Belgian National Report on Drugs 2014

SERVICE SURVEYS, LIFESTYLE AND CHRONIC DISEASES

BELGIAN NATIONAL REPORT ON DRUGS 2014

New Development and Trends

Belgian national report on drugs 2014 (data 2013)

New Development and Trends

Scientific Institute Public Health (WIV-ISP) Operational Directorate Public Health and Surveillance Service Surveys, Lifestyle and Chronic Diseases Programme Drugs Julliette Wytsmanstreet 14 | 1050 Brussels | Belgium

Public Health & Surveillance | November 2014 | Brussels, Belgium

Editors Lies Gremeaux Els Plettinckx

Authors Belgian Monitoring Center for Drugs and Drugs Addiction (BMCDDA) – Programme Drugs Jérôme Antoine Peter Blanckaert Karin De Ridder Lies Gremeaux Els Plettinckx

External Experts Lucia Casero EUROTOX asbl (socio-epidemiological observatory for alcohol and drugs in the Federation Wallonia-Brussels) Fred Laudens VAD (Association for alcohol and other drug problems) Freya Vander Laenen Department of Penal law and Criminology, Institute for International Research on Criminal Policy (IRCP), Ghent University Contact e-mail: [email protected] Website: drugs.wiv-isp.be

This document is available on the website of the Programme Drugs (drugs.wiv-isp.be) and the website of the Scientific Institute Public Health (www.wiv-isp.be).

Please use the following citation: Plettinckx, E., Antoine, J., Blanckaert, P., De Ridder, K., Vander Laenen, F., Laudens, F., Casero, L. & Gremeaux, L. (2014). Belgian National Report on drugs 2014, New Developments and Trends. WIV- ISP, Brussels.

Lay-out Nathalie da Costa Maya, CDCS ngo

www.wiv-isp.be EMCDDA Management Board Mr. Servais VERHERSTRAETEN, State Secretary Mr. Claude GILLARD, Legal adviser, Head of the for State Reform, Facility Management, in Department of criminal law, general Direction charge of Official Affairs. of law of the Federal Public Service of Justice. Mrs. Maggie DE BLOCK, State Secretary for Mr. Vladimir MARTENS, Deputy Director Asylum, Migration, Social Integration and General f.f., Administration of the French Poverty Reduction. Community. Mr. Hendrik BOGAERT, State secretary for Official Affairs, Modernization of the Public EMCDDA Scientific Committee Services. Prof. Dr. Brice DE RUYVER, Full Professor, Mr. John COMBREZ, State Secretary for the Institute for International Research on Criminal fight against social and fiscal fraud. Policy (IRCP), University of Ghent. For the Walloon Region: Ministers involved in the global Mr. Paul FURLAN, Minister of Local Authorities, and integrated drug policy in Towns and Tourism. Belgium 2013-2014 Mrs. Eliane TILLIEUX, Minister of Health, Social For the Federal Government: Action and Equal Opportunities. Mr. Elio DI RUPO, Prime Minister. Mrs. Laurette ONKELINX, Vice Prime Minister For the Federation Walloon-Brussels: and Minister of Public Health and Social Affairs, Mrs. Fadila LAANAN, Minister for Culture, in charge of Beleris and the Federal Cultural the Audiovisual Sector, Health and Equal Institutions. Opportunities. Mrs. Joëlle MILQUET, Vice-Prime Minister and Minister of the Interior and Equal Opportunities. For the Flemish Community and Flemish Mr. Didier REYNDERS, Vice-Prime Minister and Region: Minister of Foreign Affairs, International Trade Mr. Jo VANDEURZEN, Flemish Minister for and European Affairs. Welfare, Public Health and Family. Mr. Steven VANACKERE, Vice-Prime Minister, and Minister of Finance and Sustainable For the French Community: Development, in charge of official affairs. Mrs. Eliane Tillieux, Minister of Health, Social Mr. Vincent VAN QUICKENBORNE, Vice-Prime Action and Equal Opportunities. Minister and Minister of Pensions. Mr. Johan VANDE LANOTTE, Vice-Prime For the German-speaking Community: Minister and Minister of Economy, Consumers Mr. Harald MOLLERS, Minister of Family, Public and North Sea. Health and Social Affairs. Mrs. Sabine LARUELLE, Minister of Small and Medium-sized Enterprises, Self-employed For the Communal Community persons and Agriculture. Commission: Mr. Pieter DE CREM, Minister of Defence. Mrs. Céline Fremault, Member of the Joint Mr. Paul MAGNETTE, Minister of Public Board of the Common Community Commission Enterprise, Science Policy and Development (COCOM), responsible for Health and Civil Cooperation, in charge of Big Cities. Service Policy. Mrs. Annemie TURTELBOOM, Minister of Mr. Guy Vanhengel, Member of the Combined Justice. College of the Common Community Mr. Olivier CHASTEL, Minister for Budget and Commission (COCOM), responsible for Health Simplification. Policy, Finance, Budget and Foreign Relations. Mrs. Monica DE CONINCK, Minister of Work. Mr. Philippe COURARD, State Secretary for For the French Community Commission: Social Affairs, Family, Persons with Disabilities, Mrs. Céline Fremault, Member of the board of in charge of employment risks. the French Community Commission (COCOF), Mr. Melchior WATHELET, State Secretary responsible for Civil Service, Health policy and for environment, Energy, Mobility and State Vocational Training for the Self-Employed. Reform. 6 Table of Content 1. 2.

4. 1. Chapter 4.Highriskdruguer 1. Chapter 3.Prevention 29 1. Chapter 2.Druguseinthegeneralpopulation andspecifitargeted groups Chapter 1.Drugpolic Summary TABLE OFCONTENT 2. 2. 2. 3.

3. 3. 4. 4. 5. 4.

5. 6. Introduction Legal framework 2.1. National actionplan,strategy, evaluationandcoordination 3.1. 3.2. 3.3. Challenges andopportunities Introduction Introduction Introduction Prevalence ofandtrends inhighriskdrugusers Universal prevention Drug useinthegeneral population 2.1. 2.1. Drug useintheschoolandyouthpopulation 2.2. 2.2. 3.1. Characteristics ofhighriskdrugusers 2.3. 3.2. 3.1. Selective prevention inat-riskgroups andsettings 3.3. 3.2. 3.1. Drug useamongtargeted groups/settings atnationalandlocallevel Conclusions 3.2. 4.1. 3.3. Conclusions Indicated prevention 4.1. 4.2. 4.3. National andlocalmediacampaigns Conclusions Adaptation oftheBelgianDruglaw1921 National actionplanand/orstrategy Evaluation ofthefederal drugpolicy Coordination arrangements Estimation ofhighriskdruguseprevalence School Observed trends Family Drug useamongBelgiansecondaryschoolstudents Community Drug useamongFlemishuniversityandcollegestudents in theFlemishCommunity Injecting drugusersincontactwithneedles exchangeprogrammes European studyonyoungpeopleanddrugs Drug usersrecruited atthestreet intheFrench Community At-risk groups At-risk families Drug useinrecreational settingsinBelgium Recreational settings Screening andbriefintervention Early intervention Self-care andself-help y: legislation, s trategies andeconomianalysi 13 67 43 13 15 15 16 16 18 22 26 67 43 29 68 46 30 68 46 30 72 49 30 73 50 33 73 54 36 74 54 38 75 56 38 58 40 61 61 61 62 63 65 9 4. 4.

3. 3.

2. 2. 1. Chapter 8.Socialorrelates andocialreintegration 1. Chapter 7.Responto health correlates andcon sequence 1. Chapter 6.Health correlates andconequene 1. treatment availability Chapter 5.Drug-related treatment: treatment demanan 2. 2.

5. 3.

3. 4. 4.

5. Conclusions 3.4. Conclusions 3.3. 3.3. 3.2. 3.2. 3.1. 3.1. Social reintegration Prevention andtreatment ofdrug-related infectiousdiseases 2.2. 2.2. 2.1. 2.1. Social exclusionanddruguse Prevention ofdrug-related emergencies andreduction ofdrug-related deaths Introduction Introduction Introduction Introduction Drug-related infectiousdiseases Drug-related treatment inBelgium 2.1. 2.1. 2.2. 2.2. 2.3. 2.3. Conclusions Other drug-related healthcorrelates andconsequences 2.4. 4.2. 3.1. 2.5. 4.1. 3.2. Trends Drug-related deathsandmortalityofdrugusers New developments 4.1. 4.2. 4.3. Conclusions Leisure activities Employment Prevention andtreatment ofdrug-related infectiousdiseasesinprison Education &training Hepatitis CVirustreatment amonginjectingdrugusers Housing Needle exchangeprogrammes Drug useinsociallyexcludedgroups Prevention andreduction ofnon-fataloverdoses anddrug-related deaths Social exclusionamongdrugusers Prevention ofdrug-related emergencies through crisiscare services HIV/AIDS andviral hepatitis Policies andcoordination Syphilis andtuberculosis Organization andavailability ofdrugtreatment Behavioural data Treatment demanddata Treatment modalities Drug-related deathsregistered bytheBelgianEarlyWarning System onDrugs Non-fatal overdoses anddrug-related emergencies Quality assurance ofdrugtreatment services Drug-related deathsinthegeneral population Other topicsofinterest Cannabis usedisorder introubled youth–TheINCANT project Heroin-assisted treatment –TheTADAM project Analysis andoptimizationofsubstitutiontreatment –TheSUBANOPproject 117 105 126 125 115 124 114 124 113 122 110 121 110 120 107 118 105 118 105 117 105 103 102 101 101 91 77 91 77 91 78 91 78 95 78 95 82 98 84 98 85 99 86 88 88 88 89 90

7 Table of Content 8 Table of Content 5.

3. 7.

4. 3.

2. 2. AnnexES Alphabetic lis Bibliography Authors 1. Chapter 10.Drugmarkets 1. 127 Chapter 9.Drug-related crime,preventionofrug-relate d crimeanprison Annex 4:Listoffullreferences oflawsinoriginallanguage Annex 3:Listoffigures Annex 2:Listoftables Annex 1:Listofabbreviations Conclusions 4.3. 4.2. 4.1. Price/purity 3.3. 3.2. 3.1. Seizures Conclusions 6.2. 6.1. Reintegration ofdrugusersafterrelease from prison 5.4. 5.3. 5.2. 5.1. Responses todrug-related healthissuesinprisons 4.2. 4.1. Interventions inthecriminaljusticesystem Prevention ofdrug-related crime 2.2. 2.2. 2.1. 2.1. Supply toandwithinthecountry Drug-related crime Introduction Introduction Composition ofillicitdrugsanddrugtablets Purity/potency ofillicitdrugs Price ofillicitdrugsatretail levelandwholesale of production andprecise typeofillicitdrugsmanufactured there Number ofdrugproduction sitesdismantled,descriptionofmethods of illicitdrugs Quantities andnumbersofprecursor chemicalsusedinthemanufacture Quantities andnumbersofseizures ofillicitdrugs modi operandi modi Central intakeunits Social servicesfordrugusersinprison Prevention ofoverdose-risk Prevention, treatment andcare ofinfectiousdiseases Prevention andreduction ofdrug-related harm Drug treatment Other interventionsinthecriminaljusticesystem Alternatives toprison Trafficking patterns,nationalandinternationalflows, routes, Other drug-related crime Drugs origin:nationalproduction versusimported Drug lawoffences t ofrelevant internetaddressesand andorganization ofdomesticdrugmarkets atabase 173 172 147 184 170 166 162 159 159 156 154 151 151 148 145 144 144 144 143 143 142 140 140 137 134 134 133 131 148 128 148 128 147 127 192 191 189 186 High riskdruguer drugs. goal of this project is to improve parental skills concerning tobacco, alcohol and main The 2013. in started minorities ethnic of parentstowards oriented project prevention implemented new a year.Nevertheless, every are prolonged are and years several initiatives for prevention Most addictions. of prevention the in items common most the far by remains Speaking drugs illegal German and Alcohol Community. the and region Wallonia-Brussels the the Community, in initiatives Flemish different the describes 3 chapter drugs, of policy prevention the for responsibility bear not does FederalGovernment the partygoers.As and Drug prevention targets the general population, schools, families, at-risk groups Prevention NPS remains low. of use the general, In limited. more much was and users older by mostly mentioned was cannabis than other substances psychoactive of use The 2006. most popular drug. However, a declining trend in cannabis use is observed since are distinct as well and not always comparable. In general, cannabis remains the results the designs, different use studies different As 2. chapter in described is Drug use in specific targeted populations such as students, youth and partygoers Drug to order make aglobalevaluationoftheBelgiancannabispolicy. in field the in involved experts different comprising Policy, Drug Cell General the by established was group working hoc ad an addition, In Ghent. in the improvement of the effectiveness and efficiency of the drug treatment court guidelines for drug prevention and treatment for children and youngsters and 2) specific of development the 1) others amongst supported policy science federal HIV-plan national targetthe groupsThe the for 2014-2019. of one as identified are users Moreover,drug (NPS). substances psychoactive new of development rapid the counter to aiming adapted was 1921 of law drug Belgian policy,the drug integrated and global a of development further the of framework the In Drug polic SUMMARY s aog tdns n ihr dcto ad ) oyrg n ijcig drug injecting and polydrug 3) and education higher in students among use drug problematic 2) Belgium, in use drug ever-injecting of estimation the 1) on injected ever had 2012 drugs. This prevalence estimation in has been stable since 2004. adults Chapter 4 focuses 1,000 on 3.4 that estimated was it method HIV-multiplier the on Based harms’. such suffering of risk or probability high a at person the placing is or person the to harm actual causing ‘recurrent is that as use defined drug definition EMCDDA current the by is use drug risk High use in y: legislation, s the general population trategies andeconomianalysi and specifi targeted groups

9 Summary 10 Summary psychiatric comorbidity among illicit substance users is still very common. Finally, is C of prevalence hepatitis the years, past of the in stable prevalence Additionally, and although achieved. not the filters in decrease spoons, a as why explain such might equipment This water. injecting other share still injecting users many syringes, drug or needles share to reporting people of number the of reduction the to contributed have programmes exchange needle Although the settings, decade. last diagnostic the over stabilise to other seems diseases infectious and these of prevalence treatment in users drug ever-injecting of behaviour.injecting testing serologicalrisky diagnostic to on linked Based often most is diseases infectious of transmission The tuberculosis. and syphilis C, and HIV,as B chapter such hepatitis monitored, are diseases infectious relevant in most The 6. described is use substance of consequences and correlates Health Health-correlates andconequene further specialisedtreatment development. on recommendations formulate discusses to also performed were chapter that projects this pilot several Finally, observed. was treatments methadone of Belgium is relatively stable over time and even a slight decrease in the proportion in buprenorphine or methadone receiving clients of number The their consumption. to related behaviour risk the concerning as well as level socio-economic on for though different very are treatment users of groups different entering these between patients patients of of characteristics The proportion users. opiate for seen is decrease a the while abuse cannabis in steep observed a years, is two past the increase In treatment. for reason and main use a opiate as for use cannabis proportion equal an with substances, illicit for treatment withdual entered patients 9,192 aspatients of are total a such 2013, In situations. emergency and modalities diagnosis users, of drug treatment groups different specific some addition, to dedicated In general)-based treatment. or residential (psychiatric term hospital long- and detoxification to dedicated into more are that centres crisis programmes, categorized Inpatient centres. are day specialised and programmes care health mental of general types to people different has Belgium marginalized facilities, for initiatives threshold low from treatment ranging programmes outpatient of diversity of terms In availability Drug-related treatment: treatment demanantreatment cocaine were still the most popular injecting drugs. The use of drug cocktails and theinjectionofmethadonehasincreased compareddrug to2012. of use The drugs. injecting popular most the still were cocaine and community,opiates French and Flemish the in users drug injecting current of 21 and even 15% of the participants was younger than 15 years. Among the age the before started users drug injecting the of half injecting: of age starting young very revealed the is finding worrisome most The partygoers. among use an overpopulation, more and more drug-related detentions are registered in with the confronted are prisons Although again. declining is sanctions alternative Moreover,decreasing. slightly of are number suspensions drug-relatedtotal the the and level court at imported are sentences drug-related of more that indicate system prevalence justice criminal the increasedin interventions the of An analysis found The is drivers. side. among opiates or demand cannabis cocaine, with drug the combination of in to use majority amphetamine related vast the is data, offences enforcement law law of analysis the on Based Drug-related crime, interactions andasocialnetwork. social recreate new to opportunities provide activities leisure creating guided and any organised by Finally,group. target this supported of without situation working the is to regard with perspectives reintegration users social Furthermore, (ex-)drug entrance. for unstable housing to barriers other an and attendance accommodations sobriety,treatment for in requirements arranging living at housing is aim First, treatment Housing temporary in as users such projects, drug Housing ten accommodation. in housing the one improve to as aim situation, Belgium in initiatives reintegration the of Most full of aspect key recovery from drugdependency. a to is compared reintegration treatment social Therefore, in population. users general drug the of population unemployment the of in proportion higher the much and are level education lower a with of persons proportion The status. employment or level educational situation, their to housing related needs social unmet have Europe in users drug problem Many Social orrelates andocialreintegration to these findings, treatment uptake for infectious diseases remained lowin remained diseases for infectious injecting drugusers. relation uptake In treatment decreasing. findings, slightly these to to stable was programmes by exchange syringes recovered needle of number The NPS. and drugs illegal of compositions dangerous remain potential about services awareness public raising reduction for approaches important harm and prevention drug Consequently, deaths. last few years, leading to an the alarming, increased risk for toxicity symptoms and even during doubled nearly have tablets ecstasy in levels MDMA reported. were tablets ecstasy dosed highly addition, In reason. mentioned most second the is use Opiate of users. polydrug regular Most are concerns crisis centres. a experiencing crisis treatment patients the health the drug to specialised and admitted by were hosted patients harms centres, 916 intervention 2013, drug-related In Belgium. acute in available treat are to services Several Responses tohealthcorrelates andconsequences in theWalloon region, whichisatrend inlinewithotherEuropean countries. a reduction of drug-induced deaths in Belgium was observed in 2010, especially prevention of drug‑related crime and prison 11 Summary 12 Summary tablets. ecstasy for true especially is This Belgium. in found drugs of quality and purity high the remains capacity production this of consequence Another observed. not were years previous to compared price states. in changes significant member Nevertheless, EU other to compared low be to tend Belgium in prices drug capacity,production drug high and availability high the to Due versus 2012). in (38 kg 3 kg seized were methamphetamine of dismantled amounts considerable of time, number first The the For record. all-time 2013. an reached laboratories production in drug synthetic increased have quantity, and number both seizures, national Drug the Belgium. from and exported and Antwerp imported of is cocaine port airports, large the production to the Due in NPS. role of a distribution play and to begun also has Belgium years, two last MDMA). The and amphetamine (mostly drugs synthetic and cannabis for country production a as role important an plays country,it small a is Belgium Although Drug markets capacity ofdrug-related treatment servicesinprisonsalsodecreased. the savings, associated the and crisis economic the to due and prison in limited is particular) in treatment drug (specialised care health Nevertheless, years. past approved in 2008. However, the persistent harmful use of alcohol, necessitated alcohol, of However,use 2008. harmful in approvedpersistent the declaration of the Ministers of Public Health on the alcohol policy in Belgium was common A Belgium. and Europe in topic this to given was attention alcohol, of use harmful the reduce to (WHO) Organization Health World the of call the of result a As use. alcohol with also deals policy drug Belgian the NPS, and drugs illegal the Besides 2.1). (section 1921 of law Drug Belgian the of adaptation the fast increase of newly detected new psychoactive substances (NPS) necessitated the Nevertheless, drugs. illicit on particularly focussed Note Drug Federal This (B.S./M.B. Belgium in policy 15.04.2010). drug integrated concerned and global and a field constituted which working 2001 of the Note Drug Federal the on with based is Declaration Common collaboration The citizens. close in European and and international policies with line in occurred implementation This 2014. 2013- in continued 15.04.2010) (B.S./M.B. Drugs Conference Inter-ministerial The implementation of the Common Declaration of January 25th of 2010 of the 1. L. Gremeaux and P. Blanckaert E., Plettinckx AND ECONOMIANALYSIS DRUG POLIC CHAPTER 1. • • • • in order toguarantee nationalandEuropean comparable data. The Institute of Public Health remains provisionally responsible for the TDI project the communities and regions, the addiction fund is to become a federate project. to facilities treatment drug important transferring reform state sixth the to Due centre forevidence-basedmedicine. and prevention detection, the treatment of substance abuse for in children and available youngsters, validated by the are Belgian guidelines practice best New patients concerned. and further professionals makers, the policy involving to policy integrated trigger an of a development be might plan This use. drug (intravenous) actions to clear related of consists policy HIV integrated an for plan action national The actions andenablingtheinstantdestructionofseizeddrugsmaterials. generic classification to control psychoactive substances, criminalising preparatory February a of defining law by The 1921 of law drug Belgian the adapts 2014 7th Introduction Y : LEGISLATION, STRATEGIES

13 1. drug polic y: legislation, strategies and economic analysis 14 1. drug polic y: legislation, strategies and economic analysis Addiction (EMCDDA) to assure the comparability of treatment data in Europe in data treatment of comparability the assure to (EMCDDA) Addiction Drug and Drugs TDI for Centre Monitoring the European the at to place taking is adjustments register of coordination Final states. member active European is all 5) chapter in in (discussed register TDI This clients. the of needs the to the incidence of drug users in treatment in estimates Belgium to allow adjusting treatmentTDI Belgium. in centres treatment the was with cooperation (TDI) in enforced Indicator Demand Treatment the for system registration uniform a Second, facilities. treatment of range broad a of development the stimulate to projects a pilot innovative As financing for 3.3). appointed (section was Fund treatment Addiction the drug first, Belgian the on follow-up the Drug ensure and Belgian the for stimulate of to mentioned important specifically were be initiatives organization two to them, Policy.Amongst 2010 the of Common 25th the in January by defined of involved areDeclaration initiatives are different Belgium, facilities in treatment and drug ministries different As up attherequest oftheMinisterPublicHealth(section3.2.2). set was policy cannabis Belgian the of evaluation the on group working a Also, eutd n qaiaie ucm eauto o te rg ramn cut in court treatment drug the Ghent (QUALECT) of evaluation outcome qualitative a in resulted rf d. ry Vne Lee o te nttt o Itrainl eerh on Research International of institute the Criminal Policy (IRCP)attheGhentUniversitywasinvitedtocover section4. of Laenen Vander Freya dr. Prof.expert external end, this Topolicy. drug the on developments mentioned the by implied opportunities and challenges the on provided is reflection Finally,a (EMCDDA, 2014) f et rcie udlns o te eeto, rvnin n tetet of treatment and prevention detection, the substance abuseinchildren andadolescents for guidelines practice best of ADAPT-YOUTH The adaptations 3.2.1). described (section project finished were studies evaluation two others, among 2013, policy.In drug Belgian integrated and global the of evaluation supports programme on the to contribute annually that projects several research for (BELSPO) funding office the policy science federal As aresult, Belgian the of drugs treatment. drug of efficiency effectiveness the and both of importance the emphasized Note Drug Federal The were finalised. 3.1.3) (section 2014-2017 plans prevention and security the and 3.1.2) (section policy HIV integrated an for 2014-2019 plan action national a the of development 2013, In on. later rejected was 2014-2018 NAP this Nevertheless, 3.1.1). global more a of version (section 2013 in up set was health, public draftthan areas other including approach, A 2014-2018. (NAP) Plan Alcohol National a . (Vander Laenenetal.,2013) . (Hannes etal.,2011) . Asecondproject osbe o rsct tee cin nr o ez te sd aeil Nx to of preparatory actionsisalsoincluded. Next material. used the seize to synthetic drugs, the law also nor targets cannabis and drug precursors. actions A description these prosecute to possible trafficking, i.e. the materials and techniques used. In the past, it was not always actions. preparatory and production drug illegal criminalize of actions preparatory against to taken is action Firm decided legislator Belgian the Secondly, fentanyl opioid the derivatives. In this all proposal, a “base/core structure” covering for each category is category included. a tryptamines, and piperazines cathinones, phenethylamines, synthetic NPS are cannabinoids, of Royal synthetic new including categories a Several defined, for classification. drafted generic was a proposal includes a which end, Decree this To intheUSA, UK. effect the in and laws currently Hungary drug This derivatives. the analogue NPS to – unknown similar is still definition currently even – future and existing all the report this to practically cover could definition in generic a addition drugs’), illicit or (further ‘illegal as to referred In substances controlled structure. of chemical list common recognized internationally their by substances the of some control to possibility the foresee to opted has legislator Belgian the First, law ofFebruary 2014includesafourfoldchange. the problem, this to anticipate to order In legislation. the outrun to substance six the of about structure molecular takes the modify list slightly can producers the such, As to months. substances adding by legislation this changing as license. event, the a upon action to option having limited the is when set-up this of sold disadvantage The or exported imported, produced, used, be only can that substances controlled of list a provide 1921, of law drug Belgian the from derived 31.12.1930 14.01.1999), (B.S./M.B. of 22.01.1998 Decrees and Royal 10.01.1931) thelaw The (B.S./M.B. of NPS. of flexibility development rapid and the efficiency regarding the improving at aims and 10.03.2014) (B.S./M.B. 1921 of law drug Belgian the adapts 2014 7th February of law The 2.1. controlled of effects the NPS mimic new substances, however substances they 81 are not internationally These controlled of Belgium. total in a 2013, reported are In – were highs’ Belgium. ‘legal in as issue known an also becoming – increasingly NPS states, member EU other to Similar 2. Consequently, anadaptionoftheBelgiandruglegislationwasrequired. legislation. of) (setup current outruns years, last the in NPS detected of increase Legal framework Ad aptation oftheBelgianDruglaw of1921 (UNODC, 2013) . The fast

15 1. drug polic y: legislation, strategies and economic analysis 16 1. drug polic y: legislation, strategies and economic analysis s o achl n egu wr spotd y l saeodr. Nevertheless, stakeholders. all by supported were Belgium in alcohol of use harmful the of monitoring and treatment prevention, to related measures The the broaden to order in measures (community) supportforthe policy ofthedraft NAP. outlined the on comment to month one had public general the as well as Society,stakeholders Different and University). Newcastle Health of Institute Addiction Anderson, for Peter Dr. Prof. Centre Health; Rehm, Mental international and Jürgen Dr. academic Prof. three WHO; by Møller, performed Lars (Dr. was experts NAP draft the of review A early intervention, prevention, 3) improving and traffic treatment andscientific research. in and work at use alcohol limit 2) alcohol, of availability the reducing 1) by alcohol of use harmful the preventing at aimed policy.draft drug This integrated and global a develop further to written was 2014-2018 NAP the of version draft a 2013, of June In 3.1. 3. principles isproposed inaRoyalDecree. and interventions four these of performance by The phenomena. drug dangerous of risks reporting rapid health This public BEWSD. of the prevention to the immediately enables exception analysis laboratory of results the report to made was investigation judicial the of secrecy the on exception an complete, to months take easily can investigations judicial since Moreover, 10.03.2014). the ambiguity, this overcome (B.S./M.B. ToFebruary2014 7 of law the in obligation the added legislator Belgian legislation. contradictory to due rarely complied laboratories However, 14.07.2003). (B.S./M.B. 2003 June 29 of Decree of Public Institute Royal the Scientific in earlier included already the was regulation latter (WIV-ISP).The Health by hosted is which BEWSD, the to NPS) and information their transfer drugs illegal classic of use the and composition to regardingthe data (anonymous obliged exchange are experts information and Laboratories of (BEWSD). regulation profound a regarding laboratory results through includes the Belgian Early Warning System on Drugs law the Fourth, sufficient provide material visual evidence intrial.Thephysicaldestructionismandatorycaseofconfiscation. and samples that judged legislator Belgian the procedure,whole the storedduring be to seizureshave when limitations logistic of Third, this law enables the instant destruction of seized drugs and materials. Because 3.1.1. evaluation andcoordination National action plan, strategy, National a Rejection oftheNationalAlcoholPlan c tion planand/ors trategy mentioning specifically (in action 29) the aim to reduce the stigmatisation of thestigmatisation toreduce detention drug usingprisoners aim in the 29) people towards action measures (in specifically several mentioning discuss 31 to 27 actions The Roegiers, 2014) h Itrmnseil ofrne ulc elh pone a Monitoring of people with HIV was composed as well a appointed AIDS, the WIV-ISP and representatives Health of the governments concerned. A council Public HIV/ against fighting associations workers, care health of consisting Committee Conference Inter-ministerial plans The execution These plan. HIV national describe the assigned priority the actions for each an implement the minister, as to to well among as order the financial plan gave implications. divided execution minister are each ministries, HIV-plan Belgian different national of this competences of actions the As users drug for reduction risk and health public to aims regard with framework 24 legal comprehensive Action a of rooms. development the consumption at drug of establishment prevention the and and needles to material access improving 22 for need action the instance, stresses For plan use. the harm of drug Moreover, with associated HIV-policy. risks the national limit to the strategies important most for the of one groups as identified are users drug target for strategies reduction the an of develop one further to as opportunity the identified are users drug (intravenous) gives report, the policy.Throughout integrated HIV-plan national recent The discrimination (B.S./M.B.21.11.2013). and reducestigmatisation to e) and HIV with living persons of life of quality the an earlystage,c)toincrease treatment ofpersonslivingwithHIV, d)toimprove by transmission HIV of prevention increase to information, education and raising awareness, b) to increase screening of HIV a) in is HIV-plan the of aim The within their falls that the actions competences (B.S./M.B.21.11.2013). of the plan implementation to specific Next a propose 2013. to in committed also ministers affairs the priorities, set social and HIV-plan the and of distribution policy health and federal of the ministers by federate signed was 2014-2019’ ‘HIV-plan agreement protocol A 3.1.2. ofrne rg i Dcme 21. oee, h pooe health-related measures are proposed largely includedinotheractionplansandcontinuetobeapplied. the However, 2013. December in Drugs Conference alcoholic buy beverages. to Consequently, age the NAP could minimum not be the approved by regardingthe Inter-ministerial regulation the of revision a and machines vending in sales alcohol on ban a political concerning no found was end, consensus the NAP. In the of content the weakened amendments The promotions. price temporary or hours happy of prohibition the as such alcohol, of availability the to related proposals of variety a on agreement no was there A nationalactionplanforanintegrated HIVpolicy . (Belgian Research Aids&HIVConsortium,2013) (Belgian Research Aids&HIV Consortium, 2013) Consortium, Aids&HIV Research (Belgian (Belgian Research Aids&HIV Consortium, 2013; . .

17 1. drug polic y: legislation, strategies and economic analysis 18 1. drug polic y: legislation, strategies and economic analysis the prevention ofdrug-related nuisanceandcrime(B.S./M.B.31.12.2013). developed. be to contribute can work streetcorner perspective, this In included. longer areno can plans prevention care medical-therapeutic and of and initiatives prevention drug Unfortunately,primary one security is sale which nuisance and for drug-related as categories trade well the production, as cannabis as and such drugs synthetic crime of drug-related of prevention The local context(B.S./M.B.31.12.2013). cities the and municipalities to prioritise only those crimes that cause problems within the of responsibility the is It context. local the exceeding crimes certain and nuisance andprevention of reduction or prevention the level, local at stimulate, to thesecurity is plans of Theobjective of 2013. conditions defined the by the Minister of Internal Affairs requires cities and communities to comply with 2014-2017 plans prevention and security the of Approval reduction. harm and services treatment drug threshold) (low prevention, drug for subsidies receiving by policy drug local a develop to stimulated were municipalities and cities the plans, prevention and security strategic the by replaced were plans drug the As 22.12.2006). (B.S./M.B. Government Federal the from contribution financial a receive municipalities and cities exchange, In prevention.regarding crime policy security local a coordinate and develop to order in municipalities and cities to 3.2.1. 3.2. policy security integrated local a of part became plans prevention and security strategic the later, years Two plans. 2002 drug and in contracts prevention and Belgium security previous the in replace to introduced were plans prevention and security Strategic 3.1.3. 04 I 21, w poet wt a ou o te vlain f ega drug Belgian of evaluation the on focus a with projects two 2013, In 2014. demand, 2013- during started drug were disorders of use alcohol reduction and cultivation cannabis the illicit for standards quality newprojects costs, Four social to drug policy. and related Belgian support the the of to efficiency the contribute of that improvement projects research the in invests BELSPO Consortium, 2013) Consortium, a yearly report about the implementation of the HIV plan formulate b) scientific research and consultation, e) support federal practices, authorities and f) provide bad identify a) stimulate d) information, relevant all centralise c) recommendations, and advice should Committee Monitoring The quality oflife and care prevention, improve to order in plan HIV the of execution the in HIV Evaluation ofthefederalrugpolic support thefederal drugpolicy Research programme ofthe Federal sciencepolicyofficeto 2014-2017 The developmentofstrategic securityandprevention plans (Belgian Research Aids&HIVConsortium,2013) . In addition, the mission of the council is to involve people with people involve to is council the of mission the addition, In . (VandeWalle et al., 2010) al., et (VandeWalle . These plans give responsibility give plans These . . y (Belgian Research Aids&HIV involve relevant stakeholders in the process to ensure maximum relevance to their particularsettings relevance maximum ensure to process the in stakeholders relevant involve using a step-by-step approach step-by-step a using by context Belgian a for guidelines existing of appropriateness and applicability consistency,quality, the of assessment the on focuses applied researchers The lentv sntos o iet rg eedn ofnes o ramn. This treatment. to offenders dependent drug divert to of on sanctions finalised continuation was alternative study a first a 2007, is In area. Ghent this in DTC projects research the previous of evaluation outcome qualitative The substance abuse in children and youngsters to a local Belgian context (ADAPT-YOUTH) context Belgian local a to youngsters and children in abuse substance treatment ofyoungsterswhomisusedrugs and assessment screening, the concerns second The adolescents. among misuse drug and alcohol of prevention the concerns guideline first The drugs. illegal of use the to related are them Twoof 2014. of beginning the at Medicine) Based practice best in Evidence- abuse for Centre (Belgian CEBAM final by validated were substance youngsters and children of The treatment group. and detection user prevention, the potential for a guidelines in piloted and drafted were sseai rve o eitn gieie ws conducted was guidelines existing of review systematic A local, a to guidelines context Belgian international of existing, reason, adapts process this This For was introduced. process treatment ADAPTE lacking. the using were guidelines practice and best youngsters adapting on and research children for detection treatment and prevention drug prevention, for guidelines recently,specific Until authorities. decentralised the for In Belgium, drug prevention and youth care as well as ambulatory treatment are guidelines practice best Adapting uig h tetet svrl olwu ssin ae raie b te DTC the by organised are Ghent sessions follow-up several treatment, the During supervised client formulates a treatment plan which has to be approved by the DTC Ghent. and the liaison, the with consultation supported link In client. vital the and a treatment justice, are as between serves latter The offenders liaison. and prosecutor using judge, a by Drug intensively treatment. to redirect to order them in excluded) is crime drug-related (organised use drug of their because crimes committed who persons on focuses Ghent DTC The (QUALECT) 2008. evaluation since Ghent district judicial the in system justice criminal the by imposed be can that sanctions alternative outcome the of one is Ghent (DTC) court treatment drug The qualitative Ghent, Court treatment Drug production (described in chapter 9 and 10). Additionally an evaluation of the Belgian cannabispolicywasstartedatthebeginningof2014. of evaluation an Additionally 10). and 9 chapter in (described production as well; one related to supply indicators of illicit drugs and the other to cannabis Twoweretreatmentcompleted. initiatives 2013 projects in wereother finalized (Colman etal.,2011;Wittouck 2013) (Bekkering et al., 2014) al., et (Bekkering (Hannes etal.,2013) (Hannes et al., 2011) al., et (Hannes . This methodology gives the opportunity to opportunity the gives methodology This . . . (Wilms, 2014) . In conclusion, three guidelines three conclusion, In . . Bkeig t l, 2014) al., et (Bekkering .

19 1. drug polic y: legislation, strategies and economic analysis 20 1. drug polic y: legislation, strategies and economic analysis f sml o poain let i Hasselt in clients probation of sample a of those with Ghent DTC the of outcomes the compares evaluation outcome The clients afterDTC islacking Consequently,the limited. of is DTCsuccession clients structuralof support and counselling the of continuity Additionally, completed. been has trajectory DTC the once continued always not are treatments these advantages, these Despite gives DTC ‘offender’. the on probation, focus to than rather to issue’ drug a with contrary ‘persons to attention In reintegration. to work to possibility the give domains life different to oriented during approach individual treated This trajectory. be the can issues life upcoming Moreover, problematic included. all be such, As can probation). domains for case the is (which mandate a to committed not are stakeholders DTC result-oriented. work to opportunity the gives and flexible more is Secondly,DTC clients). probation the for months 22 to compared months (6 DTC in smaller much is trajectory the of the start the and faces DTC crime committed The the between trajectory. lapse time DTC the all, of the First probation. of of deficits end the at employed were often often in respondents more 3) more and went use drug additional 2)respondents without treatment treatment substitution drug realised, to was referral counselling 1) financial that and indicated analysis The in way. registered not systematic was information a and limited was survey sample the of size Ruyver et al., 2007) al., et Ruyver du) ramn ofr Mroe, h lasn n te iacn o a DTC of financing the and liaison coordinator are essential criteria the to guarantee an optimal functioning of the DTC Moreover, offer. treatment (drug) health mental care providers, 2) written engagements and and 3) a sufficient diverse and dispersed system distinction justice criminal clear the of a tasks and 1) roles the requires between implementation The districts. to judicial treatment. other order to in of important is pursue trajectory DTC the decrease the risk of relapse. the Consequently, the DTC project of can promote also be extended accomplishment can cautious A sessions follow-up trajectory, the of extinguished progress the and needs individual the on Depending client. DTCthe of history justice criminal and treatment drug the to tailored be to has supervision the of intensity The system. justice criminal the and care health to related costs less in results then which 9) chapter to refer please recidivism, of analysis the of results the (for crime and use drug decrease domains life related with probation. The treatment of problematic drug use and the support of drug- comparison in DTC the of value added the of indication an show results These (Colman etal.,2011) (Vander Laenenetal.,2013) Ghent provides the opportunity to address problems in different life domains life different in problems address to opportunity the provides Ghent DTCThe positive. was evaluation overall the addressed,were weaknesses some was conducted by Ghent University and the Service on Criminal Policy. Although n ta du-eae lf dmis mrvd fe a atraie sanction alternative an after improved domains life drug-related that and Belgian effect study showed that the levels of offending and drug use decreased . Between May 2008 and May 2009, a process evaluation study evaluation process a 2009, May and 2008 May Between . . . (Vander Laenenetal.,2013) Wtoc e a. 2013) al., et (Wittouck . Hwvr the However, . (De working group report isexpectedbyDecember2014. hoc ad the Drugs; Conference Inter-ministerial next the to presented and Policy Drug Cell General the by discussed be will recommendations and outcome The activities oftheworkinggroup ontheevaluationofcannabispolicyaswell. a scientific opinion on this subject. This subject matter is to be integrated into the formulate to appointed (FAMHP)was products health and medicines for agency Human federal the for of Use’ Human for Products Medicinal Products for ‘Commission joint the and Use’ Medicinal A Herbal for 19.07.2001). ‘Commission the (B.S./M.B. of be pharmacies group working Belgian cannot by purpose patients medical to for delivered drugs cannabis-related approved Currently, USA and Washington, Colorado Uruguay, as such countries other several policies in changing legislation recent towards the by others among fed; vividly been has cannabis of use and possession of regulation the on debate public the years, past the In working the in differently interpreted field, thecannabispolicy requires renewed attention. often is legislation current the as Still, identified. are circumstances aggravating or disturbed is order public exceeded, is plant) cannabis one or grams (3 amount’ ‘user the where cases in possession a new ministerial directive in February 2005, which called for full prosecution for The nuisance. public of the law was rescinded. A temporary solution to this annulment was issued and by use part drug and defined insufficiently be to concepts problem these found Court Constitutional of outline an introduced also which 2003 in law the in change a by determined substances, illicit other from differentiated was cannabis approach of policy cannabis possession the the years: ten to almost regard back with dates 1921 of law drug Belgian states the to law Belgian the obligations, unequivocally treaty that the possession of cannabis international is illegal. The most recent with adaption compliance In 3.2.2. political consultation. further for basis cannabis a as serve enforced will assessment this the of conclusions The prohibition. to alternatives of feasibility the on recommendations provide to and of deficiencies state indicating policy,by cannabis a current the offer on to affairs is group the of aim different main The comprising field. Policy,the in Drug involved experts Cell General the by established was a group requested Health Public of Minister the 2013, global evaluationoftheBelgiancannabispolicy. To of working thisend,anadhoc end the by light, this In more restricted cannabispolicyinourneighbouringcountryTheNetherlands. On-going evaluationoftheBelgiancannabispolicy Pro 2014) (Pardo, bt lo y h dsusd hne twrs a towards changes discussed the by also but ,

21 1. drug polic y: legislation, strategies and economic analysis 22 1. drug polic y: legislation, strategies and economic analysis intervention centres and therapeutic communities. The transfer of competences transferof The therapeuticcommunities. centresand intervention crisis centres, care day centres, treatment social medical threshold low the are reform state sixth the in involved facilities treatment drug important most The rg care drug illegal regulating specialised and support framework reduction, harm prevention, stimulate legal 4) and use the drug 3) care, drug specialised and support prevention, of network the of expansion and consolidation the 2) plans, action well different 1) enhanced strengthen to have recommendations These Brussels. Policyin Drug an as establish recommendations to was of objective The series memorandum. sectorial a a within proposed (CLDB) Brussels in addiction drugs of Drug Coordination Local for the and (FEIAT) the addiction of Drug Institutions for Employers Institutions the Ambulatory of of Federation the Wallonne), Federation Fedito – Bruxelles Walloon (Fedito and Brussels The that outlinestheoptionsandprioritiesforastatereform in2014. book) (Green proposal global a in integrated was A&D paper Green The given. was society, in fields different many with cooperates that entity field separate addiction a the as of description health a mental hand, the other the in On field proposed. was addiction sector the of integration an hand, one the On Ina written. was described. were policy A&D situation integrated future a the current for options two of phase, second an overview the phase, for first Community. a Flemish paper) the During (Green in policy draft (A&D) drug a and alcohol of an of compilation organization the guided group levels. steering the federate of A authority the become field treatment drug specialised the to related initiatives important reform, state sixth the of consequence a As the gear to implemented were registration availability ofdrugtreatment tothetreatment needsofpersons. TDI the and fund Both addiction projects. the two developed Government Federal the Belgium, in initiatives treatment drug different the coordinate to orderpolicy. In drug integrated and global this of practice and organization daily the in involved are authorities and A bottom-up approach is at the heart of the Belgian drug policy. Different actors Coordination arrangements 3.3. and theirfamilies users drug with work who appropriateprofessionals for trainings 4) adequate 5) and committees, funding review and consultation of levels different the in the 3) WallonneFedito the for programmes,policy,rolecoherent a a include of which development new of development the 2) patterns), consumption and products (new challenges new the to adaptation their and services accessibility existing of the of improvement the 1) advocates this Wallonne reach to Fedito order objective, In family. their and users drug of expectations and needs variable the to respond appropriately to necessity the highlight memorandum memorandum concerning the quality of the services specialised in drug use. This Fdt Buels t l, 2014) al., et Bruxelles (Fedito (Luisetto andHensgens,2014) Adtoal, eio alne ulse a published Wallonne Fedito Additionally, . . T registration ofTDImaybehampered. projectsthe for of as course and financing systematic the fund, addiction the of has still TDI the however, registrationWIV-ISP.the of guaranteeinstead similar made, be should decision should this case In Communities Health, the whether Public decide to possibility Conference the Inter-ministerial The period. year,transitioneach renewed the automatically after registrationis also TDI the WIV-ISPconcerning the with contract the such, As makers. policy drug support to applied is system during registration uniform results this Moreover, the period. of transition this analysis the WIV-ISP and registration the TDI data, the guarantee comparable still European will and national of importance the to Due 2017. December of 31th the until 2014 of July of 1st the from defined is The transition period for the transmission of the TDI project to the Communities to theCommunities. transferred be will fund addiction the months, six of period transitional a After or medicines 2014. of July of 1st the until initiative federalof a was fund addiction The alcohol. abuse in generalor to related is addiction 30% to remaining The related was substances. are illegal project to (70%) new the projects one of instead prolonged, Most longer financed. no were 2012 in initiated (Table projects projects 35 Seven financed 1.1). still fund addiction the 2013, In fund andtheTDIproject. addiction the on impact an has also federatelevels the to federallevel fromthe able 1.1| Title oftheproject children parents consideringtheir Project tosupportdrugusing with problems ofcannabisuse adolescents whoare confronted Evaluation andsupportof Drughulp.be Cannabishulp.be – Alcoholhulp.be – dependence athome Project ofwithdrawal ofalcohol Mighties Financed projects oftheaddictionfund,Belgium,2013 Organization Bogolan Brugmann centre University Hospital CAD Limburg La Cahoasbl health Eclips mental Centre for Main objective their children youngerthanthree yearsold. Support future ofyoungaddictedparents and environment problems duetocannabisuseandtheir implemented foradolescentsexperiencing A multi-dimensional-familytherapy is alcohol, cannabisandotherdrugs through theinternetofproblems related to Online supportanddistributionofinformation a familiarenvironment encourage withdrawal ofalcoholdependencein Implementation ofanoutreach project to limitations of reasons ofmotivation,languageormental qualified forclassictreatment projects because specific methodologyforyoungsters who aren’t Development ofpsycho-educativematerial anda

