1. Evaluation of Dutch Drug Policy Margriet van Laar 1 & Marianne van Ooyen-Houben 2 1 Trimbos-institute, Netherlands Institute for Mental Health and Addiction 2 WODC, Scientific Research & Documentation Centre, Ministry of Justice Santa Monica, ISSDP, March 15-16, 2010 Trimbos-instituut 2009 1

2. Background Debate on drug policy in Dutch parliament on 6 March 2008 Announcement of a new drug policy paper Evaluative study by Trimbos institute and WODC Primary objective: to evaluate the main objective of Dutch drug policy  To prevent and manage the harms to individuals and society that ensue from drug use ('Continuity and change', drug policy paper 1995) Approval of project plan in October 2008, deadline report: 30 April 2009 2

3. Context & problem + Assumptions ↓ Proposed approach Has it been realised/implemented? ↓ Expected outcomes Have they been realised? Were there unwanted outcomes? Context & problem + Assumptions ↓ Proposed approach Has it been realised/implemented? ↓ Expected outcomes Have they been realised? Were there unwanted outcomes? Method (1) 3 Based on logic of 'policy theory' method

4. Method (2) Analysis of existing policy documents, scientific literature, registration data, (secondary) analyses of research data, interviews with experts Period 1995 -2008 ("Continuity and change") 4

5. Method (3) Policy areas 1.Separation hard & soft drugs markets and policy on coffee shops 2.Prevention and harm reduction 3.Health care and treatment 4.Drug law crime 5.Offences committed by drug users (poster presentation) 6.Drug-related public nuisance 7.International collaboration 8.Research and monitoring 5

6. Increasing drug use by the end of the sixties Increasing scientific knowledge Problems & context Softdrugs are less harmful than hard drugs Criminalising use leads to marginalisation and has no effect on prevalence Legalising production /sale of cannabis is not feasible Coffee shops contribute to separation of drugs markets Assumptions Differentiation between cannabis and hard drugs in legislation and prosecution policy since 1976 Tolerating sale of cannabis under certain conditions (house dealers, later coffee shops) Proposed approach Separation of hard & soft drugs markets 6

7. Outcomes (1) An estimated 70% of the cannabis at retail level is bought in coffee shops – Other sources (e.g. mobile-dealers, home dealer or grower) are less important, but dependent on coffee shop density The availability of other drugs in coffee shops is low, compared to other selling points Coffee shops generally adhere to criterion 'no sale of hard drugs' 7 Are the markets of hard en soft drugs separated? Conclusion: the markets of cannabis and hard drugs are largely separated, but they are not the only place for obtaining cannabis

8. Outcomes (2) Are cannabis users prevented from using hard drugs? 8 Conclusion: this question remains unanswered No RCT or pre-post assessment → International comparisons Prevalence of hard drug use among cannabis users is (everywhere) higher compared to general population. There are both countries with higher land lower levels Prevalence of hard drugs use is moderate/low in NL, except for ecstasy Research on gateway/stepping stone: genetics, social mechanisms, shared risk factors

9. Outcomes (3) Are cannabis users not criminalised? 9 Recorded offences for cannabis use/possession for personal use (Room et al., 2008) Conclusion: the expected outcomes have been realised Per 100.000 populationPer 1.000 recent users* Australia27624 Germany23734 France22526 Netherlands193 Austria33344 United Kingdom20620 United States26931

10. Outcomes (4) 'Unacceptable' increase in cannabis use ? 10 Population 15-64 years Last year prevalence remained stable in 1997-2005 - Last year prevalence 5,4% - EU average 7% (weighted) Pupils 15-16 years - Last month prevalence15% - European average 7% (unweighted) Conclusion: Cannabis use increased in the late eighties and nineties, as in many western countries. Cannabis prevalence in adults is not exceptional. Use among young people is above international average.

