The Netherlands National Drug Monitor

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The Netherlands National Drug Monitor
The Netherlands National Drug Monitor 2005
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ND M
ND M
ND M
The Netherlands
National Drug
Monitor
Annual Report 2006
NDM Annual Report 2006
Trimbos-instuut, Utrecht, 2007
Colophon
Editors
Dr. M.W. van Laar, Trimbos-institute
Dr. A.A.N. Cruts, Trimbos-institute
Dr. J.E.E. Verdurmen, Trimbos-institute
Dr. M.M.J. van Ooyen-Houben, WODC
Drs. R.F. Meijer, WODC
In association with
Dr. E.A. Croes, Trimbos-institute
Drs. A.P.M. Ketelaars, Trimbos-institute
M. Brouwers, WODC
P.P.J. Groen, WODC
L.K. de Jonge, WODC
Production
Hessel den Uijl
Lay out
Gerda Hellwich
Ellen van Oerle
Design and Print
Ladenius Communicatie BV, Houten
This publication can be ordered online at www.trimbos.nl,
Or from the Trimbos Institute, Orders Department,
PO Box 725, 3500 AS Utrecht, + 31 (0)30-297 11 80;
fax: + 31 (0)30-297 11 11; e-mail: [email protected],
stating article number AF0760.
You will receive an invoice for payment.
ISBN: 978-90-5253-588-3
© 2007 Trimbos Institute, Utrecht
All rights reserved. No part of this publication may be copied or publicised in any form or in
any way, without prior written permission from the Trimbos Institute
To access this report as a pdf. document:
Go to www.trimbos.nl.
Or go to www.wodc.nl.
Members of the NDM Scientific Committee
Prof. dr. H.G. van de Bunt, Erasmus Universiteit Rotterdam
Prof. dr. H.F.L. Garretsen, Tilburg University (President)
Prof. dr. R.A. Knibbe, Universiteit Maastricht
Dr. M.W.J. Koeter, AIAR
Dr. D.J. Korf, Bonger Institute of Criminology, University of Amsterdam
Prof. dr. H. van de Mheen, IVO
Prof. dr. J.A.M. van Oers, RIVM, Tilburg University
A.W. Ouwehand, Stg. IVZ
Drs. A. de Vos, Netherlands Association for Mental Health Care (GGZ Nederland)
Observers
Mr. P.P. de Vrijer, Ministry of Justice
Drs. W.M. de Zwart, Ministry of Health, Welfare and Sport (VWS)
Additional referees
Dr. M.C.A. Buster, Municipal Health Service Amsterdam (GGD Amsterdam)
A. Hoekstra, Ministry of Justice
Drs. S. Houwing, SWOV
Drs. W.G.T. Kuijpers, Stg. IVZ
Dr. ir. E.L.M. Op de Coul, RIVM
Dr. M. Prins, GGD Amsterdam
Dr. M.C. Willemsen, STIVORO
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3
Contents
PREFACE
9
LIST OF ABREVIATIONS AND ACRONYMS
11
Summary
15
1
INTRODUCTION
23
2
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
CANNABIS
RECENT FACTS AND TRENDS
USAGE: GENERAL POPULATION
USAGE: JUVENILES AND YOUNG ADULTS
PROBLEM USE
USAGE: INTERNATIONAL COMPARISON
TREATMENT DEMAND
ILLNESS AND DEATHS
SUPPLY AND MARKET
27
27
27
30
35
36
39
43
43
3
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
COCAINE
RECENT FACTS AND TRENDS
USAGE: GENERAL POPULATION
USAGE: JUVENILES AND YOUNG ADULTS
PROBLEM USE
USAGE: INTERNATIONAL COMPARISON
TREATMENT DEMAND
ILLNESS AND DEATHS
SUPPLY AND MARKET
47
47
48
49
51
52
54
59
60
4
4.1
4.2
4.3
4.4
4.5
4.6
4.7
OPIATES
RECENT FACTS AND TRENDS
USAGE: GENERAL POPULATION
USAGE: JUVENILES
PROBLEM USE
USAGE: INTERNATIONAL COMPARISON
TREATMENT DEMAND
ILLNESS AND DEATHS
63
63
63
64
65
68
69
74
5
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
ECSTASY, AMPHETAMINES AND RELATED SUBSTANCES
RECENT FACTS AND TRENDS
USEAGE: GENERAL POPULATION
USAGE: JUVENILES AND YOUNG ADULTS
PROBLEM USE
USAGE: INTERNATIONAL COMPARISON
TREATMENT DEMAND
ILLNESS AND DEATHS
SUPPLY AND MARKET
85
85
86
87
89
89
92
97
98
6
6.1
6.2
6.3
ALCOHOL
RECENT FACTS AND TRENDS
USAGE: GENERAL POPULATION
USAGE: JUVENILES AND YOUNG ADULTS
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103
103
104
106
5
6.4
6.5
6.6
6.7
6.8
PROBLEM USERS
USAGE: INTERNATIONAL COMPARISON
TREATMENT DEMAND
ILLNESS AND DEATHS
SUPPLY AND MARKET
110
112
114
121
125
7
7.1
7.2
7.3
7.4
7.5
7.6
7.7
7.8
TOBACCO
RECENT FACTS AND TRENDS
USAGE: GENERAL POPULATION
USAGE: JUVENILES AND YOUNG ADULTS
PROBLEM USE
INTERNATIONAL COMPARISON
TREATMENT DEMAND
ILLNESS AND DEATHS
SUPPLY AND MARKET
129
129
129
132
134
134
136
137
139
8
DRUG-RELATED CRIME
143
8.1 RECENT FACTS AND TRENDS
143
8.2 DRUG LAW VIOLATIONS
145
8.2.1 Drug Crime Suspects
145
8.2.2 Investigations into Organised Crime
147
8.2.3 Drug seizures
148
8.2.4 Disposal of drug crime cases at the Public Prosecutions Department
150
8.2.5 Disposals by the court
155
8.2.6 Penalties imposed in drug law cases
156
8.2.7 Custodial sentences under the Opium Act
157
8.2.8 Recidivism among drug offenders
159
8.2.9 Drug crime in the law enforcement chain
160
8.3 CRIMES COMMITTED BY DRUG AND ALCOHOL USERS
161
8.3.1 Drug-using police suspects
161
8.3.2 Drugs, alcohol and violent crimes
163
8.3.3 Driving under the influence (DUI)
163
8.3.4 Drug and alcohol use among detainees
167
8.4 PROBLEM USERS IN THE LAW ENFORCEMENT SYSTEM
167
8.4.1 Probation and Aftercare of addicts
168
8.4.2 Treatment as an alternative to prosecution and sanctions.
170
8.4.3 The Judicial Placement of Addicts and the Institutions for Prolific Offenders 172
Appendix A
Glossary of Terms
I. SUBSTANCE USE AND ADDICTION
II.
DRUGS CRIME
175
175
175
179
Appendix B
Sources
185
185
Appendix C
Explanation of ICD-9 and ICD-10 codes
193
193
Appendix D
Quality criteria for behavioural interventions in the
enforcement system aimed at reducing criminal recidivism
Appendix E
6
195
law
195
197
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Websites in the area of alcohol and drugs
197
Appendix F
Drugs use in a number of new EU member states
201
201
APPENDIX G
Technical notes to chapter 8 Drug-related crime
203
203
REFERENCES
207
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8
TRIMBOS-INSTITUUT
PREFACE
The percentage of cannabis users and amphetamine users remains stable, but there is an increase in the number of users seeking treatment for these substances.
Cocaine combined with alcohol is the drug of choice. Treatment demand for cocaine-related problems appears to have peaked. A low dose of ecstasy has only
subtle effects on mental functioning, but it cannot be assumed that incidental use
of ecstasy is safe. Ageing opiate users are often battling with physical and mental
problems. The percentage of binge drinkers has declined, but young people engage
increasingly in pre-drinking before they go out. Previous years showed a drop in the
percentage of (heavy) smokers, but this trend has not continued.
These are a few of the many statistics – some disturbing, others more positive –
that are included in this 2006 Annual Report of the National Drug Monitor (NDM).
The NDM Annual Report provides an account of the prevailing substance use and
the problems associated with it.
This is already the eighth Annual Report. The reports are compiled by the NDM Bureau which is incorporated in the Trimbos Institute for Mental Health and Addiction
and the Scientific Research and Documentation Centre (WODC) of the Justice Ministry. The annual reports provide a significant contribution to the need for knowledge
in this area. Accordingly, many thanks are due to the staff of the NDM Bureau at
the Trimbos Institute and the WODC. Equally, thanks are due to all staff and participating organisations that submitted data for the report.
It is to be hoped that the Annual Reports will function for a long time to come as a
source of information on the use of drugs, alcohol and tobacco in the Netherlands
as well as the associated legal aspects.
Prof. Dr. Henk Garretsen
Chairman Scientific Committee of the National Drug Monitor.
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LIST OF ABREVIATIONS AND ACRONYMS
2C-B
4-MTA
AIAR
AIDS
AIHW
APZ
BO
BZK
BZP
CAM
CAN
(CBS)
CEDRO
CJIB
CMR
COPD
CPA
CSV
CVA
CVS
DIMS
DJI
DMS
dNRI/O&A
DOB
DSM
EHBO
EMCDDA
ESPAD
EU
FPD
GGD
GG&GD
GGZ
GHB
HAVO
HBSC
HBV
HCV
HDL-C
HIV
HKS
ICD
IDG
IGZ
ISD
IVO
IVZ
KLPD
4-bromo-2,5-dimethoxyphenethylamine
4-methylthioamphetamine
Amsterdam Institute for Addiction Research
Acquired Immune Deficiency Syndrome
Australian Institute of Health and Welfare
General Psychiatric Hospital
Primary Education
Ministry of the Interior (and Kingdom Relations)
Benzylpiperazine
Coordination Agency for the Assessment and Monitoring of New Drugs
Swedish Council for Information on Alcohol and Other Drugs
Statistics Netherlands
Centre for Drugs Research
Central Fine Collection Agency
Central Methadone Registration
Chronic Obstructive Pulmonary Disease
Central Post for Ambulance Transports
Criminal Consortium
Cerebral Vascular Accident (stroke)
Patient Monitoring System
Drugs Information and Monitoring system
Custodial Institutions Service / Correctional Institutions Service (juveniles)
Drug Monitoring System
Research and Analysis Group of the National Criminal Intelligence Service
of the National Police Agency
2,5-dimethoxy-4-bromoamphetamine
Diagnostic and Statistical Manual
First Aid
European Monitoring Centre for Drugs and Drug Addiction
European School Survey Project on Alcohol and Other Drugs
European Union
Forensic Psychiatric Service
Municipal Health Service
Community Health Service
Netherlands Association for Mental Health Care
Gamma hydroxybutyric acid
General secondary education
Health Behaviour in School-aged Children (study)
Hepatitis B virus
Hepatitis C virus
High density lipoprotein cholesterol
Human Immunodeficiency Virus
Police Records System
International Classification of Diseases
Intravenous Drug users
(Public) Health Care Inspectorate
Institution for Prolific Offenders
Addiction Research Institute (Rotterdam)
Organization of Care Information Systems
National Police Agency
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11
KMar
LADIS
LIS
LMR
LOM
LUMC
MAD
MBDB
mCPP
MDA
MDEA
MDMA
MGC
MLK
MMO
NDM
NEMESIS
NIGZ
NMG
NPO
NRI
NVIC
NWO
OBJD
OM
OPS
PBW
PMA
PMMA
POLS
RIKILT
RISc
RIVM
SAMHSA
SHM
STD
SOV
Sr
Sv
SVG
SRM
SSI
SWOV
TBS
THC
TNS NIPO
TRIAS
TULP
UvA
VBA
v.i.
12
Royal Military Police
National Alcohol and Drugs Information System
Injury Information System
National Medical Registration
School for children with learning and educational difficulties
Leiden University Medical Center
Regional and Urban Monitor of Alcohol and Drugs
N-methyl-1-(3,4-methyleen-dioxyphenyl)-2-butanamine
meta-Chlor-Phenyl-Piperazine
Methyleen-dioxyamphetamine
Methyleen-dioxyethylamphetamine
3,4-methyleen-dioxymethamphetamine
Monitor of Organised Crime
School for children with learning difficulties
Social Inclusion Monitor
National Drug Monitor
Netherlands Mental Health Survey and Incidence Study
National Institute for Health Promotion and Illness Prevention
National Mental Health Monitor
National Prevalence Survey
National Criminal Investigation Service/ National Intelligence Service
National Poisons Information Centre
Netherlands Institute of Scientific Research
Research and Policy Database of Criminal Records
Public Prosecutor / Public Prosecution Service / Office
List of wanted persons
Prisons Act
Paramethoxyamphetamine
Paramethoxymethylamphetamine
General Social Survey
Institute of Food Safety
Risc (of Recidivsm) Assessment Scales
National Institute of Public Health and the Environment
Substance Abuse and Mental Health Services Administration
HIV Monitoring Foundation
Sexually Transmittable Diseases
Judicial Placement of Addicts
Criminal Code
Code of Criminal Procedure
Addiction and Probation Department of the Netherlands Association for
Mental Health Care
Monitor of Criminal Law (enforcement)
cigarette industry foundation
Institute for Road Safety Research
Disposal to be treated on behalf of the State (hospital order)
Tetrahydrocannabinol
The Netherlands Institute of Public Opinion and Market Research
Transaction registration and information processing system
Imposition of restricted freedom sanctions in penitentiary institutions
University of Amsterdam
Drug Counselling Unit
Conditional release
TRIMBOS-INSTITUUT
VIS
VMBO-p
VMBO-t
VNG
VTV
VWO
VWS
WHO
WODC
WVMC
WvS
ZMOK
ZonMw
Zorgis
Early Intervention System
Lower secondary school: practical stream
Lower secondary school: theoretical stream
Association of Municipalities of the Netherlands
Centre for Public Health Studies
Higher Secondary School
Ministry of Health, Education, Welfare and Sport
World Health Organisation
Scientific Research and Documentation Centre
Abuse of Chemical Substances Prevention Act
Code of Criminal Law
School for children with severe educational difficulties
Netherlands Organisation for Health Research and Development
Care Information System of the Netherlands Association for Mental Health
Care
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13
Summary
Tables 1a and 1b give an overview of the most recent figures on substance use and drugrelated crime. Below is an outline of the most striking developments from the 2006 Annual Report
The percentage of recent users refers to the percentage that used a substance during the
past year; the percentage of current users refers to the percentage that has used a substance during the past month.
Drugs: use and treatment demand
Cannabis use stable, but demand for treatment continues to rise
In the general population of 15 to 64 years, the percentage of recent and current cannabis users remained stable between 2001 and 2005 (in 2005: 5.4% recent, 3.3% current). Research among school-goers has shown a slight drop in cannabis use in this age
group between 1996 and 2003, followed by a levelling off in 2005. It is not known how
the number of problem cannabis users has developed over time. However, we are witnessing a continuing rise in the number of people who seek treatment from addiction
care for problem cannabis use. Between 1994 and 2004 the number of primary cannabis
clients rose from 1,950 to 6,100. Between 2004 and 2005 there was an increase of 12
percent. Few people are admitted to general hospitals with cannabis problems as the
primary diagnosis, although there is evidence of an increase (24 cases in 2000; 62 in
2005); The number of admissions with cannabis misuse and dependence as a secondary
diagnosis rose from 193 in 2000 to 322 in 2004. In 2005, 299 cases were registered.
Cocaine treatment demand down for the first time
In the population aged 15 to 64, the percentage of recent and current cocaine users remained stable between 2001 and 2005 (in 2005: 0.6% recent, 0.3% current). Among
school-goers, cocaine use stabilised between 1996 and 2003. In certain groups, particularly among young people in social settings, cocaine use is considerably more prevalent
than in the general population. In the Amsterdam nightlife scene, use of this drug appears to have peaked; however it is not known whether this is also the case elsewhere in
the Netherlands. Cocaine combined with alcohol is the drug of choice. Among hard drug
addicts as well, cocaine in the form of crack which is smoked, is part of the standard
drugs repertoire. It is not known how many people suffer physical, mental or social problems on account of excessive cocaine use. Data from (outpatient) addiction care services
registered a sharp rise in the number of cocaine clients from 2,500 in 1994 to ten thousand in 2004. However, this trend did not continue in 2005. In fact, there was a drop of
two percent from 2004 to 2005. Other indicators, such as the number of hospital admissions involving cocaine or the number of acute cocaine-related deaths have not shown
any increase since 2002.
There was also a drop in the growth of new cocaine users in the general population between 2001 and 2005. The coming years will reveal whether these developments indicate
a stabilisation or a decline in the use of cocaine.
Increase in amphetamine clients but numbers remain low
In the general population, the percentage of recent and current amphetamine users is
fairly low and remains stable (in 2005: 0.3% recent, 0.2% current). Compared to other
drugs, few clients with an amphetamine problem seek treatment from outpatient addiction care services. Nonetheless, this number more than doubled from, 482 in 2001 to
1,118 in 2005. Between 2004 and 2005 there was an increase of 17 percent. In recent
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15
years we have also witnessed a rise in the number of general hospital admissions related
to amphetamine(-like) substances, although the percentage of these in all drug-related
admissions is low. According to data from the National Poisons Information Centre
(NIVC), requests for information concerning amphetamine intoxication rose between
2002 and 2005. Time will tell whether these developments represent anything more significant than a mere fluctuation in the registration data. For the time being, there are no
indications that amphetamine use is on the increase
Ecstasy use remains stable
The percentage of recent and current users of ecstasy in the general population remained
stable between 2001 and 2005 (in 2005: 1.2% recent, 0.4% current). In the nightlife
scene, ecstasy is still a much-used hard drug. Ecstasy-related demand for treatment remains limited (293 in 2005). However, in recent years there has been a slight increase in
the number of people presenting with a secondary ecstasy problem (from 563 in 2001 to
781 in 2005). Results from various studies have shown that frequent ecstasy use causes
changes to the serotonine-receptors in the brain. Clinical effects of frequent ecstasy use
have also been reported, such as memory loss and an increase in symptoms of depression. On the basis of recent research it cannot be concluded that occasional ecstasy use
is safe, although the effects of use in low doses on brain function are subtle.
Rise in number of young opiate users continues to slow
According to the most recent estimates which date from 2001, there were between
24,000 and 46,000 problem opiate users in the Netherlands – a similar number to previous years. Of the EU-15 member states, the Netherlands together with Greece and Germany has the smallest number of problem users per thousand inhabitants aged between
15 and 64 (2-3 compared to 8-9 in Italy, Luxembourg, Spain and the UK). The age profile of opiate users has grown older throughout the years, and the growth in young users
is declining. The percentage of young addiction care clients (15-29 years) dropped from
39% 1994 to 8% in 2004 and 6% in 2005. Between 2001 and 2004 there was also a
drop in the total number of primary opiate clients, from almost 18 thousand to 14 thousand (-22%). However this downward trend did not continue in 2005. The remaining
group of opiate clients is growing older and often has to contend with physical and mental problems. In the Netherlands approximately one percent of newly registered HIV is
related to injecting drug use. Despite a decline in high-risk behaviour, such as injecting
drugs and sharing needles, there has not been a further drop in the number of new HIV
diagnoses. This can probably be attributed to ongoing widespread high-risk sexual activity.
Alcohol and Tobacco: usage and treatment demand
Number of drinkers remains stable; binge drinking lower
The number of recent and current consumers of alcohol in the population aged 15 to 64
remained stable between 2001 and 2005 (in 2005: recent 85%, current 78%). The percentage of people who consumed six or more glasses of alcohol in one day on at least on
occasion during the past six months (‘binge drinking’) dropped during this period from 40
to 35 percent. There are considerable differences among the age groups, particularly
where more heavy alcohol use is concerned. Males aged between 20 and 24 score highest for heavy and problem drinking. In 2005, 33% of males and 8% of females in this
age group were heavy drinkers. This is less than in 2002 (42% of men and 18% of
women). Alcohol use among juveniles has also attracted a lot of attention in recent
years. The proportion of school-goers that used alcohol at a young age increased be-
16
TRIMBOS-INSTITUUT
tween 1999 and 2003. They often start to drink when they are between eleven and fourteen years old. However, among 12 year olds there was a slight drop in the percentage
of current users between 2003 and 2005. Alcohol appears to be inextricably linked to the
social scene. Particularly among younger underage drinkers, there has been a marked
increase in pre-drinking at home before going out to socialise (to keep the cost down).
Binge drinking now appears to be the norm. Despite a statutory ban on selling alcohol to
juveniles aged under 16, they apparently have no problem procuring alcoholic beverages.
In 2004, a quarter of 12 to 14 year olds reported having purchased alcohol.
Of the approximately 1.2 million problem drinkers in the Netherlands, only a small number seek treatment from addiction care. In 2005, 31,000 clients were treated for a primary alcohol problem. This is five percent more than in 2004. The rise (39%) in the
number of clients since 2001 may be linked to the effect of the Action Plan of the addiction care organisations that are affiliated to the Netherlands Association for Mental Health
Care (GGZ). The aim of the Action Plan was to get more problem drinkers to seek treatment. In hospitals we also saw an increase in recent years in the number of admissions
for a primary diagnosis of alcohol abuse and dependence, from 3,900 in 2001 to 4,500 in
2004. Between 2004 and 2005, the number of hospital admissions remained fairly stable
(4,533).
No further drop in number of (heavy) smokers
In 2005 the percentage of smokers in the population aged 15 or older remained unchanged since 2004 at 28%. The decline in the percentage of heavy smokers also stagnated in 2005 (8%). Various campaigns have been launched to encourage smokers to
quit. On or around 1 January 2004, over a million Dutch smokers decided to give up
smoking. Almost a quarter of these were still non-smokers by December of that year.
Some 111,000 smokers who wanted to quit sought the help of their GP. Among young
people, non-smoking is increasingly the social norm.
Deaths
Smoking remains the most important cause of death
In the Netherlands, smoking is still the main reason for premature deaths, even if the
trend is slightly downward.
In 2005 almost 19 thousand people aged over 20 died as a direct consequence of smoking, which was nine percent less than in 2000. Eight thousand of these died of lung cancer. In 2005 alcohol-related conditions were the direct cause of almost 800 deaths; in a
further thousand cases, alcohol-related conditions were listed as a secondary cause of
death. The rise in total alcohol-related deaths evident from the early 1990s has not continued from 2004. In 2004 and 2005 a slight drop was perceptible. Deaths from alcoholrelated conditions and tobacco are many times the rate of death caused by (hard) drug
abuse. In 2005, 122 drug-related deaths were registered – almost the same number as
in 2004 (127). By comparison with a number of other European countries, the death rate
from drugs remains low in the Netherlands.
Market
Rise in TCH-content of Dutch-grown weed unsustained
Market monitoring organisations, such as the Drugs Information and Monitoring System
(DIMS) monitor the composition of recreational drugs and cannabis. It has been found
TRIMBOS-INSTITUUT
17
that for years most ecstasy pills contain true MDMA or a related substance. However, in
2005, and particularly in 2006 a sharp increase was found in the number of pills containing the substance metachlorpiperazine (mCPP). This substance can induce unpleasant
effects. The number of pills found to have a high dose of MDMA (over 140 mg) dropped
slightly in 2006 (3%). This follows a rise of 2% in 2000 to ten percent and nine percent
in 2004 and 2005 respectively.
The increase in the average THC content (the main active ingredient in cannabis) of
Dutch-grown weed has not continued in the past two years. The amount has dropped
from 20% THC in 2004 to 18% in 2005-2006. Research has shown that the acute effects
of cannabis with a high THC content may pose a risk for people with cardio-vascular conditions.
Offences against the Opium Act
Increase in soft drug offences in the law enforcement chain; fewer hard drug offences
The volume of drug offences dealt with by the police dropped compared to 2004 (-5%
according to provisional figures for 2005). Likewise, the Public Prosecutor’s office has
registered a drop (-8%; over 20 thousand cases). However, the number still exceeds
that for the period from 2000 to 2003. Violations of the drugs laws under the Opium Act
account for seven percent of all police suspects and 7.5% of all cases disposed of by the
Public Prosecutor. The drop in the number of cases refers only to hard drug crimes (now
48% of all drug law violations). Soft drug offences have increased to 46%.
Almost three-quarters (72%) of criminal investigations into more serious forms of organised crime involve narcotics offences. These usually concern hard drugs (particularly cocaine and synthetic drugs); however, the proportion of cases involving soft drugs as well
has risen to 41 percent.
Public Prosecutor sends more cases to court
Of more than 20 thousand Opium Act offences disposed of by the Public Prosecutor, 65%
proceeded to prosecution, which represents an increase on 2004. However, there was a
drop in the number of cases dismissed on policy grounds.
Rise in number of community service orders but fewer custodial sentences
In 2005, 12,000 cases of offences against the Opium Act were heard in court in the first
instance. This was virtually the same number as in 2004. These cases account for 8% of
total cases – the same percentage as in 2004. In 2005, the courts disposed of fewer cases involving hard drugs (-9%) and more cases involving hard drugs (+13%). The number of community service orders shows an upward trend in the period 2000-2005. The
same period shows a drop in the number of unconditional custodial sentences (-10%).
2004 was no exception to this (-13%).
Fewer long sentences and fewer people detained under the Opium Act
Sixteen percent of all (partly) unconditional custodial sentences involve a drugs offence.
This percentage has remained fairly constant for a number of years. In absolute terms,
the number has dropped (-22%), which is in line with the decline in total custodial sentences. The number of detention years imposed for narcotics offences accounts for 26%
of the total, compared to 28% in 2004. The average length of prison sentences for drugrelated crimes is shorter than in 2004. 16% of all detainees are serving a sentence for a
narcotics offence, which is less than in previous years. Prison sentences are mainly handed down for offences involving hard drugs.
18
TRIMBOS-INSTITUUT
Crimes committed by users
Drug-using suspects
Crimes committed by drug users are mainly property crimes without violence, (54%),
followed by crimes with violence (32%), offences against the Opium Act (22%) and vandalism/public order offences (22%). Property crimes (with or without violence) are showing a downward trend, whereas violent crimes are following a (slight) upward trend.
Driving under the influence (DUI): increase in transactions
In 2005 over 49 thousand cases of driving under the influence – mainly of alcohol - were
registered; this figure is slightly up on 2004. It remains difficult to establish cases of
driving under the influence of illegal drugs or medication. Over 28 thousand cases of DUI
were disposed of with a standard fine – which is an increase on the number for 2004.
Drug use among detainees
Ever problem use of drugs is reported by 64% of detainees; ever problem use of alcohol
is reported by about a third. In the six months prior to detention, around a third used
cannabis or cocaine/crack on a daily basis.
Help for problem users in the criminal justice system
The addiction probation and aftercare service issued over 11 thousand diagnoses for convicted offenders who are (problem) drug users and registered over 5,400 cases of supervision; this trend is upward and is in line with policy plans. There were over two thousand
instances of users being admitted to addiction care through the criminal justice system.
TRIMBOS-INSTITUUT
19
Stable
Average
x Trend recent use (2001-2005)
x International comparison
Average
x International comparison, 15/16 yrs
Upward
x Trend (2001 – 2005)
20
(primary)
Upward
(stable from
2002)
100
550
Upward
(slight drop
2004-2005)
9 800
8 200
Unknown
Average
Stable
0.8%
Average
Stable
0.6%
0.3%
Cocaine
60
(primary)
Slightly downward
60
590
Downward
14 200
2 000
24 000-46
000IV
Average
Stable
0.5%
Low
Stable
0%
0%
Opiates
<10
Slightly upward
50
80
Slightly upward
290
780
Unknown
Below average
Downward
1.2%
Above average
Stable
1.2%
0.4%
Ecstasy
<10
Upward
1 120
730
Unknown
Below average
Downward
0.8%
Slightly below
average
Stable
0.3%
0.2%
Amphetamine
770 (prim.)VII
1 000 (sec.)
Slightly upward
4 550
11 500
Upward
31 000
5 200
1 200 000
High (>10
times last
month)
Stable (b)
Upward (g)II
58%
Average
Stable
85%
78%
Alcohol
20
TRIMBOS-INSTITUUT
Figures are rounded. I. Recent use: in the past year; current use is in the past month. b = boys, g=girls. II. Between 1999 and 2003. III. 50 000 in 1996 according
to cannabis dependence diagnosis. IV. According to new estimation methods. Numbers do not differ significantly from previous estimates. V. Based on all smokers A
No primary
deaths
Upward
x Trend (2001 – 2005)
Deaths (2005)VI
60
300
x Misuse/dependence as prim. diagnosis
x Misuse/dependence as sec. diagnosis
Number of hospital admissions (2005)
6 100
5 100
x Substance as primary problem
x Substance as secondary problem
Number of Addiction Care clients (2005)
UnknownIII
Downward (b)
Stable (g)
x Trend 12-18 yrs (1996-2003)
Number of problem users
9%
x Percentage of current users, 12-18 yrs
Use among juveniles, school-goers (2003)
5.4%
3.3%
x Percentage of recent usersI
x Percentage of current usersI
Cannabis
Key Data on Substance Use. Italics: data unknown or out of date
General Population Usage (2005)
Table 1a
19 000
(primary+sec.)
Unknown
Unknown
n.a.
Unknown
>1 000 000V
Average
Downward
20%
Average
Downward
28%
(2005)
Tobacco
7%
7.5%
Total drug crime: increase 2001-2004,
decrease in 2005
Hard drugs: increase
2001-2004, decrease
in 2005
Soft drugs: increase
2001-2005
increase
soft drugs + decrease
hard drugs = on balance a decrease
1 091
9 298
9 716
20 105
Number of Public
Prosecutor cases
TRIMBOS-INSTITUUT
8%
Total drug crime:
increase 2001-2003,
decrease in 2004,
stable in 2005
Hard drugs: increase
2001-2003, decrease
in 2004-2005
Soft drugs: increase
2001-2005
increase
Soft drugs + decrease hard drugs =
on balance stable
936
5 178
6 148
12 262
Convictions by a
court in the first
instance
I. Provisional figures. II. Total = total number of cases. Sources: HKS, KLPD/DNRI; OMDATA, WODC; OBJD, WODC.
% Opium Act offences of totalII
Total drug crime: increase 2001-2004,
decrease in 2005
Hard drugs: increase
2001-2004, decrease
in 2005
Soft drugs: increase
2001-2005
2 025
x Both
x Global trend 2001-2005
8 104
x Soft drugs
increase
soft drugs + decrease
hard drugs = on balance a decrease
10 592
x Hard drugs
x Update 2004-2005
21 223
x Total
Number of offences
Number of police suspectsI
Drug crime: Key Figures; Opium Act offences in the law enforcement chain 2005
Phase in the chain
Table 1b
16%
Total drug crime:
increase 2001-2003,
decrease in 20042005
Hard drugs: increase
2001-2003, decrease
in 2004-2005
Soft drugs: increase
2001-2004, decrease
in 2005
decrease
(mainly hard drugs;
small increase soft
drugs)
425
3 217
3 642
Custodial sentences
21
26%
Total drug crime: increase 2001-2003,
decrease in 20042005
Hard drugs: increase
2001-2003, decrease
in 2004-2005
Soft drugs: increase
2001-2005
decrease
(hard drugs; increase
in soft drugs)
218
2 066
2 284
Detention years
quarter (26%) of this group are heavy smokers (20 or more a day). VI. Primary death: substance as primary (underlying) cause of death. Secondary death: substance as secondary cause of death (contributory factor or complication). VII. Not taking account of road deaths or cancer-related deaths.
1
INTRODUCTION
The National Drug Monitor
In the Netherlands there are several monitoring organisations that follow developments
in the area of substance abuse. Scientific papers are also frequently published about usage patterns, prevention and treatment methods. In this veritable sea of information, the
National Drug Monitor (NDM) provides policymakers and professionals working in practice
as well as various other target groups with an up-to-date overview of the situation.
The primary goal of the NDM is to gather data about developments in substance use in a
coordinated and consistent manner on the basis of existing research and registered data,
and to process this information and translate it into a number of core products, such as
Annual Reports, thematic reports and fact sheets. This aim is consistent with the current
quest for evidence-based policy and practice.
The NDM was set up in 1999 on the initiative of the Minister for Health, Welfare and
Sport.1 Drug use, however, is not exclusive to the domain of public health but also comes
within the remit of the Justice Ministry. Since 2002, the Ministry of Justice has also supported the NDM.
The NDM embraces the following functions:
Acting as umbrella for and coordinator between the various surveys and registrations
in the Netherlands concerning the use of addictive substances (drugs, alcohol, tobacco) and addiction. The NDM aspires towards the improvement and harmonisation
of monitoring activities in the Netherlands, while taking account of international guidelines for data collection.
• Synthesising data and reporting to national governments and to international and national organisations. The international organisations to which the NDM reports include
the WHO (World Health Organisation), the UN and the EMCDDA (European Monitoring
Centre for Drugs and Drug Addiction).
•
Within the NDM, the collection and integration of data are central. These activities are
conducted on the basis of a limited number of key indicators – or barometers of policy –
which are agreed by the EU member states within the framework of the EMCDDA. Data
are collected on the following:
Substance use in the general population
• Problem use and addiction
• Treatment demand from addiction care
• Illness in relation to substance use
• Deaths in relation to substance use.
Where available, data are recorded on supply and market, such as the price and quality
of drugs. The NDM also reports on registered drugs crime and the response of law enforcement agencies to this. This is also conducted on the basis of a series of indicators,
for which the WODC collects data.2;3
NDM reports consist mainly of statistical data that are based on quantitative research.
Sometimes the Annual Report also contains data that are based on qualitative research.
These are often derived from the observations of key persons in specific settings. Because these feedback reports may provide indicators for potential new trends in sub-
stance use, they are sometimes included in the Annual Report. These indications may
form the basis for further statistical substantiation.
Collaborations
The NDM relies on the input of many experts. The executors of many local and national
monitoring projects make their contribution. The quality of the publications is ensured by
the NDM Scientific Committee. This Committee evaluates all draft texts and advises on
the quality of the monitoring data. The NDM is supported on thematic modules by the
study group on prevalence estimates of problem substance use and the study group on
drug-related deaths.
Once yearly, the NDM publishes a statistical overview of addiction and substance use and
their consequences. This is the NDM Annual Report. This report is included in the documentation that is presented to parliament annually.
2006 Annual Report
This is the eighth Annual Report of the NMD. Chapters two through seven deal with developments per substance or classes of substances: cannabis, cocaine, opiates, ecstasy
and amphetamines, alcohol and tobacco. In each chapter we present a concise report on
the most recent data about use, problem use, treatment demand, (illness) and deaths,
as well as supply and market. The position of the Netherlands is placed in an international perspective. Owing to differences in age group categories, definitions of usage and
methods, the differences between countries should, however, be interpreted with caution.
Chapter eight contains data on registered drug-related crime. Central to this is crime as
defined by the Opium Act and the criminal behaviour of drug users in various stages of
the law enforcement chain (police, Public Prosecutor, judiciary, custody). This chapter
also contains an up-to-date overview of the possibilities available to law enforcement
agencies for the compulsory and quasi-compulsory treatment of drug-addicted criminals.
Data on substance abuse and drug-related crime can be collected and represented in
different ways. Appendix A contains information on the terminology used. Appendix B
contains a concise overview of the most important sources of information for this Report.
The NDM Annual Report may also be accessed as a pdf document on the following websites: www.trimbos.nl.
Information Gaps
During the compilation of the Annual Reports, it has transpired that some essential data
are missing, considerably out of date or of inadequate quality. The gaps identified by the
NDM Scientific Committee include:
• The number of problem users of cannabis and cocaine is unknown.
• There are no recent data on the prevalence of HIV and Hepatitis B and C among local
groups of (injecting) hard drug users.
24
TRIMBOS-INSTITUUT
•
•
•
•
•
•
•
In a more general sense, we are losing sight of developments in risk behaviour and
problems (mental, social and health-related) in the population of problem hard drug
users. This is due to a reduction in the number of periodic quantitative field studies in
this population.
There is no national database of trends in (risk) substance use among the at-risk
group of youngsters in social settings.
Registration of clients of inpatient addiction care is incomplete.
There is insufficient information on users who seek help from private addiction clinics.
This also applies to those who obtain an offer of help for addiction problems by means
of an e-health intervention. Currently, the e-health sector is just getting off the
ground; however it can be expected that the availability of this type of health care will
increase considerably in the future.
There is still incomplete registration of the results of treatment and care in respect of
outpatient and inpatient addiction care.
The registration of drug seizures is incomplete and inconsistent.
Data on drug-using convicted offenders are incomplete or of inadequate quality.
Action has already been taken to address a number of these gaps. For instance, one of
the central themes in the ZonMw programme on risk behaviour and dependency is ‘the
nature, seriousness and volume of the problems surrounding substance use and dependency’, with a specific emphasis on cannabis and cocaine. In addition, it is important that
in the near future, all organisations for addiction care should participate in the nationwide
anonymous registration of the Diagnosis Treatment Combinations (DCBs). A number of
addiction care organisations will participate as an addiction care division within an integrated organisation for mental health care. The national DCB registration may well reduce some of the information gaps during the coming years. For other gaps, a short-term
solution may not be feasible. During the coming years, the issue of improving the quality
of monitoring data will therefore remain under scrutiny. For as long as new registration
systems are unable to take on the functions of the existing systems, it remains of great
importance that the existing registration systems such as the Dutch Hospital Registration
(LMR) and the National Alcohol and Drugs Information System (LADIS) should remain in
place.
TRIMBOS-INSTITUUT
25
2
CANNABIS
Cannabis (Cannabis Sativa or hemp) contains hashish and weed in various concentrations. THC (tetrahydrocannabinil) is the main psychoactive component. Cannabis is generally smoked in cigarette form – with or without tobacco – and sometimes through a
vaporizer. It can also be eaten in the form of space cake. Users tend to experience cannabis as calming, relaxing and mind-expanding. In high doses, cannabis can trigger anxiety, panic and psychotic symptoms.
The data below apply to both hashish and weed, unless otherwise indicated.
2.1 RECENT FACTS AND TRENDS
In this chapter, the main facts and trends concerning cannabis are:
• The percentage of cannabis users in the general population that ever used cannabis
rose between 2001 and 2005. The percentage of recent and current users remained
stable during this period (§ 2.2).
• Among school-goers (12-18 years) the percentage of current cannabis users dropped
slightly between 1996 and 2003. Data from 2005 show that cannabis use among
school-goers has stabilised (§ 2.3).
• Cannabis use occurs relatively frequently among youngsters in the social scene and
‘problem juveniles’ (§ 2.4).
• By European standards, Dutch adults score around average for recent cannabis use (§
2.5).
•
In keeping with the trend in previous years, the number of cannabis clients of (outpatient) addiction care increased between 2004 and 2005 (§ 2.6).
• General hospitals registered no further increase in the number of admissions involving
cannabis use or dependence as a secondary diagnosis between 2004 and 2005 (§
2.6).
• The number of “coffee shops” dropped slightly further between 2004 and 2005 (§
2.8).
• After a sharp rise between 2000 and 2004 the average THC content of Dutch-grown
weed appears to have stabilised at a somewhat lower level in 2005 and 2006 (§ 2.8).
• In 2005 and 2006 a number of notifications were made of mixing substances found
with Dutch-grown weed (§ 2.8).
2.2 USAGE: GENERAL POPULATION
Cannabis is the most widely used of all illegal drugs. In 1997, 2001 and 2005, National
Prevalence Surveys (NPO) were conducted. The first two surveys were conducted by the
Amsterdam Centre for Drugs Research, CEDRO. The third wave was conducted by the
Addiction Research Institute Rotterdam (IVO). 4 The findings were as follows:
• From 1997 to 2001 the percentage of the population aged from 15 to 64 that had ever
used cannabis remained stable. Between 2001 and 2005 the percentage of ever users
increased. The total percentage of recent and current users remained at the same
level in all three surveys (table 2.1).
• In 2005 over one in five people surveyed reported ever having used cannabis. One in
twenty had used cannabis in the year prior to the interview (recent use), and one in
thirty-three had done so in the month before the interview (current use).
TRIMBOS-INSTITUUT
27
•
•
Calculated in terms of the population, the number of current cannabis users amounts
to 363,000.
In 2005 1.3% of the population had used cannabis for the first time ever. The growth
of new users has remained stable throughout the years.
Table 2.1
Cannabis use in the Netherlands in the population aged from 15 to 64.
Survey years 1997, 2001 and 2005
Ever use
x Male
x Females
Recent useI
x Males
x Females
Current useII
x Males
x Females
First used in the past year
Average age of recent usersI
1997
2001
2005
19.1%
24.5%
13.6%
5.5%
7.1%
3.8%
3.0%
4.2%
1.8%
1.4%
27.3 years
19.5%
23.6%
15.3%
5.5%
7.2%
3.8%
3.4%
4.8%
1.9%
1.1%
28.3 years
22.6%
29.1%
16.1%
5.4%
7.8%
3.1%
3.3%
5.2%
1.5%
1.3%
30.5 years
Number of respondents: 17 590 (1997), 2 312 (2001), 4 516 (2005). I. In the past year. II. In the past month.
4
Source: NPO, IVO.
Age and Gender
•
•
28
More males than females use cannabis (table 2.1).
Consumption of cannabis occurs chiefly among juveniles and young adults (figure
2.1).
- Between 1997 and 2005 the percentage of recent and current users aged 15 to 24
dropped, whereas the percentage of users in the 25 to 44 year age group increased. This shift took place mainly between 1997 and 2001.
- Likewise, the average age of recent cannabis users rose – from 27 to almost 31
(table 2.1).
- The age of onset is the age at which a person first used a substance (see also appendix A: age of onset). Among ever users of cannabis, the age of onset for the 15
to 24 year old age group was 16.4 years on average. In the population aged 15 to
64, the age of onset averaged 19.6 years.
TRIMBOS-INSTITUUT
Figure 2.1
Cannabis users in the Netherlands by age group. Survey years 1997 and
2005
16
%
14
12
10
8
6
4
2
0
15-24 yrs
25-44 yrs
45-64 yrs
Recent use 1997
14.3
5.2
1.1
Recent use 2005
11.4
6.4
1.5
Current use 1997
7.3
3.1
0.6
Current use 2005
5.3
4.8
0.7
4
Percentage of recent (last year) users and current users (last month) by age group. Source: NPO, IVO.
The main cities
There is more cannabis consumption in urban than in rural areas (Table 2.2).
• In 2005 the percentage of ever and recent cannabis users was approximately three
times greater in urban than in non-urban areas.
Table 2.2
Use of cannabis in the four main cities and in non-urban areas among people aged over 12 years. Survey years 1997 and 2005
Ever Use
Very highly urbanI
Highly urbanII
Moderately urbanIII
Semi-ruralIV
RuralV
1997
31.4%
21.0%
15.5%
15.0%
12.8%
2005
37.5%
24.6%
20.2%
15.5%
13.9%
Recent Use
1997
10.4%
4.8%
4.3%
4.5%
3.8%
2005
10.8%
5.8%
4.3%
3.2%
3.0%
Current Use
1997
6.2%
2.9%
2.2%
2.2%
1.9%
2005
7.5%
3.2%
2.5%
2.0%
1.5%
Percentage of ever use, recent (last year) and current (last month). No data by urbanisation level for 2001 due
to small numbers of respondents. I. Definition (Statistics Netherlands, CBS): municipalities with over 2,500
addresses per square km. These are: Amsterdam, Rotterdam, Delft, The Hague, Groningen, Haarlem, Leiden,
Rijswijk, Schiedam, Utrecht, Vlaardingen and Voorburg. II. Municipalities with 1,500 -2,500 addresses per
square km. III. Municipalities with 1,000 – 1,500 addresses per square km. IV. Districts with 500-1,000 ad4
dresses per square km. V. Districts with fewer than 500 addresses per square km. Source: NPO, IVO.
TRIMBOS-INSTITUUT
29
Amount of use
In 2005 almost a quarter (23.3%) of current users used cannabis (almost) daily. In
population terms, this amounts to 85 thousand people.
•
Special groups
In certain groups of adults, cannabis use occurs considerably more frequently than in the
general population.
• In 2002 more than half (52%) of the homeless people in 20 Dutch municipalities were
current cannabis users.5
a
• In the same year, one in three (33%) male detainees in eight Remand centres reported daily cannabis use during the last six months before being detained. Detainees
with serious mental disorders or with restricted access orders (no contact allowed)
were excluded from the sample.6
• Cannabis use is also more prevalent among people with a (specific) mood, anxiety or
alcohol disorder than among people without these disorders.7
2.3 USAGE: JUVENILES AND YOUNG ADULTS
School-goers
Since the early 1980s, the Netherlands Institute of Mental Health and Addiction (Trimbos
Institute) has conducted surveys to establish the extent of the experience of schoolgoers aged 12 and older at regular secondary schools with alcohol, tobacco, drugs and
gambling. This survey is known as the Dutch National School Survey. The most recent
measurements were conducted in 2003.
a
In Arnhem, Den Bosch, Breda, Grave and 4 Houses of Detention in Rotterdam.
30
TRIMBOS-INSTITUUT
Figure 2.2
Cannabis use among school-goers aged 12 to 18 from 1988
Current Use
Ever Use
%
%
30
16
25
25
19
20
15
10
5
22
15
12
10
18
14
14
23
20
19
17
20
12
12
10
10
9
8
16
6
9
4
7
2
11
7
5
4
8
9
9
7
7
4
2
0
0
1988
1992
Boys
1996
Girls
1999
2003
Total
1988
1992
Boys
1996
Girls
1999
2003
Total
Percentage of ever users (left) and last month(right).
8
Source: Dutch National School Survey, Trimbos Institute.
•
•
•
Figure 2.2 shows a strong increase in cannabis use among school-goers between 1988
and 1996.8
After 1999, the percentage of ever use stabilised and stayed at about the same level
as in 1996. Current use dropped significantly between 1996 and 2003. This decline
took place mostly among boys. Among girls, the percentage of current cannabis users
remained more or less the same between 1996 and 2003.
- A comparison with data from the national Health Behaviour of School-aged Children
(HBSC) study in 2005 shows that cannabis use remained stable between 2003 and
2005.9 In 2003, 12.5 percent of school-goers aged between 12 and 16 had used
cannabis in the past year; in 2005 this figure was 11.7%.
The surveys conducted up to and including 1999 found that more boys than girls used
cannabis. In 2003 for the first time there was no difference between boys and girls for
ever use. The difference between boys and girls for current use was also less marked,
but still statistically significant.
Age
•
•
•
Cannabis use increases among juveniles with age. In 2003, few school-goers aged 12
had tried cannabis – only one in fifty (2%). By the age of 16, one in three had ever
tried cannabis (34%).
The age at which school-goers first used cannabis dropped between 1988 and 1996.10
Some cannabis users smoked their first joint at the age of 13 or younger. The number
of these among ever users doubled during this period from 21% to 40%. Between
1996 and 2003 the age of onset remained unchanged.
Recent research among twins conducted by the University of Amsterdam has shown
that juveniles who start to use cannabis before age 18 are more likely to use hard
drugs later.11 This is not because of a genetic link or family circumstances. Social factors are more likely to play a part, with early cannabis use an expression of a tendency towards anti-conventional behaviour.
TRIMBOS-INSTITUUT
31
Amount of use
Of the nine percent current users in 2003, almost half had used cannabis no more
than once or twice during the past month. A minority had used cannabis more than
ten times (17%): one in five boys and over one in ten girls (see Figure 2.3).
Per incident, almost half of the current users smoked less than one joint (46%). It is
probable that they smoke together with others and share a joint. Almost one in three
smoked between one and two joints per incident (32%), and almost a quarter smoked
more than three joints per incident (23%).
There is also a link between frequency and amount. Of the users who smoked between three and ten times a month, a quarter (27%) smoked three or more joints
each time. Of those who used cannabis more than ten times a month, two-thirds
(67%) smoked three or more joints each time. The latter group incurs a relatively high
risk of developing problems.
•
•
•
Figure 2.3
Frequency of cannabis use among current users. Survey year 2003
Girls
Boys
11%
20%
43%
51%
38%
37%
1-2 times
3-10 times
1-2 times
> 10 times
3-10 times
> 10 times
Percentage of school-goers who had used cannabis in the month before the survey. Source : Dutch National
8
School Survey, Trimbos Institute.
School level and ethnic background
In 2003 there was little or no difference in the percentage of ever users and current
users in the different levels of Dutch secondary schools VMBO-t (lower secondary,
theoretical), HAVO (middle secondary), VWO (higher secondary) and VMBO-p (lower
secondary, practical). Nor was there much difference in frequency of use in the past
month. However, the percentage of school-goers that smoked three or more joints on
average per incident was considerably higher at VMBO level than at the higher VWO
level (30% versus 8%).
Current cannabis use was less frequent among Moroccan than among Dutch girls (0%
versus 7%). No difference was found between Moroccan and Dutch boys. Antillean/Aruban (12%), Surinamese (8%) or Turkish (5%) pupils did not differ significantly on this measure from their native Dutch peers.a
According to the Antenna-monitor in Amsterdam, the percentage of ever users and
current users of cannabis is lowest among Moroccan school-goers; the percentage of
users among Turkish and Surinamese school-goers is also lower than among native
Dutch schoolchildren.12
•
•
•
a
See appendix a for the definition of native and ethnic/immigrant.
