwet 1960 BES with no authorised medical or reimbursed access on the BES islands outside of approved clinical research. Peyote/mescaline related activities would therefore fall under enforcement actions by local authorities. #.

Currently classified as a strictly controlled analogue/designer psychedelic family under national controlled‑substances enforcement in the Opiumwet 1960 BES; no authorised medical or reimbursed use exists on the BES islands outside of approved clinical research. Customs and policing efforts on the islands report seizures of designer/MDMA‑class substances, and the Opiumwet BES provides the enforcement framework. #, #.