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The consequences of this condition can vary from respiratory disruption to respiratory failure. The risks increase if the GHB is taken in combination with alcohol or other substances such as benzodiazepines. • Increased tolerance to the drug arising from frequent usage can result in ‘diminishing returns’, with users consuming more to reach the same effect. This can lead to more symptoms, such as nausea, vomiting, aggressive behaviour, dizziness, bradycardia and hypothermia. Higher doses lead to a general feeling of unwellness (Van Sassenbroeck et al., 2007). • Various substances have been tested (Kohrs et al., 2004; Zvosec et al., 2007) with a view to combating the effects of a GHB overdose. These have so far not met with success. There is no specific antidote. Acute treatment mainly consists of freeing the respiratory tract and monitoring vital functions. It is difficult to establish GHB as a cause of death. The drug is quickly broken down in the body and is therefore traceable in blood or urine for a short time only (Jones et al., 2009). In any case, presence of GHB need not be conclusive, because there are considerable differences in tolerance to the drug. Furthermore, GHB can be formed in the body after death, which hampers an evaluation of the contribution of GHB to the cause of death. A further complicating factor is the absence of a specific code for registering GHB deaths in the Cause of Death statistics. • In 2008 GHB was cited on four cause-of-death forms with Statistics Netherlands (CBS). It is not known whether GHB was the cause of or a contributory factor to death in these cases. • Between 2006 and mid-2009, there were five deaths in Amsterdam which were attributed to GHB intoxication. Three of these cases were suicides. • For 2007, the Netherlands Forensic Institute reported no fatal cases in which GHB use was the primary cause of death. In 2008 GHB was the primary cause of death in one fatality, although Ecstasy (MDMA) was also found. In 2009 (through October) four cases were known in which GHB was presumed to be the cause of death. In all these cases alcohol was also involved, and in one case there were other substances too. One case was thought to be a suicide. 6.8 Supply and market Composition of GHB The Drugs Information and Monitoring System (DIMS) monitors the market for illegal drugs. To this end it makes use of analyses of substances present in drug samples submitted by users in addiction care centres. Some of these samples (tablets) are identified by the treatment centre itself. Samples are forwarded to the laboratory for chemical analysis. • In 2008, 214 liquid samples were submitted, which had been purchased as GHB (DIMS annual report, 2008). 6 GHB 141
• Of the liquid samples sold as GHB, 97 percent actually contained GHB, with an average concentration of 44 percent (by weight). The minimum concentration of GHB solution in the liquid samples was 40 percent and the maximum was around 55 percent. In 2007 the average concentration was 42 percent. • Interestingly, GHB appeared in powder form in 2008, whereas this was not found at all in 2007. Nine powder samples, sold as GHB, did in fact contain the drug, with an average content of 47 percent. Prices The national Trendwatch Monitor the Antenna Monitor and the DIMS project give an indication of the price paid by consumers for a single dose of GHB or a litre of the substance. . • According to key observers in 2006/2007, juveniles and young adults in the social scene generally paid 10 euro per 5 ml of GHB. Litre prices varied from 150 to 260 euro (Nabben et al., 2007a). • In 2008 consumers who submitted GHB samples to the DIMS, paid approximately 6 euro per 5 ml. The price paid for a litre amounted to 180 euro (Van Dijk, 2009). 142 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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and syringes exchanged has been reg
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• 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 and 138: GHB use is more common among juveni
Page 139 and 140: • GHB use among school-goers is l
Page 141: Table 6.4 GHB incidents registered
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
Page 189 and 190: among passive smoking men, the elev
Page 191 and 192: 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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