Netherlands National Drug Monitor - Research and Documentation ...

clients and client profiles provide information about (trends in) treatment demand,
and are useful in planning and evaluating the care given to alcohol and drug users.
These data may also be an indirect indicator of trends in problem use; however
other factors, such as the extent and quality of treatment resources, registration
problems or changes in the referral system (e.g. increasingly via primary care), may
equally impact on the number of registered clients. Significantly too, those who
seek treatment may be atypical of addicts in general. There are indications that
addicts who seek treatment are in a worse state than those who do not yet look for
help. For instance, (comorbid) mental health problems are more common among
addiction care clients than among those who battle with addiction on their own.
Drug-related infectious diseases
The EMCDDA focuses on monitoring the prevalence of HIV infections and hepatitis
B and C among injecting drug users. This information is important for establishing
priorities for prevention, estimating the (future) illness burden and societal costs,
and for monitoring the effects of preventive interventions. This indicator is the least
standardised. The information sources available in the EU member states are very
diverse, and include random samples of drug users (the gold standard), results of
screening of drug users having treatment or in prison, case reports and notified
diagnoses of HIV and hepatitis. Furthermore there are large differences in scope
(local, regional, national). In an absolute sense, the data of the different countries
are therefore not comparable. They do, however, give an indication of developments
in the rate of infection. In the Netherlands too, the information is somewhat
fragmented. Nonetheless, it does permit cautious conclusions about trends in the
problems on the basis of various sources.
Deaths related to alcohol and/or drugs
Deaths due to overdose or other causes related to substance use are regarded as
the most serious and extreme consequence of substance use. Data on the extent
and nature of the deaths can be used to monitor trends in problem uses and high
risk behaviour (injecting, polydrugs use). In many countries the general cause of
death statistics constitute the main source of information on acute drug deaths
(‘overdose’). According to the EMCDDA protocol cases are selected on the basis
of a pre-ordained range of ICD-9 or ICD-10 codes, which refer to the nature of
the death (accidental, deliberate, cause unknown) and the kinds of drugs involved.
Countries differ in the procedures followed to establish the cause of death (e.g.
whether toxicological analyses are conducted or not). In countries where a postmortem
examination is standard when an unnatural case of death is suspected,
there is a greater likelihood of discovering a drug-related death than in countries
where this is not the case and/or where the cause of death is established only on
the basis of external characteristics and circumstances. And even if toxicological
30 Netherlands National Drug Monitor - NDM Annual Report 2009