23 1. drug polic y: legislation, strategies and economic analysis 24 1. drug polic y: legislation, strategies and economic analysis Title oftheproject Network RecoveryAntwerp nursing care fordrug users Free medicalconsultations and corner workinBrussels-Capital exchange programme andstreet Reinforcement ofthe syringe DocA-Project youthAntwerp problems inemergency services Specific interventionforalcohol below theageof16 awareness project: noalcohol National informationandraise discussions withpatients and medicinestoencourage the consumptionofalcohol information topharmacistson Raising awareness andgive network Bruxelles-cannabis Education withinthespecialised Project Liaisonalcohol situations Outreach workincrisis young children users ordrugusingparents with providers ofpregnant drug interventions tohealthcare Clinical casemanagementand Assertive communitytreatment young children drug usersorwomenwith Guide andsupportpregnant expertise ofhelp parents andpromotion of Education project ofdrugusing Organization CISO Comptoir DUNE Free clinic IDA IDA SSPF IPSA-APB- Bruxelles Interstices Pierre centre St. University Hospital Interstices Kompas MSCC Ghent MSCC Ostend Brabant Flemish MSCC Main objective trajectory in order todetermine anindividualtreatment Evaluation withpatientsandtheirnetwork problems Medical consultationandnursingforsomatic direct peopletotreatment corner work,nursingcare onthestreet andtryto Reinforcing syringeexchange programme, street organization offree medicalconsultations. to workonmotivationandstimulatethe treatment. Developmentofabriefintervention sector ofyouthassistanceandwillnotaccept 25yrs whohavebeenadmittedtotheresidential Specific project forvulnerable youthage15- problems for emergency servicestohandlealcohol-related The developmentofaspecificinterventionmodel selling alcoholtoyoungsterundertheageof16 sector aboutthechangeinlawwhichforbids Project toimprove theknowledgeinsales medicines andalcohol awareness forpatientswhoare combining Education ofpharmaciststocreate astateof related totheconsumptionofcannabisuse Education ofprofessionals totackleproblems for themostdifficultsituations alcohol-related problems. Alsosupportisoffered information andtoofferguidelinesabout professionals workingathospitalstogive Raising awareness andeducationof the familialcontext appropriate orientationandevaluatethoroughly is tostabilizethepatient,search forthemost at homeduring6weeks.Themainobjective their family. Anintensivefollowupisoffered Support incrisissituationstowards minorsand Raise awareness toprofessionals way. up to12yearsoldinanintensiveand integrated drug usingpregnant womenandtheirchildren Outreach project tosupportdrugusingparents, negligence ofthechildren to decrease theriskofdrugconsumptionand using drugsandtheirchildren. Theobjectiveis Project related toparenthood tosupportparents Title oftheproject Source: Federal PublicServiceHealth,Food chainsafetyandEnvironment exchange programmes medical teamwithinsyringe Development ofanursingand environment problems withalcohol andtheir Online helpforpeoplefacing (16-35yrs) counselling foryoungsters Outreaching psychiatric Synersanté problems in combinationwithdrug having amentalhandicap Improvement of care for persons alcohol dependence follow-up forpersonswitha Intensive outreach project to HCV Buxelles Social counsellorfortheréseau a dualdiagnosis to reintegrate youngadultswith Global andintegrated support about benzodiazepines and otherhealthcare services Training ofgeneral practitioners Implementation ofguidelines motivational interviewing develop anmodularofferof Equipment inorder to ASSIST screening instrument related tothealready developed Implementation ofguidelines treatment Quality promotion ofdrug cocaine use:CRA+vouchers treatment programme for Implementation ofaspecific home persons livinginarest andcare psychotropic substancesfor efficient andeffectiveuseof Promotion ofamore TADAM project project for(ex)addicts CASA: Outreach counselling Organization Entraide Sida Namur Pelican centre OLV Psychiatric riens Les petits PopovGGZ Camillus Hospital St. Psychiatric Réseau HCV Martin Hospital St. Psychiatric Neuro- collaborators ULB & VAD VAD VAD VAD De Kiem Leiehome centre treatment Residential Liège Ellipse Main objective problems ofinjecting drug use The objectiveistogrant firstcare related to counselling order toprovide informationandtherapeutic French versionofthe website alcohol.bein illegal drugs) combined consumptionofdrugs(alcoholor which are confronted withapsychiatricproblem intervention ofdifferent organizations persons withadrugproblem andcoordination of Creation ofamobilehealth celltosupport handicap andsheltered workplaces centres, servicesforpersonswithamental collaboration withspecialiseddrugtreatment The mainobjectiveistoimprove the of personswithanalcoholproblem hospitalisation andtoimprove thequalityoflife in order todecrease theduration periodof In three hospitalsacasemanagerisassigned treatment Individual counsellingforpatientsinHCV environment oftheyoungsters support whichinvolvesdifferent sectorsandthe psychiatric comorbidity. 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25 1. drug polic y: legislation, strategies and economic analysis 26 1. drug polic y: legislation, strategies and economic analysis Court in Ghent in Court Also, advice and training is required during the implementation process implementation the during required is training and advice Also, seminars. (BMCDDA)conferencesand point or focal Belgian the of network the to recommend internet, the through Respondents guidelines the providing by guidelines to suggested. access facilitate are guidelines implementation (evidence-based) the of facilitate to implementing strategies about Various knowledge practices. of evidence-based lack the and organization or population target specific the to guidelines of applicability of lack the are guidelines of use the regarding barriers mentioned commonly most the that showed study the et al., 2013) al., et ulc evc Hat, od hi sft ad niomn rsosbe o the for responsible Environment and safety chain Food Health, Service Public Federal the make to agreed Drugs Conference Inter-ministerial the 2012, Since of lack a to due resources. person liaison a without though jurisdictions, judicial other two in implemented is court treatment drug Currently,the services. treatment (drug) and system justice criminal the client, DTC the a between intermediary an for as acts allowing and confidentiality professional holds who counsellor clients a court, drug the DTC regarding data systematic outcome evaluation. Another condition is the presence of of a liaison in registration continued and structured systematic, a is prerequisite important One Belgium. in jurisdictions judicial other to project DTC the of expansion an for allow to prerequisites the to a local, Belgian context Belgian local, a to The misuse). drug guidelines international existing, adapt and to methodology specific a applied alcohol study of prevention the on one and misuse drug of treatment the on one misuse, alcohol of treatment the on (one context Belgian the to adapted and evaluated were misuse substance adolescent for guidelines instance, during the ADAPTE-youth study three existing evidence-based practice scientific 60 over funded research BELSPO projects to support 2001, the implementation of of an integrated Drugs drug policy. on For Note policy Federal the since Next, developments. – international – new to to policy resolve drug the Belgian adapt illustrate policy cannabis Belgian the of evaluation current the e evaluated” be sound and cost-effective, and aim for realistic and measurable results that can the with underpinned scientific results of be these studies: should policies these on based actions and policies Drug interventions. evaluate to studies scientific for need the to refers explicitly and the consecutive EU Action plans. Indeed, the ‘EU Drugs Strategy 2013-2020’ and balanced integrated, an evidence-based drug University policy, develop in to line with the requirements made of the EU been Ghent drug strategy have efforts Belgium, IRCP In F., Laenen Vander by Reflection 4. Challenges andopportunities . A second example is the outcome evaluation of the Drug treatment Drug the of evaluation outcome the is example second A . Cmiso o te uoen no, 2012) Union, European the of (Commission (Vander Laenen et al., 2013) al., et Laenen (Vander (Bekkering et al., 2014) al., et (Bekkering “Actions must be evidence-based, scientifically . The aim of this study was to identify to was study this of aim The . . The qualitative research part of part research qualitative The . Te e lw n P and NPS on law new The . (Hannes drug policy is complex and requires sufficient investment from the academic the from community aswellfrom governmentalagencies investment sufficient requires and complex is policy drug evidence-based an of implementation the that illustrate examples three These is collectingtheBelgianpublicexpenditure datafor2012and2013. project, the Federal Public Service is currently optimizing the data collection and the of III figures assessment in Drugs the from an researchers the by analysis upon the and collection data Based departments. some from delivery backdrop data a in to due particular in yet available not are 2013 and 2012 for data n ls coeain ih h pol i te okn field working the in people the with cooperation close in executed is policy drug Belgian the of development the approach, bottom-up the is policy drug Belgian the Drugs of characteristics General the of the one as is Next, Cell. Policy policy drug national Belgian the behind force driving A nlss s ae uo a aul eeoe i te eerh rjc ‘rg in ‘Drugs project research III’ figures the in developed manual a upon and based collection is This analysis analysis. its and data expenditure public the of collection aen F, n Eln S, 2012) S., Eelen, and F., Laneen, ulc xedtrs r icesnl a ujc o dsuso i ve o the of view in discussion of subject a increasingly are expenditures public since augmented is unrest Moreover,current users. the drug continue problem least for at offer to treatment able be will they not or whether and governments be federate will the of priorities policy drug professionals the these what yet To clear field. not work is it treatment drug the leads in also people It in levels. unrest federate to the by initiatives policy and political new defers treatmentdrug drug-related in shift This Belgium. in field only not competences specialised the on particular in impact will beyond, and 2014 in operation full in and 2012 preparationsince in is which Belgium, in reform state 6th the First, these of Three come. to year(s) the challenges andopportunitiesare in discussedindetail. policy drug Belgian the for ahead lie opportunities time same the at and challenges important to us brings latter The of thefederate levels. drug specialised the competency a which become will of subsidies accompanying the result and services treatment a as Belgium, in reform state the to is Linked plan. this prevention and security the of part as subsidies for apply can longer no reduction harm and services treatment drug result, a As subsidized. be to want they if prevention nuisance and crime on be should initiatives local of focus the decreethat ministerial states new clearly a 2014, of January of first the Since subsidies. these for apply longer no could initiatives prevention drug primary that so nuisance, and crime of prevention the towards shifted plan the threshold of focus however,the 2007 (low) Since reduction. harm and services prevention, treatment drug drug things other among for subsidies providing by policy drug local a of local integrated development the ofa stimulated plans policy.The security the development for stimulus financial a provided plans (Vander Laenen et al., 2011) al., et Laenen (Vander Fr vr dcd, h scrt ad prevention and security the decade, a over For . . In September of 2014, the analysis of the of analysis the 2014, of September In . (Uchtenhagen, 2010) D Rye, . Vander B., Ruyver, (De .

27 1. drug polic y: legislation, strategies and economic analysis 28 1. drug polic y: legislation, strategies and economic analysis ead ie u as te viaiiy n te aktn o alcohol of marketing the the and availability only the not also but addressing side policy, the demand alcohol stimulated Plan evidence-based This Alcohol an experts. National of international 2014-2018 development academic of three draft by the reviewed that was laudable is it Second, level andthatcanbeadjustedifanevolutionintheseproblems occurs. federate at problems of monitoring the and analysis the on based is that policy drug integrated fully a develop to governments federate the for opportunity an provides also competencies of transfer However,the competencies. of transfer t l, 2012) al., et UK the in case the is As alcohol. of side supply the to related measures proposed et al., 2010) al., et priority actions by means important to of both process and outcome evaluations will be it year(s), the resultsof the and execution the implementation, the monitor systematically the coming For implications. well plan. financial as the minister, HIV each as for national actions priority the the implement describe plans to execution These developed being are plans execution forward bytheEUDrugsStrategy (2013-2020). feedback. Their essentialinvolvementisgratefully acknowledged. valuable their and collection data the of contribution their Prof.for dr.Decorte Mr Martens, Mr and Theisen Laudens, Mrs Huard, Mrs Geirnaert, Mr Mrs Denoiseux, Mrs Declerck, Gillard, Mrs Pire, Mr Doms, Mr thank to like would We Acknowledgements e ta i ti HVpa te ik ih itaeos du ue s lal made clearly is plan to use the positive drug throughout (intravenous) is with link It the developed. HIV-plan this indeed in be that see can plan policy integrated an shows Belgium in ministers competent different the by HIV-plan national the Finally, for alcoholpolicyreform.” issue key a be should it, on spent money including lobbying, of aspects all in advice: following the with us provide (2014) Holden & Hawkins McCambridge, respect, this In approved. politically plan Alcohol the to failure cnmc rss n aseiy Te niiae ct i gvrmn spending government in treatment abuse cuts substance affect may anticipated The austerity. and crisis economic (McCambridge et al., 2014) al., et (McCambridge . This will strengthen the evidence base of policies and actions as put as actions and policies of base evidence the strengthen will This . Hwvr n pltcl osnu ws on wt rgr t the to regard with found was consensus political no However, . WO t l, 2012) al., et (WHO corporate lobbying had an important impact on the on impact important an had lobbying corporate I i as pstv t se ht currently that see to positive also is It . (Lievens et al., 2014) al., et (Lievens , particularly at times of times at particularly , “Transparency (Vander Laenen (Anderson CHAPTER 2. DRUG USE IN THE GENERAL POPULATION AND SPECIFIC TARGETED GROUPS

De Ridder K.

• Cannabis is by far the most common used illicit substance in all described settings, followed by amphetamines, ecstasy and cocaine. • The prevalence of cannabis use among students in secondary and higher education has been stable since 2006. • The prevalence of other illicit psychoactive substance use among students in secondary and higher education is limited and stable, if not slightly decreasing.

1. Introduction

In Belgium, there is no recurring general population survey specifically on drugs and drug addiction. General population data on drug use is mostly derived from the Belgian Health Interview Survey (BHIS), the Belgian branch of the European Health Interview survey initiative (EHIS) launched by Eurostat. The BHIS covers a broad range of health topics such as health status, life style, prevention, and medical consumption (Demarest et al., 2001; Van der Heyden et al., 2010; Van der Heyden et al., 2010). Due to limitations in the length and duration of the questionnaire, only a few questions on substance use are included in the BHIS.

As policy on education, youth and culture are competences of the Communities in Belgium, population surveys about drug use in schools and nightlife are groups and spe c i f targeted

supported by the competent administrations and our regional focal points. 2. D rug use in the general population Sometimes, more local large-scale surveys are administered with the support of the competent city administration. 29

This chapter describes the Belgian Health Interview Survey (section 2), the results of the VAD School Survey (‘Leerlingenbevraging’) among high school pupils in combination with the results of the Belgian Health behaviour in School-aged Children (HBSC) Survey (section 3.1), the ‘Head in the clouds?’ survey among university and university college students in Flanders (“In hogere sferen?”) (section 3.2), the Flash Eurobarometer 2014 (an ad hoc survey on behalf of the European Commission) (section 3.3), and some results of two surveys in the party scene, namely ‘Drugs Risk Less’ (‘Drogues Risquer Moins’) and the Belgian part of the Global Drug Survey (section 4). 2. Drug use in the general population

The most recent published results of the BHIS on psychoactive substance use date from 2008 (Gisle, L., 2010; Gisle, L., 2010; Van der Heyden et al., 2010; Van der Heyden et al., 2010). The results of this national general population survey (N= 11,026 for the drugs section; 15-64y) are described in detail in the 2011 Belgian Annual Report (Deprez et al., 2012). In 2013, the Surveys, Lifestyle and Chronic Diseases (SLCD) research group of the Scientific Institute of Public Health (WIV-ISP) performed the data collection of a new BHIS. Different from previous waves, the 2013 BHIS used the computer-assisted personal interviewing (CAPI) method for the face-to-face part of the questionnaire, although drug use is still surveyed by the use of a self-completion part. The researchers maintained the same substance-related items of the 2008 survey, being the lifetime, last year and last month cannabis use; frequency of last month cannabis use; the age of first time cannabis use and the last year use of cocaine, amphetamines, ecstasy, LSD, heroin, methadone and buprenorphine. New for the 2013 BHIS is the inclusion of information on ‘legal highs’. Results for the 2013 BHIS are expected by the end of 2014.

However, it is worth noting that the prevalence for illicit substance use (15- 64 years old persons) found in general surveys, such as the BHIS, are probably underestimated, especially for drugs other than cannabis. Marginalized people (homeless, prisoners, institutionalized persons) are excluded from the sample because invitations to participate to this study are sent only to households after a prior phone contact. The self-completion questionnaire related to substance use is only filled out after having received the visit of the interviewer (Van der Heyden et al., 2010; Van der Heyden et al., 2010). It is highly likely that “hard” or “severe” users do not accept to receive the interviewer at home and/or do not take the time to complete the questionnaire (Demarest et al., 2012). targeted groups groups and spe c i f targeted

rug use in the general population 2. D rug use in the general population 3. Drug use in the school and youth population 30 3.1. Drug use among Belgian secondary school students

In Belgium, several large-scale surveys (using self-completion questionnaires) are conducted among school students of both the Flemish and French Community. First, the HBSC survey is conducted every 4/5 years (1985/86, 1989/90, 1993/94, 1997/98, 2001/02, 2005/06, 2009/10) (Favresse and de Smet, 2008; Godin et al., 2008; Hublet et al., 2006). Second, the European School Survey Project on Alcohol and other Drugs (ESPAD) was conducted in Belgium in 2003 and repeated in the Flemish Community in 2007 and 2010 as the Flemish School Survey Project on Alcohol and other Drugs (VLASPAD) (Lambrecht et al., 2004; Lambrecht and Andries, 2013). Third, the School survey of the VAD is conducted on an annual basis among Flemish school students since 2000/01 (Kinable, 2011).

As for the most recent school year 2011-2012, only the VAD School Survey was conducted (Melis, 2013). In total, 39,999 students (12-18 years of age) from 68 Flemish schools participated in this survey. Based on sex, grade and type of education, a representative sample of 6,083 students was selected. In the 2011-2012 survey, 17.3% of the 12-18 year old students had ever used illicit psychoactive substances and 10.4% had used them the last year. In the following sections, the use of cannabis and other illicit psychoactive substances in this population are described.

3.1.1. Cannabis The prevalence found for cannabis use in the 2011-2012 VAD School Survey confirm the trend found in previous Belgian studies (Godin et al., 2011; Kinable, 2011; Lambrecht and Andries, 2013; Lombaert, 2011; Melis, 2013). The study shows that about one fifth (20.9%) of the 15-16 year old and one third (36.6%) ofthe oldest school students (17-18y) used cannabis at least once in their lives. About one fifth (21.1%) of the oldest age group also used cannabis during the last 12 months prior to the survey. Both the lifetime and the last year prevalence of the oldest students were about 10 times higher compared to those found in the youngest age group (12-13y: respectively 4.4% and 2.4%). There is a stabilisation of regular use to around 3% since the 2005-06 survey (see Figure 2.1). “Regular use” was defined as use of cannabis “once a week”, “more times a week” or “daily”. The prevalence of regular cannabis use was 2.6% for all students (12-18 years of age) with 1.2% of the girls and 3.9% for the boys. Of the 15-16 year old students, 3.1% used cannabis on a regular basis compared to 5.4% of the oldest age group. A small but not trivial group of 12-14 year old students (0.7%) reported the regular use of cannabis.

The mean age at which school students used cannabis for the first time was targeted groups groups and spe c i f targeted 15.4 years. Higher prevalence of ever, last year and regular cannabis use were found in students following technical or vocational educational programmes 2. D rug use in the general population compared to students of general programmes. The most frequently reported reasons to use cannabis were “sociability”, “relaxation”, and “curiosity”. 31 Important reasons not to use cannabis were: “they don’t need it”, “cannabis is dangerous”, “it’s unhealthy” (Melis, 2013). Figure 2.1 | Relative frequency (%) of ever, last year and regular use of cannabis in Flemish Community school students (12-18 years of age) between 2000 and 2012

equency (%) 15

10 Relative fr

0 -2002 -2008 -2012 2007 2001 2011 2000-2001 2002-2003 2003-2004 2004-2005 2005-2006 2008-2009 2009-2010 2010-2011

Ever Last year Regular use

Source: Melis, 2013a

In the cross-national HBSC study of 2009/2010, 17% of the 15 year old girls and 23% of the boys had ever used cannabis. In the Flemish Community, respectively 7% and 11% of the girls and boys had reported cannabis use the last 30 days compared to 9% and 14% in the French Community (WHO, 2012). The prevalence of frequent use of cannabis (>40 times) in life-time among 15 year old Belgian targeted groups groups and spe c i f targeted girls and boys was estimated to be respectively 2.0% and 4.9% in 2010 (ter

rug use in the general population 2. D rug use in the general population Bogt et al., 2014). Compared to the HBSC study of 2002, a decline in frequent use occurred for both the girls and boys. However, the prevalence of frequent use 32 of cannabis in 2010 has been stable compared to the prevalence of 2006. This trend is in accordance with the trend in the VAD School Survey.

3.1.2. Other illicit psychoactive substances Results of the VAD school survey 2011-2012 show that the use of illicit psychoactive substances other than cannabis was rather limited in the population of school students (Melis, 2013). In the whole school population, only the older students mentioned ever use of these substances: 4.4% of the 15-16 year old students and 7.7% of the 17-18 year old students. The highest lifetime prevalence among the oldest school students (17-18y) of the Flemish Community were reported for ecstasy (3.8%), hallucinogens (3.5%), amphetamines (3.4%) and cocaine (2.5%). A lifetime prevalence of heroin use was found to be about only 0.4% among the oldest school students (Melis, 2013).

For the school years 2007-2008 until 2009-2010, a stable prevalence of lifetime and last year use of psychoactive substance other than cannabis was found (Kinable, 2011). Compared to this, a gradual decrease was found in the school surveys of 2010-2011 and 2011-2012 (see Figure 2.2) (Melis, 2013).

Figure 2.2 | Relative frequency (%) of ever and last year use of illicit psychoactive substances other than cannabis in Flemish community school students (12-18 years of age) between 2000 and 2012

10 9 8 7 6

equency (%) 5 4 3 Relative fr 2 1 0 -2002 -2008 -2012 2007 2001 2011 2000-2001 2002-2003 2003-2004 2004-2005 2005-2006 2008-2009 2009-2010 2010-2011

Ever Last year

Source: Melis, 2013a groups and spe c i f targeted rug use in the general population 2. D rug use in the general population

3.2. Drug use among Flemish university and university college 33 students

The survey “Head in the clouds?” (“In hogere sferen?”) is based on the collaboration of the research group “Medical Sociology and Health Policy” of the University of Antwerp, the research group “Health promotion” of the University of Ghent, the Catholic University Leuven, Catholic University College Limburg and the VAD. The third version of “Head in the clouds?” surveyed the use of psychoactive substances in students of the universities and university colleges in Antwerp, Ghent, Leuven and Limburg in 2013 (Rosiers et al., 2014). These participating institutions represent 46.7% (N=107,126) of the total Flemish student population and 18.5% of the eligible students (n=19,822) participated in the survey. With a stratified sampling based on institution and sex, a representative sample of 2,375 students was selected. Of the representative sample, 55.0% was female, which is in concordance with the gender balance of the studied student population. The students’ mean age was 21.2 years. Similar to the surveys performed in 2005 and 2009, the 2013 survey was a web-based questionnaire on the use of (legal and illegal) psychoactive substances, motives and consequences of substance use, mental health, and contextual aspects of substance use (Rosiers et al., 2011; Van Hal et al., 2007).

3.2.1. Cannabis Four out of ten students reported ever cannabis use (39.6%; n=940) and one in five had used cannabis in the last 12 months (22.0%; n=519). These results are of the same size as the values reported in the previous survey (2009) (43.0% ever cannabis users and 22.9% last year cannabis users) and as the results of the VAD School Survey of 2011-2012 among the 17-18 year old school students (36.6% ever cannabis users and 22.9% last year cannabis users). Male students had more often used cannabis than female students (49.4% versus 31.6% respectively). Among the ever cannabis users, 31.0% of the male students had used cannabis the last 12 months compared to 14.7% female students.

Among the students who had used cannabis the last 12 months, about half of them used it once a month or less during the academic year. One in five used it at least once a week (for more details see Table 2.1) and one in 20 used it every day. During the holidays the frequency of daily use was slightly higher (6.3%) than during the academic year (5.3%) or the examination period (4.2%). Although nearly all of the ‘last 12 months’ cannabis users confirmed the use during the holidays, almost half of them did not use cannabis during the exam period. Regular users of cannabis were more often male than female. The survey also showed associations between age and cannabis use: a higher proportion of ‘last year use’ is found among the younger students. In addition, targeted groups groups and spe c i f targeted a younger age of first time cannabis use was associated with more frequent use

rug use in the general population 2. D rug use in the general population during the academic year and the holiday period.

34 Table 2.1 | Frequency of cannabis use (%) among students in the ‘last 12 months’ cannabis users in the Flemish Community, 2011/2012 Total (N=519) Men (N=327) Women (N=192) Time framework not <1x/ ≥1x/ not <1x/ ≥1x/ not <1x/ ≥1x/ week week week week week week Academic year 10.5 68.8 20.7 7.8 64.6 27.6 15.0 75.7 9.3 Examination period 45.3 42.3 12.4 39.0 45.4 15.6 55.5 37.2 7.3 Holiday period 4.3 72.2 23.5 3.2 66.2 30.6 6.2 81.9 11.9 Source: Rosiers et al., 2014 3.2.2. Other illicit psychoactive substances Next to cannabis use, the third wave of “Head in the clouds?” also assessed the use of amphetamines, ecstasy and cocaine. The proportion of students that used one of these substances is substantially lower than the proportions of cannabis users: about 5% ever users and 2.5% last 12 months users for each of these substances (Rosiers et al., 2014). These proportions are of the same size as the proportions in the second survey in 2009 (Rosiers et al., 2011) and the proportions are of the same size as in the 17-18 years old high school students of the VAD School Survey (Melis, 2013). Among the last 12 months users, amphetamines, ecstasy or cocaine were seldom used on a regular basis (once a week or more frequent) during the academic year or examination period. However, during holidays, they reported more often the use of these substances on regular basis (amphetamines 15.4%; ecstasy 10.1%; cocaine 6.9%). Of the last 12 months users, 3.8% of the amphetamines users and also 1.5% of the ecstasy users reported daily use in the examination period. No one reported daily use during the academic year or holidays. On the contrary, daily use among the last 12 months users of cocaine was only reported during the summer holidays (2.3%). Male students reported more ever use and last 12 months use of amphetamines, ecstasy and cocaine than female students. Older students reported less ecstasy use in the last 12 months.

3.2.3. Mental well-being and illicit substance use Well-being was measured with the General Health Questionnaire (GHQ-12) with four questions related to anxiety and depression symptoms, two questions related to self-confidence and six questions related to social functioning(Vanheule and Bogaerts, 2005). A higher GHQ-12 score (more psychological problems) was associated with a higher DAST-10 score (problems related to illicit substance use other than cannabis). Consequently, anxiety and depression symptoms were associated with more problems related to cannabis use and other illicit substance use. Less self-confidence was associated with problems related to illicit substance use other than cannabis. targeted groups groups and spe c i f targeted

3.2.4. Contextual factors of illicit psychoactive substance use 2. D rug use in the general population In the third wave of “Head in the clouds?” survey, half of the students lived in a student room, 40% lived at their parental home and 10% were living 35 independently. The latter group reported more cannabis use (54.7%) compared to students living in rooms (39.5%) or at home (36.6%). The same pattern of more substance use among independently living students was observed for the other illicit psychoactive substances. However, the living condition had no association with the frequency of substance use or problems related to illicit psychoactive substance use. In addition, the survey did not report any association between the frequency in use of illicit psychoactive substances and the membership or management in an association for students or a sport club. 3.3. European study on young people and drugs

In June 2014, the TNS Political and Social Network (Tayler Nelson Sofres) of the European Union carried out the Flash Eurobarometer Survey “Young people and drugs” in the 28 Member States on behalf of the European Commission, Directorate-General for Justice. This thematic Flash Eurobarometer has also been performed in 2002, 2004, 2008 and 2011 (TNS Political and social, 2014). About 13,000 respondents aged 15-24 from different social and demographic groups were interviewed by telephone (landline and mobile phone) in their mother tongue. The basic design applied in all countries is a multi-stage random method taking into account region and urbanisation. In Belgium, 500 young respondents were interviewed.

Overall, 13% of the participants in Belgium reported that they had used cannabis the last 12 months (Figure 2.3) compared to 17% in the EU. 5% of the Belgian participants reported the use of cannabis during the last 30 days (EU: 7%). Going against the overall EU trend, the respondents in Belgium were more likely to say they never tried cannabis (74%) compared to the Flash Eurobarometer 2011 (Belgium: 71%). The proportion of cannabis users in this survey is substantially lower than the results from the presented school and student surveys. This may be a reflection of the different designs and selection biases. In Belgium, 59% reported that it would be “easy” to obtain cannabis within 24 hours (EU: 58%) and about 61% said that cannabis should continue to be banned (EU: 53%) (TNS Political and social, 2014).

Figure 2.3 | Proportion (%) of youth aged 15-24 reporting the use of cannabis, 2014

14 13 No, never 10 8 Yes, in the last 30 days targeted groups groups and spe c i f targeted 5 Yes, in the latest 12 months, not in the last 30 days

rug use in the general population 2. D rug use in the general population 7 74 Yes, but more than 12 months ago 69 36

EU: Outer pie Belgium: Inner pie

Source: Flash Eurobarometer, TNS Political and social, 2014. The large majority (92%) of the respondents in Belgium has never tried new psychoactive substances (NPS), which is similar to the mean in the EU (92%). Only 1% had used NPS the last 30 days, 3% the last 12 months and 5% more than 12 months ago (Figure 2.4). However, the number of ever-users has risen with 4% in Belgium compared to the Flash Barometer 2011. Of the last 12 month users, 87% was given or had bought NPS by a friend, while respectively 35% and 30% reported to have bought them from a drug dealer or in a specialised shop. Only 3% reported to have bought the substances online. All of the last 12 months users reported that they used the NPS with their friends, and 76% used it during a party or event. Of all respondents, 34% reported to have received information on the effects and risks of NPS through the media, while 36% found this information on the Internet. Respectively 29% and 21% reported to have received information through a school prevention programme or from friends and 19% said that they have not been informed at all. A large majority considers regular use of NPS to carry a high health risk (87%).

Figure 2.4 | Proportion (%) of youth aged 15-24 reporting the use of NPS, 2014

3 4 1 2 5 No, never 1 Yes, in the last 30 days Yes, in the latest 12 months, not in the last 30 days 92 Yes, but more than 12 months ago 92

EU: Outer pie Belgium: Inner pie

Source: Flash Eurobarometer, TNS Political and social, 2014. targeted groups groups and spe c i f targeted rug use in the general population 2. D rug use in the general population

37 4. Drug use among targeted groups/ settings at national and local level

4.1. Drug use in recreational settings in Belgium

Several recent reports of Belgian student surveys (Kinable, 2010; Lombaert, 2011; Rosiers et al., 2011) highlighted the fact that recreational and nightlife settings (e.g. pubs, clubs, parties) are preferred settings for the use of illicit substances. Although the gap in drug use habits between music lovers and non-lovers has narrowed, dance music lovers are still more likely to (frequently) use illicit drugs (Van Havere et al., 2011; Van Havere et al., 2012). The (patterns of) use of psychoactive substances and the characteristics of users in these settings are therefore regularly monitored in the Flemish and the French Community by the VAD research in nightlife settings and the risk reduction project “Drugs risk less” (“Drogues Risquer Moins”) coordinated by Modus Vivendi (Hogge and Denoiseux, 2014) respectively. The methodological approaches of these monitors are significantly different and were described in detail in previous Belgian Annual Reports on Drugs (van Bussel, J. C. H. and Antoine, J., 2012). In preceding years, the prevalence of substance use in both Communities fluctuated to some extent. Changes in the coverage of number, type and location of recruitment settings could have contributed to this fluctuation, especially in the French Community (Rwubu and Hogge, 2013).

For 2013, data were available through the “Drugs risk less” project in the French Community. The next VAD research in night life settings is scheduled for the year 2015. “Drugs risk less” is a joint action of more than 30 harm reduction and prevention organizations active in recreational settings (Hogge and Denoiseux, 2014). Professionals and peers provide information and advice to users and those who are interested. The primary objective of the accompanying survey

targeted groups groups and spe c i f targeted (paper questionnaire; in 2013 N=1,653, mean age is 23.1 years old) is to verify whether the harm reduction activities are well matching the targeted audience. rug use in the general population 2. D rug use in the general population Therefore, the survey is not representative to the whole party scene and, hence not interpretable as prevalence data because there is no sampling method (Hogge 38 and Denoiseux, 2014). The results can be interpreted as a first indication of specific (new) issues of substance use among the targeted group. Because of changes in the questions in the 2013 survey, results on last month and last year use of illicit substances are no longer available. Instead, the participants were questioned about their usual substance use during nightlife.

Cannabis is by far the most used illicit psychoactive substance in the recreational settings in the French Community. In 2013, 66% of the partygoers has sometimes or often used an illegal drugs during nightlife events; more specifically, 53.3% had sometimes or often used cannabis, followed by amphetamines (27.1%), cocaine (24.2%), hallucinogenic mushrooms (23.5%) and ecstasy (23.5%). Additionally, 13.7% and 11.4% of the respondents reported sometimes or often use of respectively ketamine and NPS (in this questionnaire referred to as ‘research chemicals’) during nightlife events (Hogge and Denoiseux, 2014). Of all night life event visitors, 44.1% reported the use of any illegal drugs during the event. 36.0% of the respondents had used cannabis during the event, followed by amphetamines (12.5%), ecstasy (8.5%) and cocaine (6.8%) (Hogge and Denoiseux, 2014). Additionally, 4.2% of the visitors reported the use of ketamine during the event and 2.5% had used NPS.

Finally, the 2014 Global Drug Survey has launched its yearly drug research in November 2013, in which Belgium participated. This was coordinated by the Association of University and University Colleges of Ghent (Vanderplasschen, 2014). Globally, 80,000 people participated in 18 different countries. In Belgium, about 2,670 persons completed the online survey on drug use. It is important to emphasize that such kind of survey is not representative for the Belgian population, as it has shown to comprise an overrepresentation of drug users because respondents are self-selected (no sampling method). Two-thirds of the Belgian participants were men and the mean age was about 27 years. Three- quarters currently had a job or was still a student, 23% was unemployed. Two- thirds visited at least once a month a club or disco. Also, two-thirds had used at least one illicit substance during the last year, while 52% had used a substance during the last month. Cannabis was the most often used substance (42%). Among the cannabis users, half of them used it more than 50 times during the last 12 months. About 30% of the cannabis users would like to use less cannabis. Other drugs regularly used are ecstasy (23.5%) and cocaine (20%). Speed (8%) and ketamine (6.5%) were less prevalent. About 4.5% of the Belgian respondent reported to have used NPS in the last 12 months compared to 5.3% of all the Global Drug Survey respondents. Buying drugs over the internet is not yet as common (done by 7% of the Belgian participants) when compared to other countries (e.g. 22% in the UK), but the number has been increasing during the last years (Winstock, 2014). It should be noted that the samples from the different countries vary significantly in a number of ways including mean groups and spe c i f targeted age and involvement in clubbing. Therefore, caution is needed when comparing 2. D rug use in the general population the data between countries. 39 5. Conclusions

For this report, the results of the latest general population survey (BHIS 2013) were not yet available and will be presented in the Belgian national drug report of 2015. In general, we remark that population and/or school surveys usually will have difficulties to reach marginalized people, and as such, “hard” or “severe” drug users will often not be included. These surveys will give us some information on more common forms of substance use, but are not suitable to study high risk substance use such as injecting drug use (for a description of high risk drug use please refer to chapter 4) or the use of less common substances in the general population (e.g. heroin).

The regional based surveys among students of secondary and higher education in the Flemish region suggested that the use of cannabis has declined in 2006 and remained stable since then. About one fifth of the 17-18 years old (21.1%) and of the university (college) students (22.0%) used cannabis during the last 12 months prior to the survey. “Regular use” of cannabis among 12-18 years old school students was limited to 2.6% of the study population. The use of cannabis among university and university college students is very time dependent. About half of the last 12 months cannabis users did not use cannabis during the exam period, but almost all students of the last 12 months user group used cannabis during the holidays.

The decreasing trend in the prevalence of cannabis use among youngsters since 2006 has also been observed in other European countries, such as Germany, France, UK and Spain (EMCDDA, 2014). The results of the Flash Eurobarometer 2014 also showed a slight decrease in the prevalence of cannabis use compared to 2011. Therefore, the results of the latest HBSC study 2013/14, the future VLASPAD 2015 and their conclusions on spotted cannabis trends are expected with great interest. On the latest General Population Survey (GPS) expert targeted groups groups and spe c i f targeted meeting organised by the EMCDDA (June 2014), an oral presentation from the

rug use in the general population 2. D rug use in the general population Spanish national focal point (GPS expert Alvarez Elena) suggested a correlation between the risk perception of cannabis use and the prevalence of cannabis use 40 among youth. In periods of higher risk perception the prevalence of cannabis use decreased and vice versa. Additionally, the oral presentation of the French national focal point (GPS expert Spilka Stanislas) suggested a correlation between the age of onset of tobacco and of cannabis. In France, there have been no major legislative modifications concerning the use of cannabis, but when the anti-tobacco efforts increased, the age of onset of tobacco increased and so did the age of onset of cannabis. The VAD school survey also describes a gradual decrease in smoking among adolescents during the last 10 years, however more profound research on the mechanisms of onset of drug use is currently not available in Belgium. The school and university (college) based surveys also suggested that the use of other illicit psychoactive substances than cannabis is limited (about 1.5 to 2.5% last 12 months users of amphetamines, ecstasy and cocaine). A minor group of students in higher education reported the daily use of amphetamines and ecstasy during the examination period. Especially the latter is rather surprising as it not only has a central stimulating effect similar to amphetamines, but also a hallucinogen effect that might become more and more reinforced with repeated and long-term use. Although the use of NPS in Belgium still seems to be limited, based on the results of the Flash Eurobarometer 2014 and the Global Drug Survey, vigilance is needed as an increased use of these substances is reported over the last 3 years.

Observational data from the party scene (French Community) suggest that illicit substance use is much more common in this setting. Partygoers most often reported the use of cannabis during the event (33%), followed by amphetamines (12.5%), ecstasy (8.5%) and cocaine (6.8%). We also notice that 4.2% and 2.5% of the respondents reported the use of respectively ketamine and NPS during the event. As ketamine and other NPS are gaining popularity among partygoers, it should be considered in all kind of substance-related surveys to add these substances in the questionnaires in order to better monitor this phenomenon.

As no recurring general population survey specifically on drugs and drug addiction exists in Belgium, all data are cross-sectional using different samples and methodology. Therefore these data are difficult to compare and formulating general conclusions isn’t easy. Because of different time and priority schedules in the different Communities, it is also difficult to give a good national overview at all times. In a European context, Belgium is one of the few countries that is not yet systematically collecting national prevalence data on all forms of drug use (Decorte et al., 2009). As such, this research should be prioritized as it is the basic information for other research and policy actions within the field of drugs and drug addiction. targeted groups groups and spe c i f targeted rug use in the general population 2. D rug use in the general population