32
TRIMBOS-INSTITUUT
Cannabis and problem behaviour
•
•
•
School-goers who use cannabis exhibit more aggressive and delinquent behaviour and
have more school-related problems (truancy, poor results) than their non-using peers.
This association becomes stronger with increasing frequency of use. 13;14
Cannabis users are more likely to use other substances than non-users (5 or more
units of alcohol in the past month, daily smoking, ever use of hard drugs).
No differences were found for psychiatric problems, such as withdrawn behaviour,
anxiety or depression.
Place of procurement
•
•
•
•
In 2003 two out of three current users got their cannabis from friends, and one in
three (also) bought it in ‘coffee shops’ (Table 2.3). Over one in ten bought cannabis
from a (home) dealer and one in ten got it ‘through others’.
More girls than boys got cannabis through friends, and boys were more likely than
girls to purchase it in ‘coffee shops’.
A significant percentage of cannabis-using school-goers aged up to 17 reported having
purchased cannabis in a ‘coffee shop’ in 2003. This is remarkable, since the age limit
for access to these ‘coffee shops’ is 18. It is not known to what extent these underage users actually purchased the cannabis themselves, or procured it through third
parties.
Males aged 18 buy most of their cannabis from ‘coffee shops’. Eight out of ten of these
current male users did so.
Table 2.3
How do school-goers procure their cannabis? Survey year 2003
From friends
Purchased in coffee
shops
Bought from a dealer
Through others
Other
12-15 yrs
B
G
60%
78%
22%
22%
16-17 yrs
B
G
64%
77%
57%
37%
17%
16%
7%
15%
6%
2%
6%
9%
6%
12%
2%
8%
18 yrs
B
G
40%
69%
81%
56%
9%
0%
4%
0%
0%
0%
B
60%
40%
Total
G
78%
27%
Total
67%
35%
16%
11%
5%
7%
6%
6%
12%
9%
6%
School-goers aged 12 to 18 of Dutch secondary schools (current users). Respondents could tick more than one
answer. Therefore the percentages do not add up to 100. B = boys; G = girls. Source: Dutch National School
8
Survey, Trimbos Institute.
A comparative study of school-goers aged 14 to 18 shows that there is little difference
between Dutch and French school-goers for perceived availability of cannabis, despite the
differences in drugs policy in the two countries.15
• In both countries, the percentage of juveniles that indicates being able to procure
cannabis (fairly) easily increases with age.
• There is a correlation between perceived availability and cannabis use and problem
use. Use and problem use increase according as the juveniles report greater ease in
procuring cannabis.
TRIMBOS-INSTITUUT
33
Special groups of young people
In certain groups of juveniles and young adults, cannabis use is the rule rather than the
exception. Table 2.4 summarises the results of various studies – mostly regional or local.
The data are not comparable, on account of differences in age groups and research
methods. Trend data are only available for Amsterdam.
• There are relatively more current cannabis users among young drifters, school dropouts and juveniles detained in penitentiaries (between four and eight out of ten).
Lower percentages are found among frequenters of bars (over one in five).
• The Antenna-monitor follows substance use in various groups of young people in the
Amsterdam social scene, such as ‘coffee shops’, bars and fashionable clubs.
- According to a survey conducted among ‘coffee shop’ frequenters in 2001, two
thirds of current users smoke a joint every day. Per incident, current users smoke
four joints on average. Daily users smoke an average of five joints each time.16
Table 2.4
Current cannabis use in special groups
Location
Young people in the social scene
x Frequenters of dance parties, festivals, city The Hague
centre
x Bar-goers
Zaandam
x Bar-goersI
AmsterdamII
x Frequenters of bars and sport-hall canteen- Noordwijk
bars
x Discotheque-goers
NijmegenIII
x Clubbers
Amsterdam
x Coffee shop frequenters
AmsterdamIV
Nijmegen
Problem groups
x Juveniles attending special schools and truancy Amsterdam
projects
x Marginalised youthV
The Hague
x Juvenile detaineesVI
Regional
x School drop-outsVI
Regional
x Homeless YouthVII
Nationwide
Flevoland
Survey
year
Age
(years)
Current
use
2003
15 - 35
37%
2006
2000
2005
2004
14 - 44
Average 25
Average 27
Average 23
22%
24%
22%
19%
Average
Average
Average
Average
Average
12%
52%
39%
88%
84%
2006
1998
2003
2001
2005-6
21
26
28
25
27
13 - 16
32%
2000/2001
2002/2003
16 - 25
14 - 17
2002/2003
14 - 17
1999
2004
15 - 22
13 - 22
37%
58% (m)
61% (f)
62% (m)
43% (f)
76%
87%
Percentage of current users, (past month) per group. The figures in this table are not comparable on account of
differences in age groups and research methods. m =males; f =females.
I. Juveniles and young adults in mainstream bars, student bars, gay bars and hip bars. Therefore not representative of all bar-goers. II. Low response (26%). III. Low response (19%). IV. Low response (15%). V. Young
people who do not receive sufficient care and/or are insufficiently able to meet their own living needs. Surveyed
at locations for the homeless youth, low-threshold day and night centres and (other) temporary accommodation
facilities. VI. Research in the provinces of Noord-Holland, Flevoland and Utrecht. Usage among juvenile detainees: in the month prior to detention. Drop-outs are juveniles who have missed at least a month of school during the past year, not counting holidays. VII. Young drifters aged up to 23 who have had no fixed abode for at
least three months. References: 16;17;22-30
- Between 1998 and 2003 the percentage of current cannabis users among socialising juveniles and young adults in fashionable clubs (and parties) in Amsterdam
34
TRIMBOS-INSTITUUT
•
dropped from 52% to 39%. The average number of joints smoked by current users
each time also dropped from two to one and a half.12 This trend, which is also evident in Amsterdam for other drugs fits in with the ‘new sobriety’ and a perceived
trend towards more cautious use. However, among bar-goers, the use of cannabis
remained stable between 2000 and 2005. 17
- Elsewhere in the country, cannabis usage appears to have stabilised, although an
increase in use has been signalled in some clubs in the main urban areas18. Hard
data are lacking. In many clubs smoking joints is prohibited in any case, although
the rules differ.
Young socialisers often use more than one substance, and these are frequently used
together. Favourite combinations are cannabis with alcohol and cannabis with ecstasy.18-21
2.4 PROBLEM USE
It is not known exactly how many people develop problems related to cannabis use.
There is no universally accepted definition of problem cannabis use. In international research, a diagnosis of cannabis dependence is often based on the DSM psychiatric classification system. By comparison with nicotine, heroin and alcohol, cannabis is not very
addictive. However, the risk of dependence increases with long-term frequent use and is
often accompanied by dependence on other substances. Younger people are more susceptible to this than older people.31
• There are no recent figures available on the number of people who are dependent on
cannabis. According to research from 1996, between 0.3% and 0.8% of the population
aged between 18 and 64 met the criteria for a diagnosis of cannabis dependence
(DSM 3rd revised edition). In population terms, this amounted to between 30,000 and
80,000 people. The majority were aged under 23.7
• As stated in §2.3 (frequent) cannabis use is linked to problem behaviour, such as aggressive and criminal behaviour, use of other drugs and problems at school. Problem
cannabis use is especially prevalent in certain groups of young people. (See Table
2.5).
Table 2.5
Problem use of cannabis in different groups
Group
Year
Age
(years)
Definition of problem use
Percentage of
problem users
General population in
the Netherlands
1996
18 – 64
DSM-III-r diagnosis past year cannabis dependence
0.3% - 0.8%I
in the past year
General population in
central Netherlands
1999
16 – 50
Cannabis use on at least 15 days
in the past month and exhibiting
use-related mental, social and
financial problems
0.5%
past month
Young detainees
1998/
1999
12 – 18
(average 16)
DSM-III-r diagnosis of cannabis
dependence in the 6 months prior
to detention
30%
in last 6
months
High-risk juveniles
(truancy/delinquent
behaviour) in Rotterdam
1998
14 – 17
(average 16)
Used cannabis at least 11 days in
past month and exhibiting userelated
20%
past month
: 7;33;35
I. Average 0.5%. DSM-III-r=Diagnostic and Statistical Manual, 3rd edition. References
TRIMBOS-INSTITUUT
35
•
•
•
This is not to say that cannabis use is the cause of these problems. Often cannabis use
is preceded by behavioural problems, or both are part of a broader pattern of deviant
behaviour. Another possibility is an overlap of risk factors that lead to both cannabis
use and deviant behaviour.31;32
In 2005, key observers from the Amsterdam Antenna Monitor identified excessive
cannabis use among some neighbourhood youths of Moroccan origin. This excessive
cannabis use would appear to further erode the already weak position of these youths
on the jobs market.17
Elsewhere, key observers recorded excessive cannabis use among youngsters hanging
around in Den Bosch36, among at-risk juveniles in Eindhoven37, problem youth in Tilburg38 and young mothers receiving social inclusion care in Maastricht.39 However,
hard data about cannabis use in these groups are lacking.
2.5
USAGE: INTERNATIONAL COMPARISON
General population
Data about drugs use in EU member states and Norway emanate from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Institutes in the US, Canada
and Australia also regularly publish the findings of surveys on drugs use in the population.
• It is difficult to conduct a precise comparison of the data, owing to differences in survey years, measuring methods and sampling. The age group is the main variable. Table 2.6a shows usage data that have been (re)calculated according to the standard
age group of the EMCDDA (15 to 64 years). Data for the other countries are contained
in Table 2.6b. For Europe, only the EU-15 and Norway have been included. Appendix F
shows usage figures for the other EU member states, in so far as these are available.
• Between 8% and 45% of people in the general western population have ever used
cannabis (tables 2.6a and 2.6b). The lowest percentages are found in Greece and Portugal. In Canada and the US, almost one in two people have ever tried cannabis. Of all
24 countries in the EU-25 for which data are available, Malta and Estonia are exceptions at the lower end with rates of 4% and 5% respectively. Denmark and the U.K.
are at the top of the list with 31% and 30% respectively.
• For the measure ‘recent use’, the lowest scores were found in Greece and Sweden
(2%) and the highest in Canada, Australia, Spain, the U.K. and the US (10-14%). Of
the EU-25 countries for which data are available, the lowest rate of recent use was
found in Malta (1%). Cyprus tops the list with 14%, followed by Spain and the U.K.
10-11%). With a score of 5%, the Netherlands appears to occupy a position around
the middle among the European countries listed in Table 2.6a and 2.6b.
36
TRIMBOS-INSTITUUT
Table 2.6a
Country
Spain
France
Netherlands
Ireland
Austria
N.Ireland
Luxembourg
Finland
Norway
Belgium
Greece
Portugal
Cannabis use in the general population of a number of EU-15 member
states and Norway: age group 15 to 64 years
Year
2003
2000
2005
2002/2003
2005
2002/2003
1998
2004
2004
2001
2004
2001
Ever use
29%
23%
23%
18%
20%
17%
13%
13%
16%
11%
9%
8%
Recent use
11%
8%
5%
5%
8%
5%
3%
5%
2%
3%
Current use
8%
4%
3%
3%
4%
2%
2%
3%
1%
A precise comparison between countries is hampered by differences in survey year, measuring methods and
sampling. Percentage of ever users, recent (past year) and current (past month). - = not measured. Refer40
ences:
Table 2.6b
Cannabis use in the general population of a number of EU- 15 member
states and Canada, the US and Australia: other age groupsI
Country
Year
Age (yrs)
Ever use
Recent use
Current use
Canada
United States
Australia
Denmark
U.K.
Germany
Italy
Sweden
2004
2005
2004
2000
2004
2003
2003
2005
15 +
12 +
14 +
16 – 64
?
18 – 59
15 – 54
16 – 64
45%
40%
34%
31%
30%
25%
22%
12%
14%
10%
11%
6%
10%
7%
7%
2%
6%
7%
3%
6%
3%
5%
1%
A precise comparison between countries is hampered by differences in survey year, measuring methods and
sampling. Percentage of ever users, recent (past year) and current (past month). I. Drug use is relatively low in
the youngest (12-15) and oldest age groups (>64). Consumption figures in studies with respondents younger
and/or older than the EMCDDA standard may be lower than figures in studies that do use the EMCDDA40 41standard. The opposite is true for studies with a more limited age span. - = not measured. References
43;43
Trends
It is difficult to determine the trends in cannabis use on account of a lack of repeat and
comparable measurements in and between countries.
• According to the EMCDDA, cannabis use in the 1990s increased in the vast majority of
the EU countries, particularly among young adults. In recent years this increase has
continued in a number of countries (e.g. France and Spain). In the U.K., where the
percentage of recent users was typically the highest, usage has stabilised since 1998.
Greece reported a decline during this period.
• In Canada the percentage of ever users rose sharply between 1994 and 2004 from
28% to 45%. The percentage of recent users doubled in this period from 7% to 14%.
• The findings of recent surveys in the US suggest that the rising trend in cannabis use
has stabilised since 2000.41
TRIMBOS-INSTITUUT
37
Juveniles
The data from ESPAD, the European School Survey Project on Alcohol and Other Drugs
lend themselves better to comparison. The most recent surveys were conducted in 1999
and 2003 among fifteen and sixteen year old secondary school pupils.44
Table 2.7 shows cannabis use in a number of EU countries and Norway. Belgium, Germany and Austria only took part in 2003. The US did not take part in the ESPAD but conducted similar research.
• The percentage of school-goers that had ever used cannabis in 2003 was highest in
Ireland, followed closely by France, the UK and the US. Belgian school-goers were in
fourth place, and the Dutch in fifth place.
• France topped the list for current use, followed by the US, the UK and Ireland. These
were followed by the Netherlands and Italy.
• In the UK and Portugal, the percentage of current users in 2003 was 4 and 3 percentage points higher respectively than in 1999. In other countries, differences of two percentage points or less were found.
• The percentage of school-goers that had used cannabis six times or more in the past
month was lowest in the Scandinavian countries and highest in France, the US and the
UK. Dutch school-goers occupied fourth place together with their Irish and Italian
peers.
• In most countries, ever use of cannabis was associated with degree of truancy, lack of
parental control and having older siblings who used cannabis.
Table 2.7
Country
United States
Ireland
France
U.K.
Belgium
Netherlands
GermanyI
Italy
Denmark
Austria
Portugal
Finland
Norway
Sweden
Greece
Cannabis use among school-goers aged 15 and 16 in a number of EU
member states, Norway and the US. Survey years 1999 and 2003.
Ever use
Current use
1999
2003
1999
2003
41%
32%
35%
35%
28%
25%
24%
8%
10%
12%
8%
9%
36%
39%
38%
38%
32%
28%
27%
27%
23%
21%
15%
11%
9%
7%
6%
19%
15%
22%
16%
14%
14%
8%
5%
2%
4%
2%
4%
17%
17%
22%
20%
17%
13%
12%
15%
8%
10%
8%
3%
3%
1%
2%
Six or more times past
month
1999
2003
9%
5%
9%
6%
5%
4%
1%
2%
1%
1%
0%
2%
8%
6%
9%
8%
7%
6%
4%
6%
2%
3%
3%
0%
1%
0%
1%
Percentage of ever use, current use (past month) and six times or more in the past month. I. Six of sixteen
member states. - = not measured. The US did not participate in the ESPAD, but conducted comparable re44
search. Source: ESPAD.
38
TRIMBOS-INSTITUUT
2.6 TREATMENT DEMAND
Outpatient addiction care
The National Alcohol and Drugs Information System (LADIS) registers the number of
people who seek treatment from outpatient addiction care, including rehabilitation programmes and the addiction clinics that are merged with the outpatient addiction care
services (see in appendix A: LADIS client)
On account of technical problems, the Jellinek organisation for addiction care in Amsterdam and its environs was unable to submit its figures for 2005 to LADIS. For this reason,
an estimate of Jellinek’s percentage has been extrapolated from the data from 2004.45
• The number of clients registered on account of a primary cannabis problem tripled
between 1994 and 2004 (Figure 2.4). From 2004 to 2005 there was a further increase
of 12%.
• Per 100,000 inhabitants aged 15 and over, the number of primary clients rose from 16
in 1994 to 46 in 2005.
• The role of cannabis in all requests for treatment also rose – from 10% in 1994 to
19% in 2005.
• In 2005 almost a third of primary cannabis clients were newcomers (29%). These had
not previously been registered with the (outpatient) addiction care services for a drugrelated problem.
• For 61% of primary clients, cannabis was the only problem; 39% reported problems
with another substance as well.
• The number of (outpatient) addiction care clients citing cannabis as a secondary problem also rose between 1994 and 2005 (Figure 2.4). For this group, alcohol (44%), cocaine or crack (34%), heroin (10%) or amphetamine (5%) was the primary problem.
Figure 2.4
Number of (outpatient) addiction care clients with primary or secondary
cannabis problems, from 1994I
Number
6000
5000
4000
3000
2000
1000
Primary
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
1951 2274 2659 3264 3291 3281 3443 3432 3701 4485 5456 6100
Secondary 2846 2668 2718 2820 2844 3063 3144 3300 3697 4291 4630 5057
I. For 2005 the data for Jellinek have been extrapolated. Source: LADIS, IVZ.
TRIMBOS-INSTITUUT
39
Age and gender
• In 2005 the majority of primary cannabis clients were male (81%). The ratio of females fluctuated during the period 1994 to 2005 between 15% and 19%.
• In 2005 the average age was 29. The peak age group was 20 to 29 (Figure 2.5).
• In absolute terms the number of young clients aged between 15 and 29 doubled from
1,531 in 1994 to 3,598 in 2005. However, relative to the other age groups, their ratio
in this period dropped from 79% to 59%. In 2004, this figure was 61%.
Regional trends
During the period 2001-2005, the number of primary cannabis clients rose by an average of 46% compared to 1996-2000. This increase took place in almost all regions
of the Netherlands (IVZ/RIVM, Healthcare atlas).In only one region was there a drop
in the number of cannabis clients. This was the Amersfoort region (-9%). The five regions with the sharpest rise are: Almelo (211%), Oss (181%), Enschede (139%), Leiden (139%) and Gouda (135%).
•
Figure 2.5
Age distribution of primary cannabis clients of (outpatient) addiction care.
Survey year 2005I
%
30%
25%
23%
22%
20%
15%
17%
14%
11%
10%
7%
5%
3%
2%
1%
45-49
50-54
>54
0%
15-19
20-24
25-29
30-34
35-39
40-44
Age
Percentage of clients per age group. I. The data for Jellinek have been extrapolated. Source: LADIS, IVZ.
General Hospitals; incidents
In 2005, the Dutch Hospital Registration (LMR) recorded almost 1.7 million clinical admissions in general hospitals.
Drug-related problems did not figure strongly in these numbers. There were 517 cases of
drug abuse and drug addiction as the primary diagnosis and 2,012 cases as a secondary
diagnosis.
• In 12% of the main diagnoses the drug involved was cannabis (figure 2.6). Misuse of
cannabis was more often to blame than dependence (66% versus 34%). It is not
known what the symptoms were that led to the hospital admission (mental or physical).
• For 299 admissions, cannabis problems played a part as a secondary diagnosis (29%
dependence, 71% misuse). In recent years there has been a rise in this respect, albeit
40
TRIMBOS-INSTITUUT
•
•
•
•
with fluctuations. However, from 2004 to 2005 the number of cannabis secondary diagnoses dropped by 7%.
In 2005 the most common main diagnoses that accompanied the secondary diagnoses
were:
- psychoses (25%)
- injury due to accidents (14%, such as fractures, cuts, concussion)
- misuse or dependence on alcohol and drugs (16%, mainly alcohol: 14%)
- poisoning (6%, by drugs, alcohol, medication)
- respiratory tract illnesses and symptoms (5%)
- cardio-vascular illnesses (5%)
- other diagnoses (29%).
In these figures, the same person may be admitted more than once per year. In addition, more than one secondary diagnosis may be made per case. In 2005, corrected
for duplication, the total amounted to 329 persons who were admitted at least once
with cannabis misuse or dependence as the main or secondary diagnosis. Their average age was 30, and 72% were male.
In 2005 cannabis problems were also recorded as primary or secondary diagnosis in
45 day-care treatments. This is somewhat more than in 2004 (14 day care treatments).
In addition, the LMR recorded 14 admissions in 2005 for which “accidental poisoning
with hallucinogens” was cited as secondary diagnosis (ICD-9 code: E854.1). In 2001,
2002 2003 and 2004, there were 15, 8, 16 and 15 cases respectively. These may have
involved cannabis, but equally LSD or magic mushrooms.
Figure 2.6
Clinical admissions to general hospitals, related to cannabis misuse and
dependence, from 1994
Number
400
322
350
300
200
249
247
250
193
160
184
195
26
29
230
299
246
193
154
150
100
50
21
39
38
29
24
38
33
46
56
62
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Cannabis as main diagnosis
Cannabis as secondary diagnosis
Number of diagnoses, not corrected for duplication of persons or for more than one secondary diagnosis per
admission. ICD-9 codes: 304.3, 305.2 (Appendix C). Source: LMR, Prismant.
According to the injury information system (LIS) of the Consumer Safety Institute46 an
average of 2,900 people are treated annually at the accident and emergency departments of hospitals on account of an accident, violent incident or self-mutilation related to
TRIMBOS-INSTITUUT
41
drug use (cp. 13,000 on account of alcohol, chapter 6). The drugs meant here are cocaine, heroin, cannabis, ecstasy, magic mushrooms and speed. The data have been averaged over the period from 2001 through 2005.
• After cocaine, cannabis is the most frequently cited drug. Almost one in five (18%)
drug victims indicates having used cannabis. If we count only the cases where the
drug is known (71%), then cannabis accounts for 25% of all drug-related emergency
room treatment.
• These figures are likely to be an under-estimate of the true number of drug-related
accidents.
In 2004 research was conducted on the use of drugs among 641 people attending the
emergency room at the Erasmus Medical Centre in Rotterdam. 47
• Nine percent admitted having used illegal drugs in the 24 hours prior to treatment.
• Cannabis was cited by the vast majority (6.9%).
At the central post for ambulance transports (CPA), The Amsterdam Municipal Health
Service (GGD Amsterdam) keeps a log of the number of requests for emergency treatment related to drug use.
• In 2005 cannabis use played a part in 342 cases – a rise of 7% compared to 2004
(Table 2.8).
• In one out of three cases, an ambulance was needed for admission to hospital. The
remainder were treatable at the scene.
Table 2.8
Smoking
cannabis
Eating
space cake
Total
Cannabis incidents registered by the GGD Amsterdam, from 1994
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
130
137
165
211
107
118
106
243
226
196
258
281
34
73
58
47
28
21
35
46
59
61
62
61
164
210
223
258
135
139
141
289
285
257
320
342
Number of incidents per annum. Source: CPA, GGD Amsterdam.
In recent years, the National Poison Information Centre (NVIC) of the National Institute
of Public Health and the Environment (RIVM) has registered an increase in requests for
information from doctors, pharmacists and government bodies with regard to cannabis
use (table 2.9).48
• Between 2000 and 2004 there was an increase of 170%. In 2005 and 2006 there was
no further rise.
Table 2.9
Cannabis
Requests for information concerning cannabis use from the National Poisons Information Centre from 2000
2000
2001
2002
2003
2004
2005
2006
71
129
141
144
191
202
186
Annual number of information requests. Source: NVIC, RIVM.
42
TRIMBOS-INSTITUUT
2.7 ILLNESS AND DEATHS
Increasingly, cannabis use is associated with mental problems.
• Evidence is mounting that cannabis use increases the risk of later psychotic disorders.49-52
• The risk increases with the frequency of use.
• Individuals with a prior history of psychotic symptoms are at greater risk of developing
psychosis following cannabis use than those without a prior history.
• It is possible that genetic factors play a role in this. There are indications that people
with a certain variant (Val/Val) of the COMT-gene, which is involved in the breakdown
of the receptor dopamine in the brain are extra susceptible to developing a psychosis,
particularly if they have commenced cannabis use at a young age.53
• Research into the relationship between cannabis use and the onset of other mental
problems, such as depression, has yielded a less consistent picture.54
The role of the increasing concentration of THC, detected until recently in Dutch-grown
weed, in relation to acute or long-term (health) problems is unclear.
• In 2005, the RIVM conducted research into the acute effects of strong cannabis (joints
with 33, 51 and 70 mg of THC). The results showed an increase in heart rate, a drop
in blood pressure and a decline in cognitive functions and motor function. The effects
increased with higher THC doses.55 Young, healthy people can usually tolerate these
effects without suffering any health complications. However, people with cardiovascular illness incur a risk.
• Research conducted among ‘coffee shop’ frequenters shows that there is a specific
group of – mainly young – users with a clear preference for ‘strong weed’.56 They use
the drug relatively often and in large quantities and run an increased risk of dependence. It is not known how large this group of users is.
• In the US a slight increase has been found over time in the percentage of people dependent on or abusing cannabis, whereas the number of users (without a disorder)
remained the same.57 This increase was found to run parallel with a slight rise in the
THC concentration in cannabis, and was independent of frequency or amount of use.
This could indicate a causal relationship. However, the researchers were unable to explain why the increase in cannabis-related disorders occurred only among ethnic minorities and not among the white population.
The toxicity of cannabis is low.58
• For the past 20 years, Statistics Netherlands (CBS) has not recorded a single case of
death directly related to the intake of cannabis.
• No direct deaths from cannabis are known from other countries.
2.8 SUPPLY AND MARKET
Coffee shops and other points of sale
•
Since 1997 the number of coffee shops has declined (table 2.10).59;60 The sharpest
drop took place between 1997 and 1999, particularly in the smaller municipalities and
in Rotterdam. During this period, the number of coffee shops dropped by 28 percent.
After 1999 the annual decrease was less pronounced. Between 2004 and 2005 the
number of coffee shops dropped by only one percent.
TRIMBOS-INSTITUUT
43
Table 2.10
Number of coffee shops in the Netherlands by municipality, from 1997
Municipalities by number of inhabitants
< 20 000 inhabitants
20-50 000 inhabitants
50-100 000 inhabitants
100-200 000 inhabitants
> 200 000 inhabitants:
-
1997I
2000
2001
2002
2003
2004
2005
r 50
r 170
r 120
211
14
84
r115
190
13
81
109
168
11
86
112
167
12
79
106
174
12
73
104
168
10
77
101
166
10
75
103
161
628
443
442
429
411
394
383
380
340
180
87
21
288
65
70
20
283
63
62
18
16
280
61
55
17
16
270
62
46
18
15
258
62
41
18
15
249
62
40
17
15
246
62
40
17
15
± 1 179
846
813
805
782
754III
737
729
Amsterdam
Rotterdam
The Hague
Utrecht
EindhovenII
Total
1999
I. Estimate. II. Fewer than 200 000 inhabitants up to 1999. III. In 2003 three coffee shops were not listed by
municipality size. Source: Intraval 60
•
•
•
•
•
In late 2005 there were 729 officially sanctioned coffee shops in the Netherlands; approximately half (52%) of these were in the main cities with over 200 thousand inhabitants.
In 2005 78 percent of municipalities had no coffee shop.
The University of Amsterdam has conducted research into the purchasing of cannabis.
In municipalities with officially tolerated coffee shops, an estimated 70% of local cannabis is purchased directly in the coffee shop.16 The greater the number of coffee
shops per 100 000 inhabitants, the greater the share of the local coffee shops in local
cannabis sales.
On a national scale, (excluding the main cities, and municipalities without coffee
shops) it is estimated that there are several thousand non-sanctioned cannabis suppliers. These operate from fixed points of sale such as their homes or on an under-thecounter basis in food and drink establishments as well as through mobile sales such as
home delivery after telephone orders or dealing on the street.
Since the unofficial sellers account for an estimated 30% of local sales, the deals involved are probably conducted on a small or very small scale.
THC content and price
In all tests, Dutch-grown weed was found on average to contain higher concentrations of
THC than varieties from other countries.
• Figure 2.7 shows that there was a strong increase in the average THC content of
Dutch-grown weed samples between 2000 and 2004. In 2005 the average THC concentration dropped slightly, levelling off in 2006.
• The percentage of THC in foreign hashish increased up to 2002. Foreign hashish contains about the same THC content as Dutch-grown weed.
• The percentage of THC in foreign weed fluctuated in recent years at around six percent.
• Dutch-grown weed largely originates from intensive and professional domestic cultivation, which by comparison with foreign cultivation, produces weed with a higher THC
content.
44
TRIMBOS-INSTITUUT
•
In so far as data are available, no increase of significance has been found in other
European countries.62 International data are, however, difficult to compare, on account
of large differences in research methods.
Figure 2.7
Average THC percentage in cannabis products
%
25%
20%
15%
10%
5%
0%
2000
2001
2002
2003
2004
2005
2006
Dutch-grown weed
9%
11%
15%
18%
20%
18%
18%
Foreign weed
5%
5%
7%
6%
7%
7%
6%
11%
12%
18%
17%
18%
17%
19%
Foreign hashish
Source: DIMS, Trimbos Institute63
The price of a gram of Dutch-grown weed or a gram of foreign weed fluctuated slightly in
recent years.
• In 2003 the price of Dutch-grown weed was slightly higher than in 2000/2001; however, this trend was not found in the later measurements.
• The price of foreign hashish rose slightly between 2000 and 2003, but dropped again
in 2004, after which it levelled off (Table 2.11).
Table 2.11
Price (€) per gram of cannabis product
Dutch-grown weed
Foreign weed
Foreign hash
2000
5.83
3.87
6.29
2001
5.86
3.80
6.36
2002
6.28
4.16
7.14
2003
6.45
4.32
7.56
2004
5.97
4.86
6.46
2005
6.22
4.11
6.78
2006
6.20
4.40
7.30
Source: DIMS, Trimbos-instituut.63
•
•
Cannabis products from coffee shops are sometimes found to contain bacteria and
fungi. According, to the researchers from the University of Leiden, these organisms
could pose a real public health threat, particularly to those with a weakened immune
system.64
The Drugs Information and Monitoring System (DIMS) monitors the market for illegal
drugs. In 2005 and 2006 the DIMS received reports of substances being mixed with
weed, particularly Dutch-grown weed that is sold abroad. These mixers are used to
improve the external appearance of the product and to increase its weight artificially.
This development may be related to the intensification of efforts to combat (largescale) cannabis cultivation.
TRIMBOS-INSTITUUT
45
46
TRIMBOS-INSTITUUT
3
COCAINE
Cocaine works as a stimulant. Many cocaine users are able to fit cocaine into their lives
without developing problems; they use cocaine for recreational purposes. However, the
drug can lead to addiction.
Cocaine can be used in a variety of forms.65 In powder form, (cocaine hydrochloride) cocaine is usually snorted in the Netherlands, and rarely injected. Occasionally it is smoked
like a cigarette. Among problem hard drug users, the base form of cocaine (‘crack cocaine’) is the most popular. Base cocaine is obtained by heating a solution of cocaine
powder and a base substance, such as natrium bicarbonate or ammonia. It is smoked in
a little pipe or tube or inhaled from aluminium foil. Both methods are known in this study
as smoking, unless stated otherwise. Crack is impure base cocaine with residue of natrium bicarbonate. Crack owes its name to the crackling sound it emits during the heating process. In the 1980s the users made their own base cocaine. Nowadays it is sold
ready for use on the streets.
The data below applies to all forms of cocaine, unless stated otherwise.
3.1 RECENT FACTS AND TRENDS
The main facts and trends concerning cocaine in this chapter are:
• Between 2001 and 2005 ever use of cocaine in the general population increased. The
percentage of recent and current cocaine users remained stable during this period. (§
3.2).
• The increase in the number of new cocaine users in the general population dropped
between 2001 and 2005 (§ 3.2).
• Among school-goers, (12-18) the percentage of cocaine users remained stable between 1996 and 2003 (§ 3.3).
• With regard to recent use of cocaine, the Dutch score around average compared to
other European member states (§ 3.5).
• After a decline between 1998 and 2003, the use of snortable cocaine in fashionable
clubs in Amsterdam appears to have levelled off. In other parts of the country its
popularity appears to be undiminished in certain circles (§ 3.3).
• Among problem users of hard drugs, crack has now become the drug of choice (§
3.4).
• Until 2004, the (outpatient) addiction care services registered a sharp rise in the number of cocaine clients; however this trend did not continue in 2005. There was a drop
in the percentage of first-time cocaine clients seeking treatment for a drug problem (§
3.6).
• The number of cocaine-related admissions to general hospitals rose between 1996 and
2002 but did not increase further in the years following (§ 3.6).
• The rising trend in the number of registered acute deaths from cocaine use from the
late 1990s did not continue between 2002 and 2005. (§ 3.7).
• The percentage of powder cocaine used by consumers that is mixed with phenacetine
increased further between 2005 and 2006. Phenacetine is a painkiller that has been
removed from circulation because it may be carcinogenic (§ 3.8).
TRIMBOS-INSTITUUT
47
3.2 USAGE: GENERAL POPULATION
•
•
•
•
Between 2001 and 2005 there was an increase in the number of people in the Netherlands aged between 15 and 64 who had experience with cocaine (table 3.1). Between
1997 and 2001 the percentage of ever users remained stable.4
The percentage of recent and current users remained at the same level in all three
surveys.
In absolute figures, there were an estimated 32 thousand current users of cocaine in
the Netherlands in 2005. These figures are virtually certain to be an underestimation,
because problem users of hard drugs are under-represented in population surveys,
such as the NPO.
The annual increase in first-time users of cocaine dropped from 0.4% in 2001 to 0.1%
in 2005. These figures could be indicative of a decline in the popularity of cocaine.
Table 3.1
Cocaine use in the Netherlands in the population aged 15 to 64. Survey
years 1997, 2001 and 2005
1997
2.6%
0.7%
0.3%
0.3%
27.7
Ever use
Recent useI
Current useII
Used for the first time in the past year
Average age of the recent usersI
2001
2.1%
0.7%
0.1%
0.4%
26.7
2005
3.4%
0.6%
0.3%
0.1%
31.9
Number of respondents: 17 590 (1997), 2 312 (2001), 4 516 (2005). I. In the past year. II. In the past month.
4
Source: NPO, IVO.
Age, gender and urbanisation level
•
•
•
•
•
Ever use of cocaine occurs mainly among males (5.2%, versus 1.6% among females)
and in the age group 25 to 44 years (5.3%, versus 2.8% among 15-24 year olds and
1.6% among 45-64 year olds).
Cocaine use occurs mainly in the big cities. 7.6% of the population in very highly urbanised areas have used cocaine. This compares with only 0.7% of the population in
non-urban areas.
The numbers of recent and current users are too small to permit a further breakdown
by age, gender and urbanisation level.
Between 2001 and 2005 there was a rise in the average age of recent users.
The age of onset is the age at which an individual first used a substance (see also appendix A: age of onset). Among ever users of cocaine, the age of onset was 17.6 on
average for the 15 to 24 year age group. In the population aged 15 to 64, the average
age of onset is 23.1 years.
Special groups
Compared to the average population, cocaine use is relatively high among homeless people, drifters and prisoners.
• In 2002 nearly half (47%) of all the homeless and drifters in 20 Dutch municipalities
had used crack in the past month; one in five snorted cocaine 20%).5
48
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•
In 2002 a third (32%) of male detainees in eight Remand centres used cocaine/crack
on a daily basis in the six months prior to detention.6
3.3
USAGE: JUVENILES AND YOUNG ADULTS
School-goers
According to the Dutch National School Survey of the Trimbos Institute, considerably fewer secondary school students use hard drugs, such as cocaine than cannabis.8
• From 1988 to 1996 there was, however, an increase in use.
• This trend was no longer found in the measurements of 1999 and 2003. The percentage of pupils that had ever or recently used this drug appeared to drop slightly between 1996 and 2003, but these differences are not significant (Figure 3.1).
• More boys than girls have ever or recently used cocaine.
• The percentages of cocaine users seem somewhat lower among pupils attending a
higher level school (VWO, HAVO) compared to their peers who attend a lower level
school (VMBO); however these differences are not statistically significant.
Figure 3.1
3.5
Use of cocaine among school-goers aged 12 to 18 from 1988
%
3
3
2.8
2.5
2.2
2
1.6
1.2
1.5
1
0.4
0.5
1.1
1.2
0.8
0.4
0
1988
1992
1996
Ever use (%)
1999
2003
Current use (%)
Percentage of ever users and recent users (past month). Source: Dutch National School Survey, Trimbos Institute.
Special groups
In certain groups of young people, the rate of cocaine use is high. Table 3.2 contains a
summary of the results of various, often local, studies. The data are not easy to compare, on account of differences in age groups and research methods. Trend data are
available only for Amsterdam.
TRIMBOS-INSTITUUT
49
•
Cocaine is relatively popular among juveniles and young adults in the social scene. In
Amsterdam, the percentage of current cocaine users among clubbers dropped between 1998 and 2003 from 24 to 14 percent.12 This drop chiefly concerned snorting
cocaine. Among bar goers, however, the level of cocaine use remained stable between
2000 and 2005.17
Table 3.2
Cocaine use in special groups
Location
Survey
year
Age
(yrs)
Ever use
Current
use
2003
15 - 35
23%
10%
2006
2000
2005
2005
2004
14 - 44
Average 25
Average 27
14 - 34
Average 23
13%
26%
26%
20%
20%
4%
9%
8%
6%
8%
AmsterdamIV
Nijmegen
2006
1998
2003
2001
2005-6
Average
Average
Average
Average
Average
11%
49%
39%
52%
33%
3%
24%
14%
19%
10%
Problem youth
x Marginalised youthV
x Juvenile detaineesVI
The Hague
Regional
2000/2001
2002/2003
16 - 25
14 - 17
x School drop-outsVI
Regional
2002/2003
14 - 17
x Young driftersVII
Nationwide
Flevoland
1999
2004
15 - 22
13 - 22
23%
11% (b)
24% (g)
11% (b)
3% (g)
66%
29%VIII
19%IX
9%
4% (b)
11% (g)
7% (b)
1% (g)
36%
10%VIII
6%IX
Young people in the social scene
x Frequenters of dance parties, festivals, The Hague
city centre
x Pub-goers
Zaandam
x Pub-goersI
AmsterdamII
x Visitors to restaurants, hotels, pubs
Eindhoven
x Frequenters of bars and sport hall can- Noordwijk
teen-bars
x Discotheque-goers
NijmegenIII
x Clubbers
Amsterdam
x “Coffee shop” clients
21
26
28
25
27
Percentage of current users (last month) per group. The figures in this Table were not comparable on account
of differences in age groups and research methods. b=boy; g=girl.
Juveniles and young adults from mainstream bars, student bars, gay and hip bars. Therefore not representative
of all bar-goers. II. Low response rate (26%). III. Low response rate (19%). IV. Low response rate (15%). V.
Juveniles who do not receive sufficient care and/or are insufficiently able to meet their own living needs. Surveyed at locations for homeless young people, low-threshold day and night centres and other temporary accommodation facilities. VI. Research in the provinces of Noord-Holland, Flevoland and Utrecht. Use among
juvenile detainees: in the month prior to detention. School drop-outs are youngsters who have failed to attend
school for at least one month during the past 12 month, not counting holidays. VII. Young people aged up to 23
who have had no fixed abode for at least three months. VIII. Snortable cocaine in powder form. IX. Smokeable
16;17;22-24;26-30;70
cocaine in the form of crack. References:
•
•
50
In other parts of the country, the popularity of cocaine appears to remain undiminished, particularly in fashionable clubs, discotheques and bars.18 The rate of current
use of cocaine among juveniles and young adults in social settings varies for different
towns from three to ten percent (table 3.2). According to key observers, cocaine use
appears to becoming the norm. However, awareness is increasing among users of the
negative aspects and risks of cocaine use.
In 2005 key observers also noticed a ‘silent rise’ in the use of crack cocaine among
rural youth.18;66 Growth in cocaine use has also been identified among problem juveniles in the province of Gelderland 30, among young people hanging around in the city
TRIMBOS-INSTITUUT
•
•
of Den Bosch36, among marginalised youngsters in the urban areas of Eindhoven37,
Maastricht39 and Parkstad Limburg.67;68
In the social scene, cocaine is often taken together with alcohol.17-21 Excessive consumption of alcohol by revellers is often cited as one of the reasons for the growing
popularity of cocaine.18 Cocaine is meant to have a sobering effect, which means that
drinking can be increased and sustained for longer. 69
In 1999, homeless young people scored the highest for cocaine use in the Netherlands
(Table 3.2). A survey of juveniles without a fixed abode in five Dutch municipalities
showed that one in three had recently used cocaine. Smoking was the most common
method (current smokers: 32%, snorters: 11%, injectors: 1%).22 Among the homeless youth in the province of Flevoland, lower percentages were found in 2004 (Table
3.2).23
3.4
PROBLEM USE
There are no reliable estimates of the total number of problem cocaine users. According
to field studies and registration data, there are basically three groups of users.
• The first group consists of problem users of opiates (see § 4.4), who nowadays almost
all use cocaine as well, usually the ready-to-smoke type of crack.71;72 Crack use leads
to more rapid compulsive behaviour and addiction than snortable cocaine.73-75 For
many opiate addicts, cocaine is now the drug of choice. They have great difficulty in
cutting down or quitting and have a full-time job in procuring the substance.76 In Rotterdam and Parkstad Limburg the additional use of crack appears to have accelerated
the marginalisation of problem opiate users and has made the drugs scene more extreme.77
• In the hard drugs scene there are also problem users who frequently use cocaine, especially crack, without using heroin as well.
- Field studies have shown that this accounts for some 10 to 15 percent of the total
population of problem hard drug users. 76;78
- In Utrecht crack users without a prior history of heroin use comprise mainly Antillean and Moroccan juveniles and young adults.76 Crack use is also relatively highly
prevalent among the young homeless and street prostitutes.74;79
- According to research in Rotterdam, crack use can, in particular in the case of juveniles, act as a catalyst for a process of marginalisation, separating young people
more and more from family, work and healthcare services.80
• The third group consists of users who started off snorting cocaine for recreational purposes, but then developed problem use (derailed snorters). By comparison with crack
smokers, they generally started to snort coke from a more socially integrated position.
According to the observations of key figures in the social scene, every network of cocaine users knows snorters who no longer have their habit under control.18 However,
the number of these problem users is not known.
Field studies among the first two groups of users have shown that self-injecting of cocaine (or heroin) declined sharply during the 1990s, and with it the risk of infection. By
contrast, smoking cocaine (and heroin) has increased.
• For example, the number of ‘pure injectors’ of cocaine in Parkstad-Limburg as a percentage of total problem cocaine (and other hard drug) users dropped from 40% in
1996 to 4% in 1999. The number of problem users that both injected and smoked cocaine dropped from 30% to 17%. Between 1999 and 2002 this situation remained
more or less stable.73;74;79
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51
According to recent figures from Rotterdam, Utrecht and Parkstad-Limburg, smoking
cocaine is the usual method for between seven and nine out of every ten problem users of hard drugs (Table 3.3).
•
Table 3.3
Method of cocaine use by problem hard drug users
Method of administration
Always inject
Rotterdam
2003
Utrecht
1999
Parkstad-Limburg
2002
4%
1%
7%
Smoke and inject
10%
10%
19%
Always smoke
86%
86%
71%
Percentage of problem users per method of use in the past 6 months. The figures in the columns do not add up
to exactly 100 percent; the remainder involves other methods of intake (such as snorting). Source: MAD.
3.5
USAGE: INTERNATIONAL COMPARISON
General Population
In the general population of western countries, the number of people using hard drugs
such as cocaine is considerably lower than the number who use cannabis.
• Differences in survey year, measuring methods and sampling make it difficult to conduct a precise comparison. The age group is the main factor of influence. Table 3.4a
contains usage figures that have been (re)calculated according to the standard age
group of the EMCDDA (15 to 64 years). Data for the other countries are shown in Table 3.4b. For Europe, only countries from the EU-15 and Norway have been included.
Appendix F contains usage figures for the other EU member states, where available.
• The percentage of people aged up to 60 or 70 who have experienced cocaine is by far
the greatest in the US and Canada. In the EU-15 the percentage of ever users varies
from almost zero to almost seven percent. The highest rates are reported in the U.K.,
Spain and Italy. In the Netherlands, over 3% of the population aged between 15 and
64 has ever used cocaine. In the other EU member states, (appendix F), the percentage of ever users does not exceed 1.2%.
• In most EU-15 and EU-25 countries, no more than about one percent of the population
reports past year use of cocaine; in the Netherlands 0.6%. Exceptions are Spain and
the U.K., with two percent or more. In the US and Canada, the percentage of recent
users is also higher.
52
TRIMBOS-INSTITUUT
Table 3.4a
Cocaine use in the general population of a number of EU-15 member states
and Norway: age group 15 to 64 years
Country
Year
Ever use
Recent
Use
Spain
2003
5.9%
2.7%
Netherlands
2005
3.4%
0.6%
Ireland
2002/2003
3.1%
1.1%
Norway
2004
2.7%
0.8%
Austria
2004
2.3%
0.9%
2002/2003
1.7%
0.4%
France
2000
1.6%
0.2%
Finland
2004
1.2%
0.3%
Portugal
2001
0.9%
0.3%
Greece
2004
0.7%
0.1%
Luxembourg
1998
0.2%
-
Northern Ireland
Differences in survey year, measuring methods and sampling hamper a precise comparison between countries.
40
Percentage of ever users and recent users (past year). - = not measured. References:
Table 3.4b
Cocaine use in the general population of a number of EU-15 member states, the US, Canada and Australia: other age groupsI
Country
Year
Age (years)
Ever use
Recent use
US
2004
12 and older
13.8%
2.3%
Canada
2004
15 and older
10.6%
1.9%
United Kingdom
2004
?
6.5%
2.3%
Australia
2004
14 and older
4.7%
1.0%
Italy
2003
15 – 54
4.6%
1.2%
Germany
2003
18 – 59
3.2%
1.0%
Denmark
2000
16 – 64
2.5%
0.8%
Sweden
2000
16 – 64
0.7%
0.0%
Differences in survey year, measuring methods and sampling hamper a precise comparison between countries.
Percentage of ever use and recent use (past year). I. Drug use is relatively lowest in the youngest (12-15) and
older age groups (>64). Usage figures in studies with respondents who are younger and/or older than the EMCDDA standard may be lower than in studies using the EMCDDA standard. The opposite is the case for studies
40-43;43
with a more limited age range. References:
Juveniles and young adults
In de ESPAD survey of fifteen and sixteen year old school-goers in Europe conducted in
1999 and 2003, respondents were asked if they had ever used cocaine. In 2003 they
were also asked about recent use. The data from this project are easier to compare than
data from the general population.
• Table 3.5 shows cocaine use in a number of EU countries and Norway. The US did not
take part in ESPAD but conducted comparable research.
• In the US, school-goers have more frequent experience of cocaine than their peers in
the EU, notwithstanding the drop in the percentage of ever users between 1999 and
2003.
TRIMBOS-INSTITUUT
53
Italy and the UK were top of the list for ever use in 2003 (4%). The Netherlands, Belgium, France, Ireland and Portugal were above average at three percent, but the differences compared to other countries are slight.
Italy, the UK and the US have relatively the greatest number of recent users, at 3%.
In the remaining countries, no more than one to two percent of school-goers had used
cocaine recently. In the Netherlands, the figure is 1%.
•
•
Table 3.5
Cocaine use among school-goers aged 15 and 16 in a number of EU member states, Norway and the US. Survey years 1999 and 2003
1999
2003
Ever use
Ever use
Recent use
US
8%
5%
3%
Italy
2%
4%
3%
UK
3%
4%
3%
-
3%
1%
France
2%
3%
-
Ireland
2%
3%
1%
The Netherlands
3%
3%
1%
Portugal
1%
3%
2%
Denmark
1%
2%
2%
GermanyI
-
2%
2%
Greece
1%
1%
1%
Norway
1%
1%
1%
Sweden
1%
1%
0%
Finland
1%
0%
0%
Belgium
Percentage of ever users and (2003) in the past year (recent). I. Six of the sixteen member states. - = not
44
measured. The US did not participate in the ESPAD, but conducted comparable. Source: ESPAD.
3.6 TREATMENT DEMAND
Outpatient Addiction Care
The National Alcohol and Drugs Information System (LADIS) registers the number of people who seek treatment from the (outpatient) addiction care services, which include the
addiction probation and aftercare service and addiction clinics that are merged with the
outpatient addiction care services (See appendix A: LADIS clients.) On account of technical problems, the Jellinek organisation for addiction care in Amsterdam and its environs
has so far been unable to submit its data for 2005 to LADIS. A 2005 estimate for Jellinek
has therefore been extrapolated from the 2004 data.45
• The number of clients with cocaine as a primary problem quadrupled between 1994
and 2004. Between 2004 and 2005 a first small drop of two percent was registered
(figure 3.2).
