Scientific Institute of Public Health Unit of Epidemiology BELGIAN NATIONAL REPORT ON DRUGS 2004 Commissioned by the European Monitoring Centre for Drugs and Drug Addiction Lisbon Edited by Sandrine SLEIMAN IPH/EPI REPORTS Nr.2004-022 IPH Belgian national report on drugs 2004 Epidemiology Unit, Scientific Institute of Public Health, October 2004; Brussels (Belgium) IPH/EPI REPORTS N° 2004 - 22 Deposit number: D/2004/2505/19 BELGIAN NATIONAL REPORT ON DRUGS 2004 Edited by Sandrine SLEIMAN Scientific Institute of Public Health Unit of Epidemiology/Drugs Programme rue J. Wytsmanstraat 14 B-1050 BRUSSELS Tel. +32 2 642 57 82 Fax +32 2 642 57 49 Email: [email protected] http://www.iph.fgov.be/epidemio/drugs This report was coordinated and written by: the staff of the Focal Point: De clercq T. Sleiman S. Jossels G. Van der Biest E. Plasschaert S. Walckiers D. Sartor F. and the staff of Sub-Focal Points: ASL: Köttgen S. Eurotox: Hariga F., Molnar M., Rwubusisi M. CTB/ODB: Vanderveken M. VAD: Geirnaert M., Schrooten J. Acknowledgements The report was made possible thanks to the contribution of many public and private professionals, health professionals and social workers who participated in the data collection. Their essential contribution is gratefully acknowledged. We would like to especially thank for their very active contributions: Andries C. (VUB) Bastin P. (Infor Drogues) Deblaere P. (Federal Police, Road traffic division) De Pauw W. (Federal Public Service Justice) Dessoy AC. (Federal Public Service Justice) De Smet P. (FARES/VRGT and ULB) Garlement P. (Federal Police, Drug programme) Gillard C. (Federal Public Service Justice) Lambrecht P. (VUB) Maes L. (RUG) Matteï C. (Free Clinic) Mulkay JP. (Hospital St Pierre) Piette D. (ULB) Raes V. (De Sleutel) Sasse A. (IPH - HIV surveillance) Tersago M. (Federal Police) Todts S. (Federal Public Service Justice) Vander Laenen F. (RUG) Vanhyfte C. (Federal Police, Drug programme) Van Liempt A. (Federal Public Service Justice) Wanlin M. (FARES/VRGT) Windelinckx T. (Free Clinic) Call for contribution and comments Everyone interested in contributing to the next Belgian Report on Drugs can contact the Belgian Focal Point. All comments are welcome. EMCDDA MANAGEMENT BOARD Willy BRUNSON Claude GILLARD Directeur Général ConseillerJuridique Administration de la Communauté française de Direction Générale de la législation Belgique du Ministère de la Justice Bd Léopold II, 44 Bd de Waterloo, 115 B – 1080 BRUXELLES B – 1000 BRUXELLES Tel : 32-2/413.26.02 ; Fax : 32-2/413.26.13 Tel : 32-2/542.67.74 ; Fax : 32-2/542.70.34 e-mail : [email protected] e-mail : [email protected] EMCDDA SCIENTIFIC COMMITTEE Joris CASSELMAN Brice DE RUYVER Koning Leopold III laan,14 Universiteitsstraat, 4 B – 3001 HEVERLEE B – 9000 GENT Tel/fax : 32-16/40.02.81 Tel: 32-9/264.69.37; Fax : 32-9/264.69.71 e-mail : [email protected] e-mail : [email protected] MINISTERS involved in health problems related to drugs in 2004 Monsieur Rudy DEMOTTE Ministre des Affaires sociales et de la Santé publique Minister van Sociale Zaken en Volksgezondheid Monsieur Benoît CEREXHE Ministre de l’Economie, de l’Emploi, de la Recherche scientifique et de la lutte contre l’incendie et l’aide médicale urgente, Région Bruxelles Capitale Minister van Economie, Tewerkstelling, Wetenschappelijk Onderzoek en Brandbestrijding en Dringende Medische Hulp, Brusselse Hoofdstedelijke Regering Madame Christiane VIENNE Ministre de la Santé, de l’action sociale et de l’Egalité des chances de la Région Wallonne Madame Catherine FONCK Ministre de la Santé et de l’Enfance et de l’Aide à la jeunesse de la Communauté française de Belgique Mevrouw Inge VERVOTTE Minister van Welzijn, Gezondheid en Gelijke Kansen, Vlaamse Gemeenschap Herr Bend GENTGES Vize-Ministerpräsident, Minister für Ausbildung und Beschäftigung, Soziales und Tourismus Belgian National Report on drugs 2004 Table of contents SUMMARIES 9 PART A. NEW DEVELOPMENTS AND TRENDS 21 CHAPTER 1. National policies and context................................................................ 23 1.1. Legal framework 23 1.2. Institutional framework, strategies and policies 24 1.3. Budget and public expenditure 28 1.4. Social and cultural context 31 CHAPTER 2. Drug use in the population.................................................................... 36 2.1. Drug use in the general population 36 2.2. Drug use in the school and youth population 37 2.3. Drug use among specific groups 43 2.4. Attitudes to drugs and drug users 45 CHAPTER 3. Prevention .............................................................................................. 47 3.1. Universal prevention 47 3.2. Selective/ indicated prevention 54 CHAPTER 4. Problem Drug use .................................................................................. 