The Annual Drugs Conference in Brussels, Belgium

Transcription

1 Scientific Institute of Public Health Unit of Epidemiology BELGIAN NATIONAL REPORT ON DRUGS 2003 Commissioned by the European Monitoring Centre for Drugs and Drug Addiction Lisbon Edited by SLEIMAN Sandrine (IPH) IPH/EPI REPORTS Nr

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3 IPH Belgian national report on drugs 2003 Epidemiology Unit, Scientific Institute of Public Health, October 2003; Brussels (Belgium) IPH/EPI REPORTS N Deposit number: D/2003/2505/40 BELGIAN NATIONAL REPORT ON DRUGS 2003 edited by SLEIMAN Sandrine Scientific Institute of Public Health Unit of Epidemiology/Drugs Programme rue J. Wytsmanstraat 14 B-1050 BRUSSELS Tel Fax birn@iph.fgov.be

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5 This report was coordinated and written by: the staff of the Focal Point: and the staff of Sub-Focal Points: Colpaert K. Sartor F. Jossels G. Sleiman S. Leus E. Walckiers D. Protto JP. ASL: Köttgen S. CTB/ODB: Vanderveken M. Eurotox: Doulou M., Hariga F., Molnar M., Pecsteen D. VAD: Van Havere T. Acknowledgements The report was made possible thanks to the contribution of many public and private professionals, health professionals and social workers who participated in the data collection. Their essential contribution is gratefully acknowledged. We would like to especially thank for their very active contributions: Bastin P. (Infor Drogues) Deblaere P. (Federal Police, Road traffic division) De Pauw W. (Federal Public Service Justice) De Winter Ch. (Federal Police, Drug programme) Garlement P. (Federal Police, Drug programme) Geirnart M. (VAD) Gerits P. (Federal Public Service Public Health, Food Chain Safety and Environment) Gillard C. (Federal Public Service Justice) Gorissen JP. (Federal Public Service Public Health, Food Chain Safety and Environment) Kohn L. (ULB) Ludinant P. (Police,Tournai) Maes L. (RUG) Rubio G. (Babel) Sasse A. (IPH - HIV surveillance) Tack E. (Federal Public Service Justice) Todts S. (Federal Public Service Justice) Vanhyfte C. (Federal Police, Drug programme) Wanlin M. (FARES/VRGT) Call for contribution and comments Everyone interested in contributing to the next Belgian Report on Drugs can contact the Belgian Focal Point. All comments are welcome.

6 EMCDDA MANAGEMENT BOARD Willy BRUNSON Directeur Général Administration de la Communauté française de Belgique Bd Léopold II, 44 B 1080 BRUXELLES Tel : 32-2/ ; Fax : 32-2/ Willy.Brunson@cfwb.be Claude GILLARD ConseillerJuridique Direction Générale de la législation du Ministère de la Justice Bd de Waterloo, 115 B 1000 BRUXELLES Tel : 32-2/ ; Fax : 32-2/ Claude.Gillard@just.fgov.be EMCDDA SCIENTIFIC COMMITTEE Joris CASSELMAN Koning Leopold III laan,14 B 3001 HEVERLEE Tel/fax : 32-16/ Joris.Casselman@law.kuleuven.ac.be Brice DE RUYVER Universiteitsstraat, 4 B 9000 GENT Tel: 32-9/ ; Fax : 32-9/ Brice.Deruyver@rug.ac.be MINISTERS involved in health problems related to drugs (in 2002) De Heer Jef TAVERNIER Minister van Consumentenzaken, Volksgezondheid en Leefmilieu (Minister for Health of the federal governement) De Heer Jos CHABERT Minister van Volksgezondheidszorg van het Brussels Hoofdstedelijk Gewest (Minister for Health of the Region of Brussels-Capital) Monsieur Thierry DETIENNE Ministre des Affaires Sociales et de la Santé de la Région Wallonne (Minister for Health of the Walloon Region) Monsieur Didier GOSUIN Ministre de la Santé de la Région de Bruxelles-Capitale (Minister for Health of the Region of Brussels-Capital) Madame Nicole MARECHAL Ministre de la Santé et des Affaires Sociales de la Communauté française de Belgique (Minister for health of the French Community of Belgium) Herr H. NIESSEN Minister der Deutschsprachigen Gemeinschafts (Minister of the German-speaking Community) De Heer Frank VANDENBROUCKE Minister van Sociale Zaken en Pensioenen (Minister for Social Affairs of the federal governement) Mevrouw Mieke VOGELS Minister van Welzijn, Gezondheid en Gelijke Kansen, Vlaamse Gemeenschap (Minister for Health of the Flemish Community)

7 Table of contents SUMMARIES ENGLISH, FRENCH, DUTCH...3 PART I. NATIONAL STRATEGIES: INSTITUTIONAL & LEGAL FRAMEWORKS...15 CHAPTER 1. Developments in Drug Policy and Responses Political framework in the drug field Legal framework Laws implementation Developments in public attitudes and debates Budget and funding arrangements...23 PART II. EPIDEMIOLOGICAL SITUATION...25 CHAPTER 2. Prevalence, Patterns and Developments in drug use Main Developments and emerging trends Drug use in the population Problem Drug Use...33 CHAPTER 3. Health Consequences Drug Treatment Demand Drug Related Mortality Drug related infectious diseases Other Drug Related Morbidity...47 CHAPTER 4. Social and legal Correlates and Consequences Social problems Drug Offences and drug related crime Social and economic costs of drug consumption...55 CHAPTER 5. Drug Markets Availability and supply Seizures Price/purity...58 CHAPTER 6. Trends per Drug Cannabis Synthetic drugs Heroin opiates Cocaine crack Multiple use...60 CHAPTER 7. Discussion Consistency between indicators Methodological limitations and data quality...61 PART III. DEMAND REDUCTION INTERVENTIONS...63 CHAPTER 8. Strategies in Demand Reduction at National Level Major strategies and activities Approaches and new developments...66 CHAPTER 9. Prevention School programmes Youth programmes outside schools...71

