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The Netherlands Drug Situation 2004

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The Netherlands Drug Situation 2004 REPORT TO THE EMCDDA by the Reitox National Focal Point THE NETHERLANDS DRUG SITUATION 2004 FINAL VERSION REITOX 2 REPORT ON THE DRUG SITUATION 2004 Margriet van Laar1 André van Gageldonk1 Toine Ketelaars1 Marianne van Ooyen2 Guus Cruts1 Paul van Gelder1 1Trimbos Institute, Netherlands Institute of Mental Health and Addiction 2WODC, Scientific Research and Documentation Centre, Ministry of Justice as approved on 19-01-2005 by the Scientific Committee of the NDM © NDM/Netherlands Focal Point 2004 Trimbos Institute NDM/Netherlands Focal Point PO Box 725 3500 AS Utrecht The Netherlands phone: +31-30-2971100 fax: +31-30-2971111 3 The Report on the Drug Situation in the Netherlands 2004 has been written for the European Monitoring Centre of Drugs and Drug Addiction (EMCDDA). Each year, national centres of expertise on drug-related issues in the member states of the European Union (‘Focal Points’) draw up a report on the national drugs situation, according to guidelines provided by the EMCDDA. These reports form the basis of the “Annual Report on the State of the Drug Problem in the European Union” compiled by the EMCDDA. This 2004 national report was written by the staff of the Bureau of the National Drug Monitor (NDM) located at the Trimbos Institute and staff of the Scientific Research and Documentation Centre (WODC) of the Ministry of Justice. The NDM was established in 1999 on the initiative of the Ministry of Health, Welfare and Sports. The Ministry of Justice also participates in the NDM. The NDM carries out the functions of the Focal Point. The NDM relies on the contribution of a multitude of experts and input from registration systems and monitors in the Netherlands. In particular, the authors would like to thank the members of the Scientific Committee of the NDM and other expert reviewers for their valuable comments on the draft version of the report. Members of the Scientific Committee of the National Drug Monitor Mr. prof. dr. H.G. van de Bunt, Erasmus University Rotterdam Mr. prof. dr. H.F.L. Garretsen, Tilburg University Mr. prof. dr. R.A. Knibbe, Universiteit Maastricht Mr. dr. M.W.J. Koeter, Amsterdam Institute for Addiction Research (AIAR) Mr. dr. D.J. Korf, Criminological Institute Bonger, University of Amsterdam Ms. dr. H. van de Mheen, Addiction Research Institute Rotterdam (IVO) Mr. prof. dr. J.A.M. van Oers, National Institute of Public Health and the Environment (RIVM) and Tilburg University Mr. A.W. Ouwehand, Organisation for Care Information Systems (IVZ) Mr. drs. A. de Vos, Netherlands Association for Mental Health Care (GGZ-Nederland) Observers Mr. mr. P. P. de Vrijer, Ministry of Justice Mrs. drs. W.M. de Zwart, MA, Ministry of Health, Welfare and Sport Additional consultants Mr. dr. M.C.A. Buster, Municipal Health Service Amsterdam (GG&GD Amsterdam) Ms. M. Brouwers, Scientific Research and Documentation Centre, Ministry of Justice Ms. dr. ir. E.L.M. Op de Coul, National Institute of Public Health and the Environment (RIVM) Ms. E.H.B.M.A. Hoekstra, Directie Sanctie- en Preventiebeleid, Ministry of Justice Mr. drs. R.F. Meijer, Scientific Research and Documentation Centre, Ministry of Justice Mr. Th.A. Sluijs, MPH, Municipal Health Service Amsterdam (GG&GD Amsterdam) 4 Table of Contents Executive summary 7 Part A : New Developments and Trends 13 1. National policies and context 15 2. Drug Use in the Population 23 3. Prevention 33 4. Problem Drug Use 37 5. Drug-Related Treatment 49 6. Health Correlates and Consequences 55 7. Responses to Health Correlates and Consequences 71 8. Social Correlates and Consequences 75 9. Responses to Social Correlates and Consequences 85 10. Drug Markets 91 Part B: Selected Issues 99 11. Buprenorphine, treatment, misuse, and prescription practices 101 12. Alternatives to prison targeting to drug using offenders 105 13. Public nuisance: definitions, trends in policies, legal issues and intervention 111 strategies Part C: Bibliography, Annexes 121 14. Bibliography 123 15. Annexes 141 5 6 Executive summary Part A New developments and trends 1. National policies and context The most important policy document published April 2004 is the white paper on cannabis policy. With this paper the Government expressed the intention to tighten the Dutch policy on cannabis. The main policy intentions are: National Action Plan to Discourage Cannabis Use, intensified enforcement of the laws and regulations on cannabis, more severe measures to curb drug tourism and firm action to curb large-scale production of cannabis. The new act ‘Placement in an Institution for Prolific Offenders – ISD’ came into effect on 1 October 2004. This act refers to all prolific offenders, not only addicts. The Judicial Treatment of Addicts will operate as a separate programme within the ISD-programme. In order to combat drug trafficking, a complete control of all flights from the Netherlands Antilles started in December 2003 and is still operational. The 100%-control of flights from Surinam started in February 2004. The Government decided that, for a selected group of chronic treatment resistant opiate addicts, treatment units for medical prescription of heroin can be extended from 300 to 1000 participants. 