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- In the early 1990’s about one million needles were exchanged annually in Amsterdam. By 2007 this had dropped to 171,200, although there was a slight upturn to 184,000 in 2008 (GGD Amsterdam). In Rotterdam the number of syringes exchanged between 2000 and 2007 more than halved from 422,000 to 168,900. However, in 2008, the NX centres ordered almost 75,000 more syringes from the GGD than in the previous year (GGD Rotterdam). - The long-term decline in the number of needles exchanged may possibly be explained by the following factors: a drop in the number of heroin users in general, a decline in the influx of drug users (often injecting) from neighbouring countries, a decline in the popularity of injecting drugs in connection with health problems, the increase in crack cocaine use and the higher death rate among injecting drug users. It is not clear how the spike in 2008 should be interpreted. Perhaps the existing group of users injected more frequently, or needles and syringes were re-used less often. An unexpected rise in the number of injectors cannot be ruled out. Another possibility is that needle exchange staff ordered larger quantities of supplies. • In a recent qualitative study on infectious diseases among heroin users, key informants from the whole of the Netherlands reported that needles are currently only shared in emergencies, but that other injecting materials are borrowed regularly. These include tourniquets, spoons, swabs and filters (Hoogenboezem et al., 2008a). • Apart from sharing injecting materials, high-risk techniques are often used, such as injecting in the groin and neck or in veins; injecting substances that are not soluble, such as methadone liquid, Ritalin, paracetamol, benzodiazepines; using alternatives to sterile water such as rainwater or canal water; or injecting under highly unhygienic circumstances. • Interviews with key informants have revealed the emergence of a new group of high-risk injectors. In recent years there has been an increase in the number of young Eastern-European heroin users in the Netherlands. These are thought to inject frequently and excessively (see also §4.3) (Hoogenboezem et al., 2008b). High-risk sexual activity remains widespread. • However, few recent (national) data are available. According to the most recent measurements taken among injecting drug users in various cities, failure to use condoms occurred most frequently among long-term partners (76-96%), followed by casual partners (39-73%) and clients (13-50%) (Van de Laar & Op de Coul, 2004). • The number of visits to the GGD health services by drug users who participated in the Amsterdam Cohort Studies on HIV/AIDS, in which drug users indicated having had unprotected sex, dropped from 52% in 1990 to 40% in 1996. In the period following (from1996-2004), this percentage remained stable (Lindenburg et al., 2006). • Research conducted on street prostitution in Amsterdam found that virtually all street prostitutes use drugs; four-fifths have ever used heroin, and a quarter have ever injected (Korf et al., 2005a). Half the respondents reported having engaged in unprotected oral sex and a quarter had unprotected genital sex with clients. The researchers noted that these figures are likely to be an underestimate of the true situation. 4 Opiates 97
• It is thought that risk behaviour is increasing due to the effects of crack cocaine (Hoogenboezem et al., 2008b). AIDS The annual number of AIDS notifications (all transmission routes) to the Public Health Inspectorate (through 1999) and to the HIV Monitoring Foundation (SHM) (from 2000) rose from 325 in 1988 to 533 in 1995, and subsequently dropped to 159 cases in 2008 (Koedijk et al., 2009). This decline is partly due to the availability of effective anti-retroviral drugs (HAART). These drugs delay or prevent the onset of AIDS in HIVpositive patients. • The number of notified AIDS cases caused by injecting drug use in the Netherlands has remained limited throughout the years. • Of the 7,777 registered AIDS patients (up to and including 2008), 684 were injecting drug users (9%). This means that the role of injecting drug use in the development of AIDS is on average higher than for contracting HIV. • After peaking at fourteen percent in 1995, there has been a drop in number of injecting drug users among HIV-positive patients who developed full-blown AIDS. In 2007, 4% (10 instances) of notified AIDS cases involved an injecting drug user. In 2008, AIDS was diagnosed in 7 injecting drug users (likewise 4% of the total number of newly diagnosed AIDS cases (Koedijk et al., 2009) International Comparison Since the introduction of effective anti-retroviral drugs, the number of new AIDS patients has become a less reliable measure of the transmission of the HIV virus. Nonetheless, notifications of new AIDS cases still serve as an indication of the size of the problem. They are also an indication of the availability of anti-retroviral treatment for drug users. • For years, Portugal has had the highest percentages of new AIDS diagnoses among drug users. I 2006, 22.4 new cases per million inhabitants were reported (EMCDDA, 2008). Other European countries with a high percentage of new AIDS diagnoses among drug users in 2005 are Estonia, Spain and Latvia. Apart from Estonia, a downward trend can be seen in these countries. The Netherlands is one of the countries with a low number of new AIDS cases among drug users. • There are no data on the availability of HAART for drug users. However, according to WHO estimates, the rate of access to HAART medication is over 75% everywhere in the EU member states (EMCDDA, 2007). Deaths Direct deaths According to the cause of death statistics of Statistics Netherlands (CBS) the death rate from the direct consequences of opiate use is low in the Netherlands. Direct deaths are those following an overdose, i.e. intoxication from a lethal dose of a drug. According 98 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
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 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: The total number of chronic hepatit
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 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
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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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