Acknowledgements The authors greatly acknowledge the contribution of all data providers and the feedback of Mr Laudens, Mr Martens, Mr Rosiers, Mr Hogge (Ph.D.), Mrs Casero, Mrs De Donder, Mrs Huard, Mrs Melis, Prof. dr. Decorte and Prof. dr. Van Hal. 42 different aspectsoftheactionplan are implemented. year,sector.Each educational and health the in actors towards given mainly is attention framework, this (TAD)Within drugs 2009-2015. and alcohol tobacco, on Plan Action Flemish a by regulated is Community Flemish the in Prevention (Wallonia- community Brussels federation). French the in the drugs is and (EUROTOX) alcohol for Wallonia-Brussels centre Federation monitoring the in drugs and observatory alcohol socio-epidemiological for The respectively. community German and Suchtvorbeugung voor für Flemish the in structures co-coordinating (Arbeitsgemeinschaft the are (Vereniging ASL) Lebensbewältigung, und life problems with Coping drug Addiction and for Association Prevention other the and VAD) and Drugproblemen, andere alcohol en Alcohol- for Association The and coverage Belgian a have implementation ofdrug-related prevention activities. army, the the in involved within still thus is Government Federal the Therefore, use impact. national drug and the region. of C hepatitis needs specific the to medicines, hospitals, general to regard own with initiatives respondprevention Nevertheless, an to implement order in to policy authorized prevention is government Regional and Community the specific for Each governments. 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Walloon-Brussels and the and Community Flemish speaking German the in implemented activities prevention indicative and selective universal, of range broad a of given is overview an paragraphs following the In mns ohr ifrain lcue, riig, ciiis n cuslig In counselling. 2013, ASL reached atotalof6,740people,which3,985students and activities trainings, lectures, information, others amongst offers ASL use. drug illegal to related projects prevention only includes report this areaddressed.Nevertheless, drugs illegal and legal Both drugs. without life healthy a stimulate to and addiction prevent to objective the has organization PreventionareCommunity speaking German the in activities ASL.by up set This party andsportenvironments prison, reduction care, as harm such environments different to in region Brussels framework the in plan strategies formal more reduction a harm give will joint plan a This Brussels. develop for to started Vivendi, Modus and (CLDB) Brussels in Drugs of Coordination Local the Bruxelloise), (Fedito addiction Drug In 2014, three organizations, including the Brussels federation of Institutions for to 3) policies, formalize functionalpoliticalcollaborations. health of integration the facilitate to 2) society, in everyone of common political framework to favour the health of citizens and the integration (Van Huycketal.,2014) . (ASL, 2014) . 45 3. prevention 46 3. prevention applied toanindividualschool. regularly are etc.) pupils, the consulted to support the director in teams, defining the guidelines regarding well-being promotion the of members educators, at promotion health school. in Internal and external participants used of the same school usually (directors, teachers, was approaches integrated bien-être’) the of (‘Cellules continuity Cells’ ‘Well-being theoretical and philosophic the called combines project This schools. projectin implemented pilot a 2011, In confidentiality. act 4) for respect the guarantee 5) people, and participation of young dynamics create and together the with connection in adults the to prevention of the role recognize 3) resources, institution’s the to and project educational the to action five the adapt 2) following situation, the clarify the and demand the on analyse 1) principles: based are actions Federation, Wallonia-Brussels the In age using by primary pupils in terms schools thatare setbytheFlemishgovernment. end of the of skills’ one is skills life life Improving ‘general materials. appropriate so-called provides which improving Sleutel’, in ‘De by support organised trainings on appeal can Teachers 2010) Pupils as well as their parents can find more information on the website the on information more find can parents their as well as Pupils pupils. school primary grade 3rd of curriculum normal the in integrated be to use of alcohol and delay the age of onset. The intervention consists of 8 lessons alcohol’ is an intervention for youngsters aged 10-12 years to promote the non- without ‘Fun example For schools. primary Flemish in introduced are drinking of onset of delay the on focus main a with activities more years, few last the In used. be can material didactic which and (grade3) age or what 2 at 1, tackled be can drugs) illegal and/or alcohol (tobacco, topic which decide to helps instrument TAD.VADconcerning schools primary for guideline a developed VIGeZ This and focussed onthisaudience. initiatives successful of number a schools, secondary in than numerous less is Although the number of requests for prevention interventions in primary schools 2.1.1. School 2.1. 2. . Universal prevention Universal prevention inprimaryschools (VAD, al., 2013) f Peeto o adcin n hat pooin. hs tanns uh to ought trainings These promotion”. health and addiction of “Prevention of framework the in well as trainings offered are teachers addition, In schools. all the in 2013 in communicated in were results The Federation. elaborated Wallonia-Brussels the of was schools it?” of think they do what people, young the “And called survey Community,a Flemish the in survey school the with line In of addictions ononehandandtheschoolenvironment ontheotherhand. prevention Federation regarding network theWallonia-Brussels specialised the in between links strengthen to are operational points support Specific ehdlge ta fcs n nomto cnenn achl n cannabis, boundaries setting and and pressure social with alcohol coping values, and norms concerning five information uses on package focus The topic that relationships. the methodologies to on associated pupils cannabis, grade and 3rd alcohol for of package didactic a ‘Crush’, created VAD 16 to years) andthird grade (16to18years). (14 second the for programme follow-up a developed also Sleutel’ ‘De grade). (first years 14 to 12 of range age the in use drug of onset the of delay education of life skills and social influences has shown effective outcomes in the as the European programme ‘Unplugged’, in their classrooms. This approach on such programmes,prevention drug implementing in teachers trains Sleutel’ ‘De workers and prevention organizations, prevention mainly throughfrom training support and consultation. receive They themselves. teachers the by principal in education, of secondary in range used wide being are a that programmes is prevention there universal school, at policy drug the of framework the Within pupils were involvedinthisevaluation. 502,651 than more and schools 951 project, the of beginning policy.the Since drug school’s the survey improve to tools and tips school with report a renders and The school evaluate a pupils. to their of 1999 input the since (‘Leerlingenbevraging’; see also chapter 2 and 4) collects data to of all the pupils of opportunity according policy the drug have their schools secondary Flemish uptake. individual schoolsetting. wide very a has each to tailored framework, structural and and global own its develops school Each developed is schools drug secondary for framework in policy prevention structural a years, many For Community.the Flemish in schools secondary in prevention universal in tradition strong a is There consumption ofalcoholanddrugs. the concerning projects developing are Community speaking German the and Federation Wallonia-Brussels Community,the Flemish the in schools Secondary 2.1.2. . Universal prevention insecondaryschools (Baeten et (Baeten 47 3. prevention 48 3. prevention asked to participate to a quiz are students session, the year.After school secondary the in discussed only are drugs illegal while year, school secondary first the in attended are drugs Legal sessions. information these during discussed are etc. theft, vandalism, violence, in lectures give ASL agents, secondary schools police about rights, duties and risks in society. with Several topics such as Together students. school with use drug discuss to used is approach global a Community speaking German the In detru atvte, nomto ws ie aot anbs n te risks the and cannabis these about related tocannabisuse Besides given drug. was a information using activities, without adventurous ‘kick’ a experience to opportunity the students gives project This Eupen. of centre sports the at adventure two-days a EuPrevent, organised also ASL students discussion. a starts worker prevention the the made, words the of relax, classification smoking, the as of basis such the written On are etc. dependency, words which on cards sort to asked Students are discussable. addiction subject the making school, secondary of year h floig diinl riig ae raie wti shos n h French the Community: in schools within organised are trainings additional following The departments). the initiative concerned five interventions (three in schools and two in municipal 2013, relay.In adults the of training promotion health a proposes also people project young with debate the enable without posing questions about addiction too directly. to The “Art and Prevention” advantage the has approach This support to consumption. 2013 of questions the approach in to practice artistic an using Prevention” in schools and “Art project the created “Prospective the also this, Jeunesse” to Next exhibition. the discovered who speakers social the NGO “Prospective Jeunesse” organised six debates with pupils and one with exhibition, the in participated that people young the with debates the animate to (a order In sensitization). Latitudes about and Youngprevention of by actions exhibition several developing developed service interactive is an and people is young either” addressing addiction me not “Hooked, exhibition The among youngpeople. consumption responsible more and risky less promoting at aimed project The society”. and alcohol people, “Young called project the in involved are sector youth and education health, the of Community,partners French thirteen the In the with addiction subject the pupils. discuss to language common a schools offer • • • • The educationonhowschoolscanstimulatethewell-being ofpupils. to connected risks prevent addiction (drugs,alcohol,internet,videogames,etc.), to how about approach educational An Training intheuseofeducationaltools, Basic training: prevention oftheaddictionsandhealthpromotion, (ASL, 2014) (ASL, 2014) . . Another project is introduced in the first available online complete The support. parenting in package (trainer manual, interactive material such as films, leaflets, postcards) is active professionals and sector drug or alcohol the in professionals both at aiming organised were participants) 71 of total a (with trainersessions Five 2013. programmeSeptember the in of started implementation the evaluation, pretest-posttest controlled a and project pilot a After teenagers. by drugs other and alcohol tobacco, of use the to linked skills parenting improve to intends programme prevention This Community. Flemish the in years) 15 to (10 teenagers of parents for programme prevention based Starting from December 2011, VAD developed an interactive one-session family- and children) using drug have abroad objectivetodevelop‘lifeskills’. with parents only not (meaning parents all to open are programmes Several level. local a at and organizations education adult of programmesintegratedin parentsaremainly for preventioninitiatives Universal 2.2.1. 2.2. students (college) university for section dedicated a has DrugLijn-website the Flanders, In 2.1.3. developed. be will actions reduction harm concrete in tools, certain estimating and testing By campuses 2 in University. situation Saint-Louis the and College drinking Brouckère de Lucia the namely the Brussels, study to intends project The 2014. 2013- year academic the for COCOF the by subsidised is environment” student in Reduction Harm “Alcohol project experimental The Vivendi. Modus by in 2013 developed was Brussels in students among use alcohol on project Another page, are organised duringtheacademicyear. Facebook a and “Alcohol” campaign new a bike, hours 24 of plan preventive a as such alcohol, drinking concerning behaviour responsible on actions Several the operational plan. authorities, academic ofstudents, departments and institutions – were created to develop different priority axes of –consisting groups five 2013, September In environment. student Housing the in the problem 10 alcohol and the targeting Service for and Department Help plan Students the action with an association in developed UCL, has at years Santé’ ‘Univers NGO the 2010, Since to exams)ishighlighted. relation (in medication of year,use academic the the of end the At focus. the main are cannabis or alcohol year, academic the of start the At year. academic F amily (De druglijn, 2014) Improving parental skills Universal prevention inhighereducation (VAD, 2014) . The highlighted topic changes during the course of the . 49 3. prevention 50 3. prevention elh hms n aetn nml achl tbco cnai, oin and motion cannabis, tobacco, nutrition alcohol, five namely on parenting focuses in This VIGeZ, themes evaluation. and health effect VAD and by product- developed a project, executing prevention universal after 2013 of end the by launched was teenagers of parents for e-learning on website Flemish specific A 2014) The annual figures for ‘the DrugLijn’ in 2013 (N=6,197) are presented in arepresented 2012 2014) (Evenepoel, to compared 2013(N=6,197) as 6% or in contacts 364 of decrease a DrugLijn’ show and 3.1 Table ‘the for figures annual The their through provided also website. is counselling online years, few a Since helpline. the respectively FrenchCommunity.Flemish and operateonly not telephone do a for services These lines help drug the are DrugLijn’ ‘the and ‘Infor-Drogues’ 2.3.1. Community 2.3. h dfeet canl’ fee b te epie te vrl blne between balance overall telephone callsandonlineenquiries remains at anapproximate 50/50-ratio. the helpline, the by offered ‘channels’ different the in decreases and increases the Despite future. the in further rise to expected is (N=385) contacts chat online of number The 2013. in year operational its full first had and 2012 of fall the in launched was which service chat online the by compensated part large a for service however was This (-19%). thee-mail 2004 in launched was since decrease substantial first its e-mail saw of (N=2,523) number enquiries The (-5%). calls years telephone previous of to number similarly decreased The (N=3,124) evolve. medium per contacts of number way the the in differences are there However, service. chat and Skype e-mail, via Additionally, one gathering for families about ‘fit children’ was organised was children’ ‘fit about families for gathering one Additionally, organised. were participants 201 with evenings 16 total, In parents. interested by chosen themes concerning 2013 during arranged were gatherings Several population. general For the Community.for trainings education speaking organising is ASL German years, several the in implemented also is approach This Drogues’ are dealingwiththistopic(Seealso2.3.1). Also the frequently asked Flemish questions on the website of skills. the French helpline parental‘Infor- the and parents of to attention website special paying is the DrugLijn the on can helpline page children, separate their A of information. use online drug consult possible about questions have who Parents subject totraining ofprofessionals activeinparenting support. made and organizations health public diverse of channels through announced . Helplines Vgz 2014) (Vigez, . These contacts consisted of telephone calls and online enquiries online and calls telephone of consisted contacts These . I odr o rmt te mlmnain te ie was site the implementation, the promote to order In . (ASL, T service traditionally reaches older age groups and also more women. Often this Often women. more also and groups age older reachestraditionally service is and due to 2013 the success of the online in services the helpline is providing.confirmed The telephone is evolution This ago. years few a than now people young more reaches ‘DrugLijn’ the that indicated already 2012 for figures The usacs te ubr rmi lw Nvrhls, aig eea yas into years several account, thenumberofquestionsconcerningGHBseemtoincrease. taking psychoactive Nevertheless, new low. remain other numbers or the ketamine substances, are GHB, that like drugs 3.1. Table other in For mentioned decrease. not a show methadone or those heroin whereas to 2013, related in increased also amphetamines to related contacts of number The LSD. for increase small a showed and Ecstasy for stable remained enquiries of number The enquiries of proportion The decline. to continues years. medicines psychoactive about for done have they as stable cocaine fairly concerning remained questions of number The 2013after 2012. in in increase a decrease remarkable a show alcohol remains on figures cannabis The on 3.1). Table enquiries (see of stable proportion the however substance DrugLijn’, mentioned ‘the most the at been always has which drug the is Cannabis the ‘DrugLijn’alsoreceived 601hoaxcalls. figures, these from Apart advice. emergency basic as well as hours opening the on information provides which system, callers response 1,942 voice interactive pm), the 8 reached to am 10 (Mon-Fri hours staffed Outside day. per hours 24 operational not therefore and helpline emergency an not is DrugLijn’ ‘The able 3.1| Amphetamine LSD Methadone Crack Psychoactive medicines Alcohol Heroin Ecstasy Cocaine Cannabis Involved substance Total numberofcontacts Source: Infordrogues, 2012; Druglijn,2013. * Characteristics iue icue eehn cls eqiis y -al Pretgs o ‘novd usacs are substances’ ‘involved for Percentages e-mail. by calculated ontotalnumberofpersons that mentionatleast1drug(5,486persons) enquiries & calls telephone include Figures and Infor-drogues Number ()andprevalence (%)ofcallssubstancein2013,DrugLijn Infor-Drogues 1,008 2,539 109 204 327 142 431 61 29 48 49 N 100.0 13.1 17.2 40.3 2.4 1.1 4.3 1.9 8.1 5.7 1.9 % 1,475 1,935 6,197 460 492 156 297 792 N/A Druglijn* 97 73 N 100.0 27.0 14.5 35.4 N/A 8.4 1.8 1.3 9.0 2.9 5.4 % 51 3. prevention 52 3. prevention in spite of the difficulties described above. Users are essentially men from 26 to 26 from men essentially are Users above. described difficulties the of spite in compared to 37.3% in 2012. Therefore, a constancy in the user calls is observed professionals. The percentage of callers categorized as “users” was 36% in 2013 and relatives users, helpline: ‘Infor-drogues’ the contacted groups target Three This available). remains pm decrease hadanimpactonthenumberofreceived callsaswell. 2 till am 10 from Saturdays on slot time single (a weekend the during as well as am 8 is till pm 10 There from line the days. of interruption 7/7 an and day a hours 24 available line longer telephone no is the Infor-drogues 2013, of July since addition, In three 2011). and in duration 2012 than than more average more minutes minute The (one minutes impossible. 13 been calls has calls triple phone of or double makes which calls, incoming all for connection unique one only had still ‘Infor-Drogues’ 2013, In product, the explanationsonfunctioningofdetoxificationcentres, councils,etc.). a about information the (e.g. call same the during things several for not generally limited to a single request. is So, it call is the common received that every a single Indeed, caller asks “request”. of and “call” of notion the complexity distinguish to increasing inlonger the by explanation caused approached situations. Among the total number of complementary received calls, it is important calls, find of also durations can processing calls of decrease The and aquarterofthepeoplecontactinge-serviceislessthan25yearsold. cannabis concern questions of 61% users. areby mails sent of 60% women. by made are mails of 59% mails. 190 received service “e-permanence” the 2013, In hours. 72 of maximum who a within members it answer two will and question its this handle among will indicates and message the receives team The way.confidential a in site web the from answers the consult communication to and questions and their ask to users information allows service “e-permanence” The of service. “e-permanence” types other Doubtless, an has Infor-Drogues 2005, Since services). chat 2011). and internet as by (such channels for calls replaced 4,347 are and 2012 phones to for as compared calls (3,422 decrease years a strong previous represents figure This 2013. during calls 2,539 received helpline Infor-Drogue the Federation, Wallonia-Brussels the In ‘Infor-drogues’ reaches lessyoungpeopleincomparisonwiththe‘Druglijn’. It is noted with caution (because of the high percentage of unknown data), that and self-care early interventions(see4.2and4.3foradetaileddescription). self-tests, for group target valuable a are who users, drug male findings lead to the conclusion that the chat service succeeds in reaching young more drug users than the telephone or e-mail service. The combination of those and men more somewhat reaches also service chat The years. 25 than younger is them of 64% people: young to appeal to seem – service chat the especially – services online The users. drug of mothers more even and partners involves uses the local network and partners and consists of seven steps seven in of consists and updated partners and VAD method network local This the cities, 2011. uses in and launched was communities which method Flemish stepping-stone policy the in 2013 inter-sectoral-based drugs and and integral alcohol an of stimulate to objective the With 2.3.3. to and adolescents and children of prevent drivingundertheinfluenceinfuture self-awareness the improve to intends project This glasses. special wearing by drugs of influence the under be to feels it how experience heroin to opportunity cannabis, the gives about project Another lectures co-addiction. and organises e.g. ASL substances. these about more know to order in drugs illegal about lectures attend can citizens Belgian 2.3.2. this platform. a developing in with struggling local alcohol and drug policy. are Currently, they 72 prevention workers are things registered for on questions post and other locally new, on developed campaigns or policy information initiatives. They can also communicate with each exchange can workers prevention platform, this On 2014. in launched was workers prevention local and regional for platform exchange interactive online, an method, stepping-stone theoretic this to Next services. welfare and healthcare primary to access 4) and intervention early and actions implement to cities awareness raising 3) measures; structural 2) regulation; and and rules 1) concerning communities the allow to has analysis local anbs 4.%, oan (72) n achl 1.% ae h ms often most the are evoked products duringcallsintheWallonia-Brussels Federation. (13.1%) alcohol and (17.2%) cocaine (40.3%), Cannabis or (19) Flanders elsewhere (34). (741), region Walloon the (1,247), Brussels are calls most of origin the that showed statistics the call, of origin geographical the Concerning previous years. from trendage continuing a is all observation This overrepresented.Among are males groups, (13.7%). group old year 18-25 the by and (21.1%) group old 35 year continues to be the most presented (31.5%) followed by the 36-50 year 26- of group the Infor-drogues, contacting are that users of age the Regarding justice sector(5.3%),journalists(18.7%)andpublicauthorities(1.9%). health the professionalsof (27.4%), sector educational the careprofessionals(46.6%), category: professional the into included are framework. professions professional following a The in made are calls total the of 16% stable years. remains the proportion over This calls. these of 50% than less users little of a Mothers represent 2012). for 52.2% and 2013 for calls total the of (47% year last the of those than number in lower arerelatives by made Calls old. years 50 Local alcoholanddrugpolicy Other formsofcommunitybasedprevention (ASL, 2014) . (VAD, 2014) (VAD, . A . 53 3. prevention 54 3. prevention with amental disability. people for programme a also has CAD education. needs special in youngsters targeting programme a is stappen’) (‘straffe the steps’ ‘Hard in Limburg. exclusively of province operates which Limburg, CAD by developed is programme second The use. cannabis or and alcohol of consequences and risks effects, the of aware more them make to way effective an offers It disability. mental mild a with people young to tailored package a is bah’) of boe zonder cannabis en special with youngsters (‘Alcohol nonsense’ targeting no cannabis, and ‘Alcohol package didactic first The needs. are programmes prevention Flemish Two 3.1.1. situation. scope ethnic broader living unstable preventionmorepeer an investing towardsin with is people and a and has needs turn, its special in Federation, with Wallonia-Brussels people The minorities. to directed is groups activities at-risk prevention towards selective regarding Community Flemish the in focus The 3.1. other. each from differ regions both in approachesprevention selective Therefore,the promotion’. ‘Health of concept the the within while works onFederation TAD, Wallonia-Brussels plan action specific a of disposes Community Flemish The 3. ln, A dvlpd he ifrain hes oe n loo, n on one alcohol, on one sheets: information cannabis andoneonotherillegaldrugs. three these in developed drugs VAD and alcohol of plans, topic the include to cities assist and stimulate to order In organizations). welfare social and policy cities for so-called cycle management (the and legislature coming the for rules plans of policy framework their new compose a to within work to have cities Belgian all 2014, Since place. took purchasing test the which in city each for report made tailored a prepares VAD theme. this on actions preventive of effects the evaluate can to used It be minors. also to alcohol selling on legislation the on information more need they whether or legislation the with familiar arebeverages alcoholic of sellers if check to used be can monitor The minors. to alcohol to selling on up legislation cling the beverages alcoholic of sellers not or whether investigate to order in purchasing test perform to protocol a use also can workers prevention Local groups andsettings Selective preventioninat A t-risk group Selective prevention forpeoplewithspecialneeds -risk final versionsofthesixinterventionswilltakeplaceearly2015. the of the of Implementation evaluation 2014. September till April from foreseen is interventions and Testing minorities. ethnic with and working worker prevention professional a a by out carried is intervention each local of The development developed. is intervention parents new with completely a used or minorities be existing ethnic to an of region, adapted each is In parents regions. autochthonous pilot for six intervention of help the with out carried is project The tobacco. on expertise in bringing organization partner the is VIGeZ skills concerning tobacco, alcohol and drugs. VAD coordinates this project while parents of ethnic minorities. The main goal of this project is to improve parental In December 2013, VAD started with a new prevention project oriented towards In thethree regions together13preventive actionswere carriedout. were carried out after a Rapid Assessment and Response (RAR) was undertaken. regions3 these of each backgroundIn preventionGhent. of city the in activities the in chosen Moroccan a with youngsters and were Antwerp of city the background and Limburg of province Turkish ethnic a towards with actions Youngsters preventive youth. future minority up set to methodology a develop in Luxembourg 2 operations were made in Charleroi, 1 in Liège, 1 in Brussels, 1 in Namur and 1 year,last the During street:the organised on been operations have snowball six prisons. in projectsreduction harm for need the of awareprofessionals make to intends population”). Specifically for the snowball operations within prisons, this project to inform people who are not reached by general prevention initiatives (“hidden might allows method This users. drug who other know and use drug with people experience have through messages reduction harm spread to is goal main The prison. in and street the on conducted areoperations snowball population, common among homeless people and prisoners in comparison with the general more is use drug As living. are they where environment the through behaviour risk from them prevent and users drug reach to objective the has project This Vivendi Modus coordinates thesesnowballoperations. association non-profit The use. drug to linked risks other and to programme prevention specific peer A a spread prevention and harm reduction related activities. information about AIDS, is hepatitis reduction operations”, to “snowball harm called citizens and strategy, stimulate prevention to in pains actively great participate take Federation Wallonia-Brussels The 3.1.3. ‘drug project pilot a coordinated intheFlemish minorities’ VAD ethnic for 2013, prevention mainly implemented January are Until groups Community. ethnic for actions Specific 3.1.2. Drug prevention forpeoplewithunstablelivingsituation Selective prevention forethnicminorities (Modus Vivendi, 2014) . One out of the six operations was specifically Lues 2013) (Laudens, Te eea ojcie a to was objective general The . 55 3. prevention 56 3. prevention these services and developingtheirgoals. on addiction to clients. The case manager assists families in identifying their needs, obtaining drug management case provides of project The community. effects the and harmful families children, the decrease to services comprehensive offers coordinated project The parents. dependent (ex)drug of children of “Bubbels & Babbels” is a prevention project in Antwerp focusing on the problems 3.2.1. and parents). extra children (both families them dependent drug giving (ex) to harm (extra) families prevent to support at-risk to attention also pay initiatives Prevention 3.2. h ojcie o oriae o-pcaie peeto, eia ad social of thereasons isthatthisgroup are oftenconfronted withmultipleproblems. and medical One services. these prevention, of out locked often is group desolated this as non-specialised interventions coordinate to objective the has unit health This use. mobile substance of a problems with people create homeless follow to to unit aims Brussels, in “Synersanté” project the Finally, with contact have psychological, medicalandsocialprofessionals. they that show results the are vulnerable, and conditions socio-economically precarious in lives mostly group this Although was contacted. months) 6 last the (during sniffing and the injecting by public substances that uses consumer who a confirms particular, In questionnaires group. target the the reach of operations snowball analysis quantitative The 2013. in operations snowball street during collected were questionnaires 428 total, In peers (so-called‘jobistes’). by administered is risk survey products, This diseases. psychotropic infectious of of screening consumption and behaviour the as such themes of variety a approaches and choice) multiple (mostly questions questionnaire fifty about anonymous of The the composed is information. at and is contact of which tool conducted; a time is same questionnaire a operation snowball a During in prison the in one Luxembourg (menprison). other the and prison) (women Brussels in Berkendael of prison the in One prison. in done were operations snowball two also 2013, In the measure to sites. fromexchange arefar needle who living users drug injecting of behaviour intended Sambreville in the operation of The name site. the exchange enhance needle to aimed Arlon in operation The Sambreville. and Arlon in organised were operations snowball exploratory two Additionally, P). Espace partner: local a of cooperation the with Liège, (in women for organised A t-risk familie s Selective prevention fordrugusingparents andtheirchildren n rasrn faeok o te uue rg sn mte. ae and Care mother. using drug future the for framework reassuring and coherent a offers team and multidisciplinary parentsA parenthood. addicted the of future members other drugs, using specifically are Brussels, who in women pregnant Saint-Pierre Welfare,targets public of Centre the Public the of of hospital project (“Parentalité-Addiction”) “Parenthood-Addiction” The reintegration with thesocialnetwork. the improve to order in well as offered is support psychological parents to take care of the well-being of their child(ren). Social, educational and using (ex-)drug allowing at developed aims project Charleroi This project. of parenthood-addictions a health mental the of department addiction drug The parental guidanceandhavebothaninformativetherapeutic aim. provide to intend sessions coaching These month. a once meets which group point of relatives’, NADJA is offering parental coaching as well, through an open ‘welcome this Besides request. a for motivation a as parents by mentioned are 12%) violence and 12%, behaviour threats verbal harassment, 12%, criminal dealing 18%, (fights small and (58%) withdrawal isolation, (60%), with parents relation the the of degradation (68%), unhooking and absenteeism as such Symptoms behaviours. risk a alarming present with combined often consumption children problematic their because relatives’ of Liège)closely point ‘welcome of so-called the province in the of use made relatives These 2013. in people young of relatives 34 followed (based NADJA association non-profit The a during or new stageoftheirparenthood. pregnancy new a during service the to voluntarily return the persons of 30% years. 44 and 26 between previousare patients the the of to majority regard The years. with noticed was patients followed of number the in followed by the service (66% women, 24% men and 10% children). An increase were patients 126 parents’ 2013, In follow-up. psychological the a children give to strengthen and role to is project this of objective The public. young care a therapeutic for innovative an hand other the on and parents using drug for (based in Liège province) presents on the one hand a global and integrated care a ALFA association non-profit establish the of Service “Parenthood” The to harm. prevent to given is attention federation, childrenorderparentstheir in using and relationshipdrug harmonious between Wallonia-Brussels the in Also as wellprofessionals workinginlowthreshold youthwelfare organizations. for abusing Youthand ‘ChildrenTelefoon’)Jongeren the en (‘Kinderen telephone’ trained,were 2013 and substance DrugLijn’ ‘The of for in working children collaborators project, with this trainings During contact parents. in coordinated are VAD often who Community, professionals Flemish the Within drug- of skills parental using parents. the developing in support provide KIDO-projects the Community Flemish the in users drug for services threshold low of number a In 57 3. prevention 58 3. prevention and 10eventpromoters wasestablishedintheFlemishCommunity. owners club 15 with cooperation a year the of end the By festivals. and venues clubs. From new nine 2013 on,theQualityNightscharterwasimplementedinan increasing amount of with starting in Antwerp launched officially was Charter and habits of the Flemish party scene in 2012. In October 2012, the Quality Nights specificities the to adapted was Flanders) in ‘charter’ (called label this the expansion, Following operators. local seven with association in works label the where graduallyWalloonwas the it to 2009 dispersed Region, Since Brussels. in 2007 in the owners and their staff in the party environment. The project was implemented organizers,evening the recreationalcollaboratingrelatedwith to by etc.) settings return at home, conflict/violence, noise pollutions, sexually transmitted infections, addictions, (health, risks the reducing at aims Nights” “Quality Label Belgian The 3.3.1. between different countries. of even or exchange Belgium in Communities and and Regions collaboration different the some between expertise quite show setting recreational the in As opposed to other settings described in this chapter, the activities and projects 3.3. label. Night Quality the receives event or club the met, the are below When described life. services night safe facilitate to to order supported in are available promoters services several event make or owners Club use. drug to related risks the of aware people young make to order in settings recreational in activities prevention and information the boost to others, among intends, Nights Quality daily grind the escape to youngsters and children to opportunity the gives Additionally,it of holiday is to improve the parental skills and to create a pleasant family event. family holiday which is based on pedagogic principles. The objective of this type days) (four short a offers programme second The place. took programme child parent- the of sessions three 2013, In children. their nursing in parents the of confidence the increase to order in months three during parents supports and old years 3 to up children young with parents towards oriented is programme that offers two programmes to drug using parents with young children. The first ASL consult can Community speaking German the in living parents using Drug and accompaniedatotalof17births. people 187 represent which families the 71 2013, followed In family. team the Parenthood-addiction of composition new parents the to to opportunity used get an to gives children It and other. each meet to families allow to has Alizes” “the environment separate family.A the to given is follow-up postnatal Recreational settings Quality Nights (ASL, 2014) . 2013) Flemish government andgranted foroneyear(untiltheendof 2014). the with applied was However,funding Spiritek. new and Vitalsounds between cooperation interregional the of shutdown a to lead which ceased services city a the create of funding the to 2013, of end 3.3.1) the By Flanders. in (see nightlife safer and Nights healthy Quality with closely cooperate and as Facebook such media social via active also health are project on Both settings. people nightlife party in risks inform to website new a developed Vitalsounds and West Flanders and half of the province of East Flanders. In 2011, both Breakline of province the to area working its expanded Vitalsounds (Lille, project, this to Spiritek Due commission. and European the by Vitalsounds funded project, interregional 2010, an started In France) peers. motivated of and crew stronger, a experienced develop became to projects managed they both and equipped years better experienced, the more During Vitalsounds. by later and method new to promisingwork on a risk minimization as in 2000 the nightlife mid in the Flanders, firstin byFlanders Breakline in introduced was support Peer 3.3.2. etc. site, internet the via label the of policy do not have to look for them, improving the explanation on the harm reduction and the label services, improvingthe accessibility of of these visibility services the so that increasing the as beneficiaries such future, the in to label this recommendations strengthen in results of it Additionally, theusefulness public. festive the underlines for label evaluation the The places. certified were 14 questionnaires in 601 2013. collected November in Eurotox realized and was NGO evaluation CBPS an the public, by festive the by services) its (or label Nights Quality the of use the and perception the knowledge, the estimate to order In optional criteria,andthedatesresults ofcontrols. and compulsory the of implementation the places, certified and contacted the as such information, important all access to settings collaborative the allows It region.Walloon in operators local the with association in up set and developed was evaluation of plan global a Nights, Quality of coherence the Toguarantee At present, thefollowingsixcompulsoryservicesare identified: 6. 5. 4. 3. 2. 1. . consumption ofalcohol,etc. the risks connected to the consumption of certain drugs, to the on excessive information including health, about information of distribution The pollutions andQualityNights), noise conflicts, of management aids, first (addictions, training staff The the with collaboration BEWSD), in – warnings (early alerts of distribution The The availabilityofearplugsatreasonable prices, The availabilityofcondomsatreasonable prices, The availabilityoffree water, Peer supportinrecreational settings (Centre bruxellois de promotion de la santé, la de promotion de bruxellois (Centre 59 3. prevention 60 3. prevention this territory). on developed are interventions few (a province Brabant Walloon the in project Liège) the of in development the to paid interventions was attention Particular 2013. in the realized were (excluding interventions 118 total, of In 4 and report). 2 this chapter in described are project this participating respondents use of substance about results (specific hall concert or bar discotheque, festival, the at desk a via public general the to spread is etc.) compulsive, problematic, regular,entertaining, (occasional, habits consumption different and illegal) and (legal products Wallonia- of the types the all from about in Information coming 2001. implemented since professionalsFederation is Brussels as It sector. well social as and peers medical by psychological, festive up at set project is information reduction which harm places a is risks” less taking “Drugs, the people(83%)fatigueisreason tocometherelax zone. of majority the for 2012: in for those to proportion reasonsin similar rather are The admission years. women’s previous The to men. identical almost are 27%, zones reached relax proportion in welcomed public the of majority The relatively young public, who are often a less used at managing their for consumption. problems of presence the confirm results These 2009. in old 21year and years, the average age was 23.5 year is old in 2012, 22 year old in 2011 and 2010 zones relax the in care taken previousresultsof the By comparing years). 50 Max. - years 15 (min. years 21.5 goers party the peer of a age through average or The (8.1%) (4.2%). friend a through arrived minority small a only and the (32.7%) Cross Red by to sent was people the went of third A themselves. people by zone relax the of 47.9% (28.1%). cannabis and (39.5%) ecstasy by followed (60.5%), declared frequently most product the was Alcohol more). or products two even third a than more (and substance psychotropic one least at the of 80% than More consumed have to declared 2013, in experiences. (N=235) zone relax a in welcomed people consumption bad of case in people to advice gave and zones relax the in working was team mobile a festivals, these five at 2013 TribeCafé,in Couleur Dour,During festivals: Gathering, Doudou. and ’Espéranzah place took Team Mobile the of activities The job). festival the of specificities the on training beforehand second a trainings and jobiste become two This to training receive first peers. (a and and themselves users professionals often both are of group last constituted socio-sanitary is the team with mobile contact A little sector. has population This alcohol. including The Mobile Team gets in touch with young people using psychotropic products, less risks”(“Drogues Risquermoins”). are Federation Wallonia-Brusselstaking Team”“Drugs, “Mobile and namely projects, of types two by the performed in settings recreational in support Peer nurses qualifiedinthetreatment andcare ofmainlyopiateusers. and patients. doctors make to using aims addiction” drug “Connection-drug called project of Another front in exhausted and/or deprived often indeed feel teams These teams. medical the informing and of raising awareness the allows This emergencies. psychiatric the of service the in involved closely is association the of psychologist A addiction”. “Emergencies-drug called project a has NGO Interstice the Brussels, in hospital public Pierre Saint of framework the Within to ED.Furthermore, aguidewasmadeonhowEDcanimplementSBIRT. patient a of provision were pre-test literature disclosed stage the The of leaflet. the results and review the and feedback brief a to changed was intervention After evaluating the former SBIRT intervention on acceptability and usability, the problems. health Treatment’of risk at to them put may Referraluse alcohol whose clients and for (SBIRT) Intervention Brief ‘Screening, the deliver (new) to with tools provided were (ED) departments emergency of staff Additionally, workers thatwanttouseit. social and practitioners This general all users). for charge of from free is parents instrument web-based or partners (children, relatives for information and reports on scientific guidelines, guides leaflets, patient referraldrugs, other and FRAMES, tobacco alcohol, on based intervention brief a with help ASSIST), with a web-based instrument that exists of a screening tool (modified electronic developed in the Flemish Community. This toolbox provides general practitioners was ‘me-assist’ toolbox online the intervention early and screeningTo facilitate detected inprimaryhealthcare andwelfare services. population care is more likely to show symptoms of harmful substance use than the general to treatment when necessary. The population that makes use of primary (health) intervene with clients whose substance use is hazardous or harmful and to refer and identify to position unique a arewelfarein careservices and health Primary Screeningandbriefintervention 4.1. 4. stage. early an at misuse substance of,hazardous detection with and intervention and prevention indicated in interest increasing an there’s Community Flemish the In 4.2. Indicated prevention Early intervention (WHO, 2010) (WHO, . However, hazardous and problematic use is often not often is use problematic and hazardous However, . 61 3. prevention 62 3. prevention to target personality specific risks of youngsters with early onset alcohol or onsetalcohol early with cannabis use. of youngsters risks specific personality objective target the to has intervention This care. juvenile for intervention session two a develop to feasibility the showed practices best on research short a 2013, In tool willalsobeusedindrugprevention. the phase next a In initiated. was implementation the and tested was tool The brain. in the in processes unconscious greatly automatic, as well as considerations behaviour how and visualize will experiences This behaviour (drug use) results from a competition between rational clients. and conscious analyse young their to with together able situations different are intervention early and treatment drug in professionals tool, this With developed. was ‘Mighties’ psycho-education tool interactive an also instrument, screening the to addition In successfully and developed was programme training implemented. A interventions use. early providing substance in for important also are workers prevention drug evcs Baig hs n id te ep ie Te rgin (e as 2.3.1) website self- their also on online programmes and help (See assessment-tests online DrugLijn’ of number ‘The a line with section help a online contains the and mind, in media this social Bearing through services. reached easily are youngsters Nowadays, Self-c 4.3. speed, cocaine and GHB. In 2013, the website counted 78,993 visitors (of which ecstasy, cannabis, for specifically programme treatment online an run Kempen) The centres for alcohol and drug problems (CAD) and Drug aid Kempen (Drughulp visitors (+56%compared to2012)resulting inatotalof1,567,534 pageviews. 476,101 had website the total, In website. helpline’s the at users cocaine and persons (+12% 365 Finally, cannabis programmesfor self-help online the registeredfor 2012) the website. to compared on 13,984 and out test filled were self-assessment knowledge tests 42,827 knowledge six 2013, addition, In online. In available minors. are for tests gaming) alcohol, cannabis, (on test similar three and adults for internet) and gaming benzodiazepines, gambling, ecstasy,alcohol, cocaine, amphetamines, cannabis, (on tests assessment online of youngsters of young with contact people to assess the risk level of in drug use and the need for referral to treatment organizations allows SEM-J instrument screening The (of concerns parents, school)orlegalactions(police)oftheenvironment. to answer an as started is motivation of process a intervention’, help because they don’t determine their substance use as a problem. With ‘early of kind any receive to motivated not often are They problems. drug develop to Youngsters are more sensitive to the risks of substance use and more vulnerable are andself-help (Baeten et al., 2009) al., et (Baeten . Next to schools and juvenile care communities, care juvenile and schools to Next . (De druglijn, 2014) druglijn, (De . This section contains nine contains section This . h msae n prpea wy te rmn o te esg i particular in message the of framing the becomes more important. way, peripheral a in message the process to expected is audience target the when hand, other the On content. message the to go to is moreattention profoundway a in message processthe effect depends on the processing level. When the target audience is expected to of a health issue, is not always sufficient to obtain an effect an obtain to sufficient always not is issue, health a of disadvantages and advantages perceived the both recent recognize two-sided which A of messages, use task. the easy that concluded an university Ghent not the at is dissertation campaign PhD media mass a of development The intensive prevention initiativeshavetobeencouraged. Consequently,more actions. preventive other with parallel in conducted be have to they effective, campaigns media mass make to order In attitude. critical a of development the encourage and attention attract can campaigns Though, et al.,2013) of reducing (the intention to) the use of illicit drugs amongst young people young amongst drugs illicit of use the to) intention reducing(the of media mass of will review campaigns recent campaign of illicit drug A media use behaviour.could not affirmatively mass changed conclude on the in effectiveness a result thing, necessarily complex not very a is behaviour human As 5. to order treatment in (ASL, in 2014) steps groups further take to self-help support getting organises and experiences exchange Community speaking German The The websiteguarantees anonymityandconsistsof3parts: and provides thenecessarytoolstoreachgoals thosegoals. own their family set to their people allows as programme online well The as friends. and use both alcohol for problematic designed developing are are websites who French persons the and Flemish The country. the of parts both in implemented was problems alcohol-related for website specific A visitors) whichresulted in44registrations fortreatment. unique were 24,844 which (of visitors for 34,936 counted website registered This treatment. that persons 126 in resulted This visitors). unique were 49,058 • • • On-line supportwithatherapist. Support forself-help, Information (forusersandrelatives), National andlocal mediacampaigns . . (Cornelis, 2013) (Cornelis, . The . (Ferri 63 3. prevention 64 3. prevention tces -6 er n achl -8 er n lqo” a otr n a ad of card a and poster a liquor”, instruction. no years -18 alcohol; no years “-16 stickers mail, explanatory an containing municipalities, the of prevention state of the employee to sent was package postal A Brussels. in re-launched was alcohol” no “-16, campaign information the 2013, During 2013. in days 142 of total a shops. retail in 10 distributed were liquor” with no -18 stickers alcohol, 65,000 no “-16 2013, message In the law. new the enforce to how personnel retail to inform retail, youngsters and parents concerning the new law and to instruct Additionally,“-16the -18alcohol, no initiative national a is campaign liquor” no of responsibility the to attention young peoplefortheirownalcoholuse. pays and use raise alcohol of to risks objective the reduce the to has evening” advice includes the brochure This alcohol. of of consumption success the towards awareness a make to how not, or alcohol effectomètre: “The brochure The old). years 25 to (15 group age same the for implemented was campaign alcohol an region Walloon-Brussels the In already usecannabis. was appreciation who youngsters among than cannabis of The non-users among higher considerable groups. target the among penetration high a revealed workers and local health promotion. An independent evaluation of the campaign and to present all these materials, VAD organised a kick-off event for prevention by was distributed for free. In order to promote the campaign among professionals supported heavily a was campaign the large numberofexistingdidacticmaterialsfortargeting youngstersandparents During and drugs-field. and 2014 alcohol the April in working until professionals ran campaign public The TV- and radio- advertised internet, was posters, commercials. tool, banners, referral online ads, a print and Facebook, quiz using a around The built channels. website, communication of campaign variety a using spread was (‘Laat vangen’) yourself” niet fool je “don’t message campaign The cannabis. of non-use the encourage reinforceand to was aim main The years. 25 till 14 and aged youngsters parents were groups Target campaign. cannabis large and a Health launched Public Family Welfare, for Minister Flemish the 2013, 5th November On organising regularly is Security and Defence Service awareness campaignsforillegaldruguseamongsoldiers. Public Federal the of to related ‘Addictions’ cell campaigns The hospitals. in use alcohol and patients C Hepatitis sedatives, awareness in involved is Environment and safety chain Food Health, Service Public Federal the of drugs’ policy health ‘General cell The mobile booths delivering the campaign message on events were used for used were events on message campaign the delivering booths mobile uig 03 ee nedd o as aaees f h gvrmn o the on government the of awareness raise importance ofkeepingtheconcept“Healthpromotion”. to intended were 2013 during realized activities the of part important An 2014. for stakes important most the of one is COCOF the and Region Walloon the to Wallonia-Brussels) Federation the of in projects addictions the of transferpart big a includes (which sector The Promotion Health 1). chapter also (see 2014 1st July from effect in is which reform state sixth the especially and 2014 May of elections the and to linked were VAD by memorandum of (compilation Flanders) in book Green the of compilation and Wallonia) and (Brussels Fedito’s activities of number a 2013, In prevention game addiction) isbecomingincreasingly popularasatopicinprevention. in video items addiction, internet common (e.g. most addiction ICT-related the although far activities, by are drugs illegal and Alcohol projects orprocesses, thisisahighpercentage. prevention not and activities prevention single monitoring registrationis Ginger in One teachers. or Takingevaluation. of aresubject the preventionactivities that four account into experts health workers, prevention professional as such health mental centres. Tworegional third of the prevention the activities aim at intermediary target groups, in place take activities prevention the of half than sector,health more the In activities. the of three-quarters in participate schools actors in the health and educational sector. In the educational sector, secondary different prevention settings and activities. Prevention is mainly oriented towards the of importance relative the on light registrationsheds Ginger the Flanders In 6. e ol lk t tak r atn, r ec Ms e rbne ad Mrs and Brabander essential involvement isgratefully acknowledged. De Mrs Pelc, Mr Martens, Scheliga for their contribution to the data collection and valuable feedback. The Mr thank to like would We Acknowledgements C onclusions 65 3. prevention 66 rgam i te lms Cmuiy Idctos f ih ik rg s, of use, drug risk drug risk high EMCDDA of the definition follow case strictly not do high some which of Indications Community. Flemish exchange the needle the in programme by survey yearly a through investigated are injecting population the of Characteristics separately. reported are they comparable, not the the by supported of are competences framework competent administrations this areand our regional focal points. in As results are reductions therefore Activities Belgium. harm in and Communities prevention on policies The users), thepresented prevalence isrelated toever-injecting druguse. drug injecting among rate HIV-prevalence the of estimates with register AIDS fromdata HIV/ (combining national method the multiplier HIV the of use the by estimated currently is Belgium in (IDU) use drug injecting of prevalence the As of frequent ordailysubstanceusepleaserefer tochapter2. the to due overdose of synergistic effects of the different risk types of drugs combined. For the description the increasing is particular in use Polydrug use. drug risk high use of indication drug an as considered injecting be can and administration) of (patterns) (route use polydrug risk use, substance high daily prevalence by of consequence, data As and/or months. 12 patterns last the risk asthe in administration high of routes be measured by can substances psychoactive EMCDDA) of by use (defined use drug risk high Hence, (Thanki andVincente,2013) person or is placing the person at a high probability/risk the of suffering such to harms’ harm actual causing is that use drug ‘recurrent being definition current In this chapter, aspects of high risk drug use are presented following EMCDDA’s 1. K. Ridder De HIGH RISKDRUGUSERS CHAPTER 4. • • of firstinjection. use drug injecting before the age to of 21 and 14% was initiated even younger than 15 years was of age at the time users drug injecting the of half than More remained stable between2002-2012(3.4per1000inhabitants). has Belgium in use drug ever-injecting estimated of prevalence The Introduction . 67 4. High risk drug users 68 4. High risk drug users to Bollaertsetal. corrections. For a thorough overview on the methodology, the reader is referred statistical the from resulting uncertainty the reflecting properly obtained were applied to account for the non-AIDS mortality. Monte Carlo confidence intervals was modelling mortality stochastic whereas information factor risk missing the s h svn Rs r te ny aoaois usdzd o promn HIV performing for subsidized laboratories only the confirmation tests. are ARLs exhaustive seven be to the deemed as is register The Scientific (WIV-ISP). the Health by Public hosted of is Institute and 1985-86 since exists which register national HIV/AIDS the in included and recording duplicate for validated are ARLs seven the of results registration The Belgium. in (ARLs) Laboratories Reference seven AIDS the of one to confirmation for submitted are positive, were results test screening the which for serums All (NIHDI)). Insurance Disability and Health for Institute (National 2000-2010 period the during year per inhabitants 1,000 per tests screening 56 of average an with used widely is HIV-screening Belgium, In sources Data (IDUs) users drug injecting among study the sero-behavioural froma from data and register using HIV/AIDS national Belgium in years) 18-64 (aged users drug of ever-injecting prevalence the estimate to applied was method method benchmark-multiplier The HIV-multiplier strategy: Research 2.1.1. 2.1. 2. siae o te ie f h ijcig rg sn pplto. n particular, In population. using drug injecting equations chained the by imputation biased of size seriously the avoiding of allow estimates which required, were corrections statistical non- limitations, these Toovercome the benchmark. a as of use its follow-up hampering cases, AIDS lacks and information factor risk missing from suffers Modus Vivendi). of Moins’ Risquer (‘Drogues less’ risk ‘Drugs survey the through obtained were Community French the within settings recreational visiting persons among use, • National HIV/AIDSregister high riskdrugusers Prevalence ofandtrendsin Es timation ofhighriskdrugueprevalence National prevalence estimationofinjectingdruguse (Bollaerts etal.,2013) (Plasschaert et al., 2005) al., et (Plasschaert (van Buuren et al., 1999) al., et Buuren (van . . However, the national HIV/AIDS register HIV/AIDS national However,the . was used to correct for correct to used was Belgium based on the results from routine diagnostic testing diagnostic routine from results the on based Belgium in years 10 past the during observed were IDUs among rates prevalence HIV in in 2004-2005isassumedtoapplytheentire period2002-2012. conducted study sero-behavioural the from rate prevalence HIV the Therefore, for 2013 was 3.5/1,000 inhabitants (95% CI: [2.5;4.8]) and the estimated total estimated the and [2.5;4.8]) CI: (95% inhabitants 3.5/1,000 was 2013 for prevalence estimated The [17,352;33,959]). CI: (95% 25,132 be to Belgium in ever-IDUs of number total the and [2.4;4.7]) CI: (95% 3.5 be to estimated was years) 15-64 aged inhabitants, 1000 (per ever-IDU of prevalence the 2012, In the register, HIV/AIDS editions oftheBelgianAnnual ReportonDrugs(Table national 4.1). the previous the from in estimates the from file different slightly are 2012 the before estimates of update an of Because Results imprisoned were (Plasschaert et who al., 2005) users or facilities treatment drug with contact in users drug among 2004-05 in out carried was study sero-behavioural a Belgium, In The non-AIDS casesare nosubjectforfurtherfollow-up. death. possible and consultation last on collected for is year,data in subjects each follow-up; are resulting WIV-ISP, AIDS developed the which Cases to information. factor returned risk completed missing fully always not are forms standardizedUnfortunately, transmission.the mother-to-child and IDU through transfusion, blood through transmission transmission, heterosexual and homo- are transmission HIV of mode probable sexual for categories response The diagnosis. residence, nationality, HIV of time on at count CD4 and transmission HIV information of mode probable orientation, additional collect to clinician For each confirmed HIV-positive test, a standardized form is sent to the patient’s eadn te gorpia) ersnaiees f h dt. iia t other trends European to (Western) remain Similar observed data. concerns the However, of trends. representativeness (geographical) time the of regarding investigation the for allows this available, yearly are results these As testing. diagnostic routine from obtained be can IDUs among rate prevalence HIV the studies, serological to addition In yielding anoverall estimatedprevalence of3.1%(95%CI:[1.8;4.8]). (p-value=0.30), different significantly not were prevalence’s respectively.These in and treatment prison was estimated to be 2.8% (95%CI: [1.8;4.6]) and 5% (95%CI:[2.0;12.2]), in IDUs among HIV-seroprevalence The participants. the of taken to determine the HIV- as well as the Hepatitis wereB (HBV) and -C (HCV) status samples blood Intravenous life. their during once least at drugs injected (n=80) of the drug users in treatment and in prison respectively, declared to have 68% and (n=573) 57% Belgium. over geographicallydispersed differentprisons drug users (15-40 years) enrolled at 65 different drug treatment facilities and 15 • Sero-behavioral prevalence study . In total, 1,005 drug users in treatment and 117 incarcerated (EMCDDA, 2010) (EMCDDA, , no significant time trends time significant no , (Deprez et al., 2012) al., et (Deprez . 69 4. High risk drug users 70 4. High risk drug users (Melis, 2013) (Melis, Flemish among use polydrug education assessed secondary in students Survey School VAD 2011-2012 The 2.1.2. T students in higher education was assessed in the third wave of “Head in the survey in “Head of clouds?” wave third the in assessed was education higher in students Flemish among substances psychoactive other and cannabis of use Problematic drug. of the diagnostic and statistical manual on mental health (DSM-IV) health mental on manual statistical and dependency diagnostic the of cannabis for criteria on based were which questions six through ever used cannabis, 20.6% had also used another illicit psychoactive substance psychoactive illicit another used also had 20.6% had cannabis, used ever who students school Flemish the Of (EMCDDA). tasks surveillance our of part not and drugs illicit as defined not are they as alcohol or concomitant tobacco with use on focus a put not does report this that note use, drug multiple 2003) in chapter5. described is IDU to related information Complementary recorded. were trends number of ever-IDUs was 25,673 (95% CI: [18,135;34,987]). No significant time able 4.1| 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 Y Source: nationalHIV/AIDS register, WIV-ISP CI: ConfidenceInterval ear • • . Thequestionswere related to feeling theneed toreduce orstop cannabisuse, the useofcannabislongerthan planned, High risksubstanceuseamongstudents . 45.1% of the regular cannabis users had ever used another illicit another used ever had users cannabis regular the of 45.1% . years) between2002and2012 Estimated numberandprevalence ofever-injecting druguse(15-64 Rses t l, 2014) al., et (Rosiers 25,673 25,132 25,160 24,869 24,743 24,525 24,044 23,237 23,189 23,175 21,866 21,200 Ever- IDUsalive N (Melis, 2013) (Melis, Polmtc anbs s ws examined was use cannabis Problematic . [18,135; 34,987] [17,352;33,959] [17,577;34,528] [17,398;34,251] [16,975;34,026] [17,453;34,409] [17,146;33,603] [16,453;31,904] [16,067;32,886] [16,352;32,345] [15,539;30,101] [15,165;29,933] 95% CI . Although an interesting aspect of aspect interesting an Although . Prevalence ever-IDU n/1,000 3.5 3.5 3.5 3.5 3.5 3.5 3.4 3.4 3.4 3.4 3.2 3.1 (Decorte et al., et (Decorte [2.5; 4.8] [2.4;4.7] [2.4;4.8] [2.4;4.8] [2.4;4.8] [2.5;4.9] [2.5;4.8] [2.4;4.6] [2.3;4.8] [2.4;4.7] [2.3;4.4] [2.2;4.4] 95% CI visitors, 1.0% (n=14) reported IDU during the event (see Table 4.2). 1.5% and 1.5% 4.2). Table (see event the during IDU 1,418 reported (n=14) the 1.0% Of visitors, years. 24.9 was IDU reporting those of age IDU mean The lifetime settings. reported (n=61) 4.3% visitors, questioned all settings”. recreationalOf in use drug “usual terminology have the other) into and changed settings been recreational (in use drug lifetime and month last to related questions survey the 2013, In scene. party whole the for representative harm reductionthe activities whether apply well verifying to the at targeted audience aims and is survey therefore The not 2). Chapter also see Vivendi, Modus ”, less risk (“Drug scene party the within survey annual the on based obtained be can use polydrug and IDU regarding indications Community, French the In 2.1.3. DAST-10instrument screening the with assessed was cocaine and ecstasy amphetamines, of use Problematic use compared to70.2%ofthemalestudents. use. of age cannabis problematic of expressions starting no reported students female the of younger 90.6% a and use frequent more with correlated is use problematic for risk higher A use. cannabis problematic of expressions six of the one experienced never had users months 12 last were the of Three-quarter use. months cannabis stop or reduce to 12 need the feel or did last 10.0% more and planned cannabis than longer use the did 15.8% use yes/no-questions. the cannabis answer to requested reported with respondents Only substances thanfemalestudents. asthe use.Similar resultsreportedstudents male use, cannabis on more problems substance related these to their stop to difficulty the underestimate substance users these perhaps or dependency, and use drug problematic between difference a confirm could it either things: that two suggest postulates could report observation this The wanted. if substances these using stop to able to expect be they that reported group user this of respondents ten in nine time, same the use. At substance of because flashbacks or blackouts having and use, substance about guilty or bad feeling substances, the obtain to activity illegal in involvement use, polydrug reasons, non-medical for substances using reported: risk increased strongly and (11.6%) for problematic substance use. Certain symptoms were (34.1%) more frequently risk increased reported respondents the of half than Less required. is results the of interpretation limited cautious DAST-10so was (N=138), for respondents of number the survey, the In different use. drug three into down users breaks and problematicof stronglyincreasedrisk and increasedrisk risk, limited categories: year past the use consequences substance negative of experienced possible to related yes/no-questions ten • • • somatic problems causedorworsenedbycannabisuse. or psychological problems, relational despite cannabis of use sustained the reduction or suspension of social activities because of cannabis use, not beingabletokeepupworkorstudyobligations, High riskdrugusewithinthepartyscene (McCabe et al., 2006) al., et (McCabe . The questionnaire is based on based is questionnaire The . n recreational in 71 4. High risk drug users 72 4. High risk drug users T etns n h Fec Cmuiy o te eid 0621 (e Tbe 4.2) Table (see 2006-2013 period suggest astabletrend inthearea ofinjectingdruguse. the for Community French the nightlife in within settings events during IDU of prevalence observed the and 4.1) Table (see 2002-2013 period the for Belgium ever-IDUprevalencein of estimated The 2.2. reported much more in 2013 than in previous years. However, it is uncertain is whether thisisatrueincrease orrather aselectionbias. it However, years. previous in than 2013 in more much reported injecting ‘often’ and was use Polydrug nightlife. outside ‘sometimes’ IDU reported 1.6% while nightlife, in respectively drugs reported visitors the of 1.0% able 4.2| Drug usepattern Source: Drogues RisquerMoins,ModusVivendi * Injecting (N) Lifetime (%) Last month(%) During event(%) P 2 products (%) ≥3 products (%) olydrug use*(N) not part of problematic drug use definition by EMCDDA, alcohol is taken into account when used when account into together withanillegalsubstance taken is alcohol EMCDDA, by definition use drug problematic of part not Observed trends nightlife settingsintheFrench Communitybetween2006and2013 Prevalence (%)ofinjectingdruguseandpolydrugwithin 2,402 2,402 2006 18.6 13.2 2.7 1.7 - 2,618 2,618 2007 16.9 11.5 3.2 1.3 0.6 3,917 3,917 2008 23.0 12.9 3.2 1.1 0.7 2,969 2,969 2009 18.7 10.1 3.5 1.5 1.1 2,111 2,111 2010 17.3 12.7 4.6 2.1 1.2 2,778 2,778 2011 17.0 4.4 1.7 0.9 9.3 3,155 3,155 2012 13.2 3.8 1.8 0.9 7.2 1,418 1,653 2013 22.2 19.7 1.0 - - Injecting Risk Questionnaire (IRQ) Questionnaire Risk Injecting IDUs contacting one of the NEP is asked to fill out a questionnaire, based on the questionnaire since 2001 since questionnaire anonymous voluntary, structured, a through collected are Community Flemish Data on IDUs frequenting the needles exchange programmes (NEP) located in the 3.1. 3. in 2012)reported nevertohave been intreatment. the 15.7% to (compared Of 18.7% but treatment, programmes. in currently reduction is 76.6% respondents, harm and years risk several with for contact injecting in (unsafely) getting already before is IDUs the indicating of higher, much majority was the NEP first that the the frequenting injecting IDUs the when of years age The 15 time. than of younger 14.3% with even IDU, being into participants initiation at the age young the was researchers the of concern main the years, previous as Similar injection. first during else someone by injected be to reported The 65% year.years. 21.8 last is with IDU with comparison starting for in age mean 3.5% of increase an is which years, 21 of age the before IDU into initiated be to reported participants the of 54% to Up 11.7%, 2012:8.0%,2011:8.7%,2010:4.6%). (2013: increased again also has methadone injecting year, previous to similar and 2012). 26.9%), 2012: were37.5%, morecocktails (2013: frequently Drug injected in 40.1% and 58.0% (respectively 2012 to compared stable which remained (39.2%) amphetamines opiates and (58.9%) Injecting cocaine 67.9%). injecting by (2012: followed are year last to a compared choice, increase of drug substantial injected primary the were (80.8%) Opiates used). drugs of types use different 4 average polydrug on injected, drugs non-concurrent of types different reported 2.4 average (on participants the of majority vast The others). with living or (homeless environment unstable an in lived IDUs the of 50% About (79.6%). male were participants the of majority The years. 35.2 of age average an with years, 50 to <20 from ranged participants the of age The in not user drug injecting one least contact withthesyringeexchangeprogrammes. at know to indicated 2013 in study the to (N=264) participants the of IDUs these 64% substantial. with be all contact to believed in is for programmes not IDUs representative of number be the as Community, to Flemish considered the in not are and self-reported first are abscesses, site injection below described places, results The questionnaire. the to added injection were injected product used ever and recent as such questions additional 2013, and 2010 2009, In used. is questionnaire revised a items on health status, drug use and access to health care. From 2006 onwards, Characteristics ofhighriskdrugusers programmes intheFlemihCommunity Injec ting druguserinconta (Windelinckx, 2013; Windelinckx, 2014) Windelinckx, 2013; (Windelinckx, (Stimson et al., 1998) al., et (Stimson c t withneedlesex and additionally containing additionally and . Yearly, a sample of sample Yearly,a . change 73 4. High risk drug users 74 4. High risk drug users T month”) last the drugs used during “having as (defined user drug “current” a be to reported (89.1%) survey,persons 2013 279 the in street the on users drug contacted 313 the Of snowball harm reduction activitiesatlocallevel. of coverage geographic the of demand and Moreover,supply the on depending operationsfromyear vary to may year standardized. truly completion not the which is for tool, contact a as used mainly is questionnaire the not corrected for dependence on the social network of the jobistes. Additionally, fully representative not for IDUs on the street in the areFrench Community,results as the results are These peers. their among reduction harm on other information as well as prevention hepatitis and AIDS on information disseminate to paid are and training 15-hours a receive (‘jobistes’) IDUs volunteering end, this To subpopulations. hard-to-reach targeting and prevention peer is operations organised by Modus Vivendi since been 1993. The have primary objective which of these snowball Neige”), de Boule (“Opérations operations’ ‘snowball of use the by collected is Community French the in IDU among behaviour risk on Data Druguserrecruitedat thes 3.2. reported theinjectionofmethadone. three of 11.9% (n=80). 73.4% and (n=83) use 76.1% respectively cocaine, and heroin were drugs current injection popular most the the IDUs, current reported the Among (n=228) more. or products 81.7% and products two than more the of use current reported of (n=42) 15.1% 59.5% users, drug “current” or the Of IDU. users current drug reported 65.7% IDUs, all lifetime the Of of 4.3). (Table users drug 53% “current” was which IDU, lifetime reported able 4.3| Source: Opérations BouledeNeige,ModusVivendi,2013 Polydrug use Current IDUs Lifetime IDUs Consumption profile Community 3 products ormore 2 products recruited atthestreet intheFrench Community Lifetime injectingdruguseandpolydrugamongpeople Hge n Dniex 2014) Denoiseux, and (Hogge All drugusers(N=313) treet intheFrench 34.8 53.0 % . . I ttl 16 respondents 166 total, In . “Current” druguser(N=279) 81.7 15.1 39.1 59.5 % patterns thatwere more strongly associatedwithharms: development ofselectiveprevention measures further and the supports diseases certainly onset infectious of age young for This problems. risk health other associated the and habits injecting developing unsafely of risk the increases which years, several probably is exchange programmes needle frequenting and use drug injecting initiating between lapse 21 and even 15% was initiated under the age of 15 years. Additionally, the time to injecting drug use; more than half of the users were initiated under the age of most alarming observation is the young age at which current IDUs were initiated suggest that the prevalence of IDUs has been stable during the last decade. The recreationalin settings and level national Trendsa on both use drug injecting in performed was amphetamines and cocaine opioids, of users in harm to relation their and use of patterns the on study literature indicator,a key revised the in subcategories of definitions theoretical of development the the support to during effort an revised In years. been last has use’ drug risk ‘high indicator key the general, In Flemish orFrench Community)andare rather indicativethanconclusive. either in NEP and settings recreational populations, (school limited situational or geographically are results reported additional The users. months 12 last of instead reported be can Belgium in ever-IDUs of prevalence estimated an only The current available national data on high risk drug use is limited and therefore 4. usacs xrse (togy icesd ik o polmtc s (DAST-10). use problematic for risk increased (strongly) psychoactive other expressed of substances users (DSM- months’ 12 use ‘last the cannabis of half problematic than more while of IV), expressions reported 12 months’ cannabis ‘last of five users in one about education, higher in students the Among 3. 2. 1. not less harmful than the use of stimulants, a cut off on weekly (and more frequent) useofopioidsseemsreasonable. weekly on off cut a stimulants, of use the than harmful less not is use opioid that experience clinical on Based users. daily dependent, define a cut off for opioid use as most studies were only based on heavy,to clear less was It harm. of risks higher to related were (bingeing) use continuous of periods heavy of patterns and use, of frequency higher Frequency: for cocaine and amphetamines, it appeared that with higherlevelsofdependenceandoverdose risk. associated is and compulsivity of level particular a indicates it as harm, any of factor confounding significant extremely an was use Polydrug risk-free behaviours. be to considered be not could they routes, risky less were use oral and snorting Although inhaling. and smoking by followed administration, administration: of Route C onclusions Sauoa t l, 2014) al., et (Skafupova was the most risky route of route risky most the was use drug injecting Te ieaue td pitd u some out pointed study literature The . (EMCDDA, 2014) . weekly and 75 4. High risk drug users 76 4. High risk drug users valuable feedback. Theiressentialinvolvement isgratefully acknowledged. and collection data the to contribution their for De Windelinckx Mrs Mrs Laudens, and Donder Mr (Ph.D.), Hogge Mr Dom, Mr thank to want authors The Acknowledgements neto sol b floe crfly s s led te ae n oe other some buprenorphine havebecomethemostcommoninjectedopioids in case the already or fentanyl illegal is as such alternatives Finland) Estonia, (e.g. countries European as carefully followed be should injection methadone of prevalence in increase gradual the but injection, for used opioid common most the still is heroin Belgium, In methadone. of injection reported streetsthe Frenchon theoperations’)and in(‘snowball Community Flemish the of NEP the in IDUs ten in one about that is fact noticeable Another Community) (French settings recreational in requires follow-updataduringthenextyears. use polydrug of prevalence in increase sudden a of relevance of assessment The care. with handled be should use drug of pattern revealingthis contact judicial or care,pedagogic health any ratheris stimulants of use rare populations, student and school examined the in frequent of high of difficulty prevalence the the Although underestimates substances. illicit users of use drug the ending the of part a whether anddrug or abuse, dependency between difference the reflect findings these whether define longitudinal to needed is interviews and Furtherquestionnaires comprehensive with research problems. any without using stop to able be that would assume they them of most clear group, latter Although the in exceptional. use problematic rather of occur indications use drug illicit to related problems these cannabis, than other substances illicit of prevalence low the of Because (EMCDDA, 2014) . concludes thischapter. 3) (section treatment drug-related of field the in developments recent most the Finally,2). of review(section presenteda are treatment substitution a following (section modalities people Trendson aredescribed. and 1.4) treatmentdemands of number the on treatment different the on description a and 1.3) (section 2013 from data indicator demand treatment on based figures, Key presented. organizationsand drug-related1.1) on working treatmentare 1.2) (section field (section information regardingtreatmentscreened is policy drug on declaration common the First, Belgium. in treatment drug-related on situation recent most currently to a transitory situation (see chapter 1). This chapter comments on the leads country the of status institutional the in evolution This Belgium. in sector treatment drug the change radically will which initiatives, policy and political in reform,state sixth the areto Communities Due the morebecome to competent 1. J. Antoine DEMAND ANDTREATMENT AVAILABILITY DRUG-RELATED TREATMENT CHAPTER 5. • • patients whocontinuetousestreet heroin despitetreatment withmethadone. inBelgium withdiacetylmorphine recommends treatment to extent diacetylmorphine treatment as a second-line on assisted treatment for project pilot first A most patients 2013, In opiates. for commonly reported theuseofcannabis(33.5%)forenteringtreatment. decrease a and increase drug steep primary a as shows cannabis for demands treatment of number the 2011, Since Introduction : TREATMENT

