THE NETHERLANDS DRUG SITUATION 2002

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1 REPORT TO THE EMCDDA by the Reitox National Focal Point THE NETHERLANDS DRUG SITUATION 2002 FINAL VERSION REITOX

2 This file at the Trimbos Institute: <F:\NationaleDrugMonitor\Focal_Point\National Report 2002\Last versions\national_report_2002_v3.doc> Written by Part I (T. Ketelaars) Part II (M.W. van Laar) Part III (A. van Gageldonk) Part IV (A.A.N. Cruts, A. van Gageldonk) November 2002 NDM/Netherlands Focal Point 2002 Trimbos Institute NDM/Netherlands Focal Point PO Box AS Utrecht The Netherlands phone: fax:

3 Members of the Epidemiology Working Group Epidemiology of the National Drug Monitor Members of the Study Group Epidemiology of the NDM Mr. A.A.N. Cruts, Trimbos Institute Mr. H.F.L. Garretsen, Tilburg University Mrs. C.A.M. van Gorp, M.A., Ministry of Health, Welfare and Sport (Observer) Mr. R.A. Knibbe, Universiteit Maastricht Mr. M.W.J. Koeter, Amsterdam Institute for Addiction Research (AIAR) Mr. D.J. Korf, Criminological Institute Bonger, University of Amsterdam Mrs. M.W. van Laar, Trimbos Institute Mr. R.F. Meijer, Research and Documentation Centre (WODC), Ministry of Justice Mrs. H. van de Mheen, Addiction Research Institute Foundation (IVO) Mr. A. Mol, Care Information Systems Foundation (IVZ) Mr. J.A.M. van Oers, National Institute for Health Promotion and Illness Prevention (RIVM) Mrs. E.L.M. Op de Coul, National Institute for Health Promotion and Illness Prevention (RIVM) Mr. A.W. Ouwehand, Care Information Systems Foundation (IVZ) Mr. H.G.M. Rigter, Trimbos Institute Mr. Th.A. Sluijs, Municipal Health Service Amsterdam (GG&GD Amsterdam) Mrs. J.E.E. Verdurmen, Trimbos Institute Mr. G.C.G. Verweij, Statistics Netherlands (CBS) Mr. P.P. de Vrijer, Ministry of Justice (Observer) Mrs. W.M. de Zwart, Ministry of Health Welfare and Sport (Observer) Additional consultants Mr. M.C.A. Buster, Municipal Health Service Amsterdam (GG&GD Amsterdam) Mr. A.W.M. van der Heijden, National Police Agency (KLPD) Mrs. E.H.B.M.A. Hoekstra, Ministry of Justice, Directorate of Sanctions, Rehabilitation and Victim Care (DGPJS) Mrs. A.J.J. Slotboom, National Office of the Public Prosecution Service Mr. M.C. Willemsen, DEFACTO, voor een rookvrije toekomst (Institute for Public Health and Smoking)

4 INDEX SUMMARY MAIN TRENDS AND DEVELOPMENTS 7 PART 1 NATIONAL STRATEGIES: INSTITUTIONAL & LEGAL FRAMEWORK 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 24 PART 2 EPIDEMIOLOGICAL SITUATION Prevalence, patterns and developments in drug use Main developments and emerging trends Drug use in the population Problem drug use Health consequences Drug treatment demand Drug-related mortality Drug-related infectious diseases Other drug-related morbidity Social and legal correlates and consequences Social problems Drug offences and drug-related crime Social and economic costs of drug consumption Drug markets Availability and supply Sources of supply and drug seizures Price/purity 68

5 6. Main facts and trends per drug Discussion Consistency between indicators Methodological limitations and data quality 72 PART 3 DEMAND REDUCTION INTERVENTIONS Strategies in Demand Reduction at National Level Major strategies and activities Approaches and new developments Prevention School programmes Youth programmes outside school Family and childhood Other programmes Reduction of drug related harm Description of interventions Standards and evaluation Treatment Drug-free treatment and health care at national level Substitution and maintenance programmes After-care and re-integration Interventions in the Criminal Justice System Assistance to drug users in prisons Alternatives to prison for drug dependent offenders Evaluation and training Quality Assurance 111 PART 4 KEY ISSUES Demand reduction expenditures on drugs in Concepts and definitions Financial mechanisms, responsibilities and accountability Expenditures at national level Expenditures of specialised drug treatment centres Conclusions Methodological information 121

6 15. Drug and alcohol use among young people aged Prevalence, trends and patterns of use Health and social consequences Demand and harm reduction responses Methodological information Social exclusion and reintegration Definitions and concepts Drug use patterns and consequences observed among socially excluded population Relationship between social exclusion and drug use Political issues and reintegration programmes Methodological information 140 REFERENCES 145 Bibliography 145 Data Bases/Software/Internet addresses 174 ANNEXES 178 Annex 1: Drug monitoring systems and data sources 178 Annex 2: Additional tables 180 Annex 3: List of abbreviations 185 Annex 4: List of tables 187 Annex 5: List of graphs 189 Annex 6: Map of the Netherlands, provinces and cities 190

