The Netherlands Drug Situation 2010 - Trimbos-instituut

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using cannabis, it is developed by using target group information, scientific literature,theories and methods (Ter Huurne 2009).5.2.4 Withdrawal treatmentUltra rapid detoxificationThe EDOCRA project concerns ultra-rapid detoxification with naltrexone. The project consistsof two phases. In the first phase, which ran from 1999 to 2003, high abstinencerates and improved health conditions were found compared with traditional methadonewithdrawal treatment. It also appeared that adding general anaesthesia to this treatmentwas not only expensive but ineffective and dangerous. n the first phase a follow-uptreatment strategy (the Community Reinforcement Approach) was added to maintainabstinence (see also our National Report 2007, par. 5.3). The second phase targeted areplication of this withdrawal treatment option in a non-experimental context and a checkon the implementation of this treatment (Dijkstra et al. 2009). The questions to be answeredin the second phase were directed at the clinical relevance of the outcomes andwhether the outcomes could be generalized. That means, is ultra-rapid detoxification alsoeffective in regular Dutch addiction care and is implementation feasible?Comparison of the results of the second with the first phase revealed that both atpost-test and one-month after the end of detoxification, the abstinence rates did not differsignificantly (62% versus 59% respectively) The same conclusion could be drawn forother outcomes, e.g. craving, withdrawal symptoms, psychological condition, and qualityof life. However, there were fewer patients in the second phase that completed thistreatment (87% versus 100%) and patients were also more difficult to reach for a followuptest (63% versus 87%). The authors claim that these differences were probably dueto the experimental conditions in the first phase, i.e. more strict controls and correctionsof irregularities that were less easily applicable in the second phase. For instance, in thesecond phase, the Community Reinforcement Approach as a fixed follow-up treatmentstrategy was changed in regular follow-up treatment (as usual) and follow-up measurementswere restricted to one-month after detoxification only.Several interventions were realized to support implementation, e.g. information ofpatients, relatives and professionals caring for diagnosis-based treatment allocation;training professionals in this treatment technique; taking care of necessary additionalconditions (e.g. extra beds, a camera monitoring system and of additional materials andmedication. In the first phase of this project professionals were trained in a special diagnosis-basedtreatment allocation procedure, while in the second phase the professionalswere only informed how to refer patients to this treatment. The other implementationinterventions for both phases did not differ.In total 135 of the 297 eligible patients were included in the first phase of the project,and 121 in the second phase. During the treatment-allocation phase (intakefase) no researcherswere involved and no dropout rates could be determined. It is remarkable thatin the second phase fewer patients were included in treatment and that smaller numberscompleted this treatment compared to the first phase (105 versus 135), while the durationof the second phase was longer (40 versus 27 months respectively). Factors thatmay have caused the lower implementation success of the second phase are for instancethe use of a regular treatment allocation procedure with longer waiting periods beforetreatment, and a non-continuous treatment supply (due to shortage of professionals andmoney). Treatment need and treatment supply did not fit. The abstinence rates amongthe participant patients however, did not differ significantly. The authors conclude that itis feasible to implement ultra-rapid detoxification in the Dutch addiction care, but that69
special attention should be paid to the continuity of treatment supply and patient compliance.Treating cocaine problemsA preliminary test is being done of the effectiveness of varenicline among 20 patientswith cocaine dependence. It is hypothesised that this drug increases the number of dopaminereceptors in the brain, thus reducing the risk of relapse among this target group.Pre- and post-tests (after 3 weeks) with SPECT- and MRI-scanners will be carried out. Ifthe hypotheses are confirmed, a larger scale clinical study will be considered (Crunelle etal. 2009; Evenblij 2010).A detoxification clinic for people with mental retardationPeople with mental retardation are extra vulnerable for drug use and there is an increasein alcohol and drug problems and a need for treatment among this target group. Oneregional organization of addiction care is starting a detoxification clinic for this targetgroup. A special method will be developed for this vulnerable low-IQ-target group. 1GHBFollowing the increase in the number of clients in addiction care with serious GHB dependenceproblem, addiction care organisation Novadic-Kentron started a study to establisha guideline for GHB detoxification with medical GHB (see § 11.2.10).5.2.5 Substitution treatmentFeasibility study of treating crack usersDuring the past decade, tens of millions of dollars have been spent on experiments withmedical-assisted treatments for crack dependent people in the United States. However,this did not result in effective treatment options. The time may have come to turn tomaintenance treatment of this group of multi-problem drug users. This may improve thequality of life of this target group, but it may also reduce the harm related to this druguse in their environment. In 2009 a three-fold experimental study on three separate locationsof one organisation of addiction care was started. This study is funded by theNetherlands Organisation for Health Research and Development (ZonMw). The target isto investigate the feasibility of giving cognitive–behavioural maintenance treatment combinedwith either topiramate, modafinil and dex-amphetamine to Dutch crack users. Outcomemeasurement will be focused on treatment acceptance, patient compliance, durationof patient participation, potential effectiveness, medication safety, and patient satisfaction.2 Diverse measurement instruments will be used at pre-test and one, two andthree months later for the experimental groups. Control groups will be approached atpre-test and three months later (Evenblij 2009). The duration of this feasibility study is4-5 years (2009-2013).5.2.6 Heroin-assisted treatment (HAT)In the Netherlands, some of the chronic and treatment-resistant heroin addicts havequalified to receive heroin-assisted treatment (HAT). On August 2009, there were a totalof 715 HAT clients in the Netherlands (Annard 2010). At that reference date, the HAT1 www.zorgwelzijn.nl/web/Actueel/Nieuws; www.psy.nl2 Personal communication from Vincent Hendriks, v.hendriks@parnassia.nl70
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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
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
Page 64 and 65: 5 Drug-related treatment: treatment
Page 66 and 67: National performance indicatorsAn i
Page 68 and 69: From May 2010 FACT will be offered
Page 72 and 73: clients received treatment in Amste
Page 74 and 75: Figure 5.3.1: Distribution of new c
Page 76 and 77: Figure 5.3.3: Gender distribution b
Page 78: Table 5.3.1: Clinical admissions to
Page 81 and 82: In 2009, 692 new HIV diagnoses were
Page 83 and 84: Other risk behaviour included tatto
Page 85 and 86: Of the 168 new AIDS diagnoses in 20
Page 87 and 88: The Municipal Health Service (GGD)
Page 89 and 90: addiction care centre (hepatitis B
Page 91 and 92: o Chronic carriership was found in
Page 93 and 94: (4%), and hallucinogenic mushrooms
Page 95 and 96: Table 6.2.2: Information requests r
Page 97 and 98: 6.3 Drug-related deaths and mortali
Page 99: Figure 6.3.2: Trends in age distrib
Page 103 and 104: Figure 7.2.1 Number of syringes exc
Page 105 and 106: The expert group also discussed the
Page 107 and 108: Iriszorg is further experimenting w
Page 109 and 110: In line with the national policy th
Page 111 and 112: "The proportions of non-Western eth
Page 113 and 114: drugs. However, there is a narrow b
Page 115 and 116: Table 8.2.1: Programs for social re
Page 117 and 118: Evaluation researchFor the city of
Page 119 and 120: 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,
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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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