77 5. Drug-related treatment: treatment demand and treatment availability 78 5. Drug-related treatment: treatment demand and treatment availability 2.2. in order tosynchronize drugpolicies. recommendations well-elaborated formulate to is purpose main Its participate. vice-coordinator a and coordinator drug national a Governments, Regional the of representatives 18 and Government Federal the of representatives 17 which In the light of this common declaration, a general drug policy cell was created in The maintreatment-related objectivesmentionedinthisdocumentare: a common declaration entitled “A global and integrated drug policy in Belgium”. Brussels-Capital Brussels-Capitalthe in authorities signed Common have the the Region) and Region in authorities French-speaking the Community, speaking German- Region, Brussels-Capital Community, French region, Flemish Walloon region, Government, (Federal Belgium in governments all of representatives the 2010, integrated approach. In and global policy requires a drug efficient An 2.1. 2. and intermsof welfare andrespect oftheautonomy oftheclient. promotion of quality of life in terms of global health (physical and psychological) drug-related disorders. The main objective of these services for drug-users is the In Belgium, there is a large variety of treatment or help facilities for persons with 9) 8) 7) 6) 5) 4) 3) 2) 1) rmtn cs mngmn fcsd n niiulzd upr in support individualized on specific groups. focused management case promoting training ofnewhealthcare workersinorder toward offwaitinglists, specific approaches, diagnosis, dual developing a collaborative care/treatment network offering general on and focus a employment, housing,andpsychosocialproblems, with treatment integrative promoting treatment, substitution harm reduction initiatives,reintegration andaftercare, treatment, withdrawal treatment, drug-free guaranteeing the availability of various treatment programmes, including the on based evaluation ofneeds, settings the of spread geographic balanced a creating or globalhealthcare andservicesrelated towell-being, providing a large choice of facilities, specifically dedicated to drug users providing cure/treatment aswellcare andsupport, being andsocialintegration), well- as (such dimensions other integrating and health on approach froman starting help, for strategy collaborative and global a promoting Drug-related treatment inBelgium Organization andavailability ofd rug treatment Policies andoorination this information. of lack current the of because tables the in mentioned not are these however General practitioners may play an important role in the treatment of drug users, respectively.patients treated drug illicit of number of in terms in importance their presented is and centres of types facilities different the of definition treatment a describing 5.2, outpatient and Table5.1 available the of overview An 2.2.1. NIHDI willbetransferred totheCommunitiesinnearfuture. the by financed users drug for centres revalidation with Conventions Belgium. alarge in users drug for treatmentoffer the of part diversified and exhaustive) not (but represent These centres treatment. psychosocial and medical specific on working 2013, centres residential In or field. ambulant with this signed were in conventions initiatives 29 new Disability stimulate and to Health order for in (NIHDI) Institute Insurance National the and addictions of treatment the for centres specialised between concluded are conventions 80’s, the Since and support prevention, on treatment, (social) reintegration. projects specific Community funds French the Commission Brussels, In 25.06.2009). (B.S./M.B. decree addiction the recommendationsof centresrespectingthe addiction specialised subsidized For their part, the Walloon region (General Directorate Social Action and Health) in the Flemish region are coordinated by the Flemish Agency for Care in and for Health. and jurisdiction health mental their for centres level, regional a On regulations.federal implementing responsibilities under fall that institutions for have rules down laying for Communities responsible are Communities the that the implies This care. health preventive sector,and policy education health of field the in careas health administratingoutpatient well and as in- the In the basic principlesforinpatienttreatment (hospitals). defining for and insurance care health for responsible is state federal The available andwillbedescribedindetailthefollowingsections. also are treatment specialised residential or ambulatory care, primary to Next of services domiciliary care, youthadvicecentres andpubliccentre forsocialwelfare. welfare, general for centres practitioners, is general network with This composed needed. is help specialised more if redirect to eventually and evaluate to problem, related help. substance a detect for organised to best the are facilities step These low-threshold first, the is network care primary The Outpatient network

79 5. Drug-related treatment: treatment demand and treatment availability 80 5. Drug-related treatment: treatment demand and treatment availability T T able 5.2| able 5.1| Mental healthcare agencies Low-threshold treatment centres Specialised drug Mental healthcare Low-threshold agencies Specialised drugtreatment centres Source: BTDIR,2014 T Source: BTDIR,2014 T ype ofcentre ype ofcentre demand (numberofclients)in2013 T Network ofoutpatienttreatment facilities(totalnumberofunits) otal outpatienttreatment provision forillicitdrugtreatment T otal 31 34 number 9 Mentale’, SSM). centres specialisedinaddiction(knownas‘ServicedeSanté and Brussels-Capitalregion there are respectively 8and3 voor GeestelijkeGezondheidszorg’, CGG).IntheWalloon In theFlemishregion there are 20centres (knownas‘Centra use –are admittedtoanadapted,specifictreatment offer. complex problems –suchasdualdiagnosisofsubstance relational andfamilytherapy. Clientsthatpresent more within thesecentres: from anindividualapproach togroup, goal oftheirservices.Avarietytreatments isavailable of consumptionoreventotalabstinenceastheultimate treatment ofsubstance-related disorders withthereduction Some mentalhealthcentres are alsospecialisedinthe (known as‘Maisond’Accueil Socio-Sanitaire’, MASS). Capital regions, there are 3and1centre(s) respectively Opvangcentrum’, MSOC)).IntheWalloon andBrussels- region, there are 5centres (knownas‘MedischenSociaal also offeraneedleexchangeprogramme. IntheFlemish harm-reduction andsubstitutiontreatment. Someofthem part oftheirdailyworkcomprisesmedicalandsocialcare, excluded from thestandard treatment facilities.Alarge main objectiveistogetintocontactwithpeoplenormally services topersonswithasubstance-related disorder. Their agencies thatoffersocial,psychologicalandhealthcare Medical andSocialCare Centres (MSCC)are low-threshold Walloon region (19). region (6),intheBrussels-Capitalregion (9)andinthe structured life.Daycare centres are present intheFlemish guiding process duringthetransition towards abetter available inthesecentres. Theemphasisisputonthe treatment (e.g.methadone orbuprenorphine) isalso be undertheinfluenceduringactivities.Substitution total abstinenceisnotmandatory, howeverclientscannot basis oraspartofgroup therapy. Duringtheseprogrammes, administrative, judicial supportisoffered onanindividual disorders) andtheirrelatives orfriends.Psychosocial, from newuserstopersons withsevere substance-related group ofpeoplewith drug-related problems (ranging Day care centres are specialisedcentres thatreach alarge National definition 1,073 1,795 2,975 entering treatment T otal numberofclients 21 centres /31intotal 9 centres /9intotal 24 centres /34intotal treatment facilities Coverage ofmonitored T T presented below. of overview (Tabletreatmentfacilities inpatient available the provision(Tableand 5.3) is 5.4) An communities). therapeutic including centres, residential term in (long- phase users stabilized more a drug in or centres) for intervention (crisis situations centres crisis specialised Besides also are hospitals. there by structures, general represented these mostly are structures treatment Inpatient 2.2.2. able 5.4| able 5.3| Therapeutic communities Crisis interventioncentre Hospital-based residential drugtreatment Source: BTDIR,2014 residential centres other long-term communities or Therapeutic centre Crisis intervention treatment residential drug Hospital-based T Source: BTDIR,2014 T ype ofcentre ype ofcentre Inpatient network demand (numberofclients)in2013 T Network ofinpatienttreatment facilities(totalnumberofunits) otal inpatienttreatment provision forillicitdrugtreatment T otal of centres 120 15 number 8 more generally inEurope (Vanderplasschen etal.,2014). detailed picture oftherapeutic communitiesinBelgiumand Walloon region. Arecent European publicationgivesamore communities inBelgium:5theFlemishregion and3inthe reintegrate patientsintothesociety. There are 8therapeutic group therapy sessionsare thekeyleadtodetoxand and peersupport.Ahierarchical communitystructure and drug-free environments withastrong focusonself-help residential centres are alsopresented here. Theyare initiatives fordrugusersinBelgium.Otherlong-term Therapeutic communitieswere thefirsttreatment Brussels-Capital region and2intheWalloon region. There are 5crisiscentres intheFlemishregion, 1inthe guide patientstowards thebestfittedtreatment programme. physical detoxificationandmotivateforfurtherabstinenceor rapid supportincaseofacrisissituation.Theypromote a treatment centres thatguarantee theunconditionaland Crisis interventioncentres are short-termresidential substance users. Nevertheless, notallpsychiatricbedsare usedtotreat the Brussels-Capitalregion and37intheWalloon region. T, K).There are 67hospitalsintheFlemishregion, 16in psychiatric bedswere considered (ClassifiedasbedsA, users canbetreated, thenumberofhospitalswithspecific In order toevaluatethenumberofhospitalswhere drug range ofcare optionscanbeveryextendedinhospitals. hospitals, there’s aspecialprogramme fordrugusers.The capacity totreat patientswithsubstanceuse.Insome well aspsychiatricunitsingeneral hospitalshavealimited Among allhospitalsinBelgium,psychiatricas National definition 380 727 2,119 of clients T otal number 15 centres /15intotal 8 centres /8intotal 42 hospitals/120intotal treatment facilities Coverage ofmonitored

81 5. Drug-related treatment: treatment demand and treatment availability 82 5. Drug-related treatment: treatment demand and treatment availability sedatives (6.1%). Characteristics of patients and addiction profile of patients of entering treatment forthedifferent substancesare profile describedinTable 5.5. addiction and patients of Characteristics (6.1%). and sedatives hypnotics of misuse and (11.3%) cocaine than other stimulants (15.6%), cannabis (33.5%) of for entering use treatment (see Figure the 5.1), next reported to opiates (30.7%), commonly cocaine most patients centres, of types all In and 36.0%ininpatientcentres. centres outpatient in registered were (64.0%) 3 of out patients 2 less or More in centres inpatient and out- Belgium are reporting data. specialised the of 45% and 73% Around data. In 2013, a total of 9,192 drug users entered treatment in the centres that report online an TDI registration. using are a repository centres module. In 2013, around 100 specialised centres participated in this ambulatory and through data their sending are or clients their encode to 2011 since application residential specialised The 2015 onwards. from registration TDI the for basis the be will and 2013 September in adopted a as alcohol had was protocol new a level, and national At states. member as EU 2012 in implemented be to in well adopted was as protocol European drugs new A illegal substance. primary for registers treatment system entering This patients registration. the both of part not currently general are and practitioners Prisons 2011. in centres specialised in level national was registration at TDI launched the basis, this On 2.0. version Protocol EMCDDA the on 03.05.2006). Consequently, anational TDI protocol wasadopted in 2010 based officially was Belgium in approved by the Inter-ministerial conference on Public Health in registration2006 (B.S./M.B. (TDI) Indicator Demand Treatment The 2.3. Treatment deman ata Figure 5.1| into treatment in the past. The mean age of first time use is the lowest for the lowest is use time first of cannabis users. age mean The past. the in treatment into went already opiates using patients most that registrationshows The included). (alcohol substances other less using are cannabis or hypnotics for a treatment in injected ever that people of substance is the proportionhighest in the group of people in treatment The for opiates. Patients stimulants. and cannabis for treatment in group the in than opiates and hypnotics for treatment in people cannabis users in treatment. The mean age of patients in treatment is higher for hypnotics of group the in represented least for the are women opposite, the treatmentOn women. are in persons of group the of majority the Remarkably, T Characteristics ofpatientsenteringtreatment in2013bytypeof able 5.5| Source: BTDIR,2014 Source: BTDIR,2014 Characteristics ofpatients Women (%) Mean age(years) Daily users(%) Ever injected(%) Use ofonlyonesubstance(%) First timeintreatment (%) Mean age at time of first use (years) 33.5 primary drug Proportion (%)oftreatment demandsbyprimarydrugin2013 6.1 11.3 2.8 15.6 30.7 T Opiates ype ofprimarydrugmentionedforenteringtreatment 19.6 34.7 58.6 41.5 18.0 16.0 21.2 Cocaine 18.8 30.8 30.9 13.7 22.1 36.4 20.4 Other substances Cannabis Hypnotics St Cocaine Opiates imulants otherthancocaine Stimulants 24.9 28.6 30.9 18.9 30.7 34.2 18.1 Hypnotics 50.9 38.9 76.3 41.7 27.0 25.9 7.6 Cannabis 14.8 23.5 48.2 49.0 58.5 15.4 3.9

83 5. Drug-related treatment: treatment demand and treatment availability 84 5. Drug-related treatment: treatment demand and treatment availability and one in the Walloon region) Walloon the in one and region Flemish the in (one units specific two up setting 2002, in launched was project pilot a Therefore, provision. of form any lack currently and vulnerable ujce t da diagnosis dual to patients of subjected numbers increasing noted have clinicians years few past the Over 2.4.2. T French the in prescribed often more Community (2/3whencountedtogether)thanintheFlemish(1/3). are years. 39.3 buprenorphine of age and mean a had Methadone and (77.0%) men mainly were patients The buprenorphine. with treatment in were 13.5% only them, Among (see 5.6). register Table Pharmanet the in registered persons 17,482 were there 2013 In more or alternatively, inapharmacyunderthesupervisionofpharmacist. are practitioners general Community, involved. FrenchA daily delivery of the treatment can be arranged in specialised centres the in whereas centres centres. specialised the Flemish Community, substitution in treatment is often and prescribed administration: by specialised the concerning differences regional big pharmacies are there Currently, hospital pharmacies, Substitution treatments provided inprisonsare notincludedinthisdatabase. public from of March 19th 2004 (B.S./M.B. 30.04.2004). This database contains information Decree Royal the by requested as practitioners involved among warnings and allow prescriptions multiple avoid to is registration this of objective The NIHDI. the of Pharmanet-system the in registered are buprenorphine and methadone both by organised is provisionfor prescriptions 2009, April Since practitioners. general and centres specialised The (OST). treatment substitution opioid for authorized substances two the are buprenorphine and methadone Belgium, In 2.4.1. 2.4. and integrated treatment for both problems (drug use and mental disorders). mental and use (drug problems both for treatment integrated and Characteristics ofpatientsreceiving methadoneorbuprenorphine in able 5.6|

Region (%) Mean age Women (%) T Source: NIHDI,2014 otal amount(N) Treatment mod Dual diagnosispatients Opioid substitutiontreatment Walloon Brussels-capital Flemish 2013 bytypeofsubstance alities Methadone D Hr e a. 2010) al., et Hert (De 15,112 54.8 15.3 29.9 39.5 22.9 (Sabbe et al., 2008) al., et (Sabbe Buprenorphine Sc ptet ae particularly are patients Such . . These units provide intensive provide units These . 2,370 39.0 11.6 49.4 37.9 23.5 17,482 T 52.6 14.8 32.6 39.3 23.0 otal with patientsasubstance-related useproblem: dealing centres in applied be should that functioning of type the or treatment of type the describing available, are conventions or documents legal Different 2.5. use nor isthere substance consistencyconcerningitsapplication with persons for intervention, this management of effectiveness the about known However,disorders’.is little case and ‘Crisis project pilot federal the of part as institutionalized been has It 1999. since treatment abuse case substance Belgian in is implemented been disorders has management use-related Case management. substance with facilitate persons may for that management strategy crisis supportive important An or treatment. admission continue quick to arrange and motivate and detoxification physical situations in assist they hand, other crisis the On support. in intervene 7) chapter in of stay five days).maximum Second, the use-related so-called Crisis Interventiona Centres (CICs) (also described with substance beds crisis with four offer patients Belgium in centres of (8 disorders management case and exists crisis crisis project pilot the Belgium, national for a In First, projects. behaviour. two within their increase situated be can They changing care treatment. and specialised treatment to for them motivation refer the and on options patients inform treatment facilities These disorders. use-related substance with persons to aid first offering in role important an play departments Emergency 2.4.3. them tootherservicescontinuetreatment. The aim is to stabilise patients after a period of intensive treatment to then refer • • • • of care andorganization togettheagreement. the by recognized quality on respect region to rules additional have Health Flemish and Care for Agency the in Health Mental for Centres (B.S./M.B. decree a social actionandamongstthem thedrugaddictionfacilities. Brussels, in centres 08.05.2009) describesdirections forallambulatory servicesworkingon French-speaking and the the For missions the fulfil to functioning statedintheregional decree of30April2009. specialised need for activities, funding treatment request that addiction region Walloon the panelof in diverse Centres way,a this In therapeutic solutionsismadeavailable. facility. each for objectives specific describes document centresthe ambulant convention, of type this with the way their organization is to be arranged. For the other residential or and activities social or medical expected the describing precisely NIDHI the with convention a signed have (MSCC) agencies low-threshold All Quality assuranceofdrugtreatment service Crisis andcasemanagement (Bruffaerts etal.,2010) .

85 5. Drug-related treatment: treatment demand and treatment availability 86 5. Drug-related treatment: treatment demand and treatment availability Figure 5.2| as are opiates of patients demand primary drug is also notable in opiates treatmentall European countries of in proportion the decrease of a decrease This and noticed. patients cannabis a in time first increase the steep for treatment entering people among used drug primary the of new patients (see Figure 5.3). Indeed, when looking at the trends concerning group the in shift a to due is trend This 5.2). Figure (see treatment. entering for substance main the is cannabis 2013, In stimulants. and cocaine cannabis, for for opiates. At the same time, there has been an increase for clients in treatment treatment entering clients of number the in observed is decrease a 2011, Since residential centres). low- 9 the long-term 15 of the of out out 15 and 9 centres crisis 8 centres, the of out day 8 centres, threshold 34 the of out (10 drugs illicit for demands treatment for 2013 for registrations TDI the of 70% around represent centres These centres. of types other the for case the yet not is this while 2011, since registration this complete to obliged indeed are centres These NIHDI. the with convention a in participate that centres specialised the by registered data TDI the on based studied only are demand and offer treatment Currently,in trends 3. anbs te nrae pooto i as prily xlie b a high(er) a by explained partially also proportion ofjudicialreferral fortreatment. is proportion increased the cannabis, Source: BTDIR,2014

Number of clients entering treatment Trends 1,000 1,200 200 400 600 800 0 Institute forHealthandDisabilitynsurance between2011and2013 by primarydruginthecentres withaconventiontheNational T rends innumbersofclientsenteringtreatment forthefirsttime, 2011 2012 2013 (EMCDDA, 2014) . Concerning Cannabis Hypnotics St Cocaine Opiates imulants Figure 5.4| Figure 5.3| Source: NIHDI,2014 Source: BTDIR,2014 Number of clients

10,000 12,000 14,000 16,000 18,000 20,000 Number of clients entering treatment 2,000 4,000 6,000 8,000 1,000 1,500 2,000 2,500 500 0 0 Disability Insurance between2011and2013 between 2009and2013 T the T rends innumberofclientsreceiving methadoneorbuprenorphine rends innumberofallclientsenteringtreatment, byprimarydrugin 2009 centres 2011 2010 with a convention 2011 2012 with 2012 the National Institute 2013 2013 for Health Bupr Methadone T otal Cannabis Hypnotics St Cocaine Opiates imulants enorphine and

87 5. Drug-related treatment: treatment demand and treatment availability 88 5. Drug-related treatment: treatment demand and treatment availability ih ictlopie e te xetd ep etr hn h methadone the than better help expected the met diacetylmorphine with treatment The persons. addicted severe of delinquency reduce could treatment study the time, observation limited under-evaluate the amount of positive impacts to on society. The diacetylmorphine Due treatment. methadone the than aspects socio-economic in efficacy less showed diacetylmorphine via treatment of The (patients months). 12 after conditions ended treatment the experimental that knew group to experimental the due effect negative false a be could was two groups This months. 12 after significant longer no but months the 9 and 6 3, at significant between efficacy in difference The satisfaction. patient and aspects criminological aspects, socio-economic treatment, termsof the in of efficacy weredelivered and conclusions 2012 in finished was project The group and 38inthecontrol group were observedforoneyear. experimental the in people 36 order, this To treatment. methadone of at comparing the efficacy and feasibility of this treatment with regular approach aimed (TADAM) diacetylmorphine with treatment assisted on pilot-project The 4.2. (Schaub etal.,2014) information both about mentalandbehavioural characteristics determine to months 12 the for followed relatives project their and The adolescents use. cannabis of patterns problematic showing 18 to up 13 aged Family youngsters 450 Multidimensional among therapy individual of with (MDFT) comparison therapy a included Paris, and Brussels, Hague) (Berlin, The cities Geneva, European 5 in performed was trial INCANT The Cannabis uediorerintroubleyouth –TheINC 4.1. 4. diin i ipoe aiy ucinn. oee, DT rvd o e more be efficient in decreasing to externalising symptoms, especially in coerced adolescents proved MDFT However, functioning. family individual improve did in and addition and symptoms MDFT internalising and externalising both of rate that the reduce treatment demonstrated colleagues and Schaub Yet, therapy aslongotherteens in remained and this therapy accepted contradict treatment into however coerced adolescents study notion: the from Data treatment. the of outcome the to therapist Europethe establish a therapeutic alliance with of the adolescent and consequently influences Western chances the in harm therapists will teenagers of of selection treatment forced a that among belief strong a is There New developments Heroin-assis projec t . ted treatment –TheTAD (Rowe etal.,2013) (Rigter andDekker, 2014) . AM projec t . ANT diinl eerh s die rgrig h ntr ad ye f psychosocial options. of support thatisrequired type treatment foropiatedependentpersons and nature of the regarding allocation advised is the research Additional in approach information personalised valuable a provides treatments) regarding from benefits and needs support type of medication and treatment regimen) with client data (e.g. characteristics, dosage, (e.g. data treatment-related of combination The practice. and demand mapping of providers of OST as well as the follow-up on evolutions in treatment up. There’s a need of a centralized and comprehensive database that allows the set was study SUBANOP the Belgium, in OST of practices current optimize and insight more gain to order In limited. remains topic this now,on researchyears 15 over for scale large a on applied been has treatment substitution Although 4.3. organization, theinfrastructure ofthebuildingandstaff treatment the patients, the of criteria inclusion the the centre, a such of installation for conditions the on made were Recommendations restricted. arbitrarily not is length its if only but effective, more be to proved has diacetylmorphine available to patients refractory to methadone. For these patients, treatment with for treatment,only second-line remaina treatmentshould recommended. This was methadone with treatment treatment despite heroin diacetylmorphine street use of to continue who extension people the conclusion, In treatment. SUBANOP projec Analysi andoptimization ofsub t titution treatment –The (Vander Laenenetal.,2013) (Demaret etal.,2013) . .

89 5. Drug-related treatment: treatment demand and treatment availability 90 5. Drug-related treatment: treatment demand and treatment availability ehdn. eomnain wr md o te an set (target aspects main project. new Nevertheless, there similar are currently no the further plans a on implementing these results. of with development on the treatment for rules,…) the made infrastructure, group, despite were heroin street Recommendations use methadone. to continue who people for with a treatment for specific target treatment group: assisted treatment methadone with diacetylmorphine that is recommended the than effective concluded more only is diacetylmorphine diacetylmorphine on with study towork pilot treatment remarkable A of treatment assisted treatment. in aspects developments specific potential on towards conducted were studies Several often less in remains prescribed. Community Buprenorphine French Community. the Flemish in the prescribed with often comparison more is and time over stable The number of people receiving methadone or buprenorphine remains relatively justice. referredtreatmentsby of latter,number increased the however,to due partly is is The increasing. opiates is cannabis entering for for demand treatment of number demand the people and declining treatment of of number number The the drug. primary in by treatment observed is evolution clear a Moreover, in treatment forcannabis). age for treatment people for use of in drug ever-injecting (less profile use women drug terms high-risk and (less cannabis) sex in use), different opiate for very treatment in are people patients (older of groups two these However, treatment. entering patients the of majority large a for substance of type main the represent cannabis and Opiates services. outpatient in mainly centres, 100 over by registered were treatment entering patients 9,000 than more 2013, In (including low-threshold) orresidential services. treatmentambulatory providing country the in large the available are A facilities treatment Cell. of of variety Policy Drugs General charge the by in coordinated is are which addictions partners for institutional different Belgium, In 5. gratefully acknowledged. of the data collection and their valuable feedback. Their essential involvement is dr. Prof. Huard, Mrs Verstuyf, Broeckaert, Prof. Mr dr. Dom, Prof. (Ph.D.), dr. Pelc Hogge and Prof. dr. Mr Soyez for their contribution thank to like would We Acknowledgements C onclusions oslain n psil dah. h HVAD rgse i dee t be to deemed is register HIV/AIDS The exhaustive. deaths. last possible on data and collect to consultation year reported each conducted the is For study diagnosis. follow-up a HIV cases, of AIDS time the at collected is of transmission mode probable HIV and orientation sexual residence, nationality, sex, age, on ery, 2009) Defraye, (WIV-ISP) contains the AIDS- and HIV notifications since 1984-1985 since notifications HIV and AIDS- the contains (WIV-ISP) The national HIV/AIDS register, hosted by the Scientific Institute of Public Health 2.1.1. 2.1. 2. Sleutel’ the General MortalityRegister(GMR)(section4). ‘De using from obtained was centres deaths treatment drug-induced on at information Finally, 3.2). interview (section intake the of part as EuropASI, used the on based described is comorbidity psychiatric addition, In 3.1). (section emergencies drug-related on information provide to used were Centre Poison National the from Data (‘Spuitenruil 2.3). (section Flanders’ Vivendi Modus Exchange and Vlaanderen’) ‘Needle by collected were data Behavioural 2.2). and 2.1 drug (section summarized in are EMCDDA) to testing 9 Table(Standard diagnostic services from and register) tuberculosis in and use HIV/AIDS (the drug illicit of consequences Belgium. Regarding health drug-related infectious diseases, data from observed national registers describes chapter This 1. K. Ridder De HEALTH CORRELATES ANDCONSEQUEN CES CHAPTER 6. • • observed in2010,especiallytheWalloon region. was deaths drug-induced of reduction a countries, European other with line In injecting equipmentsuchasspoons,filtersandwater. share needles and syringes, but still many injecting drug users keep sharing other to reporting people of number the reduced have programmes exchange Needle Drug-related infectious diseases Introduction HIV/AIDS andviralhepatitis National HIV/AIDSregister . For every confirmed seropositive case, additional information additional case, seropositive confirmed every For . Sse and (Sasse 91 6. Health correlates and consequences 92 6. Health correlates and consequences T fluctuating moderately showing 6.1, Figure in prevalence rates withoutcleartimetrends. 1995-2013 period the for prevalence rates for the period 2006-2013 is the provided in of Tableoverview An 6.1 and 2013. illustrated and 2012 in seropositive HIV were ever-IDUs tested the of 5% to 1.9%) 4 Clinic, (N=53, Free centre person treatment outpatient new the In one registered. was 2013, in but Sleutel, clients De in for ever-IDUs among information serological registrations seropositive HIV new collects no were there 2012, In Sleutel treatment. entering De Antwerp. clinic outpatient in an located located Clinic, Free centres through and treatment region, residential Flemish the and throughout ambulatory several of an Sleutel, institution De through collected screening blood of results test on based are estimates prevalence The 2012. since region Flemish the for available only are ever-IDUs,however,among Serologicaldata throughserologicaldata. was obtained treatment at ever-IDUs among HIV-sero-positivity of rate prevalence The 2.1.2. and/or duetodifferences intreatment compliance. non-IDUs to compared IDUs among rate co-infection hepatitis higher the to due is this that hypothesized is It non-IDUs. to compared aids developing rapidlymore are IDUs that HIV-cases,indicating the among IDUs of proportion the than higher IDUs among AIDS-cases was found to be systematically (although not significantly) cases. However, with exception of the onset of the HIV-epidemic, the proportion of were observed regarding the proportion of IDUs among the newly diagnosed AIDS in the mid-eighties, but has been on a stable level since 2005. No clear time trends diagnosed with HIV are much lower compared to the beginning of the newly persons HIV among (IDUs) users epidemic drug injecting of percentage the that clear is It reported. were IDU to related diagnoses AIDS 2013, (2.5%) 2 and and (1.1%) 1 2012 respectively years the For (IDU). use drug injecting to attributable probably being HIV with diagnosed newly persons the of 1.5% and 1.1% of percentage a HIV, with diagnosed newly persons yielding transmission, HIV of mode probable the as use 17 drug intravenousreported and 14 respectively 2013, and 2012 In able 6.1| 2013 2012 2011 2010 2009 2008 2007 Y 2006 Source: DeSleutelandFree Clinic ear HIV diagnostictestingamongever-IDUs treatment intheFlemishregion between2006and2012 Prevalence rate (%)ofHIV 53 36 48 29 47 60 54 68 N De Sleutel -seropositivity amongever-IDUs in 1.9 0.0 8.3 3.4 0.0 3.3 3.7 2.9 % 382 357 328 282 334 329 408 336 N Free Clinic 5.0 3.9 4.6 5.3 5.1 6.4 5.9 5.7 % not reveal significanttimetrends. does years previous with results these Comparing infection. undergoneviremic, HCVab longer no positive a or infection A viremic chronic) or (acute 2013. a either to in associated is HCVabtest for positive tested Clinic Free De Flemish-Brabant, and MSCC Sleutel the respectively in clients the of 73.4% and 22% 7.5%, for C, RegardingHepatitis antiHBs. for werepositive 50% to 14 and antiHBc positive were 48% to 6 while for 2013, positive in tested HbsAg antigen clients HBV-indicating the the detected. of 2%) be to (0 will few antiHBs a only only B, Hepatitis and Regarding negative case be In will infection. antiHBc after vaccination, shortly of appear will infected), AntiHBc currently positive. thus test and will status HBsAg carrier chronic or hepatitis acute (either infection viremic a of case In 6.2. Figure and Table6.2 in shown is 2006-2013 ever-IDUs. An overview of the hepatitis B (HBV) and C (HCV) prevalence rates for Flemish-Brabant started provincein 2014 with providing diagnostic serological data for hepatitis C the among in (MSCC) Centres Care Social Medical four the is and based above on diagnostic described serological data rate from De prevalence Sleutel and HIV Free Clinic. the Additionally, to analogously obtained was treatment at ever-IDUs among test hepatitis positive a of rates prevalence The 2.1.3. Figure 6.1| Flemish region: DeSleutel andFree Clinic Sources: Walloon Region:l’Observatoire socio-épidémiologique alcool-drogues (EUROTOX),

Hepatitis diagnostictestingamongever-IDUs HIV prevalence rate (%) 10 20 15 0 5 confidence intervalsbyyearandsource between1995and2013 HIV 1995 -prevalence rates amonginjectingdrugusersand95%Wilson’s W Flanders (DeSleutel) Flanders (Fr allonia 2000 ee Clinic) 2005 2010 2013 93 6. Health correlates and consequences 94 6. Health correlates and consequences Figure 6.2| T able 6.2| Source: DeSleuteland Free Clinic N: totalnumberofIDUswhowere tested(validtestsonly) Hepatitis B Source: DeSleutel,Free ClinicandMedicalSocialCare Centres in Flemish-Brabant N: totalnumberof IDUs whowere tested (validtestsonly) HBsAg De Sleutel antiHBc antiHBs HBsAg Free Clinic antiHBc antiHBs