58 4.1. Prevalence and incidence estimate 58 4.2. Profile of clients in treatment 58 4.3. Main characteristics and patterns of use from non-treatment sources 61 CHAPTER 5. Drug-related Treatment ......................................................................... 67 5.1. Treatment sytems 67 5.2. Drug Free Treatment 71 5.3. Medically assisted treatment 71 CHAPTER 6. Health Correlates and Consequences.................................................. 75 6.1. Drug-related deaths and mortality of drug users 75 6.2. Drug related infectious diseases 79 6.3. Psychiatric co-morbidity 86 6.4. Other drug-related health correlates and consequences 87 CHAPTER 7. Responses to Health correlates and consequences........................... 89 7.1. Prevention of drug related deaths 89 7.2. Prevention and treatment of drug-related infectious diseases 89 7.3. Interventions related to psychiatric co-morbidity 92 7.4. INterventions related to other health correlates and consequences 92 CHAPTER 8. Social Correlates and Consequences .................................................. 94 8.1. Social exclusion 94 8.2. Drug related crime 94 8.3. Drug use in Prison 98 8.4. Social Costs 99 CHAPTER 9. Responses to social correlates and consequences.......................... 100 9.1. Social Reintegration 100 9.2. Prevention of drug related crime 101 CHAPTER 10. Drug Markets ........................................................................................ 105 10.1. Availability and supply 105 10.2. Seizures 106 10.3. Price and purity 107 PART B. SELECTED ISSUES 109 CHAPTER 11. Buprenorphine, treatment, misuse and prescription practices........ 111 11.1. Treatment 111 11.2. Misuse 113 CHAPTER 12. Alternatives to prison targeting to drug using offenders ................. 115 12.1. Political, organisational and structural information 115 12.2. Interventions 117 12.3. Quality assurance 118 CHAPTER 13. Public nuisance : definitions, trends in policies, legal issues and intervention strategies ............................................................................................................ 119 13.1. Definition 119 13.2. Genesis in The Belgian Policy 119 13.3. Results and evaluation 123 13.4. Conclusion 125 PART C. BIBLIOGRAPHY, ANNEXES 127 BIBLIOGRAPHY 129 DATA BASES -WEBSITES 139 ANNEXES 141 ANNEX 1 LIST OF STANDARD TABLES AND STRUCTURED QUESTIONNAIRES 143 ANNEX 2 LIST OF TABLES 143 ANNEX 3 LIST OF FIGURES 144 ANNEX 4 LIST OF ABBREVIATIONS 145 ANNEX 5 INDEX 147 8 Belgian National Report on drugs 2004 Belgian National Report on Drugs 2004 SUMMARY The Federal Drug Policy Note published in 2001, became the cornerstone of the national drug policy. The document enlightened three main priorities of the Federal Government being, the reduction of the number of drug users, the reduction of the physical and mental effects related to drug use and the reduction of the consequences of drug issues on society. In order to realise a global and integrated policy, a General Coordination Unit (which gathers all the representatives of the concerned ministers of the Federal Government, Communities and Regions) received a legal framework in May 2003 but is not yet operational. A Health Policy Drug Unit was already set up in May 2001 and participates since then in the organisation of the drug health policy. In addition to these coordination tools, a cooperation agreement was signed in September 2002 between the Federal Government and the federate entities. The French and Flemish Communities have promulgated this agreement through decrees respectively in July 2003 and March 2004. In 2003, a new law modified the legal framework (more specifically the Narcotic Drug Act of 1921); cannabis is being differentiated from the other illegal substances. The possession of a small amount of cannabis, even for personal use, is still a criminal offence. The new status of cannabis authorises the public prosecutor not to prosecute in the classic way the cannabis possessor if there is no evidence of a problematic drug use or of public nuisance. The public prosecutors are expected to follow guidelines published in a ministerial circular. It is important to note that these changes in the law are not applicable to minors. Some professionals involved in the drug field disagreed with the text of the new drug law and some associations introduced an annulment before the Court of Arbitration. The concepts of “problematic use” and “public nuisance” were seen as ambiguous and vague, among other critics. End October 2004, the Court of Arbitration cancelled the concerned article. In line with the legal basis promulgated in August 2002, the first Royal Decree enacting the substitution treatments was published in March