8 9.3. Family and childhood Prevention in Recreational settings Telephone help-lines Mass media campaigns Drugs use at the workplace...75 CHAPTER 10. Reduction of Drug Related Harm Description of interventions Standards and evaluations...81 CHAPTER 11. Treatments Drug-free treatment and health care at national level Substitution and maintenance programmes After-care and re-integration...86 CHAPTER 12. Interventions in the criminal justice system Assistance to drug users in prisons Alternatives to prison for drug dependent offenders Evaluation and training...92 CHAPTER 13. Quality Assurance Description of new trends and developments Formal requirements for quality assurance Criteria and instruments applied in quality assurance Application of quality assurance procedures and results...94 PART IV. SELECTED ISSUES...97 CHAPTER 14. Evaluation of Drugs National Strategies Existence of evaluation Methodology of evaluation CHAPTER 15. Cannabis problems in context: understanding increasing in treatment demand Demand for treatment for cannabis use Prevalence of problematic cannabis use and patterns of problems Specific interventions for problematic cannabis use CHAPTER 16. Co-morbidity Main Diagnoses, prevalence Impact of co-moribidity on services and staff Service Provision Examples of best practice and recommendations for future policy BIBLIOGRAPHY DATA BASES -WEBSITES ANNEX 1 : DRUG MONITORING SYTEM AND SOURCES OF INFORMATION ANNEX 2 LIST OF TABLES ANNEX 3 LIST OF FIGURES ANNEX 4 LIST OF ABBREVIATIONS ANNEX 5 INDEX

9 Belgian National Report on Drugs 2003 : SUMMARY National Strategy : a global approach In 2002, the Belgian Government has continued its national strategy in the line of the Federal Drug Policy Note presented in the beginning of The main priorities of the Federal Government consist in reducing the: - number of drug users, - physical and mental effects related to drug use, - consequences of the drug phenomena on the society. Aside to the Health Policy Drug Cell, created in 2001, the legal framework of a General Drug Cell was published in May This cell will act as coordinator of the Belgian drug policy. To propose actions, advices and promote collaboration at both Belgian and international levels are part of its missions. New laws (4 April 2003, 3 May 2003) and a Royal Decree (16 May 2003) have modified the Narcotic drug act (24 February 1921). The main changes introduced concern: - Incorporation of a Council Regulation (n 3677/90), regulating substances that can be used to produce illicit substances (so-called precursors ) into police authorities; - Drug use in group is not seen as punishable in se any more; instead, this will be changed to drug use in the presence of minors; - Cannabis gets a separate statute (defined as another category ), receiving the lowest priority in terms of prosecution. The possession of an amount of cannabis, meant for personal use, by an adult (i.e. 18 years or older), without the presence of nuisance or problematic use will only lead to a registration by the police. In the case of nuisance, however, a punishment can be imposed of minimum three months up to one year of prison sentence and / or a fine of to euro (to be multiplied by 5, the revaluation factor). Cannabis still remains an illicit drug. - Commerce, production, export and importation of substances regulated by the Narcotic Drug Act remain forbidden, and maintain their original punishments. Epidemiological Situation The results of the Health Interview Survey 2001 report a lifetime prevalence of cannabis use in the general population (15-64 years old) of 10.8% while the lifetime prevalence of XTC/amphetamines is around 2%, mainly young users. Last month prevalence of cannabis is reported for 2.8% of the sample and less than 1% for XTC/amphetamines. Gender differences are seen in both prevalences: higher among men. Regional differences are noticed as well as an impact of the level of urbanisation. Drug use among the school population appears to be the best documented. In addition to the WHO HBSC cross-sectional surveys carried in the country, an ESPAD survey was launched in All Belgian studies among the school population confirm the increasing trend of the lifetime prevalence of cannabis use. Consumption differs with gender. 3

10 In the National Report, the Treatment Demand Indicator (TDI) data were usually presented separately for each federate entity (Communities or Region) but could actually not be pooled to provide national figures because these data are not comparable between the different federate entities. In 2002, the National Focal Point initiated a study aiming at describing the Belgian situation and making recommendations in order to improve and standardise the collection of the TDI data. The report of this study is foreseen for the end of The prevalence of problematic drug use in Belgium was successfully estimated by using the prevalence of HIV among problematic drug users and data related to drug users from the national HIV/AIDS register. The lifetime prevalence of injecting drug use in 1995 and in 1997 was estimated by this method. A feasibility study on the capture-recapture method was finished in The results underline the difficulties to apply this method in Belgium, even if the conditions of data collection from at least two independent sources were promising. The National Institute of Statistics provides mortality data from which are extracted the drug-related cases. The most recent data available concern The number of drug related death has suddenly increased in Different hypothesis could explain this phenomenon however none of them is verified. Two types of information on the H I V, hepatitis B a n d C status among treated drug users are available: self-reported status and biological tested results. In 2002, the prevalence of IDU among HIV cases is around 3%, in the continuity of the declining trend initiated in In 2001, the proportion of self-reported HIV-seropositivity among IDUs starting a treatment was around 3 %. In 2001, the prevalence of HBV infection varies between 11% for self-reported data and 16% for tested patients. The prevalence of HCV is 66% for self-reported results and 36% on the basis of biological testing. In general, prevalence based on self-reported status is consistent with prevalence estimate based on biological testing. In 2000, drug possession and personal use infringements represent 73% of all infringements related to narcotics. Cannabis appears to be the most commonly involved drug of all drug related arrests. It is also noticed that the number of detainees for drug related offences has increased the last 10 years. Finally, globally speaking, the number of drug seizures has increased in the nineties. Demand Reduction Prevention policies are under the responsibility of the federate entities (Community Governments and/or regions). Drugs prevention programmes in schools are very frequent but in the kindergarten and primary schools, the prevention activities are oriented on general health and well-being. These two last years, new programmes addressed to youth outside schools are developed in collaboration with sports associations. Since 2001, syringe exchange programmes are implemented through the whole country. Reduction of drug related harm activities target injecting drug users, young people in recreational settings and drug users in prison. For these actions, peer support initiatives are very often organised. Substitution treatment have received a legal basis in August 2002, the methadone is the usually prescribed substance in Belgium. The idea included in the Federal Drug Policy 4

