Transcript VWS Nederlands Drugsbeleid 2015

Drug Policy
in the Netherlands
Yoni Dekker
Senior policy advisor
Nutrition, Health protection and
prevention directorate
Ministry of Health, Welfare and Sports
Overview
1.Objectives and principles
2.Legislation and regulations
3.Prevention, treatment and
harm reduction
4.Drug use
5.Coffee shops
6.Conclusions
Objectives and
principles
3
Drug Policy in the Netherlands
Objectives of Dutch drug policy
Balanced, integrated and evidence-based approach
•
To reduce drug demand (information, prevention and
treatment)
•
To reduce drug-related harm (health protection and care)
•
To reduce public nuisance related with production, trafficking
and use of drugs
•
To reduce use drug supply (fighting production, trafficking
and dealing)
•
To fight drug-related serious crime (organised crime and
money laundering)
This presentation focuses on demand reduction, the domain of
the Ministry of Health, Welfare and Sports
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Drug Policy in the Netherlands
Principles of effective drug policy
•
Pragmatic rather than principle-based:
do what works best
•
Fact-based: Importance of research,
evaluation and monitoring
•
Drug problem primarily a (public) health
issue
•
Health promotion and harm reduction
key concepts in effective demand
reduction efforts
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Drug Policy in the Netherlands
Drug demand reduction: integrated approach
Understanding demand reduction as
comprehensive, integrative and stepped
approach including:
•
Preventing use
•
Preventing health incidents
•
Early detection and brief interventions to
prevent addiction
•
Treatment of addiction and problem use
•
Harm reduction
•
Social rehabilitation and reintegration
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Drug Policy in the Netherlands
Law and regulations
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Drug Policy in the Netherlands
Legislation and Regulations:
• List I: Drugs posing an unacceptable risk to user and society
Including: Heroin, cocaine, ecstasy, amphetamines and GHB
• List II: Drugs that pose a less serious risk to user and
society
Including: Cannabis, sleeping pills and tranquilisers,
hallucinogenic mushrooms and khat
• Use of illicit drugs is not a criminal offense (to avoid
marginalisation and facilitate access to services)
• Possession still is (to allow for seizing the drugs)
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Drug Policy in the Netherlands
Expediency principle
Public Prosecutor has the discretionary power to refrain from prosecution
of criminal offences if this is judged to be in the public interest
Priorities laid down in guidelines for investigating and prosecuting crimes
committed under the Opium Act:
•
Highest priority: large-scale dealing in and production of hard drugs
•
No priority: possession of small quantities for personal use as such
(<0,5 g hard drugs; <5 g cannabis)
•
No priority: Selling of cannabis products through coffee shops
complying with the public prosecutor’s criteria
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Drug Policy in the Netherlands
Coffee shops:
policy and practice
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Drug Policy in the Netherlands
Coffee shop policy: national
AHOJ-G Criteria
A
no Advertising
H
no sale of Hard drugs
O
no public nuisance (Overlast) in and around the coffee shop
J
no entry or sale to young (Jong) people (< 18 yrs)
G
no sale of large (Groot) quantities per transaction (max. 5
grams); maximum stock for selling is 500 grams
Additional criteria:
•
Admission and sales only to residents of the Netherlands
•
Local competences
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Drug Policy in the Netherlands
Coffee shop policy: local competences
Municipal authorities are among others entitled:
• To decide on the permission and number of coffee shops
75% municipalities have NO coffee shops
• To define a minimum distance between coffee shops and secondary
schools (ranging from 250 to 350 meters)
• To prohibit cannabis use in public (to reduce public nuisance)
• To close down a coffee shop in case it doesn't adhere to the criteria
of the municipality
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Drug Policy in the Netherlands
Drug statistics
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Drug Policy in the Netherlands
Drug use in the general population (15-64 yrs)
(2014)
Cannabis Cocaine
Recent use 8
(%)
(last year)
Current use 4,6
(%)
(last month)
International Average
comparison
Heroin
Ecstasy
Amphetam GHB
ines
Alcohol
Tobacco
1,6
0,1
2,5
1,3
0,4
84
-
0,6
0,1
0,7
0,5
0,2
76
19
Average
Low/middle
Above
average
Above
average
-
Average Average
Source: Kerncijfers Drugsgebruik 2014,
Trimbos Institute
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Drug Policy in the Netherlands
Key facts
• Cannabis is the most popular illegal drug in
the general population aged 15-64, followed
by ecstasy and cocaine
• Current cannabis use among Dutch students
aged 15-16 is twice the European average
• Heroin use continues to decline
• GHB use is stable since 2012 (750-800)
• Use of new psychoactive substances (NPS)
relatively low
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Drug Policy in the Netherlands
International Comparison
Last year prevalence cannabis use
among young adults (15-34)
The Netherlands is among the countries
with high cannabis use prevalence
among young adults
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Drug Policy in the Netherlands
International Comparison
Last year prevalence of ecstasy use among young adults (15-34)
The Netherlands is among the countries with high ecstasy use
prevalence
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Drug Policy in the Netherlands
International Comparison
Last year prevalence of high-risk opioid use
The Netherlands is among the countries with low opioid use
prevalence
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Drug Policy in the Netherlands
International Comparison
Recent use in the general population
U.K.