11. Prevention & harm reduction ↑ popularity of club drugs (ecstasy) ↑ THC level and treatment demand (cannabis) ↑ public nuisance ↑ hiv among IDU Problems & context Drug use is personal responsibility, but protection of vulnerable groups Education must be realistic and embedded in broader health approach Drug users should receive social/medical support instead of imprisonment Assumptions Broad package of interventions directed at general public, schools, nightlife scene, coffee shops Research & monitoring (markets, users) Low-threshold services (night shelter, user rooms) Needle exchange, methadon, hep B vacc, hep C campaign Proposed approach 11

12. Outcomes: prevention & HR Most proposed activities have been realised. But: – Vague formulation of objectives (e.g.: 'intensification'of activities') – Level of implementation of developed interventions: difficult to assess Reduction of drug use among young people? – Yes. Role of policy? – Mass media campaigns & school prevention: no or marginal effects on use Reduction of harm? – Decreasing and low incidence hiv and hepatitis C – Low overdose rate 12 Conclusion: Drug use among young people has generally declined or stabilised but a causal role of policy can not be established. A combination of harm reduction measures has had favourable health effects of hard drug users

13. Coffeeshops: nuisance and crime Assumptions Problems & context 1995 Public nuisance around coffeeshops “Drug tourism” Influence of organised crime Coffeeshops are small-scale modest shops For local adult customers Supplied by small-scale individual growers Coffeeshops comply to rules

14. Coffeeshops: nuisance and crime Outcomes 2009 Proposed Approaches Local policies to reduce number of coffeehops More stringent rules for coffeeshops Intense enforcement of rules Efforts to reduce public nuisance Law to prevent criminals to exploit a coffeeshop Suppressing untolerated sale (not coffeeshops) And against organised crime Decreasing number of coffeeshops Most coffeeshops are small-scale Compliance to rules is good Some are large-scale (border regions) Causing nuisance by drug tourism Organised crime involved, but relation to coffeeshops unclear Conclusion: the expected outcomes have partly been realised but still problems

15. Number of coffeeshops 1999-2007

16. “Oasis” and “Roots”

17. Production and trafficking illicit drugs (1) Assumptions Problems & context 1995 Production and export of synthetic drugs Large-scale professional cultivation of cannabis Export of cannabis Involvement of organised crime in drug markets Position Nld in international drug trade 2001: cocaine import at airport Schiphol Follow international drug conventions Production and trafficking can be controlled but without sustained success Hard drugs more risk for users than cannabis Enforcement priority: harddrugs and Production & trafficking

18. Production and trafficking illicit drugs (2) Outcomes 2009 Proposed Approaches Taking action against: money laundering & corruption production & trafficking – hard drugs/cannabis drug related organised crime By: intense enforcement efforts international co-operation extension of laws Professional cultivation home-grown cannabis ↓ Import cocaine at airport ↓ Role in production & trafficking of ecstasy, purity ↓ Cannabis cultivation: organised crime (extent?) Better cultivation techniques Cocaine via other trafficking routes Ecstasy spreading to other countries International organised crime still involved Nld important role as transit country Conclusion: successes but also still important problems

19. Illustration: Opium Act offences at Public Prosecutor

22. General Conclusions (1) Approach of demand reduction, harm reduction and supply reduction: implemented Drug consumption in general population: average and stabilising Health objectives: risk management OK But: - Cannabis use youngsters above EU average - High-risk (cannabis) use amongst vulnerable youngsters - Use of ecstasy relatively high

23. General conclusions (2) Coffee shops: seem to contribute to separation of markets hard drugs-cannabis Some success in reducing supply of ecstasy, cocaine and home-grown cannabis in Netherlands But: -Public nuisance around coffee shops in border regions -Shifts in production and trafficking routes worldwide -Increased involvement of international organised crime

24. Project team Esther Croes, Victor Everhardt, André van Gageldonk, Moira Galloway, Hendrien Kaal, Bob Keizer, Toine Ketelaars, Margriet van Laar (project leader), Ronald Meijer, Karin Monshouwer, Marianne van Ooyen-Houben (project leader), Franz Trautmann, Wytske van der Wagen External contributors: Jaap van der Stel, Bert Bieleman, Sasja Biesma, Jacco Snippe en Arjan Beelen Trimbos-instituut 2009 24