11 Note is to develop networks of treatment as well as case managers, in the field of justice and health. No changes occur in regard with the interventions in the criminal justice system during the year In Belgium, quality assurance, in demand reduction interventions seems to be very rarely implemented. Nevertheless, the European Foundation Quality Management (EFQM) model is implemented in a Flemish institution and results are presented. Selected Issues The need of evaluation is recognised and taken in consideration in the Federal Drug Policy Note. In 2002, pilot projects were started to evaluate dual diagnosis settings and to develop future evaluation tools for example. Information on an increasing treatment demand for cannabis gather owing to the uncertainties of the TDI data collected in the country. use was difficult to A pilot project on co-morbidity has been launched in 2002 and is under evaluation. This project aims at verifying the feasibility of intensive treatment units for dual diagnosed patients. Data on dual diagnosis were extracted from the Minimum Psychiatric Data (MPD). This database concerns medical admissions in psychiatric hospitals and psychiatric services, from 2 nd semester 1996 till 1 st semester Results show that personality disorders (cluster B) are the most frequent associated disorder to substance dependence. Priorities for the future In conclusion, the country has initiated the revision of its legal framework; it is too early to measure its impacts on the society. Efforts to improve the data collection, especially for the TDI indicator are still important to afford. Further studies on methods to calculate the prevalence of problematic drug use are also to be considered. An early warning system on drugs has been developed by the Focal Point. This helps the collection and exchange of information between existing networks. Two laboratory networks were set up: the first one deals with the analyses of clinical samples and the second network is in charge of the analyses of the psychoactive substances. A website dedicated to the results of drugs analyses reported by the laboratories is under development. Moreover, a project of detection of new or particularly dangerous drugs by analysing seized samples is under progress. 5

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13 Rapport National Belge sur les drogues 2003 : Résumé Ce texte s inscrit en tant que courte introduction au document «Belgian National Report on Drugs 2003». Ce rapport est rédigé dans le cadre de la collaboration du Point Focal Belge à l Observatoire européen des drogues et toxicomanies. Le plan du rapport national est standardisé pour tous les Etats Membres, visant à harmoniser la collecte des données. Des détails complémentaires sur les études, projets en cours mentionnés dans ce texte peuvent être trouvés dans le rapport complet ou en prenant contact avec le Point Focal Belge. Stratégie Nationale La stratégie du gouvernement belge en 2002 se poursuit dans la droite ligne tracée par la Note de politique fédérale en matière de drogues de janvier Les priorités principales du gouvernement fédéral consistent à : - réduire le nombre d usagers de drogues - réduire les effets physiques et mentaux liés à l usage de drogues - et enfin à diminuer les conséquences sur la société du phénomène. En plus de la Cellule Politique Santé en matière de Drogues, créée en 2001, le cadre légal de la Cellule Générale Politique en matière de Drogues a été publié au Moniteur belge en mai Cette nouvelle Cellule jouera le rôle de Coordinateur de la Politique Belge en matière de Drogues. Ses missions principales sont de proposer des actions, de remettre des avis ainsi que de promouvoir la collaboration au niveau belge mais aussi au niveau international. De nouvelles lois et un nouveau décret royal ont modifié la loi du 24 février Les principaux changements sont : - L introduction d un règlement du Conseil (n 3677/90) régissant les substances qui peuvent être détournées pour fabriquer des substances illicites (précurseurs). - L usage en groupe n est plus considéré comme punissable (in se) mais la notion d usage en présence de mineurs est introduite. - Le cannabis bénéficie d un statut particulier (en tant que catégorie «autre») et devient le moins prioritaire en terme de poursuite judiciaire. La possession d une quantité de cannabis pour usage personnel par un adulte (18 ans et plus), sans nuisance ou usage problématique ne conduira qu à un enregistrement par la police. Dans le cas de nuisance, une peine peut être imposée avec de minimum 3 mois à 1 an de prison et/ou une amende de 1000 à (qui peut être majorée des décimes additionnels (*5)). Le cannabis reste néanmoins considéré comme une drogue illicite. - Le commerce, production, exportation et importation de substances régulées par la loi de 1921 restent interdits et les peines préalablement fixées restent d application. 4 avril 2003 et 3 mai mai