7 SUMMARY: MAIN TRENDS AND DEVELOPMENTS Annual reports of the drug situation in the Netherlands are commissioned by the European Monitoring Centre for Drugs and Drug Addiction and the Ministry of Health, Welfare and Sport. The reports concentrate on illegal drugs and give an overview of developments on the following subjects: drug policy, drug use, and drug demand reduction. Each year, three special issues are dealt with. In 2002, these issues were expenditures on demand reduction, drug and alcohol use among youngsters and social exclusion and re-integration. Developments in legal, political and organisational framework Drug policy in the Netherlands has four major objectives: (1) prevention of drug use and treatment and rehabilitation of addicts; (2) reduction of harm to drug users; (3) diminishing public nuisance caused by drug users (i.e. disturbance of public order and safety in the neighbourhood); and combating the production and trafficking of drugs. The Ministry of Health, Welfare and Sport (VWS) co-ordinates overall drug policy and treatment and prevention policy. The Ministry of Justice is charged with law enforcement related to the judicial aspects of drugs. Drug-related matters concerning the local level and the police fall under the jurisdiction of the Ministry of the Interior and Kingdom Relations. Actually, policy in the Netherlands is highly decentralised. Within the limits of the law, the local authorities have extensive responsibilities in addressing the drug problem. A bill has been accepted in 2002 to amend the Opium Act to allow the cultivation and use of cannabis for medical and scientific purposes. A governmental agency can grant permission to grow cannabis after checking the integrity of potential growers. The agency also sees to the quality control and standardisation of medicines produced from cannabis. In October 2002, the Dutch government decided that physicians may prescribe cannabis to patients and that pharmacies are allowed to supply the drug for medical reasons. Approved cannabis will not be available before Summer Legal arrangements to meet the EU directive on money laundering render it more difficult for criminal organisations to retain the proceeds of their illegal activities. New is the Act for the Promotion of Integrity Assessments by the Public Administration. A new agency investigates the background of organisations that apply for subsidies and permits. Aim is to counter attempts of criminal organisations to take advantage of public money. The number of drug couriers who swallow small packages of drugs increased to unprecedented levels in This caused stagnation in the criminal law chain. A special Act went into effect on 6 March 2002 enabling to place a number of detainees together in one cell in special emergency detention facilities. On the request of Parliament the Minister of Health, Welfare and Sport decided to forbid the testing of XTC-pills at most (house) parties. She ordered to examine other methods of monitoring drug markets. Intensifying legal measures against the production, sale and use of ecstasy are meant to counterweight the increase of trade of synthetic drugs and its precursors via Dutch harbours and airports. The judiciary and the police gear up joint efforts for an annual 18.6 million ( ). The Synthetic Drugs Unit (USD) has a pivotal role in the implementation of these efforts and international contacts with countries that are important in the trafficking of ecstasy are intensified. In July 2002, the new government of the Netherlands did not formulate a new drug policy. In stead a few intentions were formulated: to combat more firmly the production and trafficking of drugs, to force recidivist criminal addicts to submit to detoxification and to after care for two years, to close 'coffee shops' near schools and the Dutch frontiers, and to stop pill testing at parties. Because the cabinet stepped down in October 2002 and new elections will be held in January 2003, it is uncertain what will happen in the near future. Developments in the drug situation in the Netherlands 7

8 Drug use in the general population of the Netherlands has increased from 1997 onwards, but remained stable among young people. The level of cannabis consumption in the Netherlands is an average one, compared to other European Union countries, and above average when we look at cocaine and ecstasy use. A growing number of cocaine users, particularly of crack cocaine, seek help from drug treatment services. The club drug GHB has gained in popularity among partygoers. Drug trafficking and drug-related ( acquisitive ) petty crime claim a considerable amount of resources from the police and the criminal justice system. The number of recent (last month) cannabis users in the Dutch population has increased between 1997 and 2001 from approximately 326,000 to 408,000. The largest increase is reported among adolescents aged 20 24, while use among the age group years remains limited and practically unchanged since The sharp decline in the number of coffee shops between 1997 and 2000 (from 1179 to 813) has levelled off in 2001 (presently 805 coffee shops). Cannabis is not exclusively purchased in coffee shops, but also to a large extent from (older) friends and to a far lesser extent from a home dealers, in cafes or smart shops,or other recreational settings (NDM 2002). Cocaine has gained in popularity. Between 1997 and 2001, the percentage of recent users in the general population has doubled from 0.2 to 0.4 percent, which makes the Netherlands the fourth leading country in the European Union with regard to recent cocaine use, and the second leading country with regard to ever use of cocaine. Crack, the smokeable and most addictive form of cocaine, has become the main drug for many problem hard drug users. Statistics from drug treatment services show a sharp increase in the number of people seeking help for cocaine problems (representing an increase of 450% between 1994 and 2000). Two in three people seeking help for cocaine problems are crack cocaine users. The number of opiate addicts in the Netherlands between 26,000 and 30,000 is stable, and low compared to other EU countries (2.6 per 1,000 inhabitants in the Netherlands; 4.3 per 1,000 inhabitants in France; and 6.7 per 1,000 inhabitants in the United Kingdom). On average, the methadone maintenance doses prescribed for the treatment of opiate addicts are being raised (from 37 mg in 1995 to 48 mg in 2000) and higher dosages appeared to be more effective. Mortality from opiate overdose among Dutch people remains low (between 30 and 50 deaths per year), while the average age of the victims increases. The percentage of recent ecstasy users in the general population increased from 0.3% to 0.5% between 1997 and This increase was mainly caused by women. Ecstasy is still popular among young partygoers, although there are signs of a moderation in use particularly among frequent users. The party drug GHB, originally an anaesthetic, seems a new trend in club culture in spite of the fact that the line between ingesting the required GHB dose and one that may cause unconsciousness is very thin. Two in three users report that they have fallen unconscious after the use of GHB. In general, GHB use seems to have no harmful health consequences, unless it is used in combination with other substances. GHB has been linked to sex offences, road traffic accidents and deaths, but the number of serious incidents seems quite limited in proportion to the overall levels of consumption. Developments in demand and harm reduction Several reports refer to a stagnation in addiction care due to: 1) an ageing drug addict population remaining in care; 2) an ineffective co-operation between addiction care and mental health care or general practitioners, and 3) to ineffective referrals to addiction care from other care sectors. Registration data also point at the ageing of professionals in the addiction care. The combat against this stagnation is focussed on other care regimes for revolving-door clients. Studies on medical heroin co-prescription, rapid detoxification with naltrexone with or without anaesthesia, and higher doses of methadone maintenance treatment were published. Also other types of treatment were tried out. An important example is farm work for the most problematic group of addicts. Working at the farm appear to reduce 8

