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At the Ambulance Transport Centre (CPA), The Amsterdam Municipal Health Service (GGD Amsterdam) keeps a log of the number of requests for emergency treatment related to drug use. • The number of requests on account of cannabis use peaked in 2006 and 2007. • In 2008. cannabis use played a role in 381 cases, which represents a drop of 14% compared to 2007 (table 2.9). • In approximately four out of ten cases (39%), an ambulance was needed for admission to hospital. The remainder were treatable at the scene. Table 2.9 Cannabis incidents registered by the GGD Amsterdam, from 1997 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Smoking cannabis 211 107 118 106 243 226 196 258 281 347 370 318 Eating spacecake 47 28 21 35 46 59 61 62 61 114 74 63 Total 258 135 139 141 289 285 257 320 342 461 444 381 Number of incidents per annum. Source: CPA, GGD Amsterdam. In recent years, the National Poison Information Centre (NVIC) of the National Institute of Public Health and the Environment (RIVM) has registered an increase in requests for information from doctors, pharmacists and government bodies with regard to cannabis use (table 2.10). • The number of information requests concerning cannabis trebled between 2000 and 2005. From 2006 this trend came to an end (Van Velzen et al., 2009). • These data do not provide a picture of the absolute number of intoxications, because these are not notifiable. According as doctors become more familiar with the symptoms and treatment of an intoxication with a particular drug, the likelihood of consulting the NVIC is reduced. Table 2.10 Requests for information concerning cannabis use from the National Poisons Information Centre from 2000 2000 2001 2002 2003 2004 2005 2006 2007 2008 Cannabis 71 129 141 144 191 202 186 171 168 Annual number of information requests via the NVIC 24-hour telephone line. Requests via the website www.vergiftigingen.info (online since April 2007) are included for the first time in 2008. Source: NVIC, RIVM. 2 Cannabis 53
2.7 Illness and deaths Illness Increasingly, cannabis use is associated with mental problems. • Evidence is mounting that cannabis use increases the risk of later psychotic disorders (CAM, 2008). • The risk increases with the frequency of use. • Individuals with a prior history of psychotic symptoms are at greater risk of developing psychosis following cannabis use than those without a prior history. • It is possible that genetic factors play a role in this. There are indications that people with a certain variant (Val/Val) of the COMT-gene, which is involved in the breakdown of the receptor dopamine in the brain are extra susceptible to developing a psychosis, particularly if they have commenced cannabis use at a young age (Caspi et al., 2005). • Between six and ten percent of all new annual cases of psychotic disorders can be attributed to cannabis use. • Dutch-grown weed contains relatively little cannabidiol (CBD) compared to THC content. CBD counteracts some of the effects of THC, and may possibly have a protective effect against the development of psychoses. • Research into the relationship between cannabis use and the onset of other mental problems, such as anxiety disorders depression, has yielded a less consistent picture (Moore et al., 2007). • Users can become dependent on cannabis, particularly with frequent use and an early age of onset. Often other personal and environmental factors play a role as well. Chronic, heavy use of cannabis is also associated with other health risks. • Heavy, chronic cannabis use probably increases the risk of respiratory problems and lung cancer. This is because cannabis smoke contains toxic combustion and incineration substances. In addition, the manner of smoking a joint (prolonged, deep inhalation), results in increased absorption of these substances in the airwaves, compared to smoking a cigarette. - Increased likelihood of infection appears only to occur in cannabis smokers whose immune system is already compromised. - In the Netherlands, cannabis is generally mixed with tobacco. Tobacco smoke causes the same respiratory symptoms. - Since the majority of cannabis smokers quit the habit after some time, thus limiting the amount of dangerous substances that they inhale, compared to tobacco smokers who often smoke for longer periods, it is expected that the contribution of smoking cannabis to the incidence of cancer will remain limited. • To date it has not been established that cannabis use during pregnancy causes serious birth defects. Any congenital defects that have been found are slight effects on cognitive development at a later stage of development. 54 Netherlands National Drug Monitor - NDM Annual Report 2009
Page 1 and 2:
Netherlands National Drug Monitor N
Page 3 and 4: Colophon Project Manager Dr. M.W. v
Page 6: Preface This is already the tenth A
Page 9 and 10: 5.4 Problem Use 113 5.5 Usage: Inte
Page 12 and 13: List of abreviations and acronyms 2
Page 14 and 15: NEMESIS NFU NIGZ NMG NPO NRI NVIC N
Page 16 and 17: Summary Below is an outline of the
Page 18 and 19: The number of hospital admissions c
Page 20 and 21: GHB. In 2008/2009 4.6 percent of fr
Page 22 and 23: Deaths In the Netherlands, smoking
Page 24 and 25: Offences by drug users Drug users c
Page 26 and 27: Opiates Ecstasy Amphetamine Alcohol