14 Quelques indicateurs Selon les résultats de l Enquête Santé 2001, la prévalence de l usage de cannabis au cours de la vie (C est-à-dire avoir consommé au moins une fois du cannabis au cours de la vie) parmi la population générale (15 64 ans) est de 10,8 %, et celle de l XTC/amphétamines est de l ordre de 2 %, plus particulièrement parmi de jeunes usagers. La prévalence de l usage de cannabis au cours du dernier mois est de 2,8 % et est inférieure à 1 % en ce qui concerne l XTC/amphétamines. Les fréquences d usage pour ces deux drogues sont supérieures chez les hommes. Des différences régionales sont aussi observées, le facteur «urbanisation» influence également les résultats. L usage de drogues en milieu scolaire fait l objet de nombreuses recherches. En plus des enquêtes «Health Behaviour in School-aged Children» (HBSC) de l OMS (une en Communauté française et l autre en Communauté flamande), une enquête European School Survey Project on Alcohol and other Drugs (ESPAD) a démarré en Toutes les études belges en population scolaire montrent une augmentation de la prévalence de l usage de cannabis au cours de la vie. Des différences liées au sexe sont aussi observées dans ces études. Dans les versions précédentes du rapport national, l indicateur de demande de traitements était habituellement présenté séparément pour toutes les entités fédérées (Communautés et Régions) mais les données ne pouvaient être rassemblées pour fournir un résultat national parce que ces données ne sont pas comparables entre elles. En 2002, le Point Focal belge a initié une étude pour décrire la situation belge et faire des recommandations dans le but d améliorer et de standardiser la collecte des données liées à l indicateur de demandes de traitement. Le rapport final sera publié fin En Belgique, la prévalence de l usage problématique de drogue ne peut actuellement être estimée que par le biais de la prévalence du VIH parmi les usagers problématiques et de données relatives aux usagers de drogues recensés dans le registre national VIH/SIDA. La prévalence de l usage en injection au cours de la vie avait été calculée sur cette base en 1995 et En outre, une étude de faisabilité de la méthode capture/recapture a été achevée en Les résultats soulignent les difficultés d appliquer cette méthode en Belgique, même si les conditions de collecte de données (2 bases de données indépendantes) promettaient des résultats encourageants. L Institut National de Statistique fournit des données de mortalité desquelles sont extraits les cas de décès liés à une drogue. Les données les plus récentes datent de Le nombre de décès par drogue a commencé à augmenter en Deux types d information sur la fréquence du VIH, hépatites B et C parmi les consommateurs en traitement sont disponibles. D une part, les déclarations des usagers de drogues et d autre part, les résultats de tests biologiques. En 2002, la prévalence des injecteurs de drogues parmi les cas de VIH est approximativement de 3 %, la tendance semble poursuivre la diminution entamée depuis En 2001, la proportion de personnes se déclarant séropositifs VIH parmi les injecteurs de drogues en demande de traitement était de 3 %. La prévalence d hépatite B varie de 11 % parmi les résultats déclarés à 16 % parmi les individus testés. La prévalence d hépatite C en 2001 est de 66 % (déclarée) et de 36 % pour l échantillon ayant subi des tests biologiques. 8

15 En général, la prévalence estimée à partir des déclarations est comparable à celle de la prévalence calculée à partir de tests biologiques. En 2000, la possession de drogue et l usage personnel de drogues représentent 73 % des infractions liées aux drogues. Le cannabis est la drogue la plus souvent impliquée dans toutes les arrestations liées aux substances illicites. Il est également à noter que le nombre de détenus en rapport avec les drogues a augmenté ces dix dernières années. Enfin, en général on note une augmentation du nombre de saisies de drogues au cours des années 90. La réduction de la demande Les politiques de prévention relèvent de la compétence des entités fédérées (Communautés ou/et Régions). Les programmes de prévention des drogues dans les écoles sont très répandus, mais sont intégrés dans un programme de prévention plus général (bienêtre et santé) pour les écoles primaires et gardiennes. Depuis deux ans, les programmes qui s adressent aux jeunes (en dehors des activités en milieu scolaire) sont souvent développés en collaboration avec des clubs sportifs. Depuis 2001, les programmes d échange de seringues fonctionnent dans tout le pays. Des activités de réduction des risques visent les usagers injecteurs de drogues, les jeunes dans des festivals, ou autre et les usagers de drogues en prison. Ces actions sont souvent basées sur la prévention par les pairs. Les traitements de substitution ont reçu une base légale en août La méthadone est la substance la plus fréquemment prescrite en Belgique. L idée de développer des circuits de soins et de créer des fonctions de manager santé et justice, mentionnée dans la Note de politique fédérale en matière de drogues, se poursuit. Aucun changement n est apparu dans le champ des interventions au sein du système criminel de justice au cours de l année En Belgique, la mise en œuvre d un contrôle de la qualité en matière d activités de réduction de la demande est rarement existante. Dans ce rapport sont présentés les résultats de l application du modèle «European Foundation Quality Management» (EFQM) au sein d une institution flamande. Thématiques spéciales La nécessité d évaluation de la politique est reconnue et est mentionnée dans la Note de politique fédérale. En 2002, deux projets pilotes pour permettre l évaluation d unités de soins double diagnostiques ont démarré. Les résultats devraient fournir des outils de base pour ce genre de problématique. Les informations sur l accroissement des demandes de traitement pour le cannabis étaient difficiles à collecter en raison des incertitudes liées aux données de l indicateur de demandes de traitement. 9

16 Un projet pilote portant sur la comorbidité, lancé en 2002, est en cours d évaluation. Ce projet a pour but de vérifier la faisabilité d unités spécialisées dans le traitement intensif de patients présentant un double diagnostic. Les résultats présentés se basent sur des données récoltées dans le cadre du «Résumé Psychiatrique Minimum» (RPM) et concerne donc les admissions médicales dans les hôpitaux psychiatriques et services psychiatriques, à partir du 2 ème semestre 1996 au 1 er semestre Les résultats montrent que les troubles de la personnalité sont ceux qui sont les plus fréquemment associés aux cas de dépendance à l une ou l autre substance légale ou illégale. Priorités pour le futur En conclusion, la Belgique a commencé la révision de son cadre légal mais il est encore trop tôt pour en mesurer les conséquences sur la société. Des efforts pour améliorer la collecte de données, en particulier pour l indicateur de demandes de traitement, sont encore à fournir. Des études complémentaires pour perfectionner les méthodes de calcul de prévalence de l usage problématique devraient aussi être menées. Un système d alerte rapide a été développé par le Point Focal. Ce système facilite la collecte d informations, leurs échanges entre les différents réseaux. Deux réseaux de laboratoires ont été mis en place : le premier s occupe d analyses d échantillons cliniques et le second analyse des substances psychoactives. Un site web spécifiquement conçu pour la collecte de données des laboratoires est en cours de développement. Par ailleurs, un projet de détection de nouvelles substances ou de substances particulièrement dangereuses via l analyse de substances saisies est également en cours. 10