9 problems substantially. These results pave the way to introduce new treatments for these problem groups, thus enabling more efforts of regular addiction care directed at new groups of drug users. Contrary to former decades, the emphasis on pharmacological treatment (drug treatment) of addiction problems is growing. This shift might be part of a broader shift, namely the increasing focus on neurosciences and pharmacotherapies. Public support for a more repressive drug policy seems to grow, partly because of a call for zero tolerance. This has not yet led to major changes in drug policy. New elections will be held in January During the past year the policy programme Getting Results ( ) to improve the quality of addiction care and drug prevention resulted in several publications and guidelines, for instance on social addiction care, user rooms, and casemanagement for chronic addicts. The evaluation results of this programme are to be published in Important subprojects of Getting Results are initiation of facilities for education of professionals in addiction care to enlarge or to bring update their competence or expertise, improving and integrating information systems in addiction, monitoring, and co-ordination of funding and planning of outpatient addiction care. Family-based interventions are underdeveloped and should be developed and evaluated as components of broader programmes. A pilot study on the coverage of a free of charge hepatitis B vaccination programme for highrisk groups was successful, especially when combined with personal advice for less educated groups. Dual diagnosis clients are considered most problematic in addiction care, partly due to the separation of treatment and care for addiction problems and mental health problems. New types of integrated care, or rather co-ordinated care, are being developed to circumvent these barriers. Drug-dependent offenders are offered treatment modalities from the first phase of police custody to incarceration and even after detention. Most programmes are voluntary or coercive (participation as an alternative to penalties and detention). Since Spring 2001 penal law enforcement can be used for frequently re-offending addicts. There are no formal requirements for quality assurance in mental health care including addiction care. This may probably the reason for the slow development of quality systems in addiction care. Key issue: expenditures on demand reduction Information on costs of addiction care is not readily available. First, the structure of the flows of money to addiction care is complex and partly unclear. Second, different analysis strategies result in different outcomes. Third, addiction care is partly due to mergers in mental health care - often considered as a part of a broader system, for instance mental health care or psychogical/psychiatric problems (depending on the analysis strategy). Fourth, treatment of alcohol and drug problems are never separated in Dutch cost data, thus cost information on treatment of illicit drugs is not feasible. Recent studies and activities show that reducing the complexity of funding Dutch addiction care might become a political issue for the next future. When this would be pursued, the consequence will be that several laws have to be changed. Key issue: drug and alcohol use among young people aged year The use of illegal drugs is still low among this age group. Cannabis scores highest, but the use of hard drugs and synthetic drugs is almost non-existent in this age group and deaths and overdoses are rare. Cannabis use increased steeply from 1988 to 1996, but lifetime and last month prevalence stabilised afterwards (until 1999) at 19% and 15%. Boys are more frequent users than girls. The first experimental drugs for young people are predominantly 9

10 tobacco and alcohol. This pattern remained stable over the last five years or even tended to decrease. Young alcohol users also use cannabis and tobacco more frequently. During the past years, several mass media campaigns were launched targeting drugs and drug use among young people. The ten-year-old prevention programme The Healthy School and Drugs is still in operation and evaluated as well as other school-based projects. However, drugs are mostly used during weekends and several preventive activities were set out in different settings (youth pubs, coffeeshops, etc.). Furthermore, family-based prevention is done to stimulate parents in low SES neighbourhoods in talking about drug issues with their kids. A special treatment unit for the small group of very young drug addicts was evaluated. Youth media are a rich source of information for detecting, tracking and understanding emerging drug trends also among this early age group. This is especially valid for the internet. However the sheer quantity and transitoriness of websites hampers a clear overview. The number of calls and visits to the Drugs Info Line and its website illustrate the need for objective information on effects and risks of drug use. Special issue: social exclusion and reintegration Vulnerable for social exclusion are the lowly educated, the unemployed, the homeless, and immigrants from Moluccan, Turkish, Moroccan, Surinamese, Antillean, and other origins. Due to incomplete data, it is not yet certain whether immigrants and Dutch natives differ in drug use. Social exclusion and reintegration are targets of organisations with a broader view, including mental health, homelessness, or poverty. The recently initiated National Monitor on Homelessness (MMO) covers this sector. One of its targets is to report valid national data on these subjects. Valid statistics are rare and variations in outcomes are considerable. Estimations of the percentage of homeless having drug problems range from 20% to 58%. Local data exist for some big cities. The Poverty Monitor uses the following broad indicators for social exclusion: a marginal educational level; illiteracy; bad command of the Dutch language; and a marginal position on the labour market. Addiction certainly adds to social isolation. In the Netherlands, especially outpatient addiction care is historically deeply rooted in social work, targeting at keeping clients integrated with society as much as possible. Treating the addiction problem goes hand in hand with social reintegration programmes, support for financial debts, housing, and social skills training for maintaining social contacts and finding and keeping an appropriate job. Many specific programmes exist(ed) to reach these general goals. In 2003 it will be evaluated to what extent the goals of the National Action Plan for combating social exclusion have been reached. 10

