2004 Netherlands National Drug Monitor

This file at the Trimbos Institute: <F:\N D M\JB 2004\Engelse vertaling\JB 2004 En versie 5.0 vastgesteld.
doc>
Annual Report NDM 2004

Editorial Board
1
Dr. M.W. van Laar
1
Dr. A.A.N. Cruts
1
Dr. J.E.E. Verdurmen
2
Dr. M.M.J. van Ooyen
With the cooperation of

1
Dr. A.P.M. Ketelaars
1
Dr. P. van Gelder
1
Trimbos Institute
2
WODC
This publication can be ordered through www.trimbos.nl,

or directly from the Trimbos Institute, Order Department,
P.O. Box 725, 3500 AS Utrecht, the Netherlands, tel.: 030-297 11 80;
fax: 030-297 11 11; e-mail: bestel@trimbos.nl.
article number AU0290.
An invoice will be sent to you for payment.
ISBN 90-5253-487-X
© 2005 Trimbos Institute, Utrecht

All rights reserved. Nothing from this publication may be copied and or otherwise distributed without
the prior written permission of the Trimbos Institute.
2
MEMBERS OF THE SCIENTIFIC COUNCIL OF THE NDM
Prof. H.G. van de Bunt, Erasmus University Rotterdam

Prof. H.F.L. Garretsen, University of Tilburg (Chairman)
Prof. R.A. Knibbe, University of Maastricht
Dr. M.W.J. Koeter, Amsterdam Institute for Addiction Research (AIAR)
Dr. D.J. Korf, Criminological Institute Bonger, University of Amsterdam
Dr. H. van de Mheen, Addiction Research Institute Foundation (IVO)
Prof. J.A.M. van Oers, Addiction Research Institute Foundation (IVO), University of Tilburg
Mr. A.W. Ouwehand, Organisation for Care Information Systems (IVZ)
Dr. A. de Vos, Mental Health Service (GGZ Netherlands)
Observers
Mr. P.P. de Vrijer, Ministry of Justice
Dr. W.M. de Zwart, Ministry of Public Health, Welfare and Sports
Additional consultants
Ms. M. Brouwers, Research and Documentation Centre (WODC), Ministry of Justice
Dr. M.C.A. Buster, Amsterdam Area Health Authority (GG&GD Amsterdam)
Ms. E.H.B.M.A. Hoekstra, Ministry of Justice
Dr. R.F. Meijer, Research and Documentation Centre (WODC), Ministry of Justice
Dr. ir. E.L.M. Op de Coul, National Institute of Public Health and the Environment (RIVM)
Mr. Th.A. Sluijs MPH, Amsterdam Area Health Authority (GG&GD Amsterdam)
Dr. M.C. Willemsen, STIVORO
3
TABLE OF CONTENTS
Preface
List of abbreviations
Summary
1 Introduction
2 Cannabis
2.1 Latest facts and trends
2.2 Use in the general population
2.3 Use among young people
2.4 Problem use
2.5 Use: international comparisons
2.6 Treatment demand
2.7 Mortality
2.8 Supply and the market
3 Cocaine
3.4 Problem use
3.7 Mortality
3.8 Market
4 Opiates
4.4 Problem use
4.7 Illness and mortality
5 Ecstasy, amphetamines and related substances

5.4 Problem use
5
6 Alcohol
6.4 Problem use
7 Tobacco
7.4 Problem use
7.7 Mortality
8 Recorded drug crime

8.2 Recorded drug crime
8.3 Criminal drug users
8.4 Help for problem users in the criminal system
Appendices
A Glossary of Terms
B Sources
C Definition of ICD-9 and ICD-10 codes
D Overview of the products of the Netherlands (Drug) Rehabilitation Foundation and
coercive treatment processes
E Internet addresses with information on alcohol and drugs
F Data youth monitors and youth surveys
References
6
PREFACE
In the last decade, the number of cocaine users in the (outpatient) care organisations for drug addicts
has quadrupled. This increase was especially apparent in recent years. Alcohol consumption is on the
increase, particularly among young girls. In 1999, 57 percent of girls aged 12-14 had drunk alcohol
ever in their lifetime; in 2003 this had increased to 78 percent. And Dutch pupils topped the list in
respect of alcohol consumption. The chance for a person younger than sixteen to succeed in buying
alcohol and/or tobacco is 90 percent or higher. In the period 1997-2003, the number of coffee shops
dropped from nearly 1,200 to 754. This drop may affect control of drug trafficking and the separation of
markets for soft drugs and hard drugs. In addition, Opium Act offences add increasingly to the
workload of the criminal system. The increase is partly a result of cocaine couriers.
These are some of the disturbing figures from the Annual Report 2004 of the National Drug Monitor
(NDM) before you. With a view to the provision of care and the undertaking of preventive activities, it is
important to be informed of such developments annually. In this framework, much attention is often
paid to negative developments. Fortunately, many positive developments can also be reported. The
percentage of pupils using drugs remains stable or decreases. The size of the group of opiate addicts
is stable, while the average age of the group is rising. The number of heavy smokers is down. A
favourable development is also that intravenous use of cocaine and heroin decreases.
The NDM relies on the contribution of a multitude of national and local monitoring projects and
experts. Many thanks are owed to the organisations and institutions that provided data for the Annual
Report. Thanks are also owed to the Bureau of the NDM. The Bureau composes the annual reports
with great care. This gives the Netherlands a prominent position in the information collection and
provision.
