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• By contrast, amphetamine plays a much more minor role. Three percent of drug victims report having used amphetamine. If we count only those cases for which the drug is known (65%), then amphetamine accounts for 4% of all drug-related cases treated in hospital emergency departments • These figures are probably an under-estimate of the true number of drug-related incidents, as the role of drugs is not investigated systematically. GGD Amsterdam registers the number of requests for emergency treatment from the Ambulance Transport Centre (CPA). • In 2008 there were 43 Ecstasy-related requests for treatment, 36% less than in 2007 (table 5.6). • In nearly three-quarters of the Ecstasy cases (70%), removal to hospital was necessary; this is more than in the case of cannabis incidents (39%). • In 2008, amphetamines were the reason for a request for treatment from the CPA in Amsterdam in only 14 cases. Table 5.6 Drug-related incidents involving amphetamines and Ecstasy, registered by GGD Amsterdam, from 1997 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Amphetamine 7 7 7 30 6 5 7 8 3 13 17 14 Ecstasy 41 35 43 36 42 39 39 59 63 53 67 43 Number of incidents (persons) per year. Source: CPA, GGD Amsterdam. The National Poison Information Centre (NVIC) of the RIVM registers the number of information requests from doctors, pharmacists and government organisations concerning (potentially) acute intoxication by poisonous substances such as drugs (Van Velzen et al., 2009). • There are more requests for information concerning Ecstasy than concerning amphetamine (table 5.7). The number of information requests for Ecstasy rose until 2004 and dropped slightly in the years 2005 to 2007, stabilising in 2008. Table 5.7 Requests for information on account of Ecstasy and amphetamine use from the National Poisons Information Centre from 2000 2000 2001 2002 2003 2004 2005 2006 2007 2008 Ecstasy 164 194 184 208 246 217 183 171 185 Amphetamine 42 39 39 47 51 128 106 88 125 Number of information requests per year received via the NVIC 24-hour helpline. Requests made via the website www.vergiftigingen.info (online since April 2007) were included in the table for the first time in 2008. Source: NVIC, RIVM. 5 Ecstasy, amphetamine and related substances 123
• The number of requests for information on amphetamines trebled between 2000 and 2005. Most of the requests related to patients who had used amphetamines at parties, both singly and in combination with other drugs or alcohol. In 2006 and 2007, there was a slight drop in the number of information requests involving amphetamines. • The increase between 2007 and 2008 occurred partly because requests made via the website were included in the statistics for the first time in 2008. • These figures do not give a picture of the absolute number of intoxications, because these are not notifiable. The increasing familiarity of doctors with the symptoms and treatment of a certain drug overdose may play a part, as this reduces the need to seek information from the NVIC. 5.7 Illness and deaths Illnesses • According to the latest scientific findings, there is evidence of disruption to brain function, particularly the memory, concentration and mood in both users and ex-users of Ecstasy (Kalechstein et al., 2007; Rogers et al., 2009; Schilt, 2009; De Win, 2007; Jager, 2006). • This disruption can last longer than a year after the drug use has been discontinued. It is unknown whether there is a return to full recovery. • These changes are probably due to the effects of Ecstasy use; yet despite over 20 years of research, it remains unclear exactly how harmful the drug is. The reported effects are generally minor, with the exception of reduced (verbal and working) memory, and the effects fall within ‘normal’ margins. Nor can it be established with certainty what the role of other factors may be, such as the use of other drugs or the pre-existence of illnesses and conditions (Rogers et al., 2009). • The changes are probably due to damage to serotonergic nerves in the brain. • Tests on laboratory animals have shown that the risk of brain damage increases if there is a rise in body temperature after using MDMA. In humans this is also likely to be the case. • The risk of overheating and consequently (long-term brain damage) increases if a user takes large doses of MDMA in a warm environment (over 18-20 degrees Celsius). The exact dose that leads to damage is not known. • The results of research conducted by the University of Amsterdam and the University of Utrecht, do not suggest that short-term or one-off use might cause serious damage to and impairment of brain function in the long term (De Win, 2007; Jager, 2006; Schilt, 2009). At the same time it cannot simply be concluded that a low dose of Ecstasy is safe. - Research participants took an average of 1.8 to 6 Ecstasy tablets and were tested on average 8 to 19 weeks after their last dose. - The results showed a narrowing of the arteries in some parts of the brain. - Performance for memory and concentration tasks or in brain activity during the 124 Netherlands National Drug Monitor - NDM Annual Report 2009
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Netherlands National Drug Monitor N
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Colophon Project Manager Dr. M.W. v
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Preface This is already the tenth A
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5.4 Problem Use 113 5.5 Usage: Inte
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List of abreviations and acronyms 2
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NEMESIS NFU NIGZ NMG NPO NRI NVIC N
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Summary Below is an outline of the
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The number of hospital admissions c
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GHB. In 2008/2009 4.6 percent of fr
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Deaths In the Netherlands, smoking
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Offences by drug users Drug users c
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Opiates Ecstasy Amphetamine Alcohol
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1 Introduction The National Drug Mo
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use, particularly cannabis, under-r
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information is available, this is b
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2 Cannabis Cannabis (Cannabis Sativ
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Figure 2.1 Cannabis users in the Ne
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Figure 2.2 Cannabis use among secon
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Cannabis and problem behaviour •
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Table 2.4 Cannabis use among pupils
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Table 2.5 Current cannabis use in s
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• The sharp increase in treatment
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Trends It is difficult to determine
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• The role of cannabis in all req
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- misuse or dependence on alcohol a
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At the Ambulance Transport Centre (