11 PART 1 National strategies: Institutional and legal frameworks 11

12 12

13 1 Developments in drug policy and responses 1.1 Political framework in the drug field Main objectives of the national drug policy The national drug policy in the Netherlands has four major objectives: To prevent drug use and to treat and rehabilitate drug users. To reduce harm to users. To diminish public nuisance by drug users (the disturbance of public order and safety in the neighbourhood). To combat the production and trafficking of drugs. This policy is carried out in close collaboration with municipalities, health care and social care professionals and institutions, criminal justice authorities and the police. The main policy instruments are: a sharp separation of the markets for soft and hard drugs partial decriminalisation of soft drugs monitoring of changes in the use of drugs and in the consequences of drug use establishing and maintaining a highly diversified and extensive professional network of health care and social institutions offering help to drug users prevention of (problematic) drug use through information and education targeted at both the general public and at special groups social reintegration of (former) drug users reconciling the interests of crime control with those of public order, public health and welfare tackling the trafficking of hard drugs and larger quantities of soft drugs by using the full weight of the criminal law financing research into the effectiveness and efficiency of addiction care services and of prevention programmes. Dutch drug policy gives priority to a public health approach. In some cases, this resulted in a certain degree of tolerance and non-prosecution, instead of strict law enforcement. We give some examples: The Drugs Information and Monitoring System (DIMS): this service co-ordinates pill testing at special test locations (not at parties) to determine health risks, to get insight in available new drugs and in trends in substance use (see also 10). Participants of DIMS will not be prosecuted (Staatscourant 2000, nr.250). Safe Injection Rooms/User Rooms: in some municipalities hard drug users can use drugs in protected rooms, specially created for them by the local authority (see also 10). Drug dealing in or around user rooms is forbidden (Staatscourant 2000, nr.250). Coffee-shop policy: Coffee shops are alcohol free outlets resembling bars, pubs or cafés, where adults eighteen years or older may individually purchase cannabis up to five grams (Staatscourant 2000, nr.250). Yet, suppressing large-scale commercial production of cannabis is a high law enforcement priority. 13

14 1.1.2 Basic elements of drug policy at the national level Importance is given to a balanced and integrated approach of the drugs issue. This is reflected in the division of policy domains and tasks of the various ministries involved. The Ministry of Health, Welfare and Sport (VWS) (www.minvws.nl) is responsible for co-ordinating drug policy, and also has substantial responsibility for treatment and prevention of drug problems. The Ministry of Justice (www.justitie.nl) is charged with legislation, law enforcement and other matters related to the judicial aspects of drugs, while drug-related matters on a local level and the police fall under the jurisdiction of the Ministry of the Interior and Kingdom Relations (www.minbzk.nl) Co-ordination Collaboration and co-ordination between ministries and between ministries and (government) agencies is currently realised within a number of formalised and non-formalised structures. The most important co-ordination body at the administrative level is the Official Working Group on Drug Policy Implementation (AWUD). All sorts of policy questions and issues related to drugs are discussed here at a strategic level. Every month a meeting is arranged in which the ministries of Health, Welfare and Sport, Justice, Interior and Kingdom Relations, Foreign Affairs and Finance participate. All other ministries can participate whenever issues are put on the agenda that call for their attention. At operational level the Co-ordination Centre for Assessment and Monitoring of new drugs (CAM) was set up within the Health Care Inspectorate as part of the National Drugs Monitor. It carries out multi-disciplinary risk assessments on all new drugs, new combinations of drugs or new applications of existing substances. It covers both health and public order and safety dimensions. Participants in the CAM are: the ministries of Health and Justice and the Synthetic Drugs Unit (see below). The National Co-ordination Committee Precursors was established in 1999 as a coordination structure between ministries (Finance, Health, Justice, Foreign Affairs) and state bodies involved in the execution of various tasks (Economic Surveillance Department, Customs, Unit Synthetic Drugs). The committee discusses all topics involving precursors. The secretariat lies with the Ministry of Finance. It is the Committee s task to reach consensus on the Dutch position in the international arena with regard to precursor-related issues. The Synthetic Drugs Unit (USD) was formed in 1997 in an effort to fight the production and trafficking of XTC, amphetamine and other synthetic drugs. The USD consists of all possible law enforcement bodies. The Public Prosecution Service, the police, Customs, the Royal Netherlands Military Constabulary, the Fiscal Intelligence and Investigation Department/Economic Surveillance Department, the National (Criminal) Investigation and Information Department of the Central Police Services (Korps Landelijke Politiediensten), the Central Import and Export Office and the National Transport Inspectorate, all participate in this unit. The unit is led by a specially appointed Public Prosecutor and a Chief of Police. The USD s main task is to carry out criminal investigations of national or international character, either independently or in collaboration with others, and to 14