• Per 100 000 inhabitants aged 15 and older, the number of primary cocaine clients rose
from 20 in 1994 to 76 in 2004, and dropped slightly to 74 in 2005.
• The ratio of cocaine clients to all clients with a drug problem also grew, viz., from 13%
in 1994 to 30% in 2005.
54
TRIMBOS-INSTITUUT
•
•
•
•
In 2005 about one in ten (11%) primary cocaine clients had not been registered before with the (outpatient) addiction care services for a drug problem. This was a reduction compared to previous years (24% newcomers in 2003 and 18% in 2005).
For about six out of ten primary cocaine clients (59%), smoking (crack) is the main
method of use, and for four out of ten (40%) it is snorting. Only one percent inject cocaine.
Most primary cocaine clients (72%) also had problems with another substance, mainly
alcohol and heroin. For more than a quarter (28%), cocaine was the only problem.
Cocaine was also often cited as a secondary problem (Figure 3.2). In this group, the
primary problem was heroin (58%), alcohol (29%), or cannabis (7%). During the past
four years, the number of clients with secondary cocaine problems has remained stable.
Figure 3.2
Number of (outpatient) addiction care clients with primary or secondary
cocaine problems from 1994I
Number
11000
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
Primary
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
2468 2928 3349 4137 4607 5689 6103 6647 7774 9216 9999 9824
Secondary 6020 6391 6503 7015 6699 6932 7111 8426 8281 8388 8393 8157
I. The rise in secondary cocaine clients from 2000 to 2001 is partly due to the provision of opiate client data
(since 2001) by the GGD Amsterdam. For 2005, the Jellinek data have been extrapolated. Source: LADIS, IVZ
Age and gender
• In 2005 over eight out of ten primary cocaine clients were male (82%). The ratio of
female clients has risen somewhat since 1999 (16% in 1994-1999, 17% in 2000, 18%
in 2001-2005).
• In 2005 the average age was 34. This means that primary cocaine clients are younger
than opiate and alcohol clients, but older than cannabis, ecstasy and amphetamine clients.
• Figure 3.5 shows that 60% are aged between 25 and 39. The ratio of young cocaine
clients aged 15 to 29 has dropped over time from 56% in 1994 to 34% in 2005.
Regional trends
During the period 2001-2005 the number of primary cocaine clients increased by an average of 78% compared with 1996-2000. This growth took place in all regions of the
Netherlands (IVZ/RIVM, Zorgatlas). The sharpest rise was registered in three regions in
TRIMBOS-INSTITUUT
55
the east of the country: Enschede (+234%), Apeldoorn (+232%) and Deventer
(+217%). The Amersfoort region recorded the smallest increase (+22%).
Figure 3.3
Age distribution of primary cocaine clients of (outpatient) addiction care.
Survey year 2005I
%
25
22
20
20
18
15
13
12
10
5
8
3
2
2
0
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
>54 Age
Percentage of clients per age group. I. The Jellinek have been extrapolated. Source: LADIS, IVZ.
Groups of cocaine clients
Table 3.6 shows a breakdown of cocaine user groups according to method of use (smoking crack versus snorting coke) and secondary substance, in the total of cocaine clients in
(outpatient) addiction care (see also § 3.4).81
Table 3.6
Groups of cocaine clients in (outpatient) addiction care. Survey year 2005I
Groups of cocaine clients
Percentage of the total
Percentage of growth since 2000
Cocaine (crack) with opiates
41%
-2%
Cocaine (crack) without opiates
24%
54%
8%
8%
80%
80%
20%
106%
Snorting cocaine
Without secondary substance
With cannabis
With alcohol
Percentage of the total number of cocaine clients (primary and secondary clients together) and the growth
percentage per group between 2000 and 2005. I. The data from Jellinek have been extrapolated. Source:
LADIS, IVZ.
The rise in the number of cocaine clients occurred mainly in recent years among the
group who snort cocaine (80%-106%) and to a lesser extent among the users of crack
without opiates (54%). There was no increase in the group of initial opiate users who
later use crack as well (-2%).
56
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The groups of cocaine users exhibit the following profile:
• Users of opiates with crack are mainly in the older age groups (52% are aged 40 or
older). Users of snortable cocaine with cannabis are mainly in the youngest age group
(62% are under thirty).
• Users of opiates with crack constitute the most chronic and problematic group. 80% of
them have had addiction problems for longer than five years. In the case of users of
only crack, the figure is 63%; for users of only snortable cocaine 35%; for users of
snortable cocaine with alcohol 67%; and among users of snortable cocaine with cannabis, the number of long-term addicts is 54%. A total of 68% of users of opiates
combined with crack were repeat clients with the addiction care services. This contrasts with 28% of users of only snortable cocaine who were not first-time clients at
the time of measurement.
• The percentage of immigrants is highest among crack users, with or without opiates,
(33%) and is lowest among users of only snortable cocaine (12%).
• Users of opiates with crack are more often partnerless (60%), homeless, or staying in
shelters for the homeless (22%) and are more likely to be dependent on social security benefits (68%). For users of only snortable cocaine, these percentages are the
lowest, i.e. 32 %, 4% and 27% respectively.
• Users of only crack and opiates with crack are more often in contact with the law
(84% and 78%), followed by users of snortable cocaine with alcohol (76%), snortable
cocaine with cannabis (62%) and only snortable cocaine (51%).
As cocaine clients get older, they have an increasing tendency to come in contact with
the law, not to have their own home, to have no income from a paid job and in general
to manifest the characteristics of a chronically marginalised group.81
General hospitals; incidents
In general hospitals, cocaine misuse and dependence are not often recorded as the primary diagnosis for clinical admissions.
• In 2005 there were 101 cases, of which 66% were due to cocaine misuse and 34% to
cocaine dependence (Figure 3.4).
• Cocaine related problems are more often recorded as a secondary diagnosis. Between
1996 and 2002 there was a rise in the number of admissions with cocaine misuse or
dependence as a secondary diagnosis. After an initial drop in 2003, followed by a rise
in 2004, the number of secondary diagnoses stabilised in 2005 at 547.
• In 2005 the most frequently occurring categories of primary diagnoses which had cocaine misuse or dependence registered as a secondary diagnosis were:
- injury through accidents (16%, such as fractures, cuts, concussion)
- diseases and symptoms of the respiratory system (15%)
- poisoning (12%)
- diseases of the cardio-vascular system (14%)
- misuse of or dependence on alcohol or (other) drugs (10%)
- psychotic disorders (6%).
• The same person may be admitted more than once per year. In addition, more than
one secondary diagnosis may be made per case. In 2005, corrected for duplication,
the total amounted to 570 persons who were admitted at least once with cocaine misuse or dependence as the primary or secondary diagnosis. Their average age was 35,
and 74% were male.
• The LMR registered no cases of ‘accidental poisoning with cocaine’ as the secondary
diagnosis in 2005 (ICD-9 code E855.2).
TRIMBOS-INSTITUUT
57
Figure 3.4
Admissions to general hospitals related to cocaine misuse and dependence,
from 1994
Number
700
562
600
551
547
89
101
506
500
400
451
352
371
363
55
50
383
377
65
67
285
300
246
200
100
38
24
53
81
84
80
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Cocaine as main 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: LMR, Prismant.
According to the injury information system (LIS)46 of the Consumer Safety Institute, on
average 2 900 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 (cp. 13,000 on account of alcohol, chapter 6). The drugs in question are cocaine,
heroin, cannabis, ecstasy, magic mushrooms and speed. The data have been averaged
for the period from 2000 to 2005.
• Cocaine is the most frequently cited drug. Approximately one in three (35%) drug
victims indicates having used cocaine. If we count only the cases where the drug is
known (71%), then cocaine accounts for 49% of all drug-related emergency room
treatment.
• These figures are likely to be an under-estimate of the true number of drug-related
accidents.
In 2004, a study was conducted on drug use among 641 people attending the emergency
department of the Erasmus Medical Centre in Rotterdam47
• Nine percent reported having used illegal drugs in the 24 hours prior to treatment.
• Cocaine was cited by 1.9% of those interviewed.
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.48
• The number of information requests for cocaine rose steadily between 2000 and 2003
and fluctuated in the years following. From 2005 to 2006 there was a drop in the
number of requests (table 3.7)
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Table 3.7
Cocaine
Information requests concerning cocaine use from the National Poisons
Information Centre (NVIC) from 2000
2000
2001
2002
2003
2004
2005
2006
150
184
217
247
227
254
211
Number of information requests annually. Source: NVIC, RIVM.
•
A drop in the number of information requests does not necessarily equate with a decline 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.
3.7
•
•
ILLNESS AND DEATHS
Cocaine induced health problems, particularly88 from frequent crack smoking include
lung complications, exhaustion and reduced immunity, anxiety and paranoia65. Heavy
coke users also have more difficulty in keeping their aggression under control.
Young people in the social scene who have used cocaine excessively and for prolonged
periods exhibit paranoid, uptight and egotistical behaviour as well as introvertedness.18 Constant tiredness is also cited as an effect of frequent cocaine use.17
The Netherlands Cause-of-death statistics of Statistics Netherlands (CBS) lists few (acute) deaths that could be attributed to cocaine.
• Nonetheless, there is evidence of an increase over the past decade. From 1985
through 1995 there was a total of 27 cases for the entire period. From 1996 through
2005 this had risen to 180 cases (Figure 4.8 in chapter 4).
• However, the rising trend from the mid-1990s through 2002 did not continue between
2003 and 2005. In 2002, 2003, 2004 and 2005 there were 34, 17, 20 and 23 cases
respectively for which cocaine use was registered as the primary cause of death.
• Figure 3.5 shows a breakdown by age group of all cocaine deaths in the period 2000
through 2005. Two-thirds (67%) of the deceased were aged over 35. The peak is
found in the age group of 35 to 39 years. On average, eight out of ten cocaine victims
were male (82%).
• Deaths in which cocaine has played a contributory part are sometimes recorded under
natural causes, such as heart failure. Consequently, it is difficult to determine the
number of cases in which cocaine use has contributed to death.
• The total number of deaths among ‘mules’ who have swallowed pellets of cocaine is
unknown. This is partly because the cause-of-death statistics excludes persons who
are not registered in the Netherlands. The Amsterdam Municipal Health Service (GGD)
registered eight, three, five and eight cases in 2002, 2003, 2004 and 2005, respectively.
TRIMBOS-INSTITUUT
59
Figure 3.5
25
Age distribution of cocaine deaths from 2000 to 2005
%
23
19
20
15
15
15
12
10
10
5
3
1
1
<15
15-19
2
0
20-24
25-29
30-34
35-39
40-44
45-49
50-54
>54
Age
Percentage of deaths per age group. ICD-10 codes primary causes of death: F14 and X42*, X62*, Y12* (* in
combination with code T40.5). Source: Cause-of-death statistics, Statistics Netherlands (CBS).
3.8
SUPPLY AND MARKET
Composition of cocaine samples
The Drugs Information and Monitoring System (DIMS) monitors the market for illegal
drugs. To this end, it uses analyses of drug samples submitted by users in addiction care
centres to establish which substances are in the drugs. Some of these samples are identified by the care centre itself. Samples containing unknown substances and all samples
in powder form are forwarded to the laboratory for chemical analysis. In addition to drug
samples submitted by users, the DIMS also analyses drugs that are seized by bouncers
at nightclubs etc. The results of these are similar to those from the user drug samples.
• In 2006, 630 powder samples were presented, that had been bought by users as cocaine; this was about the same as in 2005 (640) and considerably more than in 2004
(386).
• In 2006 94.3% of all powder samples bought as cocaine did in fact contain that drug
(mainly cocaine hydrochloride). The concentration varied from 4% to 99%, with an
average of 53% (in terms of weight).
• 4.1% of the powder samples contained only another psychoactive substance, and
1.6% contained no psychoactive substance whatever.
• Three-quarters of the powder samples also contained by-products related to cocaine
that were released during extraction from the plant, such as tropacaine and norcocaine.
• In recent years, powder samples that were sold as cocaine have increasingly been
found to (also) contain phenacetine. From 2005 to 2006, the percentage of samples
containing phenacetine rose from 37% to 45%. This represents a sharp rise from 16%
in 2003.
- The concentration of phenacetine found in the powder cocaine varied from 1% to
84% in 2006.
60
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-
Phenacetine is a substance that was registered until 1984 as a painkiller, but because of possible carcinogenic effects, it was removed from circulation. The concentrations of phenacetine that are used as a mixing agent are far lower than the
therapeutic doses which were feared to induce damaging side-effects. However, the
risks attached to phenatecine as a mixing agent with cocaine, such as the effects
when heated for smoking crack are not known.
Prices
There are no trend statistics on the price users pay for a gram of cocaine. However, figures from the national Trendwatch-monitor and the DIMS-project give an indication of
the current situation.
• Socialising juveniles and young adults who purchased cocaine in 2004, paid on average between 40 and 50 euro per gram, depending on the type of dealer (home dealer
or in the social scene).18
• These figures tally with the prices paid by users in 2006 for cocaine samples submitted
to the DIMS-project (20 euro minimum and 60 euro maximum per gram, with median
price of 50 euro per gram).
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61
4
OPIATES
The drug class of opiates comprises many substances. Some of these are known for their
illegal use, such as heroin. Others are heroin substitutes, such as methadone or are used
therapeutically in medicine, such as morphine and codeine. This chapter is concerned
chiefly with heroin and methadone.
Opiates can induce euphoria, but may also have the opposite effect.
Heroin can be taken in various forms. Currently the most common way to take heroin in
the Netherlands is to smoke it (chasing from tinfoil). Injecting the drug is now less
common in the Netherlands.
Opiate users whose habit has got out of control often use other substances (polydrug
use), in a way that is not compatible with ‘normal’ life. Where the collective term ‘hard
drugs’ is referred to in this chapter, we usually mean at least one opiate, and in addition
mainly cocaine.
4.1 RECENT FACTS AND TRENDS
The main facts and trends concerning opiates in this chapter are:
• Heroin use is low in the general population although there was an increase in the percentage of ever use among adults between 2001 and 2005 (§ 4.2).
• Heroin has little popularity among school-goers and socialising young people (§ 4.3).
• The number of opiate addicts in the Netherlands is low compared to other European
countries (§ 4.5).
• The decline in the number of opiate clients in (outpatient) addiction care between
2001 and 2004 did not continue in 2005. However, the percentage of juveniles and
young adults among opiate clients continues to drop (§ 4.6).
• Opiate addicts are often battling psychiatric problems as well (§ 4.4).
• The number of methadone clients remained more or less unchanged between 2001
and 2005; the average daily methadone dose dropped slightly between 2003 and
2005 (§ 4.6).
• The increase in new HIV-infections among injecting drug users is very slight (§ 4.7).
• Fewer injecting drug users are sharing needles, although there are signs that this
downward trend has levelled off. Risky sexual behaviour remains at a high level (§
4.7).
• The acute death rate from drug use is low in the Netherlands, compared to other
countries (§ 4.7).
4.2 USAGE: GENERAL POPULATION
Heroin use is low in the general population.
• According to the 2005 NPO survey, 0.6% of the Dutch population aged between 15
and 64 had ever experienced heroin. This is more than the surveys of 1997 and
2001(0.3% and 0.2% respectively).4
• In all survey years, the percentage of recent and current users was around zero.
• These figures are likely to be an under-estimate, because problem users of hard drugs
are under-represented in the NPO surveys. Many users of illegal opiates or methadone
clients are not reached through random sampling, because they may be homeless, in
TRIMBOS-INSTITUUT
63
prison, or otherwise out of the picture. To a certain extent, they may yet be included
in statistics by means of other research methods (see § 4.3).
Special groups
Among certain groups of adults, heroin use is more prevalent than in the general population.
• In 2002 one in five male detainees (21%) in eight Remand centres had used heroin in
the six months prior to detention.6
• In the same year, 40% of the homeless in 20 Dutch municipalities had used this drug
in the month prior to being surveyed.5
These groups may overlap with problem users as described in § 4.3.
4.3 USAGE: JUVENILES
Heroin is not popular among secondary school-goers aged 12 and older (Table 4.1).8
• In 2003 there were more boys than girls who had ever used heroin (ever use: 1.5%
versus 0.7%; current use: 0.8% versus 0.3%).
• The percentage of ever users has fluctuated around one percent since 1988. Since
then, no more than half of that group was currently using heroin.
Table 4.1
Heroin use among school-goers aged 12 to 18 from 1988
1988
1992
1996
1999
2003
Ever use
0.7%
0.7%
1.1%
0.8%
1.1%
Current use
0.3%
0.2%
0.5%
0.4%
0.5%
Percentage of ever use and current use (past month). Source: Dutch National School Survey, Trimbos Institute.
Special Groups
In some at-risk groups, there is a higher rate of heroin use, but this does not apply to all
at-risk groups.
• In certain circles, a small minority experiments with heroin. (Table 4.2). For instance,
in 2001 almost one in ten ‘coffee shop’ frequenters in Amsterdam had ever tried heroin.16
• Among frequenters of fashionable clubs in Amsterdam, the percentage of ever users
dropped from 6% in 1998 to 2% in 2003. Current use is rare in the social scene.12;21
• In Amsterdam there are reports of heroin being used in combination with crack, benzodiazepines, alcohol and/or cannabis. This has been identified among problematic
street kids of Moroccan and Surinamese as well as Dutch origin.82 They are often in
poor physical and emotional condition and are often in contact with crime, prostitution
and drugs trafficking.
• A survey conducted in 1999 among young drifters in five municipalities (Amsterdam,
Breda, Hilversum, Tilburg and Zaanstad) showed that this group had relatively frequent experience of heroin. Over one in ten of these drifters was a current user. The
most common way of taking the drug was smoking (current smokers: 11%, injectors:
1%, snorters: 0%).20 In 2004 lower percentages were found among homeless juveniles in the province of Flevoland: 8% had ever used heroin and 2% were current users.23
64
TRIMBOS-INSTITUUT
•
Key observers in the Den Bosch region reported in 2005 that some younger hard drug
users who had started with crack, were now also using heroin.36
Table 4.2
Heroin use in special groups
Location
Survey year Age
Young people in the social
scene
x Bar-goersI
Amsterdam
Average
Average
Average
Average
Average
25
27
26
28
25
Ever use
Current
use
1%
1.5%
6%
2%
9%
0.2%
0%
x Clubbers
Amsterdam
x Coffee-shop frequentersII
Problem groups
Amsterdam
2000
2005
1998
2003
2001
x School drop-outsIII
Regional
2002/2003
14 - 17
x Juvenile detaineesIII
Regional
2002/2003
14 - 17
x Marginalised young peopleIV
x Homeless youthV
The Hague
2000/2001
16 - 25
0.9%
1.4%
3.7%
2.9%
13%
Nationwide
Flevoland
1999
2004
15 – 22
13 – 22
21%
8%
0%
0.9%
(b)
(g)
(b)
(g)
0.9% (b)
0% (g)
0% (b)
1.4% (g)
7%
11%
2%
Percentage of ever users and current users (past month) per group. The figures in this Table are not mutually
comparable on account of differences in age groups and research methods b=boy; g=girl. < means ‘less than’.
I. Selective sample of juveniles and young adults from mainstream bars, student bars, gay bars and hip bars;
therefore not representative of all bar-goers. II Low response (15%). III. Research in the provinces of NoordHolland, Flevoland and Utrecht. Drop-outs are juveniles who have not attended school for at least one month
during the past 12 months, not counting holidays. Usage among juvenile detainees: in the month prior to detention. IV. Young people who receive insufficient care or are insufficiently able to meet their own living needs.
Surveyed at locations for homeless youth, low-threshold day and night centres and (other) temporary accommodation facilities. V. Young people up to age 23 who have had no fixed abode for at least three months. Ref16;22-24;26;27
erences:
4.4
PROBLEM USE
The available estimates tend not to draw a clear distinction between problem users of
opiates on the one hand and of other hard drugs (as well) on the other hand.a The estimates in Table 4.3 refer mainly to regular users of illegal opiates or of methadone, who
generally also take other substances such as cocaine, alcohol and sleeping pills or tranquillizers. According to the most recent available estimates, there are about 33,500 problem users of hard drugs in the Netherlands. This figure is couched in a rather large margin of uncertainty, varying from some 24,000 to 46,000 problem users. By comparison
with earlier years, no significant change has taken place.
• The Netherlands has about three problem users of hard drugs per thousand inhabitants aged between 15 and 64.
• Per thousand inhabitants, the greatest proportion of problem users live in Rotterdam
and The Hague (Figure 4.1). However, the differences between the various cities
should be interpreted with caution on account of discrepancies in definitions and calculation methods.
a
See appendix A for the definition of problem user
TRIMBOS-INSTITUUT
65
According to a stricter definition, there were an estimated 3,000 problem hard drug
users in Rotterdam in 2003 who used hard drugs (almost) daily and as such engaged
in criminal activity, caused trouble or were homeless. This amounts to 7.5 persons per
thousand inhabitants aged between 15 and 64.
•
Table 4.3
Estimates of the number of problem users of hard drugs
Area
Year
Number
Nationwide
1993
28 000
Nationwide
1996
27 000 (25 000 – 29 000)I
Nationwide
1999
29 200 (26 000 – 30 000)I
Nationwide
2001
33 500 (23 800 – 46 500)I
Rotterdam
2003
5 051
Amsterdam
2005
3 728
The Hague
2000-2002
3 200 (per annum)
Parkstad Limburg
2002
800
Enschede
2005
607
Utrecht
1999
1 300
Leeuwarden
2001
389
Almelo
2004
229
Hengelo
2004
191
Owing to differences in definitions and methods, the figures should be interpreted with caution.
74 79;83-92
I. Average (and the upper and lower limit) of different estimates. References:
Figure 4.1
Estimates of the number of problem users of hard drugs per 1,000 inhabitants aged from 15 to 64
14
12.4
12
10.1
10
8
7.3
6.3
6
4
5.7
4.7
4.5
3.4
3.1
2
0
National
(2001)
Rotterdam
(2003)
The Hague
(2000-2002)
Amsterdam
(2004)
Leeuwarden
(2001)
Enschede
(2003)
Almelo
(2004)
Parkstad
Limburg
(2002)
Utrecht
(1999)
Average of highest and lowest estimates (where applicable). References: see Table 4.3.
Figure 4.2 shows the development of a number of problem opiate users in Amsterdam
according to estimates by the GGD Amsterdam.
• The number in this group peaked in 1988 at 8,800 problem users and subsequently
declined. The decline was largely due to reduction in the number of foreigners, especially Germans and Italians.
66
TRIMBOS-INSTITUUT
•
In 2005 Amsterdam still had an estimated 3,700 problem users of opiates. Of these,
49% were born in the Netherlands, 25% in Surinam, the Netherlands Antilles, Morocco
or Turkey and 26% were born elsewhere.
Figure 4.2
Problem users of opiates in Amsterdam, from 1985
Number
10000
8000
6000
4000
2000
0
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
Born in the Netherlands
Born in Surinam, the Netherlands Antilles, Morocco, or Turkey
Born elsewhere
Total
Source: GGD Amsterdam.
Age
The population of heroin users is getting older.
• In Amsterdam the average age of methadone clients rose from 32 in 1989 to 45 in
2004. In Rotterdam and Parkstad Limburg the average age of problem users between
1998 and 2002/2003 rose from 37 to 39.79;93
• The ageing of heroin users is accompanied by an increasing number of health problems (see § 4.7).
Manner of use
The use of opiates poses a particularly high health risk when the drugs are injected.
• Over time, the injecting of drugs has declined among opiate users (Table 4.4).
• Accordingly, the number of injectors of heroin in Parkstad Limburg dropped from 33%
of all heroin users in 1996 to 13% in 1999. This trend did not continue between 1999
and 2002.79
93
• In Rotterdam the ratio of injectors dropped from 15% in 1999 to 10% in 2003.
TRIMBOS-INSTITUUT
67
Among drug users participating in the Amsterdam Cohort Studies on HIV/AIDS, the
number who reported having injected opiates since the previous survey dropped from
57% in 1985 to 21% in 2004.94
The decline in the number of needles that are exchanged in the needle exchange programme of the GGD Amsterdam is also an indication of a drop in the practice of injecting opiates. In 1994, GGD Amsterdam exchanged 857,459 needles; by 2005 the number had dropped to 201,600.78
In 2005 10% of opiate clients of (outpatient) addiction care were registered as injectors, and 71% as smokers. The remainder took the drugs in a different way.45 In
1994, 16% of users were injecting.
The total number of injecting drug users in the Netherlands can be estimated on the
basis of the percentage of injectors among hard drug clients of the addiction care services as well as an estimate of the total number of problem hard drug users in the
country. In 2005, this calculation resulted in an estimate of about 3,100 injecting drug
users, within a margin of at least 2,200 and at most 4,300 cases.
•
•
•
•
Table 4.4
Manner of using heroin by problem users of hard drugs
Manner of use
Rotterdam
Utrecht
Parkstad Limburg
2003
1999
2002
Always inject
10%
1%
19%
Smoke and inject
10%
10%
16%
Always smoke
80%
86%
63%
Percentage of problem users by manner of use in the past 6 months. The figures in the columns do not fully
add up to 100 percent; the remainder includes other methods of intake (such as snorting). Source: MAD.
4.5 USAGE: INTERNATIONAL COMPARISON
Use among school-goers
•
•
According to the ESPAD survey in 2003 the percentage of 15 and 16 year olds in
Europe who had ever used heroin did not exceed two percent. An exception to this
was Italy where the figure was 4%. In the Netherlands, one percent of school-goers
had ever used heroin.44
The percentage of recent users was less than 1%, with the exception of Italy, (3%).
Problem use
•
•
•
68
The EU has an estimated 1.2 to 2.1 million problem users of hard drugs, i.e. between
four and seven per thousand inhabitants aged between 15 and 64. In most EU countries the hard drugs in question are (also) mainly opiates.40
The estimates are calculated using different statistical methods. Table 4.5 shows the
lowest and the highest figures per country. Owing to differences in definitions and
methods, the data should be interpreted with caution. In particular, the differences in
the estimates for Luxembourg indicate a high degree of uncertainty.
In the EU-15 national estimates vary from an average of two to ten problem users per
thousand inhabitants aged between 15 and 64. Germany, Greece and the Netherlands
are at the bottom of this list.
TRIMBOS-INSTITUUT
•
Of the new member states, the number of problem users varies from less than two
per thousand inhabitants aged 15 to 64 Cyprus, Latvia, Poland), to more than five per
thousand Malta, Slovenia, Slovakia).
Table 4.5
Problem users of hard drugs in a number of EU member states and Norway
Country
Year
Number per thousand inhabitants from 15 to 64 years
Lower limit – upper limitI
Central estimateII
Luxembourg
2000
6.2 – 13.6
9.3
U.K.
2003
8.9 – 9.7
9.2
Spain
2002
7.1 – 9.9
8.5
Italy
2004
6.9 – 8.4
7.7
Denmark
2001
6.7 – 7.7
7.2
Portugal
2000
6.8 – 8.5
7.1
Austria
2002
5.4 – 6.1
5.8
Ireland
2001
5.2 – 6.1
5.6
Finland
2002
4.6 – 6.1
5.3
Sweden
2003
4.5
4.5
France
1999
3.8 – 4.8
4.4
The Netherlands
2001
2.2 – 4.3
3.1
Greece
2004
2.3 – 3.0
2.6
Germany
2004
1.2 – 3.0
2.1
According to the EMCDDA definition of problem use: long-term/regular use of opiates, cocaine and/or amphetamines. Owing to differences in methods, the data should be interpreted with caution. For most countries
the estimates refer to opiate users, with the exception of Sweden and Finland, where amphetamine users are in
the majority. I. Maximum values based on 95% confidence intervals or sensitivity analysis. II. In countries with
a number of estimates, the average of these is used. Source: EMCDDA. 40
4.6 TREATMENT DEMAND
Outpatient addiction care
The National Alcohol and Drugs Information System (LADIS) registers the volume of people seeking treatment (outpatient) addiction care. (See appendix A: LADIS Clients.) On
account of technical problems, the Jellinek organisation for addiction care in Amsterdam
and environs was unable to submit its 2005 data to LADIS. An estimate for Jellinek has
therefore been extrapolated from the 2004 data.45
• The number of clients with a primary opium problem rose slightly up to 1997 (Figure
4.3). This increase was partly real and partly a distortion of the figures, following the
affiliation of a number of drug addiction care organisations to LADIS. The number of
opiate clients remained fairly stable between 1997 and 2000. The increase in 2001 can
be largely attributed to the affiliation of GGD Amsterdam to LADIS.d
• Between 2001 and 2004 the number of opiate clients dropped. From 2004 to 2005
there was a slight increase by 2% from 13,929 to 14,176 primary opiate clients. The
total number of clients with opiates as a primary or secondary problem remained unchanged however, between 2004 and 2005.
d
In 2001 GGD Amsterdam passed on 1,869 clients with a primary heroin problem, of whom 1,304
were not known to other organisations participating in LADIS.
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69
•
•
•
•
The percentage of opiates involved in all drug-related requests for treatment dropped
from 71% in 1994 to 44% in 2004. This is chiefly due to the rise in the number of clients with another drug problem, such as cocaine and cannabis. In 2005, the number
of requests for treatment on account of opiates remained unchanged at 44%.
The majority of clients have already sought treatment from (outpatient) addiction care
for a drugs problem. Approximately 3% were first-time clients in 2005.
The majority (70%) of primary opiate clients also had problems with another substance – mainly cocaine. 30% reported no secondary substance.
Opiates are less likely to be reported as a secondary problem (figure 4.3). When they
are, the primary problem is cocaine or crack (691%), alcohol (26%), or cannabis
(3%).
Figure 4.3
Number of clients of (outpatient) addiction care with primary or secondary
opiate problems from 1994I
Number
20000
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
Primary
Secondary
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
14002 14936 15247 15865 15491 15606 15544 17786 16043 15195 13929 14176
804
913
985
1112 1101 1313 1387 1761 1912 2056 2252 2023
The rise in the number of persons between 2000 and 2001 is due to inclusion for the first time of data from
GGD Amsterdam. For 2005, the data for Jellinek have been extrapolated. Source: LADIS, IVZ.
Age and gender
• In 2005 80% of primary opiate clients were male. Over time this percentage has fluctuated between 78% and 80%.
• In 2005 the average age was 42 – considerably higher than that of cannabis and cocaine clients. More than half of opiate clients were older than 39 (Figure 4.4).
• The percentage of young opiate clients (age 15 to 29) dropped between 1994 and
2004 from 39% to 8%. In 2005, the number dropped further to six percent.
Regional trends
During the period 2001-2005, the number of primary opiate clients dropped by an
average of three percent compared to 1996-2000. This decline occurred in most regions in the Netherlands and was most pronounced in the cities of Arnhem and Helmond (IVZ/RIVM, Health Care Atlas). The increase in the urban belt can be attributed
to an expansion of the organisations in this region that now participate in LADIS.
•
70
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Figure 4.4
30
Age distribution of primary opiate clients of (outpatient) addiction care.
Survey year 2005I
%
25
24
21
20
20
15
12
12
10
5
4
5
2
1
0
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
>59
Age
Percentage of clients per age group. I The data for Jellinek have been extrapolated. Source: LADIS, IVZ.
Methadone
The main dispensers of methadone are (outpatient) addiction care, GGD Amsterdam, GPs
and specialists. National data are available through LADIS for (outpatient) addiction care,
including GGD Amsterdam.45
• The number of methadone clients of (outpatient) addiction rose gradually up to 2002
(Table 4.6). This was partly a real increase and partly due to the addition of a number
of organisations that participate in LADIS.
Table 4.6
Methadone dispensing in (outpatient) addiction care, from 1994
Year
Number of persons
Average dose per intake (milligrams)
1994
8 882
46
1995
8 817
37
1996
9 068
38
1997
9 838
40
1998
9 754
42
1999
10 666
45
2000
10 805
48
2001I
12 538I
54I
2002
12 805
57
2003
12 048
57
2004
12 493
56
2005II
12 564II
54II
I. The rise in the number of persons compared to 2000 is due to the first-time inclusion of data from GGD Amsterdam. The increased average methadone dose may also be (partly) due to this. II. For 2005, the data for
Jellinek have been extrapolated from 2004 data. Source: LADIS, IVZ.
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71
Methadone is generally prescribed as a maintenance treatment. In a minority of cases
it is used for coming off heroin.
The average methadone dose per intake day rose between 1995 and 2003, after
which it fell slightly (table 4.6).90 In 2005 35% of clients received a (therapeutic) dose
of 60 mg methadone or more.
The amount of methadone received by a client each time depends on the methadone
policy of the organisation or practitioner in question.
•
•
•
General hospitals; incidents
Misuse of and dependence on opiates are rarely stated as the primary diagnosis in general hospitals. In 2005 the LMR listed 61 admissions with this primary diagnosis (69%
dependence and 31% misuse, Figure 4.5).
• More frequently, opiate misuse and dependence are cited as a secondary diagnosis
(594 in 2005; 80% dependence, 20% misuse). The primary diagnoses accompanying
these secondary diagnoses vary considerably. The most common in 2004 were:
- diseases and symptoms of the respiratory tract (26%)
- injury through accidents (11%; fractures, cuts, concussion)
- diseases of the digestive system (10%)
- poisoning (8%)
- misuse of or dependence on alcohol or drugs (6%)
- skin ailments (4%).
Figure 4.5
Admissions to general hospitals related to opiate misuse and dependence
from 1994
Number
900
800
751
700
742
627
607
596
634
627
674
606
558
600
556
594
500
400
300
200
100
74
71
71
71
76
79
75
81
88
51
57
61
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Opiates as main diagnosis
Opiates as secondary diagnosis
Number of diagnoses, not corrected for duplication of persons or more than one secondary diagnosis per admission. ICD-9 codes: 304.0, 304.7, 305.5 (see appendix C). Source: LMR, Prismant.
•
72
The same person may be admitted more than once per year. In addition, more than
one secondary diagnosis may be made per case. In 2005, corrected for duplication,
the total amounted to 521 persons who were admitted at least once with opiate mis-
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•
use or dependence as the main or secondary diagnosis. Their average age was 41,
and 70% were male.
In 2005, the LMR registered no cases of accidental poisoning with opiates as a secondary diagnosis (ICD-9 codes E850.0 through E850.2).
In 2005, the central post for ambulance transports (CPA) of GGD Amsterdam registered
230 emergency requests for ambulances for presumed non-fatal overdoses of hard
drugs.
• Most cases involved opiates and cocaine, with or without other substances.
• The number of hard drug-related ambulance journeys dropped from 307 in 1997 to
188 in 2000 and subsequently rose slightly, but now appears to have stabilised.
According to the Injury Information System (LIS) of the Consumer Safety Institute46, an
average of 2 900 persons are treated annually in the emergency department of hospitals,
following an accident, violent incident or self-mutilation related to drugs use. This compares to 13,000 related to alcohol, see Chapter 6.) The drugs involved are cocaine, heroin, cannabis, ecstasy, magic mushrooms and speed. The data have been averaged over
the period from 2000 through 2005.
• Heroin is cited in only four percent of cases. If we count only the cases where the drug
is known (71%), then heroin accounts for 6% of all drug-related emergency room
treatment.
• These figures are likely to be an under-estimate of the true number of drug-related
accidents.
In 2004, a study was conducted on drug use among 641 people attending the emergency
department of the Erasmus Medical Centre in Rotterdam.47
• Nine percent reported having used illegal drugs in the 24 hours prior to treatment.
• Opiates were cited by 1.7% of those interviewed.
The National Poison Information Centre (NVIC) 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.48
• The number of information requests for opiates doubled between 2000 and 2003, and
rose by 15% between 2004 and 2005 from 112 to 129 requests (table 4.7)
• A drop in the number of information requests in 2006 is related to a discontinuation of
listing methadone among the drugs. From this year on, methadone is listed among
medicines.
• These figures do not really give a complete picture of the absolute number of drug
intoxications, because intoxications are not strictly notifiable by doctors. In addition,
increasing familiarity among health care professionals with the symptoms and treatment of drug poisoning cases may reduce the need for information requests.
Table 4.7
Opiates
Information requests concerning opiate use from the National Poisons Information Centre (NVIC), from 2000
2000
2001
2002
2003
2004
2005
2006
51
42
95
112
112
129
32
Number of information requests per annum. Source: NVIC, RIVM.
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73
4.7 ILLNESS AND DEATHS
•
•
•
•
The population ageing taking place among opiate addicts is accompanied by premature age-related illnesses such as diabetes and cancer. Lung diseases caused by longterm heavy tobacco use and smoking heroin are also on the increase in this group.78
Key observers in the Eindhoven region have reported that some ageing heroin users
have partly switched to alcohol. This enables them to live in a permanently drugged
state.37 Likewise, in the Maastricht area, there are reports that older heroin addicts
frequently have a secondary alcohol addiction, which is accompanied by physical exhaustion.39 According to observers in Parkstad Limburg, the switch to alcohol by this
group has compounded their physical problems.67
In addition to their drug addiction, many heroin users are also battling with mental
disorders. According to provisional figures from a study among methadone clients in
the province of Noord-Brabant, 46% had a mood disorder and 43% suffered an anxiety disorder, in addition to the existing opiate addiction. Nine percent had a current
psychotic disorder and over one third (37%) had ever suffered one.95 The GGD Amsterdam also reports that some ten percent of opiate-addicted clients experiences a
psychotic episode annually.78
GGD Amsterdam reports an increase in psychopathology among addicts since the
early years of the drugs epidemic. Various explanations are put forward for this:
- self-selection, because addicts with an accompanying mental disorder are less likely
to recover from their addiction than those without a mental disorder
- the damaging consequences of a long-term existence on the street
- interruption of methadone treatment, for example in prison
- increase in crack cocaine use, which, without the calming effect of heroin can lead
to an exacerbation of mental problems.
HIV
By injecting with contaminated needles or by engaging in unprotected sex, hard drug
users incur a risk of becoming infected with HIV, the virus that causes AIDS. Between
1994 and 2003, the RIVM conducted sixteen surveys among a total of 3,500 injecting
hard drug users in nine regions of the Netherlands. The most recent survey of drug users
was carried out in 2002/2003 in Rotterdam.
• There are considerable regional differences in the rate of HIV infection among drug
users who have ever injected drugs (figure 4.6). HIV infection varies from 1% (Groningen, Arnhem) to 26% (Amsterdam).96
• In most of the cities that participated in more than one survey, the percentage of HIVinfected injecting drug users remained stable.
• The exception to this is Heerlen, where the number doubled from 11% in 1994 to 22%
in 1999.96 It is not known how the prevalence has since developed in this city.
97
• In 2005, the RIVM conducted a survey among 250 prostitutes in The Hague . Of the
nine drug-dependent and ever injecting prostitutes, two were HIV positive. A positive
HIV status was also found in 5 of the 25 transgender prostitutes. The remaining 167
prostitutes in the study were HIV negative. However, not only injecting drugs, but
other risk factors may have contributed to the higher rate of HIV among ever injecting
prostitutes: on average they were older, had been working as prostitutes for longer
and used more high-risk sexual techniques than the never-injecting prostitutes.
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Figure 4.6
HIV infection among injecting hard drug users
30%
26%
25%
20%
14%
15%
10%
10%
5%
5%
5%
3%
2%
1%
1%
Arnhem
1997
Groningen
1997/1998
0%
Amsterdam
1998
ZuidLimburg
1999
Rotterdam
2002/2003
Utrecht
1996
Brabant
1999
Twente
2000
The Hague
2000
Percentage of ever injecting hard drug users infected with HIV. Ever injecting means someone who has ever in
his life injected himself with a drug and has used hard drugs at least once weekly during the past six months.
Source: RIVM.96
Data from the HIV Monitoring Foundation (SHM) show that between one and two percent
annually of all registered new HIV infections in the Netherlands can be attributed to injecting drug use.
• The absolute number of new HIV infections among injecting drug users was 18 in
2001; 15 in 2002; 23 in 2003; 10 in 2004 and 10 in 2005.
• Among 596 (5%) of the 11,866 HIV infected persons who were registered up to June
2006, injecting drug use is the most probable transmission route.96
• In 2005, the median age of drug users diagnosed with HIV was 39; two out of ten
were female.96
• Deaths among HIV-positive people have been considerably reduced since the introduction of HAART (highly active antiretroviral treatment), compared to other transmission
routes. Nonetheless, HIV infection through injecting drug use remains a strong predictor of a fatal outcome. One reason for this is co-infection with Hepatitis C and lifestyle factors, such as excessive alcohol use.98
In a longitudinal study in Amsterdam conducted over the past 20 years, a sharp drop
was found in the percentage of HIV positive young drug users (< 30 years old when in
included in the study).
• In de period 1985-1989, 33.3% of this group were HIV positive; in the period 20002004 this was down to 6.6%. Among non-injecting drug users, the percentage of HIV
positive cases dropped from 11.5% to 1.5%.99
• The percentage of HIV infections among drug users who had ever injected drugs
dropped from 33% to 7%.100
• Cases of new HIV infections have been rare in this study in recent years. Where 7 new
diagnoses per 100 person-years were observed in 1986, this had dropped to 2 cases
per 100 person-years in 1995 and to 0 between 1999 and 2004. In 2005, 2 new HIV
diagnoses were made (= 1.2 new cases per 100 person-years)
• The decline in injecting drug use and in sharing needles is accompanied by a drop in
new HIV infections. However, the rate of high-risk sexual behaviour remains un-
TRIMBOS-INSTITUUT
75
changed and the few new HIV infections seen in recent years can mainly be attributed
to unprotected heterosexual contact.94
International comparison
Data about HIV infection in a number of EU member states emanate from a variety of
sources and differ in range. Furthermore, within a given country, the situation at local
level may diverge strongly form the general national picture. The data are therefore not
easily comparable and merely reflect an indication of the degree of contamination.40
• Figure 4.7 shows that the percentages of HIV positive injecting drug users varies from
less than one percent in Greece (data from 2004) to 10-36% in Spain (data from 2002
to 2003).40
• Figure 4.7 also shows that in a number of countries, such as the Netherlands, there is
considerable regional or local concentration of HIV infection.40
• Although there were a number of fairly recent incidents of HIV contamination from
injecting drug use in Estonia (2001), Latvia (2001) and Lithuania (2002), the percentage of new HIV infections among injecting drug users remains low in most European
countries. According to EMCDDA data, there are indications in some countries, however, of an increase in new HIV infections among injecting drug users.
- After an initial drop in the number of new cases in Ireland (from 18.3 per million
persons in 2000 to 9.8 per million in 2001), an increase was reported to 17.8 new
HIV cases per million inhabitants in 2004.
- France reported a rise from 2.3 new HIV cases per million in 2003 to 2.9 in 2004.
However, these data may be affected by the fact that HIV registration was only introduced in 2003 and new registration systems are often unreliable in the early
years.
- Doubt is now cast on an earlier reported drop in new HIV cases in Portugal, because this country reported 98.5 new HIV-positive cases per million people in 2004,
the highest rate in Europe.40
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Figure 4.7
Percentage of injecting drug users with HIV in the EU member states and
Norway
The data were derived from different sources (random samples, treatment centres, prisons, needle exchange
programmes). The percentages in brackets refer to local sources. The colours indicate the degree of contamination according to median values. Data from Italy and Portugal also contain information about non-injectors. It
can be assumed that the percentage of HIV cases among injectors is an underestimation. Differences in survey
year, measuring methods and sampling hamper a precise comparison between countries.
*Data partly or entirely for 2003 (Spain 2002-2003; France 2002-2003; Latvia 2002-2003; The Netherlands
2002). The data from Estonia are from 2005.
Source: EMCDDA.
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77
Hepatitis B and C
A chronic hepatitis B (HBV) or hepatitis C (HCV) infection can cause serious forms of liver
inflammation. HBV is transmitted by blood contact, for example via intravenous injecting
with used needles or via unsafe sexual contact. HCV can virtually only be transmitted by
direct blood-blood contact. HCV is much more contagious than HIV and can also be
transmitted by sharing other injecting materials than needles.
• Data about HCV and HBV among injecting hard drug users are not collected systematically in the Netherlands. The available figures for a number of locations in the Netherlands are not recent (table 4.8).
• When the last measurement was taken, about three-quarters of injecting hard drug
users in Rotterdam and Heerlen/Maastricht were infected with HCV, and a slightly
lower percentage was infected with HBV. The picture was less grim in The Hague. As
yet there is no direct explanation for this.96
Table 4.8
Hepatitis B and C infections among random samples of hard drug users in
Rotterdam, Heerlen/Maastricht and The Hague
Year
Rotterdam
1994
Heerlen/Maastricht
1996
II
1998/1999
2000
Den Haag
I
HCV-positive
HBV-positive
56% of IDU
27% of non-IDU
63% of IDU
67% of IDU
79% of IDU
13% of non-IDU
74% of IDU
35% of IDU
47% of IDU
IDU= ever injecting hard drug users surveyed on the street and at care locations. HBV = Hepatitis B virus. HCV
= Hepatitis C virus. I. Tested positive for anti-HBc, a marker for an earlier or current hepatitis B infection. II.
7% were HbsAg- positive, indicating a current hepatitis B infection. Source: RIVM.
In a longitudinal study in Amsterdam, the percentage of HCV infections among ever injecting drug users was found to be 65 percent in 2005.
• Women were found to be more likely to have a HCV infection (four-fifths of the women
tested, as opposed to half the men), as were older drug users and users who had
started injecting the furthest back in time.
• In recent years there has been a drop in the percentage of drug users reporting risk
factors associated with contracting HCV, such as recent injecting, long-term injecting
and sharing injecting materials.99
Injecting drug use is relatively often the reason for new HCV infections. This is not the
case for HBV infections.
• In 2005 the Public Health Care Inspectorate (IGZ) registered 299 cases of acute
hepatitis B infection, where the cause of infection was known. In none of these cases
was the infection caused by injecting drug use (source: RIVM). In only 1.4 percent of
the 1, 480 notifications of chronic hepatitis B infection was injecting drug use the
transmission route. However, for a quarter to a third of the notified cases, the manner
of virus transmission was unknown.
• Of the 19 cases of acute or recent HCV infection in 2005, the transmission route was
known in 11 cases; in 5 of these it was injecting drug use.101 Chronic HCV infection
among drug users is no longer notifiable since 2003; consequently there is a lack of
data.
• A study on blood donors in the Netherlands has shown that although the risk of
transmitting HCV via a blood transfusion is extremely low, former injecting drug user,
78
TRIMBOS-INSTITUUT
recipients of blood transfusions and immigrants belong to the most high risk groups in
terms of transmitting HCV.102
Since 1998 drug users and other risk groups are offered a vaccination against HBV. According to data from GGD Nederland, over 10,500 drug users had availed of this up to
September 2006. This group comprises ever and recent injectors as well as never injectors. Of the total group almost one percent were chronic HBV carriers. Almost 15% had
ever contracted hepatitis B and were now immune.
International Comparison
Data on HCV are not easily comparable between countries on account of differences in
sources and methods of data collection. The data only give an indication of the rate of
infection.
• EMCDDA data indicate that in the EU member states, HCV occurs very frequently
among injecting drug users, although there appears to be considerable disparity in
and between countries.40 Countries with a HCV infection rate of over 60% among injecting drug users are Belgium, Denmark, Germany, Greece, Spain, Ireland, Italy, Poland, Portugal, the U.K., Romania and Norway. An infection rate of less than 40% is
reported by Belgium, the Czech Republic, Greece, Cyprus, Hungary, Malta, Austria,
Slovenia, Finland and the U.K.
• High rates of HCV infection have also been found among young injectors, and among
drug users who started injecting recently (less than two years ago). This is an indication that in Europe, young drug users continue to exhibit at-risk behaviour.
40
• Likewise there is considerable variation in HBV infection.
Random samples yield results ranging from over 60 percent (Italy and Poland) to less than 20 percent (Belgium, Ireland, Cyprus, Austria, Portugal, Slovenia, Slovakia and the U.K.). These figures refer to ever having had a HBV infection.
• By contrast to the Netherlands, acute HBV infections in other Northern European countries are mainly found in injecting drug users. In a number of these countries, hepatitis B epidemics coincide with an increase in injecting drug use.
High-Risk Behaviour
Since the 1990s there has been a strong decline in the use of borrowed syringes among
injecting drug users. Injecting drugs is also less common (see also § 4.3).
• This trend has been found among the injecting drug users who participated in studies
such as the Amsterdam Cohort Studies on HIV/AIDS. The percentage of visits to the
GDD in which they reported having borrowed used syringes since the previous visit
dropped from 47% in 1986 to 9% in 2004. The decline was sharpest after 1996.94
• Recent data are lacking however, for most cities and areas. According to the most recent surveys, between 8% and 30% of injectors sometimes borrow needles or syringes.103
• Apart from dirty syringes, other used materials are borrowed when injecting drugs;
these include spoons, swabs, filters or water used for rinsing.
High-risk sexual activity remains widespread, however.
• The number of visits to the GGD 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, (from19962004) this percentage remained stable.94
• 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
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79
(76-96 percent), followed by casual partners (39-73 percent) and clients (13-50 percent, table 4.7).