Prof. Henk Garretsen

Chairman of the Scientific Council of the National Drug Monitor
7
LIST OF ABBREVIATIONS
2C-B 4-bromo-2,5-dimethoxyphenethylamine
4-MTA 4-methylthioamphetamine
AIAR Amsterdam Institute for Addiction Research
AIDS Acquired Immune Deficiency Syndrome
AIHW Australian Institute of Health and Welfare
APZ General Psychiatric Hospital
BiZa Ministry of the Interior
BO Primary Education
BVT Tobacco Information Agency (Bureau Voorlichting Tabak)
CAM Coordination Agency for the Assessment and Monitoring of New Drugs
CAN Swedish Council for Information on Alcohol and Other Drugs
CBS Statistics Netherlands
CEDRO Centre for Drug Research
CMR Central Methadone Registration
COPD Chronic Obstructive Pulmonary Disease
CPA Central Ambulance Station
CSV Criminal Organisation
CVA Cerebrovascular Disorders
CVS Client Follow-up System
DIMS Drugs Information and Monitoring System
DJI National Agency of Correctional Institutions
DMS Drugs Monitoring System
dNRI/O&A National Criminal Intelligence Service of the National Police Agency,
Research & Analysis Group
DOB 2,5-dimethoxy-4-bromoamphetamine
DSM Diagnostic and Statistical Manual
EHBO First Aid / Casualty Ward
EMCDDA European Monitoring Centre for Drugs and Drug Addiction
(in Dutch: EWDD)
ESPAD European School Survey Project on Alcohol and Other Drugs
EU European Union
FPD Forensic Drug Treatment Clinic
GGD Municipal Health Service
GG&GD Municipal Medical & Health Service/Area Health Authority
GGZ Mental Health Service
GHB Gamma-hydroxy-butyrate
HAVO Higher General Secondary Education
HBSC Health Behaviour in School-aged Children (study)
HBV Hepatitis B virus
HCV Hepatitis C virus
HDL-C High density lipoprotein cholesterol
HIV Human Immune Deficiency Virus
HKS Police Records System
ICD International Classification of Diseases.
IDG Intravenous Drug User
IGZ Health Care Inspectorate
IVO Addiction Research Institute Foundation
IVV Organisation Information Systems on Addiction Care and Treatment
IVZ Organisation Care Information Systems
9
KLPD National Police Agency
KMar Royal Military Police
LADIS National Information System on Alcohol and Drugs
LIS Injury Information System
LMR Dutch Hospital Registration
LOM Special School for Children with Learning and Behavioural Difficulties
LUMC Leiden University Medical Center
MAD Regions and Towns Monitor for Alcohol and Drugs
MBDB N-methyl-1-(3,4-methylenedioxyphenyl)-2-butanamine
MDA Methylene-dioxyamphetamine
MDEA Methylene-dioxyamphetamine
MDMA 3,4-methylene-dioxymethamphetamine
MGC Organised Crime Monitor
MLK Special School for Children with Learning Difficulties
MMO Social Inclusion Monitor
NDM National Drug Monitor
Nemesis Netherlands Mental Health Survey and Incidence Study
NIGZ National Institute for Health and Prevention
NMG National Monitor Mental Health Care
NPO National Prevalence Research
NRI National Criminal Intelligence Service
NVIC National Poison Information Centre
NWO Netherlands Organisation for Scientific Research
OBJD Justice Documentation Research Database
OM Public Prosecutions Department
OPS List of wanted persons
PBW Prisons Act
PiGGz Register of Inpatient Mental Health Care
PMA Paramethoxyamphetamine
PMMA Paramethoxymethylamphetamine
POLS Permanent Survey on Living Conditions
RIKILT Institute of Food Safety
RISc Risk Assessment Scales
RIVM National Institute of Public Health and the Environment
SAMHSA Substance Abuse and Mental Health Services Administration
SHM HIV Monitoring Foundation
SOA Sexually Transmittable Diseases
SOV Judicial Treatment of Addicts
Sr Criminal Law
Sv Netherlands Code of Criminal Procedure
SVG Netherlands Rehabilitation Foundation
SRM Criminal Justice Monitor
SSI Tobacco Manufacturers’ Association Netherlands
SWOV Institute for Road Safety Research
TBS Detention under a hospital order
THC Tetrahydrocannabinol
TNS NIPO Dutch Institute for Public Opinion and Market Research
TULP Enforcement of custodial measures in correctional institutions
USD Synthetic Drugs Investigation Unit
UvA University of Amsterdam
VBA Drug-free Unit
v.i. conditional release (on parole)
10
VIS Arrest Referral Scheme (Vroeghulp Interventie Systematiek)
VMBO-p Prevocational secondary education – theoretical stream
VMBO-t Prevocational secondary education – practice-oriented stream
VNG Association of Netherlands Municipalities
VTV Centre for Public Health Studies
VWO Pre-University Education
VWS Ministry of Public Health, Welfare and Sports
WHO World Health Organisation
WODC Research and Documentation Centre of the Ministry of Justice
WVMC Abuse of Chemical Substances Prevention Act
WvS Criminal Code
ZMOK Special School for Children with Severe Behavioural Learning Problems
ZONMW Netherlands Organisation for Health Research and Development
Zorgis Care information system GGZ
11
SUMMARY
Use of substances: general
In the Netherlands, the number of people that had used drugs ever or in the past month rose between
1997 and 2001, peaking among young people between the age of 20 and 24. Among secondary
school pupils drug consumption stabilised between 1996 and 2003, or was down slightly. However,
alcohol consumption increased, particularly among girls younger than 15. In some groups — such as
pupils with behavioural or learning problems, truants, detainees, psychiatric patients, homeless
people, or individuals who are vulnerable and marginalised in other ways – the use of alcohol and
drugs is considerably more prevalent than in the general population. In general, these groups are
often struggling with (additional) behavioural, psychological and social problems. Young people
associated with trendy clubs are quite often found to experiment with (new) drugs and alcohol. In
Amsterdam, drug consumption in trendy clubs decreased nevertheless between 1998 and 2003.
However, alcohol consumption increased and remained by far the main stimulant during clubbing.
Often several substances are either consumed simultaneously or in short succession each time.
Furthermore, poly use is the rule rather than the exception among problem users.
Compared to the use of drugs in the general population of other western countries, the
Netherlands rated around or somewhat above average. On indicators of problem use of hard drugs,
the Netherlands scored proportionally positively (relatively few problem users, small percentage of
injecting drug users, low drug-related mortality).
The following developments have been observed and are listed for each drug:
Cannabis
Cannabis remains by far the most popular of all illicit drugs. The number of current cannabis users in
the Dutch population rose between 1997 and 2001 from 2.5 to 3 percent. Extrapolated over the entire
population, the number of users increased from 326,000 to 408,000, an increase of 25 percent. The
proportion of current cannabis users among secondary school pupils dropped slightly between 1996
and 2003, from 11 to 9 percent. This decrease must be attributed mainly to the boys (from 14% to
10%). Compared to their peers in the old EU Member States, cannabis use of Dutch pupils can be
considered average. Among young people and young adolescents in Amsterdam trendy clubs, the
number of current users of cannabis decreased also, from 52 percent in 1998 to 39 percent in 2003.