HCV prevalence (%) and 2013 other diagnosticsettingsintheFlemishCommunitybetween2006 Prevalence rate ofHepatitisBamongever-IDUs attreatment and diagnostic settingsintheFlemishCommunitybetween2006and2013 Prevalence rate ofHepatitisCamongever-IDUs attreatment andother % % % % % % N N N N N N 10 0 2 4 6 8 2006 2006 15.8 12.3 55.0 334 329 0.0 1.5 63 38 57 - - 2007 Flanders (DeSleutel) Flanders (Fr 2007 25.0 11.1 53.5 307 303 0.0 2.6 45 28 45 - - 2008 ee Clinic) 2008 18.4 57.3 50.2 328 323 327 1.9 2.6 4.0 54 38 49 2009 2009 25.0 56.1 51.8 336 330 334 0.0 7.1 4.2 2010 44 28 40 Flanders (Flemish-Br 2010 20.0 56.3 55.2 2011 281 277 279 0.0 0.0 2.8 29 22 30 2011 2012 16.7 25.5 55.1 52.3 326 323 327 4.3 3.7 47 36 47 abant) 2013 2012 11.0 33.0 49.5 49.9 386 374 379 3.0 2.6 36 28 33 2013 13.9 48.1 50.1 379 366 371 6.3 1.6 50 32 43 0 In 2013, 264 valid questionnaires have been filled out. Of the participants, Of the of majority The (n=210). out. males were 80% and filled years 35 was age mean been the have questionnaires valid 264 2013, In is showninTable 6.3. IRQ the to related responses the of overview An care. health to access and use a questionnaire which is based on the Injecting Risk Questionnaire (IRQ) Questionnaire Risk Injecting the on based is which questionnaire a out fill to asked is programmes exchange needle the of one contacting IDUs of et al., 1998) al., et Community, have been collected since 2001 since collected been Community,have Flemish the in located (NEP) programmes exchange needle the of one frequent who IDUs among behaviour risk on data 3.1, section 4 chapter in described As 2.3.1. 2.3. disputable is factors risk identified the of registration with the However, use. associated drug intravenouswas (n=10) 1.2% which of factor risk known a reported had (N=840) 85% 2012, in Belgium in registered cases 981 the Of (18.5/100,000). Antwerp and (21.9/100,000) Liège (26.2/100,000), Brussels for in observed were residents 100,000 per cases 8.8 2013 in incidences highest to The 2001. since incidence lowest the is which 2013, 2001 in residents 100,000 per cases slightly,12.8 fromdeclined has incidence tuberculosis national the 2001, Since both regions are joinedandcheckedforduplicatesinthenationalregister. of Notifications Belgium. in compulsory is Respiratoire cases tuberculosis of notification The voor Vereniging diseases’ in the French Community (‘Fonds des Affections Respiratoires’, FARES). (‘Vlaamse control’ respiratory respiratoryTuberculosebestrijding,of ‘Fund en Gezondheidszorg the and VRGT) tuberculosis for Tuberculosis association and and ‘Flemish Lung health the Belgian with the together by (BELTA), hosted Association is register Tuberculosis The 2.2.2. treated infection. already an nor infection, old an from recent a distinguish not does test the but a infection, had syphilis a for indication strong a is TPHA-test positive clients a that noted be tested the of 5% about should It ST9P2_2014_BE).Source 16/339; 2013: 18/342; (2012: 2013, result positive and 2012 obtained In was Clinic. (TPHA) Free syphilis for from test screening positive a of prevalence The 2.2.1. Syphilisandtuberculosi 2.2. Behavioural d exchange intheFlemishregion Risk behaviourininjectingdruguserscontactwith syringe National tuberculosis register Syphilis diagnostictesting . This questionnaire contains additional items on health status, drug status, health on items additional contains questionnaire This . (Patrick deSmet,personalcommunication) ata . (Windelinckx, 2014) (Windelinckx, . Yearly,sample . a (Stimson 95 6. Health correlates and consequences 96 6. Health correlates and consequences T raising awareness on the risks of sharing paraphernalia sharing of risks the on awareness raising previous years, seem to be successful, but there is still too little available time for of needles/syringes sharing not on focus a with campaigns reduction harm the results, (limited) these on based Although paraphernalia. other shared have to to not claimed have shared who needles/syringes is higher compared to participants the percentage claiming not of percentage the years, previous to Similar from 2010-2012. (receptive: (receptive:filters and 40%) These 36%). areresults those with line in water 42%), used: (receptive/having spoons e.g. reported: frequently weeks more four is last the during equipment injecting other of sharing The partner. sexual froma syringes and/or needles lent or respectivelygiven reportedhaving participants the of 22% and 26% common; less is partners sexual with syringes with one or more persons during the last four weeks. Exchanging needles and/or equipment injecting shared participants the of 34% weeks. last the during else someone with equipment injecting of sharing no reported (63%) participants able 6.3| old syringes? been keptinthesamecontainerassomeoneelse’s How oftenhaveyouusedoldsyringesthathad (frontloading/backloading) ? one thatalready beenusedbysomeoneelse How oftenhaveyoufilledyoursyringefrom that hadalready beenusedbysomeoneelse? How oftenhaveyouinjectedwithneedles/syringes bleach assomeoneelseforflushingout? How oftenhaveyouusedthesamewateror someone elsehadputausedsyringe? How oftenhaveyouusedafilterintowhich been usedbysomeoneelse? How oftenhaveyouusedaspoonthathasalready a sexualpartner? How oftenhaveyoulentusedneedle/syringesfrom a sexualpartner? How oftenhaveyougivenusedneedle/syringesto injecting equipment? With howmanydifferent peoplehaveyoushared How oftenhaveyoushared injectingequipment? Source: SpuitenruilVlaanderen, Windelinckx2014 During thelast4weeks,… Questions needle exchangeprogrammes intheFlemishregion in2013 Responses totheInjectingiskQuestionnaire (IRQ)withinthe 263 263 261 263 262 263 179 188 263 261 N 71% 82% 77% 56% 62% 56% 77% 73% 65% 63% 0 (Windelinckx 2014) (Windelinckx 14% 11% 11% 21% 20% 21% 11% 24% 13% 9% Answers 1 19% 16% 21% 13% 15% 10% 17% 7% 4% 7% >2 . Drug . Don’t know 8% 3% 5% 4% 2% 2% 1% 1% 1% 7% clearly indicatethatextreme injectingriskbehaviour isnotruledout. they behaviours, risk the of frequency and extent the on conclusions allow not do data the Although above. exposed limits the to due interpret to difficult are percentages these of trends time The months. six last the during street the on shared have to reportedfound needles/syringes with injected even 44% 12% nearly and equipment injecting to Up sample. recruited the among common at activities reductionlocal level. Nevertheless, harm the results indicate of that injecting risk demand behaviour remains and supply the on depending year to standardized. truly not is completion year from vary the may operations snowball of Moreover,coverage geographic the which for tool contact a mainly is questionnaire the for and ‘jobistes’ the corrected of network social not the on dependence are their results The Community. French whole the in street the on IDUs for representative be to deemed administered not are results However,these 2013. surveys through collected behaviour during these snowball operations, is summarized risk in Table 6.4 for the years on 2006- information The harm other and prevention hepatitis and reduction informationamongtheirpeers. aids to on paid and information trained are disseminate and 3.1.3). ’jobiste’ as section serve IDUs 3, volunteering end, chapter this To also (see subpopulations hard-to-reach targeting and prevention peer is operations snowball collected these of objective main is The 1993. Community French the in since Vivendi Modus by organised been have which IDUs operations, snowball using among behaviour risk on Data 2.3.2. lnes aot 5 dd o eprec a ijcin bcs drn te last the during abscess year, but24%reported more injection than oneinjectionabscess an experience not did 65% about Flanders, materials in the drugs. Of the 240 respondents in the survey of Needle Exchange toxic the to veins, due death tissue and skin, the the on bacteria of of number increased the out leaking drugs by or skin the under layer fatty the into drugs of injection the factors: several of combination a by caused are infections The Skin and soft tissue infections are a common complication of injecting drug use. increasingly is injecting mentioned of compared to last way years and increases This the risk of used. health complications. regularly also are armpit and penis shoulder, groin, neck, as parts body elbow,risky are Nevertheless, hands. body and the arms legs, on zones injecting chosen common most The 2011). in 36% versus 2013 in (45% frequently more and more occurs use, of way hasty years. Injecting at previous (semi-) public with places, which implicates comparison less hygienicin and increasingmostly is behaviour drug injecting risky More which mightexplaintheveryhighHepatitisCprevalence rates amongIDUs. users remain not or less aware of the risk associated with sharing paraphernalia, the French Community Risk behaviourininjectingdrugusersrecruited atthestreet in (Windelinckx, 2014) . 97 6. Health correlates and consequences 98 6. Health correlates and consequences related to substance intoxications among adults (> 14 years old; were calls 53,591 the of 302 2013, In professionals. health and public general the by 50,000 poisoning suspected than or acute more to related receives year each Centre enquiries telephone Poison National Belgian the 1963, Since 3.1.1. 3.1. 3. T communication o lii sbtne ad h pooto i te ao gop i smlr o the to similar is groups major previous years. the in proportion the and substances illicit related calls to of number total The cocaine. to related were 15.7% derivatives. their and cannabis to related were intoxications the of (22%) majority The 6.5. 204 questions were related to illicit substances. An overview is provided in Table able 6.4| equipment tosomeoneelse? give orlendusedinjecting to someoneelse? give orlendusedneedles/syringes used bysomeoneelse? use injectingequipmentalready at thestreet? inject withneedles/syringesfound else? had already beenusedbysomeone inject withneedles/syringesthat During thelast6months,didyou… Sample size(N) Source: Eurotox, 2007-2014 Injecting Riskbehaviour correlates andconsequences O Non-fatal overdosean rug-related emergencies ther drug-related health Telephone enquiriesrelated todrugintoxications ). In 58% of the cases (n=176), only one substance was involved. was substance one only (n=176), cases the of 58% In ). between 2006and2013 injecting drugusersintheFrench Community(ModusVivendi) Proportion (%)ofinjectingriskbehaviouramongstreet-recruited 2006 31.1 32.6 47.4 30.4 135 6.7 2007 25.8 38.6 53.8 42.4 236 5.9 2008 26.3 35.1 56.6 31.1 228 5.7 2009 21.0 20.2 29.4 33.6 119 0.8 2010 35.2 24.0 26.0 13.8 196 1.5 2011 34.9 17.5 31.7 19.0 Dr. Mostin, personal 1.6 63 2012 38.5 32.5 21.4 12.8 117 2.6 2013 44.0 40.4 39.4 11.9 34.9 109 h itk itriw te uoen dito Svrt Idx ErpS) is (EuropASI), Sleutel De of centres treatment Index the of one Severity in treatment entering Addiction of clients all to European part administered As the Community. interview, Flemish intake the residential the and throughout ambulatory located several centres of consisting treatment institution an is Sleutel De 3.2.1. 3.2. year last the overdose drug one least (Windelinckx, 2014) the at of had 16% have 2013, to Flanders reported Exchange participants Needle in responses valid 235 the Of 3.1.2. T n ohr etl lnse (ul igoi) s siae b cos classifying cross by estimated severe and 4-5) scores (severity moderate is 0-3), scores (severity mild as patients diagnosis) (dual illnesses mental other and through the EuropASI, the prevalence of comorbidity between drug use disorders able 6.5| Source: NationalPoison Centre, Mostin,personalecommunication2014 ** * Ecstasy Amphetamine/speed Not specified* Cocaine Cannabis Substances GHB/GBL Poppers Heroine/Methadone T Phencyclidine Mephedrone Mescaline LSD Others** Mushrooms/hallucinogenic plants otal shabu, horseanesthetics,FEZP, N’EYE’ZZZ,5FPB-22) dse, boy, blue (e.g. call the of moment the at information little or no is there which about Products Unknown products O ther topics ofinteres the Flemishregion Psychiatric comorbidityindrugusersenteringtreatment in syringe exchangeintheFlemishregion Non-fatal overdose ininjectingdruguserscontactwith enquiries received bytheBelgianNationalP Proportion ofIllicitsubstancesmentionedduringtelephone (Raes et al., 2004; Raes and Lombaert, 2004) Lombaert, and Raes 2004; al., et (Raes . 7.2%evenhavehadmultipleoverdoses thelastyear. t 204 18 21 29 32 45 15 11 10 N 1 1 3 4 7 7 . Based on the data collected data the on Based . oison Centre in2013 10.3 14.2 15.7 22.1 100 8.8 7.4 5.4 0.5 0.5 1.5 2.0 3.4 3.4 4.9 % 99 6. Health correlates and consequences 100 6. Health correlates and consequences amphetamine samples) in 4-MA as (such substances life-threatening potentially see with contaminated be details, more (for to reported were drugs ‘pure’ less settings hand, other the On 2.2.). festivity section 7, chapter in dehydration with combination in been has tablets ecstasy certainly deaths, even in and symptoms toxicity for risk high a with levels to rising content MDMA The Drugs. on System Warning health the Early on Belgian the through documented are Research deaths) (drug-related consequences drugs. these of toxicity implications of most NPS is very limited. the Moreover, usually only the most serious on knowledge our health in of remains serious gap significant number a in the (NPS), substances about psychoactive result new concerns detected newly might the Despite drugs 10). illicit chapter (see of consequences composition and purity The 3.2.2. T prevalence ofasevere dualdiagnosis(12.6%)hasbeenstableinthisperiod. illicit substance users (52.1%) and stable during the period 2006-2013. Also the among common very is comorbidity psychiatric of prevalence The 2006-2013. entering treatment facilities of De Sleutel in the Flemish Community for the years patients of comorbidity psychiatric the of prevalence the summarizes Table6.6 had severe problems inboththesubstancemisuseandpsychiatricdomains. they when diagnosis’ dual ‘severe as classified werePatients domain. other the in problems moderatewhen with combined domain one in or problems severe had they domain, psychiatric the and misuse substance the both in problems moderate had they when diagnosis’ dual ‘moderate as classified were Patients (severity scores 6-9)ontheareas ‘alcoholanddruguse’‘psychiatricstatus’. able 6.6| Source: DeSleutel,Lombaert, personalcommunication2014 Moderate (%) Severe (%) Dual diagnosis(total,%) Sample size(N) Psychiatric comorbidity Health consequencesofsyntheticsubstances between 2006and2013 injecting drugusersintheFrench Community(ModusVivendi) Proportion (%)ofinjectingriskbehaviouramongstreet-recruited (Blanckaert etal.,2013) 2006 37.9 13.9 51.8 631 2007 40.8 12.1 52.9 639 2008 32.9 16.7 49.6 651 . 2009 37.0 13.6 50.6 814 2010 41.1 12.7 53.8 581 2011 41.9 12.0 53.9 668 2012 37.6 11.0 48.6 670 2013 39.4 12.6 52.1 720 persons (3%)in2009and2008. 4 to compared age of years 64 than older were (12%) persons 10 that 2010 observed in we hand, other the On 2009. (11%) persons 14 and 2008 in (12%) comparedpersons (7%) 17 years to 25 of wereage persons the 6 under (81%). reported drug-induced deaths, 71 persons were between the age of 25-64 years the Of trend. positive sustainable a or variation random is it whether needed decide to is data Follow-up region. Walloon the for largest the is decrease 2006. This of level the abate and 2007-2009 to compared decrease the remarkable in a 14 and Brussels in indicates Belgium are 24 in deaths drug-induced of reported region, number total The region. Flemish regionWalloon were the deaths in and 49 drug-induced which year of 87 Belgium by 2010, in In Belgium 6.7. in Table in deaths summarized drug-induced of number The to opiates, cocaine, amphetamines and accidental derivatives, cannabis and hallucinogens. due abuse, intent undetermined with drug poisoning and poisoning non-dependent intentional poisoning, dependence, drug psychoses, drug was death of cause underlying the when selected are cases definition, this to national 2003-2010 According definition. case B” the “Selection EMCDDA the using from database mortality extracted were deaths drug-induced of Cases level fortheyears2003-2010. regional and national at as available is non-residents among information) deaths drug-induced jure (de base a as regionthe to opposed were occurreddeath on the Data information). facto (de residency with registered is information until 1997. From 1998 onwards, the 10th edition (ICD-10) is used. The mortality used was (ICD-9) edition 9th The (ICD). Death of of Causes and Classification Injuries Diseases, International the to according Community Region) (Walloon French and Region) Brussels-Capital the and Flemish the both (for Flemish the of administrations competent the by coded certificates death the from coming data the centralizes Information, Economic and Statistics Directorate-general – (FPS) Economy Service Public Federal the 1991, Since (GMR). Register Mortality General the from available is deaths drug-induced on data national Belgium, In Drug-related eath s inthegeneralpopulation 4.1. 4. mortalit Drug-related deaths and y ofdrugusers 101 6. Health correlates and consequences 102 6. Health correlates and consequences stimulants. were and opioids both with products associated were deaths is drug-related 14 use common. detected quite polydrug suggest, numbers the Other As (1). GHB and (n=16). (1) PMMA (1), cocaine MDMA and (n=20) amphetamine mainly (n=31), cases the of quarter three in detected were Stimulants heroin. with associated were cases the of Five fentanyl. with case one also but (n=9), morphine and (n=14) methadone mainly detected, were opioids (n=21) cases A total of 40 drug-related deaths were reported to BEWSD in 2013. In half of the ee eetd n css I oe ae MM ws eetd 3 ae also cases for thedeathofatleast6peopleinBelgium2011-2012 3 detected; was MDMA responsible already case, was which contaminant amphetamine an one 4-MA, contained In cases. 8 in detected were amphetamine) (mainly Stimulants case. one only in reported was Heroin cases. these all in detected was methadone as well as cases, seven in detected were In 2012, the BEWSD received 13 reports related to a drug-related death. Opioids systematically not is the toxicology reported totheBEWSDbyalllaboratories performingpost-mortemanalyses. post-mortem on as list, information non-exhaustive a detailed is that this mentioned more be should It some deaths. drug-related with give associated substances Warning (BEWSD) Early Drugs Belgian the on by System reported results toxicology post-mortem The Drug-related eaths regi 4.2. T able 6.7| ** * Sources: Region Belgium Flemish region Brussels Walloon region Brussels: Observatoire delaSantéetduSocialBruxelles-Capitale GMR 2004-2009(FPSEconomy–Directorate-general Statistics andEconomicInformation) W arning Sys Mortality Register(SelectionB)between2004and2011 Number ofdrug-induceddeaths(15-64yrs)basedontheGeneral 2003* 97 43 24 30 tem onDrugs 2004* 74 36 14 24 2005* 105 53 16 36 2006* tered bytheBelgianEarly 86 39 25 22 2007* 118 68 29 21 2008* 146 80 22 44 2009* (Blanckaert etal.,2013) 132 73 19 40 2010* 87 49 24 14 2011 NA NA 16** NA . ih elh care health commonly with contact in most been has or as is users opioid opioids risk high with of majority The overdose drug. involved drug cause a common most is The death yet. drug-induced available of not is decrease this for explanation years old years 25 above people areoverdose by deaths reported the of 90% about and aging is users drug opioid problematic with cohort the that observed is it Europe, In (OST). users opioid for therapy substitution of effect treatment (late) a reflects (without sharing needles), especially when sharing filters and containers and filters sharing when (Palmateer et al., 2014) especially needles), sharing (without paraphernalia sharing when HCV transmitting of risk increased an and needles sharing when HCV for risk high a showed Scotland from study cross-sectional recent A paraphernalia. of sharing the reported still users drug injecting the of behaviour,40-45% risk about injecting this of reduction a through observed as reduction campaigns with focus harm on not sharing needles/syringes While were successful virus. C Hepatitis the especially diseases, infectious born blood of transmission the for mechanism important an remains and is use drug Injecting 5. n a erae thereafter decrease a and stabilisation a by followed 2008/2009, until 2003 between trend increasing an Europe:in countries other in observed also trendWalloonis region.This the for An interesting finding is the decrease of drug-induced deaths in 2010, especially information, drug users. injecting younger develop reach also to can that programmes need counselling and education the emphasizes This programmes. needle and exchange OST as with such programmes infected reduction already harm contacting are before many HCV HIV, than earlier users drug an injecting at among and stage easier much happens transmission users. HCV drug injecting since in Additionally,HIV) (and HCV of risk the prevent to coverage high a out points that interventions need to be provided in combination evidence with each other and with Emerging users. drug injecting among transmission HCV preventing in counselling) and education information, programmes; exchange needle (OST; interventions these of effectiveness the regarding evidence level programmes reduce could exchange interventions needle and OST for reduction strongest evidence behaviour,with risk harm injecting that indicated drugs inject who it occurred less frequent), while other causes such as infectious diseases, liver diseases, infectious as such causes (but other while death frequent), of less occurred cause it important an still are overdoses accidental aged, cohort the As years). (<40 users younger among especially overdose, opioid accidental was still OST with cohort a in death of cause major the that showed colleagues and Degenhardt of of study recent number A increasing 64. of an age the of above tendency deaths drug-induced a observe we and old years 25 above C onclusions (EMCDDA, 2014) (EMCDDA, (Macarthur et al., 2014) al., et (Macarthur ECD, 2014) (EMCDDA, . A review on interventions to prevent HIV and HCV in people . In Belgium, 93% of the overdose deaths were people were deaths overdose the of 93% Belgium, In . ECD, 2013) (EMCDDA, Oe esnbe yohss ih b ta it that be might hypothesis reasonable One . . However, there is comparatively little review- little comparatively is However,there . A ti mmn, n evidence-based an moment, this At . 103 6. Health correlates and consequences 104 6. Health correlates and consequences et al., 2014) al., et involvement is gratefully acknowledged. essential Their feedback. valuable their and collection data their the of for contribution Windelinckx Mrs and Renard Mrs Mostin, Mrs Drieskens, Mrs Mr Sasse, Lombaert, Mr (Ph.D.), Hogge Mr Smet, De Mr thank to want authors The Acknowledgements ot atr nig h tetet wih ih ngt ay rtcie effect mortality on protectiveOST of any thefirst negate might during which treatment, andespecially the OST ending of after month month first the in death of risk a raised is there that observed been has it contrary, the On deaths. overdose opioid ies, adoaclr n rsiaoy iess and importance gained diseases respiratory and cardiovascular disease, time. same the at use drug injecting in behaviours risk of facets different the tackle to interventions of combination a of coverage high no is there as minimal, be certain reducing behaviour.injecting to risky seem consequences However,health in on effects the effective be to seems programmes, exchange needle e.g. coverage, high a with interventions of Implementation documented. sparsely In general, the drug related health consequences are substantial, but also mainly studying these statementsandinformulatingpolicyrecommendations. in helpful be could register a Such lacking. is register OST detailed a moment, this at but regions, the between differs OST of use and organization the Belgium, In effect. protective expected this in result might OST prolonged . Since its introduction, OST has not resulted in a clear decrease of decrease clear a in resulted not has OST introduction, its Since . (Cornish et al., 2010) al., et (Cornish . The authors of this study suggested that suggested study this of authors The . (Degenhardt 2. (section programmes exchange 3.1.) andHCVtreatment amonginjectingdrugusers(IDUs)(section3.2.). needle 2.2.), (section deaths drug-related to responses 2.1.), (section concerns health acute with confronted are who users drug targeting services care crisis namely addressed, are interventions key four particular,In use. drug illegal with associated harm indirect and direct reducing in practices current the of some understand to aims chapter This needs. health please information more (for additional multiple Accordingly,have 6). drugs chapter use to who refer people deaths drug-related and overdoses addiction, problems, health mental emergencies, drug-related diseases, infectious related Drug use is related to several health correlates and consequences, such as drug- 1. E. Plettinckx and P. Blanckaert AND CONSEQUENES RESPONSES TO HEALTH CORRELATES CHAPTER 7. r ls al t ades elh ocrs eoe hy eoe acute become they before concerns health address to able less are drugs using are who people some that out pointed have studies International 2.1. • • • • as antiviral therapy is approved to be safe and effective among this target group. Belgian research encourages HCV treatment among currently injecting drug users, users stillengageinunsafedisposaloftheirinjectingequipment. drug injecting programmes, exchange syringe of initiative positive the Despite years. few last the during doubled nearly have tablets ecstasy in concentration MDMA specialised drugtreatment centres. by hosted centres intervention crisis the to admitted were patients 916 2013, In and reduction ofdrug-related deaths Prevention ofdrug-related emergencies Introduction c Prevention ofdrug-relate d emergenciesthroughrii are service Jcsn et (Jackson

105 7. Responses to health correlates and consequences 106 7. Responses to health correlates and consequences pae s wr i aeae ltl bt le (en g i 3) tne t use to tended 33), is age more frequently (mean andoftenusedmore thanonesubstance. older bit little a average in were of use because opiate admitted were who people users, drug other to compared When Belgium. in CIC’s eight the of one to admitted be to reason main the was use Almost 21% of the patients currently injected drugs. Table 7.1 shows that opiate drug use: 73% were using daily and 91% were using more than one substance. of pattern frequent a showed patients Most years. 31 (85%) was male age mean were the majority and The use. drug illegal of because 2013 in CIC’s the total capacity of 81 patients per day,per Belgium patients over 81 dispersed geographicallyareof capacity total InsuranceCurrentlyDisability a (NIHDI). and with Health CICs, for eight Institute National the treatment. by accredited continued are (CICs), seeking Centres Intervention in Crisis support so-called The as well as crisis, in persons to help short-term immediate offer interventions These 1980. since interventions crisis providing are centres treatment drug specialised services, these Besides users. drug to interventions crisis providing are hospitals general in units) psychiatric emergency (including units psychiatric and hospitals psychiatric 20 than More T communication) Personal NIHDI, Deraedt, (Koen 2014) al., hr-em ae o pol i a rss iuto (a tt o aue psycho- acute of state (“a situation crisis a emotional disequilibrium” in people for care short-term overall provide but disorders, drug-related to restricted not generally are units immediately after the crisis event occurred event crisis the after immediately support psychological and medical non-intrusive but professional, provide to is units intervention crisis these of aim The Belgium. in implemented were users Demographic characteristics andpatternsofusepersons able 7.1| More thanonesubstance(%) Daily consumption(%) Currently injecting(%) P Mean age(Years) Men (%) Demographic characteristics Proportion ofpersonsadmitted(%) Number ofpersonsadmitted Admissions V Source: BTDIregister, 2014 * atterns ofuse ariables Stimulants: definedintheTDIprotocol asamphetamine,MDMAandderivatives andothers . For this reason specific crisis care intervention units targeting drug targeting units intervention care crisis specific reason this For . admitted toCIC’s in2013bysubstance (Lewis andRobertsR.,2001) Opiates 93.0 74.7 34.3 33.3 85.4 40.4 370 . In total, 916 patients were admitted to admitted were patients 916 total, In . Cocaine 92.3 54.5 10.6 30.8 81.0 21.3 195 (James et al., 2013; Roberts, 2005) Roberts, 2013; al., et (James ). Stimulants* 89.8 72.0 25.2 29.9 85.0 13.9 127 Cannabis 84.5 86.4 26.2 92.7 12.0 110 3.5 . These . T 91.2 72.9 20.8 31.4 84.6 100 916 otal in theaverage lengthofstay(3.4daysin2011). S, eiie dprmn) o ban nomto o te osiuin f the of (WIV- constitution Health the on of Public information the obtain Institute to have department) Scientific Medicines ISP, the People at analysed Brussels. then are in These samples Vivendi. Modus at Vivendi sample drug a Modus in hand anonymously to by opportunity coordinated currently and is project active drug-testing small-scale one However, Belgium. in street circulating drugs the of overview up-to-date detailed a obtain to difficult is It from samples post-mortem or clinical of hospital settings. reporting the from enforcement or law Belgian authorities by seized samples drug of analysis the from results BEWSD the by collected information the of Most substances. illegal of domain the in professionally work that organizations of network multi-disciplinary a on relies BEWSD the level, Belgian the at information reliable of collection the For Europol. and (WIV-ISP) and EMCDDA the by Health authorized REITOXnetwork EWS European the of Public partner for Institute Scientific the by Addiction hosted Drug (BMCDDA), and Drugs for is Centre Monitoring BEWSD Belgian The the Belgium. by coordinated in the circulating (NPS) to substances psychoactive contributes new (BEWSD) or Drugs on System prevention of drug-related deaths (DRD) caused by dangerous mixtures Warningof drugs Early Belgian The 2.2.1 2.2. Chain Safety and Environment, personal communication) interventions (< 4 hours) and 72% for night shelters night for 72% and hours) 4 (< interventions short the for 90.7% was degree occupation average The days. 3.7 was stay of length average The drugs. illegal to related were a (41.2%) 1,750 which approximately on of registered admission registerwere admissions every 4,252 of centres for total a stay 2013, the In of basis. monthly length onwards, the 2011 and admissions From of number treatment. the to referral and care health of continuation the to given is attention special days, five these Within a maximumstayoffivedays. with beds crisis 40 total in offer units These participating. are Mons and Namur general hospitals inthecitiesofAntwerp,Brussels,Ghent,Genk,Leuven,Bruges,Liège, of this departments emergency In the of Environment). proximity the and in units Safety crisis nine project, Chain health Food mental Health, and Service use Public substance (Federal joint with patients of management case and crisis for implemented is project pilot national a 2002, October Since drug-related eaths Prevention andreuc System onDrugs Collaboration intheframework oftheBelgianEarlyWarning tion ofnon-fatal overdosean . These data confirm a stable trend (Katia Huard, FPS Health, Food Health, FPS Huard, (Katia

107 7. Responses to health correlates and consequences 108 7. Responses to health correlates and consequences eadn dvlpet o dneos rns bevd mn du users. Nights, Quality drug messages as such among projects post prevention and observed organizations can reduction Harm trends workers dangerous field or drug developments where regarding fora, internet maintain also Eurotox VADand casualties. (additional) prevent to order in Eurotox) (VADand arealerts The relayed the by in-the-field workers points to focal further regional of detectingthelatestpsychoactivesubstances. capable are labs that ensure to is messages informative these of objective main The well. as shared were XLR-11) cannabinoid synthetic the (e.g., compounds specific certain for methods Analysis Belgium. in laboratories participating the of databases spectral spectrometry mass the to updates or substances new of notifications mostly were These laboratories. forensic clinical and toxicological In 2013, the BEWSD sent out around 20 informative messages to its network of about theappearance ofNPSinBelgium,neighbouringcountriesorEurope. to information containing related communications urgent are less are Alerts messages informative 3). to while deaths, or 1 intoxications reported (level and information confirmed messages analytically alert and 0) informative (level between made messages be can distinction A threat. perceived or severity to according categories 4 into divided are BEWSD the by distributed Messages EWS an distributes BEWSD the Belgium, in message (alert)toinformprevention andharmreduction organizations. reported is NPS a or substance high-risk a Whenever network. the of partners the with interaction close in is NPS in Belgium. On the basis of the results included in this database, the BEWSD and substances illegal of effects and composition the about database extensive and unique a manages BEWSD the data), law clinical and intelligence experiences, enforcement consumer on (based information obtained all combining By intoxications) orreports ofNPSuse. potential (from samples territory,clinical Belgium corresponding of lack the and on year each found NPS of can number high This the between customs. discrepancy the the explain by seized substances is of Belgium analysis in the detected through NPS acquired regarding information of lot a example, For 10). chapter to refer please seizures drug about information more (for side supply the on market drug the of providesoverview services, an police fromby dealers seized drugs, of analysis contrast, In circulating. currently are that drugs the of event. dance large-scale overview better providesa settings these at seized samples or drug of analysis The festival a e.g. setting, certain a in used drugs the for screening at aim that 2013 in projects research some initiated BEWSD The or highlydoseddrugs.Sometimes,NPSare analysedaswell. contaminated on information valuable additional receives BEWSD the project, this Through drug. unknown an of consumption after effects bad experienced have users drug when contacted also is Vivendi Modus cases, some In sample. a potent hallucinogenic 5-HT sold as LSD. Nevertheless, these blotters contained the NPS 25I-NBOMe which is were that blotters for warn to network the urged BEWSD the MDMA, Besides work-up. in found were PMMA of quantities lower and MDMA of concentrations high Extremely reported. was case death a 2013, July In substances. other with combination in found also was MDMA reported byourneighbouringcountrytheNetherlandsaswell. observed in MDMA tablets. This phenomenon is not confined to Belgium, but is are that dosages high extremely the explain not does it although ‘revival’, this of cause leading the be to thought is precursormaterial of increased availability The MDMA.HCl. 360mg to up even cases some in seized; were dose standard frequently are MDMA HCl the of twice contained easily the that tablets dosages 2013, In tablets. as ecstasy high in encountered expressed alarming mind, 125mg, in about this is Keeping MDMA salt. of dose clinical standard A recovered. has market MDMA the decline, of years several after that, seems It BEWSD. February in network the to sent Two2013. the were to MDMA confirmed of consumption relatedthe deaths to was tablets MDMA with dosed alert highly first to The regard 10). chapter also (see market drug Belgian MDMA the dosed on highly tablets of presence continuing the is 2013 in trend worrying A 2.2.2. hs aet ae ae vial t te eea pbi truh h BEWSD the through the media. public general with shared are health public the national to risk substantial a to with Cases website. available made are alerts these information, medical privacy-related or sensitive potentially the removing After audience (formore informationabouttheseprojects pleaserefer tochapter3). target specific their to messages these tailor further Breakline and Vitalsounds 6-APB and methylone(twonewsyntheticstimulants)were alsoreported. At the end of the year, an intoxication with methoxetamine and the detection of of amphetamine,PMA,alcohol andTHC. of a fatal incident. Toxicology work-up of blood and urine revealed the presence Additionally, a PMA warning was released in January 2013 after being informed have contributedtotheexactcauseofdeaththispatient. might 25I-NBOMe of consumption the extent what to clear not is it although hospital, the at arrival after even died patient One well. as (DOC) amphetamine 2,5-dimethoxy-4-chloro- contained blotters the of One 2013. in reported were Current trends andobservations 2A agonist. In total, 5 intoxications with 25I-NBOMe oiooy lo ad urine and blood toxicology mortem post

109 7. Responses to health correlates and consequences 110 7. Responses to health correlates and consequences total, 14,905 Stérifix kits were dispatched in the pharmacies participating to the spoons, two flasks of injectable sterile water and harm reduction information. In These euro. kits include two syringes, two alcohol swabs, two dry post-injecting swabs, two 0.5 of cost the at IDUs to kits “Stérifix” distribute to pharmacists network of pharmacists participate in the “Stérifix” project. This project involves A registered. not the is services However,these within distributed equipment. syringes sterile injection of number sterile distributed services other 10 than and ST10) 251,685 were also returned, resulting in a recuperation (see rate of 77.4%. On top, more 2013 in NEP by distributed were syringes total, sterile In 325,147 Mons. and Ciney Liège, Namur, Arlon, Dinant, Charleroi, located Brussels, (with accreditation) in services and mobile offered been fixed-site has official equipment 15 through injecting sterile 2008, Since year. that for data of lack a caused which rearranged, was NEP the of organization the 2008, In 1994. since Vivendi Modus by coordinated are Community,NEP French the In 7.1 and7.2). Figure (see 105% about to rate recuperation the brings This recuperated. were 609,235 pharmacies, and ST10_2014_BE_02)throughNEP also (see distributed were syringes 582,357 total In material. equipment sterile pharmacies distributing 3 ceased although 2013, in services exchange an syringe suggests new This 8 Community.of increase Flemish the in NEP the in and contributed cities 8 villages, over dispersed pharmacies, 28 over addition, In dispersed villages. services, and cities exchange 28 Flemish needle 49 the by within distributed material was injecting Community sterile 2013, to In andcontainers syringes. used foil, bicarbonate, recover water, sterile injectable of flasks swabs, injecting sterile alcohol (Exchange©), of spoons acid, ascorbic filters, distribution syringes, including material, the in helping pharmacists and implemented care professionals health of has network a clinic creates coordinator Freeprovincial The 2001. province), in NEP per the (one Community Flemish the in MSCC the of coordinators other five with cooperation In Antwerp. in located is Free Clinic is one of the Medical and Social Care Centres (MSCC) of Belgium and by and Community Modus VivendifortheFrench Community. Flemish the for Clinic Free by coordinated are NEP These the referral of IDUs to prevention services or treatment options and other health risks, diseases such as overdoses infectious and abscesses. Moreover,of NEP can spread facilitate the prevent to aim programmes these way, and material injecting preventionadditional recuperateand IDUs among material this In needles. used sterile distribute (NEP) programmes exchange Needle 3.1. 3. drug-related infectious diseases Prevention andtreatment of Needle ex change programmes (Windelinckx, 2014) . the needleexchangeservices. of accessibility the increases this as way positive a in syringes sterile distributed are dispersed among more cities and villages which can influence the number of Community Flemish Community.the in services Moreover,exchange needle the Flemish the with comparison in syringes registeredsterile of distributed number the outside pharmacies by distributed needles Stérifix project is not registered in the French of Community, may explain the lower number the that fact The Figure 7.1| network wasnotregistered. whole the through sold effectively equipment injecting sterile of number exact Unfortunately, the distributed. were pads alcohol 271,781 and water plastic of flasks 152,256 spoons, sterile 161,934 also syringes, sterile Besides IDUs. to Stérifix project. As each kit contains 2 syringes, 29,810 syringes were dispatched 2012; Windelinckx,2013;2014 Source: Eurotox, personalcommunicationHogge,2014andVAD, Windelinckx,2011; registered needlesfortheFlemishCommunityconsiderbothsyringeexchangeservicesandpharmacies] [note: thedata2008forFrench Communityare lackingasaresult ofreorganization; thenumberof

Number of needles 100,000 200,000 300,000 400,000 500,000 600,000 700,000 pharmacists between1994and2013 and French Community(FR)byneedleexchangeprogrammes andby Number ofsyringesdistributedandrecuperated intheFlemish(FL) 0

1995 1996 1997

Distributed (FL) Recover 1998 1999

ed (FL) 2000 2001 2002 2003 2004 2005 2006 Distributed (Pharma,FR) Distributed (NEP, Recover 2007 2008 ed (NEP 2009 2010 , FR)

FR) 2011 2012 2013

111 7. Responses to health correlates and consequences 112 7. Responses to health correlates and consequences people who are reached. In 2013, 264 valid questionnaires were filled out filled were questionnaires valid 264 2013, In reached. are the who on image people an form to as well as programme the to of possible usefulness the is weight NEP,it Flemish the of survey anonymous annually an on Based Figure 7.2| (Windelinckx, 2014) (Windelinckx, start to inject at a young age, the mean age shows that people are injecting are people that shows NEP age mean the the of age, clients young most a at As inject 35. to is start age average the and house a own or rent (52%) respondents the of Half (80%). men are survey the of participants Most to chapter4(section3.1)of this report. general population. the for infection) consequent and injury needle-stick (e.g. risks the reducing in recuperation syringe of possibility the endorses NEP the of success proven The is increasing in the Flemish Community and decreasing in the French Community. the Flemish Community (Figure 7.1). The recuperation rate (Figure 7.2) however, the French Community whereas the number is declining again since two years in Compared to the past years, the number of distributed needles remains stable in 2012; Windelinckx,2013;2014 Source: Eurotox, personalcommunicationHogge,2014andVAD, Windelinckx,2011; [note: thedata2008forFrench Communityare lackingasaresult ofreorganization]

Recuperation rate (%) 100 110 10 20 30 40 50 60 70 80 90 0 and 2013 Programmes (NEP)intheFlemishandrench Communitybetween1997 Recuperation rate ofthesyringesdistributedbyNeedleExchange

. For a detailed description of the used methodology, we refer methodology,we used the of description detailed a For . 1997 1998 1999

Fr Flemish Community 2000 ench Community 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 reinfection this in uptake Treatmentgroup remains low due to therapy. concerns about poor compliance, adverse events and antiviral from excluded often is groupinfections, HCV this new for group risk important most the are IDUs that Despite adults among transplantation liver for cause common most the is HCV Consequently, advanced. already is disease liver the until non-specific are HCV of symptoms The years. many of period a over slowly progresses typically HCV obnto therapy combination Interferon/Ribavirin of months 12 to 6 comprises regimen treatment typical A because it is time-consuming and expensive and time-consuming is it because Practitioners claim that current IDUs have a poor compliance with HCV treatment 2012) (HCV) infections mostly because of injecting equipment sharing practices sharing equipment injecting of because mostly infections (HCV) be underestimated. Injecting drug users are at increased risk of Hepatitis C Virus not should that health public for impact an with disease a is C Chronichepatitis 3.2. (Crawford andBath,2013) 2002) into garbage bins or on the streetthe on or bins garbage into in unsafe disposal of their injecting equipment, e.g. throwing uncapped needles large the despite Also, reached. amount not of properly returned used is needles, 19% of the groupIDUs indicated to engage latter the users, drug injecting minor know to claimed respondents the of for 12% Although programmesyear. one these than used less only users) NEP of 3 in 1 (almost proportion this meaning clients, reachednew Community 27% Flemish the in NEP the 2013, In pharmacies. in materials injecting regularly buying are NEP of use making IDUs the of 66% as materials, injecting of distribution the in role Nevertheless, permanent an play pharmacists services. equipment exchange syringe injecting separate or sterile treatment obtain drug through people Most equipment. injecting sterile disperse to important really are friends that out pointed results Besides, (53%). programmes exchange syringe mostly through low threshold drug about treatment (63%) and through acquaintances information receive IDUs that seems It use polydrug and use drug among thetarget group. injecting regular indicate results the Moreover, initiatives. reduction harm and risk with touch in get they before years several results aboutriskbehaviour, werefer tochapter6(section2.3.1)ofthisreport. elhae okr hv be caatrsd ih itut n discrimination and mistrust with characterised been have workers healthcare . use. needle of year one within infected are IDUs of 65% Approximately . Hepatitis CVirutreatment amonginjec (Backmund et al., 2001; Robaeys et al., 2013) al., et Robaeys 2001; al., et (Backmund . Rbes t l, 2013) al., et (Robaeys (Windelinckx, 2014) (Windelinckx, A 4 t 7% f omr Ds know IDUs former of 73% to 45 As . (Backmund et al., 2001; Sylvestre, 2002) Sylvestre, 2001; al., et (Backmund . Contacts between IDUs and IDUs between Contacts . . Forthe . of discussion further ting druguser (Sylvestre, (WHO, .

113 7. Responses to health correlates and consequences 114 7. Responses to health correlates and consequences uptake andimprove serviceprovision hs en ta IU dnt ae o e xldd rm C treatment HCV from excluded be to effective and safe have be to proved also but don’t feasible only not is it IDUs as immediately, that means This rates afterasuccessfulHCVtreatment reinfection are alsolow. reported Moreover, completion. treatment the of level the lowers hand, other the on use, drug Daily completion. treatment the on impact little drugs is not required to limit the progression of the HCV disease HCV the of progression the limit to required not is drugs injecting of research,cessation Belgian published recently on based addition, In 2013) access to peer support and social support services is also of great importance great of also is services support social and support peer to patient, access the of needs health complex the Considering required. are strategies reduction harm and appointments) regular maintain to (agreement treatment the factors, risk the disease, the of course the about education pre-therapeutic treatment, the of context the In successfully. treatment HCV provide in to patient order the of psychological) and physical (both factors clinical and multidisciplinary setting social a situation, housing for level, educational need the of a evaluation the for is approach there account, into this Taken individually. netos iess n rsn ae icse i scin o catr o this of 9 chapter of 6 section report. in discussed are drug-related prison, reduce in to diseases infectious aiming initiatives, treatment and projects Prevention 3.3. (Robaeys et al., 2013) 2013) al., et (Robaeys current IDUs is feasible on the basis of their compliance rate of treatment HCV 12 that proves therapy.This to antiviral the to 6 response sustained a only of showed drugs period recentlyillegal inject a to until continue for who patients was drug-free Nevertheless, months. lived treatment have HCV IDUs year, former a if recommended half within relapse drug a . Recent and occasional drug use during treatment seemed to have only a only have to seemed treatment during use drug occasional and Recent . diseae inprion Prevention andtreatment ofdrug-related infec . These services may increase treatment knowledge, treatment Teeoe te pin f ramn hs o e assessed be to has treatment of option the Therefore, . (Crawford andBath,2013) . (Backmund et al., 2001) tious (Robaeys et al., et (Robaeys . groups for these initiatives these for groups and individuals who have had a prior non-fatal overdose may be potential target are users polydrug who people, Homeless often. more individuals overdoses witness inappropriately to likely for more recommended intervene is training prevention to overdose As such, intervene. to likely opportunities few a only more had have who people are witnessed to compared have frequently, who more individuals that is overdoses suggests training study prevention American fatality An needed. overdose targeted for attention Additionally, importance. illegal of drugs and NPS composition through drug prevention and harm reduction services, is of great dangerous possible the about awareness Raising user. the to danger additional an include substances other These tablets. ecstasy in found were MDMA than other substances several Moreover, overdose. easily can content, MDMA high tablet’s a of unaware are that Users situations. lethal even and dangerous potential to leading doubled, nearly has tablets ecstasy in last years. Compared to 2009, the standard the amount of for 125mg MDMA BEWSD processed the by monitored closely been has big phenomenon This a concern. remains 2013 in tablets ecstasy in detected content MDMA raising The the lackofclinicalintoxicationswiththesesubstances. discrepancy between the high numbers of NPS seized every year in Belgium and to suited the explain can This market. drug better the of side supply the of overview an provide are and seizures seized large-scale Drugs frequently streets. are services the police on by circulating drugs of composition the regarding services, analysis of drugs found on drug users might provide better information recreationalpolice in by screeningused seized Contrarydrugs drugs settings. to of goal the with BEWSD, the severalresearchby 2013 projectswereinitiated In crisis are regular polydrugusersand40%are admittedbecauseofopiateuse. a experiencing patients the of offer. Most large sufficiently a indicates services these of degree occupation the about information The concerns. health related drug- on grip drug- acute treat better to available are services a various those, Among harms. related get to implemented are Belgium in initiatives Several 4. willing to participate in NEP and require repeated convincing to be involved in involved be to convincing repeated require and NEP in participate to willing always not are Community.Unfortunately,pharmacies Flemish the in observed was programme the in participating pharmacies three of reduction sector.a the 2013, in In cuts budget by caused means financial of lack a to due be may syringes efficiency distributed of number the the of to decrease general The attention needed. is continuing NEP of overdoses, of prevention the to Next national leveltoassessthesituationinBelgium. at needed is research scientific regions, geographical other for representative C onclusions (Bohnert et al., 2012) al., et (Bohnert . Nevertheless, as this study is not is study this as Nevertheless, .

