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performance of these tasks remained more or less unchanged, with the exception of a negative effect on verbal memory. - Indications of possible damage to nerve endings were also found, as well as an increased need for sensation seeking. No effect on depression or impulsiveness was found. - It is not known whether the artery narrowing and memory reduction is permanent. The clinical relevance of these effects would appear to be small, for the time being at least. • Research conducted among rather older Ecstasy users (40-45 years) shows that the negative effects of Ecstasy on verbal memory exacerbate the normal age-related deterioration of the brain (Schilt, 2009). It is not known whether at a later age (65+), Ecstasy will accelerate the process of cognitive decline. • There may possibly be a degree of genetic susceptibility to the effects of Ecstasy on verbal memory (Schilt, 2009). Combined use of Ecstasy (MDMA) and other substances may incur (acute) risks. • Lab research conducted by the University of Leiden found that both MDMA and THC (the main active component of cannabis) cause a faster heartbeat. The effects can be amplified if these two substances are taken simultaneously. Furthermore, the elevated body temperature caused by MDMA use lasts longer if THC is also ingested (Dumont, 2009). An accelerated heartbeat can lead to health problems in certain individuals. • Remarkably, the consumption of a low dose of alcohol (2-3 units) appears to have a somewhat mitigating influence on certain physiological effects of MDMA, such as fluid retention and raised body temperature. It is not known whether these findings may have practical relevance. Higher doses of alcohol could have the opposite effect. • A comprehensive meta-analysis of human research does indeed suggest a certain protective effect of alcohol on the harmful consequences of Ecstasy use. The study puts forward two possible explanations for this. It may be that alcohol suppresses the harmful effects on the brain of overheating from Ecstasy use. Alternatively, Ecstasy users who simultaneously consume alcohol may tend to be more moderate users of the drug (Rogers, 2009). Deaths The exact number of deaths due to use of amphetamine and Ecstasy is unknown. • According to the cause of death statistics of Statistics Netherlands (CBS), these substances are not often the primary cause of death. In the period 1996 - 2002 there was a maximum of four acute deaths per year. In 2003 Statistics Netherlands registered seven cases, in 2004 five cases and both in 2005 and 2006 four cases. In 2007 only one case was registered and in 2008 only two (ICD-10 code F15 and ICD-10 codes X41, X61 and Y11, all three codes in combination with code T43.6; for an explanation of the codes, see appendix C). These codes not only refer to amphetamines and MDMA (-like substances), but also to other stimulants such as caffeine, ephedrine and khat. 5 Ecstasy, amphetamine and related substances 125
According to the EMCDDA, in other European countries, Ecstasy and amphetamine play a subordinate role in drugs death, at least in so far as figures are available (EMCDDA, 2009). • In 2007, throughout the entire EU, approximately 90 deaths were reported in which Ecstasy played a role. • Ecstasy was often not the only substance involved. Other factors which may have played a part in these deaths are over-heating, water intoxication or an underlying illness. • A relatively large number of deaths due to methamphetamine – the extra strong variant of amphetamine – were reported in the Czech Republic. Finland reported 64 cases in which amphetamine may possibly have had fatal consequences. 5.8 Supply and market The Drugs Information and Monitoring System (DIMS) tests drug samples submitted by users in addiction care centres, to establish which substances are in the drugs. Some of these samples (tablets) are identified by the treatment centre itself by certain features such as logo, weight and diameter. Samples containing unknown substances and all samples in powder form are forwarded to the laboratory for chemical analysis (Van Dijk, 2009). Composition of Ecstasy tablets In 2008, consumers submitted a total of 3,775 tablets for analysis, of which 60% (2,266 tablets) were sent on to the laboratory for further chemical analysis. Of these, the majority (96.3%) had been purchased by the consumer as Ecstasy. In the first half of 2009 (week 1 to week 26), as many as 4,240 tablets were submitted to the testing services. This increase is likely related to a disruption to the Ecstasy market that commenced in the second half of 2008 (see below). Table 5.8 shows the percentage of the ‘Ecstasy’ tablets analysed that were found to contain MDMA and/or another substance. The table only shows pills that were purchased by the consumer as Ecstasy, irrespective of the actual composition. • In 2008, 80% of the pills contained an MDMA-like substance (MDMA, MDA, MDEA or MBDB), compared to 91% in 2007. Most MDMA-like pills contain only MDMA. The first half of 2009 shows a remarkable change compared to previous years: Only 70% of the tablets contained an MDMA-like substance. • Increasingly, MDMA is being replaced in Ecstasy pills by various other substances, whether pharmacologically similar to MDMA or not. The number of ‘Ecstasy pills’ containing only pharmacologically active substance other than MDMA rose from 8% in 2007 to 17% in 2008 and 29% in the first half of 2009. - In most cases the other active substance was meta-Chloro-Phenyl-Piperazine (mCPP). The total amount of Ecstasy pills in which mCPP was found (alone or 126 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
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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 and 124: • The same person may be admitted
Page 125: • The number of requests for info
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
Page 175 and 176: • 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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