One in five current users consumes cannabis daily of almost daily. Consumers with intensive
use patterns can become dependent on cannabis. Young people with an outspoken preference for
‘strong’ cannabis have a good chance of becoming dependent. The total number of people concerned
is not known.
The number of clients of the (outpatient) care organisations for drug addicts with a primary
cannabis problem continued to increase slightly. From 2002 to 2003 an increase of 21 percent was
recorded. Between 1994 and 2004 their number doubled from 1,951 to 4,485. The number of clients
who named cannabis as a secondary problem increased from 2,846 to 4,291. The number of
admissions into general hospitals with cannabis abuse or dependency as primary diagnosis was low
(46 in 2003). A slight increase is observed in the number of admissions with these problems as
secondary diagnosis (246 in 2003).
The number of coffee shops fell in 2003 by four percent, from 782 in 2002 to 754. In 1997
there were still nearly 1,200 coffee shops.
The average THC content in Dutch-grown marijuana (Nederwiet) rose further between
2002/2003 and 2003/2004, from 18 to 20 percent. In 1999/2000 the THC content was half of that
(9%). It is not known whether this increase has health-related consequences, but there is increasing
scientific evidence that cannabis can induce psychotic symptoms, particularly in heavy users with a
13
predisposition for psychoses. The question of cause and effect, however, is still subject of discussion.
More research is needed to demonstrate the causality.
Cocaine
The use of cocaine in the general population is limited. However, the percentage of ever users of
cocaine did increase from 2.1 percent in 1997 to 2.9 percent in 2001. The percentage of current users
increased from 0.2% to 0.4 percent. Among secondary pupils the use remained stable in the past few
years. In 2003, two percent of them had had experience with cocaine. The use of cocaine showed a
large increase in the last decade in special groups of the population, such as problem hard drug users.
These users mainly use crack, the smokable and most addictive form of cocaine. Seven to nine out of
ten opiate addicts also use cocaine, which by now has become the main drug for many hard drug
users. Cocaine, especially sniffed coke, has become popular among the partying youth and young
adolescents. In Amsterdam, between 1998 and 2003, a decrease in the percentage of current users of
sniffed coke took place among visitors of trendy clubs, from 24 to 14 percent, but compared to
ecstasy, cocaine has grown in popularity.
Figures from (outpatient) care organisations for drug addicts show a strong increase in the
number of people seeking help for cocaine-related problems. From 2002 to 2003 an increase of 19
percent was recorded. In 2003, the number of clients with a primary cocaine problem was even four
times larger than in 1994 (9,216 and 2,468, respectively). The number of clients with cocaine as a
secondary problem increased also in this period, from 6,020 to 8,388. Two in three help-seeking
cocaine users have a crack problem. They struggle with physical and psychological complaints, such
as lung problems, exhaustion, aggression and paranoia.
Data about admissions into hospitals and about mortality suggest also an increase in cocaine
problems until 2002, but this trend did not continue in 2003. The number of cocaine users admitted to
general hospitals as a result of (crack) cocaine-related problems rose from 246 in 1996 to 562 in 2002,
after which it decreased slightly to 506 in 2003. Acute mortality as a result of cocaine use – as far as
recorded – fluctuated until the mid-nineties between one and three cases per year. In the years 2000,
2001 and 2002, 19, 26 and 34 cases, respectively, were recorded. In 2003, 17 cases were recorded.
Opiates
Heroin, the most frequently used illicit opiate, is not popular among the general population (0.1%
current users in 2001). The number of problem users of (also) opiates is stable in the Netherlands,
with an estimated figure of 32,000 (ranging between 22,000 and 42,000). Per thousand inhabitants,
the Netherlands has three hard drug problem users. This is low compared to other (old) EU Member
States, such as the United Kingdom, Italy, Portugal and Denmark, which have between seven and
nine cases per thousand inhabitants.
The treatment demand of opiate addicts in (outpatient) care organisations for addicts
decreased slightly between 2001 and 2003, from 17,786 to 15,195 clients. Corresponding with the
decreasing number of young heroin users, the proportion of young opiate clients also showed a
downward tendency.
About 12,000 opiate addicts are registered in methadone programs, generally as clients on
maintenance basis. Currently, they receive a higher dose of methadone on average than ten years
ago (57 versus 46 mg), but only one third of them receives a (therapeutic) dos of 60 mg or more.
The average age of the group of opiate addicts is rising. In 1989, the average age of the
methadone clients in Amsterdam was 32; in 2003, it was 44 years. In Rotterdam and Parkstad
Limburg, the average age of problem uses rose from 37 to 39 between 1998 and 2003. Long-term
opiate dependence often is accompanied by considerable harm to the health of the user, owing to the
use of the substance itself, but also as a result of the unhealthy lifestyle and the route of
administration. The proportion of opiate addicts injecting the drug decreased strongly in the last
decade and is now estimated at 10 to 20 percent. Heroin is now mostly smoked. Since opiate addict
14
often also smoke a large quantity of tobacco, lung disorders are more prevalent. A large proportion of
former IDUs is infected with hepatitis C (47-79%) and hepatitis B (35-67%). The proportion of IDUs
infected with HIV varies from 1 percent in Groningen and Arnhem to 22 percent in Heerlen and 26
percent in Amsterdam. Needle sharing decreased in the past ten years, but between 8 and 30 percent
of IDUs still (occasionally) share needles. Sexual risk behaviour (practising sex without condoms) is
still widespread. As a result, the risk of transfer of contamination with HIV and hepatitis B is still
considerable in a number of regions.
From 1996 to 2001 incl., recorded opiate-related mortality fluctuated between sixty and eighty
cases per year. In the last few years, a slight decrease was evident (37 in 2002 and 53 in 2003).
Ecstasy and amphetamines
The percentage of current ecstasy users in the general population between 1997 and 2001 rose from
0.3 to 0.5 percent. This increase occurred mainly among women. The percentage of current
amphetamine users remained low (0.1% in 1997 and 0.2% in 2001). Among secondary pupils, the
percentage of ever users and current users of both substances decreased between 1996 and 2003. In
2003, three percent had had experience with ecstasy and two percent with amphetamines.