115 7. Responses to health correlates and consequences 116 7. Responses to health correlates and consequences users. drug injecting of treatment HCV in progress further of base the at lies strategy injecting practices amongthispopulation and drugs about information disseminate to channel key a be may media social harm knowledge and about when, where and how to reach this target group. In addition, the prevention improve can mapping community-based Social exist. don’t probably where organizations reduction areas rural) target and to advantage the (suburban have services These services. mobile street or outreach work targeted throughcorner e.g. well, as up forced be may IDUs young more reach particularly to efforts diseases, communicable with infected be to year risky most the is drugs injecting of programmes. year exchange first Asthe that known is syringe with contact into coming It before years few a programmes.for using already are IDUs provided the reach to triggered be may IDUs be can programmes exchange syringe encouraged for further oral with advertising in their contact environment. In that way, in familiar already are that IDUs recommended. is public general the for infection) consequent and injury needle-stick (e.g. risks unsafe an in disposed still be way.the reducerecuperationConsequently, to syringe of value the highlighting may syringes that fact the underlines syringes recovered of number decreasing or stable The initiatives. reduction harm these their valuable feedback. The authors would also like to specifically thank the thank specifically laboratories participatingintheBEWSD laboratory network. to like also would authors and The collection feedback. data valuable the their of contribution their for Windelinckx Mrs and Huard Mrs Schrooten, Mr Deraedt, Mr (Ph.D.), Hogge Mr thank to want authors The Acknowledgements raiain a well as organizations support social and support peer to referpatients to Furthermore, important is it housing. and education as the such domains to life other only to also not but factors, given clinical be must attention and required is approach individual applying also and integrated an of cases, these In IDUs. infected in antiretroviralHCV of therapy importance the stresses and of patients these safety in and treatment the effectiveness the indicated however, research, Recent remain. reinfection and events adverse compliance, poor as about concerns low still are remainsthere diseases infectious concerning IDUs of uptake treatment The Cafr ad ah 2013) Bath, and (Crawford (Valdiserri etal.,2014) Cneunl, multidisciplinary a Consequently, . . policy groupsrisk stressedis declarationcommon the in integratedthe of part as drug 2012) groups such as homeless people, sex workers and prisoners will be presented be will prisoners and workers sex people, homeless as such groups excluded vulnerable, different in use substance the Also, 2.1). (section registers population general with comparison in (TDI) Indicator Demand Treatment the through registered drug-users among exclusion social at look first will chapter this level, educational and employment housing, of problems on focus a With can control users which choice lifestyle-related a of consequence is the be dependence to believed drug often because partly conditions, social and health other many than stigma greater with associated indeed is dependence Drug stigmatisation. Brotherhood, 2012) Brotherhood, unmet social needs concerning housing, education and employment and education housing, concerning needs social unmet have Europe in users of drug problem result many a 4), chapter as (see use harms substance their social and psychological physical, experiencing to Next 1. J. Antoine REINTEGRATION SOCIAL ORRELATES ANDSOCIAL CHAPTER 8. ramn fcsd n hraooia ad scooil ucms The aim ofintegrating the outcomes. with currentcommunity’ or the psychosocial former probleminto user drug intervention social and as ‘any this pharmacological defines EMCDDA on focused treatment traditional drug the than wider from is reintegration social recovery of scope The EU States. full all Member across defined of or used consistently aspect is that term key a not is a it dependency, is reintegration’ ‘social Although • • . In Belgium, the practice of social reintegration with a focus on specific on focus a with reintegration social of practice the Belgium, In . people. homeless for accommodation for solution unconditional an offers and started 2013 project in First Housing the of aim the is housing by reintegration Social or low-educatedcompared tothegeneral population. unemployed are people much as twice almost population, user drug the Among (Interministeriële Conferentie Drugs,2010) Introduction (Livingston etal.,2012) . Moreover, drug users can also meet structural barriers such as such barriers structural meet also Moreover,can . users drug . . (Sumnall and Brotherhood,and (Sumnall (Sumnall and (Sumnall

117 8. Social correlates and social reintegration 118 8. Social correlates and social reintegration treatment Smal n Bohrod 2012) Brotherhood, and (Sumnall wellbeing economic and social of development the in factor key a is Education 2.1.1. the level, educational the indicator: working statusandthehousingsituation. the by illustrated collected be can aspects patients three these through of exclusion Social centres. treatment with new every contact on in substances of information use problematic a with gathers patients of episode 5) treatment chapter also (see registration TDI The Socialex 2.1. social study exclusion amongdrugaddicts to and populations excluded socially among use drug analyse to not does exclusion social both possible is as it account, into Takingcomplexity users. this drug all to one, applies causal a necessarily not is exclusion social and use drug between relation the Nevertheless, well. as reason use a drug starting be for can marginalisation social of process the hand, other the on but social of cause a or consequence a exclusion. On one hand, drug use either may cause a deterioration of living conditions, as considered be could use Drug 2. Figure 8.1 plots the proportion of people with a low educational level in the in population level generaleducational low a with people of proportion the plots 8.1 Figure examples of initiatives supporting people from a social point of view (section 3). based on specific studies (section 2.2). A second part of the chapter will describe use drug against protecting in engagement and attendance school linking evidence 30.5%. Thisproportion isdecreasing since2011inbothpopulations. is percentage this use, substance for treatment entering people of the population For education. of degree primary a only or degree no has older), or years (Edmondsetal.,2005) Social ex Educational level (WIV-ISP,2014) clusion amongdruguer FS cnm, 2014) Economy, (FPS clusion anddruguse . . In 2013, 17.5% of the general Belgian population (15 population Belgian general the of 17.5% 2013, In . Mroe, nentoa rsac sos strong a shows research international Moreover, . (EMCDDA, 2003) n i te ouain f rg sr in users drug of population the in and . (Henkel, 2011) association the understood fully not describing thus and examined insufficiently are influence of direction evidence of amount and mechanisms exact the unemployment, and largeuse drug problematic between a is there Although 2.1.2. Figure 8.1| in treatment. are who persons for decreasing slightly is rate this whereasincreasing slightly is 2011, however, the proportion of unemployed persons in Since the employment. general in population integrated less are treatment in users drug that idea the supports This treatment. in population user drug the in 19.8% and population are general the in treatedpopulation 8.4% is rate This job. a for looking the actively people of proportion and population the representing is the rategeneral unemployment The rates. unemployment on compared both 8.2 figure In Source: FPSEconomy, 2014;WIV-ISP, 2014

% of the population with no or primary education level 40 10 15 20 25 30 35 Working status 0 5 . older) between2011and2013 in thegeneral populationandthedruguser(15years Evolution oftheproportion ofpeoplewithalowereducationallevel 2011 2012 2013 population Gener in tr Drug user eatment al

119 8. Social correlates and social reintegration 120 8. Social correlates and social reintegration no similarindicatorsinthegeneral populationtocompare thesenumberswith. Thereareetc.). (hospital, are incarceratedinstitution patients an the residein or unstable an in living Moreover,of 11.5%. 5.5% is people) homeless patients also (including accommodation of percentage the database, TDI the on Based with thesespecificgroups ofpeople. working centre specialised a of level the at studies scale small more as well as scarce, the studies taken into account can be large scale studies at national level relatively is information such Because below. presented are Belgium in groups recentmost The differentin use drug about numbers available excluded socially Druguseinocially ex 2.2. of achieving the employment enhances stability housing that recognised also is It system. justice criminal with contacts or problems health in exclusion, disruption school childhood, family experiencing as inequalities and from disadvantages result same often the and reinforcing mutually as seen are These needs. housing other and homelessness use, substance between interaction complex a is There 2.1.3. Figure 8.2| (De Boyseretal.,2010) centres for social welfare were often confronted with a drug that or public alcohol Brussels addiction and showed Walloon the of Belgium, 58.9% and Flemish in the of clients people of 81.7% homeless on 2010 in study a of results The 2.2.1. Source: FPSEconomy, 2014;WIV-ISP, 2014

% of the population with no or primary education level 30 10 15 20 25 0 5 Housing situation Homeless people the drug-userpopulation(15-64years)between2011and2013 Evolution oftheunemploymentrate inthegeneral populationandin (Pleace, 2008;SumnallandBrotherhood, 2012) 2011 . 2012 clude groups 2013 . population) r Unemployment in tr r Unemployment ate (Gener ate (Drugusers eatment) al et al., 2011) al., et Malderen, 2011) the different organizations hostingtheseprojects. of websites the from obtained generally information of collection a is overview to presented The projects. of dedicated list exhaustive an provide specifically to than rather reintegrationusers, drug social on illustrate developments to of report this variety of the intention the is the It country. in The the initiatives of life. original regions or different social interesting recent, and most the employment show to training, is objective and education housing, as such different approaches are presented targeting the main social exclusion problems social topic, this improve on actions and concern to Tothe illustrateusers. drug for reintegration up set are groups risk different targeting initiatives Several 3. 30% to amounted prison in use drug of prevalence the while 60% around was use prevalence life-time 2010), in (stopped use drug on prisons Belgian in survey biyearly the From prisoners. among issue important an also is use Drug 2.2.3. A study about drug use among sex workers took place in Belgium in 2011 2.2.2. et al. Decorte of study the of results the to similar is which 9.7% heroine and 18.3% was cocaine using workers sex association of percentage The alcohol. or drugs using were the workers by sex the of supported 35.4% results. higher slightly workers show Charleroi, in sex P’ ‘Espace 148 among results recent More (also 3.4%crack), 7.2%forheroin and3.8%foramphetamine. had been using cannabis during the last month, compared to 16.7% for cocaine causal reason (16.7%), right after finance problems, health or mental health ormental problems andadministrative problems health problems, finance after right (16.7%), reason causal mentioned commonly most fifth the as given was drugs) illicit and alcohol both (including Addiction situation. emergency social a to people these brought that working with homeless people), listed in Brussels the observed causes of rupture More recently, for the winter period of 2013-2014, ‘Samu social’ (an organization (Espace P, 2014) Social reintegration Prison Sex workers . The results showed that one in four (25.9%) of the 528 respondents528 the of (25.9%) four in one that resultsshowed The . . . (Samusocial asbl,2014) . (Decorte (Van

121 8. Social correlates and social reintegration 122 8. Social correlates and social reintegration n prmns ctee truhu a omnt. poet f supportive attendance andotherbarrierstohousingentrance of project A community. sobriety,requirementsfor the removes First treatment Housing as such housing a provided throughout is scattered Housing apartments employment. in physical and and education, mental abuse, of areas substance the health, in services treatment supportive with this combine subsequently then to action, primary a as housing provide to principle the by guided is nineties, the in USA the in launched model, First Housing The (Housing FirstBelgium,2014) First Housing of principles the on based and Charleroi) Liège, Gent, Antwerp, was project national new a 2013, launched to be endured for 2 August years in the five biggest cities of Belgium in (Brussels, initiatives, three these Besides T staff alsosupportsclientsinfurtherorientationtomore appropriate housing. the projects, these Within Table8.1). (see demands housing pressing most the Many initiatives on housing aim at providing a temporary solution for those with 3.1.1. 3.1. (12.5%) andmedicines cannabis (18.8%), heroine with also but (40.0%) alcohol with mainly problem; group addiction control an had a 50% people, 3) those Among and accommodation. fixed streets a in the living on living group control a Housing 2) the project, in First participating group experimental an 1) groups: 3 in recruited were people 300 of total A launched. was project research a initiative, this of impact the evaluate to order In project. pilot a still is First Housing Belgium, In able 8.1| Source: VilledeCharleroi, 2014;Goessens,OCMWAntwerpen,2014 Charleroi Charleroi; Ulyssenightshelter; Comme cheznousandcityof Non-profit association Crisis centre; Brussels Non-profit association Transit; Antwerp welfare Antwerp;DeBiekorf; Public centres forsocial Name oftheinitiative;City Institution incharge; Housing Temporary housingandemergency accommodation initiatives Examples oftemporary housingandemergency accommodation . addicted people,free ofcharge. which isintegrated inthenetworkofsupportforhomelessor 12 bedsavailableforadultshavinganurgent housingdifficulty, support andorientationare alsoavailable;free ofcharge. option untilthepersonfindsalong-termsolution.Administrative 21 bedsavailablefordrugusers,providing ashorttermhousing shower, breakfast, soup)-€2,5/night. homeless peoplewithanaddictionorpsychiatricproblems (incl. 54 bedsavailableasatemporary housingsolutionforadult Description (Housing FirstBelgium,2014) (Larimer etal.,2009) . . Support for drug users that require assistance in finding long-term finding in assistance require that users drug accommodation isprovided through several services(Table 8.3). for Support 3.1.3. T live to able yet not living are describedinTable 8.2. are supported as who well as clients housing transitional including independently, target completely to provided services Housing 3.1.2. T h rsls hc wl dsrb te btce ad ak udlns o good for guidelines mark and obstacles practice ofHousingFirstinBelgium,are foreseen forJune2015. the describe will which results The able 8.2| able 8.3| Source: DeKiem,2014; Goessens,2014;Thaïsasbl,2014 Welcome house;Liège Non-profit associationThaïs; Supervised flats;Brussels Non-profit association Transit; Ghent De Kiem;Halfwayhouse; Name oftheinitiative;City Institution incharge; Source: CPAS delavilleBruxelles, 2014;LeProjet Lamaasbl,2014;Thaïs2014 of housing;Liège Association forthepromotion Non-profit associationThaïs; Projet Lama;'Hestia';Brussels support service;Brussels welfare Brussels;Psychosocial Public centres forsocial Name oftheinitiative;City Institution incharge; Support infindinglong-termaccommodation Supported housing,halfwayhousesandsupportedliving living initiatives Examples ofsupportedhousing,halfwayhousesand Examples ofinitiativesinfindinglong-termaccommodation housing, health and family situation of the drug user or sex-worker. psychosocial supportisprovided togenerally improve thesocial, 9 individualplacesare preferably allocatedtofamilies.A should activelylookfornewhousing. pay therent. Whilebenefittingfrom asocialaccompaniment,they be extendable).Clientsare required tobeindependentandable 8 individuals flats are available for renting for 3 months (period can social networkandfinancialsupport. Accent isputonworkingsituation,education,developmentofa programme canbenefitfrom a6-8months residential aftercare. Drug usersthathavecompletedthetherapeutic community Description years lease. support. As from 2014,thefirsthouseswillbeavailablefora9 through decenthousing,administrative, technicalandjudicial A newinitiativeinWallonia whichpromotes socialreintegration society. creating apersonalproject togetherandreintegrate themin is alsoworkingathelpingthepatientwithadministrative tasks, Besides from thestudiosavailableforshorttermhousing,Hestia help infindingahousingsolution. medical andday-to-dayinitiatives.Oneofthemainobjectivesisto Service aimingathelpingdrug-usersintheiradministrative, social, Description

123 8. Social correlates and social reintegration 124 8. Social correlates and social reintegration drug users. focuses on special interventions that provide a supportive work environment for 8.5 Table barriers. significant are there through practice in However, market means. traditional employment the access could users drug problem theory, In 3.3. T efficacy, improve commitment to work,etc. self- increase strategies, employment support that programmes of variety wide a incorporates training Vocational qualifications. recognised nationally gain to education for formalized interventions to refers education whereby the client are faced with examinations and other forms of assessments Education and users. training drug problem vocational unemployed on focuses 8.4 Table 3.2. able 8.4| Source: Free Clinic,2014;OCMWGent,Trempoline asbl,2014 clinic; 'Buro Actief'; Antwerp Non-profit associationFree- Charleroi professional reintegration; psychological; Socialand Trempoline; Programme for Ghent welfare Ghent;'Perspectief'; Public centres forsocial Name oftheinitiative;City Institution incharge; Employment Educ Examples ofeducationandtraining initiatives ation &training initiative ispartofanintegrated care programme. anyway onalow-threshold levelinsmallworkassignments.This Buro Actief provides thepossibilityfordruguserstoengage etc. for workbyamappingoftheircompetencesorpossibledifficulties, language andmathematicsorhorticulture. Theyare alsoprepared therapeutic residential programme tofollowtraining ininformatics, This programme offersanopportunityfordrugusersfrom the new perspectives possibilities fortheirworksituationandguidancefollow-upof from anevaluationoftheiractualsituation,aproposition of Persons withacurrent orprevious addictionproblem canbenefit Description T life of quality the improving in role important an play recreation social and physical that shown has Research 3.4. T rm tesu stain. al 86 ecie sm o te rjcs e u in up set projects the of Belgium inorder toimprove involvementofdrugusersinsociallifeactivities. some describes 8.6 Table situations. stressful from self-esteem, distraction improved and anxiety and depression of reduced gain), effects health, weight (e.g., medication side reduced physical levels, activity improved and energy increased in mood, improved result may and levels able 8.6| able 8.5| Start-MASS; Liège Medical socialcare centre La trace; Brussels Antwerp Free Clinic;Activation project; Name oftheinitiative;City Institution incharge; Source: ModusVivendi, 2013;Trempoline asbl,2014;Weerwerk, 2014 Charleroi professional reintegration; psychosocial, socialand Trempoline; Programme for ; Brussels Modus Vivendi;Peer support Antwerp WeerWerk; Ghentand Name oftheinitiative;City Institution incharge; Source: Free Clinic,2014; LaTrace asbl,2014;Start-MASS, 2014 Leisure a Examples ofemploymentinitiatives Examples ofemploymentinitiatives c tivities activities thantheirsubstanceuse. activities withtheirpatientsinorder tomotivatethemother The treatment centre organizes sports,cookingsessionsorartistic provide psycho-socialfollow-uparound theseactivities. create acommonchallenge,tostimulatemutualassistance andto locations forareasonable costtodrugusers.Theobjective isto This centre organizes hikingtoursofseveral daysatdifferent events order toactivatethemandforce themtobeinvolvedinsmall meetings) allowingdruguserstoparticipatefree projects in This project provides opportunitiesofsocialactivities(music,sport, Description are drugusersintreatment inTrempoline. or constructiontasks)foramaximumof1year. Thetarget group This programme offersjobopportunities(administrative, gardening support atdifferent places. and are obligedtofollowatraining tobeallowedprovide peer towards theirpeers.Drugusersare recruited forashortperiod reduction projects, prevention programmes orexpertisemeetings The expertiseandcooperation ofdrugusersisusefulforharm- social problems receive additionalsupporttoaddress druguse,financialandother to reintegrate slowlyinasocialenterprisebusiness.Participants ‘Weerwerk’ givesthe opportunity tocurrent orformerdrugusers Description (Fountain et al., 2000) al., et (Fountain . This can benefit at different at benefit can This .

125 8. Social correlates and social reintegration 126 8. Social correlates and social reintegration life. social a reintegrate to (ex-)users for challenges and opportunities provide to up set been also have people using Finally, drug targeting initiatives leisure specific in findingastableaccommodation. example, For needs. of help also may employment regular types and work to access improve different may education between interaction strong a also is there addition, In topics. specific on trainings or jobs paid small throughto work access regain to drugs use who people allow initiatives employment Next, atfinding aims of 2013 unconditional accommodationsolutionforhomelesspeople. project first” “Housing started newly The temporary solutions. finding from varies objective Their housing solutions in an emergency situation to more long-term accommodation ones. common initiatives most housing reinsertion, the social are concerning initiatives up set all Among frequently is the available consumption the drug therefore, Nevertheless, mentioned amonghomelesspeople,sexworkersorprisoners. and fragmented. studied is been information recently only in groups excluded are socially few) Belgium (a in consumption drug of condition the as the streets. on or accommodation unstable an in living are treatment in users drug the of comparison to the general population. Furthermore, a non-negligible proportion social in situation on problematic socially a in much risk as twice themselves find using higher drug much a has treatment exclusion. When looking at the in education level and working status situation, the population using drug The overview onsocio-economiccharacteristics ofdrugusers. is information this Although often only available for the subgroup of users entering treatment, it provides an users. drug by encountered isolation social and Social exclusion can be defined as problems of housing, education, employment 4. ioa, r utr, r a Buhue M Vne ad s hie fr the for Theizen Ms Mr and Joosen, information provided. Theiressential involvementisgratefully Vinken acknowledged. Mr Mr Bouchaute, Fanelli, Van Mr Mr Ruyters, Dheendene, Mr Mr Nicolas, thank to like would author The Acknowledgements C onclusions reintegration ofdrugusersafterrelease from prison. related health issues in prisons, while section 6 describes the services to improve the examine sections two drug situation last in prisons: section 5 covers information on the The responses to drug- 4.2). (section level court and prosecution (youth) at cases drug-related and 4.1) (section prison to alternatives 3), (section of influence reoffending the and crime drug-related of prevention the 2.2), (section drugs illegal under driving to related offences drug- 2.1), the (section of offences overview law an provides chapter this priorities, these to According and cannabis and driving under the influence of alcohol and drugs areput and drugs alcohol of forward asleadingtopics influence the under driving and cannabis and dealing, drug 2012-2015, period drugs synthetic the of trafficking and production the cocaine, of export and import For importance. high of are priorities these crime, drug-related regarding actors important most the of one is police Belgian the As Belgium. in police federal and local the of competences the of aspects different prioritises plan safety national This Justice. and Affairs Home of federalMinister the by 2012 in implemented was plan safety national new A 1. E. Plettinckx DRUG-RELATED CRIMEANDPRISON DRUG-RELATED CRIME,PREVENTIONOF CHAPTER 9. • • • • system is twice as high as the cases at the level of the prosecutor of firstprosecution line youth court. the entering cases doping-related or drug- of prevalence The the housesofjustice. over 10% compared to the total number of drug-related mandate assignments at with declined surveillance electronic for mandates of proportion the years, 4 In remains themostwanteddrug. marihuana 2013, in cannabis: of popularity the confirm data enforcement Law The numberoftrade-related druglawoffencesisincreasing. Introduction (Turtelboom andMilquet, 2012) .

127 9. Drug-related crime, prevention of drug- related crime and prison 128 9. Drug-related crime, prevention of drug- related crime and prison trafficking, or production of drugs). The proportion of drug-related offences of drug-related raised to4.8%.Thiswasthefirstincrease ofprevalence infouryears. The proportion trade, of drugs). use), (and production or (possession trafficking, offences law drug concerned 47,269 which of registered, were offences criminal 979,020 of total a 2013, In on. 2010 from reported only are numbers reason, this For offences. law drug of number total the of overestimation an in resulted which account, into taken separately often drug use implies the possession of drugs. Before 2010, use and possession were use and possession are reported together as one offence since 2010, as individual Drug 2013. to 2010 period the during committed offences law drug of number 2013) Figure 9.1| crimes various describe and police federal figuresThese priorities. identifying in are on and based local the both of reports makers policy support to statistics publishes regularly police federal Belgian The Druglaw offences 2.1. 2. Source: CGOP/BFederal Police -CGOP/policydata,2014 . Figure 9.1 illustrates the total number of offences in relation to the total the to relation in offences of number total the illustrates 9.1 Figure .

Total number of offences Drug-related crime 1,000,000 1,100,000 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 between 2010and2013 Drug lawoffencesinrelation tothetotalnumberoflawoffences 0 1.025.117 2010 4.7 1.061.227 2011 4.5 Fdrl Plte CO / Beleidsgegevens, / CGOP - Politie (Federale 1.035.567 2012 4.3 979.020 2013 4.8 0 1 2 3 4 5 6 7 8 9 10

Proportion drug-related offences (%) of thedruglawoffencesbycategory. D’Huyvetter, 2014) Beleidsgegevens, 2013) Beleidsgegevens, presence of the money presumably refers to the illegal sale activities sale illegal the to refers presumably money the of presence drugs. illegal of dealers carry around more money in one’s pockets than the average citizen. The possession for charge only However, the analysis of police charges and public prosecutor files revealed that can be police can dealing the for often evidence demonstrated, no when are interference, upon that dealers known is that it as indicated precaution this use Antwerp They them. with drugs of amounts small very in only carrying ecstasy and amphetamines cocaine, cannabis, of amounts) user of sale (the trade retail about study case A declining. The registered druglawoffencesrelated totrade are stable. is law export and drug import of to related proportion forces police The by registered 2013. offences in 3.3% reached and increasing of is production drugs of prevalence the Also 73.4%. of record a reached prevalence the 2013, In drugs. evolution of possession and the use the by to related offences determined law drug mainly in is (n=44,108) 2012 with comparison in (n=47,269) 2013 in registered offences drug-related of increase observed The Figure 9.2| pcfig ifrn ctgre sc a ue n pseso, mot and import possession, and drugs use illicit by of trafficking offences as and production law trade, such drug export, about categories reports different police specifying federal Belgian he year, Every Source: CGOP/BFederal Police -CGOP/policydata,2014 Proportion of drug law offences (%) 10 20 30 40 50 60 70 80 0 Proportion ofdruglawoffencesbycategorybetween2010and2013 2010 . . Figure 9.2 describes the evolution between 2010 and 2013 and 2010 between evolution the describes 9.2 Figure . 2011 2012 2013 Fdrl Plte CO / CGOP - Politie (Federale Other Pr Import andexport Tr Po ade oduction ssession (Decorte and (Decorte

129 9. Drug-related crime, prevention of drug- related crime and prison 130 9. Drug-related crime, prevention of drug- related crime and prison Figure 9.3| since three years. trendstable a shows drugs’ ‘other category The years. past the decreasingover are offences law Heroine-related cocaine. regarding offences law for found is trend similar A increase. slight a show offences law ecstasy-related registered the time, same the Regarding years. of past the in number stable remained (Meth)amphetamine-relatedoffences record law reported. a was 2013, offences In cannabis-related years. 30,113 the increase over slight a offences show data cannabis-related These of drugs. to other to 8% 5% heroin, and to crack 6% or ecstasy,cocaine to 3% (meth)amphetamine, to to related 7% be cannabis, to offences law drug these of 71% reported police federal The total numberofdruglawoffencesinFigure 9.1and9.2. the total number of drug law offences mentioned in Figure 9.3 is lower than the feedback on these results, this sometimes takes several months. For this reason, receives police federal the cases the of 90% laboratory.about a in by Although what know kind of illicit drug is involved. As such, always some seizures request additional analyses not do police federal and local the Nevertheless, months. drugs as well (Figure 9.3) and extract data from the national of database every two type by offences law drug study police federal the of analysts strategic The Source: Federal police * The figures indicatetheproportion (%)in relation tothetotal.

mushrooms LSD, benzodiazepine, phenethylline, codeine, GHB, ketamine, khat, methadone, morphine, opium and Number of drug law offences 10,000 15,000 20,000 25,000 30,000 5,000 0

70.4 drug Drug lawoffencesasmainoffencebetween2010and2013,bytypeof

2010 7.8 1.6 8.6 8.9 2.7

70.0

2011 7.4 2.2 6.8 8.8 4.8

69.1

2012 7.4 2.8 6.3 9.6 4.9

71.4

2013 7.1 3.1 5.5 8.4 4.6 Other* Cocaine/cr Her Ecstasy (Meth)amphetamine Cannabis oin ack injured drivers that test positive for at least one psychoactive substance psychoactive one least of at for positive prevalence test that drivers injuredhighest the with countries the of one as considered is Belgium et al., 2013) al., et 2.2.1. (Ricour, Personal communication, 2011) communication, (Ricour,Personal 2013) al., et (Hels accidents severe injury of risk increases the drugs of influence the under Driving 2.2. influence of a combination of amphetamine and cocaine, amphetamine and amphetamine opiates, andamphetamine,cocainecannabis. andcocaine, ofamphetamine acombination of influence the under drivers of persons of group the of increase Proportionally,an there’s the in drugs illegal past three years. Only the combined use of of opiates and cocaine is less observed. influence the under driving of tests positive of number different figures increasing combined These an 4%. indicate in opiates and 21% in cocaine 28%, in also drivers amphetamine cases, the of and 61% some in involved was cannabis total, cocaine In Nonetheless, substances. only opiates. used only 10% of used amphetamine, influence 2% the only under used was 14% drivers only, the cannabis of 48% results, these to According substance. one of use the only indicated (74%) analyses Most tests. screening Table 9.1 shows that 9% of these samples were related to false positive oral fluid other by performed laboratories, astheserepresent about87%ofthetotalanalysesinvolved. analyses the for representative as considered are results These NICC. the by conducted analyses resultsthe the of of overview detailed a gives Table9.1 (NICC). Criminology and Criminalistics for institute National the sample is collected for further confirmation through analysis in a laboratory in analysis through ablood confirmation well, further as for collected is positive is test sample fluid oral this If conducted. is test screening oralan use, fluid drug illicit of indications positive of case In checklist. visual a is procedure this in step first The use. drug for drivers screen to posts control up Belgium exceeds the European average of 7.4% of average European the exceeds Belgium O ther drug-related crime Driving undertheinfluenceofdrugs . In this framework, the local police and Federal Highway Police set Police Highway Federal and police local the framework, this In . . The prevalence of psychoactive substances in the traffic in traffic the in substances psychoactive of prevalence The . . Most of these blood samples are analysed by analysed are samples blood these of Most . (Houwing et al., 2012) al., et (Houwing . Moreover,. (Legrand

131 9. Drug-related crime, prevention of drug- related crime and prison 132 9. Drug-related crime, prevention of drug- related crime and prison T Total bloodtests Below legalcut-offvalue T Cocaine +opiates Opiates Substancesdetectedinbloodsamplesafterapositiveoral fluid able 9.1| Cocaine Cannabis +cocaineopiates Cannabis +opiates Cannabis +cocaine Cannabis Amphetamine +cannabiscocaineopiates Amphetamine +cocaineopiates Amphetamine +cannabisopiates Amphetamine +cannabiscocaine Amphetamine +opiates Amphetamine +cocaine Amphetamine +cannabis Amphetamine Substances detectedinblood Source: NICC,Personal communication,2014 otal positivetests screening testbetween2011and2013 1,269 1,384 115 124 726 202 11 31 70 19 73 N 2 3 0 0 0 7 1 2011 91.7 52.5 14.6 100 8.3 0.8 2.3 9.0 0.1 0.2 5.1 0.0 0.0 0.0 0.5 0.1 1.4 5.3 % 1,495 1,718 223 181 777 261 27 38 78 11 28 76 N 5 9 0 0 0 4 2012 87.0 13.0 10.5 45.2 15.2 100 1.6 2.2 0.3 0.5 4.5 0.0 0.0 0.0 0.6 0.2 1.6 4.4 % 1,803 1,982 179 203 118 956 106 274 35 14 56 N 5 2 8 0 1 0 5 2013 91.0 10.2 48.2 13.8 100 9.0 1.3 1.8 0.1 0.4 6.0 0.0 0.1 0.0 0.7 0.3 2.8 5.3 % are available on retail and production level, though sufficient indicators at indicators sufficient though level, production and retail on indicators available In Belgium, are indicators. specific proactively, echelon as act well to as order general in requires data quantitative and qualitative both Obtaining enforcement community and some actors active in the drug trade as well as trade drug the in active actors some and community enforcement a to Next information was collected through interviews with different cannabis. members of the law additional and crime, drug-related and markets drug ecstasy on review literature profound amphetamines, cocaine, heroin, markets, namely drug classic the to given was attention project, research this Within offences law drug of prevention and acting proactive enable would indicators these way, this In community. enforcement law the of information supply indicate to 2011 indicators (SUPMAP). These supply indicators ought to combine the fragmented in project SUPMAP the started University Ghent the of (IRCP) policy criminal on research international of institute the light, this In ramn, bte mntrn i eald f h du spl i Belgium. in supply who are usingindicatorsindailypractice drug the groups of drug two only the currently are police enabled airport the and and customs Nevertheless, is hospitals monitoring laboratories, better a toxicological treatment, prosecutor, public the andthe information from with data this the police combining By of information. of source a as importance customs the confirmed experts enforcement Law et al.,2013) 2013) operandi and 3) the locations where these illegal activities take place take activities illegal these where locations the 3) and operandi modus the 2) involved, actors different the to act 1) on needed proactively. is knowledge detailed more order much available, in is seizures and arrests concerning information drug markets Although the about knowledge insufficient have often actors these such, As market. drug changing ever the to respond to difficulties experiences enforcement law Consequently, community. activities. enforcement enforcement law the law successful of effect side a is activities of illegal of Moreover,displacement the members various among fragmented currently is side supply the of information The markets. drug the of dynamics international and national the into insight further obtain to importance crucial of is it chapter, this in earlier described crime drug-related prevent to order In 3. 2013) ald ot nomto) aa hud e novd n re t mk te s of use the make drug supplyindicatorsofbetter interest to order in involved be should data information) soft called so- (the qualitative as well as quantitative both result, a As crime. drug-related arrests,areordercurrentlypurposes) in policyusefulreducefor lessto collected and seizures of number as (such data quantitative that out pointed study The . . Prevention ofdrug-related crime . (Smet etal.,2013) (Smet etal.,2013) . . (Smet et al., et (Smet (Smet et al., et (Smet (Smet

133 9. Drug-related crime, prevention of drug- related crime and prison 134 9. Drug-related crime, prevention of drug- related crime and prison in combination withdrugtreatment) not or (whether education or housing work, to related conditions on insist and scope their broaden also may system justice criminal the crime, drug-related in involved are people unemployed and educated low homeless, of number large n nes f ah offender each of needs and cntkr n Jh, 2007) John, and Schnittker of thealternativesanction promotes alternatives to prison especially for drug users if drug treatment is part the commitment of crimes of commitment the on effect deterrent a have not does imprisonment that indicated has Research 2012; Nagin et al., 2009) al., et Nagin 2012; lentv sntos r siuae aog tes y h Inter-ministerial the by others Drugs among Conference stimulated are sanctions Alternative 4.1. 4. (Smet etal.,2013) 2008) aspects of life crime, but can also give cause to negative effects on social, physical and psychic al., 2008; De Wree et al., 2009; Spohn, 2007) Spohn, 2009; al., et Wree De 2008; al., reduction and several life domains has been demonstrated been has domains life several and reduction uiil lentvs r apial i vros tgs f h ciia justice treatment drug to criminal related be These others, may,among conditions offenders. the the by met of be to have stages which conditions various include and system in applicable are alternatives Judicial detailed information about the organization of drug markets can be collected be can markets drug of organization the about information detailed more different and additional Subsequently, between laboratories. and thedataflow services enforcement law to improve be would priority first a this, For the provided study initial impetus to strengthen SUPMAP the current efforts in The preventing drug-related crime. market. drug (European) the of functioning crimes and consequently a better insight in the different types of crimes and the committed of context the specify to possibility the gives tool This forces. police by used tool registration existing an adapting slightly by feasible be to showed information of type this of monitoring Profound levels. different at networks) crime networks and 3) the role of facilitators (independently and within criminal organised 2) Netherlands, The with connection the and country transition a as Belgium of role the 1) determine to imposes crime drug-related of prevention efficient and Systematic lacking. are level trade drug international and middle a more adequate answer to offences than imprisonment than offences to answer adequate more a , including the advantage to fine-tune measures to the individual situation individual the to measures fine-tune to advantage the including , Interventions inthecriminaljustice system Alternatives to prison (Hardy and Snowden, 2010; Liebling and Arnold, 2012; Nieuwbeerta et al., 2009; . . Detention may not only risk the increase of drug use and use drug of increase the risk only not may Detention . D We e a. 20; nemnseil Cneete rg, 2010) Drugs, Conferentie Interministeriële 2009; al., et Wree (De Te oiie fet o atraie acin o crime on sanctions alternative of effects positive The . (Lurigio, 2000;Vorma etal.,2013) (Freiburger and Iannacchione, 2011; McGrath and Weatherburn, and McGrath 2011; Iannacchione, and (Freiburger D We e a. 20; e re t l, 2009) al., et Wree De 2008; al., et Wree (De (De Ruyveretal.,2008) . As a result, alternative sanctions present sanctions alternative result, a As . . . (Cid, 2009; De Wree et al., et Wree De 2009; (Cid, (Cid, 2009; De Wree et Wree De 2009; (Cid, (Defillet, 2012) (Defillet, Research . . As a As . . both parties is required is parties both measure alternative this on before mediation in criminal matters can agreestart. Moreover, active collaboration to of have parties both of such, harm As emotional offence. or the material the repair to order in offender the and victim the between communication the facilitate to is matters criminal in mediation of purpose The years. last the over mandates new of number smallest the includes these two alternatives can be observed. Mediation in criminal matters, however, for offences drug to related a assignments new of pattern: number the this of increase slight from deviate criminal which measures in alternative only mediation the are and matters detention pre-conviction to Alternatives matters. criminal in mediation and new surveillance probation, electronic of sentence, detention, work number autonomous pre-conviction the to on alternatives total based the concerning 2010, of assignments since decrease A noticed 2013. is and measures 2006 alternative between justice of houses the at offences drug to related assignments new of number the illustrates 9.4 Figure and 34yearsold. the Belgian nationality (77%). The majority of all clients is male and between 18 have sanction alternative an receives who houses justice of clients the of most that show 2013 and 2006 between mandates drug-related new of analysis The drug to offences from theSIPAR related database. mandates all time first the for extracted Justice of Houses for Directorate-General the of service quality and analysis data the 2012, In 2005. imposed since1964(B.S./M.B.17.07.1964). be can and system justice criminal Belgian the in history long a has Probation year. each mandates new of number highest the with measure alternative the General for Houses of Justice of Houses generalfor General a in recorded Directorate- the are within PARajudiciaire) Informatique measures (Système‘SIPAR’ database alternative the of mandates guided All 28 housesofjusticeinBelgium. the for responsible is who supervision and guidance of these alternative measures and works in one of the 1999, assistant justice since a to case, referred this be will In offender years,…). the 5 of sentence maximum offender, adult (e.g. circumstances certain level) in measure prosecution alternative an (at level) court propose(at impose or to possibility the has judge or prosecutor The (FPS Justitie, 2014) Justitie, (FPS (Burssens, 2012) (Burssens, . Probation, although declining, remains declining, although Probation, . . This registration is mandatory since mandatory registrationis This .

135 9. Drug-related crime, prevention of drug- related crime and prison 136 9. Drug-related crime, prevention of drug- related crime and prison ie a rltvl sal n hs vlain td, t s rlmnr conclusion preliminary The progress. largest is the shows trajectory DTC it the followed study,who persons that evaluation this in small relatively sample was the size as Also, trajectory. DTC are the offences followed who drug-related persons less by committed probation, to compared general, clients. in probation with However comparison in recidivism frequently more committed trajectory, DTC the followed that persons recidivistic Nevertheless, probation. or judgement classic the to answered who persons to comparison in trajectory the DTC trajectory conducted less recidivism during the first 18 months after the followed who persons that indicated and FederalJustice of Service policy Public criminal service the by performed was evaluation towards an Moreover, work reintegration. to possibility the creates approach individual this domains, life different on focusing By ‘offender’. the on only focus to than rather issue’ drug meets the deficits of probation and enables to focus more on the ‘person with a . n Toas S, 03 Vne Lee e a. 2013) al., et Laenen Vander 2013; S., Thomaes, and S. added value of a DTC as implemented in Ghent in implemented as DTC a of value added the proved which studies evaluation different of subject was project years, pilot this past The liaison. and prosecutor judge, a by intensively supervised and supported are offenders using Drug treatment. to them redirect to order in use drug their of because crimes committed who persons at targeted specifically is Ghent DTC The 2008. in Ghent district judicial the in implemented was which (also described in chapter 1 of this report). It is an additional alternative to prison An Important pilot project on this topic is the Drug Treatment Court (DTC) Ghent Figure 9.4| Source: DGMJHservice -DataAnalysisandquality12June2014 *

exist orare veryscarce for2006 not do mandates registered the why explains This 2012). Vanhaelemeesch, 2009; A., Devos, 2012; got only a legal basis in 2006 and is only legally entrusted to the houses of justice since 2007 (Burssens, Although a national centre for electronic surveillance was implemented in 2000, electronic surveillance Number of new drug-related assignments 1,000 1,200 1,400 1,600 1,800 2,000 200 400 600 800 0 crimes between2006and2013 Number ofnewassignmentsatthehousesjusticefordrug-related 2006 2007 2008 2009 2010 2011 A dsrbd n hpe 1 DTC 1, chapter in described As . 2012 (Colman et al., 2011; De Keulenaer, De 2011; al., et (Colman 2013 criminal matters Mediation in surveillance* Electr sentence Autonomous work Pr detention pr Alternatives to obation e-conviction onic related to drugs or doping. This is the highest prevalence reported in the last eight years. the in reported prevalence highest the is This doping. or drugs to related were prosecution youth the entering cases all of 11% 9.6). Figure (see court 2013 in line first of prosecutor the of level the at than higher as twice is system prosecutionyouth the entering doping-relatedcases or drug- prevalenceof The Figure 9.5| with exceptionofaslightincrease in2013. observed, is trend declining a which after 2008, until found was prevalence the and indicates a fluctuatingyears trend in the drug- or doping-related cases.8 An increase of last the of level prosecution the entering cases doping-related or 5% drug- about prosecution.numbers illustratesFigureentering the 9.5 cases all of almost represents This 2013. during Belgium in courts line first of system prosecution the entered cases doping-related or drug- 34,000 Approximately 4.2. ags gop f epnet ta d nt ogr omt n cie fe the after crime any judicial intervention commit longer not do that respondents of group largest the trajectory,DTCcovers the followed who persons that out pointed analyses Source: Board oftheProsecutor General, 2013 * both newandreopened cases O Number of drug-/doping-related ther interventionsinthecriminalju

cases entering prosecution 2013 cases enteringtheprosecution systemoffirstlinecourtbetween2006- Drug/doping related casesincomparisonwiththetotalamountof 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 5,000 0 (De Keulenaer, S.andThomaes,S.,2013) 2006 33,874 2007 39,058 2008 40,843 2009 40,695 2010 37,835 . 2011

37,952 tice sy 2012 31,815 tem 2013 34,289

137 9. Drug-related crime, prevention of drug- related crime and prison 138 9. Drug-related crime, prevention of drug- related crime and prison Figure 9.7| The immediatesummonsseemtoslightlyincrease overtheyears. years. recent the in successfully completed often more be to out turn decisions closing last two These cases. the of 1% in completed only was mediation a and were cases the of 6% chamber.summoned immediately. An pre-trial out of court settlement was paid in a 5% of the cases to cases doping-related or drug- the of 7% redirected prosecutor The common. less are cases doping-related or over.handed were cases the drug- of Joined 13% while 2013, in consequences cases at the prosecution system of first line court (57%) were still closed without the of part greater The included). not is prosecution (youth level prosecution at cases doping-related and drug- for decisions closing the illustrates 9.7. Figure Figure 9.6| Source: Board oftheProsecutor General, 2013 Source: Board oftheProsecutor General, 2013 Closing decision for drug/doping related cases at prosecution level Out ofcourtsettlementpaid system incomparisonwiththeadultprosecution system,Belgium,2013 Proportion ofdrug/dopingrelated casesenteringtheyouthprosecution prosecution leveloffirstlinecourtin2013 Number ofclosingdecisionsfordrug/doping-related casesat Without consequence Mediation completed Immediate summons 4.9 Pr e-trial chamber Handed over Joinder 01 02 11.6 12.6 57.2 6.8 6.4 0.7 4.7 11.2 03 % 04 05 pr Cases enteringtheyouth pr Cases enterinthe osecution system(%) osecution system(%) 06 0 until 2012. 2006 years the in drugs, Belgium in judged narcotic substances psychotropic and pills for sleeping suspensions and sentences of evolution Figure the 2012. describes from 9.8 those are available central data the recent to most courts the registry, the criminal from extractions’ ‘judgement the of registry the of s oiebe n 09 Du-eae ssesos o te otay have contrary, suspensions andsentences. the on at looking total the to relation in sentences drug-related and when suspensions drug-related the suspensions, confirmed is trend This Drug-related years. seven last the 2009. over decreased in noticeable is increased fromslightly drug-related5,284 of dip a Nevertheless, 2012. to 2006 sentences have sentences drug-related registry, criminal central the on Based Figure 9.8| h Srie o Ciia Plc clet te nomto aot h final the in about updated was information database established the online published was and 2014 The collects courts. Belgian Policy all in Criminal judgements for Service The Source: ServiceforCriminal Policy: sentencesandsuspensions, 2013 Number 1,000 2,000 3,000 4,000 5,000 6,000 0 2006 psychotropic substancesbetween2006and2012 Sentences andsuspensionsfornarcotic drugs,sleepingpillsand 2007 2008 (Dienst voor strafrechtelijkvoor (Dienst 2013) beleid, 2009 2010 2011 2012 . Due to a delay a to Due . suspensions Drug-r sentences Drug-r elated elated