17 Belgisch Nationaal Rapport over drugs 2003 : Samenvatting Deze samenvatting wil een korte inleiding zijn tot het Belgian National Report on Drugs Dit rapport kadert in de samenwerking tussen het Belgisch Focal Point en het Europees Waarnemingscentrum voor Drugs en Drugsverslaving. De structuur van het nationaal rapport is gestandaardiseerd voor alle lidstaten met het oog op harmonisering van de gegevens. Bijkomende gegevens over studies en lopende projecten, vernoemd in deze samenvatting, kunnen gevonden worden in de volledige tekst van het rapport of door contact op te nemen met het Belgisch Focal Point. Nationaal Beleid : een globale aanpak In 2002 koos de Belgische Regering ervoor zijn nationale aanpak verder te zetten in de lijn van de Beleidsnota van de Federale Regering in verband met de drugsproblematiek van begin De prioriteiten van de regering omvatten : - het reduceren van het aantal druggebruikers - het reduceren van de fysieke en mentale effecten van druggebruik - en het reduceren van de gevolgen van drugs voor de samenleving. Naast de Cel Gezondheidsbeleid Drugs, opgericht in 2001, werden in mei 2003 wettelijke bepalingen gepubliceerd voor de oprichting van een Algemene Cel Drugbeleid. Deze Algemene Cel zal optreden als coördinator van het Belgisch drugbeleid. Er wordt verwacht dat deze cel acties zal voorstellen, advies zal geven en de samenwerking op nationaal en internationaal niveau zal bevorderen. Nieuwe wetten en een Koninklijk Besluit hebben wijzigingen aangebracht aan de wet van 24 februari 1921 betreffende het verhandelen van giftstoffen, slaapmiddelen en verdovende middelen, ontsmettingsstoffen en antiseptica. De belangrijkste wijzigingen zijn : - Het incorporeren van de verordening n 3677/90 van de Raad van Europa houdende maatregelen om te voorkomen dat bepaalde stoffen worden misbruikt voor de illegale vervaardiging van verdovende middelen en psychotrope stoffen. - Druggebruik in groep wordt op zich niet meer als strafbaar aanzien; dit wordt vervangen door druggebruik in de aanwezigheid van minderjarigen. - Cannabis krijgt een speciaal statuut (gedefinieerd als een andere category ), met de laagste prioriteit betreffende vervolging. Het bezit van een hoeveelheid cannabis door een meerderjarige (18 jaar of ouder), bedoeld voor persoonlijk gebruik, zonder overlast of problematisch gebruik, zal enkel aanleiding geven tot een registratie door de politie. In geval van overlast echter, kan een gevangenisstraf opgelegd worden van minimum drie maand tot één jaar en/of een boete van 1000 tot euro (vermenigvuldigd met 5, de opdecimen). Cannabis blijft een illegale drug. - Handel, productie, export en import van substanties onderworpen aan de wet van 1921 blijven verboden en behouden hun oorspronkelijke straffen. 4 april 2003, 3 mei mei

18 Epidemiologische situatie Uit de resultaten van de Gezondheidsenquête door Middel van Interview 2001 blijkt dat 10.8% van de bevolking (tussen 15 en 64 jaar oud) ooit cannabis heeft gebruikt terwijl dit voor XTC/amfetamines rond 2% ligt, voornamelijk jonge gebruikers. 2.8% van de populatie gebruikte cannabis in de laatste maand en minder dan 1% XTC/amfetamines. De percentages voor mannelijke gebruikers liggen steeds hoger dan voor vrouwen. Regionale verschillen werden vastgesteld evenals een invloed van de graad van verstedelijking. Druggebruik onder schoolgaande jeugd lijkt het beste gedocumenteerd te zijn. Ter aanvulling van de WHO «Health Behaviour in School-aged Children» (HBSC) enquête, werd een European School Survey Project on Alcohol and other Drugs (ESPAD) enquête opgestart in Alle Belgische studies onder schoolgaande jeugd bevestigen de stijgende trend van het ooit-gebruik van cannabis. Ook hier is consumptie geslachtsgebonden. In voorgaande uitgaves van het Nationaal Rapport, werden de Treatment Demand Indicator (TDI) data voorgesteld per gemeenschap of gewest. Dit jaar werd daarvan afgestapt omdat deze gegevens niet vergelijkbaar zijn en dus niet tot een nationaal cijfer kunnen samengebracht worden. In 2002 startte het Nationaal Focal Point een studie met als opzet de beschrijving van de Belgische situatie en het opstellen van aanbevelingen om het verzamelen van TDI data te verbeteren en te standaardiseren. Het rapport van deze studie wordt verwacht tegen eind Het aantal druggerelateerde overlijdens kan afgeleid worden uit de mortaliteitsgegevens van het Nationaal Instituut voor de Statistiek. De meest recente gegevens betreffen Het aantal drugsdoden onderging een plotse stijging in Wat betreft het voorkomen van HIV, Hepatitis B en C onder druggebruikers in behandeling bestaan er twee informatiebronnen: zelf-rapportering en biologische testen. In 2002 waren ongeveer 3% van de HIV-gevallen injecterende druggebruikers. De dalende tendens gestart in 1998 wordt dus verder gezet. In 2001 rapporteerde 3% van de injecterende druggebruikers die een behandeling startten zelf HIV-seropositiviteit. De prevalentie van HBVinfecties in dit jaar varieert van 11% gebaseerd op zelf-rapportering tot 16% gebaseerd op biologische testen. Voor HCV is de prevalentie 66% op basis van zelf-rapportering en 36% op basis van biologische testen. Over het algemeen komt de prevalentie gebaseerd op zelfrapportering overeen met de prevalentie gebaseerd op biologische testen. In 2000 hadden 73% van alle inbreuken i.v.m. narcotica te maken met bezit en persoonlijk gebruik van drugs. In de meeste gevallen gaat het om cannabis. Ook werd vastgesteld dat het aantal gedetineerden door drugsdelicten gestegen is gedurende de laatste 10 jaar. Algemeen kan men zeggen dat er een stijging is in het aantal drugsvangsten in de jaren negentig. Het terugdringen van de vraag Preventie behoort tot de taken van de gemeenschappen en/of gewesten. Op school worden veel drugpreventiecampagnes gevoerd, hoewel preventie-activiteiten in de kleuterschool en lagere school meer gericht zijn op algemene gezondheid en welzijn. In 12