Ecstasy is still popular among young clubbers, although the use is showing signs of
moderation. An increasing number of young people seem to handle this substance intelligently and to
be aware of the risks. Among visitors of trendy clubs in Amsterdam, the percentage of current ecstasy
users halved from 41 percent in 1998 to 19 percent in 2003. The use of amphetamine, a considerably
less popular substance in party life, also showed a decrease, from 13 to 7 percent.
Compared to other hard drugs, problem use of ecstasy did not occur often. Since 1999, the
treatment demand in outpatient care organisations for addicts primarily for ecstasy is low compared to
other drugs and relatively stable. In 2003, 277 clients were recorded with ecstasy as a primary
problem and 655 clients for whom ecstasy was a secondary problem. The number of primary
amphetamine clients increased slightly from 482 in 2001 to 735 in 2003. In 2003, 552 clients named
amphetamines as a secondary problem.
The acute health risks from ecstasy intoxication can be considerable, but it is not known how
often such intoxications occur. The number of ecstasy-related incidents at parties dropped. This may
be connected with the stable composition of ecstasy pills. In the last few years, more than nine in ten
ecstasy pills that consumers handed in for testing at care organisations for addicts contained only
MDMA or an MDMA-like substance. However, the percentage of pills with a high MDMA content of
more than 140 milligrams per pill increased slightly, from one percent in 1999 to six percent in 2003.
According to the latest scientific insights, the use of ecstasy may lead to long-term memory
problems, to problems with the capacity to concentrate and mood problems. The risk of brain damage
depends on the dose and the temperature at which ecstasy is used. The exact number of people who
have died as a result of ecstasy use is not known. The Cause of Death Statistics Agency recorded
seven cases in 2003.
Alcohol
Alcohol consumption is widespread in Dutch society. Of the population aged 16 and over, 85% drink
alcohol ‘occasionally’. This percentage has been stable in the last few years. Sales figures, however,
show a slight decrease in the total per capita consumption of alcohol in 2003. This decrease is due to
the decrease in the consumption of distilled spirits, which dropped by nearly ten percent in 2003
compared to the year before.
Heavy drinking – six glasses or more on at least one day a week – was prevalent in eleven
percent of the population aged 12 and over, a slight decrease compared to 2001. Proportionally,
heavy drinking is most prevalent among young men aged 18 to 24 incl. This age group also accounts
for a relatively high number of traffic accidents in which alcohol is involved. Ten percent of the Dutch
population aged 16 to 69 are problem drinkers.
15
Alcohol consumption among secondary pupils increased between 1999 and 2003. In 1999, 74
percent of the pupils had experience with alcohol, in 2003 this was 85 percent. The increase was
especially noticeable among young girls, aged 12 -14. In 2003, there was no difference in the
percentage of boys or girls who had a drink in the month prior to the survey. There were however
differences in drinking pattern. Boys drank alcohol more frequently than girls. They also drank larger
quantities than girls, particularly older boys.
Compared to pupils in other countries, Dutch pupils drank frequently.
In 2003, 26,874 persons were treated at the (outpatient) care organisations for drug addicts
with alcohol use as primary problem. This is thirteen percent more than in 2002. Many people were
also admitted into general hospitals as a result of alcohol consumption; in 2003, 4,239 were admitted
with an alcohol-related disorder as primary diagnosis and 10,899 with an alcohol-related secondary
diagnosis.
The number of recorded dead and injured in traffic as a result of alcohol consumption dropped
slightly since 1997. In 2003, their number was nearly 2,700. Total alcohol-related mortality, however,
has risen in the past few years. In 2003, nearly 1,900 people died from causes in which alcohol was
named explicitly, seven percent more than in 2002 and over forty percent more than in 1995.
Tobacco
In 2003, the Netherlands had over four million smokers; slightly more men than women (33% versus
27%). While in the early eighties as many as 52 percent of the men and 35 percent of the women
smoked cigarettes, the percentage of heavy smokers has fallen over the past years. In 2000, ten
percent of the population aged 12 and over smoked at least twenty cigarettes a day and in 2003 this
dropped to eight percent. Among pupils aged 12 and over, the percentage of ever users decreased
from 55 to 45 percent. The percentage of pupils who had smoked in the month before the survey
dropped in that same period from 27 to 20 percent.
In 2003, over 20,000 people died from the direct consequences of smoking. Per 100,000
inhabitants, 67 people died from lung cancer, the main cause of death from smoking. While mortality
from this illness is decreasing among men, it is rising among women.
Recorded drug-related crime
Offences under the Opium Act put a heavier strain on the resources of the criminal system in 2003
than in 2002; this also applied to all the phases of the criminal process. In 2003 more suspects were
booked for Opium Act offences than in 2002. Most of those offences were still related to hard drugs.
Of the investigations into organised crime 66 percent concerns Opium Act offences. This is more or
less the same as in 2002, when this proportion was 63 percent. The number of Opium Act cases taken
in by the Public Prosecutions Department continued to increase, although the increase by 8 percent in
2003 was somewhat less than in the two previous years. The Court dealt with over 12,000 Opium Act
cases, more than in 2002 when over 10,000 cases were dealt with. The number of imposed
community sentences and confiscation orders in cases under the Opium Act increased strongly in
2003. The number of unsuspended custodial sentences in Opium Act cases increased also in 2003. In
2003, these made up 15 percent of the total number of custodial sentences. The increase was due to
the hard drug cases, which made up 14 percent of the total in 2003. The proportion of soft drug cases
remained stable, being 1 percent of the total. One in three sentences involving prison years was drug-
related, which is more than before; 28 percent concerned hard drugs. In 2003, a quarter of the prison
population were detained because of Opium Act offences.
Offenders under the Opium Act repeated the offence more often than other offenders. In 2003,
criminal drug users put an approximately the same burden on the criminal system as in 2002. That
same year, the police recorded over 10,000 suspects as 'drug users'.. These suspects mainly
committed property offences in 2003 as well. Offences involving violence and Opium Act offences
were somewhat more frequent in 2003 than in the previous years. Three in four drug-using suspects
16
had eleven or more crime-related police reports in his/her criminal history. More than 70 percent of the
‘very high rate’ frequent offenders are regular drug users.
