Drug Policy in the Netherlands Yoni Dekker Senior policy advisor Nutrition, Health protection and prevention directorate Ministry of Health, Welfare and

Drug Policyin the Netherlands

Yoni DekkerSenior policy advisor

Nutrition, Health protection and prevention directorate

Ministry of Health, Welfare and Sports

Overview

1.Objectives and principles

2.Legislation and regulations

3.Prevention, treatment and harm reduction

4.Drug use

5.Coffee shops

6.Conclusions

Objectives and principles

Drug Policy in the Netherlands3

Objectives of Dutch drug policy

Balanced, integrated and evidence-based approach

• To reduce drug demand (information, prevention and

treatment)

• To reduce drug-related harm (health protection and care)

• To reduce public nuisance related with production, trafficking

and use of drugs

• To reduce use drug supply (fighting production, trafficking and

dealing)

• To fight drug-related serious crime (organised crime and money

laundering)

This presentation focuses on demand reduction, the domain of the

Ministry of Health, Welfare and Sports


Principles of effective drug policy

• Pragmatic rather than principle-based:

do what works best

• Fact-based: Importance of research,

evaluation and monitoring

• Drug problem primarily a (public) health

issue

• Health promotion and harm reduction

key concepts in effective demand

reduction efforts

5 Drug Policy in the Netherlands

Drug demand reduction: integrated approach

Understanding demand reduction as

comprehensive, integrative and stepped

approach including:

• Preventing use

• Preventing health incidents

• Early detection and brief interventions to

prevent addiction

• Treatment of addiction and problem use

• Harm reduction

• Social rehabilitation and reintegration


Law and regulations


Legislation and Regulations:

• List I: Drugs posing an unacceptable risk to user and society

Including: Heroin, cocaine, ecstasy, amphetamines and GHB

• List II: Drugs that pose a less serious risk to user and society

Including: Cannabis, sleeping pills and tranquilisers, hallucinogenic mushrooms and khat

• Use of illicit drugs is not a criminal offense (to avoid marginalisation and facilitate access to services)

• Possession still is (to allow for seizing the drugs)


Expediency principle

Public Prosecutor has the discretionary power to refrain from prosecution

of criminal offences if this is judged to be in the public interest

Priorities laid down in guidelines for investigating and prosecuting crimes

committed under the Opium Act:

• Highest priority: large-scale dealing in and production of hard drugs

• No priority: possession of small quantities for personal use as such

(<0,5 g hard drugs; <5 g cannabis)

• No priority: Selling of cannabis products through coffee shops

complying with the public prosecutor’s criteria


Coffee shops:policy and practice


Coffee shop policy: national

AHOJ-G Criteria

A no Advertising

H no sale of Hard drugs

O no public nuisance (Overlast) in and around the coffee shop

J no entry or sale to young (Jong) people (< 18 yrs)

G no sale of large (Groot) quantities per transaction (max. 5

grams); maximum stock for selling is 500 grams

Additional criteria:

• Admission and sales only to residents of the Netherlands

• Local competences11 Drug Policy in the Netherlands

Coffee shop policy: local competences

Municipal authorities are among others entitled:

• To decide on the permission and number of coffee shops

75% municipalities have NO coffee shops

• To define a minimum distance between coffee shops and secondary

schools (ranging from 250 to 350 meters)

• To prohibit cannabis use in public (to reduce public nuisance)

• To close down a coffee shop in case it doesn't adhere to the criteria

of the municipality


Drug statistics


Drug use in the general population (15-64 yrs) (2014)


Source: Kerncijfers Drugsgebruik 2014, Trimbos Institute

Cannabis Cocaine Heroin Ecstasy Amphetamines

GHB Alcohol Tobacco

Recent use (%)(last year)

8 1,6 0,1 2,5 1,3 0,4 84 -

Current use (%)(last month)

4,6 0,6 0,1 0,7 0,5 0,2 76 19

International comparison

Average Average Low/middle Above average

Above average

- Average Average

Key facts

• Cannabis is the most popular illegal drug in the general population aged 15-64, followed by ecstasy and cocaine

• Current cannabis use among Dutch students aged 15-16 is twice the European average