Table 4.9
Borrowing syringes and high-risk sexual activity among injecting hard drug
users
Borrowing
syringes or
needlesI
No condom steadyII partner
No condomII
casual partner
No condomII
clients
1996
18%
76%
40%
30%
1998
12%
85%
47%
29%
1994
18%
91%
47%
20%
1997
10%
84%
54%
31%
8%
85%
43%
32%
1994
19%
86%
61%
13%
1996
17%
87%
39%
17%
1999
10%
89%
49%
25%
Utrecht
1996
17%
84%
45%
17%
Arnhem
1991/1992
42%
-
-
40%
1995/1996
39%
90%
51%
21%
1997
16%
96%
53%
22%
Groningen
1997/1998
11%
89%
57%
24%
BrabantIV
1999
17%
88%
61%
17%
The Hague
2000
21%
84%
73%
40%
TwenteV
2000
30%
92%
68%
50%
Region
Survey year
Amsterdam
Rotterdam
2002/2003
ZuidLimburgIII
I. Percentage of ever injecting hard drug users who had borrowed syringes or needles from others during the
past 6 months. II. Not always used condoms in the past 6 months. III. Heerlen and Maastricht. IV. Eindhoven,
103
Helmond, Den Bosch. V. Almelo, Hengelo, Enschede. - = unknown. Source: RIVM.
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 230 - 280
cases in more recent years.96 This decline is partly due to the availability of effective
anti-retroviral drugs (HAART). These 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: 10% on average, with a peak of 14% in
1995. In 2005 six percent (17 cases) of Aids notifications involved an injecting drug
user. Up to and including 2005, there were a total of 659 patients.96
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.
• In Western Europe, the countries with the highest percentages of new AIDS diagnoses
among drug users are Spain, France, Italy and Portugal. Portugal has 31 new AIDS
cases per million inhabitants annually (among drug users), which is the highest percentage in Europe. This is closely followed by Latvia, with 30 new AIDS diagnoses in
80
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•
drug users per million inhabitants. In Latvia, as is the case in Estonia, this represents
an increase in the annual new AIDS cases among drug users.40
There are no data available for the availability of HAART for drug users.40 According to
WHO estimates from 2003, some 70% of all inhabitants of Western Europe who
needed anti-retroviral treatment were able to get it. The percentage was much lower
in Eastern Europe. The data were much more positive in 2005, when at least 75% of
Eastern Europeans were estimated to have access to HAART drugs.
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 to
the EMCDDA standard for calculating direct drug deaths, both accidental and nonaccidental overdoses (suicide) are included, as well as cases where it has not been determined whether the poisoning was accidental or not.104;105
Between the mid-1990s and 2001, there was a rise across the spectrum –not only for
opiates - in the number of registered deaths from overdose (Figure 4.8).
Figure 4.8
Deaths from drug overdose in the Netherlands from 1985
Number
160
140
120
100
80
60
40
20
0
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Total
57
68
54
51
56
70
80
75
75
87
70
108
108
110
115 131
144
103
104 127
Opiates
51
67
49
47
54
62
76
72
68
77
56
81
71
71
63
68
75
37
53
52
122
60
Cocaine
3
1
3
2
1
3
1
2
3
2
6
10
8
11
12
19
26
34
17
20
23
Other
3
0
2
2
1
5
3
1
4
8
8
17
29
28
40
44
43
32
34
55
39
Number of deaths. From 1985-1995 ICD-9 codes: 292, 304.0, 304.2-9, 305.2-3, 305.5-7, 305.9, E850.0,
E850.8*, E854.1-2, E855.2, E858.8*, E950.0*, E950.4*, E980.0*, E980.4* (*In combination with codes
N965.0 and/or N968.5 and/or N969.6 and/or N969.7). From 1996 ICD-10 codes: F11-F12, F14-F16, F19, X42*,
X41*, X62*, X61*, Y12*, Y11* (*In combination with the T-codes T40.0-9, T43.6). For an explanation of the
codes: see appendix C. Source: Cause of death statistics, Statistics Netherlands (CBS).
•
This trend can be partly attributed to an increase in cocaine-related deaths (see §
3.7).
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81
•
•
•
The transition from classification system ICD-9 to ICD-10 also plays a part in the increase. A greater number of cases may possibly be counted as drugs deaths since
1996 according to the ICD-10 than was formerly the case with the ICD-9.
Between 1996 and 2001 there was also a rise in the number of cases of “poisoning by
other or unspecified narcotics” and “poisoning by other or unspecified psychodysleptics”. These cases often involve (combinations) of hard drugs, with or without other
substances, and sometimes also (combinations) of medicines and/or alcohol.
In 2002 there was a drop in the number of deaths; this was followed by a rise in 2004
which levelled off in 2005.
The number of registered deaths by opiate overdose is low in the Netherlands.
Until 2001 this number fluctuated between 47 and 77 cases per annum. The initial
drop in 2002 and 2003 did not continue during the last three years.
• As is the case with opiate users in general, overdose victims are also getting older.
From 1985 through 1989, only 16% of these were older than 34, compared to 67%
between 2000 and 2005 (Figure 4.9).
•
Figure 4.9
Age distribution of deaths from overdose of opiates in the periods
1985-1989, 1990-1994, 1995-1999 and 2000-2005
%
100%
80%
60%
40%
20%
0%
1985-1989
1990-1994
1995-1999
2000-2005
>=65
1
4
3
6
35-64
15
35
50
61
15-34
82
61
47
34
0-14
1
0
0
0
Percentage of deaths per age group. Source: Cause of Death Statistics, CBS.
Total deaths
The EMCDDA protocol charts only the volume of acute (overdose) deaths. Drug users
may also die of other causes, such as accidents and illnesses incurred by injecting drugs
(indirect drug-related deaths). In addition, drug users may die of causes that are neither
directly nor indirectly related to their drug habit (age-dependent basic death rate) These
three components – overdose, indirect and basic death rate – constitute the total death
rate among drug users.
• By means of data on deaths among drug users in Amsterdam (see following paragraph) and the estimate of the total number of problem hard drug users in the Netherlands, an estimate can be made of the total death rate.
• An estimated 480 problem hard drug users died in the Netherlands in 2001. This figure lies within margins of at least 340 and at most 660 deaths.
82
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•
Of these total deaths, it is estimated that 11% can be attributed to the basic death
rate that is not related to drugs; 23% are related directly to drugs and 66% are related indirectly to drug use.106
Amsterdam
GGD Amsterdam reports the number of deaths among drug users on an annual basis
(Figure 4.10). Unlike the cause of death figures of Statistics Netherlands (CBS) the overdose deaths registered by GGD Amsterdam also include deaths among illegal immigrants
and tourists. The register also takes account of opiate users in Amsterdam who died of
causes other than an overdose.
• In 2005, 29 drug users in Amsterdam died following an ‘overdose’ of drugs, often opiates with or without other substances.
• Deceased opiate clients have usually died of causes other than an overdose (see note
to Figure 4.11). As they grow older, opiate users are more likely die of underlying
conditions such as diseases of the lungs, liver or heart.
- The drop in the number of deaths registered in the early 1990s did not continue
through the mid-1990s. After a sharp rise in 2004 in the category ‘other causes of
death’, the number in this category rose in 2005 (figure 4.10).
Deaths among drug users in Amsterdam, from 1992I
Figure 4.10
Number
160
140
120
100
80
60
40
20
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Overdose
52
37
39
26
26
22
25
27
31
32
29
21
22
29
Other causes
83
102
86
92
90
76
67
73
76
112
96
128
61
84
Total
135
139
125
118
116
98
92
100
107
144
125
149
83
113
I. Other causes of death (such as endocarditis, sepsis, lung disease, liver cirrhosis, suicide, accidents, violence,
AIDS) of persons registered with the GGD Amsterdam as ever having used opiates. Source: GGD Amsterdam.
International Comparison
• Annually, between seven and nine thousand people in the EU die following a drug
overdose, often involving opiates in combination with other substances. This can e
seen as the minimum number, since not all cases of drug-related deaths are registered.40
• According to national definitions and registrations of drug deaths, the number of drug
deaths per 100,000 inhabitants varies from almost zero to five. The highest rates are
reported in Denmark, Estonia, Luxembourg, Finland, the U.K. and Norway.
• International comparison of the number of ‘drug deaths’ is hampered by discrepancies
in the definition of this term.
- Figure 4.11 shows the number of deaths per 100,000 inhabitants directly related to
drug use for five EU member states and Norway. In the case of these countries it
TRIMBOS-INSTITUUT
83
was possible to use the same ICD-10 codes, thus removing a major source of disparity among the countries.
- The codes refer to opiates, hallucinogens, cocaine, amphetamines and cannabis.
The majority of cases (also) include opiates.
- According to these figures, Norway and Denmark top the list, although a sharp
downward trend has been visible in Norway since 2001. The Netherlands is at the
bottom.
Figure 4.11
Acute deaths from taking drugs: a comparison of six EU member states
plus Norway based on the same ICD codes
Number per 100,000
inhabitants
9
8
7
6
5
4
3
2
1
0
1994
1995
1996
4.3
5.5
4.1
4.6
United Kingdom
2.4
2.5
2.8
Finland
2.1
1.9
1.7
1.5
Norway
Denmark
Sweden*
1997
1998
1999
2000
2001
2002
2003
3.9
5.9
5.0
7.7
8.2
6.0
4.9
4.8
4.5
4.5
4.5
3.0
3.3
3.1
3.1
2.4
2.3
2.6
2.1
1.9
1.9
1.6
1.8
2.2
1.9
1.8
1.7
1.6
1.6
1.8
1.5
1.4
1.4
0.7
0.7
0.8
0.9
0.6
0.6
Germany
The Netherlands
0.7
0.7
2004
2.6
0.8
ICD-10 codes: F11-F12, F14-F16, F19, X42*, X41*, X62*, X61*, Y12*, Y11* (*In combination with the T-codes
T40.0-9, T43.6). I. For better comparability, T40.4 is not counted in Sweden. Source: EMCDDA.
•
84
Data from the EMCDDA show that the number of acute deaths due to drugs at European level rose from the early 90s until 2000. In the new EU member states, this rise
occurred chiefly among young drug users (aged under 25). From 2000 a general
downward trend is evident, however, this did not continue in 2003 and 2004.
TRIMBOS-INSTITUUT
5
ECSTASY, AMPHETAMINES AND RELATED
SUBSTANCES
The official name for ecstasy is 3,4-methylenedioxymethamphetamine (MDMA). Other
substances that are chemically similar to MDMA – or indeed substances that bear no resemblance to it - are also sold as ecstasy without the user being aware of the difference.
These include MDA, MDEA, MBDB and amphetamines. In this chapter, unless otherwise
indicated, ‘ecstasy’ is understood to mean substances that are taken or passed off as
ecstasy. By amphetamines we mean ‘ordinary’ amphetamine - and methamphetamine,
the stronger variant - unless otherwise indicated.
Ecstasy has a stimulating and entactogenic effect. An entactogenic effect means that
people feel drawn to each other and make contact more easily. This combination of qualities has contributed to ecstasy’s reputation as a party or dance drug. The addictive effect
is thought to be low. Ecstasy is generally swallowed in the form of tablets. Sometimes it
is dissolved as a powder in a drink and then taken. Amphetamine also has a stimulating
effect, stronger than ecstasy, but has no entactogenic effect. Amphetamine is used socially, but also by opiate or polydrug addicts. Frequent use can lead to dependence. This
risk is greater for methamphetamine than for ordinary amphetamine. In the Netherlands,
amphetamines are generally swallowed or snorted, and sometimes injected. Methamphetamine is sometimes smoked.
5.1 RECENT FACTS AND TRENDS
The most important facts and trends about ecstasy and amphetamines in this chapter
are:
• The percentage of ever users and recent users of ecstasy in the general population
rose between 2001 and 2005. The percentage of current ecstasy users remained stable (§ 5.2).
• Amphetamines are less popular than ecstasy. Between 2001 and 2005 the use of this
substance in the general population remained stable (§ 5.2).
• Between 1996 and 2003 the percentage of school-going adolescents that had ever
used these substances dropped somewhat. There was also a drop in the percentage of
current users (§ 5.3).
• Compared to a number of other EU member states, the percentage of recent ecstasy
users in the Netherlands is on the high side (§ 5.5).
• In Amsterdam the popularity of ecstasy has peaked. Nationwide, ecstasy remains
popular among young revellers, particularly at discos and (rave) parties. (§ 5.3).
• The number of primary ecstasy clients seeking treatment from (outpatient) addiction
care is small, and remained fairly stable in recent years. However, there has been an
increase in the number of female clients (§ 5.6).
• The rise in the number of primary clients since 2001 with a primary amphetamine
problem continued between 2004 and 2005 (§ 5.6).
• The number of admissions to general hospitals with a primary diagnosis of misuse of
or dependency on amphetamine(-like substances) is low, but has risen somewhat in
recent years (§ 5.6).
• Nowadays, Ecstasy pills almost always contain an MDMA-like substance. However,
between 2005 and 2006 there was an increase in the number of pills (also) containing
mCPP (§ 5.8).
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85
•
•
After increasing between 2002 and 2005, the percentage of ecstasy pills with a high
dose of MDMA dropped in 2006 (§ 5.8).
Research has shown that heavy ecstasy use can cause long-term disruption of certain
brain functions. However, this does not necessarily mean that occasional ecstasy use
is safe, although the effects on mental functioning of using a low dose are subtle (§
5.7).
5.2 USEAGE: GENERAL POPULATION
•
•
•
•
•
The number of Dutch people aged between 15 and 64 that had ever used ecstasy increased between 2001 and 2005 (table 5.1). The percentage of recent and current users remained stable during this period.4
Considerably fewer people have ever or recently used amphetamines. Their numbers
remained stable between 2001 and 2005.
The percentage of current users for both ecstasy and amphetamines remained well
below one percent.
In absolute terms, the number of current ecstasy users in 2005 amounted to 40,000,
while there were 21,000 current amphetamine users. These estimates are probably on
the low side, because problem users of hard drugs were under-represented in the survey in question.
The annual increase in new ecstasy users remained stable between 2001 and 2005.
For amphetamines, the drop between 2001 and 2005 is significant. This may be an indication of a slight loss of popularity of this substance.
Table 5.1
Use of ecstasy and amphetamines among people aged between 15 and 64
in the Netherlands. Survey years 1997, 2001 and 2005
Ever use
Recent useI
Current useII
Used for the first time in the past
year
Average age of recent users I
1997
2.3%
0.8%
0.3%
Ecstasy
2001
3.2%
1.1%
0.3%
2005
4.3%
1.2%
0.4%
1997
2.2%
0.4%
0.1%
Amphetamine
2001
2.0%
0.4%
0.0%
2005
2.1%
0.3%
0.2%
0.5%
0.5%
0.3%
0.2%
0.2%
0.1%
25.1
26.6
28.1
25.8
27.0
25.9
Number of respondents: 17 590 (1997), 2 312 (2001), 4 516 (2005). I. In the past year. II. In the past month.
4
Source: NPO, IVO.
Age, Gender and Urbanisation Level
•
•
86
For both ecstasy and amphetamines, the percentage of ever user is three times higher
in males than in females. The figures for 2005 are 6.6% and 1.2% for ecstasy and
3.2% and 1.0% for amphetamines respectively.4
Ever use of ecstasy occurs most in very highly urbanised areas (9.6%) and least in
non-urban areas (2.0%). For amphetamines, the differences are less pronounced but
the same pattern is visible (4.1% in very highly urbanised areas, versus 1.3% in nonurban areas.
TRIMBOS-INSTITUUT
•
•
•
•
People in the 25 to 44 year age group have the most experience with ecstasy (7.1%
versus 5.1% among 15-24 year olds and 0.9% among 45-64 year olds). For amphetamines, there are no differences in ever use between the age groups.
The number of recent and current ecstasy- and amphetamine users is too small for a
breakdown by age, gender and urbanisation.
The average age of recent ecstasy users has risen from 25 in 1997 to 28 in 2005. The
difference between 2001 and 2005 was not significant. For amphetamines, no differences have been found over the years.
The age of onset is the age at which an individual first used a substance (see also appendix A: age of onset). Among ever users in the 15 to 24 age group, the age of onset
averaged 17.3 years for ecstasy and 17.4 years for amphetamines. In the 15 to 64
age group, the age of onset averaged 22.2 for ecstasy and 21.6 for amphetamines.
5.3 USAGE: JUVENILES AND YOUNG ADULTS
School-goers
•
•
•
From 1992 to 1996 there was a rise in the percentage of ecstasy and amphetamine
users among pupils in mainstream secondary schools.8
For both drugs, the percentage of ever users dropped more rapidly between 1996 and
1999 than between 1999 and 2003.
The percentage of current users of ecstasy and amphetamines dropped between 1996
and 1999 and subsequently stabilised between 1999 and 2003 (Figure 5.1).
Figure 5.1
Use of ecstasy and amphetamines among school-goers aged 12 to 18 from
1992
%
Ecstasy
7
6
7
%
Amphetamines
6
5.8
5.3
5
5
4
4
3.8
3.4
3
2.9
2.3
2
3
2
2.8
2.2
1.4
1
1.2
1.0
2.2
1.9
1.1
1
0.8
0.6
0
0
1992
1996
Ever
1999
2003
Current
1992
1996
Ever
1999
2003
Current
Percentage of ever users and current users (past month). Source: Dutch National School Survey, Trimbos Institute.
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87
Special groups
In certain groups of young people there are relatively more users of ecstasy and amphetamines. Table 5.2 contains a summary of the results of various studies.
The figures are not mutually comparable because of differences in age groups and research methods. Trend data are only available for Amsterdam.
After cannabis, ecstasy remains the illegal drug of choice for young people in the social
scene, particularly at ‘raves’, albeit with signs of stabilising use.
• By far the highest percentage of ecstasy users in 2001-2002 was reported among frequenters of rave parties.107
• Among frequenters of mainstream bars, student bars, gay bars and hip bars in Amsterdam, the percentage of current ecstasy users remained stable between 2000 and
2005 (7% and10% respectively, i.e. not a significant difference).17 In the hip bars and
gay bars, the percentage of ecstasy users is twice as high as in mainstream and student bars.
• Among frequenters of fashionable clubs in Amsterdam the percentage of current users
halved from 41% in 1998 to 19% in 2003. In The Hague, the percentage of ecstasy
users among young socialisers was around the same level in 2003.21
• It is not known whether the declining/stabilising trend in Amsterdam is taking place
elsewhere. There are no trend figures for other regions. However, key observers
throughout the country have indicated that despite some exceptions, young people
socialising, particularly in clubs, are behaving more ‘sensibly’ with ecstasy and are
more aware of the risks involved. However, large-scale rave parties attract a younger
clientele that uses more ecstasy than the average clubber; even at parties nonetheless, usage appears to have stabilised.
• The experience or expectation of negative physical or emotional consequences of using ecstasy such as headache, dizziness, anxiety or depression appears to be deterring
young people from using ecstasy.107;108 The shift in music culture from dance (with a
mainly western clientele) to urban (with more ethnic influences) may also play role in
the stabilisation or moderation of ecstasy use, particularly in the club scene.18
• In nightlife settings, ecstasy is often taken with other substances, such as alcohol,
cannabis and amphetamines. According to the observations of health workers at rave
parties, the number of symptoms and incidents following the combined use of alcohol
and ecstasy is increasing.18 There is a lack of data, however.
Amphetamines are less popular among young people out on the town than ecstasy.
• Among frequenters of mainstream bars, student bars, gay bars and hip bars in Amsterdam, the percentage of ever users of this drug stabilised at 17% between 2000
and 2005. The percentage of current users stabilised during this period at 2%.17
• Although there are no definite figures concerning amphetamine use in other regions,
key observers in the social scene are of the opinion that amphetamine use is fairly
stable and not very widespread.18 The substance often has a negative image. At hardcore gatherings and in certain (alternative) scenes, amphetamine use is somewhat
more prevalent (punk, electro, trance, underground, rock and techno) than in fashionable clubs. In these settings, usage may possibly be on the increase.18;20
A survey among juvenile detainees shows that ecstasy and amphetamine use prior to
detention is considerably higher among girls than among boys.27 This may involve a
highly deviant group.
88
TRIMBOS-INSTITUUT
Table 5.2
Use of ecstasy and amphetamine in special groups
Location
Survey
year
Age
(years)
Socialising Youth
Attending dance parties, outdoor music
festivals, city centre
• Attending Raves
•
•
•
Bar-goers
Bar-goersI
Frequenters of bars
and sports canteens
• Disco-goers
• Clubbers
•
•
Coffee shop clients
Ecstasy
Amphetamine
Ever
35%
Current
17%
Ever
-
Current
-
14 - 43
Avge. 22
76%
65%
-
-
14 - 44
Avge. 25
Avge. 27
Avge. 23
17%
34%
32%
20%
7%
10%
7%
6%
7%
17%
17%
-
2%
2%
2%
-
AmsterdamIV
Nijmegen
2006
1998
2003
2001
2005-6
Avge.
Avge.
Avge.
Avge.
Avge.
17%
66%
33%
63%
40%
5%
41%
19%
23%
13%
7%
45%
34%
39%
25%
3%
13%
7%
5%
6%
7% (b)
15% (g)
9% (b)
3% (g)
18%
8%
8% (b)
13% (g)
12% (b)
14% (g)
47%
26%
3% (b)
4% (g)
3% (b)
0% (g)
10%
2%
The Hague
2003
Four
raves 2001-2
distributed
throughout
the country
Zaandam
2006
AmsterdamII
2000
2005
Noordwijk
2004
NijmegenIII
Amsterdam
15 - 35
21
26
26
25
27
Problem youth
•
Juvenile detaineesV
Regional
2002/2003
14 - 17
•
School drop-outsV
Regional
2002/2003
14 - 17
•
Homeless youthVI
Nationwide
Flevoland
1999
2004
15 - 22
13 - 22
18%
34%
20%
16%
55%
38%
(b)
(g)
(b)
(g)
Percentage of ever users and current users (last month) per group. The figures in this table are not mutually
comparable because of differences in age group and research methods. b = boy; g = girl.
I. Juveniles and young adults from mainstream bars, student bars, gay bars and hip bars. Therefore not representative of all bar-goers. II. Low response (26%). III. Low response (19%). IV. Low response (15%). V. Research in the provinces of Noord-Holland, Flevoland and Utrecht. Use among juvenile detainees: in the month
prior to detention. School drop-outs are juveniles who have not attended school for at least one month during
the past 12 months, not counting holidays. VI. Young people aged up to 23 who have had no fixed abode for at
least three months. References: 16;17;22-24;26-30;70;107
5.4 PROBLEM USE
•
It is not known how many problem users of ecstasy and amphetamines there are, i.e.
people who are impeded in their daily functioning by their drug use or even become
addicted. However we do know how many seek treatment (see § 5.6).
5.5 USAGE: INTERNATIONAL COMPARISON
General population
Table 5.3 presents data on the use of ecstasy and amphetamines in a number of EU
member states, Norway, Australia, Canada and the US.
• Differences in survey year, measuring methods and sampling hamper a precise comparison. The main factor of influence is the age group. Table 5.3a shows usage figures
that have been (re)calculated according to the standard age group of the EMCDDA (15
TRIMBOS-INSTITUUT
89
to 64). Figures for the other countries are contained in Table 5.3b. For Europe only
countries in the EU-15 plus Norway are included. Appendix F shows usage figures for
the other EU member states, where available.
Table 5.3a
Use of amphetamines and ecstasy in the general population of a number of
EU-15 member states and Norway: age group 15 to 64
Country
Year
Ecstasy
Amphetamines
Ever
Recent
Ever
Recent
Northern Ireland
2002/2003
5.9%
1.7%
3.9%
0.8%
The Netherlands
2005
4.3%
1.2%
2.1%
0.3%
Spain
2001
4.2%
1.9%
3.0%
1.2%
Ireland
2002/2003
3.8%
1.1%
3.0%
0.4%
Finland
2004
1.4%
0.5%
1.9%
0.6%
Norway
1999
1.3%
0.7%
3.8%
1.2%
Luxembourg
1998
1.2%
-
-
-
France
2000
0.9%
0.2%
1.5%
0.2%
Portugal
2001
0.7%
0.4%
0.5%
0.1%
Greece
2004
0.4%
0.2%
0.1%
0.0%
Belgium
2001
-
-
2.1%
-
Differences in survey year, measuring methods and sampling hamper a precise comparison between countries.
40
Percentage of ever users and recent users (past year) - = not measured. References:
Table 5.3b
Ecstasy and amphetamine use in the general population of a number of
EU-15 member states, the US, Canada and Australia: other age groupsI
Country
Year
Age
Ecstasy
Amphetamines
Ever
Recent
Ever
Recent
Australia
2004
14 +
7.5%
3.4%
9.1%
3.2%
The U.K.
2004
?
6.7%
1.9%
11.7%
1.5%
US
2005
12 +
4.7%
0.8%
7.8%
1.1%
Canada
2004
15 +
4.1%
1.1%
6.4%
0.8%
Germany
2003
18 - 59
2.4%
0.8%
3.4%
0.9%
Italy
2003
15 - 54
1.8%
0.4%
1.9%
0.2%
Denmark
2000
16 - 64
1.0%
0.5%
5.9%
1.3%
Sweden
2000
16 - 64
0.2%
0.2%
1.9%
0.2%
Differences in survey year, measuring methods and sampling hamper a precise comparison between countries.
Percentage of ever use and recent use (past year). I. Drug use is relatively low in the youngest age groups
(12-15) and in the oldest age groups (>64). Usage figures in studies with respondents who are younger and/or
older than the EMCDDA-standard may be lower than in studies that use the EMCDDA-standard. The opposite
40-43;43
will be true for studies using a more restricted age range. References:
•
•
90
With regard to ever use of ecstasy, Australia, the U.K. and Northern Ireland top the
list with values of almost six percent or higher. In the Netherlands, 4% have ever
used ecstasy. In Denmark, France, Portugal, Greece and Sweden the percentage of
ever users does not exceed one percent. Of the new member states, the Czech Republic stands out with a rate of seven percent (appendix F).
The percentage of ever users of amphetamines ranges from less than 1% in Portugal
and Greece to 9% in Australia, with a high of 12% in the U.K. 2% of people in the
TRIMBOS-INSTITUUT
•
Netherlands have ever used amphetamines. In the new member states, ever use of
amphetamines remains below 3% (appendix F).
Of the countries shown in Tables 5.3a and 5.3b, the percentage of recent users is
highest for both substances in Australia, at over 3%. In the EU-15 member states, the
figures for recent ecstasy use range from almost zero to two percent. At 1.2% the
Netherlands belongs to the upper echelons for ecstasy use. Of the new member
states, the Czech Republic and Cyprus top the list with 3.5% and 2.5% respectively
for recent ecstasy use (appendix F).
Juveniles and young adults
The data from the ESPAD-study on school-goers aged 15 and 16 in European countries
lend themselves better to comparison. Table 5.4 shows the use of ecstasy and amphetamines in a number of EU states and Norway. Belgium, Germany and Austria only participated in the 2003 wave of the survey. The US did not take part in ESPAD but conducted
comparable research.44
Table 5.4
Ecstasy and amphetamine use among school-goers aged 15 and 16 in a
number of EU member states, Norway and the US. Survey years 1999 and
2003
Ecstasy
Amphetamine
1999
2003
2003
2003
2003
Ever
Ever
Recent
6%
6%
3%
Ever
Ever
Recent
16%
13%
Austria
-
3%
2%
9%
-
4%
Ireland
5%
5%
4%
2%
3%
1%
Belgium
-
0%
4%
3%
-
2%
The Netherlands
1%
4%
5%
3%
2%
1%
1%
United Kingdom
3%
5%
3%
8%
3%
2%
France
3%
4%
-
2%
3%
-
Germany
-
3%
2%
-
5%
3%
Denmark
3%
2%
2%
4%
4%
3%
Norway
3%
2%
1%
3%
2%
1%
Italy
2%
3%
2%
2%
3%
2%
Greece
2%
2%
2%
1%
0%
0%
Portugal
2%
4%
2%
3%
3%
2%
Finland
1%
1%
1%
1%
1%
0%
Sweden
1%
2%
1%
1%
1%
1%
US
1999
Percentage of ever users and past year users (recent). The US did not take part in the ESPAD, but conducted
comparable research. - = not measured. Source: ESPAD.
•
•
In 2003, the percentage of school-goers that had ever taken ecstasy was lowest in
Finland, Greece, Denmark, Norway and Sweden (2% or less). The US topped the list
with 6%, followed by the Netherlands, Ireland and the UK with five percent. The percentage of recent users varied between one percent in Finland, Sweden and Norway,
to three percent in the Netherlands, Belgium, the U.K. and the US.
Of the countries listed in Table 5.4, the US scored by far the highest for recent amphetamine use (13%), followed by Germany, Austria and Denmark (4% - 5%). The
TRIMBOS-INSTITUUT
91
Netherlands together with Finland, Greece, Ireland and Sweden occupied the lowest
position. The percentage for recent use was highest in the US (9%). In the other
countries in table 5.4 between 0 and 4% of school-goers had used amphetamines in
the past year.
5.6 TREATMENT DEMAND
Outpatient addiction care
The National Alcohol and Drugs Information System (LADIS) registers the number of people seeking treatment from (outpatient) addiction care services, including the addiction
probation and aftercare services and the addiction clinics that are merged with the outpatient addiction care services. (See Appendix A: LADIS clients.) On account of technical
problems, the Jellinek organisation for addiction care in Amsterdam and its environs was
unable to submit its data for 2005 to LADIS. The 2005 estimate for Jellinek has therefore
been extrapolated on the basis of 2004 data.45
Ecstasy
•
The number of (outpatient) addiction care client with ecstasy as a primary problem
rose until 1997 (Figure 5.2). This increase was partly due to expansion of the registration process. After 1997 the number dropped until 1999, when it levelled off. Between
2004 and 2005 the number of primary ecstasy clients remained stable.
Figure 5.2
Numbers registered with (outpatient) addiction care for primary or secondary ecstasy problems from 1994I
Number
1000
900
800
700
600
500
400
300
200
100
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Primary
29
208
398
457
340
252
241
225
250
277
291
293
Secondary
32
321
552
672
607
549
573
563
622
655
750
781
I. In 1994 the registration of ecstasy problems was not yet complete. For 2005, the data for Jellinek have been
extrapolated. Source: LADIS, IVZ.
•
92
Per 100,000 inhabitants aged 15 and older, LADIS registered two primary ecstasy clients in 2005 – considerably fewer than for most other drugs (46 for cannabis, 74 for
cocaine, 107 for opiates).
TRIMBOS-INSTITUUT
•
•
•
•
The rate of ecstasy problems in the entire treatment demand for drugs problems has
remained low in recent years: below 1%.
In 2005 approximately one third of ecstasy clients (31%) were newcomers to (outpatient) addiction care for a drugs problem.
The majority of ecstasy clients also had problems with another substance (82%).
There are more clients who cite ecstasy as a secondary problem than as a primary
problem. After a drop between 1997 and 1999 the number of these clients has risen
again in the last four years. Between 2004 and 2005 this number increased by 4%. In
2005 the primary problem for these secondary ecstasy clients was mainly cocaine
(37%), followed by cannabis (23%), amphetamines (19%) or alcohol (16%).
Amphetamines
•
•
•
•
•
•
The number of clients with amphetamines as the primary problem rose until 1998,
followed by a drop, but rose again from 2001. Between 2004 and 2005 the number of
amphetamine clients increased by 17% (Figure 5.3).
The percentage of amphetamines in the entire treatment demand for drug problems
remained low throughout the years under review (between 2% and 3%).
Per 100,000 inhabitants aged 15 and older, LADIS registered eight primary amphetamine clients in 2005 - more than in 1994 or in 2001 (4 in both years).
In 2005, approximately one quarter (26%) were first-time clients of (outpatient) addiction care for a drugs problem.
The majority of clients with a primary amphetamine problem also reported problems
with other substances (79%).
For about seven hundred clients amphetamines were a secondary problem in 2005.
This represents an increase of 13% compared to 2004. For this group, the primary
problem was cocaine or crack (32%), alcohol (23%), cannabis (27%), heroin (10%),
or ecstasy (6%).
Figure 5.3
Numbers registered with (outpatient) addiction care for primary or secondary amphetamine problems from 1994I
Number
1200
1000
800
600
400
200
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Primary
497
566
667
794
870
810
623
482
543
735
954
1118
Secondary
489
566
558
610
590
560
498
474
481
552
645
728
I. For 2005 the data for Jellinek have been extrapolated. Source LADIS, IVZ.
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93
Age and Gender
Ecstasy
• In 2005 seven out of ten (69)% of primary ecstasy clients were male. The ratio of
female clients is greater than for cannabis, cocaine or opiates (18-20%). Between
2000 and 2005 the percentage of female clients rose from 19 to 31 percent.
• The average age of primary ecstasy clients was 24. Accordingly, they are the youngest
of all drugs clients. The peak age group is 20-24 (see Figure 5.4).
Amphetamines
In 2005 three quarters of primary amphetamine clients were male (76%). The percentage of female clients rose slightly from 21% in 2000 to 24% in 2004, where it
remained in 2005.
• The average age is 26, somewhat older than ecstasy clients, but slightly younger than
the average age in 2004, when it was 28. Here too, the peak age is 20-24 (Figure
5.4).
•
Figure 5.4
Age distribution of primary ecstasy and amphetamine clients of (outpatient) addiction care. Survey year 2005I
%
45
40
Amphetamine
37
Ecstasy
35
28
30
24
25
18
20
15
17
14
15 16
8
10
6
4 3
5
4
1
2 1
1 0
50-54
55-59
0
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Age
Percentage per age group. I. For 2005 the data for Jellinek have been extrapolated. Source: LADIS, IVZ.
General hospitals; incidents
The Dutch Hospital Registration (LMR) registers few annual admissions to general hospitals, with amphetamine problems, including other psycho-stimulants such as ecstasy, as
the primary diagnosis (Figure 5.5).
• In 2005 there were 45 admissions, which accounts for 9% of all admissions with drugs
as the primary diagnosis. The majority (78%) of these admissions related to amphetamine misuse; a minority of 22% were diagnosed as dependent on amphetamines.
• There were somewhat more numerous occurrences of secondary diagnosis involving
amphetamines (82 in 2005). Between 2004 and 2005 the number of secondary diagnoses dropped by 24%. The main illnesses or disorders accompanied by secondary di-
94
TRIMBOS-INSTITUUT
•
•
agnoses of amphetamine misuse or dependence were very diverse. The most common
main diagnoses were:
- psychosis (15%)
- misuse or dependence on alcohol (14%)
- misuse or dependence on drugs (10%)
- accidents (21%)
- cardio-vascular diseases (7%)
- diseases of the respiratory tract (4%)
- poisoning (10%).
The same person may be admitted more than once per year. In addition, more than
one secondary diagnosis may be made per case. In 2005, corrected for duplication,
the total amounted to 110 persons who were admitted at least once during the year
with amphetamine misuse or dependence as the main or secondary diagnosis. Their
average age was 29, and 79% were male.
In 2005 the LMR registered no cases of accidental poisoning, with amphetamines as a
secondary diagnosis (ICD-9 code E854.2).
Figure 5.5
Admissions to general hospitals related to amphetamine misuse and dependence from 1994
Number
120
108
100
82
80
80
69
60
40
20
66
70
61
58
63
46
33
24
40
30
29
29
23
45
33
25
29
36
21
29
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Amphetamine as secondary diagnosis
Number of diagnoses, not corrected for duplication of persons or more than one secondary diagnosis per admission. ICD-9 codes: 304.4, 305.7 (appendix C). Ecstasy and amphetamines are registered under the same
codes. Source: LMR, Prismant.
GGD Amsterdam registers the number of requests for emergency treatment from the
Central Post for Ambulance Transports (CPA).
• In 2005 there were 63 ecstasy-related requests for treatment. This was about the
same as in 2004, but more than in previous years. 1996 was an exception to this
trend, with 66 requests (table 5.5).
• In three-quarters of the ecstasy cases (75%) removal to hospital was necessary; this
is more than in the case of cannabis incidents (35%).
• Amphetamines are rarely the reason for a request for treatment from the CPA in Amsterdam.
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95
Table 5.5
Amphetamine
Ecstasy
Drug-related incidents involving amphetamines and ecstasy, registered by
GGD Amsterdam, from 1995
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
6
1
7
7
7
30
6
5
7
8
3
38
66
41
35
43
36
42
39
39
59
63
Number of incidents (persons) per year. Source: CPA, GGD Amsterdam.
According to the Educare Foundation, an organisation that provides first aid at raves in
the Netherlands, the number of acute health problems caused by drug use is relatively
low, and dropped between 1996 and 2002.109
• However, recent data are lacking. Observations from health care workers who are active in the party scene, suggest that the declining trend in incidents related to ecstasy
has continued in recent years. Conversely, however, there appears to be an increase
in the number of incidents involving a combination of ecstasy and alcohol, although
there are no hard data for this.18
According to the national Injury Information System (LIS) of the consumer safety association46 some 2,900 people annually receive emergency treatment in a hospital for injury caused by an accident, violence or self-mutilation incident involving drugs use (cp.
13,000 on account of alcohol, Chapter 6). The drugs involved are cocaine, heroin, cannabis, ecstasy, magic mushrooms and speed. The data have been averaged for the period
from 2000 through 2005.
• Approximately one in eight (12%) drug victims reports having used ecstasy. If we
count only those cases for which the drug is known (71%), then ecstasy accounts for
17% of all drug-related cases treated in emergency departments.
• These figures are probably an under-estimate of the true number of drug-related incidents.
The National Poison Information Centre (NVIC) of the RIVM registers the number of information requests from doctors, pharmacists and government organisations concerning
(potentially) acute intoxication by poisonous substances such as drugs.48 These figures
do not provide insight into the total number of intoxications; however the trends may be
an indication of developments in problems related to drug use.
• There are more requests for information concerning ecstasy than concerning amphetamines (table 5.6). The number of information requests for ecstasy rose until
2004 and dropped slightly in 2005 and 2006.
Table 5.6
Ecstasy
Amphetamine
Requests for information on account of ecstasy and amphetamine use from
the National Poisons Information Centre from 2000
2000
2001
2002
2003
2004
2005
2006
164
42
194
39
184
39
208
47
246
51
217
128
183
106
Number of information requests per year. Source: NVIC, RIVM.
•
96
The number of requests for information on amphetamines trebled between 2000 and
2005. Most of the requests related to patients who had used amphetamines at parties,
both singly and in combination with other drugs or alcohol. In 2006 there was a slight
drop in the number of information requests involving amphetamines.
TRIMBOS-INSTITUUT
A drop in the number of information requests does not necessarily imply a drop in the
number of intoxications. The increasing familiarity of healthcare professionals with the
symptoms and treatment of a certain drug overdose may play a part, as this reduces the
need to seek information from the NVIC.
5.7 ILLNESS AND DEATHS
Illnesses
•
•
•
•
•
•
According to the latest scientific evidence, ecstasy use can cause long-term disruption
of brain function, particularly the memory, concentration and mood.110
This disruption can last longer than a year after the drug use has been discontinued. It
is unknown whether there is a return to full recovery.
These changes are probably due to damage to serotonergic nerves in the brain; The
effects can be attributed to ecstasy use; however, taking substances other than ecstasy may also play a role.
Tests on laboratory animals have shown that the risk of brain damage increases if
there is a rise in body temperature after using MDMA. In humans this is also likely to
be the case.
The risk of overheating and consequently (long-term brain damage) increases if a user
swallows large doses of MDMA in a warm environment (over 18-20 degrees Celsius).
The exact dose that leads to damage is not known. It is presumed that swallowing
high-dose pills containing two to three times the potency of average pills would be
enough. The average tablet contains between 75 and 80 mg of MDMA (see § 5.8).
The results of research conducted by the University of Amsterdam and the University
of Utrecht, do not suggest that short-term or one-off use might cause serious damage
to and impairment of brain function in the long term.111;112 At the same time it cannot
simply be concluded that a low dose of ecstasy is safe.
- In new users, who had swallowed an average of 1.8 ecstasy tablets and were
tested 8 weeks after their last dose, a narrowing of the arteries in some parts of the
brain was found.111
- A follow-up study performed on average 11 weeks after the last ecstasy dose did
not however show any significant change in performance for memory and concentration tasks or in brain activity during the performance of these tasks.112
- A further follow-up test was conducted on average 19 weeks after the last dose
among respondents who (by now) had taken on average 6 tablets. Again artery
narrowing in the brain was found, as well as possible damage to nerve endings and
an increased need for sensation seeking. No effect on depression or impulsiveness
was found.111
- It is not known whether the artery narrowing is permanent. The clinical relevance
of this effect would appear to be small, for the time being.
Deaths
The exact number of deaths due to use of amphetamines and ecstasy is unknown.
• According to the cause of death statistics of Statistics Netherlands (CBS), these substances are not often the primary cause of death. In the period 1996 - 2002 there was
a maximum of four acute deaths per year. In 2003 Statistics Netherlands registered
seven cases, in 2004 five cases and in 2005 four cases (ICD-10 code F15 and ICD-10
codes X41, X61 and Y11, all three codes in combination with code T43.6; for an explanation of the codes, see appendix C). These codes not only refer to amphetamines
TRIMBOS-INSTITUUT
97
and MDMA (-like substances), but also to other stimulants such as caffeine, ephedrine
and khat.
According to the EMCDDA, in other European countries, ecstasy plays a subordinate role
in drugs death, at least in so far as figures are available.40
• In 2003 or 2004, cases were reported in Denmark (2), Germany (20), France (4),
Hungary (3) and the U.K. (48).
• Ecstasy was often not the only substance involved. Other factors which may have
played a part in these deaths are over-heating, water intoxication or an underlying illness.
5.8 SUPPLY AND MARKET
The Drugs Information and Monitoring System (DIMS) tests drug samples submitted by
users in addiction care centres, to establish which substances are in the drugs. Some of
these samples (tablets) are identified by the care centre itself by certain features such as
logo, weight and diameter. Samples containing unknown substances and all samples in
powder form are forwarded to the laboratory for chemical analysis. It is not known to
what extent the DIMS provides a representative picture of the total drugs market. In addition to drug samples submitted by consumers, the DIMS also analyses drugs that are
seized by security staff at clubs and discos. The results of these tests are comparable to
those for the consumer samples.
Composition of ecstasy tablets
Table 5.7 shows the percentage of the ‘ecstasy tablets analysed that were found to contain MDMA and/or another substance.
• Between 1997 and 2000, there was a strong increase in the percentage of tablets containing only MDMA or an MDMA-like substance, whereas the percentage of tablets containing another psycho-active substance, such as amphetamine (as well), dropped
during this period. This situation stabilised in the years following.
• In 2006, 90% of 'ecstasy’ tablets did in fact contain MDMA, MDEA or MDA, or a combination of these. This is about the same as in 2005 (89%).
• In 2006, the average concentration of MDMA in ecstasy tablets was 74 mg; in 2005 it
was 78 mg. The highest dose found in 2006 was 173 mg.
•
Figure 5.7 shows that the percentage of ecstasy tablets with a high dose of MDMA
(more than 140 mg) decreased from nine percent in 2005 to three percent in 2006.
This appears to end the increase in the number of high-dose tablets found from 2002
to 2004.
• The percentage of ‘ecstasy’ tablets containing no MDMA, MDA and/or MDEA, but containing a completely different psycho-active substance rose from 2.5% in 2005 to
6.7% in 2006. This can mainly be attributed to the substance metachlorophenylpiperazine (mCPP; see “Other Substances”).
98
TRIMBOS-INSTITUUT
Table 5.7
Number and composition of (ecstasy) tablets submitted to DIMS that were
analysed in the lab, from 1997
Substances (% of the tablets)
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
44.6% 75.2% 82.0% 89.5% 91.4% 88.7% 91.2% 89.4% 80.3% 81.3%
MDMA
8.2%
1.3%
1.4%
0.9%
1.2%
0.4%
0.5%
0.2%
0.3%
0.2%
MDEA
1.5%
2.2%
2.8%
2.0%
0.7%
1.4%
0.9%
1.9%
2.9%
0.4%
MDA
2.6%
1.6%
1.0%
3.0%
3.0%
1.7%
2.7%
4.6%
5.9%
1.2%
Combination MDMA, MDA
and/or MDEA
9.0%
4.3%
3.3%
1.2%
0.9%
3.7%
2.1%
1.4%
2.7%
6.7%
Combination MDMA, MDA
and/or other psychoactive
substanceI
Pills without MDMA, MDEA
and/or MDA:
15.5%
6.5%
3.9%
0.9%
1.0%
1.7%
1.0%
0.3%
2.8%
1.6%
AmphetamineII
0.3%
0.3%
0.1%
1.2%
0.2%
Methamphetamine
4.5%
2.7%
1.6%
1.2%
1.3%
0.7%
1.7%
3.2%
7.1%
Other psychoactive substanceI 14.7%
3.9%
4.3%
2.9%
0.8%
0.5%
0.8%
0.8%
0.7%
1.2%
1.2%
No psychoactive substance
Total number of tablets analysed
2 434
2 713
2 306
2 497
2 402
2 149
2 187
1 985
2 140
Percentage of tablets containing a particular substance or combination of substances. Categories are mutually
exclusive and add up to 100 percent. I. For example mCPP, 2C-B, MBDB, DOB, PMA, caffeine, ephedrine etc. II.
Until 2002 no distinction was made between amphetamine and methamphetamine. Source: DIMS, Trimbos
Institute.
Figure 5.6
Concentration of MDMA in ‘ecstasy’ tablets submitted to the DIMS
%
100%
80%
60%
40%
20%
0%
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
>140 mg
1
1
1
2
4
4
6
10
9
3
106-140 mg
6
5
6
9
14
11
12
12
13
17
71-105 mg
36
27
29
35
49
42
38
34
28
30
36-70 mg
39
53
52
45
28
39
38
39
36
37
1-35 mg
17
15
11
9
5
5
7
5
13
13
Percentage of tablets with a certain percentage of MDMA. These are tablets that were tested in the lab and
were found to contain at least 1 mg MDMA. Source: DIMS, Trimbos Institute.
TRIMBOS-INSTITUUT
99
2 523
Other substances
Table 5.8 indicates the number of samples found by DIMS (ecstasy tablets, powders or
other) containing substances that are undergoing continuous scrutiny at European level
and/or may possibly constitute a public health threat.
• By 2006, some of the substances listed in Table 5.8 had virtually disappeared from the
market.
• The former anaesthetic GHB is submitted to DIMS on a regular basis. In recent years,
GHB has become popular in certain circles. However, in the main cities there are indications that interest in this substance is waning.12;20 In other parts of the country, particularly in the north and east, the trend is rising.18
• In 2006, ketamine was found significantly more often than in previous years. There
appears to be increasing interest in this substance in Internet chat-rooms; however,
its limited availability seems to be a factor in restricting its use.18 No definite figures
are available.
Table 5.8
2C-B
4-MTA
Atropine
BZP
GHB/GBL
DOB
Ketamine
MBDB
mCPP
PMA/(PMMA)I
Strychnine
Number of samples containing other psychoactive substances
1997
317
9
128
50
1
0
113
1998
12
16
52
16
15
16
12
1999
25
8
0
1
24
26
1
0
2000
12
6
1
0
36
5
2
0
1
1
2001
11
1
0
0
102
5
1
0
8
0
2002
2
5
0
0
72
0
2
0
0
0
2003
15
0
0
3
72
0
3
0
0
0
2004
5
1
3
3
98
2
19
1
13
0
0
2005
9
0
5
0
114
9
17
1
92
0
0
I. Tablets containing more than 1 mg. Source: DIMS, Trimbos.
New substances in ecstasy tablets
• In late 2004 the substance meta-Chloro-Phenyl-Piperazine (mCPP) appeared on the
Dutch ecstasy market.
- mCPP, like MDMA works on serotonergenic brain cells and is chiefly used for research purposes. The effect of mCPP is partly comparable to that of MDMA; however it hardly has any stimulative effect. Users report many negative effects such
as nausea, dizziness, anxiety, hallucinations, restlessness, shivers and headache.
The higher the dose, the greater the likelihood of these effects.
- Since 2000 it has been appearing in various European countries as a ‘legal’ alternative to illegal stimulants such as MDMA.
• Another piperazine that has recently been found in ecstasy tablets is benzylpiperazine
(BZP). BZP is occasionally found by the DIMS.
- BZP is listed on the international doping list of substances that are banned in competition.
- BZP can cause unpredictable and serious effects in users. Reports from New Zealand, where BZP is a ‘legal party drug’, contain various health incidents after use of
BZP, which had to be treated in hospital emergency rooms, or even on an inpatient basis.
100
TRIMBOS-INSTITUUT
2006
18
0
0
13
142
13
50
0
256
0
0
•
In the Netherlands, mCPP and BZP are regarded as non-registered drugs that are covered by the Medicines Act (WoG). Unlicensed trade in mCPP or BZP is illegal.