Page 28 and 29: 1 Introduction The National Drug Mo
Page 30 and 31: use, particularly cannabis, under-r
Page 32 and 33: information is available, this is b
Page 34 and 35: 2 Cannabis Cannabis (Cannabis Sativ
Page 36 and 37: Figure 2.1 Cannabis users in the Ne
Page 38 and 39: Figure 2.2 Cannabis use among secon
Page 40 and 41: Cannabis and problem behaviour •
Page 42 and 43: Table 2.4 Cannabis use among pupils
Page 44 and 45: Table 2.5 Current cannabis use in s
Page 46 and 47: • The sharp increase in treatment
Page 48 and 49: Trends It is difficult to determine
Page 50 and 51: • The role of cannabis in all req
Page 52 and 53: - misuse or dependence on alcohol a
Page 56 and 57: • So far, epidemiological studies
Page 58 and 59: Quality and price The Trimbos Insti
Page 60 and 61: 3 Cocaine Cocaine works as a stimul
Page 62 and 63: Age, gender and urbanisation level
Page 64 and 65: Special groups In certain groups of
Page 66 and 67: Table 3.3 Cocaine use in special gr
Page 68 and 69: and 7.7% in the U.K (England and Wa
Page 70 and 71: Table 3.5 Cocaine use among school-
Page 72 and 73: 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
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• Pupils attending REC-4 schools
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5.3 Usage: juveniles and young adul
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• In 2008, key observers in Amste
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Table 5.3 Use of Ecstasy and amphet
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Table 5.4a Use of amphetamines and
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Table 5.5a Ecstasy use among school
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Ecstasy • The number of (outpatie
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Figure 5.3 Numbers registered with
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• The same person may be admitted
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• The number of requests for info
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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
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6.2 Usage: general population The r
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GHB use is more common among juveni
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• GHB use among school-goers is l
Page 141 and 142:
Table 6.4 GHB incidents registered
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• Of the liquid samples sold as G
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• Total deaths from alcohol-relat
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Figure 7.1 Alcohol consumption amon
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Ethnic background • Among seconda
Page 151 and 152:
Table 7.3 Percentage of current dri
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Table 7.4 Alcohol use in the social
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Holiday-makers • Research conduct
Page 157 and 158:
Figure 7.3 Heavy drinkers by gender
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The countries with the lowest perce
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• In France it is more likely tha
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Figure 7.6 Age distribution of prim
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• In 2008, 337 day-care admission
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• In approximately 1,200 admissio
Page 169 and 170:
Table 7.9 Estimated number of injur
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• 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
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Special education Table 8.3 shows t
Page 185 and 186:
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
Page 199 and 200:
Table 9.1 Criminal investigations i
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Table 9.2 Number of dismantled prod
Page 203 and 204:
Table 9.3 Characteristics of suspec
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Figure 9.2 Number of Opium Act case
Page 207 and 208:
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
Page 213 and 214:
Table 9.9 Prevalence of new crimina
Page 215 and 216:
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
Page 231 and 232:
Dismissal on policy grounds Decisio
Page 233 and 234:
eintegration and rehabilitation of
Page 235 and 236:
I. Use and problem use Source Targe
Page 237 and 238:
II. Treatment demand and treatment
Page 239 and 240:
IV. Market information Source Targe
Page 241 and 242:
Source Target group/subject Sources
Page 244 and 245:
Appendix C Explanation of ICD-9 and
Page 246 and 247:
Appendix D Websites in the area of
Page 248 and 249:
Ministry for Health, Welfare and Sp
Page 250:
Appendix E Drug use in a number of
Page 254 and 255:
References Adlaf, E.M., Korf, D.J.,
Page 256 and 257:
Coumans, A.M. (2005). Survival on t
Page 258 and 259:
Ganpat, S., Wits, E., Schoenmakers,
Page 260 and 261:
Knibbe, R.A., Joosten, J., Derickx,
Page 262 and 263:
Monshouwer, K., Smit, F., De Graaf,
Page 264 and 265:
Rigter, H., Van Laar, M. (2002). Ep
Page 266 and 267:
Tweede Kamer der Staten-Generaal (2
Page 268 and 269:
Van Leeuwen, F.E. (1999). Epidemiol
Page 270:
In the Netherlands various monitori
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