19 de laatste twee jaar, werden enkele nieuwe programma s opgestart voor jongeren buiten de scholen in samenwerking met sportverenigingen. Sinds 2001 werden spuitenruil-programma s over het hele land opgestart. In het kader van het terugdringen van de schade gerelateerd aan druggebruik, richt men zich tot injecterende druggebruikers, jongeren in hun vrijetijdsomgeving en druggebruikers in de gevangenis. Hiervoor maakt men vaak gebruik van initiatieven georganiseerd onder peergroups. Een wettelijke basis voor substitutiebehandeling werd in augustus 2002 gelegd. Methadone wordt in België het meeste voorgeschreven. De idee achter de Federale Beleidsnota is het ontwikkelen van zorgcircuits en case-managent. Er waren geen aanpassingen van het strafrechtsysteem in België gedurende Projecten in België voor het terugdringen van de vraag naar drugs implementeren slechts zelden kwaliteitszorg. Eén Vlaamse instelling maakte gebruik van het EFQM (European Foundation Quality Management) model. De bevindingen staan in het rapport. Enkele thema s Er is nood aan evaluatie zoals ook door de Federale Beleidsnota i.v.m. de Drugsproblematiek in beschouwing werd genomen. In 2002 werden enkele pilootprojecten opgestart om onder andere behandelingssettings voor dubbele diagnose te evalueren en verdere evaluatie-instrumenten te ontwikkelen. Informatie over een stijgende vraag naar behandeling voor cannabisgebruik was moeilijk te verzamelen wegens de onzekerheid over de TDI-data in België. In 2002 werd een pilootproject over co-morbiditeit opgestart dat momenteel geëvalueerd wordt. Dit project gaat de haalbaarheid na van intensieve behandelingseenheden voor patiënten in dubbel diagnose. Data over dubbel diagnose werden uit de Minimaal Psychiatrische Gegevens gehaald. Dit gegevensbestand bevat het aantal opnames in psychiatrische hospitalen en op psychiatrische afdelingen van algemene ziekenhuizen, vanaf het tweede semester van 1996 tot het eerste semester van Resultaten tonen aan dat persoonlijkheidsstoornissen (cluster B) de meest frequente afwijkingen zijn die samengaan met afhankelijkheid. Prioriteiten voor de toekomst Tot besluit kan men zeggen dat België gestart is met haar wettelijk kader i.v.m. drugs te herzien. Om de impact op de samenleving hiervan in te schatten is het nog te vroeg. Inspanningen om de gegevensverzameling te verbeteren, zeker voor TDI-data, blijven belangrijk. Verdere studies over methodes om de prevalentie van problematisch druggebruik te berekenen moeten ook overwogen worden. Een early warning system on drugs is ontwikkeld door het Focal Point. Dit coördineert het verzamelen en uitwisselen van informatie tussen bestaande netwerken. Er zijn twee 13

20 soorten netwerken: enerzijds een netwerk dat zich bezighoudt met analyse van klinische stalen en anderzijds een netwerk dat analyses van psyco-actieve substanties behandelt. Er wordt gewerkt aan een website waar de labo s hun resultaten van analyses kunnen ingeven. Daarenboven is een nieuw project gestart waarbij in beslag genomen stalen worden geanalyseerd, ten einde tot een snelle opsporing te komen van nieuwe en vooral van gevaarlijke drugs. 14

21 PART I. National Strategies: Institutional & legal frameworks

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23 CHAPTER 1. Developments in Drug Policy and Responses 1.1. POLITICAL FRAMEWORK IN THE DRUG FIELD 1.1.a Objectives and priorities at national level The Federal Drug Policy Note, presented by the Belgian Federal Government (19 January 2001) formulates the national policy regarding drugs from 2001 onwards. One of the issues of the note is to modify the Narcotic Drug Act (of 24 February ), which will be discussed later on in this report (see 1.2.a). However, the main priorities of the Federal Government are the following: - to reduce the number of drug users, - to reduce the physical and mental effects related to drug use, - to reduce the consequences of the drug phenomena on the society. Overall, the note comprises three fields of action, being prevention, treatment and repression. Also, the creation of a Drug Cell is foreseen in the note (see 1.1.c). For more details on the policy note, please refer to the previous Belgian National Report on Drugs (2002). 1.1.b New initiatives and major changes in political approach In accordance with the Belgian political structure, this section deals with: - the federal level, - the federate levels: Flemish, French and German Communities and the Brussels Capital Region. Federal level At federal level, no real new changes are to be mentioned as the government continues the implementation of the Federal Drug Policy Note, started in In this respect, three pilot projects were initiated in collaboration with some federate entities. They concern dual diagnosis treatment offer, crisis intervention and case-management, networks for integrated drug treatment programs. More details are given in chapter 16.4.d on dual diagnosis pilot project. The Security and Prevention Contracts initiatives (previously known as Security and Society Contracts) will be continued, as well as the Drug plans. No major change is to be mentioned on this particular point neither. Federate levels Drug Policy in the Flemish Community In the Flemish Community, there is a global approach for prevention and to a much lesser extent for treatment (as treatment is mainly financed by the federal government). The Flemish government has organised its policy through a covenant that is signed between the government and the coordinating agency VAD (Vereniging voor Alcohol- en andere 1 Full references of laws can be found in the bibliography.