In 2003, in general more activities of the Netherlands (Drug) Rehabilitation Foundation were recorded
in the criminal system. The number of addicts entering the Judicial Treatment of Addicts (SOV) rose
also steadily in 2003. End 2003 there were 192 participants. The degree of capacity utilisation
increased compared to 2002 and was 85 percent end 2003. From April 2003, the regular outflow of
participants started.
17
18
1 INTRODUCTION
The National Drug Monitor
In the Netherlands, numerous monitors record developments in the field of substance use. In addition,
frequently research is published about patterns of use, prevention of substance use and treatments.
To policymakers and professionals in the field and to other target groups the National Drug Monitor
(NDM) provides an updated overview in this large data flow.
The NDM aims primarily to collect data about developments in substance use in a coordinated and
consistent manner based on existing research and records and to combine and convert this
knowledge into a number of basic products, such as annual reports, thematic reports and fact sheets.
This objective is in line with the current social pursuit of a policy and practice based on facts.
The NDM was established in 1999 on the initiative of the Minister of Public Health, Welfare and Sports
1
(VWS). However, drug use is not only within the focus of public health, but also of the judicial system.
Since 2002, the NDM has also been supported by the Ministry of Justice.
The NDM promotes the following functions:

• Acting as a coordinating body for currently ongoing surveys in the Netherlands and for registering
data on substance use (drugs, alcohol, tobacco) and dependence. The NDM strives for an
improved harmonisation of monitoring activities in the Netherlands, taking international data
collection guidelines into account.
• Achieving a synthesis of the compiled data, and reporting to national authorities and international
and domestic organisations. The international organisations that receive reports from the NDM
include the WHO (World Health Organisation), the United Nations and the EMCDDA (the
European Monitoring Centre for Drugs and Drug Addiction).
At the centre of the NDM’s work is the collection and integration of figures. To that end a limited
number of key indicators or ‘policy barometers’ are used, which were agreed upon by the Member
States of the European Union in the framework of the United Nations and the European Monitoring
Centre for Drugs and Drug Addiction (EMCDDA). This involves information on:
• substance use in the general population
• problem use and dependence
• the use of professional services
• illness
• and drug-related mortality.
The NDM also reports on recorded drug crime and penal response. Here too, a series of key
indicators are used, which are collected by the Research and Documentation Centre of the Ministry of
2;3
Justice (WODC). To that end, the Ministry of Justice in 1999 initiated a developmental program.
Collaboration
The NDM relies on the contribution of a multitude of experts. Implementing organisations of numerous
local and national monitoring projects supply the building blocks. The quality of the publications is
warranted by the Scientific Council of the NDM. This Council evaluates all written concepts and offers
advice on the quality of monitored data. Three work groups - – the work group Prevalence Estimates
19
of Problem Substance Use, the work group Drug-related Mortality, and the workgroup Effectiveness in
the Treatment of the Drug Problem – support the NDM on thematic sub(fields).
Each year the NDM publishes a statistical overview of addiction and substance use and its
consequences: the Annual Report. This report is part of the annual documentation submitted to
Parliament.
Annual Report 2004
This is the sixth Annual Report of the NDM. Chapters two to seven incl. describe developments per
substance or classes of substances: cannabis, cocaine, opiates, ecstasy and amphetamines, alcohol
and tobacco. Per chapter we briefly and concisely present the most recent figures pertaining to the
use, problem use, treatment demand, (illness and) mortality and finally supply and the market. The
situation in the Netherlands is (carefully) placed in an international context.
In Chapter 8 the information on recorded drug crime is presented, with the focus on narcotics offences
(violations of the Dutch Opium Act) and drug crime by users in the different sections of the penal chain
(police, Public Prosecutor’s Office, justice system, detention). This chapter also provides a current
overview of the penal options in terms of mandatory and coercive measures for criminal drug addicts.
Figures on substance use and drug crime can be measured and reflected in various ways. Appendix A
contains information about the terminology used. In Appendix B we give a concise overview of the
main sources of the information in this Annual Report.
The Annual Report can also be accessed via internet:
http://www.trimbos.nl/Downloads/Producten/NDM%202004.pdf
Other information
• Key figures about the addiction care sector can be found in the Brancherapport [Mental Health
4
Sector Report] GGZ-MZ 2000-2003.
• The NDM background study ‘Hulp bij Probleemgebruik van Drugs’ [Treatment for Problem Use of
5
Drugs] gives a detailed overview of effective treatments of drug addiction.
• For more details about the results and gaps of monitor systems in the field of alcohol and drugs
6
we refer to the report ‘Monitoring van alcohol en drugs onder the loep’ [Monitoring of alcohol and
drugs under the microscope], which can also be found on internet (www.trimbos.nl/ndm of
www.ivo.nl). A detailed overview of recording systems and research in the Netherlands about the
monitoring of alcohol and drugs can be found on the website of the Trimbos Institute, the
Research Institute Foundation (IVO) and the Netherlands Organization for Health Research and
Development (ZonMw) (www.trimbos.nl/monitors of www.ivo.nl of www.zonmw.nl).
Earlier publications of NDM are:

• ‘Fact sheet Drugsbeleid’ [Fact sheet on drug policy], briefly outlining information on drug policy,
7
drug use, addiction care, drug education and prevention and public nuisance, drug-related crime
and drug trafficking.
• ‘Bovenmatig drinken in Nederland’ [Excessive drinking in the Netherlands], a report based on the
8
outcomes of the Nemesis household survey.

• ‘Cannabis. Feiten en cijfers 2003’ [Cannabis. Facts and figures in 2003], a background study of
9
the state of science on cannabis.
20
In addition to the NDM the Trimbos Institute oversees the coordination of two other national monitors,
resulting in cooperation with: the Netherlands Mental Health Monitor (NMG) and the Homelessness
and Social Inclusion Monitor (Monitor Maatschappelijke Opvang – MMO).
• Annual reports and other reports produced by these monitors can be found on the website of the
Trimbos Institute (www.trimbos.nl).
21
22
2 CANNABIS
Cannabis (Cannabis Sativa or hemp) comprises hashish and pot in various preparations. THC
(tetrahydrocannabinol) is the main psychoactive ingredient. Cannabis is usually smoked in cigarettes,
whether or not in combination with tobacco, and sometimes via an evaporator. Eating it – in the form
of space cake – also occurs. Consumers experience cannabis as having a calming, relaxing and
psychedelic effect. At a high dose, cannabis may cause fear, panic and psychotic symptoms.
