The Netherlands Drug Situation 2010 - Trimbos-instituut

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Health correlates and consequences (chapter 6)Several sources indicate that the incidence of HIV and hepatitis B and C among (ever)injecting drug users remained low in the past years. The reduction in HIV transmission inIDUs can be partly explained by the decline in injecting and needle sharing, althoughsexual risk behaviour is still occurring. The main route of HIV transmission in the Netherlandsis sexual, both through MSMs and heterosexuals. Nonetheless, the number ofchronically infected drug users and hence (future) disease burden is fairly high, especiallywith regard to hepatitis C. The registration of the HIV Monitoring Foundation shows that91% of HIV-positive IDUs is also infected with HCV. A cross sectional serosurvey amongmale detainees found that 58% of the 19 ever-IDUs in the sample was infected withHCV, which is in line with data from several drug treatment sources (Amsterdam, Heerlen).The number of health emergencies related to GHB use has strongly increased in thepast, and there are indications that the number of emergencies related to hallucinogenicmushrooms has decreased, at least in Amsterdam, after they have been brought undercontrol of the Opium Act. In absolute terms, cannabis is still the drug most commonlyassociated with emergencies (reflecting its relatively high prevalence of use), althoughthe majority of cases refer to mild intoxications.Quite some research studies addressed the association between cannabis use andmental disorders, especially psychosis.Responses to health correlates and consequences (chapter 7)Attention for hepatitis (both in general and for drug users as high risk group) has grownin the past years and many preventive and treatment interventions have been reported.In 2009, a national hepatitis C information campaign, among others targeted at drugusers, was conducted. In 2010, the hepatitis B vaccination programme for drug users hasbeen reassessed. Still, risk behaviour related to injecting is decreasing, among otherssuggested by the ongoing decline in exchanged needles and syringes.Several initiatives have been taken to improve care for dual diagnosis patients andpreventive interventions have been developed for substance using people with mild intellectualdisabilities.Social correlates and social reintegration (chapter 8)The social state of the Netherlands in general shows positive signs by means of a lowscore on the misery index, more tolerance towards minorities, and more satisfaction withthe government. However, there is dissatisfaction with the Dutch health care policy asthere is a general feeling that the government should spend more on care. Moreover,there is a sizeable group in the Dutch society which has little or no trust in politics, andthere are a number of groups who remain stubbornly distanced from society. Social exclusionespecially touches people with a low income, a low education level, members ofethnic minorities, and people with an impairment or disability.Increased problem drug use among socially excluded groups has been noticed amonghomeless youth, especially among youngsters who cannot manage soft drugs, and whoconsider it rather normal to sell drugs. Social exclusion among drug users is indicated bya bad housing situation, especially during the winter, and less access to health care andaddiction care. Moreover, due to the new local zerotolerance policies throughout thecountry, recreational drug users may now also experience social exclusion.Within the framework of the Strategy Plan for Social Relief and underscored by theCharter of Maastricht, the social reintegration of (former) problem drug users has been11
oasted by means of programs to prevent homelessness, outreaching treatment, AssertiveCommunity Treatment (ACT), Community Reinforcement Approach, Multi DimensionalFamily Treatment (MDFT), Supported Living, expertise by experience, time-outservices, work projects, schooling projects, activation projects, and co-ordinated probationand treatment. The results of the Strategy Plan for Social Relief have been evaluatedin the four largest cities.Drug-related crime, prevention of drug-related crime and prison (chapter 9)The majority of recorded more serious forms of organised crime is drug-related. The fractionof cannabis related cases increased, that of hard drug related cases decreased.The investigation and prosecution of organised drug related crime is a priority for Policeand Prosecution for 2008-2012. A combination of administrative and preventive measures,judicial approaches and international co-operation is applied, with a strong focus ina combat on the local level.The absolute number of Opium Act offences in the criminal justice chain – police, PublicProsecutor, Courts – appears to be decreasing. This is in line with a general decliningtrend in criminal justice cases in the Netherlands. The fraction of hard drug cases showsa decreasing trend; that of soft drug cases a clear increasing trend.Recorded property crimes committed by drug users show a decreasing trend, but drugusers commit more violent crimes.Referrals to care facilities outside prison as an alternative to imprisonment are increasing.A new law for forensic care for detainees with addiction or mental health problemswill be in force in 2011. The minister of Security and Justice has budget to buy care outsideprison. Detainees with triple problems – addiction, psychiatric symptoms and mildlearning disabilities – are addressed with priority.The judges convicted over 1,800 prolific offenders, most of whom are problematic polydrugusers, to the measure of placement in an Institution for Prolific Offenders fromOctober 2004 until June 2010. The number of convictions is decreasing.Male adolescents in juvenile justice institutions have high levels of alcohol and druguse prior to their detention, especially the age group of 13-14 years. The ministry of Securityand Justice announced more stringent controls and preventive activities in the institutions.Drugs markets (chapter 10)The number of coffee shops where the sale of cannabis is tolerated further decreasedfrom 700 in 2008 to 666 in 2009. In 2010 pilot projects started in ten municipalities tofurther regulate coffee shops and reduce public nuisance.Potency of cannabis samples sold in coffee shops, as measured by THC concentration,varied in the past years between 15% and 19% for Dutch marihuana, which is the mostpopular type of cannabis used in the Netherlands. The slight upward trend in 2010 mightbe associated with the change to a new laboratory for conducting the chemical analysis.Cannabidiol (CBD) content in Dutch marihuana is low. Scientific knowledge on the importanceof CBD relative to THC content in cannabis in causing adverse effects (mental disorders,dependence) is growing.In 2008/2009 various indicators (seizures, purity) pointed at a reduced availability ofprecursors PMK and BMK synthesising for ecstasy and amphetamine, respectively, whichresulted in a lower purity of these drugs on the retail market. In 2009, substances likemCPP and mefedrone seemed to some extent to replace MDMA in tablets sold as ecstasy,and speed samples were to a large extent adulterated with caffeine. In 2010 the purity of12
Page 1 and 2: Margriet van Laar, Guus Cruts, Andr
Page 3 and 4: ColophonThis National Report was su
Page 6: PREFACEThe Report on the Drug Situa
Page 9 and 10: 9.6 New developments 14110 Drug mar
Page 11: these groups are relatively scarce.