15 prosecute offenders of the drug laws. The USD can also suggest new policy initiatives in the area of synthetic drugs. The National Drug Monitor (NDM) was set up by the ministers of Health and Justice, but the secretariat is located at the Trimbos-institute. The creation of the NDM in 1999 confirms the importance of an effective monitoring of drugs and drug-related problems. One of its tasks is the production of an authoritative annual report on a broad range of drug-related issues. The Steering Group International Information (Stuurgroep Voorlichting Buitenland) is made up of representatives of the ministry of Health, Welfare and Sport, the ministry of Foreign Affairs, the ministry of Justice and the ministry of Interior and Kingdom Relations. This Steering Group was set up to discuss the way of giving information about the Dutch drug policy to policy makers, politicians, media, and citizens in foreign countries. The meetings of the Steering group take place once a month. Within each ministry co-ordination mechanisms are set up. The ministry of Health, Welfare and Sport has structural meetings regarding substance use (legal and illegal) with all directorates involved. Every month, topics such as policy on alcohol, tobacco and illegal drugs and legislation are being discussed. The Drugs Bureau (Bureau Coördinatie Drugsbeleid) and the Law Enforcement Directorate General (DGRh) of the ministry of Justice is responsible for different aspects of the judicial side of drug policy. Formalised meetings take place between both directorates to co-ordinate and to promote co-operation in drug related files. Both departments stay in close contact with the National Board of Prosecutors General, head of the Public Prosecution and appointed with the task under the responsibility of the Minister of Justice - for setting the law enforcement and prosecution guidelines Communication lines exist with the Central Police Services (Korps Landelijke Politiediensten) and the National Expert Network on Drugs (Nationaal Netwerk Drugsexpertise), which consists of police officials working in the field of narcotics Basic elements of drug policy at the regional and local level Policy in the Netherlands is highly decentralised. Local authorities have their own responsibilities in addressing the drug problem, though within the limits of national drug laws. Dealing with the drug issue at the local level: 'tripartite consultations' between the mayor, the police commissioner and the public prosecutor take place regularly on a structural basis. These three parties jointly execute the local drug policy on the basis of their institutional responsibilities and powers. The national Support and Information Point Drugs and Safety (SIDV) (www.sidv.nl) provides information and support to municipalities in developing local drug policy (see 9.4). Addiction care and prevention: national government creates the condition for the development, implementation and evaluation of prevention, information and education. The implementation is largely in hands of intermediary organisations, such as those in the field of education, youth care, sport and socio-cultural work, and addiction care organisations. 15

16 Prevention: a National Support Centre for Prevention (LSP) has been set up to strengthen the collaboration between the many prevention units in addiction care. 1.2 Legal framework The use of drugs is not penalised in the Netherlands, in contrast to the production, trafficking and possession of drugs. (Article 2 and 3 of the Opium Act) The framework for prosecuting unlawful activities, especially the production and trafficking of drugs, and for sentencing criminal drug users has been gradually expanded in the past decade and now involves an extensive set of laws and other legal instruments (see hereafter) The Opium Act Dutch legislation is consistent with the provisions of all the international agreements the Netherlands has signed, i.e. the UN Conventions of 1961, 1971 and 1988, and other bilateral and multilateral agreements on drugs. The Dutch Opium Act (1928), or Narcotics Act, is a penal law. It was fundamentally changed in Since then, the Opium Act has been amended repeatedly but its basic structure has been maintained. The new Act distinguished drugs presenting unacceptable risks (hard drugs) and other drugs (e.g. cannabis), which were seen as less dangerous (soft drugs). In an appendix to the Act several substances, including opiates, cocaine, amphetamine and LSD, were listed in Schedule I under the heading drugs presenting unacceptable risks. In Schedule IIb only cannabis was listed, without the qualification of unacceptability. In 1993, the Netherlands ratified the1971 Convention of the United Nations on Psychotropic Substances. As a result, many other substances had to be added to the two Schedules of the Opium Act. This included MDMA (ecstasy). New substances continue to be placed on the lists. In 2000, 4-MTA, an analogue of MDMA. was placed on Schedule I. In 2001, the Co-ordination Centre for the Assessment and Monitoring of New Drugs (CAM) has published a risk assessment of GHB (gamma-hydroxybutyric acid). CAM recommended that the use of GHB should be monitored and that a new risk assessment should be carried out as soon as monitoring data call for a re-assessment. In 2002, however, GHB and Zolpidem were placed on Schedule IIa of the Opium Act, and PMMA on Schedule I, because these substances were placed on the lists of the UN Convention on Psychotropic Substances. In 2002, the Opium Act was amended in relation to the medical use of cannabis (Staatsblad 2002, 520). In the amendment the cultivation of cannabis for medical and scientific purposes is regulated. A governmental agency, the Bureau for Medical Cannabis (BMC), can grant permission to qualified growers to cultivate cannabis. It has to check the integrity of applicant cannabis growers. The BMC also sees to the quality and the standardisation of medicines produced from cannabis. At the moment, the cannabis products used in practice for medical reasons are of uncertain composition and are not subject to rigid quality control. In October 2002, the Dutch government decided that physicians may prescribe cannabis to patients and that pharmacies are allowed to supply this drug. The first approved medicinal preparations of cannabis will not be available at the pharmacies before Summer 2003 (T.K , nr.9). 16