The below data apply to hashish and pot together, unless stated otherwise.
2.1 LATEST FACTS AND TRENDS
The main facts and trends regarding cannabis in this chapter are:
• The percentage of users of cannabis in the general population increased between 1997 and 2001.
The proportion of (almost) daily consumers among recent users decreased in this period (Chapter
2.2).
• The percentage of recent users among school-aged children (12-18 years) decreased slightly
between 1996 and 2003. The credit of this decrease goes to the boys; among the girls the
consumption remained the same (Chapter 2.3).
• Compared with their peers in a number of other Member States of the European Union, in respect
of cannabis use, Dutch pupils are in the middle range (Chapter 2.5).
• Among visitors of trendy clubs in Amsterdam the use of cannabis decreased between 1998 and
2003 (Chapter 2.3).
• Just as in previous years, the number of cannabis patients who sought help from the (outpatient)
care organisations increased between 2002 and 2003 (Chapter 2.6).
• The number of coffee shops fell slightly between 2002 and 2003 (Chapter 2.8).
• The average THC content in Dutch-grown cannabis rose further between 2002/2003 and
2003/2004 (Chapter 2.8).
2.2 USE IN THE GENERAL POPULATION
Of all drugs, cannabis is the most commonly used substance. In 1997 and 2001, National Prevalence
10
Surveys (NPO) were conducted by the Amsterdam drug research institute CEDRO.
Between 1997 and 2001 a slight rise in the use of cannabis was noted in the Netherlands. Key figures
are as follows:
• In 2001, one in six respondents aged 12 and over had ever used cannabis (see Table 2.1).
• One in 33 respondents had used cannabis in the month prior to the interview (current use).
• Extrapolated over the entire population, in absolute numbers, this represents an increase from
326,000 to 408,000 in current cannabis users over these four years (1997 – 2001); a rise of 25
percent.
• Cannabis consumption is most prevalent among young people and adolescents (see Figure 2.1).
- The rise in both ever use and current use figures was found to be highest in the age group 20
to 24 years incl. (see Figure 2.1).
- Ever use figures dropped slightly among young people aged 12 to 15 incl. (see Chapter 2.3 for
comparison).
• Cannabis use is more prevalent among men than among women (see Table 2.1).
23
Table 2.1 Cannabis use in the Netherlands among people aged 12 and over. Survey years
1997 and 2001
1997 2001
Has ever used 15.6% 17.0%
• Men 20.6% 21.3%
• Women 10.8% 12.8%
I
Used currently 2.5% 3.0%
• Men 3.5% 4.3%
• Women 1.4% 1.8%
First use in the past year 1.3% 1.0%
Average age of current users 28 years 28 years
I. In the last month. Source: National Prevalence Research (NPO), Centre for Drug Research (CEDRO).
Figure 2.1 Cannabis users in the Netherlands by age group. Survey years 1997 and 2001
%
50
40
30
20
10
0
12-15 16-19 20-24 25-29 30-34 35-39 40-49 50-59 60-69 >=70 Age
Ever 1997 7.5 27.5 31.7 30.6 21.7 20.5 16.8 6.7 1.9 0.5
Ever 2001 5.9 28.4 41.9 33.8 25.9 21.9 18.5 8.3 1.2 0.4
Current 1997 2.0 8.3 7.1 4.7 2.1 3.6 1.5 0.5 0.0 0.0
Current 2001 2.2 8.6 11.2 6.6 3.6 2.7 1.7 0.9 0.0 0.0
Percentage of ever and current (last month) users per age group. Source: National Prevalence Research (NPO),
Centre for Drug Research (CEDRO).
24
The large cities
Consumption of cannabis is more prevalent in cities than in rural areas (see Table 2.2.
Table 2.2 Cannabis use in the four large cities and in rural areas among people aged 12
and over. Survey years 1997 and 2001
Ever use Current use
1997 2001 1997 2001
Amsterdam 36.7% 38.1% 8.1% 7.8%
Rotterdam 18.5% 22.4% 3.3% 5.0%
Other primarily urban 23.0% 26.3% 4.1% 4.8%
I
municipalities
II
Utrecht 27.3% - 4.2% -
II
The Hague 20.1% - 4.2% -
III
Rural municipalities 10.5% 11.4% 1.5% 1.7%
Percentage of ever (lifetime) and current (last month) users. I. Definition: municipalities with more than 2,500
addresses per square kilometre with the exception of Amsterdam and Rotterdam. These are: Delft, The Hague,
Groningen, Haarlem, Leiden, Rijswijk, Schiedam, Utrecht, Vlaardingen and Voorburg. II. Utrecht and The Hague
were not listed separately in the 2001 survey. III. Definition (Statistics Netherlands - CBS): towns with fewer than
500 addresses per square kilometre. Source: National Prevalence Research (NPO), Centre for Drug Research
(CEDRO).
Level of consumption
The frequency of cannabis use among current users varies strongly.

• In 2001, almost half of all current users in the Netherlands used cannabis less than once a week
10
(see Figure 2.2).
• Approximately one fifth of this group used cannabis (almost) daily. Extrapolated over the entire
population this amounts to nearly 78,000 people; fewer than in 1997 (over 83,000 people). This
decline did not occur evenly across the Netherlands. In Amsterdam and Rotterdam the percentage
of heavy users rather seemed to increase.
25
Figure 2.2 Cannabis consumption levels in the Netherlands among current users aged 12 and
over. Survey years 1997 and 2001
%
60
51
50 45
40
1997
30 26
2001
18 19
20 15
14
12
10
0
1-4 5-8 9-20 >20
Number of days in last month
Percentage among current users. Number of days on which cannabis was used in the last month. Source:
National Prevalence Research (NPO), Centre for Drug Research (CEDRO).
Sources of procurement
Cannabis users procure cannabis mainly in coffee shops or obtain it through friends and
acquaintances (see Table 2.3).
• Young people between the age of 12 and 17 are more likely to obtain cannabis through friends
and acquaintances than from coffee shops. The opposite is true for cannabis users aged 18 and
over.