(2014)
16-59
Germany
(2014)
18-64
EU-27
(2015)
15-64
Netherlands
(2014)
15-64
US
(2013)
12+
Canada
(2012)
15+
Australia
(2013)
14+
Cannabis
8%
4.5%
5.7%
8%
12.6%
10.2%
10.2%
Cocaine
2.4%
0.8%
1.0%
1.6%
1.8%
0.7%
2.1%
Ecstasy
1.6%
0.4%
0.6%
2.5%
1%
0.6%
2.5%
Amphetamines
0.8%
0.7%
0.5%
1.3%
1.3%
0.5%
(2011)
2.1%
Source: Source: National Drug Monitor – Annual Report 2015, Trimbos Institute
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Drug Policy in the Netherlands
International Comparison
Problem hard drug users
Country
Year
Number per thousand inhabitants 15-64 yrs
Mean estimate
lower - upper limit
2010/2011
81
79 - 84
Luxembourg
2007
59
50 - 76
Austria
2013
50
49 - 51
Italy
2013
44
38 - 49
Finland
2012
41
38 - 45
Germany
2012
-
28 - 34
Norway
2012
23
19 - 31
Greece
2013
22
20 - 26
Spain
2012
22
18 - 26
Netherlands
2012
13
12 - 15
United Kingdom
Source: National Drug Monitor – Annual Report 2015, Trimbos Institute
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Drug Policy in the Netherlands
Deaths from drug overdose in the Netherlands (2005-2011)
Aantal 160
140
120
100
80
60
40
20
0
2005
122
2006
112
2007
99
2008
129
2009
139
2010
94
2011
103
2012
118
Opiaten
60
44
34
52
52
37
33
Cocaïne
23
21
23
22
30
14
19
Overig
39
47
42
55
57
43
51
Totaal
…
2013
144
2014
123
28
44
40
22
24
24
68
76
59
Source: National Drug Monitor – Annual Report 2015, Trimbos Institute
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Drug Policy in the Netherlands
Prevention
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Drug Policy in the Netherlands
Drug prevention: stepped approach
Stepped approach of drug prevention
aiming at:
•
Supporting abstinence
•
Delaying onset
•
Reduction of frequency / dosage
•
Limiting possible health damage
→ Risk management / harm reduction
Cooperation of national, regional and local
organisations
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Drug Policy in the Netherlands
Drug prevention: integrative approach
•
Covering different life areas of young people: school, home
and leisure time
•
Full, factual and non-judgemental information
•
Addressing attitudes, social norms life skills: to strengthen
resilience and independent decision-making
•
Integrated in broad framework: health promotion, lifestyle,
youth culture
•
Targeting young people (10-25 y) and intermediaries
(teachers, parents, club / pub staff, etc.)