17 In the 150 to 200 "smart shops" in the Netherlands mushrooms with psychedelic properties can be bought. The active ingredients psilocybine and psilocyne are listed in Schedule I, but until recently it was not clear if the Opium Act also applies to the fresh or dried mushrooms themselves. At issue was whether drying these products should be considered processing in the sense of the Opium Act. According to a regional Court of Justice, the Opium Act extends to psychedelic mushrooms that have been dried or processed into any other form - for example, waffles -, but not to fresh mushrooms. The Supreme Court of the Netherlands confirmed the sentence in this case on 5 November Sanctions The maximum penalty in the Opium Act for the import or export of a hard drug is twelve years of imprisonment or a fine of 45,000. For manufacture, transportation or sale, eight years; and for possession or storage four years or 45,000 (Article 10 of the Opium Act). The maximum penalties for cannabis in the Opium Act are four years of imprisonment or a fine of 45,000 for import or export. And four years or 45,000 for manufacture including cultivation of hemp and for transportation, sale or storage. All commercial cultivation of cannabis in glasshouses or domestically is forbidden unless a license has been granted. Open-air cultivation is permitted only for cannabis fibre varieties with clear-cut agricultural applicability as defined by national or European Union regulations. The maximum penalty for the possession of maximum 30 grams of cannabis amounts to one-month imprisonment (or 2250) (Article 11 of the Opium Act). Habitual offenders against the Opium Act are likely to be sentenced to higher penalties than are people without a criminal track record. The maximum penalty for repeated violation of the Opium Act with regard to hard drugs is sixteen years of imprisonment or a fine of 450,000. The offender may be subject to confiscation of any assets gained from the offence. In 1999, an article called Damocles was added to the Opium Act (Article 13b). This article allows mayors to act against coffee shops, pubs, shops and other public places if these create drug-related nuisance or trespass against the Opium Act or the Opium Act Directive. Measures to be taken under this article include closure of the premises and seizure of any drug stock. In 2001, the Medicines Act and the Economic Offences Act were changed. Illegal trafficking in all kinds of medicines or drugs were characterised as an economic offence and can be punished as such (maximum 6 years of imprisonment). The purpose of this amendment was to create more judicial possibilities to combat dope in sports and the abuse of GHB Chemical precursors In 1995, the Abuse of Chemical Substances Prevention Act (Wet Voorkoming Misbruik Chemicaliën), came into force. This Act deals with the trafficking in chemical substances that may be used in the production of drugs, and addresses international regulations. For the manufacture and the trafficking of substances registered in category 1 of Appendix I of the Act, a licence issued by the Minister of Health, Welfare and Sport is required. The Economic Surveillance Department of the Ministry of Economic Affairs oversees the implementation of the Act. A breach of this law constitutes an economic offence. Profits thus acquired may be confiscated. 17

18 The investigation of these illegal transactions will be intensified. Data on the seizures of precursors are sent to the International Narcotics Control Board (INCB) and the exporting countries. A special policy guide line has been established this year for providing some data to China (Ministerie van Volksgezondheid, Welzijn en Sport, 2002a). From 1996 to 2000 about twenty cases were settled, but in 2001 there was a steep rise: 39 offences of this law were brought before justice (Bureau NDM, 2002, p.159) Money laundering The Netherlands has introduced or changed laws to meet the EU directive on money laundering, making it more difficult for criminal organisations to retain the proceeds of their illegal activities. The most recent legal action of the Dutch government to get a grip on money laundering is the Act for the Promotion of Integrity Assessments by the Public Administration (Wet bevordering integriteitsbeoordelingen door het openbaar bestuur or Wet Bibob). By creating an Investigation Agency, that checks background data of organisations that apply for subsidies and permits, the Dutch government attempts to prevent criminal organisations from taking advantage of public money or laundering money with the unintentional assistance of the Public Administration. The Agency can only investigate when asked to do so by governing bodies. This act came into effect on 20 June Within three years the efficacy of this act will be evaluated (Staatsblad 2002, 347) Other important laws The Prisons Act (Penitentiaire beginselenwet -1998) contains the basic principles of the Dutch prison system. The most important principle is to prepare prisoners to return to the society. Detainees who have been sentenced to an unconditional prison term of more than one year may enter a so-called penitentiary programme of at most six months duration. The aim of the penitentiary programme is to facilitate the social reintegration of offenders by helping them to gain job experience outside the prison walls. Violating the rules of the penitentiary programme will result in the mandatory completion of the remainder of the prison sentence. Penitentiary programmes are not accessible by addicts who are sentenced under the Compulsory Treatment Order (Penitentiaire beginselenwet, Article 2). On 1 April 2001 the Judicial Treatment of Addicts (Strafrechtelijke Opvang Verslaafden-SOV) was introduced. It allows the courts to commit addicted habitual offenders to a special institution for up to two years. The alternative is a prison sentence. The act is set up as an experiment. Further implementation of the law must await the outcomes of a stringent evaluation for three to four years. The experiment will run in four institutions in Amsterdam, Rotterdam, Utrecht and the Southern municipalities -, totalling 288 admission lots. All the institutions have commenced operation and in June 2002 more than 120 inmates had been ordered there (Bureau NDM, 2002)(see 9.5). In 2001, the number of drug couriers who swallow small packages of drugs increased to unprecedented levels at the Dutch national airport Schiphol. The limits of the criminal law chain were reached by the end of that year. A special Act was drawn up: Act Temporary Measures for Penitentiary Capacity for Drug Couriers (Tijdelijke Wet Noodcapaciteit Drugskoeriers). This went into effect on 6 March 2002 (Staatsblad 2002, 124). This Act is unique as it is specially made for one kind of offender. The temporary measures enable law enforcement agencies to place detainees together in one cell in special emergency detention 18