I
Table 2.3 Cannabis procurement sources of recent users? Survey year 2001
Users aged 12 to Users aged 18
17 incl. and over
They obtain their cannabis
- through friends and acquaintances 46% 37%
- from coffee shops 37% 47%
- from a ‘house dealer’ 3% 2%
- in a pub 2% 2%
- in a smart shop 2% 2%
- at another public nightlife location 4% 2%
- through growing it themselves 3% 4%
II 4% 4%
- Other
I. The percentage of cannabis procurement sources of recent users in the last year. A respondent may have more
than one source. II. Through youth clubs, dealer delivery services, strangers on the street, etc. Source: National
Prevalence Research (NPO), Centre for Drug Research (CEDRO).
26
Special groups
In certain groups of adults a considerably higher prevalence of cannabis use was noted than in the
general population.
• In 2002, over half (52%) of the homeless in 20 Dutch towns were current cannabis users.
11
a
• In the same year, one in three (33%) male detainees in eight penitentiaries stated to have used
cannabis daily in the last six month prior to detention. Detainees with serious psychological
12
disorders or prison-imposed restrictions (contact ban) were not represented in the sample.
• There are indications that cannabis use is very common among certain groups of psychiatric
13;14
patients, such as people with schizophrenia or borderline disorder. Hard figures are scarce.
According to older data by Nemesis (from 1996) cannabis use is more prevalent among people
with mood disorders and combined anxiety/mood disorders than among people without these
disorders (7%, 9% and 3% recent users, respectively). As regards patients with anxiety problems
alone, no (significant) difference was observed.
2.3 USE AMONG YOUNG PEOPLE
To classify the use of cannabis among young people, figures from the National Prevalence Research
are available, as mentioned in Chapter § 2.1.
In addition, in the last few years, numerous local and regional surveys have been conducted
commissioned by municipalities. In Appendix F we give an overview of recent figures concerning the
use of cannabis among young people in 29 municipalities or regions in the Netherlands based on
representative samples from the population.
These figures provide a picture of the surveys that are conducted throughout the country. Due to
methodological differences, in particular in age groups, it is complicated to make comparisons, but,
nevertheless, the figures give an impression of the difference in cannabis use between the various
municipalities. The percentage of young people aged 19 to 23, for example, who ever tried cannabis is
remarkably low in Urk (16%) compared to Almere and Lelystad (50%). The ever use in the last-
mentioned cities seems also to be higher than the national average (see Figure 2.1).
In this paragraph we also present the data of the Dutch National School Survey and data from (often
local) surveys among special groups of young people.
Pupils
Since the mid-eighties the Trimbos Institute has monitored the extent to which secondary school
pupils aged 12 and over have experience with alcohol, tobacco, drugs and gambling. This is done in,
what is called, the Dutch National School Survey.
• Figure 2.3 shows that the percentage of cannabis users among school-aged youth increased
15
significantly between 1988 and 1996.
• After 1999 the ever use stabilised and remained at approximately the same level as in 1996. The
current use decreased significantly between 1996 and 2003. The credit of this decrease goes
mainly to the boys. Among girls, the percentage of current users of cannabis remained more or
less the same between 1996 and 2003.
a
In Arnhem, Den Bosch, Breda, Grave and 4 remand prisons in Rotterdam.
27
• In the measurements of up to 1999 incl., more boys than girls used cannabis. In 2003, for the first
time, the ever use was the same for boys and girls. The difference of actual use between boys
and girls decreased also, but remained statistically significant.
Figure 2.3 Use of cannabis among school-aged youths aged 12 and over, from 1988
Ever use (%) Current use (%)
30 16
14 14
25
25
23 12
12
19 22 20
20 10
20 19 10 9 11
17 9
15 18 8 9
15 16 7 8 7
10 12 6 5 7
10
9
4
4 4
5 7
2
2
0 0
1988 1992 1996 1999 2003 1988 1992 1996 1999 2003
Boys Girls Total Boys Girls Total
Percentage of ever users (on the left) and current users (on the right). Source: Dutch National School Survey,
16
Trimbos Institute.
Age
• The use of cannabis increases with age. Only few twelve-year olds have experience with
cannabis: one in fifty (2%). At age sixteen, one in three pupils ever used cannabis (34%).
• The age on which school-aged youth used cannabis for the first time dropped between 1988 and
186
1996. The percentage of ever users of cannabis who smoked their first joint at the age of
thirteen or younger doubled in this period from 21 to 40 percent. Between 1996 and 2003 the
first-use age remained the same.
Level of consumption
• Of the nine percent current users in 2003, nearly half had used cannabis not more than once or
twice in the past month. A minority blew more than ten times (17%): one in five boys and more
than one in ten girls (see Figure 2.4).
• Per occasion nearly half the current users smoked less than one joint (46%). They probably
smoke together with others, sharing a joint. Nearly one in three smoked one or two joints per
occasion (32%) and nearly a quarter smoked more than three joints per occasion (23%).
• There is also a correlation between frequency and quantity. Of those who blow three to ten times
a month, a quarter (27%) smoke three or more joints per occasion. Of those who blow more than
ten times a month, two-thirds (67%) smoke three or more joints per occasion. This last group runs
a relative large risk of getting into problems.
28
Figure 2.4 Frequency of cannabis use among current users. Survey year 2003
boys girls
11%
20%
43%
51%
38%
37%
1-2 times 3-10 times > 10 times 1-2 times 3-10 times > 10 times
Percentage of school-aged youth who had used cannabis in the month before the survey. Source: Dutch National
16
School Survey, Trimbos Institute.
School level and ethnic origin
• The percentage of ever users and current users among pupils of VMBO-t (pre-vocational
secondary education - theoretical stream), HAVO (senior general secondary education), VWO
(pre-university education) and VMBO-p (pre-vocational secondary education - practical stream) is
about the same. The frequency of use in the last month does not differ much either between the
school levels. However, the percentage of pupils who smoke three or more joints on average per
time is significantly higher at VMBO than at VWO (30% versus 8%).
• Current use of cannabis is less common among Moroccan than native Dutch girls (0% versus
7%). No difference is found between Moroccan and native boys. Antillian/Aruban (12%),
b
Surinamese (8%) or Turkish (5%) pupils do not differ significantly in this from native pupils.