24 PART 1 National Strategies Drugproblemen). A policy plan was developed in which 4 domains were defined to implement a Flemish drug policy The plan contains different actions in each domain, with indicators for measuring its realisation (evaluation). The main areas of work are: research and development of evidence-based new concepts, information, training, networking and coordination. The provincial networks, involved in the coordination, implementation of concepts and data collection have no longer a covenant with the Flemish government but will be coordinated by the provinces. In 2002, the Flemish government subsided 10 new prevention workers in the mental health centres. Political agreements have led to the implementation of needle exchange programmes in 2001 as well as in From 2003 onwards, the programme will be continued by means of an agreement between the Flemish government and the Medical Social Centres of each province. In some regions, institutions of the treatment sector have set up an experimental, voluntary crisis network. Within the Flemish Community different pilot projects (above-mentioned) started at the end of 2002 subsided by the federal government. Drug Policy in the French Community In 2002, the five-year Health Promotion Programme ( ) continued, focusing mainly on six health problems, one of them being addictions. Concerning the target population, priority is given to socially excluded populations and to schoolchildren. The AIDS prevention programme targets intravenous drug users. Drug Policy in the Walloon Region A decree (15 May 2003 Decree concerning neighbourhood prevention in the Walloon cities and municipalities ) provides a subsidy from the Walloon Region to certain municipalities that work out a plan for prevention at city/village level. Among others, these plans should include initiatives to reduce the risks associated with drug addiction. All initiatives are to be integrated in an umbrella policy for the city quarters. Each year, the government evaluates these plans in order to decide if the municipalities will continue to receive their subsidy. Drug Policy in the German-speaking Community No change has taken place in Drug Policy in the Brussels-Capital Region The Brussels Drug Programme is continued (please refer to the previous Belgian National Report on Drugs). 1.1.c Coordination policies The Health Policy Drug Cell, as mentioned in the Federal Drug Policy Note, has been set up by the cooperation protocol of 30 May In addition, recently, the law of 11 May 2003 provided the legal framework for the coordination structure General Drug Cell ( Cellule Drogue / Drug cell ), as well as for two other cells, being a Control Cell and a Cell International Cooperation. This General Drug Cell will act as support for the Inter- 18

25 PART 1 National Strategies ministerial Conference and will be an actor in the coordination of the Belgian drug policy. Its missions are among others to propose actions, to draft advice and to promote collaboration at a Belgian as well as at an international level. The General Drug Cell can always create other ad hoc Cells when necessary LEGAL FRAMEWORK 1.2.a Major changes in law and regulations existent and/or planned in the field of drug demand, supply, precursors and drugs related money laundering The following section is divided into two parts, being changes to the Narcotic Drug Act on one hand, and other changes to the legislation on the other hand. Changes to the Narcotic Drug Act (24 February 1921) The major existing change in the legal framework, and probably the one most spoken of by politicians, media and others, are the modifications to the Narcotic Drug Act. These changes have been mentioned in two laws (of 4 April and 3 May 2003) and one royal decree (16 May 2003). An overview of the most important topics: Incorporation of a Council Regulation (n 3677/90), regulating substances that can be used to produce illicit substances (so-called precursors ) into police authorities; Drug use in group is not seen as punishable in se any more; instead, this will be changed to drug use in the presence of minors; Cannabis gets a separate statute (defined as another category ): the possession of an amount of cannabis, meant for personal use, by an adult (i.e. 18 years or older), without the presence of nuisance or problematic use will only lead to a registration by the police. In the case of nuisance, however, a punishment can be imposed of minimum three months up to one year of prison sentence and / or a fine of to euro (to be multiplied by 5, the revaluation factor) 2. Commerce, production, export and importation of substances regulated by the Narcotic Drug Act remain forbidden, and maintain their original punishments. Other changes to the legislation First of all, two royal decrees (date of promulgation: 30 April 2002) have been enacted, changing the royal decree of 22 January 1998, controlling certain psychotropic substances. These two royal decrees add, among others, PMMA and 2-CB to the list of controlled substances. Secondly, a ministerial decree concerning hemp (28 November 2002), regulates the importation of hemp seed (whether or not to be used for sowing) and raw hemp and deals with, among others, the necessary certificates, control measures and the maximum THC level allowed. Finally, a law (3 May 2002) has been enacted, that changes the existing legislation on prevention of money laundering (law of 11 January 1993). This modification enables the authorized instances to report activities that are possibly linked to money laundering, committed by persons or organisations located in a state, country or region of which an authorised international instance has declared that their legal regulations are inadequate or that are perceived as a hindrance in the fight against money laundering. 2 For a full list of possible punishments, please refer to the laws and the royal decree mentioned. 19