139 9. Drug-related crime, prevention of drug- related crime and prison 140 9. Drug-related crime, prevention of drug- related crime and prison in prisonshasbeendecreasing overthepastyears. (drug-related)the of capacity the savings, associated the and treatment services crisis economic the Unfortunately,treatment.to substitution due opiate the for a reference as function that physicians as such field, drug-related specific a in specialised are who experts by supported also are teams health Prison release. providers exists with intention to work towards community drug treatment upon service drug external with Cooperation providers. external by and teams health prison the of part are that experts by both delivered are users drug for Services coordinators were assigned. regional two Toend, well. this as prisons in enforcement) and treatment harm, (prevention,policy drug the of pillars reductionfour the to given be of to ought attention that implies This re-offending. prevent may users drug for treatment and services as prison, outside policy drug the to possible as much as prison in policy drug the adjust to is objective the Nevertheless, limited. consequently is drugs illicit using detainees carefor Special possible. is careinstitution health or hospital extent), limited a to assignments hospital performing clinic outpatients’ However, exist. services as functioning section a with (e.g. prison specialised a to prisoner transferringa medical basic only system prison Belgian the Within service. care the health prison the of head the by agreement upon and groundsreasonable Therefore, trained. paramedically on possible only or is setting prison the in physician this by treatment of provision medically staff are the prisons of minority in A secrecy. members professional by bound are care of Providers prisons. in care health for service central the by formulated as policy health the executing for installed is care health for service single a prison Belgian each In of part as responsibility ofthepsychosocialservice. advise the is turn psychosocial its in which and perspective), (security probation and medical measures security providing and care, to health care for health service providing central the of between responsibility the is division which perspective), clear (health prisoners a is In Justice. there of Minister prisons, the Belgian of competence a is care health prison Belgium, In 5. rgrltd elh evcs sc a cgiiebhvorl interventions, cognitive-behavioural as Different such prisons. Belgian services, in practice health into drug-related put gradually is treatment Drug Drugtreatment 5.1. health issuesinprisons Responses to drug-related prison physiciansincasesofoverdose where methadonewasinvolved. prosecution of former and care staff health of lack the as well as detoxification, for obstacle an as experienced is environment prisoner’s the from pressure The a reference. as assigned are specialists addiction prisoners, remand for prisons In service. of assurance quality a as used is OST on procedureclients. strict a as protocol the technical A of functioning personal and social the enhance to order in prison 2014) DiClemente, 1984) DiClemente, less 50 prisoners to 16 in 2012. This pre-therapeutic drugs programme, called programme, drugs pre-therapeutic This 2012. in 16 to prisoners 50 less or more from decrease to forced was programme this of capacity the reasons, financial 16 to Due to offending. their offered to led is has addiction drug May) whom for of prisoners end the to October of beginning the (from months eight of programme behavioural intensity,cognitive high a perspective, this In alcohol andillegaldrugsare notallowed. illness, mental treat to medication of use the Ruiselede, are of prison open Bruges, the In and Ruiselede of prison the offering adrug-free programme totheirdetainees. namely prisons, Belgian two Only 5.1.4. are compelledtoworkandliveasacommunity. an intense programme oriented towards reintegration and education. Detainees of of prison The prison approach. the TC-oriented Ruiselede has an open regime a excluded from many security of provisions, towardsproviding made (‘B.Leave’) are programme efforts Ruiselede, drugs pre-therapeutic the Within 5.1.3. cases the prison with of 26% other treated the Belgian in those prescribed is buprenorphine total of and OST 74% the therapy for of used substitution is 4% Methadone OST. almost received opiate 2012, population august for In prisons. used Belgian are in buprenorphine and Methadone 5.1.2. DiClemente and Prochaska of change of model theoretical trans the on based is duration short of programme drug This offenders. using drug for therapy behavioural cognitive with system prison British the the of of experience occasion the on developed was programme This Bruges. of prison the in installed was weeks six of programme’ drug duration ‘short first a 2012, In 5.1.1. programmes are available. drug-free and (TC) communities therapeutic (OST), therapy substitution opiate prison-oriented, standardised manual,basedonpractical experience. . Detoxification as well as maintenance programmes are available in areavailable programmes asmaintenance well as Detoxification . Drug-free Programmes Therapeutic communities Opiate substitutiontherapy Cognitive behavioural interventions . An existing manual is used as reference in order to develop a develop to order in reference as used is manual existing An . Pohsa and (Prochaska (FPS Justitie, (FPS

141 9. Drug-related crime, prevention of drug- related crime and prison 142 9. Drug-related crime, prevention of drug- related crime and prison 5.2.2. of effects policy, drug use, drug behaviour, different drugsanddrugusers’behaviourbyofferingtraining. risk on informed is staff Prison executed withattentionfordruguseandpsychopathological disorders. is intake medical within a procedure, consultation standard As custody. into medical entry upon a hours 24 foresees 21.04.2011) (B.S./M.B. 2011 April 8 of Decree Royal the and 01.02.2005) (B.S./M.B. 2005 of principals of law The 5.2.1. and informationavailableforprisonerswhoare usingdrugs. were initiatives several consultation medical prisons the describes paragraph This years. past in the implemented harm drug-related reduce and prevent To 5.2. Federal Public Service (FPS) Justice. This booklet is available in the French prisons by and for prisoners, in collaboration with Modus Vivendi and is financed by the made is prison in behaviour risk problemsand drug-relatedhealth on booklet A different of effect the on drugs, are availableineveryprison. prisoners inform to posters and brochures, Flyers, as the programme in Ruiselede, the daily structure with obliged working and leisure activitiesisofgreat importance. working obliged with structure daily the Ruiselede, in programme the as Similar functioning. personal increase to order in skills life other and personal Next to relapse therapy, the service aims at the development of prisoner’s social, prisoners. other together,the fromliving separated programmeare this but within Prisoners criteria. exclusion and in- defined clearly as well as developed screening, were admission) for condition for (a testing drug voluntary procedures and prisoners of intake Standardised prisoners. 44 to increased a wing for free available initially was section drug-free maximum of 20 prisoners. Despite the economic crisis, the capacity of One this drug- successful. be time to in which proved prison Bruges the in up set was wing drug-free new a 2009 In of theseprisonersisassistedinRuiselede. release Finally,the training. also skill social a and prevention relapse of offering follow-up by provided is care of continuation the finished, is programme the Once activities. leisure and work of structure day strict a through skills life and social personal, develop to therapy,learn of they means By programme. the to therapy and sport. Prisoners have to take a drug education, test before they can participate through life drug-free a with for prisoners 1995 using drug in cram to implemented objective was 5.1.3.), section in mentioned (also ‘B.Leave’ Prevention andreuc Drugprevention andharmreduction information upon entryintocustody Medical consultation,screening andassessmentofdruguse tion ofdrug-related harm case ofanoverdose withafellowprisoner. such as drug-related infectious diseases, as well as information on what to do in external collaborators. Arange ofhealth-anddrug-related topicsare discussed, and throughinternal distributed is prison in health on booklet a prison, every In 5.4. for therapy interferon and HIV hepatitis BandC.Moreover, acooperation existswithAidsresource centres. for offered is treatment Antiretroviral C. and B HIV,hepatitis of diagnosis the upon possible is reatment prisons, Belgian In 5.3.1. is provided intheBelgianprisons. In order to prevent the spread of infectious diseases among prisoners treatment 5.3. related healthrisks,suchassharingneedlesandcommunicablediseases. detailed drug- more about informed being receive on prisoners to help will This people wanted. if information these contact contact can Prisoners health topics. prisoners’ related Snowball and prisons. details) more speaking for (‘Détenus contact santé’) are two projects with aim to train French prisoners on health- 3 in chapter installed (see operations are projects support Peer campaign orientedonhepatitisChasbeenlaunchedinBelgianprisons. information new a 2011, In prisons. Flemish the in 2011 since and 2009, since Prevention ofoverdose-rik Prevention, treatment andc Diagnosis andtreatment ofdrug-related infectiousdiseases are ofinfec tious dieae

143 9. Drug-related crime, prevention of drug- related crime and prison 144 9. Drug-related crime, prevention of drug- related crime and prison risk taxationorrecidivism. working from a health care perspective and do not formulate advice concerning are CIU the of workers drug the authority. Nonetheless, this by financed is CIU the Justice, FPS the of competence a is policy drug and care health prison Since to healthcare andtreatment servicesoutsidetheprisonisrealised afterrelease. referral a and organizations,drug worker treatment drug external with contact the arranges social The programme. treatment a proper defines worker social drug the need, prisoner’s the of assessment an on Based cluster. prison one to worker drug each link to order in clusters (geographical) several into divided pragmatically are Prisons workers. drug social external by run are units These the within a facilitate prisoners to prison every using referral totreatment inthecommunity. in 2011 drug in installed for was release, intended their of prospect (CIU), Unit Intake Central A Centralintake units 6.2. only not receive training, butalsotheopportunitytoattendsociocultural andsportactivities. can prisoners Verviers, of prison the in Also Hoogstraten. of prison the in detainees using drug for sessions group therapeutic of option the service and service provider show a great variety. An example of such of a service type is the but exist, services of kind such prisons, some in Although rare. are life different the strengthen to users drug for programmes Specific relapse. or use. As a matter of fact, a balanced lifestyle might help people to avoid drug use users. employment, housing drug and social-cultural skills, they also have an impact towards on drug specifically oriented not generalon education, focus as services such these domains as life Nevertheless, are services these general, In supports several prisonprojects according tolocalneeds. and cultural activities in every prison. The government of the French Community education training, vocational including services providing for plan strategic a the social services of the community. The Flemish Government has implemented The domains. life different representedby is but authorities, prison the in by employed not is staff appointed skills of development the in prisoners that support services and organizations encourage governments regional Belgian The Socialserviefordruguerinprion 6.1. 6. after release fromprison Reintegration ofdrugusers fecs r as ntcd n h ciia jsie ytm Mr drug-related More system. justice criminal the sentences are reported at in court level. Moreover, noticed the drug-related suspensions also are are drug-related offences towards customs and forces police of actions firm observed The drug marketisboundtoincrease thestrength ofdrugsupplyreduction. Belgian the of monitoring profound This indicators. of kind this using in actors stimulate should services between dataflow the amending detailed and data Improvedqualitative market. drug the in changes fast assess act to to elements and key proactively the of one be to shown is – side demand the but about side, also supply the about only not The – information sources. contextual of different triangulation from information quantitative and qualitative tocombine existing indicators, supply several identified SUPMAP project research the light, this In enforcement. law by crime drug-related of prevention the allow to and middle the of of the national and international dynamics of the Belgian drug market is needed situation the that others international drug trade level amongst has been quite shows unparalleled. A better understanding chapter This these substanceswhiledriving. combination in are use of involvement the realincreasein a suggests opiates or cannabis cocaine, with people amphetamine of more prevalence increased that the Nevertheless, years. concluded past the with comparison in this be drugs illegal of tackle influence the cannot under to driving reserved it were Therefore, resources more phenomenon. that possible is it enforcement law authorities, the for priority set a is this As drugs. illegal of influence the under driving of tests positive of number increasing the interpreting when well as needed is Caution drugs. of possession for charges record the This explain might drugs. illegal of possession for charge only can police the dealing, of act the of evidence exact Without drugs. of amount small very a carry only often dealers drug arepossible why forcescustoms a reason police and of action firm observed The 2012-2015. of plan safety national the in prioritised are cannabis and drugs synthetic of traffic and production the as the well as under drugs of driving influence cocaine, of smuggling dealing, drug 2012, Since priorities. setting forces enforcement law of result a be may This well. as years the over law drug of increasing is trade and production of prevalence The majority 2013. in record a reached vast the enforcement, law possession relatedto offences law Drug side. demand the relatedto is offences of analysis the on Based 7. this way, a fixed team of external drug workers are in contact with different with contact in drug treatment providers intheregion. are workers drug external of team fixed a way, this in Moreover, person. specialised one by services and treatment specialised to efficient referralpreparationan the of within lies team a such of advantage The C onclusions

145 9. Drug-related crime, prevention of drug- related crime and prison 146 9. Drug-related crime, prevention of drug- related crime and prison heavy investmentinevidence-basedpolicy. of progress further conclusion, these challenges in the prevention In or reduction of drug-related Health. crime will rely on Public of Minister the to prisons in healthcare of competence the of transfer the advocate professionals evolution, with society. providedin have would this they to reactionas a Asservice care health same the not are prisoners objective, general a associated is the this and Although crisis savings. economic the to due years past the over decreased prisons in services treatment (drug-related) of Moreover,capacity prison. the in life. Nevertheless, health care (specialised drug treatment in particular) is limited of aspects psychic and physical social, on effects negative cause may detention Additionally,crime. and use drug of increase the risk may Detention reoffend. to not or whether on effect significant a has settlement judicial of type the that revealed Research years. recent in registered are detentions drug-related more as well. Despite declining the fact are that prisons justice are confronted of with overpopulation, more houses and work the at alternative surveillance electronic probations, and sentences of number the imprisonment, than offences to answer adequate more a are sanctions alternative Although decreasing. slightly acknowledged. gratefully is involvement essential Their feedback. valuable their and collection Mrs data Pire, the in Mr contribution their Laeremans, for Decorte dr. Mr Prof and (Ph.D.), Ovaere Mrs Hogge Denoiseux, Mr thank to want authors The Acknowledgements section 4.3. is Belgium in 4.2) (section covered in briefly arealso agents cutting and contaminants used The discussed. purity drug regarding data and 4.1) (section data price drug as well as 3), (section services police federal by made seizures drug and 2.2) (section trafficking drug 2.1), (section drugs illegal of origin the about Information Belgium. in market drug the of overview an provides chapter This 1. P. Blanckaert DRUG MARKETS CHAPTER 10. • • • Pre-precursors continue to play a growing role in the synthesis of amphetamines. towards afullyrecovered MDMAmarket. MDMA content in ecstasy tablets reached an all-time high level in 2013, pointing and MDMA as such drugs role synthetic the for amphetamine. confirmed country producing 2013 a in as precursors Belgium and of labs seized of amounts Record Introduction 147 10. Drug markets 148 10. Drug markets uc du mre, hr i i sl i “ofe hp” Te oiain to motivation The shops”. “coffee materials in The profit. or consumption sold personal for either be can is cannabis grow it where market, the drug to export Dutch for destined is production cannabis Belgian the Netherlands, of The majority in the cultivation cannabis on pressure increased of result a As for mostillicitsubstances. imported from Africa the is tendency new import ofcocainefrom Brazil. A of cocaine wasalso amount small very In2013,a such Venezuela. and countries Mexico American Rica, Costa Latin Panama, other Chili, as from imported also is and Peru Cocaine Colombia, Bolivia. remain cocaine for origin of countries predominant The Turkey. In addition, heroin seizures were also imported from Africa and Pakistan. icvrd n sie i Blim se lo .) Te rdmnn cuty of country predominant origin formostseizedNPSremains China. The 3.3). was also (see ever Belgium lab in seized drug and synthetic discovered largest the 2013, In ecstasy. and amphetamine of capacity production their for well-known are Netherlands The and Belgium The drug market is a complex phenomenon 2.2. 2014) communication, personal (Ovaere, remained origin Morocco of country which frequent most for the exception, or an Netherlands is The resin Cannabis from itself. originated Belgium Belgium in seizures most cannabis, For Drug s origin:national produc 2.1. the Drug against Persons (DGJ-DJP). by provided Crime of is Direction Police, Judicial the of Directorate General the trafficking of Programme and origin drugs regarding Information 2. 2013) Heroin and cocaine are not produced in Belgium and hence always imported always hence and Belgium in produced not are cocaine and Heroin Ghana, from 2013. imported Honduras andSenegal(seealso3.1). were in cannabis seized herbal were of Pakistan tonnes several from Nevertheless, coming resin cannabis of tonnes three . Besides being a country of destination, Belgium is also a transit country transit a also is Belgium destination, of country a being Besides . Suppl markets routes, modioperananorganization ofdomes Trafficking patterns, national andinternational flows, y to andwithinthecountry (Ovaere, personalcommunication) I 21, eon a lrey motd from imported largely was heroin 2013, In . (Ovaere, personal communication) personal (Ovaere, (Decorte and D’Huyvetter, 2013; Smet et al., tion versuimported . . Additionally, . tic drug is a common practice common a is meter electricity the of manipulation illicit by costs electricity avoiding example, For profit. maximise to used are strategies several process, growth the During to theamountseachmembercanbuy such, there is no constant availability of cannabis. Also, there are imposed limits As gram. per amount fixed a paying by harvest every after members club’s the among distributed is cannabis The months. 3 to 2 every harvested usually are Crops plant. individual each to attached is card, identity his/her of copy a with member,a by signed ownership of statement A issues. legal evade to try clubs social cannabis prosecution, for priority lowest the has currently plant cannabis female one of member.possession per the Asplant one growing collectively of also have to members take part in an intake addition, interview. These In clubs operate on problems. the premise abuse drug of absence and record criminal a of absence area, certain a in residence years), among 21 or (18 age minimum a include, others, These enrolment. for criteria strict have clubs the as selected carefully are Members non-members. to any products cannabis without selling of members, intention Theseclubs their persons. of consumption of450 personal the for total membership cannabis grow a with known are clubs five Currently,Belgium. in operating are clubs social cannabis context, this in Also, participate inthisinvestigation However, (21.4%). since this research was survey-based, partner it is assumed that criminal growers did not one with collaborated or respondents) of (66.3% personal for cannabis ratherconsumption profit-oriented.than growers of majority The growing alone worked and itself process by growth motivated the of mainly pleasure were the growers that show been also also results have The violence of documented. use actual the and Threats plants. of destruction CANMARKT the and equipment or harvest plants, of the theft including cannabis, of cultivation in the investigated to related harms additional other been reported research this addition, study.In by have caused plantations damage the cannabis to domestic contributing factors other and for suited These locations cultivation. rent to used are cards identity false conviction, minimise lo oe ega go sos ae tre t appear to started have shops although grow shops, Belgian grow more Dutch also in purchased often are cultivation the for used Belgian drugmarket. organizations have cut and split the drugs, the cocaine is imported again for the Dutch destined after Only is Netherlands. the to that exported first share is consumption The Belgian for Netherlands. The to export for destined mostly is cocaine The Antilles. Dutch the or Suriname Jamaica, Republic, Dominican the is also still imported through passengers of international flights originating from Cocaine quantities). smaller only mostly for (Zaventem, airport Brussels the and America to Europe. The main routes of entry in Belgium are the port of Antwerp Belgium also remains a transit country for cocaine traffic from South- or Central- (Decorte and Paoli, 2014; Vanhove et al., 2014) al., et Vanhove 2014; Paoli, and (Decorte (DecorteandPaoli, 2014) (Decorte, 2014) . . Dcre n Poi 2014) Paoli, and (Decorte . Also, in order to order in Also, . . 149 10. Drug markets 150 10. Drug markets monitoring ofdrugsupplyinBelgium the optimize orderto in needed is echelons market middle and wholesale these concerning knowledge more Consequently, accessible. less is contrary, the on of market retail The synthetic drugs is very drugs. open and informal. The wholesale market of these drugs, synthetic of dealers for case the especially is This eal elr ae lo novd n oyrg trade polydrug in involved also are dealers retail communication) (Decorte and D’Huyvetter,2014) and (Decorte h itre. osqety tee rnatos trc ls pbi attention public less attract through transactions and these cars (rented) Consequently, bars, dealers internet. houses, street, private the the in on drugs their dealing sell Besides to dealing. prefer drug for different used that are show (ISD) channels research Drug Social of Institute the of researchers the by conducted visible files prosecutor public and charges police less of Analyses years. past became market drug the ecstasy, and amphetamine cocaine, well. as cannabis, of changed trade retail on Antwerp in has study case a of results market the to According drug retail Belgian the years, few last the Over including countries Germany, to France, Spainandthe UK. transport further for destined are Belgium in imported osdrd s ik management risk as considered and maritime traffic (mainly from Mozambique and Pakistan) Mozambique from (mainly traffic maritime and origin) African South and (East air origin), (Turkish road by imported is Heroin amphetamine on the other hand retail and ecstasy the of market the from and hand separatedone the on largelyheroin and cocaine is of market cannabis of market retail the that reveal domain drug the in professionallyworking experts and dealers drug users, drug poiet oe n h Blin rdcin n dsrbto o synthetic of distribution and involve international organised criminal networks region border production Belgian-Dutch play the Belgian in laboratories probably drug the Synthetic citizens drugs. in Dutch role market, prominent cocaine and a cannabis the to Similar . . Reducing the number of visible transactions can be can transactions visible of number the Reducing . (Decorte and D’Huyvetter, 2014) Se e a. 2013) al., et (Smet (Smet etal.,2013) (Smet et al., 2013) Fc-ofc itriw with interviews Face-to-face . Dcre n DHyetr 2014) D’Huyvetter, and (Decorte . . In addition, most NPS . Nevertheless, some Oar, personal (Ovaere, . ezrs vr h yas 2% n oprsn ih 02 dmntae the demonstrates 2012) with comparison in recovery oftheecstasymarket. (21% years ecstasy-related the of over number the seizures in increase The 2012. to compared also increased general in drugs synthetic of seizures of numbers The respectively. 5.8% and 7.1% was seizures heroin and amphetamine all of of proportion The (8.7% seizures). drug seized primary second the being cocaine with cannabis, to cannabis-related 13% of increase an seizures was observed. In total, 73.2% of all consequence, seizures made in 2013 were related a As 2013. in 30,641 to seizurescomparison 27,004 werein of made, total a seizures.2012 cannabis In herbal resinand cannabis both of number the in Largeincreaseswereobserved (Table 10.1). 2013) in seizures 41,824 versus in 2012 in seizures total seizures (38,069 2013 in drug Belgium of number total the in seen was 10% around of increase An 3.1. French the and Flemish the both for prices Community. drug on data police collect federal Belgium, services In level. federal the at and local the at both Belgium, in reports police all gathers which (GND), Database National General the from extracted Judicial is are data the These (DGJ-DJP). laboratories of Persons against Directorate Crime of General drug Direction Police, the illicit of Programme seized Drug the and by provided seizures drug regarding Information 3. Seizures Quantities andnumberofeizureillicitrug 151 10. Drug markets 152 10. Drug markets

Table 10.1 | Number of drug seizures by substance between 2007 and 2013

2007 2008 2009 2010 2011 2012 2013 Drug type N % N % N % N % N % N % N % Cannabis Total 25,532 69.6 22,418 69.7 29,212 71.8 27,512 71.2 29,847 72.0 27,004 70.9 30,641 73.2 Resin 5,870 16.0 4,921 15.3 6,206 15.3 5,048 13.1 5,622 13.6 4,818 12.6 5,529 13.2 Herbal 19,196 52.4 16,831 52.3 22,274 54.8 21,485 55.6 23,155 55.9 21,075 55.3 23,900 57.14 Plants 4,660 1.3 666 2.1 732 1.8 979 2.5 1,070 2.6 1,111 2.9 1,212 2.89 Heroin 2,850 7.8 2,307 7.2 3,054 7.5 3,433 8.9 2,930 7.1 2,507 6.6 2,431 5.8 Cocaine 3,656 10.0 3,345 10.4 4,021 9.9 3,448 8.9 3,777 9.1 3,859 10.1 3,653 8.7 Amphetamine 2,767 7.6 2,646 8.2 2,944 7.2 2,912 7.65 3,079 7.4 2,830 7.4 2,978 7.1 Methamphetamine ...... 64 0.2 99 0.24 102 0.26 107 0.25 Ecstasy-type 1,798 4.9 1,412 4.4 921 2.3 650 1.7 919 2.2 1,098 2.9 1,338 3.2 LSD 1 0.0 . . . . 59 0.2 85 0.2 49 0.12 76 0.2 GHB* . . . . 473 1.2 503 1.3 605 1.4 550 1.4 546 1.3 Khat* . . . . 49 0.1 51 0.1 87 0.2 70 0.18 54 0.13 Total 36,604 100 32,128 100 40,674 100 38,632 100 41,428 100 38,069 100 41,824 100 * GHB and Khat are only monitored by BMCDDA since 2009 Source: Federal police Mozambique anddestinedforTheNetherlands from coming 2013: 865 kg of seizure large in very one to due is observed rise year.This previous was heroin seized of quantity heroinof 1,182 kg were increasean seized; compared1,000% over with the to the in increase drastic A khat plantsroughly remained thesame. A years. the over decreasing keeps decrease was also observed in the amount of seized GHB. The amount of seized blotters LSD seized of quantity total the Moreover,2013. in seized quantities the by judging least at anecdotal, remains 10.4). Comparable tootherEuropean countries,thepresence ofLSDinBelgium (Tablelaboratories production drug synthetic seized of number drastic the in the increase of consequence logical a are developments These tablets. seized ecstasy of The number the in export. observed was increase for 38% a versus Also, 2012 2013). or in in 178 kg (54 kg market tripled than Belgian more has amphetamine the seized of on amount consumption for destined of was methamphetamine synthesized quantities this whether unclear currently seized is It availability. in in gain a indicate numbers increase last these However, market. drug Belgian the tenfold from absent practically been the has methamphetamine years, is For methamphetamine. observation worrying A cannabis was seized earlier in the year, containing a smaller amount of 1,781 kg of herbal seized, this time coming from Ghana. Another container coming from Honduras were cannabis of 4,178 kg later,another days few A Senegal. from originating coconuts of shipment a in Antwerp of port of the in 7,600 kg seized was 2013, cannabis November herbal In cannabis. herbal seized of amount total the to contributed shipments large three Especially 5,635 kg increase). only 250% a to (or 2012 compared in 2013, in seized was 14,882 kg cannabis, herbal evcs n h pr o Antwerp of port the in services large exceptionally one by customs explained the by 2013 February in made (3,020 kg), Pakistanifromorigin seizure of be increase can an phenomenon presents This and 300%. 2013 over in 4,274 were to resin changed cannabis number of this 1,338 kg seized; 2012, has In cannabis seized 10.2). (Table of increased quantity the drastically seizures, of number the with parallel In cocaine seizure was353 kg,comingfrom Chili seized cocaine is comparable to the years previous of 2012. In 2013, the largest of quantity total the such, As 2012. in cocaine seized of quantity large the for responsible was seizure large very one since perspective, in put be to has This For cocaine, the seized amount in 2013 was drastically lower compared to 2012. (Ovaere, personalcommunication) Oar, esnl communication) personal (Ovaere, . (Ovaere, personalcommunication) (Ovaere, personalcommunication) Lkws, for Likewise, . . . 153 10. Drug markets 154 10. Drug markets T able 10.2| Khat GHB LSD Ecstasy-type substances Methamphetamine Amphetamine Cocaine Heroin Cannabis plants Herbal cannabis Cannabis resin Source: Federal police ** * Drug type GHB andKhatare only monitored byBMCDDA since2009. are lessreliable. the reporting of plantations is done directly to the DGJ-DJP instead of through the GND. The data from 2006 and 2007 seizureactual and the reported is of instead plantations cannabis of capacity the 2008 since methodology: in Change uniis rgntd rm hn ad ee eeal dsie fr The for destined generally production drug were synthetic in seized and been have quantities China Other Netherlands. from seized originated largest the as well quantities as 2013, in precursors drug seized of majority The in Belgium. precursors drug to regard with information provided Services PoliceFederal the with together (FAMHP) Products Health and Medicines for Agency Federal The 3.2. been already had tonnes) received bythiscompany 7 to 3 from (ranging shipments 13 years, previous the In anti-depressant). registered a trazodone, of production the for used be also can (mCPP mCPP importing for documents required the have not did that company a for destined was shipment This reported. was mCPP of tonnes 4 of Besides the quantities seized of the more classic illegal substances, also a seizure Ayahuasca plantmaterialwere seizedin2013. of 2.3 kg and ketamine of 4.5 kg Also well. wereas (1 kg) seized AM-2201 and in seized was cannabinoid, For synthetic country.2013. Other synthetic cannabinoids, such as 5F-AKB48 (1 kg), a 5F-UR144 (20 kg) EU JWH-018, another of to 12 kg China almost from example, transit in mostly are Belgium, substances in these of seized quantities large very year, each NPS, to regard With T the manufa Quantities andnumberofprecurorhemi otal quantitiesofseizeddrugsbysubstancebetween2007and2013 tablets units* units Unit litre kg kg kg kg kg kg kg c ture ofillicitdrugs 541,245 148,251 12,732 58,544 2,470 (Ovaere, personalcommunication) 2007 483 548 1 . . . 162,821 177,190 3,851 4,891 1,529 2008 411 63 . . . . 272,714 31,025 18,659 1,685 4,605 4,486 2009 104 275 49 . . 312,528 32,954 1,018 3,924 6,844 5,208 3,153 2010 . 362 386 24 39 337,955 64,384 1,128 7,999 6,095 5,020 2011 als uedin 838 112 140 82 2 330,675 26,874 19,178 1,298 5,635 1,338 2012 225 112 76 54 3 396,758 37,152 14,882 1,149 6,486 1,182 4,274 2013 121 178 45 38 T of Antwerp port the in seized were MDMA, of synthesis the for reagent a methylamine, of 45,838 kg of content total a with Additionally,China from coming containers 2 tablets. ecstasy of component turn principal in the MDMA, which for precursor PMK, direct the for is pre-precursors be to meant are product this of litres 720 The 3.3). section also (see Belgium in seized ever laboratory drug synthetic largest the in 2013 in discovered been has (iso)safrole of quantity important An laboratories production ecstasy (Ovaere, or personal communication) amphetamine in or labs conversion in were APAANmade of seizures Other seized. were 1,120 kg again July, In The for Netherlands. destined was and China was origin container’s The Antwerp. of port the in services custom the by performed APAANwas of tonnes 4 of seizure a April, In mut o sie BK te rsi icesn aon o AAN ht was that APAAN of amount seized inBelgium2013isofspecialattention. increasing drastic the BMK, decreasing the seized of of light amounts In amphetamines. 1-phenyl-2-propanon of production the seized for less and less of amount the 40 litres were seized in 2013. This may indicate that this precursor is being used in observed (benzylmethylketon, BMK), the direct precursor for amphetamine synthesis: is only decrease A is 2011-2013 period time provided inTable 10.3. the in seized precursors drug of overview An 3.3). section also (see pre-precursors of conversion the for labs and/or laboratories other non-controlled (pre-)precursors toevadedrugandprecursor laws. to turn will producers drug illicit out, sold APAANis suppliers the of stock the current once that, expected is it Hence, 1259/2013). and 1258/2013 regulations (EU 2013 of end the since precursor controlled a APAANas listed regulation European in Belgium used APAAN as a pre-precursor in 2013. However, it is worth noting that able 10.3| Substance Source: FAMHP, data2011-2013, personalcommunication;Ovaere, personalcommunication, 2014 1-phenyl-2-propanon (BMK) Phenyl-2-nitropropene N-methyl-L-alanine Formic Acid Formamide Sodium hydroxide Alphaphenylacetoacetonitrile (APAAN) Gamma-butyro-lactone (GBL) (iso)Safrole Methylamine Piperonylmethylketon (PMK) (Ovaere, personalcommunication) Amounts ofprecursors seizedbetween2011and2013 . This confirms that most illicit amphetamine laboratories . Unit litre litre litre litre litre litre kg kg kg kg kg 9,000 896.5 2011 265 15 30 10 1 . . . . 1,150 5,875 8,763 2012 503 9 ...... 45,838 5,392 2,781 2013 720 7.5 40 . . . . . 155 10. Drug markets 156 10. Drug markets anbs Sne h yas 00 ognsd rmnl ewrs r atv in sometimes cultivation laboratories, cannabis active with synthetic combined are up set networks to region criminal border organised Belgian-Dutch as the 2000, well years as drugs the synthetic Since for cannabis. country production well-known a is Belgium Netherlands, The country neighbouring our to similar and above mentioned As 3.3. 2013. 16 production sites (3 partially dismantled) and 2 sites for the stocking the for sites 2 and dismantled) partially drug (3 sites production synthetic 16 2013. seized of number the in noticed was included) labs in conversion (pre-precursorlaboratories production increase be drastic to tended a labs drug stable, seized of relatively number the years few last the in Whereas communication) production are often spread over the two neighbouring countries al 1. gvs n vriw f imnld ytei du lb i te period the in 2007-2013. labs drug synthetic dismantled of overview an gives found. 10.4 are Table laboratories drug illicit of particularly types other effort Also seized. oramphetamine are enforcement laboratories ecstasy illicit of law anumber the year, every makes Nevertheless, difficult. production drug of stages T able 10.4| T

Other

Labs forsyntheticdrugs Source: Ovaere, personalcommunication,2014 Lab type otal Production ofNPS Creation oftablets Unknown/unspecified combinations DMT GHB LSD Amphetamine +APAAN conversion conversion MDMA +amphetamineAPAAN MDMA APAAN conversionlab Methamphetamine Amphetamines manufa of methodsproduc Number ofdrugprouc police servicesbetween2007and2013 Number andtypeofsyntheticdruglabsdismantledbyBelgian . The capacity of criminal organizations to separate the different the separate to organizations criminal of capacity The . c tured there tion andprecisetype ofillicitdrugs 2007 tion sitedimantle,escription (Smet et al., 2013) al., et (Smet 8 4 1 3 ...... 2008 6 1 1 1 3 ...... 2009 2 1 1 ...... The different steps of the of steps different The . 2010 6 2 4 ...... 2011 3 1 1 1 ...... (Ovaere, personal 2012 7 1 1 2 1 2 ...... 2013 16 2 1 2 4 2 2 1 2 . . . . ot fe dsie fr xot o h Dth market are Dutch the scale/industrial, to large export for especially destined Belgium, often most in produced crops Cannabis (Ovaere, personal communication) personal (Ovaere, (Ovaere, personalcommunication) (Decorte and Paoli, 2014; Vanhove et al., 2014) communication) o oe hn n mlin cts tbes e pouto run production per tablets equals ecstasy This million one batch. than per more MDMA to of 179 kg at estimated capacity, production scale large a with laboratory MDMA an of seizure the is mentioning worth Also methamphetamine of traces even (produced from BMK)were found. and PMK amphetamines PMK), amphetamines), for (precursor BMK for (precursor BMK), for (precursor isosafrole APAAN MDMA, as MDMA), for (precursor such substances several analysis, of products or materials were found, compared to only 7 laboratories in 2012 in laboratories 7 only to compared found, were materials or products of Netherlands increase with increasing plantation size The most mediatized cases concerned 2 production sites of exceptional capacity ikd ih esn hvn cnetos ih h Ntelns r vn Dutch even entrepreneurs criminal or Netherlands The with connections having persons with linked The materials used for the cultivation are often purchased in Dutch grow shops grow Dutch in purchased often are cultivation the for used materials The cannabis. of production the concerning character commercial a with cases of majority a to linked inextricably are Netherlands the drugs, synthetic to Similar materials are required forthesynthesis labs” “pop-up These labs”. “kitchen convert so-called in produced is GHB of lot a as underestimation an probably is labs production GHB of number reported The Belgian the highly dosedMDMAtabletswere sentin2013(seealsochapter7,section 2.2). to regard on with warnings found early of tablets number increased ecstasy an Consequently, market. in MDMA of concentrations average higher the to contribute might and market recovering the of indication another yet is precursors MDMA of availability renewed This synthesis). amphetamine for conversion APAAN-BMK such the to pre-precursors (comparable PMK-glycidate from and safrole starting as synthesized is PMK Currently, precursors. precursors, of MDMA production has reached an industrial level in Belgium. The past shortage was labs these of set-up of the number that largest mentioning strikingly professional andwithenormousproduction capacity. the worth represent is It BMK labs. into dismantled APAAN of conversion the and amphetamines of production for labs The 2013. in increased phenomenon This noticed. was laboratories conversion APAAN/BMK of emergence the 2012, In btrlcoe o H truh laie yrlss N sophisticated No hydrolysis. alkaline through GHB to γ-butyrolactone . PMK, clearly has been resolved by the use of alternative of use the by resolved been has clearly PMK, casu in (Vanhove et al., 2014) al., et (Vanhove . : 1 active site and 1 non-active site. After chemical After site. non-active 1 and site active 1 : . The discovered plantations are also often (Ovaere, personalcommunication) . Moreover, the connections with The with connections Moreover,the . (Ovaere, personal communication) Dcre n Poi 2014) Paoli, and (Decorte Oar, personal (Ovaere, . . . 157 10. Drug markets T able 10.5| Source: Ovaere, personalcommunication,2014 *** ** * Plantation size* Micro Mini Small No info*** Middle sized Large T Industrial T 158 otal otal (withinfo)

plantations. to the DGJ-DJP instead of through the GND. For 2007, the corrections on capacity of plantations could be done for only a part of the directly reported are plantations the and seizure; actual the of instead reported is plantations cannabis of capacity the 2008, Since including cannabiscuttingsitesandotherplantationswithunknownsize 10.Percentage basedontotalnumberofplantationswithknownsize plants D>1000 Industrial: plants; 500-999 large: plants; 250-499 sized: Middle plants; 50-249 Small: plants; rug6-49 Mini: plants: 2-5 Micro: markets sized andindustrialplantationswasobserved. in 2013). Compared to 2012, an increase in the number of micro-, mini-, middle- increased with about 10% (from 1,111 plantations in 2012 to 1,212 plantations plantations seized of number the 2012, to Compared 2013. in increasing keeps capacity production cannabis Belgian the that show 10.5 Tablefrom data The Vanhove etal.,2014) that even microeven that generatecan plantations scale profitshigh shown has research reasons, commercial for cannabis cultivate growers these as micro or mini plantations and contain less than 50 plants. Although not all of n eea, n ido) anbs lnain a gnrt o aeae 575 average on generate can cannabis/m² plantation cannabis (indoor) an general, In and re-import ittoBelgium. cannabis buy to Netherlands the to travel Belgians of lot Paradoxically,a Number ofseizedcannabisplantationsbetween2008and2013,byplantationsize 666 646 136 219 125 (Smet et al., 2013) 20 58 63 45 N 2008 . 21.1 33.9 19.3 %** 100 9.0 9.8 7.0 738 737 138 227 161 73 67 71 . Most of the plantations (57.4%) can be categorised N 1 2009 18.7 30.8 21.8 %** 100 9.9 9.1 9.6 968 979 211 312 165 104 94 11 82 N 2010 21.8 32.2 17.0 10.7 %** 100 9.7 8.5 1,061 1,070 190 376 187 101 119 88 N 9 2011 17.9 35.4 17.6 11.2 (Decorte and Paoli,and (Decorte 2014; %** 100 9.5 8.3 1,105 1,111 172 453 166 142 89 83 N 6 2012 15.6 41.0 15.0 12.9 %** 100 8.0 7.5 g 1,207 1,212 228 465 156 119 141 98 N 5 2013 18.9 38.5 12.9 11.7 %** 100 9.9 8.1 T Cannabispriceatstreet level(euro) between2008and2013 able 10.6| Source: Federal police:Ovaere, personalcommunication,2014 Community Police, French Federal Cannabis resin pergram Community Flemish Federal Police, Community Police, French Federal Herbal cannabispergram Community Flemish Federal Police, average pricewas€9to€10pergram. the resin: cannabis for goes same year.The previous the to identical practically are values These 2013. in €9.5 and €8 between varied cannabis herbal of gram 1 for price average the region, the on Depending Table10.6. in presented are 2008-2013 period time the for products cannabis for prices retail average The is observedwiththefederal policedata,thesedataare notshownhere. difference significant no Since surveys. of use the through Eurotox by collected Information regarding the street prices of drugs in the An French Community is also users. and type drug and region is provided by in dealers Tablesprices 10.6 to 10.10 for maximum the time period 2008 to and 2013. drug minimum mean, reported (suspected) the of overview of interrogation are during data These obtained services. police federal the by collected the is and Community Flemish French the both from prices street drug on information Belgium, In 4.1. 4. Price/purit Price ofilliitdrugsat retail levelandwholesale 7.9 6.8 8.1 5.9 mean 2008 3.0 3.0 3.0 2.6 min 15.0 12.0 25.0 10.0 max 7.5 6.5 6.9 7.4 mean y 2009 4.0 5.0 3.3 3.0 min 12.0 10.0 12.0 12.5 max 7.0 7.5 8.2 6.4 mean 2010 3.0 5.0 5.0 2.8 min 15.0 10.0 12.5 10.0 max 6.7 7.4 8.0 6.9 mean 2011 2.0 2.0 2.5 2.5 min 25.0 25.0 16.7 16.7 max 9.3 8.6 8.9 8.9 mean 2012 2.5 2.5 1.8 1.8 min 18.4 18.4 25.0 25.0 max 10.0 9.0 9.5 8.0 mean 2013 2.75 2.75 3.0 3.0 min 20.0 20.0 20.0 20.0 max 159 10. Drug markets Heroin prices at street level between 2008 and 2013 can be found in Table 10.7. In 2013, the mean prices for heroin varied for the different parts of the country. There is no significant difference compared to the previous years. The prices varied between €25.5 and €31.3 per gram.

Table 10.7 | Heroin price at street level (euro) between 2008 and 2013

2008 2009 2010 2011 2012 2013 mean min max mean min max mean min max mean min max mean min max mean min max Heroin unspecified per gram Federal Police, French 23.9 5.0 50.0 24.4 10.0 50.0 24.2 8.0 50.0 29.7 7.0 100.0 27.3 6.0 100.0 25.5 7.4 125.0 Community Federal Police, Flemish 25.2 12.0 40.0 22.7 10.0 40.0 23.8 9.0 62.5 30.0 7.0 100.0 28.3 6.0 100.0 31.3 7.4 125.0 Community Source: Federal police: Ovaere, personal communication, 2014

Retail prices for cocaine are shown in Table 10.8. Average prices varied between €49 per gram in the Flemish Community, versus €67 per gram in the French Community. For crack cocaine, no price data are available as it is almost never found, except in a few very large cities such as Antwerp and Brussels. Compared to the previous year, a 10% price increase has been observed for cocaine in the French Community. Prices in the Flemish Community remained unchanged. One explanation why cocaine prices are lower in the Flemish Community could be the presence of the port of Antwerp in Flanders, which is the major source for cocaine entering Belgium. This could potentially result in an increased supply of cocaine in that region, hence the lower prices.

Table 10.8 | Cocaine price at street level (euro) between 2008 and 2013

2008 2009 2010 2011 2012 2013

160 mean min max mean min max mean min max mean min max mean min max mean min max Cocaine per gram Federal Police, French 47.8 5.0 87.0 52.8 10.0 100.0 52.2 30.0 100.0 51.8 20.0 100.0 60.9 20.0 125.0 67.0 14.3 133.3 Community Federal Police, Flemish 50.8 30.0 70.0 48.9 15.0 70.0 49.1 30.0 100.0 56.0 20.0 100.0 51.6 20.0 125.0 49.0 14.3 133.3 Community Source: Federal police: Ovaere, personal communication, 2014 T able 10.9| Source: Federal police:Ovaere, personalcommunication,2014 Community Police, French Federal Amphetamine pergram Community Flemish Federal Police, of yearsinBelgium. the of confirmation recovery - or even more, the blooming - of the ecstasy market in the last couple a more once is this 4.2), (see purity and seizures on data with together account, into this Takingwhatsoever. changed not have prices maximum and minimum also and remainedunchanged Community Flemish the in Community.Prices French the in tablet per €4.6 to €5.8 from decreased has tablet ecstasy single a averagefor remarkablethe price however that is It years. previous to compared unchanged remained has LSD of price The trip). paper or between blotters LSD and tablet (per unit per Tablegiven arein presented Prices is 10.10. 2013 and ‘ecstasy’-tablets 2008 for prices retail of evolution The found in the Flemish Community could suggest a shorter supply route in the in route Flemish Community,supply possiblyresponsible forthelowerprice. shorter a suggest could French Community Flemish are and the in laboratories found Flemish amphetamine most the that fact between The observed. difference was Community price A 20%. prices maximum with observed the decreased However, 2013). in gram per €8.2 gram to €8.4per 2012 (from in Community Flemish the in seen was but slight decrease very negligible a whereas 2013), in gram per €10.5 to 2012 in gram €9.8per in called is Belgium. A slight increase in price was observed in it the French Community (from as “speed” or amphetamine, for prices retail reflects 10.9 Table Amphetamine priceatstreet level(euro) between2008and2013 6.6 8.7 mean 2008 1.5 3.5 min 10.0 20.0 max 10.9 8.1 mean 2009 2.8 5.0 min 25.0 12.0 max 9.1 8.4 mean 2010 2.5 2.5 min 10.0 15.0 max 8.4 7.5 mean 2011 3.0 3.0 min 16.7 16.7 max 9.8 8.4 mean 2012 3.0 3.0 min 25.0 25.0 max 10.5 8.2 mean 2013 3 3 min 20 20 max 161 10. Drug markets 162

10. Drug markets T able 10.10| Community Flemish Federal Police, Community Police, French Federal Ecstasy pertablet Source: Federal police:Ovaere, personalcommunication,2014 Community Police, French Federal LSD perdose Community Flemish Federal Police, for herbal cannabis or cannabis resin in the last 4 years. For herbal cannabis, the the in changes large concentration of tetrahydrocannabinol (THC, the active component in cannabis) no been have there 10.1, Figure in illustrated clearly As contaminated or cut be (powders suchascocaineor heroin). can that drugs especially Belgium, the in of drugs overestimation of potential purity a in result can This seizures. drug pure more larger, encompass often seizures police since results, these interpreting needed when is the Caution seizures, reported. are police seizures small-scale For and festivals). large both dance of results at bins amnesty of contents the of analysis (e.g. streetcirculatinglevel at drugs of contents the analyse to aim also projects research Some Vivendi). (Modus region Brussels the in project testing drug local small-scale a through submitted are samples drug cases, of minority a In (NICC). Criminology and Criminalistics on Institute National the by analysed are and customs, federal or police by seizure after collected mostly are samples (BEWSD) Drug Belgium. in samples drug reportedanalysed all of database Drugs a keeps Belgian which on System the Warning on Early Belgian circulating the by drugs provided are illicit market classic the the of regarding Data purity 10.3. and and composition 10.2 10.1, Figures in presented are 2013 and 2002 between market drug Belgian the on found heroin) and cocaine MDMA, Mean concentrations of the most common illicit drugs (cannabis, amphetamine, 4.2. Ecstasy andLSDpriceatstreet level(euro) between2008and2013 Purity/potenc 3.2 4.1 8.3 . mean 2008 1.8 1.1 6.5 . min 10.0 10.0 5.0 . max 10.0 3.5 4.1 . mean y ofillicitdrugs 2009 10.0 1.0 1.2 . min 10.0 10.0 8.0 . max 12.0 5.2 3.4

. mean 2010 12.0 2.0 1.0

. min 10.0 10.0 12.0

. max 11.8 4.6 4.5

. mean 2011 2.0 2.0 7.0

. min 10.0 10.0 15.0

. max 10.0 5.8 4.5 10 mean 2012 1.0 1.0 3.0 3.0 min 10.0 10.0 10.0 10.0 max 4.6 4.4 10 10 mean 2013 1.5 1.5 10 10 min 10 10 12 12 max users or first-time users, such dosages can easily result in toxicity symptoms, intoxicity result caneasily dosages such users, first-time or even users containing Tablets 2.2). section young For Netherlands. the in found 7, been have base MDMA 250mg than more chapter highly (see concerning issued tablets were MDMA alerts dosed several 2013, During similar. largely is Netherlands The and The Belgium in market especially ecstasy the that and seems It FranceNetherlands. countries neighbouring our in observed been has also it since especially alarming, is trend This 2013). in tablet per base MDMA (221 mg Belgium in seen ever highest the was tablet ecstasy one in observed amount maximum the Also, tablet). per base MDMA (128.6 mg 2013 in record new a reaching rising, on kept has tablets ecstasy in content MDMA mean the 2009, Since 2008. to 2005 period the revival in decline a a after market towards ecstasy the point of factors multiple times, several mentioned already As Figure 10.1| lower in2013,compared to2012. previous levels (15%). approachingThe observed maximum THC concentrationsdecreased, in cannabis resin resinwere cannabis in level THC mean the 2013, were In year 2012. in observed previous was THC 17.2% peak the a resin, cannabis to Foreither. found compared concentration in differences minimum significant or No maximum (13.1%). 2012 in concentration mean the with mean THC concentration in 2013 was 10.4%, which is not significantly different Source: BEWSDdatabase.Error barsindicatemaximumobservedconcentration values

Purity (% THC) 10 20 30 40 50 60 70 0 2002-2013 Mean THCconcentration (%)insamplesofcannabis(herbalandresin),

2002 Cannabis re Herbal cannabis 2003

2004 sin 2005

2006

2007

2008

2009

2010

2011

2012

2013 163 10. Drug markets 164 10. Drug markets -ehlmhtmn (-A rmis n motn cnaiat n the on contaminant important an Belgian amphetaminemarket (see4.3.2.). Also, remains 2013. 2013. in in (4-MA) 71.2% 16.6% to 2012 4-Methylamphetamine only in 86.8% was from dropped purity value purity mean maximum the the 2012, in observed 19.4% of were values purity mean seized amphetamine Whereas sharply. of decreasing on the purity keeps samples 2013: in confirmed again was Belgium in powders amphetamine of purity the regarding years three last the of trend The Figure 10.2| (61.4%); however,2012 thesamplesizewasonly13samples. in purity the to comparable fully was 2013 average in Reported powder MDMA “sand”). for purity or “molly” term: (slang form powder or crystal in market drug the on MDMA of appearance the is phenomenon new relatively A other substances,e.g.PM(M)A. with contaminated tablets or tablets, ecstasy dosed highly of consumption due to 2013 in workers died Netherlands) field The (and both Belgium in alert people several users, to and actions swift the despite Unfortunately, market. The settings. ecstasy changing this of festive aware well currently are Belgium in services reduction in dehydration Harm phenomenon. this regarding e.g. extensively partners its warned has BEWSD with combined when especially Source: BEWSDdatabase.Error barsindicatemaximumobservedconcentration values.

