February <strong>2010</strong>, a total of 225 homeless people made use of the winter-cold regulation, ofwhom 105 were interviewed. It was found that 24% of them had used opiates or cocaineduring the past month, compared to 45% during the winter of 2005-2006. Among thehomeless, less drug users will have been found due the successful efforts that have beenmade to arrange better housing for this group.In case a drug user is promoted from social relief to a hostel, that drug user may experienceless social exclusion with regard to the housing situation. Nonetheless, some experienceof social exclusion may still remain on other domains. Research has been conductedin July and August 2009 among a total of 109 inhabitants (respons 77%) of sixhostels in the city of Utrecht (Wolf et al. <strong>2010</strong>). Almost daily substance use was found formethadone (67%), cocaine (51%), heroin (28%), and prescribed heroin (13%), whichmakes 84% of the hostel inhabitants a harddrug user. From the hostel inhabitants, 72%had no fixed daily activities. Other indications of social exclusion were given by the factthat 14% had no contact with family, and 18% had no contact with friends. Moreover,40% had been arrested during the past year and 38% had been a victim of crime. Furthermore,issues for which the inhabitants were in need of help but declared not to receivethat help were found with regard to housing (35%), finding work (20%), physicalhealth (17%), dental care (13%), daily activities (13%), and taking care of oneself(12%).Besides a bad housing situation, having less access to health care also counts as a formof social exclusion. This aspect of social exclusion has been signaled recently among Moroccandrug users. On behalf of the Mainline Foundation (Stichting Mainline), field researchersconducted structured in-depth interviews between October 2006 and February2007 among 23 Moroccan drug users. During the past three years, these drug users hadused cocaine, heroin, or methadone at least three days a week, and had not completedan inpatient drug treatment during the past year (Voets 2008). <strong>The</strong>ir average age was40.4 years (range 20-57 years) and they had come from Morocco to the <strong>Netherlands</strong>between 1956 and 1994. Cocaine was used the most, followed by heroin and methadone.It was found that most "Moroccan drug users do use general food and accommodationservices and, to a lesser extent, public medical services". However, nearly "none of themmade use of drug treatment clinics". "<strong>The</strong>y were not interested in the assistance of theseclinics. <strong>The</strong>y said they were not ready to quit drugs, or thought that they could kick thehabit without professional support." It appeared that the Moroccan drug users are morein need of practical care with regard to issues like housing, daily activities and aftercareafter detoxification. <strong>The</strong>y do not expect the treatment clinics to offer this kind of practicalcare.Baza and Sabir have interviewed Moroccan drug addicts from the city of Utrecht (Baza etal. <strong>2010</strong>). According to these researchers, there is a high threshold in this group to seektreatment and more dropout during treatment due to former negative experience withtreatment, a negative image of counselors, not feeling understood with regard to culturalbackground, rules maintained by the institutes, and not being ready yet for treatment.Baza and Sabir therefore recommend that counselors do not primarily focus on abstinence,but first take care about housing, benefits, and daily activities. This way addictscan come to grips again with their life.In the <strong>Netherlands</strong>, the pragmatic policy used to be to avoid, as much as possible, thesocial exclusion of people who only use drugs, but do not produce, transport, or deal111
drugs. However, there is a narrow border between only using drugs and dealing drugs. Itis common practice within a group of drug users that one of the users buys the drugs forthe whole group. <strong>The</strong> buyer then shares the drugs within the group.In previous years, such a "sharing provider" was only seen as a user, but since 2008the police and the public prosecutor in some jurisdictions have changed their policy. Atcertain public parties, a "sharing provider" is now seen and treated as a drug dealer. <strong>The</strong>latest Trendwatch, for example, describes a telling case of a generous user who wantedto share ecstasy, GHB, and speed, just to celebrate his birthday (Doekhie et al. <strong>2010</strong>).Having been arrested by an undercover agent, and having made a settlement with thepublic prosecutor, this celebrating drug user now has a criminal record. Moreover, withinthe framework of the new local zerotolerance policies that are spreading throughout thewhole country (in Dutch: nultolerantiebeleid), the General Public Prosecutor's Office hasofficially confirmed that, at dance parties, detection is no longer restricted to dealers.Police detection now targets "all possessors of drugs". With regard to the issue of socialexclusion, the change in the Dutch prosecution policy implies that, since 2008, certaindrug users in the <strong>Netherlands</strong> have come at a greater risk to experience social exclusion.Finally, with regard to the rather sensitive issue of undercover operations, the opportunitiesand risks of this precarious method to detect the illegal possession of illegal drugshave been evaluated (Kruisbergen et al. <strong>2010</strong>).8.2 Social reintegrationMany chronic drug users also have other problems, for instance problems due to causingpublic nuisance or conducting criminal behaviour, financial problems, or having no housingor work. Although the vulnerable group with multiple problems also includes peoplewho do not use drugs, a considerable overlap exists with the group of problem drug users.In February 2006, the national government and the municipalities of the four largest citiesof the <strong>Netherlands</strong> signed and funded the "Strategy Plan for Social Relief" for thegroup with complex and persistent problems (Plan van Aanpak Maatschappelijke Opvang).From 2006 up to including 2009, in the four largest cities Amsterdam, Rotterdam,<strong>The</strong> Hague, and Utrecht, the Great 4 (G4), a total of 9,786 homeless people were pickedoff from the streets and were taken into social relief. This was only the first phase of theStrategy Plan