19 facilities - contrary to the Prisons Act. The regime in these emergency facilities is severely restricted but complies with the relevant minimum international requirements (see ) Addressing drug-related public nuisance Since the end of the 1980s legal measures have been taken to reduce the public nuisance caused by drug users. The Damocles Regulation has expanded the legal armament of municipalities to redress unwanted developments such as an unchecked increase in the number of coffee shops or to sanction infractions to national or local drug policy. These legal instruments stem from either public health or public order concerns, or both. Another tool is the Closing Drug Premises Act, or Victoria Act (Wet sluiting drugspanden), which came into effect in This law added an article to the Municipality Act (Gemeentewet, article 174a). It allows mayors of municipalities to close down premises where drug use or trafficking causes public nuisance. Initial experience with the Victoria Act has been favourable but also illustrative of the legal difficulties local government may face when it tries to deprive citizens of access to their property. Municipalities can create additional means of intervention by formulating a coffee shop policy and by introducing bylaws. In 2002, the use and usefulness of both the Damocles Regulation and the Victoria Act were evaluated. Most mayors regard these legal instruments as effective law enforcement tools to reduce public nuisance (Smits and Smallenbroek, 2002). The shutdown of buildings and especially the nailing up of houses may adversely affect the appearance and social structure of a street or neighbourhood. Two members of Parliament have drafted a bill for the so-called Victor Act - to allow municipalities to give a new destination to closed premises, such as permitting new tenants to move in. The Victor Act went into effect on 29 May 2002 (Staatsblad 2002, 348). An important pilot project to combat drug-related crime and nuisance at the local level is the Hektor Project in the city of Venlo. The purpose is to diminish the nuisance caused by many German drug tourists who buy cannabis mostly at illegal coffee shops, i.e. coffee shops not tolerated by the local authorities. The project has a three-line approach: 1. Low tolerance towards nuisance in the public space; 2. Revision of the coffee shop policy; 3. To combat the infiltration of the real estate market by organised crime. By creating special teams the local government, the regional police, the Public Prosecution Service and the Fiscal Intelligence and Investigation Department (FIOD), succeeded in closing many drug dealing premises and illegal coffee shops. Also, substantial amounts of black money could be confiscated. The Hektor Project runs from 2001 to 2005 and will be evaluated (Ministerie van Volksgezondheid, Welzijn en Sport, 2002a) Important new initatives Pill testing Following the wish of the majority of the Lower House, the Minister of Health, Welfare and Sport decided to forbid the testing of XTC-pills at (house) parties. At the same time, the Minister ordered to examine other methods of monitoring the drug markets. The final decision on monitoring activities will be taken in January 2003 (Ministerie van Volksgezondheid, Welzijn en Sport, 2002b). 19

20 District bans for addicts In July 2002, the mayor of Rotterdam imposed a personal ban for six months on about 50 drug addicts to linger around in the Rotterdam borough of Delfshaven during daytime. These addicts caused much drug-related nuisance for the local residents. The ban is based on Article 172 of the Municipality Act (Gemeentewet) which gives the mayor the power to restore public order. A pressure group of addicts (de Junkiebond) brought the case to the Regional Court, that decided that the mayor is entitled to combat nuisance, but also that the ban of six months is too long and not well motivated (Steun- & Informatiepunt Drugs & Veiligheid, 2002). The city of Rotterdam will continue this banning policy. 1.3 Law implementation Opium Act Directive In the Netherlands, criminal investigation and prosecution operate under the so-called expediency principle or principle of discretionary powers (opportuniteitsbeginsel). The Dutch Public Prosecution Service has full authority to decide whether or not to prosecute and may also issue guidelines. The most recent set of comprehensive guidelines for enforcing the Opium Act was the Opium Act Directive of 2000, which is valid from 2001 until 2005 (Staatscourant 2000, nr.250). The Opium Act Directive stipulates when the maximum penalty or a lesser sanction is required. Decision criteria are the amount of drug, the kind of drug, the place where the drug was sold, and occasional versus long-term dealing. The Polaris Tables (2001) give a very detailed elaboration of this principle. The sale of cannabis is illegal, yet coffee shops are allowed to maintain a stock of 500 grams and to sell up to 5 grams to a customer. In 2002, a feasibility study started to find a method for counting not tolerated outlets of cannabis sales (Ministerie van Volksgezondheid, Welzijn en Sport, 2002a, p.16). Cultivation of cannabis is forbidden, but growth of five or less plants for personal use has a low prosecution priority. Also, in the Opium Act Directive the AHOJ-G criteria to which coffee shops must adhere are clearly described: A stands for no Advertising of any drug H for no Hard drug sale J for not selling cannabis to Young persons (under 18); up to 1996 the age limit was 16. O for no public nuisance, and G for no large quantities (more than 5 grams cannabis) per transaction. Up to 1996 the limit was 30 grams. In recent years, the government policy has been to reduce the number of coffee shops. The estimated number went down from almost 1200 in 1997 to 805 in 2001 (see 4.1.1). It is unclear yet if this has resulted in increased supply of cannabis through channels outside coffee shops. Most of the Dutch municipalities do not have a coffee shop. High prosecution priority is given to professional and commercial cannabis cultivation. The indicators for professional dealing with regard to cannabis cultivation are listed in great detail in the Opium Act Directive. In 2001, 1973 large-scale cannabis growers were apprehended (Ministerie van Volksgezondheid, Welzijn en Sport, 2002a) Prosecution priorities The relative prosecution priorities (high to lower) in the Netherlands are: 20