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• So far, epidemiological studies
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Quality and price The Trimbos Insti
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3 Cocaine Cocaine works as a stimul
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Age, gender and urbanisation level
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Special groups In certain groups of
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Table 3.3 Cocaine use in special gr
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and 7.7% in the U.K (England and Wa
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Table 3.5 Cocaine use among school-
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Figure 3.2 Number of (outpatient) a
Page 74 and 75: Figure 3.4 Admissions to general ho
Page 76 and 77: The Netherlands Cause-of-Death stat
Page 78: • Little is known as yet about a
Page 81 and 82: 4.2 Usage: general population Heroi
Page 83 and 84: • In the province of Gelderland,
Page 85 and 86: Figure 4.1 Estimates of the number
Page 87 and 88: and syringes exchanged has been reg
Page 89 and 90: • Between 2001 and 2004 the numbe
Page 91 and 92: - misuse of or dependence on alcoho
Page 93 and 94: same time it should be noted that t
Page 95 and 96: International comparison The Europe
Page 97 and 98: The total number of chronic hepatit
Page 99 and 100: • It is thought that risk behavio
Page 101 and 102: the ICD-9 classification. Drug deat
Page 103 and 104: Amsterdam GGD Amsterdam reports the
Page 105 and 106: Figure 4.9 Number of drug-induced d
Page 107 and 108: • Pupils attending REC-4 schools
Page 109 and 110: 5.3 Usage: juveniles and young adul
Page 111 and 112: • In 2008, key observers in Amste
Page 113 and 114: Table 5.3 Use of Ecstasy and amphet
Page 115 and 116: Table 5.4a Use of amphetamines and
Page 117 and 118: Table 5.5a Ecstasy use among school
Page 119 and 120: Ecstasy • The number of (outpatie
Page 121 and 122: Figure 5.3 Numbers registered with
Page 123: • The same person may be admitted
Page 127 and 128: According to the EMCDDA, in other E
Page 129 and 130: Figure 5.6 Concentration of MDMA in
Page 131 and 132: Table 5.9 Number of samples contain
Page 133 and 134: • Consumers who had drug samples
Page 135 and 136: 6.2 Usage: general population The r
Page 137 and 138: GHB use is more common among juveni
Page 139 and 140: • GHB use among school-goers is l
Page 141 and 142: Table 6.4 GHB incidents registered
Page 143 and 144: • Of the liquid samples sold as G
Page 145 and 146: • Total deaths from alcohol-relat
Page 147 and 148: Figure 7.1 Alcohol consumption amon
Page 149 and 150: Ethnic background • Among seconda
Page 151 and 152: Table 7.3 Percentage of current dri
Page 153 and 154: Table 7.4 Alcohol use in the social
Page 155 and 156: Holiday-makers • Research conduct
Page 157 and 158: Figure 7.3 Heavy drinkers by gender
Page 159 and 160: The countries with the lowest perce
Page 161 and 162: • In France it is more likely tha
Page 163 and 164: Figure 7.6 Age distribution of prim
Page 165 and 166: • In 2008, 337 day-care admission
Page 167 and 168: • In approximately 1,200 admissio
Page 169 and 170: Table 7.9 Estimated number of injur
Page 171 and 172: • On the basis of current researc
Page 173 and 174: Figure 7.10 Deaths from alcohol use
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• EU member states have different
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• Surveys by the Continuous Surve
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Figure 8.1 Percentage of smokers in
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8.3 Usage: juveniles and young adul
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Special education Table 8.3 shows t
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Table 8.4 Smokers in the EU-15 plus
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medication, Champix ® , which was
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among passive smoking men, the elev
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Table 8.6 Deaths from lung cancer a
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Since 1 January 2003 it is no longe
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Table 8.8 Cigarette prices and taxe
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eported. These refer to 2007 in the
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Table 9.1 Criminal investigations i
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Table 9.2 Number of dismantled prod
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Table 9.3 Characteristics of suspec
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Figure 9.2 Number of Opium Act case
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Table 9.5 Opium Act cases as a perc
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Disposals by the courts (in the fir
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• Financial orders (Public Prosec
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Table 9.9 Prevalence of new crimina
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10.2 Drug use among offenders Drug-
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• In some two-thirds of cases opi
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I, II Table 10.2 Number of times th
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• The ISD has a capacity of 1,000
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• Although there are some female
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Clinical admission Admission to a h
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Mellow Type of music at raves that
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Secondary diagnosis A secondary or
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Dismissal on policy grounds Decisio
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eintegration and rehabilitation of
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I. Use and problem use Source Targe
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II. Treatment demand and treatment
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IV. Market information Source Targe
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Source Target group/subject Sources
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Appendix C Explanation of ICD-9 and
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Appendix D Websites in the area of
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Ministry for Health, Welfare and Sp
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Appendix E Drug use in a number of
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References Adlaf, E.M., Korf, D.J.,
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Coumans, A.M. (2005). Survival on t
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Ganpat, S., Wits, E., Schoenmakers,
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Knibbe, R.A., Joosten, J., Derickx,
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Monshouwer, K., Smit, F., De Graaf,
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Rigter, H., Van Laar, M. (2002). Ep
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Tweede Kamer der Staten-Generaal (2
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Van Leeuwen, F.E. (1999). Epidemiol
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In the Netherlands various monitori
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