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after the last dose of the drug. To treat this withdrawal syndrome, pharmaco-therapeutic intervention may be necessary. Internationally, a large number of studies have been conducted on GHB dependence and on withdrawal symptoms (Gonzales and Nutt, 2005). • Prevalence figures vary considerably: 21 percent of a random sample of GHB users in the US were dependent on the substance, compared to 4 percent of a sample of GHB users in Australia. • There is a consensus among researchers that daily use of GHB (with daytime doses every one to three hours) increases the likelihood of dependency. There is a lack of data on the number of GHB addicts in the Netherlands. • Qualitative research conducted in the Netherlands in 2006/2007 found that the first GHB addicts have been encountered in the social scene. These are mainly daily users (Nabben et al., 2007a). • Addiction care organisations throughout the Netherlands report a sharp increase in the number of GHB clients in 2008 – estimated at several hundred, although precise data are not available (Trimbos report) (see § 6.6). Likewise, the number of acute incidents appears to be on the increase (see§ 6.6). Various organisations operating in the area of nightlife and addiction report a change in attitudes among certain groups of young people in relation to GHB use. It appears that use of this drug is now considered more normal. GBH is increasingly regarded as a cheap alternative to alcohol and other drugs. Passing out (into a coma) is regarded in these circles as a harmless side effect of the drug. 6.5 Usage: international comparison General Population As is the case in Dutch population surveys on drug use, little is known about GHB use in the general population in other countries. • The only country outside the EU that has (recent) data on GHB use is Australia. 0.5 percent of the Australian population aged over 14 reported having ever having used GHB, while 0.1 percent reported recent use. The peak age group was between 20 and 29 (Degenhardt & Dunn, 2008). Juveniles and Young Adults In the ESPAD surveys conducted among 15 and 16 year old school-goers in Europe in 2007, respondents were asked about ever use of GHB. The data from this research lend themselves better to international comparison than data from surveys conducted in the general population (Hibell et al., 2009). 6 GHB 137
• GHB use among school-goers is low. In most EU member states, including the Netherlands, no more than 1 percent of school-goers aged 15-16 had ever tried GHB, with the exception of Austria, Italy, Germany and Denmark, where the figure was 2%. GHB use appears to be more common among clubbers and frequenters of dance parties. • There are no internationally comparable studies. The results of mainly local surveys conducted among attendees of dance parties show percentages of ever use of GHB varying from 17.4 percent in the Netherlands (Amsterdam) and 13 percent in Belgium, to 6.7 percent in the Czech Republic, 5.9 percent in Hungary and 5.8 percent in the U.K. Because the methods differ between studies and between countries, the results should be interpreted with caution (EMCDDA, 2009). • Ever use of GHB among clubbers (average age 24) in New York city in 2005/2006 was 22 percent (Parsons et al., 2009). Recent use (during the past four months) of GHB was less than five percent of the clubbers. • Ever use of GHB among regular Ecstasy users in Australia (average age 24) increased from 5 percent in 2000 to 40 percent in 2006. The percentage of users in the six months prior to the survey rose during that period from 1 percent to 21 percent (Dunn et al., 2009). The number of days of use in the past half year in 2006 varied from 1 to 40 ml (median dose 3 ml). On a ‘typical’ day 0.25 to 20 ml GHB was taken (median 3.5 ml); and on a ‘heavy’ day, the dose was 0.25 to 40 ml (median 6 ml). 6.6 Treatment demand Addiction Care Services In 2008/2009 various organisations for addiction care and prevention throughout the Netherlands have reported a rise in the number of requests for treatment in relation to GHB (Trimbos Institute, 2009a). However, national data are incomplete. GHB is registered as a separate substance in the LADIS database only since 2008. The as yet incomplete data show that in 2008 145 primary GHB clients were registered with LADIS. For 49 clients, GHB was a secondary substance (IVZ, 2009). • Addiction care in the North of the country (Noord Nederland) reported 62 GHB clients in 2008 for the regions of Groningen, Friesland and Drenthe, compared to 22 in 2007. • The region Gelderland reported a rise in GHB use, but seldom as a primary problem, with some 20 people receiving treatment, compared to only two in 2004. • In the second half of 2008, addiction care in Brabant registered around 50 requests for treatment in connection with GHB dependence. By 2009, the number had risen to 80. • Many other regions in the Netherlands have also identified a rise in treatment demand; however no definite figures have been reported. 138 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
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The Netherlands Cause-of-Death stat
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• Little is known as yet about a
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4.2 Usage: general population Heroi
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• In the province of Gelderland,
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Figure 4.1 Estimates of the number
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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 and 126: • The number of requests for info
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: GHB use is more common among juveni
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
Page 177 and 178: • Surveys by the Continuous Surve
Page 179 and 180: Figure 8.1 Percentage of smokers in
Page 181 and 182: 8.3 Usage: juveniles and young adul
Page 183 and 184: Special education Table 8.3 shows t
Page 185 and 186: Table 8.4 Smokers in the EU-15 plus
Page 187 and 188: 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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