Composition of (meth)amphetamine samples
DIMS also receives samples of powders that are sold as ‘speed’. In 2006 there were 553
samples, virtually the same amount as in 2005 (552).
• In 2006, the majority (93%) (also) contained amphetamine; two percent contained
only methamphetamine. Methamphetamine is stronger and more effective for longer
than amphetamine.
• The average amphetamine content was 34% (of weight).
• Many speed samples contain caffeine (as well). The percentage of samples containing
caffeine was 56% in 2005 and 59% in 2006.
Prices
The prices that consumers pay for ecstasy and amphetamines are not monitored systematically. Therefore, no assertions can be made about price trends. However, recent data
from the Trendwatch-monitor and the DIMS project give some indication of the current
situation.
• In 2004, the price of an ecstasy tablet at consumer level fluctuated between three and
eight euro. The price of a gram of amphetamine varied between five and fifteen euro.18
• Consumers who had tablets tested with DIMS in 2006 paid an average of 3 euro per
tablet, varying from 50 cent to 8 euro.
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101
6
ALCOHOL
Alcohol is made from fermenting grains or fruits. It is drunk in the form of beer, wine or
spirits. One glass of wine, beer or a measure of spirits contains approximately the same
amount of alcohol. This is because the size of the glass used is reduced according as the
alcohol content of the drink is higher.
In social situations, drinkers experience alcohol as relaxing and convivial. In less sociable
situations, alcohol can exacerbate an aggressive mood. Excessive use (even where incidental) can result in accidents – at work, at home and in traffic. Alcohol is an addictive
substance. With regular use, habit and tolerance are increased. Excessive use of alcohol
can lead to a number of illnesses, particularly diseases of the liver and the cardiovascular system as well as cancer.
6.1 RECENT FACTS AND TRENDS
The main facts and trends concerning alcohol in this chapter are:
• According to sales figures, the consumption of alcohol per head of the population in
the Netherlands remained stable in 2005 (§ 6.2).
• The number of recent and current alcohol users in the population aged 15-64 remained stable between 2001 and 2005 (in 2005: recent 85%, current 78%). The percentage of binge drinkers dropped in this period from 40% to 35%.
• Alcohol use among school-goers increased between 1999 and 2003, most markedly
among young girls aged between 12 and 14. Since 2003 there have been signs of a
slight drop in this age group. However, binge drinking among drinking school-goers
seems to be on the increase (§ 6.3).
• By comparison with other countries, alcohol consumption among school-goers in the
Netherlands is high (§ 6.5).
• Despite a legal ban, juveniles aged under 16 are easily able to procure alcoholic beverages (§ 6.8).
• Ten percent of the Dutch population aged 16 - 69 are problem drinkers (§ 6.4).
• Heavy drinking, problem drinking and alcohol misuse and dependence are relatively
more prevalent among young men aged 18 to 24 (§ 6.4).
• The rise in the number of alcohol clients of (outpatient) addiction care since 2001 continued in 2005 (§ 6.6).
• The registration data of general hospitals show no further increase in 2005 in the
number of admissions involving an alcohol-related condition. The number of children
and juveniles up to age 16 admitted for alcohol related reasons rose between 2001
and 2005 (§ 6.6).
• The number of road deaths and injuries caused by alcohol use has dropped further in
recent years. Likewise, there has been a drop in the percentage of drink-driving motorists (§ 6.6).
• Total deaths from alcohol-related conditions (primary and secondary causes of death
together) did not rise further in 2004 and 2005 (§ 6.7).
• Excessive alcohol use is the most important determinant for loss of quality of life (§
6.7).
• On a world-wide basis, alcohol use causes almost as many deaths and illnesses as
smoking and high blood pressure (§ 6.7).
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103
6.2 USAGE: GENERAL POPULATION
Alcohol use is widespread in Dutch society.
• According to a survey conducted by Statistics Netherlands (CBS) in 2005, over four
out of five people (81%) aged 12 and older ‘sometimes drink alcohol’. In 2001 the figure was 82%. The percentage of drinkers has remained fairly stable for years.
In 1997, 2001 and 2005, National Prevalence Surveys (NPO) were conducted.4
- According to the findings, the percentage of people in the population aged 15 to 64
that used alcohol in the past year dropped slightly from 87% in 1997 to 85% in
2001. This drop was most marked among females and among respondents in the
25-44 age group.
- Between 2001 and 2005 the percentage of recent drinkers remained stable.
- The number of people who had taken alcohol in the past month remained stable
throughout the years at around 78%.
- The percentage of drinkers who had consumed six or more drinks in one day during
the past six months (binge drinking) dropped from 40% in 2001 to 35% in 2005.
This decline took place both among males and females and among respondents
aged from 15 to 44.
- The age of onset is the age at which an individual first uses a substance (see also
appendix A: age of onset). Among recent users of alcohol, the age of onset in the
15 to 24 age group was 14.6 years on average. In the population aged 15 to 64 the
age of onset averaged at 16.5.
Sales figures give an indication of the amount of alcohol consumed annually per head of
the population (Table 6.1).
• Alcohol use was highest in the Netherlands during the second half of the 1970s and in
the 1980s. Then followed a slight decline, which did not continue from the early
1990s.
Table 6.1
Beer, wine and spirits per capita (in litres of pure alcohol), from 1960
Year
Beer
Wine
Spirits
Total
1960
1.2
0.2
1.1
2.6
1965
1.9
0.5
1.9
4.2
1970
2.9
0.8
2.0
5.7
1975
4.0
1.5
3.4
8.9
1980
4.8
1.4
2.7
8.9
1985
4.2
2.0
2.2
8.5
1990
4.1
1.9
2.0
8.1
1995
4.1
2.2
1.7
8.0
2000
4.1
2.3
1.7
8.2
2001
4.0
2.3
1.7
8.1
2002
4.0
2.3
1.7
8.0
2003
4.0
2.5
1.5
7.9
2004
3.9
2.6
1.4
7.9
2005
3.9
2.7
1.3
7.9
Source: Drinks Product Board; Wine Product Board.113;114
•
In 2005, 7.9 litres of pure alcohol were consumed per capita – the same amount as in
2004.
104
TRIMBOS-INSTITUUT
•
•
•
The consumption of spirits dropped slightly in 2005. Beer consumption remained stable and wine drinking rose slightly from 20.6 litres in 2004 to 21.3 litres in 2005.
After a sharp drop in 2003 (minus one third compared to 2002) sales of ready-mixed
drinks (‘alcopops’) stabilised in 2004. However, in 2005 there was another sharp drop
in 2005 (by 31% on 2004). Accordingly the consumption of these drinks has more
than halved since 2002 to 141,000 hectolitres.
In 2005, 78 litres of beer, 21 litres of wine and four litres of spirits per person were
imbibed.
Special groups
•
•
•
Research conducted in Amsterdam (2004) shows that far fewer people of Moroccan or
Turkish origin drink alcohol than native Dutch people. a ;115
- There are three times as many drinkers among the native Dutch population as in
the Turkish Amsterdam community and six times as many as in the Moroccan community in Amsterdam.
- Between 1999/2000 and 2004 the percentage of drinkers among Turks dropped by
over 6%, whereas it increased among Moroccans by almost 7%.
A Rotterdam-based study (2004) shows that in second-generation Turkish people (1630 years) there are fewer drinkers than among Dutch people of the same age.116
- Among Turkish people aged 16-30, 36% had drunk alcohol during the past six
months, compared to 94% of their native Dutch peers.
- There is also less excessive drinking in the Turkish group. Six percent of this age
group drinks excessively, compared to fourteen percent in the Dutch cohort.
- When only regular drinkers are compared, the difference found in excessive drinking disappears.
Both religious and cultural factors appear to be related to alcohol use among second
generation Turkish and Moroccan drinkers. Socio-cognitive factors, such as the influence of family and Turkish/Moroccan friends, as well as alcohol expectations are more
important as predictors of alcohol use in this group.117
•
Over a third (35%) of the homeless in twenty Dutch municipalities were found to be
high-risk drinkers in 2002 (defined here as more than 25 units of alcohol weekly);
23% drank more than 56 units a week, and 13% more than 112 units weekly.5
•
Of the alcohol-drinking working population some four percent sometimes
just before or during work: one percent does so at least once weekly.118
- 38% sometimes drink alcohol straight after work; 12% do so weekly.
sector has the greatest number of workers drinking after work (31%
healthcare sector and the civil service have the least (5% and 4%
weekly).118
drink alcohol
The catering
weekly); the
respectively,
a
The Municipal Health Service Amsterdam applies for ethnic background the definition from
BZK/VNG, see appendix A.
TRIMBOS-INSTITUUT
105
6.3 USAGE: JUVENILES AND YOUNG ADULTS
School-goers
Since the mid-1980, the Trimbos Institute has monitored the extent to which pupils aged
12 and older attending mainstream secondary schools have experience with alcohol, tobacco, drugs and gambling. This takes place within the context of the Dutch National
School Survey.
• In 2003, 85% of pupils attending mainstream secondary schools had ever used alcohol. This was an increase on 1999 when the figure was 74%. However, the percentage
fluctuated somewhat over a fifteen-year period. (Figure 6.1).8
• In 2003, 58% of pupils interviewed had drunk alcohol in the month before the survey,
which was about the same as in 1999.
Figure 6.1
90
Alcohol consumption among school-goers aged 12 to 18, from 1988
%
85
80
79
79
74
70
69
60
58
54
54
55
50
45
40
1988
1992
1996
Ever
Current
1999
2003
Percentage of ever drinkers and in the month before the survey (current). Source: Dutch National School Survey, Trimbos Institute.8
Age and gender
•
•
•
Particularly among young girls aged 12 to 14, ever use and current (past month) use
of alcohol has increased (Figure 6.2).
- In 1999, 57% of girls aged 12-14 had ever drunk alcohol; in 2003 this had risen to
78%.
- In 1999, 32% of this group had drunk alcohol in the past month; in 2003 the figure
was 44%.
Fifteen percent of the school-goers reported having taken their first drink at the age of
ten or younger; almost twice as many of these were boys (19%) as girls (10%). The
majority of pupils who drink, started at the age of 11 to 14.
In 2003 there was no difference in the percentage of boys and girls that had ever or
recently taken alcohol. However differences were found in drinking patterns. Boys
drink alcohol more often than girls, and in greater quantities. This difference is most
marked among older boys:
- Of the 16-year old boys who had consumed alcohol during the past month, 29%
had drunk on more than ten occasions in the month, compared to 19% of girls.
106
TRIMBOS-INSTITUUT
•
•
- Likewise, 29% of 16-year old boys drank more than ten units on average on a
weekend day, whereas for girls, the figure was 9%.
In 2003 almost half of school-goers (47%) had already drunk a glass of alcohol by age
12; by age 15, 52% are drinking on a weekly basis.
Among secondary school students, beer and alcopops are the most popular drinks.8
- Among boys, beer is the most popular: 42% of the boys who had drunk alcohol
during the past month reported drinking beer weekly.
- Among girls, alcopops are the most popular: 30% of the girls who had drunk alcohol during the past month reported drinking alcopops weekly.
Figure 6.2
Trends in ever alcohol use in secondary school pupils by age and gender
from 1992
Boys
%
Girls
%
100
100
80
80
60
60
40
40
20
20
0
0
1992
1996
12
1999
13
2003
1992
1996
12
14
1999
13
2003
14
Percentage of ever drinkers. Source: Dutch National School Survey, Trimbos Institute.8
A comparison of data from the national Health Behaviour of School-aged Children (HBSC)
study in 2005 shows that both ever and past month use of alcohol in the entire cohort of
school-goers aged 12 to 16 remained stable between 2003 and 2005.9
• Among the youngest age groups, however, alcohol use declined somewhat between
2003 and 2005. In 2003, 71 percent of 12 year olds had ever drunk alcohol; in 2005
this had dropped to 61 percent. A similar drop was found among 13 year olds – from
80% in 2003 to 70% in 2005. Likewise, the percentage of 12 year olds who had consumed alcohol in the past month dropped (from 31% to 23%).
• The percentage of school-goers that had drunk five or more units of alcohol on at least
one occasion in the past four weeks (binge drinking), remained stable between 2003
and 2005 (35% and 37% respectively).
• There was an increase in binge drinking among school-goers who drink. Of those who
report having consumed alcohol in the past month, 75% drank five or more units of
alcohol on at least one occasion in 2005, compared to 64% in 2003.
• Nonetheless, according to NPO data, binge drinking in the 15-24 age group declined
between 2001 and 2005 – from 53% to 40%. These figures refer to people who on at
least one occasion consumed six or more units of alcohol in a single day during the
past half year. This definition differs somewhat from that in the HBSC study; therefore
the results are not mutually comparable.4
TRIMBOS-INSTITUUT
107
Ethnic background
•
•
Among school-goers with a Moroccan or Turkish background aged 12 to 16, current
alcohol use is significantly lower than among native Dutch pupils (8% and 15% versus
63%). Pupils with a Surinamese background occupy an intermediate position (47%).8
The quantity taken per occasion does not, however, differ between ethnic groups.119
Alcohol and problem behaviour
•
•
Pupils aged 12-16 who drink on a weekly basis exhibit more delinquent and aggressive
behaviour than those who do not drink every week. There is no difference between
boys and girls in this respect, but the association is stronger among the younger age
groups.120
Among juveniles of 12 and 13, weekly alcohol use is linked to somatic symptoms and
feelings of anxiety and depression.
Special groups of young people
Socialising youngsters
Many young people drink when they are out socialising. Table 6.2 summarises the results
of a number of studies conducted among young people in the social scene. The figures
are not mutually comparable on account of differences in age groups and research methods.
• In 2005 one fifth of young socialisers aged 13 drank alcohol while out, as did nearly
two-thirds of fourteen and fifteen year olds and almost nine out of ten sixteen and
seventeen year olds. These figures are comparable with those from 2003.121
• Nine out of ten young socialisers in The Hague (15-35 years) had drunk alcohol during
the past month and six out of ten during the past week.21
• Alcohol consumption is lower among fans of Hip-hop/Rap/R&B than among fans of
Pop/Rock or Dance/House/Techno. This may be associated with the preference of
young Moroccans for the former, since alcohol use is lower among Morroccans.21
• In Amsterdam one third of bar-goers, coffee-shop clients and frequenters of fashionable clubs use alcohol daily or a few times a week, and consume at least four or five
drinks on each occasion. Half the bar-goers drink alcohol a few times a week and 7%
consume alcohol daily. The percentage of bar-goers that consume alcohol daily appears to have remained the same since 2000.12;16;17
• The percentage of binge drinkers (6 or more drinks) among young people going out
ranges in various studies from 49% to 64%.17;28;29
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TRIMBOS-INSTITUUT
Table 6.2
Alcohol use in the social youth scene
Population
Location
Measure for alcohol useI
Age
Nationwide
Survey
year
2005
Young people socialising in general
Past year
The Hague
2003
Past month
Past week
13
14-15
16-17
15-35
Attending raves, outdoor festivals, city
centre
Bar-goers
Zaandam
2006
Binge drinking:
Six drinks or more
Ten drinks or more
Binge drinking:
more than 6 drinks
more than 10 drinks
Binge drinking:
10 or more drinks
Past month
Daily or a few times
weekly, at least four or
five drinks per occasion
Binge drinking:
Six drinks or more
Daily or a few times
weekly, at least five
drinks per occasion
Daily or a few times
weekly, at least four or
five drinks per occasion
Frequenters of bars
and sports club canteens
Disco-goers
Noordwijk
2004
Nijmegen
2005
Bar-goers
Amsterdam
2005
Coffee shop clients
Amsterdam
2001
Clubbers
Amsterdam
2003
14-44
Average 21
Percentage
19%
62%
87%
88%
60%
64%
50%
Average 23
61%
32%
15-40
Average 21
Average 26
29%
97%
33%
Average 25
49%
30%
Average 28
33%
The figures in this table are not mutually comparable on account of differences in age groups and research
methods. References: 12;16;17;21;28;122 29;30;121
I. The following definitions of binge drinking are used: Zaandam: 6/10 drinks or more on an average night out;
Noordwijk: on average more than 6/10 drinks on a weekend night out; Nijmegen: 10 or more drinks on the
evening of the survey; Amsterdam: 6/10 drinks when out on the town.
Pre-drinking
• According to reports from key observers in the social scene, “pre-drinking” has been
on the increase in recent years.18 This can take place at home, on the street, in a
‘hangout’ , at a friend’s place, or indeed increasingly in bars themselves (encouraged
by special offers). In general it appears to be mainly younger people who engage in
pre-drinking before a night out, in order to cut costs.
• A survey conducted in 2005 among teenagers out socialising (aged 13-17) found that
half of those who drink sometimes do so before going out. They pre-drink mainly at
home (61%) or at a friend’s house (65%).121 The percentages of pre-drinkers vary per
age group:
- A quarter (26%) of 13 year old socialising drinkers (or 1.5% of all 13 year olds).
- 41% of 14/15 year old socialising drinkers (or 12% of all 14/15 year olds).
- 56% of 16/17 year old socialising drinkers (or 39% of all 16/17 year olds).
Hangouts
11% of adolescents aged 13-17 sometimes go to a hangout.121 These are private ‘dens’
(often a barn, attic or caravan) where youngsters come together to meet and to drink. In
the Netherlands there are estimated to be some 1 500 such hangouts.123
TRIMBOS-INSTITUUT
109
•
•
•
8% of 13 year olds report sometimes going to a hangout, as well as 15% of 14-15
year olds and 12% of 16-17 year olds.121
It is mostly older groups who frequent hangouts. Of the 16-17 year olds who go there,
82% drink alcohol there. Of the 14-15 year olds and 13 year olds, 65% and 26% respectively report drinking alcohol in these dens.
On average, five alcoholic drinks are consumed.
Other groups of young people
Alcohol use also occurs frequently among (young) holidaymakers and among certain
groups of problem youth.
• Research conducted at youth camp sites (average age 17.4), has shown that over
80% of the boys and nearly half the girls drink alcohol every day during the holiday.
Boys consume an average of 17 drinks per day, and girls take seven drinks a day.124
• Juveniles attending a truancy project in Amsterdam are more likely to be current
drinkers (over 50%) than their non-truant peers who attend school regularly(40%).12
• Pupils attending schools for children with severe educational difficulties (ZMOK) do not
differ significantly in terms of frequency and intensity of alcohol use from their peers
in mainstream schools. However, when only the native Dutch pupils are compared, the
ZMOK school pupils do drink more and more often.125
6.4 PROBLEM USERS
The extent of alcohol problems depends on the definition used. Researchers distinguish
between heavy drinking, problem drinking, irresponsible drinking and dependence on or
misuse of alcohol.
Heavy drinking
According to Statistics Netherlands (CBS) ‘heavy drinking’ means consuming at least six
units of alcohol on one or more days per week.
• Based on this definition, 11% of the Dutch population aged 12 and over were heavy
drinkers in 2005. This is about the same as ten years previously. In recent years the
trend may have been downward, although a distinct pattern is not yet evident: 13
percent in 2000, 14 percent in 2001, 12 percent in 2002, 11 percent in 2003 and 12
percent in 2004.
• In 2005 there were four and a half times more male heavy drinkers than female.
• Young people aged between 18 and 24 scored highest on this measure. In 2005 the
percentage of heavy drinkers among young men was 33% and 8% among young
women (Table 6.3). This is lower than in 2002, when 42% of young males were heavy
drinkers and 18% of young females.
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TRIMBOS-INSTITUUT
Table 6.3
Heavy drinkers by gender and age among people aged 12 and older. Survey year 2005
Age
Male
Female
12-17
8%
4%
6%
18-24
33%
8%
19%
25-34
22%
4%
13%
35-44
16%
3%
9%
45-54
25%
5%
15%
55-64
18%
5%
12%
65-74
9%
1%
5%
75 +
3%
1%
2%
18%
4%
11%
Total: 12 years and older
Total
Percentage of people who drink six units of alcohol on one or more days per week. Source: POLS, Statistics
Netherlands (CBS).
Problem drinking
Problem drinkers are people who not only drink above a certain level, but also experience
problems caused by their alcohol consumption.
• In 2003 10% of the Dutch population aged between 16 and 69 were problem drinkers,
with more male problem drinkers (17%) than female (4%).126
• Problem drinking is most prevalent in the age group 16-24, where 34% of males and
9% of females are problem drinkers (Figure 6.3).
Figure 6.3
40
35
Percentage of problem drinkers by age and gender. Survey year 2003
%
34
30
25
19
20
Male
Female
15
10
13
9
8
4
5
3
3
0
16-24 years
25-34 years
Source: University of Maastricht
•
•
35-54 years
55-69 years
126
Of the problem drinkers recorded in 2003, a year later almost half (46%) were still
problem drinkers. This means that over half of this group no longer meet the criteria
for problem drinking.127
The severity of the alcohol-related problems as well as age and gender are the main
factors which determine whether problem drinkers are still categorised as such after
TRIMBOS-INSTITUUT
111
•
one year. The likelihood of remaining a problem drinker increases with the severity of
the problems and is greatest among younger age groups and males.
Of those measured who were not problem drinkers in 2003, two percent had developed a problem with alcohol by 2004.
Alcohol misuse and dependence
•
•
According to data from the 1996 Nemesis study, 8% of the Dutch population aged
between 18 and 64 fulfilled the diagnostic criteria for alcohol misuse (4.6%) or dependence (3.7%). More recent figures are not available.128
Alcohol misuse and dependence are most common among young men aged between
18 and 25; In 1996, 18% of this age group met the criteria for alcohol misuse and
13% for alcohol dependence.129
Within the general population, a large proportion of people who at some stage meet the
criteria for alcohol misuse or dependence will recover over time.130
• Of those with alcohol misuse, 85% recover over a three-year period.
• Of those with alcohol dependence 74% recover over a three-year period.
• Of those who recover, only a small percentage relapse into their drinking habits.
6.5 USAGE: INTERNATIONAL COMPARISON
General Population
•
•
In 2003, alcohol consumption in Western Europe varied from 4.9 to 12.6 litres per
head of population (Figure 6.4). By comparison with the other Western European
countries, the Netherlands appears to occupy an intermediate position.
Per capita alcohol consumption is determined in this study on the basis of sales figures. However, there are considerable discrepancies between countries with regard to
so-called ‘unregistered’ consumption, such as private imports, duty-free and homebrewed alcohol. For this reason, the figures are not entirely mutually comparable.131
112
TRIMBOS-INSTITUUT
Figure 6.4
Extent of per capita alcohol consumption in a number of EU member states, measured in litres of pure alcohol. Survey year 2003
Luxembourg
12.6
10.8
Ireland
Germany
10.2
10
Spain
Portugal
9.6
United Kingdom
9.6
Denmark
9.5
France
9.3
Austria
9.3
Belgium
8.8
The Netherlands
7.9
Finland
7.9
Greece
7.7
Italy
6.9
Sweden
4.9
0
2
4
6
8
10
12
14
16
Litres per capita
Source: Drinks Product Board, Distillers Commission.
Juveniles
In the ESPAD survey of fifteen and sixteen year old school-goers in Europe, respondents
were asked about their use of alcohol and frequency of drunkenness.44
• Table 6.4 shows alcohol use in a number of EU countries and Norway. Belgium, Germany and Austria only participated in 2003. The US did not take part in ESPAD but
conducted comparable research.
• In 2003 the Netherlands scored in the higher echelons for the measure ‘having taken
alcohol at least 40 times in my entire life’
• The Netherlands topped the list for the measure ‘having taken alcohol at least ten
times in the month prior to the survey’.
• For the measure ‘drunkenness’, Dutch school-goers scored considerably less highly.
Approximately one in eight reported having been drunk at least twenty times in their
lives.
• Between 1999 and 2003 the percentage of pupils that had drunk alcohol on ten or
more occasions increased in the Netherlands and Italy, whereas it dropped in Denmark.
• In 2003, the percentage for 20 or more occasions of intoxication dropped only in Denmark; in the remaining countries, it remained stable.
TRIMBOS-INSTITUUT
113
Table 6.4
Alcohol use and drunkenness among school-goers aged 15 and 16 in a
number of EU member states, Norway and the US. Survey year 2003
Country
Consumption:
40 times or more in
lifetime
Denmark
UK
Ireland
Intoxication:
20 times or more in
lifetime
1999
2003
1999
2003
1999
2003
59%
50%
18%
13%
41%
36%
-
48%
-
21%
-
21%
37%
45%
20%
25%
8%
6%
47%
43%
16%
17%
29%
27%
Austria
The Netherlands
Consumption:
10 times or more in
past month
40%
39%
16%
16%
25%
30%
Germany
-
37%
-
11%
-
12%
Belgium
-
36%
-
20%
-
7%
Greece
42%
35%
13%
13%
4%
3%
Italy
17%
24%
7%
12%
2%
5%
France
20%
22%
8%
7%
4%
3%
Finland
20%
20%
1%
2%
28%
26%
Sweden
19%
17%
2%
1%
19%
17%
Norway
16%
15%
3%
3%
16%
14%
Portugal
15%
14%
6%
7%
4%
3%
US
16%
12%
5%
4%
11%
7%
Percentage of school-goers. - = not measured. The US did not participate in ESPAD, but conducted comparable
research. Source: ESPAD.
A study which compared the reported availability and use of alcohol among school-goer
aged between 14 and 17 in the Netherlands and France found the following:15;132
• Dutch juveniles find it easier to procure alcohol than their French peers; 72% of the
Dutch and 59% of the French juveniles find it easy to procure alcohol.
• In both countries there is an association between perceived availability and alcohol
use; teenagers who find it easy to get alcohol drink more often and they more frequently take five or more drinks per occasion.
• Perceived availability has more impact on use in the Netherlands than in France.
• Evaluated on the basis of relevant aspects of drinking patterns, there is no difference
between France and the Netherlands with regard to the likelihood of youngsters becoming involved in violence or aggression on account of drinking.
• In France it is more likely that peers and/or older people will criticise teenagers’ drinking habits, even before negative consequences appear. Informal social control on
adolescent drinking is stricter in France than in the Netherlands.
6.6 TREATMENT DEMAND
Outpatient addiction care
The National Alcohol and Drugs Information System (LADIS) registers the number of people seeking treatment from (outpatient) addiction care, including the probation and aftercare services and the addiction clinics that are merged with outpatient addiction care.
(See in appendix A:LADIS Client) On account of technical problems, the Jellinek organi-
114
TRIMBOS-INSTITUUT
sation for addiction care in Amsterdam and environs has been unable to submit its 2005
data to LADIS. The 2005 estimate for Jellinek has therefore been extrapolated from the
2004 data.45
• In 2005, 31,073 people were registered with (outpatient) addiction care with alcohol
use as the primary problem. This represents an estimated three percent of problem
drinkers.
• The absolute number of clients with a primary alcohol problem in (outpatient) addiction care increased by 48% between 1996 and 2005 (Figure 6.5). From 2004 to 2005
there was an increase of 5%. This rise may possibly be related to the effect of the Alcohol Action Plan of the addiction care organisations within the Netherlands Association for Mental Health Care (GGZ Nederland).133
• Per 10,000 inhabitants in the Netherlands, the number of primary clients rose from 14
in 2000 to 19 in 2005.
• Between 1994 and 2000, the percentage of alcohol in all requests for treatment from
outpatient addiction care varied from 37% to 40%. Thereafter there was a distinct increase from 41% in 2001 to 47% in 2005.
• In 2005 a fifth (21%) of primary clients were newcomers. They had not been registered before with (outpatient) addiction care on account of an alcohol problem. This is
similar to the percentage of first-time clients in 2004 (23%).
• In the case of three-quarters of primary alcohol clients, alcohol was the only problem
substance (75%). One in four reported a secondary substance (25%).
• The number of (outpatient) addiction care clients who cite alcohol as a secondary
problem also rose between 1995 and 2005 (Figure 6.5). In 2005 the number of secondary alcohol clients rose by 5% compared to 2004. For this group, cocaine (44%),
cannabis (22%) or heroin (16%) were the primary problem.
Figure 6.5
Number of clients of (outpatient) addiction care with primary or secondary
alcohol problems, from 1995
Number
35000
30000
25000
20000
15000
10000
5000
0
Primary
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
20085 20175 20939 21134 22378 22554 22365 22388 23849 26874 29518 31073
Secondary 2441 2473 2465 2622 2718 2847 3007 3945 4121 4631 4987 5261
Source: LADIS, IVZ.
TRIMBOS-INSTITUUT
115
Age and gender
• In 2005 the majority of primary alcohol clients were male (75%). The ratio of female
clients fluctuated in 1994-2005 between 23 and 27 percent.
• Of the primary alcohol clients, 89% were of native Dutch origin, 2% were non-Dutch
westerners and 9% were non-western immigrants.
• The average age in 2005 was 44. The peak age group for primary alcohol clients was
40-54 (Figure 6.6).
There has been an increase in the percentage of older people seeking treatment.134
20% of outpatient alcohol clients are over 55. Ten years ago the figure was only 13%.
• Since 1996 the ratio of over 55s seeking treatment for alcohol has increased by over
90% (corrected for population ageing). Among clients aged under 55, there was a
39% increase.
• One third (32%) of the over 55s seeking treatment are female. Among the under-55
age group, the ratio of females is 24%.
• The number of females over 55 seeking treatment for alcohol has grown faster than
the male cohort. In 2005, 32% of the over 55s seeking treatment were female; In
1996 the figure was 28%.
•
Figure 6.6
20
Age distribution of primary alcohol clients of the (outpatient) addiction care
services. Survey year 2005
%
18
16
16
17
15
13
14
12
11
10
9
10
8
6
4
2
6
3
1
0
15-19
yrs
20-24
yrs
25-29
yrs
30-34
yrs
35-39
yrs
40-44
yrs
45-49
yrs
50-54
yrs
55-59
yrs
> 59 yrs
Age
Percentage of clients per age group. Source: LADIS, IVZ.
Regional Trends
• A comparison of the period 2001-2005 with the period 1996-2000, shows an increase
in the number of alcohol clients outside the main cities, most markedly in the regions
of Oost-Brabant and de Achterhoek.
General hospitals and incidents
The number of admissions to general hospitals with an alcohol-related condition as the
primary diagnosis increased by a third (34%) from 1996 to 2005 (Figure 6.7). From 2004
to 2005 the number of admissions remained more or less stable.
• In 2005 there were 4,553 admissions with an alcohol-related condition as the primary
diagnosis. The most frequent diagnoses were:
- alcohol misuse (29%)
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•
•
- alcohol-related liver disease (28%)
- alcohol dependence (17%)
- intoxication and toxic effects of alcohol (15%)
- alcohol induced psychoses (10%).
Alcohol problems are far more often involved in secondary diagnoses. Between 1996
and 2004 there was a rise in the number of secondary diagnoses (Figure 6.7). From
2003 to 2004 there was a rise of 14%. In 2005, the number of secondary diagnoses
appeared to stabilise.
In 2005, 11,546 alcohol-related secondary diagnoses were registered. In order of occurrence these were alcohol misuse (48%), alcohol dependence (24%), alcoholrelated liver disease (14%), intoxication and toxic effects of alcohol (6%) and alcoholinduced psychoses (6%). The primary diagnoses accompanying these secondary diagnoses were:
- accidents (other than poisoning; 30%)
- gastric disorders (16%)
- poisoning (14%)
- diseases of the cardio-vascular system (6%)
- illnesses and symptoms of the respiratory tract (4%)
- psychoses (4%).
Figure 6.7
Admissions to general hospitals for alcohol-related problems, from 1996
14000
12000
10000
8000
6000
4000
2000
0
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Alcohol as main diagnosis
3406
4011
4076
4079
3923
3880
4254
4239
4501
4553
Alcohol as secondary
diagnosis
8513
9973
9822
9652
10116
9949
10291 10899 11991 11546
Number of admissions, not corrected for duplication of persons. ICD-9 codes: 291, 303, 305.0, 357.5, 425.5,
535.3, 571.0-3, 980.0-1, E860.0-2, E950.0*, E980.9* (*only admitted if 980.0-1 is reported as a complication.). For an explanation of the codes: see appendix C. The figures refer to all alcohol-related secondary diagnoses. More than one secondary diagnosis is possible per admission. Source: 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 2005, corrected for duplication,
the total amounted to 12,198 persons who were admitted at least once with one (or
more) alcohol-related condition(s) as the main or secondary diagnosis. Their average
age was 47, and 70% were male.
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•
•
These figures are probably an under-representation of the true situation, since the role
of alcohol is by no means always identified and registered in hospitals as the cause of
an illness.
In 2005, 357 day-care admissions were also registered as an alcohol-related primary
diagnosis. In 2004 there were 347 and in 2003, 415.
Between 2001 and 2005 there was a sharp rise in the number of children and juveniles
aged under 17 who were admitted to hospital for alcohol-related reasons (figure 6.8).
• In 2005 424 juveniles aged under 17 were admitted to hospital for an alcohol-related
problem. Of these the majority (244) were boys and 180 were girls.
• This represents a sharp increase of 61% compared to figures from 2001 when the total number of juveniles admitted on account of alcohol was 263.
• The increase is relatively greater among girls than among boys. Among girls, the
number of admissions has more than doubled since 2001 (a rise of 117%); for the
boys, the increase was more than a third (36%).
Figure 6.8
Hospital admissions (main or secondary diagnosis) of juveniles aged under
17 for alcohol-related reasons, from 2001
450
400
350
300
250
200
150
100
50
0
2001
2002
2003
2004
2005
boys
180
204
227
238
244
girls
83
121
134
176
180
total
263
325
361
414
424
Number of admissions, not corrected for duplication of persons. ICD-9 codes: 291, 303, 305.0, 357.5, 425.5,
535.3, 571.0-3, 980.0-1, E860.0-2, E950.0*, E980.9* (*only admitted if 980.0-1 is reported as a complication.). For an explanation of the codes: see appendix C. Source: LMR, Prismant.
An average General Practice (2,350 patients) has around 200 problem drinkers. Of these,
only a minority are identified as such by the GP: GPs identify only 1.7 of 1,000 patients
as chronic drinkers.135;136
At the central post for ambulance transports (CPA), The Amsterdam Municipal Health
Service (GGD Amsterdam) keeps a log of the number of requests for emergency treatment related to alcohol use.
• In 2005 the CPA Amsterdam registered 2,056 alcohol-related ambulance journeys.
• The number of alcohol-related ambulance journeys dropped slightly between 2001 and
2003 (1,957 in 2001; 1,887 in 2002; 1,733 in 2003) and has been rising since then
(1,825 in 2004; 2,056 in 2005).
• By comparison with 2004, this represents a rise of 13%.
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•
Half of the patients (50%) were transported to the emergency room in a hospital. In
the other half of cases, the ambulance staff provided first aid at the scene.
According to the injury information system (LIS) of the consumer safety association6
some 13,000 people annually receive emergency treatment in a hospital for injury caused by an accident, violence or self-mutilation incident involving alcohol (Table 6.5).46
• 73% of registered victims are male.
• 12% are aged between 0 and 19 years (which means 1,550 children annually); 25%
are aged 20 to 29 and 41% are in the 30-39 age group.
• Half of the accidents take place in private circumstances (Table 6.5), such as a fall
when intoxicated, or alcohol poisoning. In second place are road accidents (particularly falls from bicycles), followed by self-mutilation (often involving a combination of
alcohol and drugs and/or medicines) and violence.
• Thirty percent of the cases involve alcohol poisoning, either with or without other substances.
• Over one in three victims were admitted to hospital (36%). By contrast, for the average accident in private circumstances, the admission rate is 10%, and 16% for road
traffic accidents.
• From 2001 to 2005, 31 deaths were registered following emergency treatment for an
alcohol-related accident.
• The total annual direct medical costs incurred for victims who are treated in the Emergency Room or as in-patients, following an alcohol-related accident, violent incident
or self-mutilation are estimated at 31 million euro.
• These figures are probably an under-representation of the true scale of alcohol-related
accidents.
Table 6.5
Type of alcohol-related incidents that were treated in the emergency department in Dutch hospitals (average over 2001-2005)
Type of incident
Number
Percentage
Private circumstances
6 700
53%
Road accident
3 000
23%
Self-mutilationI
2 200
17%
Violence
Total
800
6%
±13 000
100%
Such as suicide attempts by using alcohol and medicines. Source: (LIS).
In 2004 a survey was conducted on alcohol use among 5,500 people attending the
Emergency Room in four hospitals in the Netherlands (Rotterdam, Maastricht, Emmen,
Amersfoort).47
• Approximately 15% had consumed alcohol in the six hours prior to treatment
• Compared to non-users, those who had taken alcohol were more likely to be treated
between 12 midnight and 8.00 a.m. and were more likely to have been brought to
hospital by ambulance. They had also consumed relatively more illegal drugs in the 24
hours prior to treatment and were more often frequent and excessive drinkers.
The National Poison Information Centre (NVIC) of the RIVM provides doctors and health
workers with information about poisoning.
• In 2006 there were 1,658 information requests about poisoning with alcoholic drinks.
This was slightly less than in 2005 and 2005, and may possibly indicate a decline in
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•
•
the rate of intoxications. Alcohol poisoning is not a notifiable condition. In addition,
doctors are generally familiar with the symptoms of alcohol use and overdose. The
real number of intoxications is therefore likely to be significantly higher than represented by the number of information requests.
In 2005 and 2006 nearly three-quarters of cases involved a combination of alcohol
and medicines.
The number of information requests for alcohol poisoning involving juveniles aged between 13 and 17 has increased in recent years from about 4% in 2002 to 8% in 2005.
No further rise was registered in 2006. Alcohol poisoning among juveniles is mostly
the result of drinking spirits with friends.137
Table 6.6
Requests for information on account of alcohol poisoning from the National
Poisons Information Centre (NVIC) from 2000
Total
- % in 13-17 age group
2000
2001
2002
2003
2004
2005
2006
1 372
1 247
1 403
1 709
1 817
1 780
1 658
4%
5%
- % alcohol and medicines
4%
5%
7%
8%
8%
77%
75%
68%
72%
73%
Number of information requests annually. Source: NVIC,RIVM.
People who drink heavily can be both the victim and perpetrator of violence.138
• Individuals who are tipsy or drunk between once a month and daily run nearly three
times the risk of being a victim compared to those who are never tipsy or drunk.
• For perpetrators of violence, the amount drunk at weekends is also important in addition to the number of times being drunk. People who drink 12 or more units of alcohol
in a weekend have twice the likelihood of instigating aggression when out socialising.
According to estimates from the Traffic and Transport Advisory Service of the Ministry of
Transport, Public Works and Water Management, there were over 2,700 deaths and hospital admissions following road accidents as a result of alcohol use in 2005 (Table 6.7).a
• The total number of alcohol-related hospital admissions and deaths has dropped since
1996 (Table 6.7).
• The percentage of alcohol-related traffic-accident deaths and hospital admissions in
this period has also dropped in relation to the total number of traffic-accident deaths
and hospital admissions.
- In 1996 19% of traffic accident deaths and hospital admissions were alcoholrelated; in 2005 this was 14%.
• The AVV estimates the costs to society of alcohol-related road accidents at approximately 2 billion Euro (based on figures from 2003).
Table 6.7
Estimated number of injuries and deaths in traffic accidents involving alcohol use, from 1996
Deaths
Hospital admissions
1996
240
3 800
1997
225
3 700
1998
225
3 600
1999
210
3 300
2000
200
3 300
2001
180
3 100
2002
170
3 000
2003
170
2 900
Source: Ministry of Transport, Public Works and Water Management/AVV, 2006.
a
Figures partly overlap with the figures from the Injury Information System (LIS).
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2004
135
2 800
2005
115
2 600
The percentage of drink-drivers registered a further drop in 2005.139
Sobriety tests conducted during weekend nights in 2005 showed that 2.8% of the
tested motorists had more than 0.5 pro mille of alcohol in their blood. This is a significant drop compared to the preceding years (3.4% in 2004 and 4.3% in 2000).
• The decline mainly involves drivers who were just over the limit (0.2-1.3‰). The
number of offenders with a high blood-alcohol count of 1.3‰ or higher has fluctuated
around 0.6% for years.
• In 2005 there were more male than female drink-drivers (3.3% versus 1.7%).
• In recent years there has been a decline in drink-driving among males in all age
groups. However, among women, the number of offenders rose by one percent vis à
vis 2004.
• The highest percentage of drink-drivers among males is in the 25-34 age group;
among females it is in the 35-49 age group.
• The percentage of drink-drivers is highest between 2.00 and 4.00 a.m.
•
Alcohol and drug use in traffic increases the risk of serious injury.140
• Research conducted among motorists shows that 35% of serious injuries among drivers are related to alcohol and/or illegal drug use (particularly alcohol per mille rates of
1.3 and upwards, drug/alcohol combinations (particularly with alcohol per mille rates
of 0.8 and upwards) and drug/drug combinations.
• This research also shows that driving when under the influence of cannabis – with or
without alcohol – is more common than driving under the influence of alcohol (4.5%
versus 2.1%), while driving while using benzodiazepines – with or without alcohol – is
equally common (2.1%).
Since 1 January 2006, the maximum permitted blood-alcohol count for newly licensed
drivers (holding a license for less than 5 years) has been reduced from 0.5 to 0.2‰.139
• A similar reduction in the legal alcohol limit for newly licensed drivers had already
been introduced in a number of North-American states as well as Australia and Austria. This reduction appears to have had a positive effect on road traffic safety.
• In Austria, for instance, the number serious traffic accidents involving newly licensed
drivers dropped by almost 17% in a five-year period.
• The Institute for Road Safety Research (SWOV), has estimated that the reduction in
the legal alcohol limit in the Netherlands can cut road deaths by ten and serious injuries by 150 per annum. This is based on an expected 5% decline in alcohol-related accidents.
6.7 ILLNESS AND DEATHS
Illnesses
Light and moderate alcohol consumption
Among some population groups, a low dose of alcohol reduces the risk of cardio-vascular
illnesses. However, the exact degree of risk reduction and the amount of alcohol required
to maximise this risk reduction are still being debated.141
• There are indications that compared to teetotallers on the one hand, and heavy drinkers on the other hand, moderate drinkers have a lower rate of coronary heart disease.
It is thought that this may be due to an increase in ‘good’ cholesterol, HDL-C (highdensity lipoprotein cholesterol).142;143
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•
•
•
Moderate drinkers also have less risk of ischemic stroke. Among the over 55s, moderate alcohol use may also reduce the risk of vascular dementia - caused by problems
with blood circulation in the brain.144
The greatest reduction in risk for cardio-vascular diseases appears to be reached by
drinking one standard glass every two days. If more than two glasses per day are
taken, this actually increases the risk of these diseases.141
In recent Dutch research it was found that moderate alcohol consumption before the
age of 45 has no effect on cardio-vascular illness after that age. This study did find a
slightly reduced risk of premature death or a diagnosis of cardio-vascular illness
among people aged 45 and older who consume alcohol in moderation. However, the
extent of the association depends partly on the alcohol questionnaire used and on including other factors in the results, such as lifestyle.145
There are indications that light to moderate drinkers are less likely to die prematurely
than non-drinkers or heavy drinkers.
• These associations appear only to apply to people who have a regular moderate drinking pattern, without episodes of heavy drinking.146
• In a recent meta-analysis of the association between moderate alcohol use and death,
it was concluded that the positive effects of moderate alcohol use were grossly overestimated in the past. A major reason for this is that studies often listed people who
had given up alcohol as non-drinkers. Giving up drink is also related to having poor
health. Taking only those studies without this mistake, no significant difference in
deaths was found between non-drinkers and moderate drinkers.147
Excessive alcohol use
The injurious effects of excessive alcohol use are numerous.148;149;150;141
• Lifestyle factors can result in a considerable number of years spent in an unhealthy
way and consequently loss of quality of life. Excessive alcohol use is the main determining factor for loss of quality of life.151
• Almost 12.5% of the illness burden among men, and 2.3% among women can be attributed to excessive alcohol use.
• Alcohol use is related to over 60 medical conditions. For most of these, risk increases
according as more alcohol is consumed.146;141
• Globally, alcohol use causes almost as many deaths and illnesses as smoking and high
blood pressure. The global illness burden from alcohol has been calculated to be four
percent. For smoking the figure is 4.1% and for high blood pressure, it is 4.4%.146
- In the Netherlands, excessive alcohol use contributes 4.5% to the national illness
burden, chiefly on account of alcohol dependence.152
Excessive alcohol use increases the risk of certain types of cancer.150
• Drinking two or more units of alcohol increases the risk of cancer of the mouth and
throat, as well as a certain type of oesophageal cancer. The risk is further exacerbated
for those who smoke as well.
• There are clear indications, that alcohol consumption is accompanied by a slightly increased risk of breast cancer, viz. 7% to 9% with each unit of alcohol per day.
• There are very clear indications of an increased risk of colon cancer, however only if
three or more units per day are consumed.
• For liver cancer, there are also clear indications of an increased risk from alcohol, but
only after cirrhosis has first developed.
Excessive alcohol use also increases the risk of cardio-vascular disease and damage to
the brain and nervous system.148;149
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•
•
•
•
Daily consumption of five or more drinks increases the risk of coronary artery disease.
Daily consumption of more than two drinks increases the risk of hemorrhagic strokes.
Long-term and excessive alcohol consumption (more than 8 units per day) may damage the nervous system (polyneuropathy), shrink the brain and damage cognitive
functions (learning, memory, concentration etc.).
Binge-drinking increases the risk of coronary vascular disease, acute kidney failure
and brain damage.
In its advice on alcohol use in relation to conception, pregnancy and breast-feeding, the
Health Board concluded that it is impossible to set a safe limit for alcohol use by either
men or women prior to conception and for women during pregnancy and breastfeeding.153
• There are indications that one standard glass or possibly even less of alcohol per day
before conception may affect a woman’s fertility, and increase the risk of miscarriage
and foetal death. The latter two risks are also increased by alcohol consumption by the
father.
• An average alcohol consumption of less than one standard glass per day during pregnancy may increase the risks of miscarriage, foetal death and premature birth. It may
also have a negative impact on the child’s psychomotor development after birth. The
effects are exacerbated by a higher average consumption. Consumption of six or more
standard drinks per day increases the risk that the child will be born with defects and
the typical facial characteristics of Foetal Alcohol Syndrome.
• During breastfeeding, after consumption of one to two glasses of alcohol by the
mother, infants have shown much less inclination to feed during the three hours afterwards and have a disturbed sleep-waking pattern.
Laboratory experiments conducted on animals have shown that susceptibility for alcoholrelated brain damage (in terms of loss of function) is greater at an earlier age than at a
later age.154
• Research among humans confirms this finding. Young people with an alcohol problem
exhibit comparable function loss, compared to their peers who are not problem drinkers.
• Owing to methodological deficiencies, there is less clear proof of a direct causal effect
among adolescents, although result from scientific research point in the same direction.
In its recently published ‘Healthy Eating Guidelines’, the Health Board issues the following advice with regard to alcohol use:155
• No more than two standard measures of alcohol daily for men
• No more than one standard measure of alcohol daily for women
• Alcohol consumption is not advised below the age of 18.
• Women who are or want to become pregnant or who are breastfeeding are also advised to abstain from alcohol.
Deaths
The number of alcohol-related deaths showed a rising trend from 1995 through 2003. In
2004 and 2005 there was evidence of a slight decline.
• According to the Causes of Death Statistics of Statistics Netherlands, in 2005 almost
1,800 people died of causes linked specifically to alcohol, over 30% more than in 1995
(Figure 6.9).
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•
•
•
•
•
In 2005, alcohol was stated to be the primary cause of death in 43% of all alcoholrelated deaths; in the remaining 57%, alcohol use was the secondary cause of death.
In 2005, dependence and other mental disorders caused by alcohol use were the main
causes of death (61%), followed by alcoholic liver disease (33%).
Alcohol-related deaths were most prevalent in the age group from 50 to 65 (Figure
6.10). Most of those who died were male (on average 73%).
The role of alcohol use in deaths is not always identified. Therefore these figures do
not fully reflect the true situation.
- On the basis of epidemiological research it is thought that between four and six
percent of cancer deaths are linked to chronic excessive alcohol use. This would
mean that in 2002, between 1,500 and 2,300 alcohol-related cancer deaths took
place instead of the 150 registered cases.156;157
- It may also be assumed that deaths caused by alcohol-related accidents and alcohol-related aggression are not included fully in these figures.
In a list of lifestyle factors causing death, alcohol is in fourth place, after smoking,
physical inactivity and poor nutrition.158
Figure 6.9
Deaths from alcohol-related conditions, from 1995
Number
2000
1800
1600
1400
1200
1000
800
600
400
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
secondary
669
705
710
750
774
809
888
928
1090
1029
1003
primary
663
690
686
744
783
820
906
826
796
722
771
Number of deaths. 1995: ICD-9 codes 291, 303, 305.0, 357.5, 425.5, 535.3, 571.0-3, 980.0-1, E860.0-2,
E950.9*, E980.9* (* only included if stated as complication 980.0-1) From 1996-2004: ICD-10 codes F10,
G31.2, G62.1, I42.6, K29.2, K70.0-4, K70.9, K86.0, X45*, X65*, Y15*, T51.0-1 (* only included if stated as
complication T51.0-1). For an explanation of the codes: see appendix C. Source: Cause of Deaths Statistics,
Statistics Netherlands (CBS). Primary cause of death: the illness or the event which started the started the
process leading to death. This is known as the underlying illness. Secondary cause of death: consequences or
complications of the primary cause of death, like other illnesses that were present at the time of death and may
have contributed to the death.
