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

2. Overview Objectives and principles Legislation and regulations
Prevention, treatment and harm reduction
Drug use
Coffee shops
Conclusions

3. Drug Policy in the Netherlands
Objectives and principles
Drug Policy in the Netherlands

4. 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
Deze presentatie zoomt in op het terugdringen van de vraag naar drugs (demand reduction) aangezien dit het domein van het Ministerie van Volksgezondheid, Welzijn en Sport is. Het terugdringen van het aanbod van drugs behoort tot de taken van het Ministerie van V en J en blijft in deze presentatie goeddeels buiten beschouwing.
Drug Policy in the Netherlands

5. 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
Drug Policy in the Netherlands

6. 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
Drug Policy in the Netherlands

7. Drug Policy in the Netherlands
Law and regulations
Drug Policy in the Netherlands

8. 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)
Cannabis with 15% THC or more (in preparation, list I)
Separation of the market: to reduce the risk that users of soft drugs gets in contact with hard drugs
Drug Policy in the Netherlands

9. Drug Policy in the Netherlands
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
Drug Policy in the Netherlands

10. Drug Policy in the Netherlands
Coffee shops: policy and practice
Drug Policy in the Netherlands

11. 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 competences
Het afstandscriterium is nog in voorbereiding
Drug Policy in the Netherlands

12. 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 Policy in the Netherlands

13. Drug Policy in the Netherlands
Drug statistics
Drug Policy in the Netherlands

14. Drug use in the general population (15-64 yrs) (2014)
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
0,7
0,5
0,2 76 19
International comparison
Average
Low/middle
Above average
Source: Kerncijfers Drugsgebruik 2014, Trimbos Institute
Drug Policy in the Netherlands

15. Drug Policy in the Netherlands
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 is twice the European average
Heroin use continues to decline
GHB use is stable since 2012 ( )
Use of new psychoactive substances (NPS) relatively low
* Cijfers per bullet point uit recent Nederlands factsheet halen
Drug Policy in the Netherlands

16. 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
Drug Policy in the Netherlands

17. International Comparison
Last year prevalence of ecstasy use among young adults (15-34)
The Netherlands is among the countries with high ecstasy use prevalence
Drug Policy in the Netherlands

18. International Comparison
Last year prevalence of high-risk opioid use
The Netherlands is among the countries with low opioid use prevalence
Drug Policy in the Netherlands

19. 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)
US (2013)
12+
Canada (2012) 15+
Australia (2013)
14+
Cannabis 8%
4.5%
5.7%
12.6%
10.2%
Cocaine
2.4%
0.8%
1.0%
1.6%
1.8%
0.7%
2.1%
Ecstasy
0.4%
0.6%
2.5% 1%
Ampheta-mines
0.5%
1.3%
0.5% (2011)
Source: Source: National Drug Monitor – Annual Report 2015, Trimbos Institute
Drug Policy in the Netherlands

20. International Comparison
Problem hard drug users
Country
Year
Number per thousand inhabitants yrs
Mean estimate
lower - upper limit
United Kingdom
2010/2011 81
Luxembourg
2007 59
Austria
2013 50
Italy 44
Finland
2012 41
Germany -
Norway 23
Greece 22
Spain
Netherlands 13
Source: National Drug Monitor – Annual Report 2015, Trimbos Institute
Drug Policy in the Netherlands

21. Deaths from drug overdose in the Netherlands (2005-2011)
Note: Between 2012 and 2013 the registration method changed. Hence the interruption in the graph.
Source: National Drug Monitor – Annual Report 2015, Trimbos Institute
Drug Policy in the Netherlands

22. Drug Policy in the Netherlands
Prevention
Drug Policy in the Netherlands

23. 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 Policy in the Netherlands

24. 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
*passende afbeelding zoeken
Drug Policy in the Netherlands

25. 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)
Drug Policy in the Netherlands

26. 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 drugsbeleid

27. Examples: Healthy Nightlife activities
Contributions 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
Drug Policy in the Netherlands

28. DIMS: Drugs Information and Monitoring System
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
Drug Policy in the Netherlands

29. 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
Drug Policy in the Netherlands

30. 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
Drug Policy in the Netherlands

31. Drug Policy in the Netherlands
Treatment
Drug Policy in the Netherlands

32. Drug Policy in the Netherlands
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
Drug Policy in the Netherlands

33. 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.)
Drug Policy in the Netherlands

34. Drug Policy in the Netherlands
Harm reduction
Drug Policy in the Netherlands

35. 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)
van de naar schatting opiaatgebruikers in Nederland zijn er in in ingeschreven bij een instelling voor verslavingszorg. 80% van deze ingeschrevenen stonden in 2011 ook ingeschreven bij een methadonprogramma en/of heroïneproject. (Bronnen: NDM Jaarbericht 2011; Kerncijfers Verslavingszorg 2011 (LADIS)
Drug Policy in the Netherlands

36. Drug Policy in the Netherlands
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
in 2013 wordt een nieuwe schatting van het aantal injecterende drugsgebruikers verwacht.
Is deze er gekomen ?
Drug Policy in the Netherlands

37. Drug Policy in the Netherlands
Conclusions
Drug Policy in the Netherlands

38. Is Dutch drug policy effective?
Drug Policy in the Netherlands

39. 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
Drug Policy in the Netherlands

40. 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
Drug Policy in the Netherlands