26 PART 1 National Strategies 1.2.b Legal framework in the demand reduction field: prevention, treatment and harm reduction The law of 22 August 2002 provides a legal basis for substitution treatment in Belgium. This law states in its article 2 that a medical practitioner cannot be punished for using controlled substances for treatment. The list of controlled substances that are eligible for substitution treatment and guidelines for practice are still to be legally designed. 1.2.c Other Decrees of the French Community on doping Following the previously enacted decree on doping (8 March 2001), the French Community promulgated three other decrees concerning doping and sports. One of them (10 October 2002) concerns the appointment of medical practitioners and laboratories for the analyses. It also states the rules and procedures for organizing tests. The second decree (18 October 2002) lays down the forms used during test procedures, while the third (5 December 2002) determines the final list of substances and their maximum quantity eligible for use. Transmission of laboratory data A royal decree has also been proposed making anonymous transmission of data from certain laboratories to the Focal Point possible. Furthermore, it authorizes the Institute of Public Health to retain reference samples as pure as possible of different substances, to create a collection of reference samples at national level (Leus and Walckiers 2002). 1.2.d Legislation regulating traffic between bordering countries In the beginning of 2003, the first actions were held by the police in cooperation with Luxemburg and the Netherlands concerning customs checks. No further information on this subject is available yet LAWS IMPLEMENTATION 1.3.a Implementation of law No new information available for b Prosecution policy, changes in priorities and objectives in relation to drug users offenders drug related crime A directive has been written by the Minister of Justice (16 May 2003) urging the Public Prosecutor to use a limit of 3 grams for cannabis possession or in case of plant a limit of 1 plant (or seed). In this case, on condition that there are no aggravating circumstances (like use in the presence of minors, public nuisance or problematic drug use), the police will only need to make a simple, anonymous registration of the facts. 20

27 PART 1 National Strategies In line with the drug policy note, 8 justice case managers have been appointed. These case managers need to follow up more problematic drug users personally and make sure that therapeutic advisors (called upon by the Public Prosecutor) do not interfere with the treatment sector in individual cases DEVELOPMENTS IN PUBLIC ATTITUDES AND DEBATES 1.4.a Public perception of the drug issues: main results from surveys A public opinion poll on drugs was managed from April 2002 to June 2002 among young European citizens aged from 15 to 24 years (European Opinion Research Group 2002). In Belgium, 24.7% of the sample, say they have already tried cannabis once (lifetime prevalence) and 9.5% mentioned they have used cannabis during the last month. Regarding other drugs, the lifetime prevalence is amounted to 6.8% and the last month prevalence for other drugs is 1.9%. The access to drugs near their living place is seen as easy by 64%. The main perceived reasons for experimentation of drugs are: 64.2% Curiosity 47.8% Peer pressure 31.1% Thrill seeking 33.7% Problems at home 24.9% Expected effects The five possible consequences of drug use that get the highest score are the following: 49.1 % Dependence 36.5 % Problems with law 34.1 % Mental problems 25.5 % Infectious diseases 30.8 % Relief from pain and stress Regarding the most effective methods of management of drug-related problems, tougher measures against dealers and traffickers is mentioned by 60.3%, more treatment and rehabilitation by 40.6% and information campaigns by 37.1%. 1.4.b Orientations of the main public debates in civil society, national Parliament, organisations, NGO s Conference on Cannabis (February 2002) On the 25 th of February 2002, a conference on cannabis was held in Brussels, being a joint international effort at the initiative of the Ministers of Public Health of Belgium, France, Germany, The Netherlands and Switzerland. This conference led to the Cannabis 2002 Report. Several topics are discussed in this report, like epidemiological aspects, physical and mental health, prevention of cannabis use, medicinal cannabis and the influence of cannabis possession laws. The report can be downloaded from the following url: 21

28 PART 1 National Strategies Conference La ville carrefour d une politique de prévention des toxicomanies (June 2002) The conference aimed at opening the dialogue on the relation between drugs and public nuisance. The event was organized by the city of Liège, the Belgian Forum for Prevention and Urban Securtiy and the Permanent Secretariat for Prevention Policy. Different aspects were discussed, like the global drugs policy, public order, legal provisions, Brussels Parliament Drugs Conference (January 2003) In the Brussels Region, a conference was held on drug policy, epidemiological trends, prevention, harm reduction and treatment issues. This was seen as an opportunity for a successful meeting and discussion between fieldworkers and policymakers. Conference Drugs Policy 2000 (February 2003) During this national conference several drug-related topics were discussed, including new drug regulation and cooperation between justice and health care / treatment, case management, the evolution of the concept harm reduction, needle exchange, substitution treatment and synthetic drugs. 1.4.c Media presentation and imaging drug use The Federal Drug Policy Note on drugs and all the legislative publications on this issue kept the attention of the media. Along 2002, cannabis was still a topic of several debates on television and of numerous local conferences. Campaigns in the Flemish Community The VAD developed some new information materials (posters, brochures) on cannabis and adapted existing materials. All available information and prevention materials were brought together in a leaflet that was distributed largely to a variety of key persons in the different areas (education, youth work, local prevention workers, ) and through the waiting rooms of general practitioners. The Flemish Community launched and continued three campaigns: - Alcohol: give it a sober look: As media coverage on illegal drugs is so huge, VAD decided to launch a long-term campaign on alcohol. Every year the campaign focuses on a specific target group: 2001: years old with Alcoolworld website and flyers alcopops (2002), : years with free drinks brochure with information on the risks of alcohol misuse. - Sports sector: As long as you stay clean (Alcohol and drugs don t make a sport of it). With the national football union, VAD set up a campaign in which was realised a poster, information and training sessions and material for key persons (trainers) of sport clubs. - Night life sector: Deceived is a campaign which focuses on young people (18-25 years) and chemical substance use in nightlife; the main message is: You never know what you are taking. 22