•
Focusing on legal and illegal substances
•
Development, research and implementation: best practice
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Drug Policy in the Netherlands
Examples: The Healthy School and Drugs
• Covering alcohol, drugs and tobacco
• Used in 70% of high schools
• Proven effective
Aim for primary schools: Prevent pupils in grade
7 and 8 from starting to use tobacco and alcohol
Aim for secondary schools: Encourage students to resist drinking
alcohol until age 16 at least and discourage them from ever using
tobacco or drugs
Aim for secondary vocational schools: Initiatives to prevent,
reduce smoking, excessive alcohol and drug use among students
vocational education (MBO)
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Drug Policy in the Netherlands
Examples: The Healthy School and Drugs
To increase effectiveness shift of focus from information about
drugs to:
•
Setting norms
•
Generic skills / life skills training / resilience /
•
Impulse control
•
Policy: Drug Free Schools
•
Early detection and guidance
•
Selective and indicated prevention (Moti-4)
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Het Nederlandse drugsbeleid
Examples: Healthy Nightlife activities
Contributions from local, national and international initiatives
•
‘Celebrate Safe’ initiative for and by clubbers, providing
information on a safe and healthy nightlife
•
Centre for a Safe and Healthy Nightlife
•
Safe and Healthy Nightlife and Events Programme
•
EU projects: Healthy Nightlife Toolkit (HNT) and electronic
Screening, Brief Intervention and Referral to Treatment at
emergency services (eSBIRTes)
•
Factsheets:
27
•
Serving low alcohol beers on events
•
Alcohol and aggression
•
Alcohol and safety policies for New Years eve
Drug Policy in the Netherlands
DIMS: Drugs Information and Monitoring System
• A national monitor run by Trimbos Institute
and addiction care services
• Monitors the market for illicit (party) drugs
• Analyses composition of drugs
• Observes trends (emergence of new drugs)
• Informs users about health risks
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Drug Policy in the Netherlands
DIMS: Drugs Information and Monitoring System
• Consumers of (party) drugs can have their drugs tested
anonymously (free of charge or at low cost)
• 30 testing facilities throughout the country
• 2013: >10,000 samples were delivered at the test services
• In case hazardous contents are detected: warning (campaign)
• Individual feedback
• Targeting users through social media
• Information through websites
• Red alert: regional or national multimedia campaign
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Drug Policy in the Netherlands
Monitor Drug Emergencies
• Monitor nature and extent of drug use related emergencies
• Participants: Hospital ERs, ambulances, police doctors, First
Aid at dance events
• Collecting anonymised information on emergencies (age and
gender, substance used, intoxication or trauma, setting, etc.)
• Close link with DIMS: analyse composition of drugs and
emergence of new drugs
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Drug Policy in the Netherlands
Treatment
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Drug Policy in the Netherlands
Treatment
• ‘Face-to-face'
Public drug services/centres for addiction care (address 95%
of requests for help)
Commercial or belief-based addiction care services
• E-health interventions
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Drug Policy in the Netherlands
Public addiction care organisations
13 specialised addiction care organisations in the Netherlands (spread
over 200 locations)
Addiction care integrated in mental health services
Funding is arranged through 3 laws:
• Healthcare Insurance Act (ZVW): regular drug treatment, from
abstinence oriented treatment to methadone maintenance
treatment
• Chronic Care Act (WLZ):
• Social Support Act (WMO): social care and harm reduction
programmes (drug consumption rooms, shelters, etc.)
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Drug Policy in the Netherlands
Harm reduction
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Drug Policy in the Netherlands
Harm reduction for hard drug users
• Decreasing demand: decrease of injecting drug use
• Needle exchange (Amsterdam 2013: 175,000 syringes supplied)
• Methadone treatment (7.569 clients (2014), average dose 80 mg
(2014)
• Heroin assisted treatment (in 2014: 740 slots in 18 settings in 16
cities)
• Low-threshold facilities
• day and night shelters
• basis counselling and medical care)
• Outreach work among difficult-to-reach groups
• Drug consumption rooms (in 2013: 31 dcr’s)
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Drug Policy in the Netherlands
Infectious Diseases
• Estimated number of injecting drug users: 2,300 (2008)
• HIV
• Less than 1% of all registered new HIV infections annually are
related to injecting drug use
• In 4% of all registered HIV infections up to 2010 injecting
drug use was the most likely route of transmission
• 700 of the 8,345 AIDS patients (registered up to 2010) are
injecting drug users (8.4%)
• Hepatitis B and C
• Data not collected systematically
• Injecting drug users belong to the groups with the largest
numbers infected with HCV
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Drug Policy in the Netherlands
Conclusions
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Drug Policy in the Netherlands
Is Dutch drug policy effective?
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Drug Policy in the Netherlands
Evaluation of drug policy in the Netherlands
(2009)
Health situation drug users relatively positive
• Low mortality rate (low rate of drug related deaths)
• Low HIV prevalence and incidence
• Moderate prevalence of hepatitis B and C
• Stable number of problematic hard-drug users (relatively low)
• Rise in average age, nearly no treatment admissions
• 70-80% addicts in contact with healthcare
• Use prevalence among adults stabilised; internationally an
average
• Harm reduction measures are effective
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Drug Policy in the Netherlands
New challenges: new responses
Challenge: Increasing drug use in night life settings
• Intensified and better prevention efforts
More emphasis on risks of use
More emphasis on healthy lifestyle, having fun without drugs
Challenge: Increasing problematic GHB use
• Intensified information about risks (overdose and dependence)
• Research on effective treatment and relapse prevention
• Developing and implementing treatment standards
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Drug Policy in the Netherlands