MDMA content in ecstasy tablets (mg MDMA base per tablet) 100 120 140 160 180 200 Mean DMAcontent(mg)inecstasytabletsbetween2002and2013 20 40 60 80 0

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013 Figure 10.3| to previous years(66.2%). values obtained in 2011 (21.1%). The maximum obtained value was purity comparable the than lower still is but market 2012), in 13.3% versus heroin 2013 in purity (18.7% the on drugs of 2012 to compared 2013 in higher purity was purity heroin mean poor.The remained the market, cocaine the to Contrary and100% (98.19% 2012 pure) cocainewere made,whichcouldhaveskewedtheresults. and 2011 (88.6%), in (more of seizures large 2012, and 2011 in high that noted be to has It respectively). those are than concentrations lower reported significantly maximum remains but Belgium the in Also, cocaine of high. purity very ~350). the countries, similar: EU was other samples to analysed Compared collected of number the respectively; between the mean cocaine concentration in 2012 and 2013 (59.1% and 57.8% found was difference significant no samples, cocaine of purity the Concerning Source: BEWSDdatabase.Error barsindicatemaximumobservedconcentration values.

Average drug purity (%) 100 10 20 30 40 50 60 70 80 90 0 and 2013 Mean purity(%)ofcocaine,heroin andamphetaminebetween2002

2002 Cocaine 2003

2004

Her 2005 oin 2006

2007 Amphetamine

2008

2009

2010

2011

2012

2013 165 10. Drug markets 166 10. Drug markets Figure 10.4| 2013 containingamphetamine. effectively MDMA as MDMA- sold contained only were only MDMA as the active component. Only 3 that tablets were analysed containing in tablets tablets Most increased. seized substances of like amount the 2012, to Compared 4.3.1. powders and (tablets, drug samples of seized liquids) isavailablethrough theBEWSDdatabase. composition specific the on Similar to the information obtained for drug purity in paragraph 4.2, information Compositionofillicitdrugantablets 4.3. Source: BEWSDdatabase 6 5 4 3 2 1 % oe f h shdld usacs ne te 91 N ovnin n scorpc Substances Psychotropic on Convention UN 1971 the Schedules IandIIorunderEuropean legislation(CouncilDecisions). under substances scheduled the of none containing but tablets drug illicit as seized/submitted tablets to refers ‘Miscellaneous’ category The (e.g. MDMA-like substances non-scheduled with mCPP, without caffeine,DOB). association or with in together or (meth)amphetamine, and/or alone substances (meth)amphetamine), or substances MDMA-like (than substances scheduled other containing tablets to refers substances)’ (scheduled ‘Others category The together withorwithoutnon-scheduledsubstances(e.g.mCPP, caffeine). methamphetamine, MDMA-likerefersand/or only substances)’ containing amphetamine and tablets substances to scheduled only the (as (meth)amphetamine and substances ‘MDMA-like category The mCPP,(e.g. caffeine). substances non-scheduled without or with together methamphetamine, and/or amphetamine The category ‘(meth)amphetamine (as the only scheduled substances)’ refers to tablets containing only with orwithoutnon-scheduledsubstances(e.g.mCPP, caffeine). MDMA and/or other MDMA-like substances (MDEA, MDA) as the only scheduled substances, together containing tablets to refers substances)’ scheduled only the (as substances ‘MDMA-like category The Psychotropic on Convention UN 1971 the Substances SchedulesIandIIunderEuropean legislation(CouncilDecisions). under controlled substances to refer drugs Scheduled 100 10 20 30 40 50 60 70 80 90 0 Tablets 2008 Composition ofillicitdrugtabletsbetween2008and2013 2009 2010 2011 2012 2013 only MDMA only (meth)amphetamine (meth)amphetamine MDMA substances other scheduled miscellaneous -like+ -like derivatives. containing citrateerectilesildenafil therapyas and dysfunction were agentssuch observed, tablets (counterfeit) Also, oxymetholone. and methandrostenolon substances. These predominantly included hormonal non-psychoactive agents such as clenbuterol, but active, pharmaceutically contain to found and analysed were tablets of amount mCPP.substantial containing a tablets Also, of number substances” the in decrease small a psychoactive except observed, were category ‘miscellaneous’ “other the such of composition the the in stimulants, differences real no in years, prescription previous to found Compared category. and were benzodiazepines methylphenidate, pharmaceuticals. (counterfeit) as as of such substances contain lot not psychoactive A do other that but tablets drugs, comprises illegal mostly category miscellaneous The Figure 10.5| hy ee lo o icue i te mselnos ctgr. detailed A category. provided inFigure “miscellaneous” 10.5. the in is category “miscellaneous” the in tablets included the of composition the of description not also were They calculations. these in included not were tablets fillers) inert (e.g. or lactose substances only containing psychotropic any contain not did that tablets Seized Source: BEWSDdatabase hormones, tramadol and sulpiride The category“Other psychoactive substances”includedmostlybenzodiazepines,antidepressants, % 100 10 20 30 40 50 60 70 80 90 0 2008 Description oftabletcategory‘miscellaneous’between2008and2013 2009 2010 2011 2012 2013 ingr only non-active substances other psychoactive combination mCPP in mCPP alone edients 167 10. Drug markets 168 10. Drug markets people have died due to this contamination this to due died have people result of a contamination of BMK with 4-methyl-BMK. In 2012 and 2013, several the probably is samples amphetamine in presence Its samples). tested of (12% amphetamine for contaminant a as found frequently was 4-MA 2013, in Again Belgium. in drug pure least the remains amphetamine years, previous to Similar is samples presented inTable powder 10.11. heroin and cocaine amphetamine, analysed and concentration seized mean in their and agents adulterants/cutting the of overview An 4.3.2. process. They were present in 16 to 20% of tested samples, in relatively low relatively in concentrations (1to10%). samples, tested of 20% to 16 in present were They process. manufacturing heroin the from mean originating impurities or a impurities natural together are in 20%), samples of of concentration 18% caffeine concentration in of mean 40%). Monoacetylmorphine (MAM), noscapine and was papaverine present a (paracetamol, Belgium in acetaminophen in samples with samples of heroin 21% in in agent (present cutting used most The lidocaine and phenacetinewere alsofrequently encountered. hydroxyzine, Caffeine, properties. stimulating with compound toxic relatively a aminorex, form to metabolized be also can Levamisole problematic. risk of serious side effects (such as agranulocytosis), the addition of levamisole is the to Due crack. or cocaine smokable produce to required reaction acid/base to the weight to of freebase cocaine, since levamisole cannot be removed with the adds countries) it Also, cocaine. Latin-American cut the of (mostly appearance the improve production and weight of increase country the in added is and samples, cocaine in worldwide found is Levamisole ~10%). concentration mean samples, of 48% in (present samples cocaine in adulterant encountered Belgium does not come as a surprise. In 2013, levamisole was the in analysed samples most cocaine in frequentlyagents cutting and adulterants of concentration Considering the high purity of cocaine in Belgium (see 4.2, Figure 10.2), the low might indicateagrowing popularityof4-FA. this Netherlands, was The in observed it already As 3.3%). Belgium, concentration mean 3%, in substance scheduled samples, (5 samples amphetamine in contaminant a as a times multiple detected already is (4-FA) amphetamine caffeine (62% of tested samples, mean concentration 53%). Although 4-Fluoro- include samples amphetamine in agents cutting encountered frequently Other to previous years(1.9%versus7.6%). in 2012 versus 12% in 2013). The mean concentration was also lower compared (18% year last to compared lower was 4-MA with contamination of frequency Other product types (Blanckaert et al., 2013) al., et (Blanckaert . However,the . T able 10.11| Source: FAMHP, data2011-2013, personalcommunication; Ovaere, personalcommunication,2014 Drug type Amphetamine Cocaine Heroin Adulterants/cutting agentsfoundinseizeddrugpowders2013 Adulterants mCPP 4-Fluoro-amphetamine Caffeine 4-MA Hydroxyzine Levamisole MAM Acetaminophen Caffeine Diltiazem Lidocaine Phenacetine Caffeine Noscapine Papaverine Samples 101 255 178 151 178 175 172 (N) 19 52 36 96 74 3 5 5 samples % of 12.0 10.0 62.3 18.0 14.0 48.0 21.0 18.0 21.0 21.0 20.0 1.9 3.1 1.0 7.0 concentration (%) Mean adulterant 53.0 10.7 27.0 40.0 20.0 3.3 1.9 4.0 2.0 4.5 6.7 9.0 8.8 9.0 0.8 169 10. Drug markets 170 10. Drug markets o (ehapeaie wr sie. lo te ubr f ytei drug synthetic of number the Also, production laboratories reached anall-timehighin2013. seized. were (meth)amphetamine, for APAAN, of pre-precursor amounts forced a large very 2013, In precursors. new find been to have producers drug strictly, more enforced are precursors to drug regard with regulations international the Since pre-precursors. the of is Although introduction market amphetamine the on Belgium. evolution important An in market. the fromdisappear to drug starting presence it’s “pure”reported, been still has least 4-MA contaminant the remains Amphetamine changes were observedin2013concerningthepotencyofcannabis. herbal cannabis and cannabis resin analysed was observed in the past five years, no large of of concentration purity THC the in the fluctuation slight in some Although seen samples. heroin was increase an However, the cocaine. in of observed purity was change in No observed. observed were years drugs previous to of compared differences major quality no 2013, in Belgium high in purity drug overall to regard With Belgium. the is result another Moreover, to previous years.Cocainestillremains themostexpensivedruginBelgium. health problems associatedwithitsuse,remained absentinBelgium. national and social the and meth”) “crystal as known (also methamphetamine far, So Slovakia. and Republic Czech of the as such countries European eastern introduction to confined been the has use methamphetamine Historically, is Belgium. in seized were stimulant-market the on methamphetamine; for the first observation time, considerable amounts of methamphetamine alarming An (EMCDDA, 2014) prices in Belgium tend to be generally low compared to other EU member states drug scale, import large the and capacity production the of consequence a As NPS orprecursor products from Asia totherest ofEurope. national the and the last two years, Belgium has taken up an important role in the distribution of Antwerp of port example, For narcotics. other of large trafficking the in role major a ensures the airports, as such points access Also, existing easy the MDMA). with combination and in Europe within amphetamine location geographical (mostly central the drugs synthetic and a cannabis being for despite country production complicated: important an rather been historically is has Belgium country, Belgium small within and to supply Drug 5. nrae a osre i te ocnrto o MM i esay tablets. ecstasy in MDMA of concentration the in observed was increase drastic a tablets, ecstasy in contaminants reported many low and of content years MDMA few a After market. in ecstasy issue the of main revival obvious the an problems, is Belgium health correlated and potency drug of terms In C onclusions . No significant changes in price were observed in 2013 compared involvement is gratefully acknowledged. essential Their feedback. valuable their and collection their data the for of contribution Verstraete dr. Prof. and Tytgat dr. Prof. Neels, dr. Prof. Martens, dr. Prof. Lambert, dr.Prof. Decorte, dr.Prof.Charlier,dr. Prof. Maes, Mrs. Linden, VanderMrs Ovaere, Mrs VanDurme, Mr Van Camp, Mr Schrooten, Mr Pire, Mr (Ph.D.), Hogge Mr Evenepoel, Mr Cordonnier, dr. Maudens, Apr. dr. Beer, De dr.Apr.Apr.Mergan,Clerck, Apr. De Buck, Apr. De thank to want authors The Acknowledgements drug market. Belgian the drug of landscape changing and current performed the of monitoring accurate the regular and all encompassing analyses are still lacking in Belgium. Although, it is of paramount importance for system reporting data and collection data solid a Hence, analyses. of kind these for system consistent no is latter are sometimes reported throughThe the early warning system, however there amounts. smaller in streets the on circulating drugs of purity the indicate reliably not may figures these such, As retail. to wholesale from shifting when contaminated and cut get drugs that known well is It drugs. of seizures large from obtained are to analyses drug important of results is the of it purity,majority the drug that emphasize on information the to regard with general, In sold asMDMA,actuallycontainedonlyMDMAactivecomponent. were that tablets most contaminated: were to tablets seized compared Less years. significantly previous changed hasn’t tablets drug illegal of composition the tablets, ecstasy in amounts MDMA increased the from apart Nevertheless, 171 10. Drug markets AUTHORS

Antoine Jerome, Ir. joined the Scientific Institute of Public Health in 2009 with a background of Bioengineering at the university of Liège and developed an expertise in epidemiology and statistics. Since 2011, he is the is working at the Belgian Monitoring Centre for Drugs and Drug Addiction (BMCDDDA) as the coordinator for the treatment demand indicator (TDI) registration.

Blanckaert peter, ph.D. focused on research after his Master in Pharmaceutical Sciences and completed his PhD in Pharmaceutical Sciences at Ghent University. He was engaged as a post-doc for two years at the Ghent University Hospital to further develop his expertise in analytical, organic and radiochemistry. Since 2012, Peter is the coordinator of the BEWSD, the Early Warning System of the BMCDDA since 2012.

Casero Lucia joined Eurotox in 2007 as a coordinator after graduating with a Master in Public Health from the ULB-UCL University. She holds complementary certificates in Public Health in particular from the University Carlos III in Madrid and from the Tropical Institute of Medicine in Antwerp. Her career includes several years of programme management in Non-profit organizations. She is the representative liaison between Eurotox, the Walloon Regional Focal Point, and the WIV-ISP.

De Ridder Karin, M.D., Ph.D. graduated as Medical Doctor at KU Leuven in 2000 and became medical specialist in Community Health in Norway in 2009. She has clinical experience from general practice and physical medicine/rehabilitation and administrative experience from health care organization, infection control and environmental health. She completed her PhD in Public Health at the Norwegian University of Science and Technology in 2014, after which she joined the BMCDDA.

Gremeaux Lies, Ph.D. graduated as Master in Biology at KU Leuven in 2007 and specialised in educational coaching and group management after obtaining her PhD degree in Medical Sciences in 2011. As from 2013, she is the Head of the Belgian National Focal Point (BMCDDA) and responsible for the scientific unit Programme Drugs at the WIV-ISP.

Laudens Fred is Master in Psychology and works for VAD since 1999. He is the representative liaison between VAD, the Flemish Regional Focal Point, and the WIV-ISP.

Plettinckx Els graduated as Master in Criminological Sciences at Ghent University in 2011. After an internship at the EMCDDA, she started working at the Belgian Monitoring Centre for Drugs and Drug Addiction in 2012 as the coordinator for the Belgian Annual Report.

uthors Freya Vander Laenen, Ph.D. is Bachelor of Social Work (1993), Master of Criminology (1996) and A doctor in Criminology (2007). She is Professor at Ghent University attached to the Department of Penal law and Criminology and member of the research group ‘Institute for International Research 172 on Criminal Policy’ (IRCP). Prof. dr. Vander Laenen participates in different international networks and is an expert with regard to drug prevention, harm reduction, drug-related crime, drug policy and on qualitative methodology in drug research.

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W., Vanderplasschen, and B., Ruyver, De F., Laenen, Vander studenten Antwerpse bij middelengebruik Gezondheidstoestand I: 2010. Rapport J., - Tafforeau, & 2008 E., Hesse, België S., Drieskens, S., Demarest, L., Gezondheidsenquête, Gisle, J., Heyden, der Van of illicit cannabis growersGÇÖ profits in Belgium. Vanhove,W., T.,Surmont, P.,VanDamme, estimation An blanks. the Ruyver,in De Filling & 2014. B., Fatik Vanderplasschen, W., Vandevelde, S., & Broekaert, E., 2014. E., Broekaert, & S., Vandevelde, W., Vanderplasschen, [Accessed at: Available Vanderplasschen, W., 2014. W., Vanderplasschen, Academia Press. addictions in Europe. Evidence, current practices and future challanges future and practices current Evidence, Europe. in addictions naar de overheidsuitgaven voor het drugsbeleid in België in drugsbeleid het voor overheidsuitgaven de naar adWle G, aebr, . Drel, . & atn M, 00 D pat e btkns van betekenis en plaats De 2010. M., Easton, evaluatie indeinterbestuurlijkeveiligheids-enpreventieplannen. & A., Dormeals, E., Wayenberg, G., VandeWalle, Office oftheEuropean Union. Scope and responses. and Scope qualitative outcome evaluation outcome qualitative 443. Thomas, S., 2013. VanderF.,Laenen, Vanderplasschen,Ruyver, W.,De A., Keulenaer,Dekkers, De C., B., Wittouck, & S., (SUBANOP), Gent:Academia Press. nightlife: more than just dance Music. dance just than more nightlife: Van Havere, T., Vanderplasschen, W., Lammertyn, J., Broekaert, E., & Bellis, M.A., 2011. Drug use and 18, pp.153-160. , 2012,(134),pp.4-9. Het pilootproject drugsbehandelingskamer te Gent: een uitkomstenevaluatie een Gent: te drugsbehandelingskamer pilootproject Het , Bruxelles :ModusVivendiasbletFEDITO bruxelloise. ‘s Werelds grootste drugsonderzoek: de Belgische resultaten Belgische de drugsonderzoek: grootste Werelds ‘s . [Online] Belspo. Available at:

H, 2010. WHO, [Accessed 8-10-2014]. at: HIV prevention, treatment and care for injecting drug users drug injecting for care and treatment prevention, HIV n eiivodrok a d Gns drugbehandelingskamer. Gentse de van recidieveonderzoek en Wittouck, S., Vander Laenen, F., Dekkers, A., Vanderplasschen, W., & De Ruyver, B., 2013. Uitkomsten- globaldrugsurvey.com/facts-figures/the-global-drug-survey-2014-findings/> [Accessed 2-10-2014]. WHO, 2012. WHO, World Healthorganisation. Weerwerk, 2014. Weerwerk, Windelinckx, T., 2011. mesrg/publications-of-research-projects> [Accessed 8-10-2014]. WIV-ISP. 2014.BelgianTreatment DemandIndicatorRegister(BTDIR). 2014. B., Wilms, in school-aged children (HBSC) study: international report from the 2009/2010 survey 2009/2010 the from report international study: (HBSC) children school-aged in isok A 2014. A, Winstock, Free Clinicvzw, Antwerpen. Windelinckx, T., 2014. Free clinicvzw. druggebruikers ie, 2014. Vigez, Windelinckx, T., 2013. T., Windelinckx, Windelinckx, T., 2012. Ville de Charleroi, 2014. Charleroi, de Ville Ziektepreventie. Available at: [Accessed 8-10-2014]. H, 1986. WHO, [Accessed 29-9-2014]. usac ue Mna fr s i piay care primary in use for Manual use. substance WHO, 2012. WHO, [Accessed 29-9-2014]. WHO, UNODC, & UNAIDS, 2012. UNAIDS, & UNODC, WHO, WHO RegionalOfficeforEurope. Addictive Behaviors Addictive Prevention and control of viral hepatitis infection: framework for global action global for framework infection: hepatitis viral of control and Prevention Oln] Uevn Aalbe t [Online] [nie Wrd elh raiain Available organisation. health World [Online] . , Geneva:WHO. [nie Aalbe t Vlaamse Spuitenruil, , Copenhagen: , , Geneva: , 183 Bibliography ALPHABETIC LIST OF RELEVANT INTERNET ADDRESSES AND DATABASES

This alphabetic list contains only specific drug-related websites in Belgium, which contains background information about illegal drugs. (accessed on 31/10/2014).

Belgian Early Warning System on Drugs – Information about the Early Warning system [EN] ewsd.wiv-isp.be

Belgian Health Interview Survey – Information about the general population survey [FR-NL-EN] his.wiv-isp.be

Breakline – Prevention group for partygoers [NL] www.breakline.be

Cannabis Hulp – Online treatment and prevention for cannabis users [NL] www.cannabishulp.be

De Druglijn – Information about drugs in general [NL] www.druglijn.be

Drug Hulp – Online treatment and prevention for drug users [NL] www.drughulp.be

Drugs in beweging – Prevention initiative for youth [NL] www.drugsinbeweging.be

Federal public service Health – Cell Drugs [FR-NL] www.health.belgium.be

Federal public service Justice – Theme drugs [FR-NL] www.justitie.belgium.be

Flemish Agency for Care and Health – Mental health theme [NL] http://www.zorg-en-gezondheid.be

VLASPAD (VUB) – Flemish school research project about alcohol and other drugs [NL] www.vlaspad.be b ases internet addresses and data Infor Drogues – Information about drugs in general [FR] 184 www.infor-drogues.be Mental Health Consultation platform in Brussels-Capital Region [FR-NL] www.pfcsm-opgg.be

Modus Vivendi – Prevention and harm-reduction information [FR] www.modusvivendi-be.org

VAD – non-profit association for alcohol and other drug problems [FR-NL-EN] www.vad.be

SPZ – Social and psychological center in the German Community [DE-FR-NL] www.spz.be EUROTOX – Socio-epidemiological observatory for alcohol and drugs in the French community [FR] www.eurotox.org

Treatment demand indicator Belgium – Information about the indicator collection [FR-NL] tdi.wiv-isp.be

BELSPO – Federal scientific policy office financing research projects on drugs [FR-NL-EN] www.belspo.be

VAD Ginger – Information about prevention activities related to drugs or alcohol [NL] www.vadginger.be

PortailDrogues – Collection of treatment centers, trainings or documentation related to drugs and alcohol [FR] www.ida-fr.be

IDA – Information about drugs and alcohol [NL] www.ida-nl.be

BiblioDrogues – Collection of publications over drugs and alcohol [FR] www.biblio-drogues.be

OutilsDrogues – Directory of tools related to drugs or alcohol prevention and harm reduction [FR] www.outils-drogues.be

FEDITO BXL – Brussels federation of centers for drug addiction [FR] www.feditobxl.be

FEDITO Wallonne – Walloon federation of centers for drug addiction [FR] www.feditowallonne.be

Plate-forme de réduction des risques – Initiative to reduce drug-related harm [FR] reductiondesrisques.be

b ases internet addresses and data

185 186 List of abbreviations DG MJH DGJ-DJP DAST COCOF CLDB CIU CICs CI CGOP CEBAM CD4 CBPS CAPI CAO CAD BTDIR BMK BMCDDA BHIS BEWSD BELTA BELSPO B.S/M.B ASSIST ASL ASBL ARLs APB APAAN AM-2201 ALFA AIDS ADHD A&D 6-APB 5F-UR144 5F-AKB48 4-MA 4-FA Abbreviation LIST OFABBREVIATIONS ANNEX 1 CRA CPAS COCOM Directoraat Generaal Justitiehuizen-Direction générale desMaisonsdejustice Directorate General ofthe Judicial Police -Directorate ofcrimeagainstpersons Drug AbuseScreening Test Community Reinforcement Approach Centre Publicd’AideSociale Commission Communautaire Commune Commission communautaire française Coordination Locale Drogues Bruxelles Central IntakeUnit Crisis InterventionCentres Confidence Interval Centraal Georganiseerd OverlegPolitie Belgian Centre forEvidence-BasedMedicine Cluster ofDifferentiation 4 Centre BruxelloisdePromotion delasanté Computer-Assisted Personal Interviewing Collectieve arbeidsovereenkomst Centre forAlcoholandotherDrugs Belgian Treatment DemandIndicatorRegister benzylmethylketon (1-phenyl-2-propanon) Belgian MonitoringCentre fordrugsanddrugaddiction Belgian HealthinterviewSurvey Belgian EarlyWarning System onDrugs Belgian Lung andTuberculosis Association Belgian Federal SciencePolicy Office Belgisch Staatsblad/Moniteur Belge Alcohol, SmokingandSubstanceInvolvementScreening Test Arbeitsgemeinschaft fürSuchtvorbeugungundLebensbewältigung Association sansbutlucratif AIDS Reference Laboratories Algemene PharmaceutischeBond-Association PharmaceuticBelge Alphaphenylacetoacetonitrile 1-(5-fluoropentyl)-1H-indol-3-yl]-1-naphthalenyl-methanone (Help LiegetoAlcoholicsandtheirfamilies) Aide LiégeoiseauxAlcooliquesetàleurFamille Acquired ImmuneDeficiency Syndrome Attention DeficitHyperactivity Disorder Alcohol andDrugs 6-(2-aminopropyl)benzofuran XLR-11 N-((3s,5s,7s)-adamantan-1-yl)-1-(5-fluoropentyl)-1H-indazole-3-carboxamide 4-Methylamphetamine 4-fluoro-amphetamine Explanation (Directorate General - Houses of Justice) of Houses - General (Directorate Brussels) health of Promotion the for (Centre management) life and prevention addiction for (Association Belgium) Association Pharmaceutical (General (Public Centre of social assistance) social of Centre (Public (Non-profit association) (Non-profit (Collective Agreement) (Collective (Belgian official Journal) official (Belgian (Commission of the French Community) French the of (Commission (Local Coordination of Drugs in Brussels) in Drugs of Coordination (Local (Centrally Organised Consultation Police) Consultation Organised (Centrally (Common Community Commission) Community (Common NAP MSCC MDMA-HCI MDFT MDEA MDA mCPP MAM LSD ISD IRQ IRCP IPSA IDUs IDU IDA ICT ICD HIV HCV (ab) HBV (ab) HBSC HBsAg GPS GP GND GMR GHQ GHB GBL FPS FEIAT FARES FAMHP EWS EuropASI EU ESPAD EMCDDA EHIS ED DTC DSM DRD DOC DOB DMT National AlcoholPlan Medical andSocial Care Centres 3,4-Methylenedioxy-N-Methamphetamine hydrochloride salt Multi-Dimensional Family Therapy Methylenedioxyethylamphetamine 3,4-Methylenedioxyamphetamine meta-Chlorophenylpiperazine Monoacetylmorphine Lysergic Acid Diethylamide Institute ofSocialDrugresearch Injecting RiskQuestionnaire Institute forInternationalResearch onCriminalPolicy Instituut voorPermanente Studie voorApothekers Injecting DrugUsers Injecting DrugUse Information onDrugsandAlcohol Information andcommunicationstechnology International Classificationofdiseases,injuriesandcauses deaths Human ImmunodeficiencyVirusinfection Hepatitis CVirus(antibody) Hepatitis BVirus(antibody) Health BehaviourinSchool-agedChildren Hepatitis BSurfaceantigen General Population Survey General Practitioner General NationalDatabase General MortalityRegister General HealthQuestionnaire Gamma-Hydroxybutyric acid Gamma-butyro-lactone Federal PublicService Federation oftheEmployersAmbulatoryInstitutionsforDrugaddiction Fonds desAffectionsRespiratoires Federal AgencyforMedicinesandHealthProducts Early Warning System European AddictionSeverityIndex European Union European SchoolsurveyProject onAlcoholandotherDrugs European MonitoringCentre fordrugsanddrugaddiction European HealthInterviewSurvey Emergency Department Drug Treatment Court Diagnostic andstatisticalManualonMentalhealth Drug-Related Deaths 2,5-dimethodxy-4-chloro-amphetamine Dimethoxybromoamphetamine N,N-Dimethyltryptamine (Institute for Permanent Study for pharmacists) for Study Permanent for (Institute (fund of respiratory diseases) respiratory of (fund 187 List of abbreviations 188 List of abbreviations (Italics): English translation English (Italics): WIV-ISP WHO VRGT VLASPAD VIGEZ VAD USA UNODC UN ULB UK UCL TPHA THC TDI TAD ST SSPF SLCD SIPAR SEM-J SBIRT RAR PMMA PMK PMA OST OCMW NPS NIHDI NICC NGO NEP

Publique Wetenschappelijk InstituutvoorVolksgezondheid –InstitutScientifiquedeSanté Drugs) World HealthOrganization other and Alcohol bestrijding on Project survey Vlaamse vereniging voorRespiratoire Gezondheidszorg enTuberculose School (Flemish problems) drug VLAams SchoolonderzoeksProject naarAlcoholenandere Drugs other and alcohol Vlaams InstituutvoordeGezondheid for (Association Vereniging vooralcoholenandere drugproblemen United States ofAmerica United NationsOfficeonDrugsandCrime United Nations Université Libre deBruxelles United Kingdom Université catholiquedeLouvain Treponema pallidumhaemagglutination Tetrahydrocannabinol Treatment DemandIndicator Pharmacists) Speaking Tobacco, AlcoholandDrugs French of Standard Table association (Scientifique youth) – use Société ScientifiquedesPharmaciensFrancophones substance with Survey, LifestyleandChronic Diseases experience Système InformatiquePARajudiciaire instrument (Screening Screeningsinstrument ErvaringenmetMiddelengebruik–Jongeren Screening, BriefInterventionandReferral toTreatment Rapid Assessment andResponse para-Methoxymethamphetamine Piperonylmethylketon para-Methoxyamphetamine Opioid SubstitutionTreatment Openbare CentrumvoorMaatschappelijkWelzijn New PsychoactiveSubstances National InstituteforhealthanddisabilityInsurance National InstituteforCriminalisticsandCriminology Non-Governmental Organization Needle ExchangeProgramme (Public centre for social welfare) social for centre (Public (Scientific Institute of Public Health) Public of Institute (Scientific (Flemish Association for Respiratory health and Tuberculosis control) Tuberculosis and health Respiratory for Association (Flemish (Free University of Brussels) of University (Free (Catholic University of Louvain) of University (Catholic (Flemish institute for health) for institute (Flemish Table 1.1. LIST OFTABLES ANNEX 2 Table 2.1. Table 3.1. Table 4.1. Table 4.2. Table 4.3. Table 5.1. Table 5.2. Table 5.3. Table 5.4. Table 5.5. Table 5.6. Table 6.1. Table 6.2. Table 6.3. Table 6.4. Table 6.5. Table 10.3. Table 10.2. Table 10.1. Table 9.1. Table 8.6. Table 8.5. Table 8.4. Table 8.3. Table 8.2. Table 8.1. Table 7.1. Table 6.7. Table 6.6. Financed projects of the addictionfundin2013 users intheFlemishCommunity, 2011/2012 Frequency ofcannabis use(%)amongstudentsinthe‘last12months’ cannabis DrugLijn andInfor-drogues Number (N)andprevalence (%)ofcallsbygenderandsubstancein2013, between 2002and2012 Estimated numberandprevalence ofever-injecting druguse(15-64years) in theFrench Communitybetween2006and2013 Prevalence (%)ofinjectingdruguseandpolydrugwithinnightlife settings in theFrench Community Lifetime injectingdruguseandpolydrugamongpeoplerecruited atthestreet Network ofoutpatienttreatment facilities(totalnumberofunits) (number ofclients)in2013 Total outpatienttreatment provision forillicitdrugtreatment demand Network ofinpatienttreatment facilities(totalnumberofunits) (number ofclients)in2013 Total inpatienttreatment provision forillicitdrugtreatment demand Characteristics ofpatientsenteringtreatment in2013bytypeofprimarydrug type ofsubstance Characteristics ofpatientsreceiving methadoneorbuprenorphine in2013by Flemish region between2006and2012 Prevalence rate (%)ofHIV-seropositivity amongever-IDUs intreatment inthe settings intheFlemishCommunitybetween2006and2013 Prevalence rate ofHepatitisBamongever-IDUs attreatment andotherdiagnostic programmes intheFlemishregion in2013 Responses totheInjectingRiskQuestionnaire (IRQ)withintheneedleexchange users intheFrench Community(ModusVivendi)between2006and2013 Proportion (%)ofinjectingriskbehaviouramongstreet-recruited injectingdrug by theBelgianNationalPoison Centre in2013 Proportion ofIllicitsubstancesmentionedduringtelephoneenquiries received Amounts ofprecursors seizedbetween 2011 and2013 Total quantitiesofseizeddrugsbysubstancebetween2007and2013 Number ofdrugseizures bysubstancebetween2007and 2013 between 2011and2013 Substances detectedinbloodsamples afterapositiveoral fluid screening test Examples ofleisure activitiesinitiatives Examples ofemploymentinitiatives Examples ofeducationandtraining initiatives Examples ofinitiativesinfindinglong-termaccommodation Examples ofsupportedhousing,halfwayhousesandliving initiatives Examples oftemporary housingandemergency accommodationinitiatives in 2013bysubstance Demographic characteristics andpatternsofusepersonsadmittedtoCIC’s Register (SelectionB)between2004and2011 Number ofdrug-induceddeaths(15-64yrs)basedontheGeneral Mortality Community (DeSleutel)between2006and2013 Prevalence ofpsychiatriccomorbidityclientsenteringtreatment intheFlemish 155 154 152 132 125 125 124 123 123 122 106 102 100 23 34 51 70 72 74 80 80 81 81 83 84 92 94 96 98 99 189 List of tables 190 List of tables Table 10.11. Table 10.10. Table 10.9. Table 10.8. Table 10.7. Table 10.6. Table 10.5. Table 10.4. Adulterants/cutting agentsfoundinseizeddrugpowders2013 Ecstasy andLSDpriceatstreet level(euro) between2008and2013 Amphetamine priceatstreet level(euro) between2008and2013 Cocaine priceatstreet level(euro) between2008and2013 Heroin priceatstreet level(euro) between2008and2013 Cannabis priceatstreet level(euro) between2008and2013 size Number ofseizedcannabisplantationsbetween2008and2013,by plantation between 2007and2013 Number andtypeofsyntheticdruglabsdismantledbyBelgianpolice services 169 162 161 160 160 159 158 156 Figure 2.1. LIST OFIGURES ANNEX 3 Figure 2. Figure 2.3. Figure 2.4. Figure 5.1. Figure 5.2. Figure 5.3. Figure 5.4. Figure 6.1. Figure 6.2 Figure 10.1. Figure 9.8. Figure 9.7. Figure 9.6. Figure 9.5. Figure 9.4. Figure 9.3. Figure 9.2. Figure 9.1. Figure 8.2. Figure 8.1. Figure 7.2. Figure 7.1. Figure 10.5. Figure 10.4. Figure 10.3. Figure 10.2. Community schoolstudents(12-18 yearsofage)between2000and2012 Relative frequency (%) ofever, lastyearandregular useofcannabisinFlemish between 2000and2012 other thancannabisinFlemishcommunityschoolstudents(12-18 yearsofage) Relative frequency (%) ofeverandlastyearuseillicitpsychoactive substances Proportion (%)ofyouthaged15-24reporting theuseofcannabis,2014 Proportion (%)ofyouthaged15-24reporting theuseofNPS,2014 Proportion (%)oftreatment demandsbyprimarydrugin2013 Disability Insurance between2011and2013 in thecentres withaconventiontheNationalInstituteforHealthand Trends innumbersofclientsenteringtreatment forthe firsttime,byprimarydrug between 2011and2013 with aconventiontheNationalInstituteforHealthandDisabilityInsurance Trends innumberofallclientsenteringtreatment, by primary druginthecentres and 2013 Trends innumberofclientsreceiving methadoneorbuprenorphine between 2009 intervals byyearandsource between1995and2013 HIV-prevalence rates amonginjectingdrugusersand95%Wilson’s confidence settings intheFlemishCommunitybetween2006and2013 Prevalence rate ofHepatitisCamongever-IDUs attreatment andotherdiagnostic substances between2006and2012 Sentences andsuspensionsfornarcotic drugs,sleepingpills andpsychotropic of firstlinecourtin2013 Number ofclosingdecisionsfordrug/doping-related casesatprosecution level Drug/doping related casesenteringtheyouthprosecution systemin2013 the prosecution systemoffirstlinecourtbetween2006-2013 Drug/doping related casesincomparisonwiththetotalamountof entering between 2006and2013 Number ofnewassignmentsatthehousesjusticefordrug-related crimes Drug lawoffencesasmainoffencebetween2010and2013,bytype ofdrug Proportion ofdruglawoffencesbycategorybetween2010and2013 and 2013 Drug lawoffencesinrelation tothetotalnumberoflawoffencesbetween2010 drug-user population(15-64years)between2011and2013 Evolution oftheunemploymentrate inthegeneral populationandinthe and 2013 population andthedruguser(15yearsolder)between2011 Evolution oftheproportion ofpeoplewithalowereducationallevelinthegeneral (NEP) intheFlemishandFrench Communitybetween1997and2013 Recuperation rate ofthesyringesdistributedbyNeedleExchangeProgrammes 1994 and2013 Community (FR)byneedleexchangeprogrammes andbypharmacistsbetween Number ofsyringesdistributedandrecuperated intheFlemish(FL)andFrench Description oftablet category‘miscellaneous’between 2008and2013 Composition ofillicit drugtabletsbetween2008and2013 Mean purity(%)ofcocaine,heroin andamphetaminebetween 2002and2013 Mean MDMAcontent(mg)inecstasy tabletsbetween2002and2013 Mean THCconcentration (%)insamplesofcannabis(herbal andresin), 2002-2013

139 138 138 137 136 130 129 128 120 119 112 111 167 166 165 164 163 32 33 36 37 83 86 87 87 93 94 191 List of figures 192 List of full references of laws overheid endeOverhedenbedoeldin artikel128,130en135vandeGrondwet (B.S.21.11.2013) Federale de waarover bevoegdheden specifieke de op Gelet 2014-2019’ `HIV-plan Protocolakkoord het gevangeniswezenenderechtspositie vandegedetineerden (B.S.21.04.2011) verscheidene bepalingen van de titels III en V en VII van de basiswet van 12 januari 2005 betreffende van uitvoering en inwerkingtreding van datum de van bepaling tot besluit Koninklijk – 2011 april 8 van deInterministeriëleConferentie Drugs(B.S.15.04.2010) 25 januari 2010 – Een global en geïntegreerd drugsbeleid voor België. Gemeenschappelijke verklaring subsidies aanhunfederaties (B.S.25.06.2009) verslavingen, alsook de erkenning met het oog op de toekenning van subsidies en de toekenning van in gespecialiseerd -diensten en hulpverleningsnetwerken en zorg- de aan subsidies van toekenning de en subsidies van toekenning de op Decreetoog – het 2009 betreffendemet april erkenning 30 de de van domeinen de sociale actie,hetgezinendegezondheid(B.S.08.05.2009) in diensten ambulante van aanbod het betreffende Decreet – 2009 maart 5 (B.S. 22.12.2006) preventieplannen en veiligheids- strategische de betreffende besluit Koninklijk – 2006 december 7 van deEuropese Treatment DemandIndicator(B.S.03.05.2006) de via de Treatment Demand Indicator Registratie van van de behandelingsaanvragen via de operationalisatie rechtspositie de Interministeriële Conferentie Volksgezondheid en Drugs 13.2. – Registratie gevangeniswezen van de behandelingsaanvragen het betreffende Basiswet gedetineerden (B.S.01.02.2005) – 2005 januari 12 (B.S. 30.04.2004) vervangingsmiddelen met behandeling de reglementeringvan Koninklijktot – besluit 2004 maart 19 van het afleveren van Point Europees informatienetwerkoverdrugsendrugsverslaving(B.S.14.07.2003) Focal Belgisch het het van informeren het voor betreffende besluit Koninklijk voorwaarden – 2003 juni 29 de van bepaling tot besluit Koninklijk geneesmiddelen dieéénofmeertetrahydrocannabinolen bevatten(B.S.19.07.2001) – 2001 juli 4 en stoffen psychotrope sommige van reglementering tot besluit betreffende risicobeperkingentherapeutisch advies(B.S.14.01.1999). Koninklijk – 1998 januari 22 29 juni1964–Wet betreffende deopschorting,hetuitstelenprobatie (B.S.17.07.1964) middelen enbetreffende risicobeperkingentherapeutisch advies(B.S.10.01.1931). verdovende de en slaapmiddelen de van regeling houdende besluit Koninklijk – 1930 december 31 Dutch IN ORIGINALLANGUAGE LIST OFULLREERENCESLAWS ANNEX 4 25.06.2009) de l’octroi à et la qu’à subventions ainsi assuétudes reconnaissance de en vue de en l’octroi de subventions et à l’octroispécialisés de subventions l’octroià leurs fédérations soins (M.B. de de et d’aide vue services aux en et réseaux l’agrément aux subventions à relatif Décret – 2009. avril 30 de lafamilleetsanté(M.B.08.05.2009) sociale, l’action de domaines les dans ambulatoires services de l’offre à relatifDécret – 2009 mars 5 (M.B. prévention de et sécurité 22.12.2006) de stratégiques plans aux relatif royal Arrêté – 2006 décembre 7 via traitement de demandes des Enregistrement de l’opérationnalisation duTreatment DemandIndicator Européen (M.B.03.05.2006) Indicator demandes Demand des Treatment Enregistrement le – via 13.2 traitement Drogues publique Santé interministérielle Conférence statut le que ainsi pénitentiaire l’administration concernant juridique desdétenus(M.B.01.02.2005) principes de Loi – 2005 janvier 12 19 mars2004–Arrêté royal réglementant letraitement desubstitution(M.B.30.04.2004) européen d’informationsurlesdrogues etlestoxicomanies(M.B.14.07.2003) réseau du belge Focal Point au d’informations transmission la à relatif royal Arrêté – 2003 juin 29 un oudestétrahydrocannabinol(s) (M.B.19.07.2001) 4 juillet 2001 – Arrêté royal déterminant les conditions pour la délivrance des médicaments contenant des risquesetàl’avisthérapeutique (M.B.14.01.1999) 22 janvier 1998 – Arrêté royal réglementant certaines substances psychotropes et relatif à la réduction 29 juin1964–Loi concernantlasuspension,lesursisetprobation (M.B.17.07.1964) la réduction desrisquesetàl’avisthérapeutique (M.B.10.01.1931) 31 décembre 1930 – Arrêté royal réglementant les substances soporifiques et stupéfiantes, et relatif à French van vervaardiging illegale de voor worden verdovende middelenenpsychotrope gebruikt stoffen(B.S.10.03.2014) kunnen die stoffen de van en ontsmettingsstoffen antiseptica stoffen, en psychotrope middelen, verdovende en slaapmiddelen gifstoffen, van verhandelen het betreffende 1921 februari 24 van wet de van wijziging tot Wet – 2014 februari 7 (B.S. en 2014-2017 en preventieplannen opvolgings- indienings-, veiligheids- 31.12.2013) de strategische de van van toelage financiële bepaling de van tot besluit controlevoorwaarden en aanwendings- toekennings-, de Ministerieel van bepaling tot en evaluatievoorwaarden – 2013 december 24 193 List of full references of laws

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