21 offences involving hard drugs rather than soft drugs the production or trafficking of any drug rather than the possession for personal use (lowest priority: possession of a hard drug [heroin] up to 0,5 grams and possession of cannabis up to five grams) offences committed by recidivists rather than first-time offences large-scale cultivation or sale of cannabis the sale of cannabis outside coffee shops through street dealers, couriers, the Internet, pubs, shops and so on, rather than sale in coffee shops. In January 2002, the Code of Criminal Procedure was changed. Besides investigations on the body of suspects, including rectal and vaginal searching, which were already legal, more intrusive methods - investigations 'in the body' - such as the use of X-rays and ultrasound scans are permitted, as long as a physician applies these techniques. (Staatsblad 2002, 66). These additional methods may be used for instance in persons suspected of having swallowed small packages of drugs or having pushed packed drugs into body orifices (body packing) Intensified actions against ecstasy In 2001, the national government announced measures against the production, sale and use of ecstasy (Ministerie van Justitie, 2001). The Public Prosecution Service will intensify investigations into the manufacture and sale of ecstasy. The Ministry of Justice and the police will gear up their joint efforts. Actions from 2002 to 2006 also include mass medial health promotion campaigns highlighting the adverse effects of ecstasy. This action plan costs 18.6 million each year and will be evaluated in The Synthetic Drugs Unit (USD) has a pivotal role in the implementation of these efforts and five special XTC-teams will be created by the regional police forces. The contacts with countries that are important in the trafficking of ecstasy will be intensified ( Ministerie van Volksgezondheid, Welzijn en Sport, 2002a, p.24-25). 1.4 Developments in public attitudes and debates Public attitudes There are no recent general surveys or opinion polls focusing on attitudes towards the drug problem (see National Report 2001 and 8.2.3). However, in 1996, 1997, 1998, 2000 and 2002 drug-related nuisance was surveyed by interviewing 19,000 persons in underprivileged neighbourhoods in 13 municipalities (the Integral Security Report- Integrale Veiligheidsrapportage) (see 4.1.1). From 1996 to 2000 the experienced drug-related nuisance was decreased significantly in these neighbourhoods, but this trend did not continue after Instead, it stabilised at the same level. Five kinds of nuisance were considered. Not all of these had the same trend: concerns with regards to the annexation of the public space by drug addicts and street-walking decreased, whereas the subjective nuisance caused by drug dealing activities, pollution of the public space by addicts and nuisance caused by coffee shops increased (Ministerie van Volksgezondheid, Welzijn en Sport, 2002a, p.19) Drug policy of the new government 21

22 In July 2002, the new government presented its coalition agreement. No new drug policy was formulated, but a few intentions were announced: To combat more firmly the production and trafficking of drugs. To mandate recidivist criminal addicts to detoxification. To close 'coffee shops' near schools and the Dutch frontiers. To stop pill testing at parties. As the government stepped down in October 2002, it is at this moment uncertain what will happen in the near future. In January 2003 there will be new elections Public debate Increased public debates on drug issues in Parliament illustrate the strong public interest in these issues. We already mentioned combating drug-related crime and the reduction of drugrelated nuisance, including mandating criminal addicts into treatment or guidance (see above and ). In 2002, public opinion was pressing for stricter law enforcement in general, but also regarding drug-related nuisance. Some issues featuring in public debates are presented below Drug trafficking A recurrent theme in the public debate is fear of alienation from drug policies in other countries concerning drug trafficking. There is general consensus that international collaboration should be sought. In 2001 and 2002, the collaboration with France was intensified in the field of exchanging information on law enforcement issues, but also in the field of treatment and prevention. The A-teams of police forces of France, Belgium, Luxembourg and the Netherlands concentrate on cross-border drug tourism by checking motorway traffic and passengers in international trains. These teams appear to be very successful. In one year 1271 drug runners were caught. Therefore the investigation services of France and the Netherlands decided to collaborate more systematically (Ministerie van Volksgezondheid, Welzijn en Sport, 2002a, p. 33). In November 2001, a special Collaborative Investigation Team was installed (Recherchesamenwerkingsteam), in which special forces of the Netherlands, the Netherlands Antilles and Aruba join activities to combat organised crime (in most cases related to drug trade). The increase in the number of people arrested at Schiphol Airport for carrying swallowed pellets of drugs (cocaine) resulted in an overload of criminal cases, thus the limits of the criminal law chain were reached. This problem was frequently discussed in the mass media. The regional courts are hardly able to handle this extra case load and it became highly problematic to find prison cells for the arrested couriers (see 1.2.5). In January 2002 the government accepted the "Plan of Action for Drug Trafficking at Schiphol", which intends to intensify the existing two-line approach (TK , 28192, nr.1). The first line comprises measures to prevent drug transports from the Netherlands Antilles to the Netherlands. The second is directed at ensuring that intercepted drugs are confiscated and judicial intervention against couriers will follow. New measures regarding the supply of drugs, drug control, criminal policy and penitentiary capacity did not lead to a substantial decrease in the number of drug couriers. One of these measures is pre-flight control. In 2001, 1233 drug couriers were arrested at Schiphol Airport. From January to September 2002, 1311 drug couriers of 22

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