Page 16: Part A: New developments and trends
Page 19 and 20: Regulation Opium Act Exemptions (mi
Page 21 and 22: Medicinal cannabisOn 6 October 2009
Page 23 and 24: The Public Administration Probity S
Page 25 and 26: local circumstances into account. T
Page 27 and 28: The police district of West and Cen
Page 29 and 30: treatment for drug addiction. "Labe
Page 32 and 33: 2 Drug use in the population2.1 Dru
Page 34 and 35: Table 2.1.3Annual prevalence and nu
Page 36 and 37: Cannabis and age (of onset)Figure 2
Page 38 and 39: ment of regular cannabis use (4 or
Page 40 and 41: Table 2.3.1Prevalence (%) of substa
Page 42 and 43: the ecstasy (see also § 10.3), som
Page 44 and 45: Table 2.3.2Prevalence of substance
Page 46 and 47: 3 PreventionIntroductionIn the Neth
Page 48 and 49: CVGU). this Centre will support loc
Page 50 and 51: friends list in Windows live Messen
Page 52: entiate for group characteristics l
Page 55 and 56: in the number of problem opiate use
Page 57 and 58: emaining 131 problem hard drug user
Page 59 and 60: The largest difference in the propo
Page 61 and 62: Logistic regression analysis showed
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5 Drug-related treatment: treatment
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National performance indicatorsAn i
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From May 2010 FACT will be offered
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using cannabis, it is developed by
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clients received treatment in Amste
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Figure 5.3.1: Distribution of new c
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Figure 5.3.3: Gender distribution b
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Table 5.3.1: Clinical admissions to
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In 2009, 692 new HIV diagnoses were
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Other risk behaviour included tatto
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Of the 168 new AIDS diagnoses in 20
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The Municipal Health Service (GGD)
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addiction care centre (hepatitis B
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o Chronic carriership was found in
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(4%), and hallucinogenic mushrooms
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Table 6.2.2: Information requests r
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6.3 Drug-related deaths and mortali
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Figure 6.3.2: Trends in age distrib
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Figure 7.2.1 Number of syringes exc
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The expert group also discussed the
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Iriszorg is further experimenting w
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In line with the national policy th
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"The proportions of non-Western eth
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drugs. However, there is a narrow b
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Table 8.2.1: Programs for social re
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Evaluation researchFor the city of
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and 2009 has found that hostels rol
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against money laundering and other
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Table 9.1.1: Investigations into mo
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amounts, which are considered as me
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Opium Act offenders in prisons (fig
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cases is increasing. The proportion
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property crimes is decreasing, wher
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country. They offer a combination o
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mated 250 to 1,150 detainees in the
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Table 9.3.3: Types of assistance of
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Figure 9.3.1: Number of persons per
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It is important that detainees are
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The coming Law on Compulsory Mental
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Over half (53%) of the coffee shops
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Research on organised crime shows t
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Table 10.2.1: Number of dismantleme
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Table 10.3.2: Content of tablets so
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caine samples solely contained anot
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nabidiol (CBD) - in contributing to
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156
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11 History, methods and implementat
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diction care was published in 1997
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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,
Page 196 and 197:
Ivens, Y. and Wittenberg, S. (2008)
Page 198 and 199:
Malmberg, M., Overbeek, G., Monshou
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RIEC (2009). Bestuurlijke aanpak va
Page 202 and 203:
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:
Page 212 and 213:
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
Page 227 and 228:
226
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