2. Drug use in the population General population surveys show that drug use increased between 1997 and 2001, at least in the population above age 15. According to a series of national school surveys among pupils between 12 and 18 years, drug use increased between 1988 and 1996 and overall stabilised in 1999 and 2003. Among boys, the last month prevalence of cannabis use significantly decreased from 14% in 1996 to 10% in 2003. There was no significant change in cannabis use among girls (LMP 8% in 1996 and 7% in 2003). The percentage of pupils using other drugs, such as ecstasy, cocaine, amphetamine or heroin, peaked in 1996 and stabilised or decreased since then. In 2003, 4.5% of the pupils had ever tried one of these drugs and 1.5% had currently used. Compared to the general (school) population, drug use is much more common among specific populations, such as young people in recreational settings. Recent quantitative and qualitative studies indicate that ecstasy remains the main illicit drug (after cannabis) in the nightlife scene, although a moderation of its use and ‘ecstasy weariness’ have been noted. Cocaine has gained popularity throughout the country. Among visitors of clubs in Amsterdam, drug use seems to have decreased between 1998 and 2003. 3. Prevention There are no major new developments in drug prevention but several new report were published. Some older projects (the Drugs Info Line, Educare, the Healthy School and Drugs, the Drugs Information and Monitoring System, and Unity) are continued. Several new projects were reported. A public campaign targeting cannabis use among youth outside school, was not particularly successful. Knowledge about this drug only increased among cannabis users and information seeking did not change at all. The results of a local school- based project favoured drug use instead of imposing a negative attitude towards drugs. The results of a peer project on four locations in Amsterdam were mixed. The third study is an analysis of registration data. The outcomes refuted general prejudice about large numbers of serious drug casualties in recreational settings. This study shows that since 1996, serious 7 trouble appears to be rare in these settings. Finally, various studies, amongst which one systematic review of Dutch authors, initiated a scientific discussion on possible causal links between cannabis use and psychotic disorders. Such a link could have consequences for future cannabis prevention activities. 4. Problem drug use The number of problem opiate users in 2001 was estimated at some 32,000, which is not significantly different from previous estimates in 1996 and 1999. Converted to population rates, there are about 3 problem opiate drug users per 1000 inhabitants between 15 and 64 years. Most of these users also consume crack cocaine and other substances. An estimate on the total number of problem cocaine users (crack users as well as cocaine sniffers) is not available, nor are there any recent and/or reliable estimates available on the number of problem users of cannabis, ecstasy and amphetamines. According to outpatient treatment data, the proportion of cocaine and cannabis clients among all drug clients has strongly increased in the past ten years, amounting to 38% and 20% in 2003, respectively. The proportion of new cocaine and cannabis clients among all drug clients applying for help for the first time (first treatments) is even more pronounced (41% and 32% in 2003, respectively) The average age of the population of drug clients has increased from 29 years in 1994 to 33 years in 2003. There are no major changes in gender distribution. The percentage of injecting drug clients decreased in this period from 12% to 5%. 5. Drug-related treatment Some studies illustrate a lack of insight in what type of interventions for substance use problems are used in daily practice, but registration and reporting has improved in the past years. A critical review of the international literature offers the latest evidence for effectiveness of interventions. The attention in addiction care is increasingly towards evidence-based or ‘good’ practice. Although the effectiveness of self help groups cannot be determined, these groups are perceived to improve retention and to reduce relapse rates, when added to (or after) regular treatment. Recent Dutch experiments have opened possibilities for effective treatment or harm reduction modalities: medical heroin prescription, rapid detoxification and after care with naltrexone, and higher doses of methadone. Still, much remains to be improved. Recently published reports from the National Court of Audit and the National Inspectorate of Health are critical about the Dutch system of addiction care. Criticisms relate to funding arrangements, the organisation, actual cooperation with other organisations and the quality of care.
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