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Figure 6.10
Deaths from alcohol use (primary and secondary) in men and women by
age group. Survey year 2005
Numb er
300
250
200
150
100
50
0
<40
40-45
45-50
50-55
55-60
60-65
65-70
70-75
Female
18
16
47
79
81
63
47
44
75+
77
Male
55
74
145
188
202
180
159
135
164
Number of deaths. ICD-10 codes: F10, G31.2, G62.1, I42.6, K29.2, K70.0-4, K70.9, K86.0, X45*, X65*, Y15*,
T51.0-1 (* only included if stated as complication T51.0-1). For an explanation of the codes: see appendix C.
Source: Cause of death statistics, Statistics Netherlands (CBS)
6.8 SUPPLY AND MARKET
Alcohol is widely available in grocery stores, liquor stores and in pubs and restaurants.
According to the Licensing and Catering Act, it is not permitted to sell drinks containing
alcohol to juveniles aged under 16. For spirits, the age limit is 18.
• In 2005, 7% of 13-15 year olds had purchased alcohol in bars in the past month. One
percent purchased alcohol from a liquor store and seven percent from a grocery store
(table 6.8).121
• Since 2001 there has been a decline in the percentage of youngsters aged under 16
who purchase low-alcohol beverages. This decline can be seen in bars (from 14% to
7%), in liquor stores (from 4% to 1%) and in grocery stores (from 13% to 7%).
• Spirits are less likely to be purchased than other alcohol types. Of 16-17 year olds,
five percent had purchased spirits in a bar and 8% in a liquor store in 2005. Youngsters aged under 16 rarely buy spirits.
• Since 2001 there has been a decline in the percentage of juveniles that purchase spirits in bars (from 4% to 2%). The drop registered at liquor stores is not significant
(from 4% to 3%).
• According to a survey conducted in 2004, a quarter of all juveniles aged 12 to 16 had
ever bought alcohol.159
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125
Table 6.8
Percentage of legally underage juveniles that bought weak or strong alcoholic beverages in the past month from various sales outlets. Survey 2005
Age
Weak alcoholic
beverage
Strong alcoholic
beverage
Bars etc.
Liquor store
Grocery store
Bars etc.
Liquor store
13 y
1
0
2
0
0
14 -15 y
13
2
11
1
0.5
16 -17 y
5
8
total
7
1
7
2
3
Source:121
There are few obstacles preventing youngsters from purchasing alcohol. In 2005 compliance with the age limits in Dutch supermarkets and liquor stores was measured for the
first time by means of the ‘mystery shopping’ method. For this experiment, adolescents
aged 15 and 17 attempted to purchase alcohol in a total of 150 supermarkets and 150
liquor stores.160
• 86% of all attempts were successful.
• In the case of low alcoholic beverages, 88% of attempts by 15 year olds to make supermarket purchases were successful. In liquor stores, 77% of attempts were successful for this age group.
• In purchasing spirits, 89% of 17 year olds were successful.
• Girls have more success than boys (93% versus 78%).
• One in seven adolescents (14%), who sometimes or regularly participate in the social
scene, uses or has used a fake ID to purchase alcohol.161 These are usually ID papers
that have been faked or that belong to an older acquaintance.
Three quarter of secondary schools provide alcohol at school parties.162
Schools that provide alcohol at school parties almost without exception operate a policy that alcohol may not be given to pupils aged under 16.
• Half of the pupils who are not yet sixteen (51%) drink alcohol at school parties.
• Almost two-thirds of this group (64%) report having been able to purchase alcohol
themselves at a school party.
• Over one in three (39%) of the pupils attending a school party report having drunk
between five and ten alcoholic drinks; 12% (chiefly boys) take more than ten drinks at
a school party.
•
Ten percent of the working labour force say alcohol is available for sale at the work
place, in the canteen or company restaurant.118
• For 34%, alcohol is sometimes available in a different way at the workplace, for example in the fridge or through a colleague.
• For eleven percent, a company drinks-event with alcohol is arranged at least once
weekly.
Excise
•
•
•
The 18% increase of excise duty on spirits that was introduced on 1 January 2003 was
reversed on 1 January 2006. This means the excise on per litre of pure alcohol is now
15.04 euro.
Accordingly, a bottle of spirits has become 1.00 to 1.5 Euro cheaper.163
In October 2006, the excise on a litre of spirits (35% alcohol) was €5.30, on a litre of
wine €0.59 and on a litre of beer, €0.25 (Table 6.9).
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•
•
•
•
For a glass of beer of 0.25 litres, this means €0.06, for a glass of wine of 0.1 litres it is
also €0.06 and for a measure of spirits (0.035 litres) it is €0.18.
EU member states have different excise policies, with widely disparate rates of tax. In
Italy, the tax on a litre of spirits with 35 volume percent alcohol is three euro compared to 19 euro in Sweden (Table 6.9).
Seven wine producing countries impose no excise duty at all on wine.
Table 6.9 shows that the Dutch excise rates are in the mid-range.
Table 6.9
Excise duty on alcoholic beverages in a number of EU member states. Survey dates April-July 2006
Member state
I
Beer
II
Wine
III
Spirits
Sweden
79
237
1 885
Ireland
99
273
1 374
U.K.
98
253
1 007
Finland
97
212
989
Denmark
34
82
704
Belgium
21
47
613
The Netherlands
25
59
526
France
13
3
508
9
0
456
Greece
14
0
397
Luxembourg
10
0
364
Austria
24
0
350
Portugal
16
0
328
Spain
11
0
291
Italy
28
0
280
Germany
Amounts in Euros per hectolitre of consumption. I. 5% alcohol by volume, survey date 1 July 2006. II. 11%
alcohol by volume; survey date 1 July 2006. III. 35% alcohol by volume; survey date 1 April 2006. Sources:
Alcohol Product Board, Wine Product Board, European Commission
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127
7
TOBACCO
Tobacco is made from the dried leaves of the tobacco plant (Nicotiana). It is generally
smoked in the form of a cigarette, cigar or pipe, and more rarely taken as snuff or chewed.
Users experience tobacco as stimulating (improves concentration) and calming. Nicotine,
its most important psychoactive component, is an addictive substance. Regular use is
habit forming and increases tolerance. When tobacco smoke is inhaled, various substances are released, such as nicotine, tar and carbon monoxide, as well as number
other chemicals that are harmful to the health.
7.1 RECENT FACTS AND TRENDS
In this chapter, the main facts and trends concerning tobacco are:
• The percentage of smokers in the general population did not drop further between
2004 and 2005. However there was a drop in the average tobacco sales per smoker (§
7.2).
• The decline in the number of heavy smokers did not continue in 2005 (§ 7.2).
• The number of smokers in the school-going population dropped between 1999 and
2003 (§ 7.3).
• The Netherlands occupies an intermediate position in the EU with regard to smoking
among school-goers (§ 7.5).
• Non-smoking is increasingly the social norm among young people (§ 7.6).
• There has been a slight reduction in total smoking-related deaths in recent years (§
7.7).
• Until recently, deaths from lung cancer were dropping for men, but continue to rise for
women (§ 7.7).
7.2 USAGE: GENERAL POPULATION
In the 1960s and 1970s smoking was the norm, particularly among men. From the late
1960s until the early 1990s, the percentage of smokers declined sharply. This decline
subsequently became less marked.
• Surveys by TNS NIPO point to a possible further drop in the number of smokers from
early 2000. In 2005 this decline levelled off (Table 7.1).164
• Likewise, according to TNS NIPO, in 2005 28% of the Dutch population aged 15 and
older were smokers - the same as in 2004. A further 31% were ex-smokers, whereas
41% had never smoked.165
• In terms of the whole population, there are almost four million smokers in the Netherlands.
- The gap between men and women has shrunk (Table 7.1). Female smokers now
smoke virtually as much as male smokers. Female smokers smoke on average 14.4
cigarettes daily, and male smokers smoke on average 15.5 cigarettes (or roll-ups).
Women are less likely to smoke roll-ups, pipe or cigars, and prefer low-tar, lownicotine, tipped cigarettes.
- The highest percentage of smokers is found in the age group from 35 to 49. (Figure
7.1).165
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Table 7.1
Male and female smokers in the Netherlands aged 15 and older, from 1970
Year
Male
Female
Total
1970
75%
42%
59%
1975
66%
40%
53%
1980
52%
34%
43%
1985
43%
34%
39%
1990
39%
31%
35%
1995
39%
31%
35%
1996
39%
32%
35%
1997
37%
30%
33%
1998
37%
30%
34%
1999
37%
31%
34%
2000
37%
29%
33%
2001I
33%
27%
30%
2002
34%
28%
31%
2003
33%
27%
30%
2004
31%
25%
28%
2005
31%
24%
28%
Percentage of smokers. I. In 2001, the research method was changed: instead of a face-to-face interview at
home, the survey is conducted via the Internet. This change may have affected the outcomes. Source:
STIVORO, TNS NIPO.164
•
•
In addition to the annual TNS NIPO surveys (tobacco only) the NPO (National Prevalence Research) conducted surveys on substance use in 1997, 2001 and 2005.
- According to the NPO, the percentage of the population aged 15 to 64 that ever
smoked dropped from 70% in 1997 to 62% in 2005. The drop was most marked
between 2001 and 2005.
- The number of daily smokers dropped between 1997 and 2005 from 35% to 27%.
These data deviate somewhat from those of the TNS NIPO measurements.4
The National Anti-Smoking Programme 2006-2010 has set the target to reduce the
number of smoker in Dutch society from 28% in 2005 to 20% in 2010.166
130
TRIMBOS-INSTITUUT
Figure 7.1
Percentage of smokers in the Netherlands by age group and gender. Survey year 2005
%
50
40
34
32
30
27
22
20
14
10
Age
0
15-19
20-34
35-49
50-64
>64
Source: STIVORO, TNS NIPO.
By contrast with the reduction in the number of smokers, there was an increase in the
1970s in the amount of tobacco used per smoker. Since the 1980s, the average number
of cigarettes or roll-ups smoked daily has been estimated at around the twenty mark.
• In 2005 some 24.5 billion cigarettes or roll-ups were smoked in the Netherlands – a
drop of over 2 billion compared to 2004 (Table 7.2).
164
• Rolling tobacco has declined in popularity since 1990 by comparison with cigarettes.
Table 7.2
Use of cigarettes and rolling tobacco in the Netherlands, since 1967
Year
Cigarettes
(billion)
Roll-ups
(billion)
Total
(billion)
Average daily
sales per
smokerI
1967
16.6
9.1
25.7
12.9
1970
18.7
9.9
28.6
14.0
1975
23.9
13.1
37.0
18.6
1980
23.0
13.9
36.9
21.3
1985
16.3
17.8
34.1
20.7
1990
17.3
16.6
33.4
22.4
1995
17.2
14.4
31.6
20.1
2000
16.7
13.7
30.4
19.9
2001
16.3
12.4
28.7
20.1
2002
16.9
13.2
30.1
20.5
2003
17.0
13.1
30.1
20.9
2004
14.8
12.1
26.9
20.0
2005
13.5
11.1
24.6
18.3
I. Average number of cigarettes or roll-ups. Source: STIVORO, Statistics Netherlands (CBS), Ministry of Finance.
164
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131
Heavy smoking
According to Statistics Netherlands (CBS), there has been a decline in recent years in the
percentage of heavy smokers. However, this trend did not continue in 2005.
• In 2005, 7.7% of the population aged 12 and older smoked 20 or more cigarettes a
day (9.5% of males and 6.0% of females). This percentage does not differ greatly
from that in 2005 (7.4%). In 2000 it was 10%.158
• In 2005 over a quarter of all smokers were heavy smokers (26%). This compares with
25% in 2004 and 35% in 2000.
7.3 USAGE: JUVENILES AND YOUNG ADULTS
The percentage of young smokers has dropped in recent years.
• According to the Dutch National School Survey, there was drop between 1999 and
2003 in the percentage of school-goers who had ever smoked and in those who had
smoked during the past month (Figure 7.2).
• Data from the TNS NIPO-survey show that the percentage of current smokers among
those aged 10 to 19 remained stable from 1992 through 2002 (between 27% and
31%). In 2004, the percentage of current smokers in this age group dropped to 23%
where it remained in 2005.164
Figure 7.2
Smoking among school-goers aged 12 to 18, from 1988
%
65
59
55
55
55
55
45
45
35
30
27
26
25
23
20
Ever
Current
15
1988
1992
1996
1999
2003
Percentage of lifetime smokers (ever) and in the last month before the survey (current).
Source: Dutch National School Survey, Trimbos Institute.
Smokers start young.8
• In 2003 11% of pupils in the two most senior years of primary school had ever
smoked. Of pupils attending mainstream secondary schools, 45% had ever smoked.
These figures reflect the average; the percentage rises with age (Figure 7.3).
132
TRIMBOS-INSTITUUT
Figure 7.3
70
Smoking in school-goers aged 10 and older, by age. Survey year 2003
%
63
60
60
55
49
50
40
35
32
30
28
30
23
20
20
12
11
6
10
Ever
1
Current
0
PE
12 yr
13 yr
14 yr
15 yr
16 yr
17-18 yr
Percentage of current (past month) and lifetime (ever). PE = primary education
Source: Dutch National School Survey, Trimbos Institute.
•
•
•
A fifth (20%) of secondary school pupils had smoked in the past month; 9% smoked
every day.
These percentages, too, increase as the pupils get older. In the oldest age group
(16+), nearly one third were current smokers, compared to 6% of 12 year olds and
12% of thirteen year olds.
Almost the same number of boys (18%) as girls (22%) had smoked in the past
month.
Extent of smoking
•
•
For current smokers among school-goers, it is known how much they smoke per day
on average. One third (34%) smoke less than one cigarette daily, and a quarter
smoke more than ten a day.8
Nine percent of school-goers smoke daily. Over a third of this group (36%) smoke
more than ten a day.8
A comparison with data from the national Health Behaviour in School-aged Children (HBSC) study in 2005 suggests that the percentage of juveniles that ever smoked underwent
a further decline between 2003 and 2005.9
• In 2003, 43% of school-goers aged 12 to 16 had ever smoked; in 2005 this was 33%.
• The percentage of daily smokers remained unchanged, however, during this period
(8.6% in 2003; 8.4% in 2005).
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133
Special groups
Smoking is considerably more common among young people in the social scene than
among school-goers. In so far as trend data are available, these show a decline in smoking in these groups as well.
• Among frequenters of Amsterdam bars the percentage of daily smokers dropped from
46% in 2000 to 31% in 2005. The number of heavy smokers (at least 20 cigarettes or
roll-ups per day) declined from one quarter in 2000 to 18% in 2005.17
• In 2001, daily smoking was common among clients of Amsterdam coffee shops
(70%).16
• The daily smokers among coffee-shop clients and bar-goers smoked on average 14 to
16 cigarettes or roll-ups per day.
• Between 1998 and 2003 the percentage of clubbers that had smoked in the past
month dropped from 67% to 55%.12
7.4 PROBLEM USE
A clear indication of the extent to which smokers find their use of tobacco problematic is
their desire to stop smoking.
• In 2005, 7% of smokers said they wanted to stop smoking within a month, 10%
wanted to stop within six months, 8% within a year, and 13% said they wanted to quit
at some time in the future.165
In scientific circles, the term ‘nicotine dependence’ is sometimes favoured above ‘tobacco
addiction’. Dependence can be measured on different scales: the Fagerström Test for
Nicotine Dependence, a scale which runs from zero to ten (highly addicted); the DSM-IV,
the Cigarette Dependence Scale, the Nicotine Dependence Syndrome Scale and the Winsconsin Inventory.167
In 2000, the Fagerström Test for Nicotine Dependence was conducted among twins from
the Dutch Register of Twins.168
• Nicotine dependence is linked to the number of cigarettes that are smoked.
• Male smokers have a higher average score for nicotine dependence than female smokers: 3.02 versus 2.77.
• Attempts to quit smoking are likely to be more successful, the less one is dependent
on nicotine.
7.5 INTERNATIONAL COMPARISON
The percentage of smokers in the population of different EU member states varies considerably. However, the comparability of the figures may be questionable. For instance,
there are discrepancies in how smoking is defined and in the age groups (Table 7.3). In
many countries the data concern daily smokers; in the Netherlands smokers are people
who smoke ‘daily or sometimes’.
• Of the countries that measured daily smoking, Greece had the most smokers (38%)
and Sweden the fewest (16%).
• With the exception of Ireland and Sweden there are more male than female smokers.
In Portugal, where only ten percent of the female population smoke daily or sometimes, this gender difference was the greatest.
134
TRIMBOS-INSTITUUT
Table 7.3
Smokers in the adult population in a number of EU member states plus
Norway and SwitzerlandI
Country
Year
Age
Male
Female
Total
Criterion for
smoking
Belgium
20022005
18+
30%
25%
27%
Daily
Denmark
20022005
15+
28%
23%
25%
Daily
France
20022005
15+
33%
27%
30%
Daily
Greece
19992001
15+
47%
29%
38%
Daily
Ireland
20022005
15+
24%
24%
24%
Daily
Italy
20022005
15+
31%
17%
24%
Daily
Luxembourg
20022005
15+
39%
26%
33%
Daily
Norway
20022005
16-74
27%
25%
26%
Daily
Spain
20022005
16+
34%
22%
28%
Daily
Sweden
20022005
16-84
14%
19%
16%
Daily
Switzerland
20022005
14-65
24%
20%
22%
Daily
The Netherlands
2005
15+
31%
25%
28%
Daily or sometimes
Austria
20022005
15+
48%
47%
47%
Daily or sometimes
Portugal
19992001
15+
33%
10%
21%
Daily or sometimes
Finland
20022005
15-64
27%
20%
23%
Current smokers
UK
20022005
16+
28%
24%
26%
Current smokers
Germany
20022005
18-54
37%
31%
34%
Past 30 days
Percentage of smokers per year or average per year. I. Differences in survey year, measuring methods and
definitions hamper a precise comparison between countries.
Source: WHO.
With ESPAD (see appendix B) it is possible to compare the smoking behaviour of 15 and
16 year old pupils in secondary schools. Figure 7.4 shows data for the percentage of
school-goers that had smoked during the past month in 2003.
• Of the countries under review, Austria had the most and Sweden the fewest smokers
among secondary school students.
• The Netherlands occupies an intermediate position.
• In most of the countries, more girls smoke than boys.
TRIMBOS-INSTITUUT
135
Figure 7.4
Smokers among secondary school pupils aged 15 and 16 in a number of EU
member states plus Norway and Switzerland. Survey year 2003
49
Austria
48
Germany
43
38
Finland
38
35
45
46
41
35
Italy
56
40
34
34
33
Switzerland
33
France
36
31
33
Ireland
37
28
32
33
32
Belgium
31
31
32
The Netherlands
30
Denmark
27
32
29
United Kingdom
34
25
28
Greece
27
30
28
Norway
32
24
28
27
28
Portugal
27
Spain
22
23
Sweden
20
0
10
20
31
26
%
30
Boys
Girls
40
50
60
Total
Percentage that had smoked in the past month. Source: ESPAD.
•
Over a quarter of Dutch school-goers (27%) report having smoked more than forty
times in their lives. In the other countries, this percentage varies from 18% in Portugal to 42% in Austria.
7.6 TREATMENT DEMAND
This mainly involves self-help and requests for treatment from the GP. Addiction Care
sometimes provides cessation programmes, but not on a large scale.
136
TRIMBOS-INSTITUUT
•
•
•
•
•
•
•
•
•
Almost two-thirds (62%) of smokers who attempt to quit, do so without any external
help. The remainder attend courses, consult their GP, use nicotine replacement therapies (patches, chewing gum or Zyban®), undergo acupuncture or hypnosis, or try a
different method. The most common reason for giving up smoking is smokers’ concern
about their own health.165
The use of nicotine replacement therapies has declined. Sales in patches, chewing
gum and tablets dropped between December 2005 and November 2006 from some
14 million euro to 13.2 million euro.169 In 2005, Zyban® was only issued 48,000
times, a drop of 20% compared to 2004.170
In late 2006, the new anti-smoking medication, Champix®, (active ingredient: varenicline) was registered as a new drug.171
People who want to give up smoking can go to their GP for advice. In 2005 an estimated 53,200 men and 58,500 women consulted their GP about quitting smoking. In
total, this is 1.5% less than in 2004. The majority of quitters are aged between 40 and
60.172 The Minimal Intervention Strategy (MIS) has proved to be an effective instrument which GPs, nurses and cardiologists can use to encourage patients to give up
smoking.173 However, there is still room for significant improvement in the adoption
and implementation of MIS by cardiology nursing wards and by midwives.174
The STIVORO advisory centre also provides support to people who want to give up
smoking. In 2005, 947 people requested Telephone Coaching, and 7,000 coaching
conversations took place.164
In January 2006, STIVORO launched the Guideline for Tobacco Prevention in Local
Healthcare Policy. This guideline was developed in order to support municipalities and
GGDs in implementing local policies for discouraging smoking.164
The campaign ‘Smokers deserve a reward’ was launched on 2 November 2006. Its aim
was to motivate as many smokers as possible from lower socio-economic classes to
try to stop smoking for 24 hours. More than half of the 12,272 participants succeeded
in not smoking for 24 hours.175
The youth campaigns were aimed at preventing youngsters from taking up smoking.176
The emphasis was on improving the image of non-smokers and putting non-smoking
forward as the social norm. Between 2001 and 2005, the non-smoker did indeed receive a more positive image. The percentage of youngsters that felt that friends
wanted them not to smoke rose from 19% to 25% between 2004 and 2005.177
In late 2004, an official CBO (Dutch Institute for Health Care Improvement) guideline
for the treatment of tobacco addiction was released. This guideline addresses the
treatment of smokers in medical practice and describes the effectiveness of various
treatments.178;179
Another issue is the demand on the health care system for conditions caused or exacerbated by smoking. The number of hospital admissions associated with smoking amounted
to nearly 100,000 in the early 1990s.180 More recent figures are not yet available.
7.7
ILLNESS AND DEATHS
In the Netherlands, smoking is the most important cause of premature death.
• In 2005 nearly 19,000 people aged 20 and older in the Netherlands died from the direct consequences of smoking; this was somewhat fewer than in 2004 (19,415). Compared to 2000, this represents a drop of almost nine percent.181
• Of all deaths in the Netherlands among people aged 20 and older, nearly 14% were
directly attributable to smoking in 2005 (20% for men and 8% for women).181
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137
•
•
Smoking is linked to cardio-vascular disease, lung diseases and cancer. Table 7.4
shows that lung cancer is caused overwhelmingly by smoking. In 2005 74% of lung
cancer cases among women and 91% among men were caused by smoking.
The true death rate from smoking is higher, because the effect of passive smoking has
not been factored in. Passive smoking can cause a variety of illnesses.
- People who do not smoke themselves, but are regularly exposed to passive smoking from a partner who smokes have an increased risk of developing lung cancer. In
the case of passive smoking women, the increased risk is 20% and among passive
smoking men, the increased risk of lung cancer is 30%.182
- Besides lung cancer, passive smoking also increases the risk of diseases of the respiratory tract, such as asthma and bronchitis. There is furthermore an increased
risk of cardio-vascular diseases and brain haemorrhage. 183
- Children have a higher risk of developing infections of the respiratory tract and
middle-ear infection from passive smoking. Babies whose mother smokes have a
higher risk of complications during pregnancy, as well as premature birth, low birth
weight and cot death.184-186
- Annual deaths from passive smoking are estimated at several thousand cases due
to heart conditions, several hundred cases from lung cancer and about a dozen
cases of cot death. 187
Table 7.4
Deaths due to a number of conditions among men and women aged 20 and
older. Survey year 2005I
Total deaths
Condition
Deaths from smoking
Men
Women
Men
Women
Lung cancer
6 359
3 055
5 807
2 247
COPD
3 718
2 690
3 148
1 858
Coronary heart disease
5 360
4 141
1 516
492
Stroke (CVA)
4 057
6 363
834
631
Heart failure
2 592
4 196
463
237
Oesophageal cancer
1 031
412
818
255
Cancer of the larynx
190
37
151
31
Oral cavity cancer
337
191
311
108
23 644
21 085
13 048
5 859
TotalI
I. Per condition, first rounded to whole numbers and then added up. Source: RIVM, Statistics Netherlands
(CBS).
Thanks to the fall-off in smoking among men between 1960 and 1990, deaths from lung
cancer have dropped – at least until recently. Among women, however, who have taken
up smoking in greater numbers, the trend is reversed (Table 7.5).
• The upward trend in lung cancer deaths among women will continue for some decades.188
• The decline among men until 2003 did not continue in 2004 and 2005.
• The opposite trends for men and women balance each other out. Consequently, total
deaths from lung cancer have remained fairly stable for some years.
138
TRIMBOS-INSTITUUT
Table 7.5
Deaths from lung cancer as the primary cause of death among people aged
15 and older from 1985. Deaths per 100,000 inhabitants
Year
Males
Females
Total
1985
127
16
71
1986
130
17
72
1987
127
17
71
1988
128
19
72
1989
123
20
70
1990
117
20
67
1991
118
20
68
1992
117
22
69
1993
115
24
69
1994
113
26
68
1995
112
27
69
1996
109
28
68
1997
108
29
68
1998
106
30
68
1999
105
33
68
2000
99
34
66
2001
100
35
67
2002
96
39
68
2003
95
40
67
2004
99
42
70
2005
97
45
71
1985-1996: ICD-9 code 162, from 1996: ICD-10 codes C33-34 (see appendix C). Source: Cause of death statistics, Statistics Netherlands (CBS).
7.8
SUPPLY AND MARKET
Availability of tobacco
•
In 2005 46% of cigarettes were purchased in supermarkets, 30% in tobacconist and
convenience stores, 11% in other shops and 13% at petrol stations. In the same
year, the percentages for cigars, rolling tobacco and pipe tobacco were: 56% purchased in supermarkets, 24% purchased in tobacconists and convenience stores, 12%
at petrol stations and 8% in other shops.189
Since 1 January 2003 it is no longer permitted under the amended tobacco laws, to sell
tobacco products to juveniles aged under 16.
• The number of juveniles aged between 13 and 15 who have bought tobacco products
dropped between 1999 and 2005 from 26% to 6%.190
• Of the minors who had purchased tobacco, 57% indicated having made the purchase
themselves in 2005, whereas in 1999 this was 43%.
• Youngsters purchase tobacco products from four different kinds of retail outlets: tobacconist (40%), grocery store (49%), petrol station (43%), cigarette machines
(23%). The trend is moving away from grocery stores and cigarette machines.
• The likelihood of juveniles aged under 16 succeeding in purchasing tobacco products is
at least 90%, which is the same as in 1999, 2001 and 2003. Nonetheless, 93% of retailers claim that they never sell tobacco to children aged under 16.190
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139
Excise duty
•
Since 1 April, 2006, a packet of 19 cigarettes in the most popular price bracket costs
3.80 euro. This converts to 5 euro for 25 cigarettes, of which €2.85 is excise tax and
€0.80 is VAT. A packet of rolling tobacco weighing 50 grams also costs 5 euro, of
which €2.25 is excise duty and €0.80 is VAT (Table 7.6).191;192
Table 7.6
Cigarette prices and taxes from 1970. Survey date July 2006
Year
Price
Taxes
Taxes in %
1970
0.86
0.60
69%
1975
1.02
0.68
67%
1980
1.36
0.98
72%
1985
1.88
1.35
72%
1990
1.97
1.37
70%
1995
2.56
1.84
72%
1996
2.61
1.87
72%
1997
2.79
2.01
72%
1998
2.93
2.11
72%
1999
3.04
2.19
72%
2000
3.15
2.27
72%
2001
3.43
2.50
73%
2002
3.54
2.58
73%
2003
3.54
2.63
74%
2004
4.60
3.36
73%
2006
5.00
3.65
73%
Price and taxes in Euro per pack of 25 (converted). Tax includes excise duty and VAT. Source: European Commission.
192
The taxes imposed on tobacco products differ considerably among EU member states.
• In the EU-15 the excise duty is highest in the UK and lowest in Spain (Table 7.7). The
Netherlands occupies an intermediate position.192
• In 2003 the World Bank published an overview of six cost-effective interventions designed to discourage the use of tobacco. In particular, if they are introduced in tandem, these anti-smoking measures have the potential to reduce illness and deaths
from tobacco use. The European Network for Smoking Prevention (ENSP) commissioned European experts to allocate a relative weighting to these interventions.
• Out of a maximum total of 100 points, the six interventions were accorded the following scores:
•
Price of tobacco products: 30 points; smoking ban in public places and workplace: 22
points; amount of national budget allocated to smoking deterrent policy: 15 points; a
ban on advertising tobacco products: 13 points; warnings on tobacco packaging: 10
points; and the availability of smoking cessation treatments: 10 points.
• In 2004 the experts rated 28 European countries on the basis of this scale. The Netherlands was placed 7th.193 In 2005, 30 European countries were rated and the Netherlands dropped to tenth place.194
140
TRIMBOS-INSTITUUT
Table 7.7
Cigarette prices and taxes in a number of EU member states. Survey date
July 2006
Country
Price
Excise duty
VAT
Excise + VAT
UK
9.61
5.98
1.43
7.41
Ireland
8.06
4.81
1.40
6.21
France
6.25
4.00
1.02
5.02
Germany
5.56
3.47
0.77
4.24
Sweden
5.37
2.64
1.07
3.72
Denmark
5.28
2.85
1.06
3.91
Finland
5.13
2.94
0.92
3.86
The Netherlands
5.00
2.85
0.80
3.65
Belgium
4.45
2.56
0.77
3.34
Italy
4.00
2.34
0.67
3.01
Austria
3.88
2.27
0.65
2.92
Luxembourg
3.60
2.05
0.47
2.52
Greece
3.50
2.01
0.56
2.57
Portugal
3.44
2.10
0.60
2.70
Spain
2.81
1.81
0.39
2.20
Price, excise duty and VAT expressed in euros per pack of 25 cigarettes (converted). Source: European Commission. 192
•
In 2005 the Netherlands received the following scores in relation to the other European countries for the six cost-effective anti-smoking measures:
- price of tobacco products: below average
- smoking bans in public places and workplace: above average
- amount of national budget allocated to anti-smoking policy: above average
- ban on advertising tobacco products: above average
- warnings on tobacco packaging: average
- the availability of smoking cessation treatments: average.
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141
8
DRUG-RELATED CRIME
This chapter deals with the following issues:
• Drug law crime: crime as described in legislation on drugs (Opium Act, Abuse of
Chemical Substances Prevention Act (WVMC) or crime that is related to these drug
laws (organised crime);
• Criminal activity related to drug use and drug users: crimes perpetrated by drug users, addiction probation and aftercare service, compulsive and quasi-compulsive
treatment orders;
• Driving under the influence of legal and illegal substances: crimes described in the
Road Traffic Act.
The data refer mainly to crime registered by law enforcement agencies. This includes
both crimes that are registered when a suspect is arrested and booked (registered and
solved crimes) and crimes that are registered but not solved (such as investigations into
organised drug crime and drugs that have been seized without a suspect).
Information on crime related to drug use and perpetrated by drug users is very limited,
because information on drug use is not systematically sought by the law enforcement
agencies, and little research has been conducted in this area. Incidentally we do not assume a causal relationship between drug use/addiction and criminal activity; however,
there is likely to be a dynamic, interactive relationship between the two.195
With regard to driving under the influence (of alcohol or drugs), our report says relatively
little about drugs, because little is known about this; the data available mostly refer to
alcohol.
We do not make any assertions about the percentage of drug-related crime in total crime
(registered and unregistered). Therefore the data cannot be imputed to total drugrelated crime. To a certain extent, the figures also reflect the crime-solving priorities and
capacity of the law enforcement authorities, as well as the leeway afforded them in providing information. This calls for a certain degree of caution in interpreting the data.
Appendix B gives a schematic overview of the information sources used. For more information we refer you to www.trimbos.nl/monitors. Not all the data are of equally high
quality. This problem has been highlighted earlier.2;196 In particular, data about drug
seizures should be interpreted with caution.197;198.
This report contains an update of a number of tables. Consequently, the data contained
in the tables about criminal investigations, prosecutions, trials and disposals (Tables 8.1,
8.2 and 8.5 - 8.14) cannot be compared directly to the tables in previous annual reports.
8.1 RECENT FACTS AND TRENDS
The most striking development in 2005 is that the number of drug crimes at the start of
the law enforcement chain (Public Prosecutor, and - according to provisional figures also the police) has dropped in relation to 2004. However, the total number remains
above that for the period preceding 2004. The drop in 2005 refers only to hard drug offences; soft drug offences have in fact increased.
The main facts and trends for 2005 are:
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143
•
•
•
•
•
•
•
•
•
•
•
•
•
•
According to provisional figures, there has been a drop in the number of people
booked by the police on suspicion of drug offences, compared to 2004. In 2005, there
were over 21,000 (§ 8.2.1). There was also a drop in the number of charges issued by
the Public Prosecutor: down from nearly 22,000 to over 20,000 (§ 8.2.4). There had
been an increase each year between 20000 and 2004. The number of drug offences is
lower than in 2004, but remains relatively high compared to the period prior to 2004.
The decline refers to hard drug offences. Soft drug offences rose further in 2005. Hard
drug crimes still account for the majority of Opium Act cases, but the gap with soft
drug offences is considerably smaller than in previous years (§ 8.2.1 and § 8.2.4).
Criminal investigations of more serious forms of organised crime show an increase in
the percentage related to drugs. In 2005 the total was 72% drug-related. The bulk of
these cases involve hard drugs (85%) - chiefly cocaine and synthetic drugs (§ 8.2.2).
The number of hard drug cases appearing in court was higher than in 2004. This can
be attributed to the fact that in 2005 fewer cases were dropped on policy grounds,
chiefly on account of the reversal of the ‘substance-oriented approach’ to drug couriers at Schiphol airport (§ 8.2.4).
Virtually the same number of drug cases were disposed of in court in the first instance
as in 2004 (+ 1%). The total amounts to over 12,200 (§ 8.2.5).
There was a further rise in the number of community orders imposed for Opium Act
offences in 2005 (§ 8.2.6).
Compared to 2004, there was a drop in the number of unconditional custodial sentences imposed for drug offences. However, the percentage remained the same
(16%). This reflects an overall declining trend in prison sentences (§ 8.2.6 and §
8.2.7).
There is a decline in the number of detention years imposed on drug offenders: custodial sentences are becoming shorter. Likewise, the number of detainees convicted on
drugs charges shows a downward trend (§ 8.2.7).
Recidivism occurs among approximately one third of drug offenders. The rate of recidivism is somewhat higher among drug offenders than among all other law-breakers
together. Approximately one tenth will commit a father drug offence within two years
(§ 8.2.8).
The average age of suspects categorised by the police as ‘drug users’ in 2005 was 36.
These are mainly users who have committed offences on at least 10 previous occasions. These are chiefly non-violent property offences; however, there is a decline in
the percentage of these property offences compared to other offences perpetrated by
the same suspects (§ 8.3.1).
In 2005, over 48,000 people were booked for driving under the influence. This was
chiefly alcohol-related. 90% of suspects were male, and half had already been in contact with the police. An increasing number of drink-driving charges are settled with a
standard financial order (§ 8.3.3).
Relatively little is known about driving under the influence of medicines and illegal
drugs; a survey of a representative sample showed that some 10% of drivers were
driving under the influence; 4.5% of these had taken cannabis, and 2.1% were under
the influence of benzodiazepines; 2.1% tested positive for alcohol (§ 8.3.3).
30-64% of detainees in regular prisons were found to be problem drug users or drugdependent in the year prior to detention (§ 8.3.4).
In 2005, the addiction probation and aftercare services conducted a greater number of
supervisory activities. Likewise, there was an increase in the number of drug diagnoses issued and in the number of reports submitted to the courts, public prosecutor or
prison system about addicted offenders. These activities reflect policy developments
(§ 8.4.1).
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•
Since late 2004, the SOV provision has become part of the Placement in an Institution
for Prolific Offenders measure. The number of participants in the (old) SOV declined in
2005 (§ 8.4.3).
8.2 DRUG LAW VIOLATIONS
How many violations of the drug laws have been committed, what is the nature of these
crimes and what are the characteristics of the perpetrators? These questions are answered in the following section, starting at the beginning of the law enforcement chain.
The Opium Act is central. First we present the police data: the number of suspects
booked, criminal investigations into organised crime and drug seizures. This is followed
by the number of cases and the way these are disposed of by the Public Prosecutor. A
number of these cases come before the courts. We present data on the number of cases
dealt with by the courts and what the verdicts are. Finally we report on custodial sentences for drug law violations and recidivism among the perpetrators.
8.2.1
Drug Crime Suspects
Table 8.1 shows the annual number of suspects booked by the regular police or the Royal
Military Police for violating the Opium Act (production, transport, dealing in and/or possession of drugs). If the violation of the drug laws involved hard drugs, we speak of ‘hard
drug offences’. If only soft drugs are involved, these are called ‘soft drug offences’. The
figures for 2005 are provisional (see Appendix G).
Table 8.1
SuspectsI of Opium Act violations booked by the police and the Royal Military Police for hard and soft drugs, 2000-2005
Number
Total Opium Act
x Hard drugs
x Soft drugs
x Hard and soft drugs
x Other/ unknown
2000
9 957
5 871
2 693
947
446
2001
12 736
7 437
3 578
1160
561
2002
15 810
9 357
4 595
1222
636
2003
18 921
10 881
5 915
1392
733
2004
22 304
12 065
7 432
2107
700
2005II
21 223
10 592
8 104
2025
502
Total all lawsIII
% Opium Act
x Hard drugs
x Soft drugs
x Hard and soft drugs
x Other/unknown
202 479
5%
59%
27%
10%
4%
221 514
6%
58%
28%
9%
4%
252 478
6%
59%
29%
8%
4%
277 899
7%
58%
31%
7%
4%
295 902
8%
54%
33%
9%
3%
294 406
7%
50%
38%
10%
2%
I. refers to the number of times that a suspect charged with an Opium Act offence was listed in police records
(HKS). II.Provisional figures. III. Refers to the total number of charges. Source: HKS, KLPD/DNRI.
•
•
In 2005 suspects were booked on over 21 thousand occasions for violations of the
Opium Act; this was 5% less (provisionally) than in 2004. From 2000-2004 there had
been a continuous rising trend; now, however, the level is the same as in 2003, but
still higher than in the years preceding.
The drop in the number of Opium Act suspects in 2005 refers only to hard drug offences: (provisionally) 12% less than in 2004. The number of people suspected of soft
drug offences has risen (provisionally) by 9%. Between 2000 and 2005 there was an
TRIMBOS-INSTITUUT
145
•
uninterrupted rise in the number of soft drug violations. Compared to 2000, there has
been a three-fold increase.
Hard drug offences still constituted the majority (50%) of all drug offences in 2005.
However, the number of soft drug offenders increased from 33% in 2004 to 38% in
2005.
Table 8.2 shows a number of characteristics of suspects of Opium Act violations 2005.
The majority are male: 83%. Between 2000 and 2005 the percentage of female suspects increased: from 13% to 17% (not in the table). Females are relatively more often suspects in soft drugs offences. Males are relatively more often suspects in offences involving hard and soft drugs.
•
Table 8.2
Characteristics of suspects of Opium Act violations by hard and soft drugs,
2005I, II
Hard
drugs
9 915
Soft
drugs
7 702
2 069
451
20 137
84%
16%
82%
18%
86%
14%
84%
16%
83%
17%
1%
1%
19%
12%
16%
25%
0%
1%
26%
21%
22%
13%
0%
1%
28%
19%
19%
18%
0%
1%
25%
12%
13%
31%
0%
1%
23%
16%
18%
20%
27%
16%
14%
17%
21%
1
2
3–4
5 – 10
11 – 20
21 – 50
> 50
44%
12%
12%
15%
9%
7%
2%
44%
14%
13%
15%
9%
4%
1%
35%
14%
16%
20%
9%
5%
1%
47%
13%
10%
16%
9%
3%
2%
43%
13%
13%
16%
9%
6%
2%
12-17
18-24
25-34
35-44
45-54
55-64
65+
4%
31%
32%
21%
10%
2%
0%
4%
18%
31%
28%
14%
5%
1%
3%
22%
34%
25%
11%
3%
1%
4%
16%
28%
34%
13%
6%
0%
4%
25%
32%
25%
12%
3%
1%
Total number
Gender
Male
Female
Place of residence by number of inhabitantsIII
Unknown
Less than 10 000
10 000 – 50 000
50 000 - 100 000
100 000 - 250 000
250 000 + (G4)
Outside the Netherlands
Number of previous offencesIV from total registered criminal record
Age on registration of last
offence
Both Unknown
I. The Table shows suspects of single crimes; each accused is represented only once in the table, even if a
suspect is booked for Opium Act offences more than once in year. II. Provisional figures. III The offences may
have been committed in another municipality than the accused’s place of residence. IV. A previous offence is
when police have booked a suspect for one or more offences. Source: HKS, KLPD/DNRI.
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Total
•
•
•
Approximately half of the accused living in the Netherlands are resident in cities of
over 100,000 inhabitants. 20% of suspects live in one of the four major cities. Hard
drugs suspects are relatively more likely to live in a big city. More hard drug suspects
also live outside the Netherlands.
A considerable percentage of Opium Act suspects have a number of previous offences
on record. One third have five or more, and 17% have more than ten. Suspects of offences involving hard drugs have the greatest number of previous convictions: 9%
have more than 20.
73% of suspects are aged over 24. Few are younger than 18 (4%) or older than 45
(16%) The average age of drug offenders in 2004 was 31.199 Those accused of drug
production have the highest average age; on average they are ten years older than
those accused of exporting or possession of drugs. Soft drugs offenders are more often in the age group of 35 and older; hard drug offenders are younger: 31% are aged
between 18 and 25. The number of younger suspects aged up to 24 remained stable
in the period from 2000 to 2005.
8.2.2
Investigations into Organised Crime
For the purpose of Europol’s European Threat Scenario, the Research and Analysis Group
of the National Criminal Intelligence Service of the National Police Agency (KLPD), records the criminal investigations conducted annually by the Dutch police into organised
crime. All 25 Dutch police regions, as well as the National Police Research and Analysis
Group and special criminal investigation departments were asked to report on both their
ongoing and completed investigations.
A number of observations need to be made with regard to the data:
• The data from 2002 onwards can no longer be directly compared to data from previous years. This is because in 2002 the KLPD switched to a new registration method.
• The numbers of criminal investigations in 2005 are not directly comparable with those
of the preceding years: owing to a change in Europol’s methods, data collection for
2005 took place from January to November instead of the entire calendar year.
• A single investigation may target trafficking in, or production of, a number of different
kinds of drugs.
Table 8.3 shows that in 2005, the bulk of criminal investigations was aimed at trafficking
in or production of drugs.
• For 2005 (January to November), 176 criminal investigations into organised crime
were reported. Almost three-quarters (72%) of these targeted the trafficking in or
production of drugs.
• The percentage of drug-related investigations rose between 2000 and 2005.
• The majority of criminal investigations into drugs involved hard drugs (85%). In 41
percent of cases, soft drugs were (also) involved. Investigations involving soft drugs
have increased compared to 2004.
• Of the108 investigations that included hard drugs, more than half (56%) involved
only one kind of hard drug.
• Of the 52 investigations that included soft drugs, 37 percent of cases concerned soft
drugs only, whereas in 63% hard drugs were also involved..
• Cocaine occurs in 58 (54%) of criminal investigations of hard drug cases. 48 (44%)
investigations involved synthetic drugs and 31 (29%) involved heroin.
• The bulk of criminal investigations concerning soft drugs are aimed at trafficking in or
cultivation of Dutch-grown weed or hashish.
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147
Table 8.3
Criminal investigations into more serious forms of organised crime, drug
law crime and hard and soft drugs, 2000-2005
2000
2001
2002
2003
2004
2005
148
146
185
221
289
176
78 (53%)
90 (62%)
117 (63%)
146 (66%)
200 (69%)
127 (72%)
Investigations of hard
drugs
Of which
- Cocaine (%)
- Heroin (%)
- Synthetic drugs (%)
64 (82%)
75 (83%)
97 (83%)
121 (83%)
168 (84%)
108 (85%)
60%
17%
54%
57%
18%
39%
54%
29%
44%
Investigations of soft
drugs
43 (55%)
37 (41%)
53 (45%)
57 (39%)
53 (27%)
52 (41%)
Hard drugs only
Soft drugs only
35 (45%)
14 (18%)
53 (59%)
15 (17%)
64 (55%)
20 (17%)
89 (61%)
25 (17%)
137 (69%)
22 (11%)
75 (59%)
19 (15%)
Hard and soft drugs
29 (37%)
22 (24%)
33 (28%)
32 (22%)
31 (16%)
33 (26%)
Total number of criminal
investigations
Targeting drugs (% of
total)
Targeting drugs (% of
all drug investigations):
Source: KLPD/DNRI, Research and Analysis Group
8.2.3
Drug seizures
The National Criminal Intelligence Service of the National Police Agency (KLPD), reports
annually on the quantities of drugs seized. For the 2005 report, information was collected
from the police agencies, the Royal Military Police, customs and the Inland Revenue Intelligence and Investigations Department (FIOD).198 21 of the 25 police regions supplied
data on their drug seizures in 2005. The data presented in Table 8.4 below are therefore
not complete and should be considered with caution:
• Registration of drug seizures by police agencies and other investigative authorities is
not centrally organised, and often not conducted uniformly.198;200
• The differences recorded for the drug varieties are difficult to interpret.
• The data may fluctuate as a result of large seizures made in one year. For this reason,
researchers recommend that data on seizures should be viewed over several years
(three to ten).200-202 However, this recommendation cannot be put into practice here,
because of substantial differences in the regional police data supplied over the years.
The data also reflect the level of investigative effort.
Because of the lack of reliability in the data registration and the difficulty in making comparisons with previous years, we present only rounded figures and only for 2005 (Table
8.4). We do not report on the total number of seizures in 2005, because the data available were too limited.
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Table 8.4
Drug seizures in the Netherlands in 2005I
Type
Heroin
Cocaine
Morphine
Amphetamine
Kilos
+ 900
+ 14 600
Tablets
Litres
Number
+ 1 600II
+ 1 000
+ 300 (oil)
+ 200 kg (pasta)
Ecstasy (MDMA, MDA, MDEA)III
MMDMA/MDA/MDEA
+ 200II
+ 1 900 000
+ 10 (oil)
+ 200 (oil)
+ 200 kg (pasta)
GHB
LSD
Methadone
Opium
Cannabis
Hashish
Marijuana
Dutch-grown weed
Hemp plants
Hemp plant shoots
Hemp nurseries
Magic mushrooms
BMK
PMK
IV
+ 100
IV
IV
IV
+ 13 800
IV
+ 625 000 trips
+ 5 500
+ 2 000
+ 2 200
+ 1 700 000
+ 97 800
+ 5 600
IV
+ 300
+ 1 100
I. Figures have been rounded. II. Powder. III. Data on ecstasy are also available from the National Criminal
Intelligence Service, Southern Unit. According to these figures, in 2005 1 800 000 tablets were seized, plus
approx. 220 kilograms of powder and some 2000 kilograms of paste. IV. < 10 kilograms or litres. Source:
KLPD/NRI, Research and Analysis Group. Data processing: WODC.
Based on the KLPD report198, the picture in 2005 was as follows:
• Approximately 900 kilograms of heroin were seized. The bulk of this was seized by the
National Criminal Intelligence Service. Most seizures result from targeted detective
work and investigation; sometimes they result from search-and-control activities. Of
the regional police corps, the Amsterdam corps reported the greatest number of heroin seizures.
• Over 14,000 kilograms of cocaine were seized, chiefly at national borders, i.e. at sea
ports and at Schiphol airport. This figure includes a large haul of 4,600 kilos of cocaine from Venezuela that was intercepted at Rotterdam port. According to the KLPD it
probably reflects the 100 percent controls of high-risk flights for cocaine smuggling at
Schiphol. The cocaine originates mainly from Venezuela, the Netherlands Antilles, Surinam, Brazil and Peru and is mostly destined for transit to other European countries.
• Approximately 1,600 kilograms of amphetamine plus 1,000 tablets, 300 litres of amphetamine oil and 200 kilos of amphetamine paste were seized. According to the
KLPD, the main destination markets for amphetamine are in the U.K., the Scandinavian countries, and more recently also Poland and the Baltic States.
• With regard to ecstasy (MDMA, MDA or MDEA), 200 kilograms were seized, about 1.9
million tablets and 10 litres of the drug and 200 kilos of paste. 19 production locations
for synthetic drugs were dismantled.
