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Figure 3.4 Admissions to general hospitals related to cocaine misuse and dependence, from 1995 700 Number 600 500 451 562 506 551 547 514 607 617 400 371 363 383 377 300 285 246 200 100 24 53 55 50 65 67 81 84 80 89 101 90 114 131 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Cocaine as primary diagnosis Cocaine as secondary diagnosis Number of diagnoses, not corrected for duplication of persons or of more than one secondary diagnosis per admission. ICD-9 codes: 304.2, 305.6 (appendix C). Source: Dutch Hospital Data, LMR, Prismant. • The same person may be admitted more than once per year. In addition, more than one secondary diagnosis may be made per case. In 2008, corrected for duplication, the total amounted to 599 persons who were admitted at least once with cocaine misuse or dependence as the primary or secondary diagnosis. Their average age was 35, and 73% were male. The peak age group is between 25 and 34 (35%). • The LMR registered no cases of ‘accidental poisoning with cocaine’ as the secondary diagnosis in 2007 or in 2008 (ICD-9 code E855.2) According to the injury information system (LIS) of the Consumer Safety Institute, on average 3,800 people are treated annually at the accident and emergency departments of hospitals on account of an accident, violent incident or self-mutilation related to drug use (Valkenberg, 2009). The drugs in question are cannabis, cocaine, heroin, , ecstasy, amphetamine and magic mushrooms. The data have been averaged for the period from 2004 through 2008, and consist of estimates for the entire country, based on data from a representative sample of hospitals. • Cocaine is the most frequently cited drug. Almost one in three (30%) drug victims indicates having used cocaine. If we count only the cases where the drug is known (65%), then cocaine accounts for 46% of all drug-related emergency room treatment. • Approximately eleven percent of all drug victims (410 cases) are treated for complications caused by a foreign body. In most cases, these involve pellet swallowers. 3 Cocaine 73
• These figures are likely to be an under-estimate of the true number of drug-related accidents. This is because the role of drugs in these incidents is not examined systematically. The National Poison Information Centre of the National Institute of Public Health and the Environment (RIVM) registers the number of requests for information from doctors, pharmacists and government organisations about (potentially) acute poisoning by foreign bodies such as drugs (Van Velzen et al., 2009). • The number of information requests for cocaine rose steadily between 2000 and 2003 and fluctuated in the years following. From 2006 to 2007 and again in 2008 there was a slight rise in the number of requests (table 3.6). This increase can be partly explained by the fact that in 2008 requests via the website were included in the statistics. • A trend in the number of information requests does not necessarily equate with a trend in the number of intoxications. Increasing familiarity among professionals with the symptoms and treatment of drug poisoning cases may reduce the need for information requests from the NVIC. Table 3.6 Information requests concerning cocaine use from the National Poisons Information Centre (NVIC) from 2000 2000 2001 2002 2003 2004 2005 2006 2007 2008 Cocaine 150 184 217 247 227 254 211 231 255 Number of information requests annually via the NVIC 24 telephone helpline. Requests via the website www.vergiftigingen.info (online since April 2007) were included in the data for the first time in 2008. Source: NVIC, RIVM. 3.7 Illness and deaths • Cocaine induced health problems, particularly from frequent crack smoking include lung complications (coke lung), heart attacks, brain haemorrhage, kidney failure, epileptic fits, exhaustion and reduced immunity, restlessness, irritability, depression, anxiety, psychoses and paranoia (Korf et al., 2004a). • Heavy coke users also have more difficulty in keeping their aggression under control. Moreover, cocaine raises the pain threshold, making violent cocaine users more difficult for the police to restrain (CIV, 2009). • Juveniles and young adults in the social scene who have used cocaine excessively and for prolonged periods exhibit paranoid, uptight and egotistical behaviour as well as introvertedness (Nabben et al., 2006, 2007). Constant tiredness is also cited as an effect of frequent cocaine use. 21 And the nostrils can become damaged from frequent snorting (Mainline Foundation, 2008; Scheenstra et al., 2007). 74 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
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 54 and 55: At the Ambulance Transport Centre (
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 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
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• The number of requests for info
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According to the EMCDDA, in other E
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Figure 5.6 Concentration of MDMA in
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Table 5.9 Number of samples contain
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• 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
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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
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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
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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
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Table 7.9 Estimated number of injur
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• On the basis of current researc
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Figure 7.10 Deaths from alcohol use
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• 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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