• Heroin use continues to decline

• GHB use is stable since 2012 (750-800)

• Use of new psychoactive substances (NPS) relatively low


International Comparison

Last year prevalence cannabis use among young adults (15-34)

The Netherlands is among the countries with high cannabis use prevalence among young adults


International ComparisonLast year prevalence of ecstasy use among young adults (15-34)

17

The Netherlands is among the countries with high ecstasy use prevalence

Drug Policy in the Netherlands

International ComparisonLast year prevalence of high-risk opioid use

18

The Netherlands is among the countries with low opioid use prevalence


International Comparison Recent use in the general population

U.K.(2014)16-59

Germany(2014) 18-64

EU-27(2015) 15-64

Nether-lands

(2014) 15-64

US (2013)

12+

Canada (2012)

15+

Australia (2013)

14+

Cannabis 8% 4.5% 5.7% 8% 12.6% 10.2% 10.2%

Cocaine 2.4% 0.8% 1.0% 1.6% 1.8% 0.7% 2.1%

Ecstasy 1.6% 0.4% 0.6% 2.5% 1% 0.6% 2.5%

Ampheta-mines

0.8% 0.7% 0.5% 1.3% 1.3% 0.5% (2011)

2.1%


Source: Source: National Drug Monitor – Annual Report 2015, Trimbos Institute

International Comparison


Source: National Drug Monitor – Annual Report 2015, Trimbos Institute

Country Year Number per thousand inhabitants 15-64 yrs

Mean estimate lower - upper limit

United Kingdom 2010/2011 81 79 - 84

Luxembourg 2007 59 50 - 76

Austria 2013 50 49 - 51

Italy 2013 44 38 - 49

Finland 2012 41 38 - 45

Germany 2012 - 28 - 34

Norway 2012 23 19 - 31

Greece 2013 22 20 - 26

Spain 2012 22 18 - 26

Netherlands 2012 13 12 - 15

Problem hard drug users

Deaths from drug overdose in the Netherlands (2005-2011)


Source: National Drug Monitor – Annual Report 2015, Trimbos Institute

2005 2006 2007 2008 2009 2010 2011 2012 … 2013 2014

Totaal 122 112 99 129 139 94 103 118 NaN 144 123

Opiaten 60 44 34 52 52 37 33 28 NaN 44 40

Cocaïne 23 21 23 22 30 14 19 22 NaN 24 24

Overig 39 47 42 55 57 43 51 68 NaN 76 59

10

30

50

70

90

110

130

150

Aantal

Prevention


Drug prevention: stepped approach

Stepped approach of drug prevention aiming at:

• Supporting abstinence

• Delaying onset

• Reduction of frequency / dosage

• Limiting possible health damage

→ Risk management / harm reduction

Cooperation of national, regional and local organisations


Drug prevention: integrative approach• Covering different life areas of young people: school, home

and leisure time

• Full, factual and non-judgemental information

• Addressing attitudes, social norms life skills: to strengthen resilience and independent decision-making

• Integrated in broad framework: health promotion, lifestyle, youth culture

• Targeting young people (10-25 y) and intermediaries (teachers, parents, club / pub staff, etc.)

• Focusing on legal and illegal substances

• Development, research and implementation: best practice


Examples: The Healthy School and Drugs

• Covering alcohol, drugs and tobacco

• Used in 70% of high schools

• Proven effective

Aim for primary schools: Prevent pupils in grade 7 and 8 from starting to use tobacco and alcohol

Aim for secondary schools: Encourage students to resist drinking alcohol until age 16 at least and discourage them from ever using tobacco or drugs

Aim for secondary vocational schools: Initiatives to prevent, reduce smoking, excessive alcohol and drug use among students vocational education (MBO)


Examples: The Healthy School and Drugs

To increase effectiveness shift of focus from information about drugs to:

• Setting norms

• Generic skills / life skills training / resilience /

• Impulse control

• Policy: Drug Free Schools

• Early detection and guidance

• Selective and indicated prevention (Moti-4)

Het Nederlandse drugsbeleid26

Examples: Healthy Nightlife activitiesContributions from local, national and international initiatives