• Some 600,000 LSD tabs were found. This is a considerable haul and largely resulted
from two large dismantling operations in Amsterdam and on the island of St. Martin.
• Methadone seizures were mainly of tablets, of which some 14,000 were found.
• About 100 litres of GHB was seized.
• Almost 10,000 kilograms of cannabis (hashish, marijuana and Dutch-grown weed)
were seized, in addition to over 1.7 million cannabis plants and over 97 thousand
plant shoots.
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149
•
•
There were very few seizures of opium and magic mushrooms; there were no morphine seizures.
Three hundred litres of the precursor BMK and one thousand litres of PMK were found.
Precursors are treated on the basis of the Abuse of Chemical Substances Prevention
Act (WVMC).
8.2.4
Disposal of drug crime cases at the Public Prosecutions Department
Official reports of drug law violations are forwarded by the police to the offices of the
Public Prosecutor. Not all incidents are registered with the Public Prosecutor. Offences are
filtered first by the police on the basis of likelihood of successful prosecution. Cases that
are deemed ‘unprosecutable’ are not forwarded to the offices of the Public Prosecutor.
Table 8.5 shows the numbers of cases reported to the Public Prosecutor, divided into
hard drugs and soft drugs cases.
• In 2005, 20.105 drug offences were reported. This is less than in 2004 (- 8%), but
remains higher than in the period 2000-2003. Between 2000 and 2004 there was an
uninterrupted rise in the number of drug offences registered.
• Drug law offences constitute 7.5% of the total number of cases registered with the
Public Prosecutor in 2005. This is comparable with 2004 (8%), but remains higher
than the period 2000-2003.
• The drop involves hard drug cases only (-17%). By contrast, the number of soft drug
cases continues to rise: over 9,000 in 2005, which is 2% more than in 2004 and double the number in 2000.
Table 8.5
Drug law cases registered with the Public Prosecution Department, by hard
and soft drugs, 2000-2005I
Total drug law offences
x Hard drugs
x Soft drugs
x Hard and soft drugs
Total offences, all laws
Percentage of drug law
offences in total offences
Hard drugs
Soft drugs
Hard and soft drugs
2000
11 685
6 412
4 493
780
2001
13 951
7 704
5 445
802
2002
16 623
9 301
6 525
797
2003
18 173
10 045
7 164
964
2004
21 940
11 728
9 099
1 113
2005
20 105
9 716
9 298
1 091
238 988
238 183
254 396
273 786
275 419
268 496
4.9%
5.9%
6.5%
6.6%
8.0%
7.5%
55%
38%
7%
100%
55%
39%
6%
100%
56%
39%
5%
100%
55%
39%
5%
100%
53%
41%
5%
100%
48%
46%
5%
100%
I. More than one case may be registered per accused. Source: OMDATA, WODC.
•
•
In 2005, hard drug cases accounted for less than half of all Opium Act cases: 48%
(53% in 2004). Soft drugs cases now account for 46% (41% in 2004). Five percent of
cases involve both hard and soft drugs.
The majority of cases involve offences relating to the preparation, production and trafficking/smuggling of drugs (71% in 2004 and 69% in 2005). Cases involving possession mainly concern hard drugs (64% in 2004 and 66% in 2005).
150
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•
The decline in the number of cases is mainly in the area of preparation, production
and trafficking/smuggling of hard drugs (- 25%) and is not related to the possession
of hard drugs. There is an increase in the number of offences involving the preparation, production and trafficking/smuggling of soft drugs (+ 8%). In 2005 over half of
Opium Act offences (53%) consisted of this type of violation involving soft drugs. In
2004 violations of this nature involving hard drugs were in the majority (57%).
Recent research affords a more detailed understanding of the type of drug and type of
offence involved in drugs cases.199 756 police files were analysed in 2004a by the nineteen public prosecutor’s offices. The data were compared with those of comparable samples from 1993, 1995 and 1999.
• In 2004, the cities of Haarlem, Breda, Amsterdam, Maastricht and ’s-Hertogenbosch
had the most drugs cases – in each city more than a thousand. Haarlem stands out
well above the rest with 4,221 cases. This is mainly as a result of cocaine smuggled
by couriers through Schiphol airport.
• Comparing the years 1993-1995-1999-2004, it is clear that cases involving drug imports have increased. In 1999 there were relatively numerous cases involving drug
production; however, this dropped again in 2004. There was also a decline in the percentage of cases involving domestic trade. There was a significant increase in the percentage of cocaine cases between 1999 and 2004.
Looking at the cases by drug type, the following picture emerges (Table 8.6):
40% of the cases involve cocaine. Most cases (in 47% of the cocaine cases) concern
imports, followed by trade (17%), possession (15%), possession for sale or supply
(11%) and possession for own use (7%).
• The average amount in cocaine seizures is 12 kilograms; the median amount is 85
grams. For drug imports, the median amount per crime is 934 grams.
• 35% of cases involve Dutch-grown weed, particularly in relation to production (40%).
Exports are involved in 15% of Dutch-grown weed cases, possession of the drug in
15%, possession for own use in 12% and trade in 7% of cases.
• The nurseries included in the sample had 5,460 plants on average, with a median
number of 150 plants. In general the nurseries are organised fairly professionally.
They are often equipped with timed artificial light, centrally regulated watering systems and external ventilation; they are usually contained in separate, concealed and
heated constructions.
• In 50 percent of hemp cultivation cases, charges are pressed by the Public Prosecutor.
In 25% of cases, the Public Prosecutor requests a financial penalty, and in 22% of
cases a community service order. In 51% of cases, the court imposes a community
service order, in 24% a suspended prison sentence, in 16% of cases a fine and in 7%
an unconditional prison sentence.
• Other weed or hashish types (excluding Dutch-grown weed) account for only one percent of the total.
• Eleven percent of cases involve ecstasy. Most of these refer to possession of the drug
(46%), followed by possession for own use in 17% of cases, possession for sale or
supply in 16% and trade in 12%. The average number of ecstasy tablets seized per
offence is 1,751; the median amount is ten tablets. Large amounts of the drug are
found in transit in the Netherlands.
•
The research was conducted for this report. Survey year 2004 was chosen because the
Public Prosecutor’s files for the research period were reasonably complete (October 2006January 2007).
a
TRIMBOS-INSTITUUT
151
•
•
•
Three percent of Opium Act cases involve amphetamines. Possession accounts for
28%, sale or supply and possession for sale or supply account jointly for 28%, possession for own use accounts for 25% and exports 20%.
Nine percent of drug law crimes involve opiates. A third of these cases concern trade
(35%), 22% refer to possession for sale or supply, 18% involve exports, and 14%
possession. On average, almost five kilos are seized per haul, and the median amount
is 7 grams per offence.
Other drug seizures are few and far between: soft drugs other than (Dutch-grown)
weed or hashish in one percent of cases, LSD and GHB both in 0.4% of cases.
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TRIMBOS-INSTITUUT
Table 8.6:
Overview of drug type and offence by level of offence (weighted numbers)
Drug Type
Production
Import
Export
Transport
Trade
Possession for
trade
Possession
Other
Total
13
Possession for
own
use
34
n
115
0
44
14
20
43
7
290
%
13.8
-
5.3
1.7
2.4
1.6
4.1
5.1
0.8
34.7
n
0
1
0
0
0
0
0
4
0
5
%
-
0.1
-
-
-
-
-
0.5
-
0.6
Ecstasy
n
%
0
-
0
-
6
0.7
2
0.2
11
1.3
15
1.8
16
1.9
43
5.1
0
-
93
11.1
Cocaine
n
%
0
-
156
18.7
6
0.7
2
0.2
58
6.9
38
4.6
22
2.6
51
6.1
0
-
333
39.9
Opiates
n
%
0
3
0.4
13
1.6
0
26
3.1
16
1.9
6
0.7
10
1.2
0
74
8.9
Ampheta
mine
n
0
0
5
0
3
4
6
7
0
25
%
-
-
0.6
-
0.4
0.5
0.7
0.8
-
3.0
n
0
0
0
0
0
0
0
3
0
3
%
-
-
-
-
-
-
-
0.4
-
0.4
GHB
n
%
0
-
0
-
0
-
0
-
0
-
0
-
1
0.1
2
0.2
0
-
3
0.4
Ecodrugs/
Magic
mushrooms
etc.
n
0
0
0
0
0
2
0
0
0
2
%
n
0
0
0
0
0
0.2
0
0
5
0
0.2
5
%
-
-
-
-
-
-
-
0.6
-
0.6
n
0
0
0
0
1
0
0
0
1
2
%
-
-
-
-
0.1
-
-
-
0.1
0.2
n
%
115
13.8
160
19.2
74
8.9
18
2.2
119
14.3
88
10.5
85
10.2
168
20.1
8
1.0
835
100.0
Dutchgrown
weed
Other
weed/has
hish
LSD
Other soft
drugs
Drug unknown
TotalI
I. The total n in the table may deviate from the weighted total n because of rounding-off effects. Source: Jacobs, 2007.199
TRIMBOS-INSTITUUT
153
Table 8.7 shows the decisions of the Public Prosecutor regarding drug law cases in 2005.
• In 2005, a total of 20 094 cases were disposed of by the Public Prosecutor. For the
majority of drugs cases, the Public Prosecutor issues a summons. This means that
most of these cases appear before the court.
Table 8.7
Disposals of drug law cases by decision of the Public Prosecutor and by
hard and soft drugs, 2000-2005
Total number of drugs cases
x Summons
x Financial order
2000
2001
2002
2003
2004
2005
11 480
73%
13 115
71%
16 058
70%
17 935
72%
21 047
61%
20 094
65%
19%
10%
15%
19%
18%
20%
x Dismissals on policy grounds
5%
4%
3%
3%
10%
8%
x Dismissals on technicality
9%
7%
5%
5%
7%
6%
x Joinder
3%
3%
3%
3%
2%
2%
Hard drugs
x Summons
78%
79%
80%
80%
61%
64%
x Financial order
4%
6%
8%
9%
10%
13%
x Dismissals on policy grounds
5%
4%
3%
3%
17%
13%
x Dismissals on technicality
9%
8%
6%
5%
10%
7%
x Joinder
3%
3%
3%
3%
3%
3%
Soft drugs
x Summons
64%
58%
55%
59%
58%
63%
x Financial order
27%
19%
30%
35%
31%
34%
x Dismissals on policy grounds
5%
4%
3%
3%
2%
3%
x Dismissals on technicality
8%
5%
5%
4%
4%
4%
x Joinder
3%
3%
2%
2%
2%
2%
Hard and soft drugs
76%
79%
83%
85%
84%
86%
x Financial order
5%
4%
5%
7%
6%
5%
x Dismissals on policy grounds
5%
4%
3%
2%
3%
2%
12%
12%
7%
5%
5%
5%
2%
1%
2%
1%
1%
1%
236 064
230 769
247 540
268 839
268 031
263 465
5%
6%
6%
7%
8%
8%
x Summons
x Dismissals on technicality
x Joinder
Total all laws
% drug laws of total
Source: OMDATA, WODC
•
•
The number of summonses is higher than in 2004, but lower than in preceding years.
There was a drop in 2004, which can largely be attributed to a higher number of dismissals on policy grounds. These chiefly involved cases of drug couriers at Schiphol
airport who were dealt with on the basis of a substance oriented approach.b In 2005
the percentage of dismissals on policy grounds dropped to 8%. This is less than in
2004, but remains higher than in 2003 and earlier years.
The percentage of summonses issued for soft drug cases also increased in 2005.
b
Drugs couriers without a previous criminal record and who are found with only a small quantity of drugs were not prosecuted,
236-238
but were deported after seizure of the drugs; they were then blacklisted in order to prevent future entry to the Netherlands .
154
TRIMBOS-INSTITUUT
•
•
•
•
In 2005 19% of Opium Act cases resulted in a financial order. This percentage has
fluctuated between 18 and 20 percent in recent years.
The (median) amount for financial transactions in 2005 was 270 Euro. This sum has
increased over the period 2000-2005 (not in Table).
The percentage of cases culminating in a financial order or a summons can be seen as
a rough indicator of the effectiveness of sanctions imposed within the law enforcement
system. Between 2000 and 2003 this percentage increased from 83 to 90 percent. In
2004 the rate dropped to 81%, chiefly as a result of the drug courier policy at Schiphol. In 2005, it rose to 84%.
Criminal cases involving drug offences constitute 8% of the total number of cases disposed of by the Public Prosecutor in 2005. This amount is the same as in 2004. In the
period 2000-2004 the number rose from five to eight percent.
Table 8.8 shows the number of cases relating to the Abuse of Chemical Substances Prevention Act (WVMC).
• In 2005 the number of WVMC cases dropped from 40 in 2004 to 22; there were 54 in
2002 and 2003. Most of these were WVMC cases in combination with Opium Act cases.
These cases virtually always involved hard drugs, or else chemical precursors used to
manufacture hard drugs. In 2005 there were five cases of violations of the WVMC act
alone.
Table 8.8
Number of disposals of cases of violations of the WVMC, 2000-2005
Only WVMC
WVMC and Opium Act
Total
2000
2001
2002
2003
2004
2005
6
32
38
11
64
75
6
48
54
7
47
54
2
38
40
5
17
22
Source: OMDATA. Data processing: WODC.
•
In 2005, 412 charges were brought relating to membership of a criminal organization
in combination with an Opium Act offence (section 140 of the Dutch Criminal Code
(Table 8.9). This represents an increase on 2004.
Table 8.9
Number of disposals of cases concerning section 140 of the Criminal Code,
2000-2005
Number of cases, section 140
2000
2001
2002
2003
2004
2005
356
422
357
348
387
412
Source: OMDATA, data processing: WODC.
8.2.5
•
Disposals by the court
In 2005 over 12,000 Opium Act (drug law) cases were disposed of in court in the first
instance. This is virtually the same number as in 2004 (table 8.10). In 2005 Opium
Act crimes accounted for 8% of total cases tried in court in the first instance, likewise
the same as in 2004. In this respect, no major changes took place between 2003 and
2005.
TRIMBOS-INSTITUUT
155
•
•
Hard drug cases declined by comparison with 2004 by 9%, whereas soft drug cases
rose by 13%.
The percentage of hard drug cases dropped from 56 percent in 2004 to 50 percent in
2005; however, hard drugs still account for the majority of drug offences. The proportion of soft drug cases has been increasing in recent years.
Table 8.10
Cases disposed of in court in the first instance, by hard and soft drugs,
2000-2005I
Total Opium Act offences
x Hard drugs
x Soft drugs
x Hard and soft drugs
Total all laws
%
x Hard drugs
x Soft drugs
x Hard and soft drugs
Total Opium Act
2000
2001
2002
2003
2004
2005
8 085
8 855
10 713
12 720
12 196
12 262
4 718
2 766
601
5 317
2 890
648
6 870
3 203
640
8 034
3 888
798
6 784
4 564
848
6 148
5 178
936
123 320
123 389
129 046
148 340
146 192
145 851
58%
34%
7%
60%
33%
7%
64%
30%
6%
63%
31%
6%
56%
37%
7%
50%
42%
8%
100%
100%
100%
100%
100%
100%
7%
7%
8%
9%
8%
8%
% of Opium Act in total
I. More than one case may be registered per suspect. Source: OMDATA, WODC.
8.2.6
Penalties imposed in drug law cases
Table 8.11 shows the penalties imposed by the court in the first instance: community
orders, unconditional custodial sentences and fines.c
• In 2005 the number of community service orders increased by 17% compared to
2004. Between 2000 and 2005 the number of community service orders more than
doubled.
Table 8.11
Sanctions imposed in Opium Act cases, 2000-2005
Type of sanction
x Community service order
x Unconditional custodial sentence
x Fines
2000
2001
2002
2003
2004
2005
2 340
3 416
2 533
4 086
2 864
5 481
3 769
6 270
4 093
5 436
4 789
4 839
1 512
1 622
1 797
1 943
2 039
1 823
Source: OMDATA, Data processing, WODC.
c
The number of dispossessions cannot be retrieved in a reliable way from OMDATA and is therefore
not listed.
156
TRIMBOS-INSTITUUT
•
•
In 2005 the number of unconditional custodial sentences dropped by 10% compared
to 2004. In 2004 there had already been a drop (of 13%). Between 2000 and 2003
there had been a 78% increase in the number of unconditional custodial sentences.
In 2005 the number of fines imposed declined compared to 2004 (-11%). Between
2000 and 2004 there had been a rise in this number (+ 35%). The median financial
order amounted to 500 euro in 2005; this sum has remained fairly stable between
2000 and 2005.
Table 8.12 shows the severity of sentence in number of days of community service or
custodial sentence.
• In 2005 the average number of days of community service dropped to 113. Between
2000 and 2004 the average duration of community service orders varied between 121
and 127 days.
• In 2005 the average duration of unconditional custodial sentences dropped to 351
days. Between 2000 and 2004 the average fluctuated at around 400 days.
Table 8.12
Average duration (days) of community service orders and unconditional
custodial sentences imposed for Opium Act violations, 2000-2005
Community service order
Unconditional custodial sentence
2000
2001
2002
2003
2004
2005
122
395
121
408
120
420
127
389
122
391
113
351
Source: OMDATA, data processing, WODC.
8.2.7
Custodial sentences under the Opium Act
Ultimately a number of convicted offenders end up in prison (Table 8.13).
Table 8.13
Custodial sentences and detention years in Opium Act cases, 2000- 2005I
Number of custodial sentences
Total Opium Act
x Hard drugsII
x Soft drugs
Other criminal cases
Detention yearsIII
2000
2001
2002
2003
2004
2005
25 746
12%
11%
27 332
13%
12%
31 163
16%
15%
34 262
16%
15%
29 650
16%
14%
23 052
16%
14%
1%
88%
1%
87%
1%
84%
1%
84%
2%
84%
2%
84%
9 193
10 318
12 500
13 171
11 917
8 787
Total Opium Act
x Hard drugsII
25%
23%
28%
26%
32%
31%
31%
30%
28%
27%
26%
24%
x Soft drugs
Other criminal cases
1%
75%
1%
72%
1%
68%
1%
69%
2%
72%
2%
74%
Excluding juveniles. II. A case involving a hard drugs offence as well as a soft drugs offence is classified under
hard drugs. III. Detention years are calculated by adding up the unconditional part of the prison term, and
subtracting first the part that is not completed on the basis of the regulation on release on parole (v.i.). Source:
OBJD, WODC.
•
In 2005 there was a sharp drop in the number of unconditional custodial sentences
and detention years imposed for drugs offences: minus 22 and minus 26 percent respectively. There was an equally marked drop in the total number of unconditional
TRIMBOS-INSTITUUT
157
•
•
•
•
•
•
custodial sentences and detention years imposed for all offences. Sentences for drugs
offences are following the general trend.
The percentage of Opium Act cases in all custodial sentences has remained constant at
sixteen percent. Since 2002, this percentage has remained unchanged.
The percentage of detention years for Opium Act cases has dropped: from 32 percent
in 2002 to 26 percent in 2005. This means shorter sentences are being handed down.
Perpetrators of hard drug offences are much more likely to receive an unconditional
custodial sentence than soft drug offenders. The number of detention years for hard
drugs is also many times higher than for soft drugs.
At the time of measurement in September 2005, a total of 17 600 people were detained; sixteen percent of these for an Opium Act offence (Table 8.14 and Figure 8.1).
The percentage of detainees in custody for Opium Act offences is lower than the percentage serving sentences for property crimes or violent crime.
The sixteen percent cited above is significantly lower than in previous years, and is the
lowest number in the period 2000-2005.
Table 8.14
Detainees in the prison system I measured on 30 September 2005, by offender groupII, 2000-2005
Total number
x Road traffic offences
x Vandalism / public order
x Property crimes
x Opium Act
x Violent crime
x Unknown/other
x Total
2000
2001
2002
2003
2004
2005
11 760
1%
6%
25%
17%
29%
23%
100%
12 410
1%
6%
26%
19%
29%
18%
100%
13 060
0%
4%
18%
21%
38%
19%
100%
13 980
0%
4%
20%
19%
38%
18%
100%
16 455
1%
4%
19%
20%
35%
20%
100%
17 600
1%
5%
20%
16%
32%
27%
100%
I. Including convicted offenders placed extramurally. Places occupied under the Temporary Special Facilities
Directorate (TDBV) by drug couriers and illegal immigrants are included since 2004. The figures for 2002 and
2003 are only for the places occupied by drug couriers and illegal immigrants. Extramural prisoners (subjected
to electronic tagging and penitentiary programs) are included. II. This refers to an offence of which a person is
suspected or convicted. Source: Criminaliteit en Rechtshandhaving,[Crime and law enforcement] WODC.
158
TRIMBOS-INSTITUUT
Figure 8.1
Detainees in the prison system as measured on 30 September 2005, by
offender group
1% 5%
27%
20%
16%
32%
8.2.8
Road traffic offences
Vandalism/public order
Property crimes
Opium Act
Violent crimes
Unknown/other
Recidivism among drug offenders
Despite having being penalised by the courts, some drug offenders come into contact
with the law again. In order to obtain an impression of the level of recidivism, a selection
was taken from the WOCD Monitor on Recidivism of all persons who were convicted at
least once from 1997 to 2003 for a drugs offence (see also appendix G). This produced a
group of 8,000 to over 13,000 convicted drug offenders. A search was then conducted of
the entire criminal history of these offenders in order to establish whether they were registered with a law enforcement agency for a punishable offence within two years of the
drugs offence for which they had been convicted. For this purpose, three types of recidivism were distinguished: general recidivism, serious recidivism and specific recidivism.
In order to establish general recidivism, all new contacts with the law are counted, except those that end in an acquittal, dismissal on technical grounds or other technical
judgement. Serious recidivism involves new offences that carry a sentence of at least
four years. Specific recidivism among drug offenders refers only to new contacts with the
law arising from a violation of the drug laws (Opium Act).
The development of the general, serious and specific recidivism of Opium Act offenders
has been charted for the 1997 to 2003 period by calculating the percentage of offenders
that re-offend within two years (Figure 8.2).
• There is somewhat higher recidivism among drug offenders than the population norm,
viz., than among all convicted offenders together. During the period under review,
the two year recidivism rate for the population norm was between 27 and 30 percent.203 The two year recidivism rate for the Opium Act offenders was between 29
and 33 percent.
• The general rate of recidivism for Opium Act offenders was fairly stable until 2001;
this was followed by a drop (from 32% for the 2000 cohort to 30% for the 2002 cohort). Recidivism subsequently rose to 33 percent in 2003. Opium Act offenders from
the 2003 cohort showed the highest rate of recidivism of all the groups examined.
• Serious recidivism follows almost the same pattern as general recidivism: fairly constant until 2001, followed by a drop in the 2001 and 2002 cohorts, with a slight rise
among the cohort from 2003. However the percentages of serious recidivism are significantly lower than those for general recidivism i.e., around sixteen to nineteen percent.
• Specific recidivism among Opium Act offenders rose slightly from 11% in the 1997
cohort to 12% in the 2003 cohort. Within each cohort, over 10% of Opium Act offenders commit another drugs offence within two years.
TRIMBOS-INSTITUUT
159
•
•
Opium Act offenders who reoffend have committed mainly other crimes than drug offences.
There is generally a higher rate of recidivism among male drug law violators than
among female offenders (not in Table).
Figure 8.2
Prevalence of various types of two-year recidivism in seven successive cohorts of Opium Act offenders
35
Percentage of prolific
offenders
30
25
20
15
10
5
0
1997
1998
1999
2000
2001
2002
2003 Year of measurement
General recidivism
30.9
31.2
31.8
31.6
30.3
29.9
32.6
Serious recidivism
18.2
17.8
18.0
17.5
16.1
15.9
17.4
Specific recidivism
10.9
10.5
11.1
10.9
11.0
11.6
12.4
Source: WODC-Monitor on recidivism.
8.2.9
Drug crime in the law enforcement chain
Table 8.15 gives an overview of drug crimes within the law enforcement chain in 2005.
Because the data were derived from various sources, they should be interpreted with
caution. Table 8.16 lists Opium Act offences beside a number of other offences.
• The proportion of drug crimes increases as we look further along the chain: Drug
crimes are relatively likely to occur along the full length of the law enforcement
chain.204
• Throughout the entire chain there are more hard drug offences than soft drug offences. Hard drug offences are more prominent in the later phases of the chain. (Table
8.15).
• Compared to other groups of offenders (violent crime, vandalism, public order offences, property crimes and other crimes), perpetrators of drug law crimes relatively
often have to complete a custodial sentence : in fact more than double the rate that
might be expected on the grounds of numbers alone. (Table 8.16). By comparison,
those accused of violent crimes comprise 24% of the total number of suspects, and
25% of those who receive custodial sentences. In their case, the sentencing is in proportion to their numbers.
• Relatively speaking, drug law violators sit out four times the number of detention
years than might be expected on the basis of their numbers (Table 8.16). Perpetrators
of violent crimes sit out twice the number of detention years, relatively speaking.
160
TRIMBOS-INSTITUUT
Table 8.15
Opium Act offences in the law enforcement chain: suspects, convicted offenders, custodial sentences and detention years, by hard and soft drugs,
2005
I
Phase in chain
Police
Total Opium Act
offences
x Hard drugs
x Soft drugs
x Both
21 223
% Opium Act of totalII
% hard drugs-soft
drugs
x Hard drugs
x Soft drugs
x Both
Public Prose- Court 1st instance
cutor
20 105
12 262
Custodial sentences
3 642
Detention
years
2 284
10 592
8 104
2 527
9 716
9 298
1 091
6 148
5 178
936
3 217
425
2 066
218
III
III
7%
7,5%
8%
16%
26%
50%
38%
12%
48%
46%
5%
50%
42%
8%
88%
12%
90%
10%
III
III
I. There are 502 police suspects (6%) for ‘other Opium Act violations’ included in ‘both’. II. Total = total number of cases III. A case involving both a hard drugs offence and a soft drugs offence is classified here under
hard drugs. Sources: HKS, KLPD/DNRI; OMDATA, WODC; OBJD, WODC.
Table 8.16
Percentage of various offence categories in the law enforcement chain,
2005I
Cases heard in
court
Opium Act
Violent crimes
Property crimes
Vandalism and public order
Other
Total
Financial orders Unconditional cusand guilty vertodial sentences
dicts
7%
24%
32%
16%
21%
100%
6%
17%
26%
13%
38%
100%
Detention
years
13%
25%
45%
8%
9%
100%
21%
43%
23%
7%
6%
100%
I. Table is an update of Figure 8.10 from Eggen & Van der Heide (2005).204 Source: CBS. Data processing,
WODC.
8.3 CRIMES COMMITTED BY DRUG AND ALCOHOL USERS
8.3.1
Drug-using police suspects
There is only limited information available about criminality related to drug use and drug
users. This is because drug use is not registered in a systematic way by either the police,
the Public Prosecutor, the courts or the prisons; in addition, little research has been conducted on this area.
In the police records system (HKS), suspects may be registered as ‘drug users’. This is a
so-called a danger classification. A suspect is registered as a ‘drug user’ if there are rea-
TRIMBOS-INSTITUUT
161
sons to believe that he or she poses a threat to the law enforcement officer on account of
the drug use. Suspects may also be registered as ‘drug users’ on the basis of information they have supplied themselves, e.g. to the effect that they have a drug problem or
because they have requested drug-replacement medication such as methadone. However, the police do not seek information about drug use in a systematic way. Therefore,
there is always a distinct possibility that a suspect may be drug user, but is not registered as such in the HKS, because the police are not aware of this or do not recognise
the fact. In addition, there are regional differences in the registration practice with regard
to this category.
According to police records (HKS), between nine and ten thousand suspects registered as
‘drug users’ are arrested at least once a year on suspicion of committing a crime. In
2005, there were over nine thousand such arrests. Current (not yet published) research
confirms that the HKS danger castigation yields a gross underestimate of the number of
suspects with a drugs problem. Approximately 20% to 45% of suspects whose drug
problem is registered elsewhere are not registered as drug users in the HKS and are
therefore unaccounted for in police statistics.205 Those who slip through the net are
typically users who are less well known to the police, perhaps because they have not
been charged as often, or because they are not resident in the place where they were
arrested.
With regard to the police suspects who are registered in the HKS as drug users, the following profile emerges:
• 90 percent are male. The male-female ratio has remained constant between 2000 and
2005.
• 90 percent are older than 24. Over a quarter (28%) are between 25 and 34 years of
age and the majority (66%) are over 34. The average age is 36.
• 38 percent live in one of the main cities in the Netherlands (250 000 + inhabitants)
and 14 percent live outside the Netherlands. Between 2000 and 2005 there was a
drop in the percentage that live in the main cities (from 47% to 38%); during the
same period, the percentage that live abroad increased from 6% to 14%.
• Approximately 70 percent had come into contact with the police for an offence on
more than 10 previous occasions; one in five even had over 50 previous encounters.
• Of the suspects who live outside the Netherlands, 67% had 10 previous encounters
with the police and 19% had over 50 previous encounters.
• Drug users account for 71-73 percent of prolific offenders – defined as having received
a prison sentence or other punishment at least three times in the past five years.206
Table 8.16 shows a breakdown of drug-using police suspects according to offences committed.
• 54 percent are held on suspicion of non-violent property crimes. This is lower than in
2004, and reflects a declining trend since 2002.
• Aggravated burglaries (i.e. property crimes with violence) occur in 8% of cases. This
percentage has also been dropping since 2002.
• Other relatively frequently committed offences are: “other violent acts” (against persons; 24%), Opium Act offences (22%) and vandalism or public order offences (22%).
These percentages are virtually the same as in 2004.
162
TRIMBOS-INSTITUUT
Table 8.17:
Type of offence (in %) by police suspects classified as drug users, 20002005
Type of offenceI
Property crimes
Theft violence/extortion
Other violent acts
Opium Act offences
Vandalism, public order / breach of the peace
Road traffic offences
Sexual violence
Other crimes
2000
63%
11%
19%
18%
20%
10%
1%
10%
2001
63%
11%
20%
18%
21%
10%
1%
10%
2002
63%
12%
22%
19%
23%
10%
1%
10%
2003
58%
11%
23%
22%
23%
10%
1%
11%
2004
56%
10%
24%
23%
23%
11%
1%
11%
2005
54%
8%
24%
22%
22%
11%
1%
10%
I. Suspects may be accused of more than one type of offence. Source: HKS, KLPD/DNRI.
8.3.2
Drugs, alcohol and violent crimes
Combating violent crime is an important topic in Cabinet security policy. In November
2005 the Action Plan on Violence was launched.207
• Police files do not contain systematic information about the role of alcohol or drugs in
violent crime.208
• Police will only register substance use if it plays a very obvious role in the crime.
• Of 2 072 police files examined, 339 contained information on alcohol use and 94 on
drugs use. The majority of files contained no information of this nature.208
• As far as is known from these files, the drug or alcohol use mainly refers to the suspect; however, in a relevant number of cases the victim was the user (as well), particularly in cases of violent incidents in the public domain.208
• In recent research, approximately one third of 394 juvenile delinquents and schooldropouts admitted having used drugs or alcohol prior to involvement in a serious violent incident. According to most, the substance use had no significant impact on the
incident, which they said would have taken place even without the substance use.
Other factors appear to play a more important role, such as impulsiveness or having a
behavioural disorder. The more serious types of violent crime are more often substance-related than the less serious types.27
• HKS records show that of police suspects registered as “drug users” in 2005, eight
percent were accused of a violent property crime and 24 percent of a violent crime
against persons (Table 8.19).
8.3.3
•
•
•
•
Driving under the influence (DUI)
Driving under the influence of both legal and illegal substances is a punishable offence
under article 8, paragraph 1 of the 1994 Road Traffic Act. Paragraph 2 of article 8
specifies the legal limit for alcohol, which is a blood-alcohol level of 0.5‰ or a breathalcohol level of 235 µg/l. Since January 2006, the legal limit for newly qualified drivers
(holding a license for less than five years) is lower: 0.2‰ (article 8 par. 3 and 4).
The limits for prosecution are somewhat higher than the limits stated in the legislation, in order to avoid convictions on the basis of unreliable measurements.
Unlike alcohol there is no objective measure for psycho-active medicines or for illegal
drugs. These come under a general ban contained in article 8 paragraph 1.
The severity of penalties imposed for driving under the influence depend not only on
the blood-alcohol content but also on any previous offences and the level of danger
involved, i.e. the type of vehicle driven, whether there was dangerous driving as well
or whether an accident was caused.
TRIMBOS-INSTITUUT
163
•
•
For driving under the influence, a maximum fine of €6,700 or a maximum prison sentence of three months can be imposed. In addition, there may be a driving ban of up
to five years. For driving under the influence causing an accident, there is a maximum
fine of €67,000 or nine years imprisonment.
Large-scale screening for drugs is currently not feasible, due to a lack of suitable instruments.140;209 Research is currently being conducted in this area. On 15-10-2006
the European project was launched “Driving under the Influence of Alcohol, Drugs and
Medicines” (DRUID), aimed at developing guidelines and measures to combat this
problem.210;211 In practice, the police will only screen for medicines or drugs if a motorist is seen driving in an aberrant way, and/ or if a motorist involved in a traffic accident is suspected of driving under the influence of a substance, on the basis of physical symptoms. If alcohol is found to be present, then usually no further screening is
conducted to detect other substances.
In a survey conducted as part of the European IMMORTAL project (Impaired Motorists,
Methods of Roadside Testing and Assessment of Licensing), between 2000 and 2004 in
the Tilburg police region, blood and/or urine samples were taken from a representative
sample of 3 799 motorists and 184 seriously injured drivers who had been admitted to
hospital.140
• Ten percent of the sample tested positive for drugs, alcohol or psychoactive medication.
• Cannabis, alcohol and benzodiazepines occurred the most frequently: cannabis in 4.5
percent (0.6% in combination with alcohol), benzodiazepines in two percent (0.1% in
combination with other drugs and/or alcohol). Two percent tested positive for alcohol
(with a blood-alcohol content –BAC- • 0.2 g/l; 0.3 percent in combination with other
substances).
• The largest group who tested positive for drugs were males aged 18 to 24 (18%).
Women aged over 50 were the largest group who tested positive for psychoactive
medication (11%).
• Of the seriously injured drivers, 45 percent were found to be under the influence of
drugs, alcohol or medication. 27 percent of the males in this sample had a BAC of •
1.3 g/l.
• Two local surveys conducted among young people in nightlife settings showed that
driving under the influence of drugs, especially cannabis occurs frequently in certain
groups.212
The criminal cases involving driving under the influence (DUI) have been charted below
on the basis of the 1994 Road Traffic Act, Art. 8, par 1 and 2, and in some tables also on
the basis of art. 163 and 162, par. 3. All these cases refer to road traffic incidents. The
vast majority of cases registered by the police and the courts involve alcohol. This is
partly due to the above described methodology.
• In 2005 over 40,000 people were booked for driving under the influence of a substance. This number is somewhat higher (+1%) than in 2004 (Table 8.18).
• Most offenders were male: nine out of ten people held on suspicion of driving under
the influence were male.
• The majority of suspects live in municipalities of between 10,000 and 50,000 inhabitants, and are aged between 25 and 44.
• Half the suspects had never been in contact with the police for an offence; the other
half had. In the latter group, most had between two and ten previous offences on record.
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Table 8.18
Number of people suspected of driving under the influence (DUI) and refusing blood and breath samples booked by the police and Royal Military
Police, 2000-2005
2000
2001
2002
2003
2004
2005I
38 401
37 244
766
40 175
39 102
664
44 234
43 179
628
48 767
47 871
530
49 029
48 186
544
49 652
48 905
465
391
409
427
366
299
282
Number
Total
DUI
Refusal
Combination
DUI/refusal
I.Provisional figures. Source: HKS, KLPD/DNRI.
DUI offences come under the competence of the Public Prosecutor, but incur standard
financial orders. The police are authorized to propose a transaction to DUI suspects –
with the exception of repeat offenders – up to a limit of 1.3 per mille blood alcohol content. The Central Fine Collection Agency (CJIB) processes these transactions in DUI cases. If the offender pays the fine, the case is concluded without any intervention by the
Public Prosecutor. If no payment is made, the case is then sent to the Office of the Public
Prosecutor. Cases which are not eligible to be settled through the CJIB are sent on directly. Table 8.19 shows the number of cases dealt with by the CJIB. These overlap to a
certain extent with the number processed by the Public Prosecutor’s office. The categories are not entirely mutually comparable.
• In 2005 the option of paying a fine was given in over 28 thousand cases. This represents an increase on 2004. The expansion of police powers is clear from the figures,
as is the fact that the police are making greater use of these powers.
• The vast majority of cases involve drivers of motor vehicles. To a lesser extent there
were also riders of mopeds and scooters as well as cyclists.
• More than half the fines were paid (57% in 2005). Of the unpaid fines, a large percentage was sent on to the office of the Public Prosecutor (41% in 2005). In a minority of cases, the charge was dropped, case dismissed or otherwise disposed of.
Table 8.19
Number of standard transactions (TRIAS) for driving under the influence
processed by the CJIB, by driver and blood alcohol content (BAC) tested (in
‰) 2002-2005I
Number
Total
Drivers of motor vehicles
Of which:
- BAC 0.5‰ to 0.8‰
- BAC 0.8‰ to 1.3‰
- BAC > 1.3‰
- BAC unknown
Drivers of moped/ motor scooter
Cyclists
2002
11 355
10 355
2003
12 488
11 374
2004
25 329
23 478
2005
28 666
26 262
7 858
2 496
1
851
149
8 680
2 694
36
969
145
11 692
11 205
545
48
1 622
229
12 418
13 058
735
51
2 105
299
I. Categories changed in 2004. Order in Table adapted here by WODC to those of the Department of Public
Works, whereby breath-alcohol content was converted to blood-alcohol content (BAC). Source: CJIB. Data
processing, WODC.
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165
Table 8.20
DUI cases disposed of the Public Prosecutor by vehicle type and type of
substance, 2000-2005I
Number
Drivers of cars/ motorcycles
Of which
Mopeds/cyclists
Of which
Drivers of other vehicles
Of which
Type of vehicle not registered
Of which
Total driving under the influence
2000
2001
2002
2003
2004
2005
34 806 34 747 36 129 39 960 30 572 31 111
Alcohol
34 502 34 450 35 771 39 468 30 037 30 526
Other substanceII
299
293
354
475
521
568
Alcohol and
other substanceIII
5
4
4
17
14
17
Alcohol
Other substance
Alcohol and
other substance
Alcohol
Other substance
Alcohol and
other substance
Alcohol
Other substance
Alcohol and
other substance
Substance
not identifiableIV
2 263
2 246
2 389
2 376
2 613
2 602
3 362
3 351
2 840
2 826
3 443
3 424
16
11
11
11
12
19
1
2
-
-
2
-
813
783
780
919
914
816
809
688
679
972
964
803
3
5
6
9
8
10
-
-
1
-
-
644
496
239
75
1 502
1 371
880
757
1 572
1 475
1 341
1 199
1
2
5
2
5
27
-
-
-
-
-
-
147
162
126
121
92
115
38 526 38 158 41 163 45 018 35 672 36 867
I. DUI cases registered with offices of Public Prosecutor, WVW 1994 sect. 8 par. 1 and 2, excluding transfers
within the Dept of the Public Prosecutor. Broken down by type of vehicle, using social classification, according
to type of substance, using registered articles of law and the Compass case number. II. These were cases involving different offences at different times following a joinder of charges, and not cases of the driver being
under the influence of different substances at the same time. III. The category ‘other substance’ is not clearly
defined. IV. These refer to accidents that are fatal or involve serious physical injury, caused by a DUI driver. In
these cases, the type of vehicle and the type of substance cannot be determined from the records. Source:
OMDATA, WODC.
•
•
In 2005, over 36 800 DUI cases were registered with the Public Prosecutor (higher
than in 2004, Table 8.20). Most of these involved the driver of a passenger car or motor cycle (84%); in the majority of cases the substance involved was alcohol.
In 70% of cases, the Public Prosecutor pressed charges, particularly in cases involving
a BAC of over 1.3‰ (not in Table). About one quarter of these are settled. This number declined in 2005, as was the case in 2004. The number of charges dropped is low.
166
TRIMBOS-INSTITUUT
•
In 2005, over 25,000 cases were brought before a court (not in Table). This is about
the same as in 2004. In the vast majority of cases, the defendants were found guilty
by the judge (95%) (in 2004: 96%). There were few acquittals (1%) or other judgements (4%).
8.3.4
Drug and alcohol use among detainees
Between 2000 and 2006 a number of studies were conducted on drug use by detainees
prior to detention. Two of these involve representative samples in mainstream penitentiary facilities (Table 8.21).6;213 Although the studies use different definitions and instruments, nevertheless the following picture emerges:
• Daily drug use or drug dependence in the period prior to detention (six months or a
year) occurs among 21 percent (heroin) to 33 percent (cannabis).
• Ever problem drug use is reported for 64 percent; 40 percent report severe or very
severe problem use.
• Alcohol dependence or problem alcohol use (recent) occurs among 28-33 percent.
Table 8.21:
Studies on drug and alcohol use among representative groups of detainees
in mainstream penitentiary institutions, by authors, year of publication,
group studied and major findings
Authors and year
Vogelvang et al (2003)6
Group studied
N=355 detainees in remand
centres, 103 convicted offenders and 252 in preventative custody
Major findings
Cannabis use last 6 months: 39%
- daily: 33%
Hard drugs use last 6 months: 61%
- daily use of cocaine/crack: 32%
- daily use of heroin: 21%
Ever problems with drug use: 64%
- serious or very serious: 40%
Problems with recent alcohol use: 33%
Bulten et al (2005)213
N=191 detainees in a penitentiary institution
Drugs dependency last 12 months: 30%
Alcohol dependency last 12 months: 28%
8.4 PROBLEM USERS IN THE LAW ENFORCEMENT SYSTEM
Problem drug and alcohol users within the penal system can avail of support and treatment options or they may be placed under a court order to do so.
• The Probation and Aftercare service offers various forms of support.
• There are possibilities within the legal system for users to participate in a treatment
project as an alternative to prosecution and sanctions (legal provisos).215;216
• Users may participate in reintegration programs while in detention.
• From January 2001 to October 2004, addicts with a high rate of recidivism, could be
placed for compulsory treatment under the Judicial Placements of Addicts measure
(SOV).
• In October 2004, the ISD measure took effect. This measure means that people may
be placed in an institution for prolific offenders (ISD); since that date, the SOV has
become one of the programs within the ISD.
As a result of the safety program entitled “Towards a safer society” that was launched in
2002, there is increased focus on prolific offenders. Systematic screening, diagnostics
TRIMBOS-INSTITUUT
167
and monitoring constitute an important element of tackling prolific offenders, many of
whom are drug addicts.206;217;218
In this paragraph we describe which options were available in 2005 and how often they
were availed of by problem users.
• Probationary aftercare (§ 8.4.1)
• Treatment as an alternative to prosecution and sanctions (§ 8.4.2)
• SOV and ISD (§ 8.4.3).
The data were derived from the following sources:
Patient Monitoring System (CVS) of (Addict) Probation and Aftercare that was implemented in 2001 (see appendix B). This system contains information on patients and
output data; the latter without details about the nature of the addiction (alcohol,
drugs, gambling etc.) or the type of drug involved.
• The National Alcohol and Drugs Information System (LADIS). This contains the data
from the CVS, which enables a link to be made between CVS data and individuals in
LADIS files. Data from the Organization of Addiction Care Information Systems are
available concerning Probation and Aftercare clients from 2001-2005.
• The Custodial Institutions Service (DJI) (of the Justice Ministry) has provided information on Drug Counselling Units (VBAs) in penitentiary institutions, cf. article 43, par.
3, SOV and ISD.
•
8.4.1
Probation and Aftercare of addicts
Addiction rehabilitation is offered in some 50 locations by 15 establishments for addiction care that are certified for probationary rehabilitation.219
• Rehabilitation is the subject of new policy. The task distinction between probationary
addiction rehabilitation and the prison system is being redefined.220
• Probation and Aftercare includes 12 core activities for convicted offenders; these are
carried out at the request of the Public Prosecutor and the judiciary.221
Table 8.22 shows how often the various activities have been carried out. The data refer
to all kinds of problems (drugs, alcohol, gambling etc.). In 2003 “diagnosing” was added as a separate activity. This involves conducting a probationary rehabilitation test, in
which new instruments must be used to select clients more stringently for programs.222;223
•
168
TRIMBOS-INSTITUUT
Table 8.22
Number of times that Probation and Aftercare conducted core activities,
2002-2004I, II
ActivitiesIII
Early intervention visit
Early intervention report
Project supervision
DiagnosisIV
Directed to treatment
Monitoring
Reintegration program
Work orderV
Education order
Information report
Advisory report
Evaluative report
2002
3 629
995
10 048
1
2
1
3
568
407
696
382
139
4 423
2 989
175
2003
4 305
922
9 156
10 615
2 115
3 726
2 566
4 098
217
4 254
4 408
84
2004
4 110
889
1 028
10 605
2 254
4 919
2 929
4 650
241
4 537
3 630
202
2005
3 962
1 152
11 368
2 081
5 454
2 806
4 904
286
4 857
3 517
80
I. No data available at client level or specified by type of substance. II. Data from 2001 not included as figures
deviate because patient monitoring system (CVS) was implemented in that year. III. Figures show number of
activities after auditing IV. Re-defined in 2003 number includes RISc (136 times). V. Individual or group work
orders. Source: SVG.
•
•
•
•
•
•
•
•
Diagnosing and monitoring have increased, which is fully in keeping with policy priorities.
There was a slight decrease in early intervention visits. About four thousand of these
took place.
Early intervention visits (reports to the court containing a recommendation about
whether to continue temporary custody) increased slightly.
Project Supervision was fully discontinued in 2005.
Directing to treatment took place over two thousand times, which was less than in
2004.
2 800 reintegration programs were organised. These provide training to teach participants awareness and/or skills in the areas of home life, work, schooling, finances, behaviour, relationships etc. The activities of Drug Counselling (VBAs) in penitentiary establishments are also included here.
There was an increase in activities concerning work and education orders; here too,
the trend is rising.
Reports were drawn up on over 8 thousand occasions. These are informative, advisory
and evaluative reports. Informative reports contain written information for the courts
relating to decisions to be made on prosecution, trial, or the imposition of sentences
and or penal measures. Advisory reports comprise a written form of furnishing information about the client to a (judicial) body, in connection with specific questioning or
a judgment to be given. Evaluative reports contain written information to the Ministry
of Justice, the Forensic Psychiatric Service (FPD), Forensic Psychiatric Hospitals (TBS)
and/or judiciary, with a view to making decisions or orders concerning a measure. Informative reports in particular were drawn up relatively often in 2005.
TRIMBOS-INSTITUUT
169
Table 8.23:
Clients of probation and aftercare for addicts 2002-2005I
Clients:
Total number
Average age
Number of males
Primary problem alcohol
Primary problem opiate use
Primary problem crack/cocaine
Primary problem cannabis
Addicts with alternating treatment and probationary aftercare
2002
12 399
35
92%
38%
25%
26%
6%
7 794
(63%)
2003
14 579
35,3
92%
40%
21%
27%
6%
8 501
(58%)
2004
14 875
35,6
92%
43%
18%
25%
7%
8 489
(57%)
2005
15 574
36,1
92%
46%
16%
24%
8%
8 734
(56%)
I. Data from a large organisation for addiction care are missing; dummy figures have been imputed. Source:
SVG.
•
•
•
In 2005 there were 15 574 addicts in probation and aftercare; their average age is
36.1; 92 percent are male and eight percent are female (Table 8.23). They had a total
of over 19,000 contacts with the probation and aftercare service (not in Table).
Most of the clients had a primary problem with alcohol (46 percent). 24 percent had a
primary cocaine problem, 16 percent an opiate problem and 8% a problem with cannabis use.
56 percent received alternating addiction treatment and probationary aftercare. 44
percent are only clients of probationary aftercare.
8.4.2
•
•
•
•
•
Treatment as an alternative to prosecution and sanctions.
Since the 1990s the policy of the criminal justice system has been to direct criminal
drug users explicitly to treatment programs as an alternative to prosecution and sanctions, when the nature of the crime permits this. The aim is to improve the situation of
the users by means of a treatment program, and by implication, to reduce the societal
burden of criminal recidivism. The threat of a sentence or activation of a suspended
sentence is intended to have a coercive effect (“quasi compulsory” participation). The
law provides for different possibilities in this respect (Table 8.24).
Possibilities in the form of conditional sanctions will be expanded in the near future.213;215
In 2005/2006 preparations were made for the introduction of new legislation on early
release from custody, which likewise should expand the possible alternatives.224-228
In 2005 135 placements in treatment were made from a penitentiary institution on
the basis of art. 43, par 3 of the Prisons Act (Pbw ): 54 placements (55%) were made
from a Drug Counselling Unit (VBO) within a penitentiary institution and 77 placements were made from a regular prison department.