for Social Relief. On the 9th of February <strong>2010</strong>, the second phase of theplan was launched (GGZ Nederland <strong>2010</strong>;Maas et al. <strong>2010</strong>). In this second phase of theplan, apart from the G4, the remaining 39 centre municipalities started implementing theplan. Including the G4, there are a total of 43 centre municipalities in the <strong>Netherlands</strong>.Moreover, apart from taking care for the homeless, measures will be taken to preventhomelessness in the first place among vulnerable people who are at risk to becomehomeless. <strong>The</strong> second phase of the plan will run until February 2014.Programs advertised in annual reportsAs a reflection of the social relief strategy, institutes for addiction care can be found toadvertise in their annual social reports special programs that aim at the social reintegrationof drug users. Moreover, on the 21st of May <strong>2010</strong>, the customer councils and 15institutes for addiction care signed the Charter of Maastricht (Handvest van Maastricht).According to this charter, social reintegration will become the guiding principle in the addictioncare (Oude Bos et al. <strong>2010</strong>). Table 8.2.1 reviews the social-reintegration programsas advertised in the annual reports. All care institutions in the <strong>Netherlands</strong> are112
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Margriet van Laar, Guus Cruts, Andr
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ColophonThis National Report was su
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PREFACEThe Report on the Drug Situa
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9.6 New developments 14110 Drug mar
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these groups are relatively scarce.
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oasted by means of programs to prev
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Part A: New developments and trends
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Regulation Opium Act Exemptions (mi
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Medicinal cannabisOn 6 October 2009
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The Public Administration Probity S
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local circumstances into account. T
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The police district of West and Cen
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treatment for drug addiction. "Labe
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2 Drug use in the population2.1 Dru
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Table 2.1.3Annual prevalence and nu
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Cannabis and age (of onset)Figure 2
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ment of regular cannabis use (4 or
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Table 2.3.1Prevalence (%) of substa
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the ecstasy (see also § 10.3), som
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Table 2.3.2Prevalence of substance
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3 PreventionIntroductionIn the Neth
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CVGU). this Centre will support loc
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friends list in Windows live Messen
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in the number of problem opiate use
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emaining 131 problem hard drug user
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The largest difference in the propo
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example, there may be a climate in
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tion transfer between physicians an
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methadone treatment, and guidelines
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11.3.1 Implementation of guidelines
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Institute for Quality in Health Car
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For most guidelines, the rate of im
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The question has remained how to im
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Name of Assessors: André van Gagel
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WHO guidelines coherence: only to b
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Figure 12.1.1:Number of deaths amon
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were about 341 deaths among the pro
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Part C: Bibliography and annexes185
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13 Bibliography13.1 ReferencesAarts
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Burns, T., Fioritti, A., Holloway,
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De Jong I, Dijkstra M, Van der Poel
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Ganpat, S., Wits, E., Schoenmakers,
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Ivens, Y. and Wittenberg, S. (2008)
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Malmberg, M., Overbeek, G., Monshou
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RIEC (2009). Bestuurlijke aanpak va
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Smolders, M., Laurant, M., Van Duin
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T.K.24077-255. Tweede Kamer der Sta
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T.K.32159-5. Tweede Kamer der State
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Van den Berg C, et al. (2007). Majo
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Van Veldhuizen, J.R. (2007). FACT:
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13.2 Alphabetic list of relevant da
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LMR, Landelijke Medische Registrati
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13.3 List of relevant internet addr
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http://www.tactus.nl/http://www.ggz
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Table 9.1.1: Investigations into mo
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14.3 List of abbreviations used in
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PPCRIOBRIScRIVMROMSCPSHMSOVSRMSTISV
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