• ‘Celebrate Safe’ initiative for and by clubbers, providing information on a safe and healthy nightlife

• Centre for a Safe and Healthy Nightlife

• Safe and Healthy Nightlife and Events Programme

• EU projects: Healthy Nightlife Toolkit (HNT) and electronic Screening, Brief Intervention and Referral to Treatment at emergency services (eSBIRTes)

• Factsheets:

• Serving low alcohol beers on events

• Alcohol and aggression

• Alcohol and safety policies for New Years eve


DIMS: Drugs Information and Monitoring System

28

• A national monitor run by Trimbos Institute and addiction care services

• Monitors the market for illicit (party) drugs

• Analyses composition of drugs

• Observes trends (emergence of new drugs)

• Informs users about health risks


DIMS: Drugs Information and Monitoring System


• Consumers of (party) drugs can have their drugs tested anonymously (free of charge or at low cost)

• 30 testing facilities throughout the country

• 2013: >10,000 samples were delivered at the test services

• In case hazardous contents are detected: warning (campaign)

• Individual feedback

• Targeting users through social media

• Information through websites

• Red alert: regional or national multimedia campaign

Monitor Drug Emergencies


• Monitor nature and extent of drug use related emergencies

• Participants: Hospital ERs, ambulances, police doctors, First Aid at dance events

• Collecting anonymised information on emergencies (age and gender, substance used, intoxication or trauma, setting, etc.)

• Close link with DIMS: analyse composition of drugs and emergence of new drugs

Treatment


• ‘Face-to-face'

Public drug services/centres for addiction care (address 95% of requests for help)

Commercial or belief-based addiction care services

• E-health interventions

Treatment


Public addiction care organisations

13 specialised addiction care organisations in the Netherlands (spread over 200 locations)

Addiction care integrated in mental health services

Funding is arranged through 3 laws:

• Healthcare Insurance Act (ZVW): regular drug treatment, from abstinence oriented treatment to methadone maintenance treatment

• Chronic Care Act (WLZ):

• Social Support Act (WMO): social care and harm reduction programmes (drug consumption rooms, shelters, etc.)


Harm reduction


Harm reduction for hard drug users

• Decreasing demand: decrease of injecting drug use

• Needle exchange (Amsterdam 2013: 175,000 syringes supplied)

• Methadone treatment (7.569 clients (2014), average dose 80 mg (2014)

• Heroin assisted treatment (in 2014: 740 slots in 18 settings in 16 cities)

• Low-threshold facilities

• day and night shelters

• basis counselling and medical care)

• Outreach work among difficult-to-reach groups

• Drug consumption rooms (in 2013: 31 dcr’s)


Infectious Diseases

• Estimated number of injecting drug users: 2,300 (2008)

• HIV

• Less than 1% of all registered new HIV infections annually are related to injecting drug use

• In 4% of all registered HIV infections up to 2010 injecting drug use was the most likely route of transmission

• 700 of the 8,345 AIDS patients (registered up to 2010) are injecting drug users (8.4%)

• Hepatitis B and C

• Data not collected systematically

• Injecting drug users belong to the groups with the largest numbers infected with HCV


Conclusions


Is Dutch drug policy effective?


Evaluation of drug policy in the Netherlands (2009)

Health situation drug users relatively positive

• Low mortality rate (low rate of drug related deaths)

• Low HIV prevalence and incidence

• Moderate prevalence of hepatitis B and C

• Stable number of problematic hard-drug users (relatively low)

• Rise in average age, nearly no treatment admissions

• 70-80% addicts in contact with healthcare

• Use prevalence among adults stabilised; internationally an average

• Harm reduction measures are effective


New challenges: new responses

Challenge: Increasing drug use in night life settings

• Intensified and better prevention efforts

More emphasis on risks of use

More emphasis on healthy lifestyle, having fun without drugs

Challenge: Increasing problematic GHB use

• Intensified information about risks (overdose and dependence)

• Research on effective treatment and relapse prevention

• Developing and implementing treatment standards


Documents

Drug Policy in the Netherlands Yoni Dekker Senior policy advisor Nutrition, Health protection and prevention directorate Ministry of Health, Welfare and