As of 1 January 2008 the Justice Ministry will have a separate budget for funding forensic treatment within the law enforcement system.229
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TRIMBOS-INSTITUUT
Table 8.24
Possibilities within the law for directing offenders to treatment programs as
an alternative to prosecution and detention, by phase in the law enforcement chain, 2005
Phase in law enforcement: Legal possibilities:
During remand for ques- x None
tioning without extension
(police custody phase)
During pre-trial detention
x (Conditional) dismissal of
charges by Public Prosecutor
(art. 167 Sv)
x Conditional suspension of pretrial detention (art. 80 Sv)
Arraignment and session
x Adjourn session/delay sentencing (art. 281 Sv and art.
346 Sv)
x Impose (partly) conditional
sentence, on condition of an
external treatment program
proposed in court (Art. 14a
and 14c Sr)
During detention
x Participation in an external
treatment program under the
‘Placement in an Institution
for Prolific Offenders Act
(ISD) under proviso (art.
38m-u Sr)
x Participation in a program, in
a designated institution if necessary outside the penitentiary institution, (art. 43 Prisons Act( Pbw) (alternative to
detention)
x Participation in a Penitentiary
Program (art. 4 Pbw)
After detention
x Early release subject to conditions (in preparation)
Explanation:
Placement in a treatment program on a voluntary basis
Quasi-compulsory placement in
a treatment program
Quasi-compulsory placement in
a treatment program
Quasi-compulsory placement in
a treatment program
Placement in a treatment program on a quasi-compulsory
basis
Source: Van Ooyen 2004230; update WODC 2006.
•
In 2005, 37 percent of the clients were directed to an outpatient or part-time treatment facility; 35 percent to a facility for clinical addiction care; eight percent went to
social inclusion programs and seven percent went to a non-clinical facility for psychiatric care (Table 8.25). Compared to previous years, there was a decline in the use of
clinical treatment for addicts (- 6%), but an increase in the use of outpatient and parttime addiction treatment and of non-clinical psychiatric care (+ 5%).
TRIMBOS-INSTITUUT
171
Table 8.25
Referrals to care by addiction and probation services, by type of treatment
program, 2002-2005I
Type of care program:
Clinical treatment for addicts
Outpatient and part-time addiction care
Social inclusion program
Psychiatric treatment in a general
psychiatric hospital
Non-clinical psychiatric treatment
Part-time Psychiatric treatment
Social bed & breakfast accommodation
Hostel for the homeless
Psychiatric outpatient clinic
24 hour crisis help
Other facilities
Total II
2002
650
42%
474
30%
2003
863
40%
725
34%
2004
926
41%
796
35%
2005
732
35%
765
37%
126
123
8%
8%
170
75
8%
4%
196
52
9%
2%
174
54
8%
3%
44
28
24
3%
2%
2%
83
50
23
4%
2%
1%
113
48
18
5%
2%
1%
153
42
16
7%
2%
1%
24
1%
35
2%
19
1%
57
3%
2 153 100%
22
32
19
45
2 278
22
1%
20
1%
19
1%
38
2%
1 568 100%
1%
1%
1%
2%
100% 2
22
53
10
60
1%
3%
<1%
3%
081 100%
I. No figures available at client level, not specified by type of substance. II. Including 24 activities which have
not shown evidence of output. Source: SVG.
•
•
During detention, problem drug users may be placed voluntarily in special Drug Counselling Units (VBAs). VBAs were designed to function as a progression program towards a care program. Currently there are 15 VBAs. In 2005, 284 addicts were participating in the program.
Detained addicts can participate in programs while they are in detention. In 2005 the
accreditation commission for judicial interventions was set up for the purpose of monitoring the quality criteria of the interventions (see appendix D).231 Four programs were
accorded provisional accreditation in 2005 and 2006 (until 1 November 2006) (provisional, because they did not yet meet all the criteria); these interventions show considerable promise (Table 8.26); see: www.justitie.nl/recidivie. In the longer term, only
behavioural interventions that are recognised by the accreditation commission will be
financed by the Justice Ministry. These programs are not intended for addicts only.
Table 8.26
(Provisionally) accredited programs for detainees
Program:
Training in Cognitive Skills (COVA)
Training in Cognitive Skills plusI (COVA+)
Behavioural intervention for work
Lifestyle training (LST)
Aggression control training (ART)
Date of provisional accreditation
December 2005
June 2006
June 2006
October 2006
October 2006
I. This program is intended for individuals with an IQ of 70-90. Source: Ministry of Justice, DG PJS.
8.4.3
•
The Judicial Placement of Addicts and the Institutions for Prolific Offenders
The Judicial Placement of Addicts (SOV) was launched in 2001 and since 2004 has
been incorporated in a new measure: the Placement in an Institution for Prolific Offenders Act (ISD). The ISD was introduced in October 2004 but in practice it started in
2005.232;234 Under this measure, prolific offenders - even of minor offences - may be
sentenced for up to two years detention. Progression to treatment (outside the institu-
172
TRIMBOS-INSTITUUT
•
•
•
•
•
•
•
tion) is possible and is encouraged within the framework of this measure. Since a
large proportion of habitual offenders are drug users, this measure is often applied to
this group.235 Unlike the earlier SOV measure, the ISD can be applied to non-addicts,
female offenders and who are battling psychiatric problems, with or without an addiction.
The courts no longer impose an SOV; instead an ISD order is made. Within the ISD,
screening and selection for programs are conducted on the basis of the RISc (risk assessment scales) diagnostic instrument. At the same time the aspect of motivation is
taken into account. Users who cannot or do not want to participate in a program –
whether SOV or another program – remain detained in the ISD.
The SOV-criteria relating to the number of offences committed still apply, but a candidate no longer has to have participated previously in a quasi-compulsory program.
Psychiatric problems are also no longer a contra-indication for participation in a program.
The structure of the SOV-program within the ISD has not changed: the duration is still
two years maximum; the program is divided into phases, with a closed phase, a halfopen phase and an open phase outside the institution. Each phase lasts from six to
nine months.
The number of participants in the ‘old’ SOV declined in 2005. The number who participated per month varied from 77 to 171, with an average of 140 (Figure 8.3).
In January 2005 there were 101 people in phase 1 of the ‘old’ SOV-program, 65 in
phase 2 and five in phase 3. In December 2005 there were 26 people in phase 1, 47
in phase 2 and four in phase 3 (Table 8.27).
In 2005 there were 544 ISD-places available. As of 2006 there are 844 places. The
number of ISD participants increased in 2005, averaging 122 per month ( Figure 8.3).
In December 2005 there were 301 participants. The ISD data do not show how many
participants there were in the ‘new’ (incorporated in the ISD) SOV.
An effect study on the ‘old’ SOV is being prepared and will be available in 2007.
Figure 8.3:
Number of participants per month in SOVI and ISD, 2005
Number
350
300
250
200
150
100
50
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
SOV participants
171
162
171
162
162
148
136
132
137
112
106
77
ISD participants
13
43
43
43
56
70
114
128
191
202
258
301
Month
I. SOV measure (up to October 2004). Source: Custodial Institutions Service (DJI).
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173
Table 8.27
SOVI participants by phase, stay in unit 4 and in other institution, December 2005
Phase/unit
Phase 1
Phase 2
Phase 3
Unit 4
Total
Number of participants
26
47
4
0
77
I. SOV measure (up to October 2004). Source: Custodial Institutions Service (DJI).
174
TRIMBOS-INSTITUUT
Appendix A
Glossary of Terms
This appendix consists of two parts. In the first part terms are explained that relate to
substance use and addiction. The second part explains the terminology used in connection with drug-related crime.
I. SUBSTANCE USE AND ADDICTION
Addiction
Problem use of a substance, involving dependence. As a rule, this Annual Report means
the clinical diagnosis of dependence. Hover, it is not possible for judicial monitoring organisations to establish clinical diagnoses. Judicial monitors register for example addition
danger from drug use or ‘clear indications of addiction’ (see §8.3.2., SRM). The clinical
diagnosis of dependence is established via classification systems as the DSM and the
ICD. Characteristics of dependence are: frequent use of large amounts or prolonged periods of use, needing increasing quantities of the substance to induce the desired effect
(habituation), withdrawal symptoms, using the substance to counteract withdrawal
symptoms, wanting to quit without success, devoting considerable time to acquire the
substance or to recover from use, neglecting important activities at home, at school at
work or in leisure time and continuing with use despite the realization that it causes many problems.
Age of onset
The age at which an individual first used a substance, depending on the group to which it
is applied. Age of onset may apply to ever users (ever lifetime use), recent users (in the
past year) and current users (past month). The age of onset may also be determined for
different age groups. For example, in 2005, the average age of onset for cannabis users
in the 15 to 24 age group was 16.4 years. In the population aged 15 to 64 it was 19.6
years. In a younger age group, the average age of onset may be lower than in a broader
population, because some ‘late’ substance users may not be included in the calculations.
However, at a later age there may be distorted recall about the age at which a substance
was first used. Data on age of onset should therefore be interpreted with caution.
Chasing (the dragon)
Smoking heroin from tinfoil.
Clinical admission
Admission to a hospital during which the patient stays for one or more nights in the hospital.
Convenience stores
See: Tobacconist and convenience store.
Current Use
The use of a substance in the past month, irrespective of frequency (from once to daily).
Current users are automatically counted with recent users (past year), who in turn are
automatically counted with ever users (lifetime use).
Day care
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175
Admission to a hospital for a maximum of one day, without an overnight stay.
Dependence
See: Addiction.
DSM
DSM stands for Diagnostic and Statistical Manual of Mental Disorders. DSM forms a guide
for determining which mental disorder a person has. According to the DSM, addiction is
one of the mental disorders. DSM-III-r is the third (revised) version, and DSM-IV is the
fourth version.
Dutch-grown weed
Weed (a cannabis product) which is produced in the Netherlands.
Ever use
The use of a substance ever in one’s lifetime, irrespective of frequency (from once to
daily). Ever use does not say anything about recent or current use. If someone once tried
a substance a long time ago that was popular in those days, this counts as ever use for
life.
Hallucination
Sensory experience (seeing, hearing or feeling) that someone has, but is not shared by
others. Hallucinations may be a symptom of a mental disorder, but are induced deliberately by some through drugs.
Hallucinogens
Substances that induce hallucinations, such as magic mushrooms and LSD. These are
also known as psychodysleptic drugs. Cannabis can sometimes cause hallucinations.
Hardcore
Heavy form of music at raves.
Hard drugs
Drugs on list I of the Opium Act. These drugs constitute an unacceptable public health
risk. Hard drugs include, for instance, heroin, cocaine, crack, ecstasy and amphetamine.
Hepatitis
A highly contagious disease in which the liver is damaged by the hepatitis virus. The hepatitis virus occurs in various forms: hepatitis A, hepatitis B and hepatitis C. HBV is the
hepatitis B virus, and HCV is the hepatitis C virus.
ICD
International Classification of Diseases. The ICD is the diagnostic classification system of
the World Health Organisation (WHO) for somatic illnesses, accidents and mental disorders. Causes of death are also registered in ICD codes. The ICD-9 is the ninth and the
ICD-10 is the tenth version. See also appendix C.
Immigrant, foreign, ethnic
Owing to differences in definitions, figures on non-nationals are not always comparable.
Some definitions are:
According to the Ministry of the Interior, the Association of Municipalities of the Netherlands (VNG), the Dutch National School Survey, the Antenna-monitor and the most
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common definition in this Annual Report (unless otherwise indicated), “immigrant” means
an inhabitant of the Netherlands who was born abroad, or at least one of whose parents
was born abroad.
According to Statistics Netherlands (CBS): "immigrant" is an inhabitant of the Netherlands, at least one of whose parents was born abroad, despite the country of birth of the
person himself or herself.
According to GG&GD Amsterdam: "immigrants" are inhabitants who were themselves
born abroad.
According to LADIS: "immigrants" are clients who in their own experience have a cultural
origin that is outside the Netherlands.
Inpatient addiction care
Addiction care for which the client is admitted to an institution..
LADIS Client
Client of (outpatient) addiction care some of whose data about background, treatment
demand and treatment received are registered anonymously with LADIS, the National
Alcohol and Drugs Information System. Clients are registered with addiction care for many kinds of help varying from therapeutic treatment to support in the form of debt restructuring, obtaining methadone, probation and aftercare or monitored access to a users’ area. Clients who no longer avail of the treatment after some time are automatically
deleted and are no longer included in the list of clients. The Ladis system corrects for
duplication. Each person is included only once in the list of clients.
Mellow
Type of music at raves that is more melodious and less heavy than hardcore music.
Misuse
Problematic use of a substance that does not (yet) constitute addiction. Misuse is established by diagnostic classification systems such as the DSM and the ICD. Characteristics
of misuse are: neglect of duties at home, at school or at work, use in dangerous situations (such as driving under the influence), coming into contact with the law and continuing with use despite the problems that it induces.
Narcotics
General, collective term for drugs.
Native Dutch
According to the Ministry of the Interior, the Association of Municipalities of the Netherlands (VNG), the Dutch National School Survey, the Antenna-monitor and the most
common definition in this Annual Report (unless otherwise indicated), “native Dutch”
means someone who was born in the Netherlands and both of whose parents were born
in the Netherlands.
Outpatient addiction care
Addiction care for which the client is not admitted to an institution. For inpatient addiction care, the client is admitted to an institution.
Parkstad Limburg
The conglomeration of South Limburg municipalities of Brunssum, Heerlen, Kerkrade,
Landgraaf, Nuth, Onderbanken, Simpelveld and Voerendaal. (The municipality of Nuth
has since withdrawn from the collaboration).
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Party drugs
Drugs used by some revellers at parties and raves, such as ecstasy, amphetamines, cannabis, GHB and LSD.
Polydrug use
Use of several drugs by a drug user, such as heroin and cocaine.
Primary diagnosis
The main illness for which a patient is admitted to hospital.
Primary problem
If someone has problems with two (or more) substances, then the primary problem is
the substance that causes the most problems. The other substance is the secondary problem.
Primary cause of death
The direct cause of someone’s death. If someone dies directly from an overdose of drugs,
then this is the primary cause of death. If someone dies from an accident that occurred
under the influence of a drug, the accident is the primary cause of death. The drug is a
secondary cause.
Problem use
The use of a substance in such a way that physical, mental or social problems arise, or
that a nuisance to a society arises. Problem use is not always addiction. “Misuse” is a
form of problem use that does not mean addiction.
Psychodysleptic drugs
See: Hallucinogens
Psychosis
Mental disorder involving hallucinations, i.e. sensory experience (seeing, hearing or feeling) that someone has, but is not shared by others. If the disorder does not last longer
than a month, then it is called a temporary psychotic disorder.
Recent use
The use of a substance in the past year, irrespective of the frequency (from once to daily). Recent users are automatically included with ever users (use ever in one’s life).
Recreational use
Use of a substance (generally in the user’s leisure time), without problem use (misuse or
addiction).
Schizophrenia
Mental disorder involving hallucinations, i.e. sensory experience (seeing, hearing or feeling) that someone has, but is not shared by others People suffering from this disorder
function poorly at school at work and in the family. The disorder is only known as schizophrenia if the disorder has lasted for at least six months.
Secondary cause of death
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A cause that has contributed indirectly to death. If someone died from an accident that
took place while he or she was under the influence of a drug, the drug is a secondary
cause of death.
Secondary diagnosis
A secondary or underlying illness, in addition to the main illness (primary diagnosis) for
which a person has been admitted to hospital.
Secondary problem
If a user has a problem with two (or more) substances, the secondary problem is the
substance that causes relatively the least problems. The other substance is the primary
problem.
Soft drugs
Drugs on list II of the Opium Act, particularly cannabis. These are drugs that constitute a
less great public health hazard than the hard drugs on list I of the Opium Act.
Special secondary education
Education for children with learning difficulties (MLK), education for children with learning
and educational difficulties (LOM) and education for children with severe educational difficulties (ZMOK).
THC
Tetrahydrocannabinol, the main psycho-active ingredient of cannabis.
Tobacconists and convenience stores
Shops that generally sell products such as tobacco products, (cigarettes, cigars, rolling
tobacco), smokers requisites (pipes, lighters) and magazines, newspapers, greeting
cards, snacks, sweets and lottery tickets and scratch cards.
Use / Usage
The use of a substance ever in one’s life (ever use or lifetime use), in the past year (recent use) or in the past month (current use). Current users are automatically included
with recent users (past year), who in turn are automatically included with ever users.
II.
DRUGS CRIME8
Acquittal
Verdict by the judge when it is deemed not proven that the charges laid against the accused have been committed by the accused.
See also: case dismissal
Adult suspect / offender
Suspects who are 18 or older at the time of committing a punishable offence.
Appeal
Legal instrument permissible to anyone against whom a judgment was pronounced.
Case dismissal
8
Source: Statistics Netherlands (CBS), Voorburg/Heerlen, 2003; edited by WODC.
TRIMBOS-INSTITUUT
179
Decision by the public prosecutor not to prosecute an established punishable offence on
policy or technical grounds;
See also: Dismissal on policy grounds. Dismissal on technical grounds.
Case inadmissible
Final judgment in which the judge refuses the request or demand of a party or denies the
Public Prosecutor permission to prosecute on grounds that lie outside the case itself
(such as a procedural error).
Charge
Written record by an investigating officer about facts or circumstances observed by him
or her.
Compulsion
Compulsion means the user is given no choice. He can be admitted without his consent.
See also: Quasi-compulsion.
Crime / felony
More severe punishable act, defined as such in the law; the division of punishable acts
into crimes and offences is of importance in procedural law (absolute competence and
legal remedies) and penalization; trials in the first instance are mainly held before the
court as opposed to an offence, which is less severe.
Criminal Case
Charges against a suspect registered with an office of the public prosecutor.
Criminal record/prior offence
A criminal record / prior offence refers to a contact with the police in which charges were
made relating to one or more offences.
Custody
Principal- : detention for a maximum of one year and four months; this is a lighter sentence than a prison sentence and is generally sat out in a remand centre.
Subsidiary- : detention on the grounds of not or not fully paying a fine.
Discharge from (further) prosecution
Decision by the judge, despite evidence supporting the case of the Public Prosecutor,
based on the opinion that the offence or the accused is not punishable.
See also: Verdict of guilt, Acquittal.
Dismissal on policy grounds
Decision by the public prosecutor not to prosecute a suspect for an established offence
on the grounds of public interest.
See also: Dismissal.
Dismissal on technical grounds
Decision by the public prosecutor not to prosecute for a punishable act on the grounds
that prosecution cannot lead to a conviction (for example because there is insufficient
evidence or because the suspect cannot be sentenced.
Disposal by the court
Final judgment, whether conviction, acquittal, dismissal of charges or other verdicts.
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Disposal by the Public Prosecutor
Final decision about a case registered with the office of public
to drop charges, create a joinder, offer a transaction or submit
Early release
Statutory early release from penitentiary institutions of prisone
detention.
Final judgment
Verdict by a judge that concludes a civil case which started wit
Financial order / transaction
Under certain circumstances, payment of one or more penalt
creed by the investigating officer or public prosecutor who the
secute.
In the first instance
Primary judicial body before which a case is heard.
See also: appeal.
Joinder ad informandum
Presentation by the public prosecutor of a case not being pros
ing heard by the judge, with the intention that the judge will t
case in determining the sentence.
See also: Disposal by public prosecutor.
Joinder of causes of action
Joining together by the public prosecutor of a number of regist
tion that the judge will dispose of these cases together with a s
See Disposal by public prosecutor.
Joinder of session
Joining together by the judge of a number of different cases r
the public prosecutor with the intention of dealing with these a
See Disposal by the court
Juvenile suspect / offender
Suspects who are under 18 at the time of committing a
straightforward juvenile cases are usually dealt with by Halt ag
NB. No-one can be prosecuted for an offence committed before
Offence
Punishable act of a less serious nature, defined as such in the
able acts into crimes and offences is of importance in proced
tence and legal remedies) and penalization; disposal usua
ment/financial order via the Public Prosecutor or are heard befo
See also: crime/felon
Percentage of solved crimes
The total number of crimes solved during a specific period in relation to the total number
of charges pressed by the police during the same period for similar crimes, expressed in
percentages.
Placed in remand / remanded in custody
Detention in police custody for a maximum of four days on the order of the (assistant)
public prosecutor, if the normal time permitted for questioning a suspect (six hours) is
not enough.
Pre-trial detention / temporary custody
Detention in a Remand centre pending trial, generally when there is suspicion of a serious crime (crime carrying a prison sentence of at least four years) or of absconding
and/or of a danger to society.
Prison sentence
Detention, for life or for a limited period, with a maximum of 20 years, generally sat out
in a prison.
See also: custody.
Probation and aftercare service
Organisation that aims by its efforts to make a demonstrable contribution towards the
reintegration and rehabilitation of offenders into society. Accordingly, an important aim is
to prevent the repetition of punishable offences. To this end, the organisation conducts
examinations and drafts reports with regard to the character and circumstances of the
suspect or convicted offender; it devises plans of action to achieve its goals, conducts
supervision and monitoring of the accused and of task orders. Only in cases that promise
distinct possibilities of changed behaviour and the likelihood of success is deemed considerable, are intensive programs undertaken with these goals in mind.
Public Prosecutor
Government agency charged with the following tasks: enforcing laws, detecting and prosecuting punishable offences, issuing sentences and informing the judge insofar as prescribed by law.
Quasi-compulsion
Using quasi-compulsion, the authorities try to steer a user who is also a repeat offender
in the direction of a care program. The user has the choice between a care program and
a judicial punishment. The choice is influenced as follows: if the user opts for a care program, not only can he or she improve their situation, but any further prosecution and
sanction will be dismissed or adjourned. If not, or if he does not comply with the conditions put forward, then the judicial sanction will be imposed.
Sentence / Verdict
Binding decision explained by the judge in a case submitted to the court for judgment.
Solved crimes
Crimes for which at least one suspect /offender is known to the police, even if he or she
is at large or denies having committed the act.
Summons
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Official document (writ) that requires a person to appear in court at a certain time in
connection with a punishable offence.
Suspect
The person against whom, prior to the start of prosecution, there is a reasonable assumption of guilt of committing a punishable offence on the grounds of facts or circumstances; then known as ‘the accused’ once prosecution commences.
Unconditional judgment
Decision by the judge without leave to appeal (by a regular legal instrument).
Verdict of guilt
Judgment by the judge, after the charges put forward by the public prosecutor have been
deemed proven and punishable and the suspect is deemed to be punishable.
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Appendix B
Sources
This appendix contains a schematic overview of the main sources used by the National
Drug Monitor (NDM) for (I) use and problem use and (II) treatment demand and treatment, (III) illness and death, (IV) market information and (V) crime and law enforcement. For a more detailed description of the sources used see: see
www.trimbos.nl/monitors, or www.ivo.nl, or www.zonmw.nl.
TRIMBOS-INSTITUUT
185
School-goers aged 15 and 16 in 35 European countries
Participants in the social scene aged 1635 in The Hague
School-goers aged 11-17
General population and/or juveniles depending on location and region;
ESPAD
Market research on the social
scene in The Hague
HBSC
Local and regional monitoring
organisations
TRIMBOS-INSTITUUT
School-goers and socialising young people in Amsterdam
Antenne
186
Target group
Source
I. USE AND PROBLEM USE
Generally annually,
varies per location and
region.
2001, 2005
Alcohol, cannabis,
tobacco
Alcohol, drugs, tobacco, depending
on location and
region.
2002, 2003
1995, 1999, 2003
Annually since 1993,
with varying target
groups
Measurements
Alcohol, drugs
Alcohol, drugs, tobacco
Alcohol, drugs, tobacco
Substances
Organisation responsible/
Homepage
Bonger Institute of Criminology,
University of Amsterdam in collaboration with Jellinek Preventie
www.jur.uva.nl
www.jellinek.nl/
CAN, Pompidou Group,
For the Netherlands, Trimbos Institute
www.can.se/
MORE
www.denhaag.nl/
WHO, for the Netherlands: Trimbos
Institute, Radboud University Nijmegen and Utrecht University
www.hbsc.org
www.trimbos.nl
Local GGDs in liaison with GGD
Nederland, municipal and private
research agencies
www.ggd.nl
School-goers aged 10-18 in the last two
years in primary schools and in mainstream secondary schools: VMBO, HAVO
and VWO; sometimes programs at special
schools
National population aged 12 and older,
Juveniles and young adults aged 12-29
years.
Dutch National School Survey
TRIMBOS-INSTITUUT
National population aged 16 to 64
NEMESIS
Permanent research on home
life situation (POLS)
Alcohol, drugs, tobacco
National population aged 12 and older
(1997, 2001) or 15-64 years (2005)
Alcohol, tobacco,
for the youth module, also drugs
Alcohol, drugs, tobacco
Alcohol, drugs
Tobacco
National population aged 15 and older
National Institute for public
opinion and market research
(TNS NIPO)
National Prevalence Survey
(NPO)
Substances
Target group
Source
CEDRO, University of Amsterdam
(1997, 2001) www.cedro-uva.org
IVO (2005)
www.ivo.nl
Trimbos Institute
www.trimbos.nl
Trimbos Institute
www.trimbos.nl
Organisation responsible /
Homepage
STIVORO
www.stivoro.nl
187
Special schools, projects: 1990, 1997
Annual (alcohol, tobac- Statistics Netherlands (CBS)
co); 2001 (drugs)
www.Statistics Netherlands
(CBS).nl
1996 and follow-up in
1997 and 1999
1984, 1988, 1992,
1996, 1999, 2003
1997, 2001, 2005
Annual
Measurements
People seeking treatment at first aid centres at raves
Clients of (outpatient) addiction care
(partly extrapolated).
Hospital patients (partly extrapolated)
Educare monitor
National Alcohol and Drugs Information System (LADIS)
National Medical Registration
(LMR)
Injury Information System (LIS)
188
Patient register for inpatient
mental health care (PiGGz).
Being replaced by Zorgis.
Methadone clients in the Amsterdam region
Central Methadone Registration
(CMR)
TRIMBOS-INSTITUUT
Patients who receive emergency treatment following an accident.
Clients of inpatient addiction care
Target group
Source
II. TREATMENT DEMAND AND TREATMENT
Alcohol, drugs
Alcohol, drugs
Alcohol, drugs
Alcohol, drugs
Alcohol, drugs
Methadone
Substances
Organisation responsible/
Homepage
Annual
GGD(Community Health Service)
Amsterdam
www.ggd.amsterdam.nl
Annual from 1996
Educare Ambulant, Nursing & Education Consultancy Foundation
www.educaregroningen.nl
Annual
IVZ, Houten
www.sivz.nl
Annual
Prismant
www.prismant.nl
Annual
The Consumer Safety Institute
www.veiligheid.nl
Annual, complete up to GGZ Nederland, Prismant
1996
www.ggznederland.nl
www.prismant.nl
Measurements
Motorists
DUI (Driving under the influence) monitor
HIV-monitoring among risk
groups including drug users
TRIMBOS-INSTITUUT
Causes of death among methadone clients and recreational drug users in Amsterdam
Ambulance journeys for the population of
Amsterdam and surrounding area
Causes of death for inhabitants of the
Netherlands registered in the population
register, and law court records
HIV-infected and AIDS patients among
intravenous drug users
Intravenous drug users in various cities
Amsterdam cohort study and
monitor of drugs-related
deaths
Central Post for Ambulance
Transports (CPA)
Cause of death statistics
HIV/AIDS-registration
Target group/subject
Illness and Deaths
Source
III.
Annual
Alcohol, drugs, tobacco
Alcohol
Hard drugs
From 1991 various
measurements in
various cities
Annually, from 1970
Half yearly
Annual
Alcohol, drugs
Hard drugs
Annually from 1976
Measurements
Hard drugs, recreational drugs
Substances
189
AVV, Ministry of Road Traffic and
Public Works
www.rws-avv.nl
Organization responsible /
Homepage
GGD (Municipal Health Service)
Amsterdam
www.ggd.amsterdam.nl
GGD Amsterdam
www.ggd.amsterdam.nl
Statistics Netherlands (CBS)
www.Statistics Netherlands
(CBS).nl
IGZ, SHM, RIVM
www.hiv-monitoring.nl
RIVM and GGDs
www.rivm.nl/
190
THC-monitor
TRIMBOS-INSTITUUT
Number of officially sanctioned coffee
shops; coffee shop policy of municipalities plus enforcement policy
THC concentrations and price of cannabis samples from coffee shops
Cannabis
Cannabis
Social scene drugs by recreational users Social scene drugs
Drugs Information and Monitoring System (DIMS)
Monitor of official coffee shops
Substances
Target group/subject
Source
IV. MARKET INFORMATION
Twice yearly; annual
report
Continuous; annual
report
1997, 1999, annually
from 2000
Measurements
Trimbos Institute
www.trimbos.nl
Responsible organisation /
Homepage
Trimbos Institute
www.trimbos.nl
WODC
www.wodc.nl/
Output data of addiction rehabilitation
and probation, clients of addiction rehabilitation and probation and aftercare
Summonses arising from charges;
Charges made against suspects; registered criminal record of suspects
Drug seizures; number of criminal investigations; dismantled hemp farms;
uncovered production locations of synthetic drugs
Patient monitoring system
(CVS)
Police Records System (HKS)
Drug seizures
TRIMBOS-INSTITUUT
Target group/subject
Source
V. CRIME AND LAW ENFORCEMENT
All substances, divided into type of
drug
Danger classification ‘drug users’ or
‘alcohol dependent’;
drugs offences divided into hard and
soft drugs
All substances, no
breakdown into
type
Sources
Continuous registration, annual report
Updating at the end of
the first quarter of the
entire previous year;
also extraction of definite figures for previous year (because of
processing lag)
Daily files
Measurements
191
K&O/O&A/dNRI/KLPD, in collaboration with police regions
www.politie.nl/KLPD/
Organisation responsible /
Homepage
Addiction and Probation department of the GGZ (SVG) in collaboration with Dutch Probation and the
Youth Care, Probation and after
care of the Salvation Army
www.ggznederland.nl
Research and Analysis Group of the
National Criminal Intelligence Service of the National Police Agency
(O&A/dNRI/KLPD),
in collaboration with the police
regions; The Scientific Research
and Documentation Centre (WODC)
of the Justice Ministry has a copy
www.politie.nl/KLPD/
www.wodc.nl/
Policy information on criminal law enforcement; anonymous copy of the database of the Criminal Records (OBJD)
National database of the national public
prosecution department containing data
about prosecutions and judgements in
the first instance
Research and Policy database of
Criminal Records (OBJD)
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Criminal investigations by the Dutch
police of more serious forms of organised crime; offenders against laws that
include the Opium Act who act in collaboration
Enforcement of penalties involv- Characteristics of detainees, offences,
length of sentences and characteristics
ing detention and measures in
of the penal institutions; juvenile penipenitentiary (TULP)
tentiaries (TULP/JJI) and TBSinstitutions are registered separately
WODC-Monitor of Recidivism
Longitudinal research project with standardised recidivism measurements
among various groups of convicted offenders.
Data base of Central Fine Collec- Data on financial penalties offered by
tion Agency (TRIAS)
the police and district courts. These are
recorded and relayed afterwards.
National Investigation Information Services
Public Prosecutor data (OMDATA)
Target group/Subject
Source
Sub-divided into
hard and soft drugs
Drug offences, subdivided into hard
and soft drugs
Drug offences, subdivided into hard
and soft drugs
Substances
Public Prosecutor and Council for
the Judiciary. The Office of the
Public Prosecutor collects and manages the data. The WODC has a
copy
www.wodc.nl/
K&O/O&A/dNRI/KLPD, in cooperation with the police regions
www.politie.nl/KLPD/
Organisation responsible /
Homepage
WODC
www.wodc.nl/
Continuous registration Central Fine Collection Agency
(CJIB); administrative organization
of the Justice Ministry.
www.cjib.nl/
Reports on the basis of WODC
the OBJD
www.wodc.nl/
Continuous registration Custodial Institutions Service (DJI
of the Justice Ministry
www.dji.nl/
Annual report
Updated three times
yearly
Updated four times
yearly
Measurements
Appendix C
Explanation of ICD-9 and ICD-10 codes
Explanation of ICD-9 codes
ICD-9 code
162
291
292
303
304
304.0
304.2
304.3
304.4
304.7
305
305.0
305.2
305.3
305.4
305.5
305.6
305.7
305.8
305.9
357.5
425.5
535.3
571.0
571.1
571.2
571.3
980.0-1
E850
E850.0
E854.1
E854.2
E855.2
E860.0-2
E950.9*
E980.9*
Explanation
Malignant neoplasm of trachea, bronchus and lungs
Alcohol psychoses
Drug psychoses
Alcohol dependence syndrome
Drug dependence
Opioid type dependence
Cocaine dependence
Cannabis addiction
Amphetamine and other psychostimulant dependence
Combinations of opioid type drug with any other
Non-dependent abuse of drugs or other substances
Alcohol abuse
Cannabis abuse
Hallucinogen abuse
Sedative, hypnotic or anxiolytic abuse
Opioid abuse
Cocaine abuse
Amphetamine or related acting sympathicomimetic abuse
Anti-depressant type abuse
Other, mixed, or unspecified drug abuse
Alcoholic polyneuropathy
Alcoholic cardio-myopathy
Alcoholic gastritis
Alcoholic fatty liver
Acute alcohol hepatitis
Alcoholic liver cirrhosis
Unspecified alcoholic liver damage
Toxic effect of alcohol
Accidental poisoning by analgesics, antipyretics and antirheumatics
Accidental poisoning by heroin
Accidental poisoning by psychodysleptics (hallucinogens)
Accidental poisoning by psycho-stimulants
Accidental poisoning by local anaesthetics (including cocaine)
Accidental poisoning by alcoholic drinks (ethanol/methanol)
Suicide by poisoning through solid substances or liquids
Poisoning by solid substances or liquids, undetermined intent
* Only included if registered as complication 980.0-1.
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193
Explanation of ICD-10 codes
ICD-10 code
C33
C34
F10
F11
F12
F13
F14
F15
F18
F19
G31.2
G62.1
I42.6
K29.2
K70.0
K70.1
K70.2
K70.3
K70.4
K70.9
K86.0
T51.0-1
X41 + T43.6
X42
X42 + T40.5
X45*
X61 + T43.6
X65*
Y11 + T43.6
Y15*
Explanation
Malignant neoplasm of trachea
Malignant neoplasm of bronchus and lung
Mental and behavioural disorders due to use of alcohol
Mental and behavioural disorders due to use of opiates
Mental and behavioural disorders due to use of cannabinoids
Mental and behavioural disorders due to use of sedatives or hypnotics
Mental and behavioural disorders due to use of cocaine
Mental and behavioural disorders due to use of other stimulants
Mental and behavioural disorders due to use of volatile solvents
Mental disorders and behavioural disorders due to multiple drug use and use of
other psychoactive substances
Degeneration of nervous system due to alcohol
Alcoholic polyneuropathy
Alcoholic cardio-myopathy
Alcoholic gastritis
Alcoholic fatty liver
Alcoholic hepatitis
Alcoholic fibrosis and sclerosis of liver
Alcoholic liver cirrhosis
Alcoholic hepatic failure
Alcoholic liver disease, unspecified
Alcohol-induced chronic pancreatitis
Toxic effect of alcohol, ethanol and methanol (only as secondary code)
Accidental poisoning by psychostimulants
Accidental poisoning by narcotics and psychodysleptics (hallucinogens) not classified elsewhere
Accidental poisoning by cocaine
Accidental poisoning by and exposure to alcohol
Suicide by psychostimulants
Intentional poisoning by and exposure to alcohol
Poisoning by psychostimulants, undetermined intent
Poisoning by and exposure to alcohol, undetermined intent
*Only included if stated as complication T51.0-1.
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Appendix D
Quality criteria for behavioural interventions in the law enforcement system
aimed at reducing criminal recidivism
Criteria:
Theoretical basis: the intervention is based on an explicit model of behaviour change, of
which the effects have been scientifically proven.
Target group selection: the type of offender targeted by the intervention is clearly specified
and selected.
Dynamic crime-centred factors: the intervention is aimed at risk factors that correlate to the
criminal behaviour.
Effective treatment methods: the methods applied have been demonstrated to be or likely to
be effective.
Skills and protective factors: the approach focuses on acquiring practical, social and coping
skills.
Phasing, intensity and duration: the intensity and duration of the intervention are tailored to
the problems of the participant.
Commitment and motivation: commitment and motivation of the participant have to be increased and encouraged.
Continuity: there should be distinct continuity between the intervention and subsequent supervision and monitoring of the offender.
Integrity: the intervention is implemented according to plan
Evaluation: continuous evaluation affords insight into the effectiveness of the intervention
Source: Gedragsinterventies [Behavioural Interventions] 2005.231
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Appendix E
Websites in the area of alcohol and drugs
Australian Institute of Health and Welfare (AIHW)
http://www.aihw.gov.au/
Bouman GGZ
http://www.boumanggz.nl/
Brijder Verslavingszorg
http://www.brijder.nl/
CEDRO Centrum voor Drugsonderzoek (UvA)
http://www.cedro-uva.org/
Centraal Bureau voor de Statistiek (STATISTICS NETHERLANDS (CBS))
http://www.Statistics Netherlands (CBS).nl/
Centrum Maliebaan
http://www.centrummaliebaan.nl/
De Hoop
http://www.dehoop.nl/
DeltaBouman
http://www.deltabouman.nl/
Emergis Verslavingszorg
http://www.emergis.nl/verslavingszorg/
European Centre for the Epidemiological Monitoring of AIDS
http://www.eurohiv.org/sida.htm
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
http://www.emcdda.org/
Europese Commissie, Taxation and Customs Union
http://europa.eu.int/comm/taxation_customs/publications/info_doc/info_doc.htm#Excise
s
Europol
http://www.europol.eu.int/home.htm
GGD Amsterdam
http://www.ggd.amsterdam.nl/
GGD Nederland
http://www.ggd.nl/
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GGZ Noord- en Midden Limburg/Verslavingszorg (GGZ NML)
http://www.ggz-groepnmlimburg.nl/
GGZ Nederland
http://www.ggznederland.nl
Inspectie voor de Gezondheidszorg
http://www.igz.nl/productie/indexie.html
Instituut voor Onderzoek naar Leefwijzen & Verslaving (IVO)
http://www.ivo.nl/
Intraval. Bureau voor onderzoek en advies
http://www.intraval.nl/
IrisZorg
http://www.iriszorg.nl/
Jellinek kliniek (Amsterdam)
http://www.jellinek.nl/
Korps Landelijke Politiediensten (KLPD)
http://www.klpd.nl/
Ministerie van Justitie
http://www.justitie.nl/
Ministerie van VWS
http://www.minvws.nl/index.html
Mondriaan Zorggroep/Verslavingszorg
http://www.mondriaanzorggroep.nl/
Nationaal Instituut voor Gezondheidsbevordering en Ziektepreventie (NIGZ)
http://www.nigz.nl/
Novadic-Kentron, netwerk voor verslavingszorg
http://www.novadic-kentron.nl/
Openbaar Ministerie
http://www.openbaarministerie.nl/
Parnassia, Psycho-Medisch Centrum
http://www.parnassia.nl/
Politie
http://www.politie.nl/
Prismant
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http://www.prismant.nl/index.htm
Rijksinstituut voor Volksgezondheid en Milieu (RIVM)
http://www.rivm.nl/
Rijks-Kwaliteitsinstituut voor land- en tuinbouwprodukten
www.rikilt.dlo.nl/
Stichting Consument en Veiligheid
http://www.consument-en-veiligheid.nl/
Stichting Informatievoorziening Zorg (IVZ)
http://www.ivv.nl/
http://www.sivz.nl/
STIVORO, voor een rookvrije toekomst
http://www.stivoro.nl/
Substance Abuse & Mental Health Service Administration (SAMHSA)
http://www.samhsa.gov/
SWOV-Stichting Wetenschappelijk Onderzoek Verkeersveiligheid
http://www.swov.nl
TACTUS, Instelling voor verslavingszorg
http://www.tactus.nl/
Trimbos Institute
http://www.trimbos.nl/
Vereniging GGZ Nederland
http://www.ggznederland.nl/
Verslavingszorg Noord Nederland
http://www.verslavingszorgnoordnederland.nl/
Wetenschappelijk Onderzoek- en Documentatiecentrum (WODC)
http://www.wodc.nl/
World Health Organisation (WHO)
http://www.who.int/en/
ZonMw
http://www.zonmw.nl/
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Appendix F
Drugs use in a number of new EU member states
Use of cannabis, cocaine, ecstasy and amphetamine in the general population of a number of new EU member states
Country
Cyprus
Estonia
Hongary
Latvia
Lithunia
Malta
Poland
Slovakia
Czech
Year
2003
2003
2003
2003
2004
2001
2002
2004
2004
AgeI
15 - 65
15 - 69
18 - 54
15 - 64
15 - 64
18 – 64
16 – 64
15 - 64
18 – 64
Cannabis
Cocaine
Ever
19.8%
9.8%
10.6%
7.6%
3.5%
7.7%
15.6%
20.6%
Ever
1.1%
1.0%
1.2%
0.4%
0.4%
0.8%
1.1%
1.1%
Recent
14.1%
4.6%
3.9%
3.8%
2.2%
0.8%
2.8%
3.6%
9.3%
Ecstasy
Recent
0.7%
0.6%
0.4%
0.2%
0.3%
0.3%
0.5%
0.6%
0.2%
Ever
4.3%
3.1%
2.4%
1.0%
0.7%
0.7%
4.0%
7.1%
Amphetamine
Recent
2.5%
1.7%
1.4%
0.8%
0.4%
0.2%
0.2%
0.8%
3.5%
Ever
1.4%
2.5%
2.6%
1.1%
0.4%
1.9%
1.5%
2.5%
Recent
0.2%
1.3%
1.0%
1.1%
0.3%
0%
0.7%
0.2%
0.7%
Percentage of ever users and recent users (past year). I. Drug use is relatively low in the youngest (12-15)
and older age groups (>64). Usage figures in studies with respondents who are younger and/or older than the
EMCDDA-standard (15-64) may be lower than in studies that apply the EMCDDA-standard. The opposite is true
for studies with a more limited age range. - = not measured. Source: EMCDDA.
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APPENDIX G
Technical notes to chapter 8 Drug-related crime
In the chapter on drug law crime, a number of adjustments have been made for reasons
relating to the source data, new developments in this respect and to improve the efficiency of data collection. The adjustments affect most of the tables on detection, prosecution, trial and execution; where relevant they have been backdated. -1.
The most significant changes are in the figures on judgements in the first instance, which
replace the data on cases of final and conclusive judgement (see under 4 below). The
figures on judgements in the first instance are significantly higher, and the trends have
changed: first instance figures give a more up to date picture. The effect of the other
updates is relatively minor. Backdated recalculations have in general resulted in some
minor changes in the numbers (see under 1). The tightening of the selection process for
Opium Act offences has resulted in an upward adjustment of the numbers and also to
higher percentages of soft drugs cases and lower percentages of hard drugs cases (see
under 2). The definitive HKS data are higher than the provisional data, which means the
drops have been weakened and rises are accentuated. The definitive trends still follow
the same pattern as the provisional trends (see under 3).
1. Backdated recalculation
In this annual report we have recalculated and backdated figures published earlier in order to neutralise the (cumulative) effect of changes made retrospectively in the sources
used. Otherwise, these could give rise to unjustified changes in interpretation.
In the annual reports published to date only the values of the year under review were
calculated, while the values published earlier were not. However, the sources from which
the data are derived remain dynamic – many minor changes are made retrospectively.
Over time, these effects become noticeable, and the difference between values published
earlier with the values recalculated at a later date become larger.
The effect of this adjustment has resulted in minor changes in the numbers. The differences in table 8.5 relating to total number of cases registered are virtually negligible:
+0.01%. In table 8.9 the differences average -0.01% for the total number of cases disposed of.
2. Tightening of the selection process for Opium Act offences
The selection process relating to Opium Act offences has been tightened, in order to
maintain consistency throughout the entire law enforcement chain. This has resulted in a
limited upward adjustment of the numbers as well as changes in the percentages of the
hard and soft drugs ratios. In the first instance, this concerns police records (HKS data).
Here a switch was made from selecting Opium Act offences on the basis of the most severe crime, to selecting Opium Act offences only on the basis of the existence of hard
and or soft drug offences.2
As a result the figures in table 8.1 on drug suspects booked between 2000 and 2003 are
on average 0.9% higher per year than was reported in the 2005 NDM Annual Report.
There are also changes in the percentages of drug offences by type of drug compared to
last year’s annual report: on account of the more precise measurements, there is a rise
in the number of people accused of combined hard and soft drug offences. This is ‘at the
1
The changes concern the following tables: 8.1, 8.2, 8.5, 8.6, 8.7, 8.8, 8.9, 8.10, 8.11, 8.12, 8.13 en 8.14
The most serious crime method: in cases where an offence is defined by more than one article, the article with
the heaviest maximum penalty (prison sentence) is applied.
2
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expense of’ the share of soft drug offences and hard drug offences separately. There is
also a drop in the category ‘other/unknown’.
Secondly, the method of selecting drugs offences with regard to prosecution and trial
(public prosecutor and court) has been adapted. Formerly, a number of offences (chiefly
soft drugs) were wrongly left out of the picture because of inconsistencies in registration
(registered under district court).
As a result, the figures in table 8.5 for 2000 to 2004 on Opium Act cases registered with
the Public Prosecutor are on average 3.4% higher per year than in the 2005 Annual Report; in 2002 (+4.9%) and 2003 (+6.9%) the differences are particularly large. Because
of the tightening of the criteria, the percentages for soft drugs in particular are higher
(on average +3.8%) and those for hard drugs are lower (-3.2%). The numbers in table
8.9 for drug offences disposed of in court between 2000 and 2004 are 1.8% higher on
average per year than in the 2005 report, particularly in 2002 (+5.0%) and 2003
(+3.2%).
3. Definitive versus provisional HKS data on numbers of suspects of Opium Act offences.
Since 2002 the National Police Agency (KLPD), which is in charge of the police records
system (HKS) uses both provisional and definitive data. The definitive data contain completed backlogs and corrections. The effect of these adjustments on the national total of
data and trends is limited and shows a downward curve. In general, the definitive data
are higher than the provisional data, which weakens the declines and accentuates the
increases. The definitive data for 2002 to 2004 were on average 4% higher. The definitive trends remain within the same line as the provisional trends. We do not expect the
definitive figures for 2005 to deviate more than average from this pattern. HKS data are
still viewed in relation to Public Prosecutor data, which are more stable. The difference
between definitive and provisional data for the total number of suspects amounted to
+6.2% for 2002, +3.7% for 2003 and +1.5% for 2004 (van Tilburg et al. 2004, p.
189; Lammers et al. 2005, p. 151; Emmett et al. 2006, p. 141). The number of drug
suspects was higher by 6.7%, 3.1% and 2.0% respectively. Likewise, the definitive
trends were higher: 2002-2003 +22% (compared to provisional: +18%) and 2003-2004
+17% (versus +15%).
4. Data referring to cases disposed of in the first instance replace data on cases of final
and conclusive judgement
Fourthly, the data in the tables on cases disposed of in final and conclusive judgement by
the Public Prosecutor have been replaced with data that refer to disposals in the first instance.1 This is because the latter provide a more up-to- date picture. Since it takes a
considerable length of time before cases reach final judgement, and not all cases are
disposed of in final and conclusive judgement, the data on final judgements tend to lag
behind. Certainly sudden, sharp changes are more easily reflected in the data on judgements in the first instance.
A clear example is the development surrounding the substance-oriented controls at Schiphol airport. This development first became manifest in the period from 2003 to 2004.
The percentage of summonses in Opium Act criminal cases (final and conclusive judgement) dropped during that period by 13%, whereas the percentage for cases disposed of
in the first instance dropped by 16%; the rise in the percentage of dismissals on policy
grounds which caused the drop was +140% for final and conclusive, but was as much as
+ 246% for disposals in the first instance.
1
Mainly tables 8.6 to 8.8 and 8.10 to 8.12.
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The data published in this annual report on the basis of cases disposed of in the first instance are not directly comparable with the data published in previous annual reports on
cases disposed of in final and conclusive judgement.1
5. Other adjustments
Lastly, data have been changed in two tables in order to provide a better representation
of developments, or so that the data would be closer to those in existing publications. In
the latter case, this is to prevent different data from being published unnecessarily on
the same subject and to avoid double work.
For instance, table 8.1 now contains the total number of charges (including criminal record) made by the police instead of the data published last year on total numbers of suspects per year; this provides a clearer picture of the percentage of Opium Act police suspects in the total group of offenders. And in table 8.14, the data on the number of people
in penitentiary institutions have been adjusted to match data from the WODC publication
on crime and law enforcement.
1
In the selection process for Opium Act cases disposed of in final and conclusive judgement, drug cases that
ended in acquittal or dismissal – although other offences in the same case were heard – used to be omitted.
Now these offences are included – in the data on cases disposed of in the first instance. Likewise, cases marked
‘District Court’ used to be left out, whereas they are now included.
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