People who use illicit drugs (PWUD) experience a wide range of drug-related harms. The goal of harm reduction is to reduce these adverse effects of drug use, without necessarily reducing drug use itself. By providing a safe and hygienic environment to consume pre-obtained drugs under the supervision of trained staff, drug consumption rooms (DCRs) aim to reduce both individual-level and public-level harms associated with illicit drug use. A substantial body of evidence has accumulated over the past three decades to support the effectiveness of DCRs in achieving their primary health and public order objectives, and therefore supports their role within a continuum of services for PWUD. Despite the abundance of scientific evidence supporting DCRs, there continues to be social and structural barriers to the implementation of this public health intervention in communities across the globe. Yet, the debate about implementing new DCRs remains high on the political agenda in a number of countries worldwide. To date, Belgium does not offer a DCR to its drug using population. Against this background, the Belgian Science Policy Office (BELSPO) commissioned a first-ever study to assess the feasibility of DCRs in Belgium. The objective of the current feasibility study was to identify (legal) preconditions, design and operational considerations that would allow a DCR to be added within a continuum of policy initiatives for PWUD in five Belgian cities: Ghent, Antwerp, Brussels, Charleroi and Liège. The aims were threefold: (1) provide an up-to-date overview of the effectiveness, models, and barriers of DCRs worldwide, with particular attention to DCRs in Belgium’s four neighbouring countries; (2) conduct an in-depth analysis of the legal framework within a DCR could operate in Belgium; and (3) conduct a feasibility study with local stakeholders and PWUD from each of the five cities. Based on our findings, we formulate 18 recommendations specifically tailored to the Belgian context: essential preconditions (including legal ...