• According to data from the Antenne Monitor, in Amsterdam the percentage of ever users and
current users of cannabis is lowest among Moroccan pupils but also the percentage of users
among Turkish and Surinamese pupils is lower than among native Dutch pupils.
Sources of procurement
• Two in three current users receive cannabis from friends and one in three buys it (also) in coffee
shops (see Table 2.4). More than one in ten buy cannabis from a ‘house dealer’ and one in ten
receives it ‘in a roundabout way’.
• More girls than boys obtain cannabis through friends; boys buy in coffee shops more often than
girls.
• A considerable part of the blowing pupils of up to 17 years incl. buy cannabis in a coffee shop.
This is remarkable, because the legal minimum age for access to a coffee shop is 18 years. It is
unknown to what extent these young people themselves actually bought cannabis in a coffee shop
or had others by it for them.
• Boys aged 18 are used to buying cannabis mostly in coffee shops. Eight in ten current users
among boys buy their cannabis there.
b
For the definition of native Dutch and immigrant: see Appendix A.
29
Table 2.4 Cannabis procurement sources of school-aged youth? Survey year 2003
12-15 years 16-17 years 18 years Total
b g b g b g b m Total
Through friends 60% 78% 64% 77% 40% 69% 60% 78% 67%
Buy in coffee shops 22% 22% 57% 37% 81% 56% 40% 27% 35%
Buy from dealer 17% 6% 15% 12% 9% 0% 16% 7% 12%
In a roundabout way 16% 9% 6% 2% 0% 0% 11% 6% 9%
Otherwise 7% 6% 2% 8% 4% 0% 5% 6% 6%
Secondary school pupils aged 12 and over (current users). The pupils were allowed to check multiple answers.
Therefore, the percentages do not add up to 100%. b = boys, g = girls. Source: Dutch National School Survey,
16
Trimbos Institute.
Special groups of young people
The use of cannabis in certain groups of young adolescents is the rule rather than the exception.
Table 2.5 summarises the results of a broad spectrum of studies. The figures in this table are not
comparable due to differences in age categories and research methods.
• Among young people in special schools and participants in truancy projects relatively many current
users are found.
• The Antenne-monitor monitors the use of substances in various groups of young people in the
Amsterdam club scene, such as coffee shops, pubs and trendy clubs.
- According to a survey among visitors of coffee shops, two thirds of the current blowers use
cannabis daily. Current blowers smoke four joints on average per occasion. Daily blowers
17
smoke five joints on average per occasion.
- In 2001, the number of Amsterdam coffee shop visitors under the age of 18 was 50 percent
c
lower than in 1994 (7% and 14% respectively). This may be connected with the raise of the
legal minimum age from sixteen to eighteen years for the sale of cannabis to young people by
coffee shops.
- Between 1998 and 2003, the percentage of cannabis users among young people and
adolescents who visit trendy clubs (and parties) in Amsterdam dropped from 52 to 39 percent.
The average number of joints smoked by current users per time dropped also, from two to one
18
and half. This trend, which also applies to most of the other drugs, is in line with the phase
of the ‘new level-headedness’ and the observed tendency to more prudent use.
• Young people who visit clubs and pubs often also have experience with other substances. Table
2.6 shows the percentage of young people visiting clubs and pubs in The Hague who used both
cannabis and another substance in the month prior to the interview. Often these substances are
used simultaneously. Favourite combinations are cannabis with alcohol and cannabis with
19-21
ecstasy.
• The use of cannabis (and other substances) is common among young homeless people. Four in
22
ten young homeless people in the Netherlands are (almost) daily users. In 2004, 87% of the
23
young homeless people in Flevoland were current users of cannabis.
c
Coffee shop visitors up to the age of 25 only, were included in the comparison between 1994 and 2001.
30
Table 2.5 Current cannabis use in special groups
Location Survey Age Current
year (year) use
I
Young people in special education Nationwide 1997 12 - 18 14%
II
Pub visitors Amsterdam 2000 Mean age 25 24%
Young people in truancy programs Nationwide 1997 12 - 18 35%
III
Marginalised young people The Hague 2000/2001 16 - 25 37%
Young clubbers The Hague 2003 15 - 35 37%
Visitors of trendy clubs Amsterdam 2003 Mean age 28 39%
Young people in special education and truancy Amsterdam 2003 13 - 16 32%
projects
IV
Young homeless people Nationwide 1999 15 - 22 76%
Flevoland 2004 13 - 22 87%
V
Coffee shop clientele Amsterdam 2001 Mean age 25 88%
Percentage of current (last month) users by group. The figures in this table are not comparable owing to
differences in age groups and research methods. I. Special schools for children with learning and/or behavioural
difficulties (MLK, LOM, ZMOK). II. Young people and adolescents visiting mainstream, student, gay, and trendy
pubs. The sample is therefore not representative for all pub visitors. III. Young people receiving inadequate care
and/or cannot provide sufficiently in their own livelihood. Recruited at locations for young homeless people, low-
threshold day- and night shelters and (other) temporary living accommodations. V. Young people up to 23 years
17;22;24-26 23
of age without a fixed address for three months or longer. References: .
Table 2.6 Poly-consumption of cannabis and other substances among young clubbers in
The Hague. Survey year 2003
Combination Percentage of recent users.
Cannabis with alcohol 34%
Cannabis with ecstasy 14%
Cannabis with cocaine 8%
Cannabis, cocaine and ecstasy 6%
The same person may occur in several categories. I. Number of respondents: 634. Source: Survey of clubbers in
21
The Hague.
2.4 PROBLEM USE
The precise number of people experiencing problems as a result of cannabis use is not known, nor is
there a generally accepted definition of problem cannabis use. The addictive potential of cannabis is
minimal compared to that of nicotine, heroin and alcohol. However, the risk of dependence does
increase with prolonged and frequent use and often is associated with an additional dependence on
27
other substances. Young people are more vulnerable to becoming dependent than older people.
• The Nemesis study provides information about the prevalence of cannabis dependence according
rd
to the psychiatric classification system Diagnostic and Statistical Manual (DSM) (3 amended
edition). In 1996, between 0.3 and 0.8 percent of the population aged 18 to 64 incl. showed the
symptom criteria for this diagnosis in the year prior to the study. Extrapolated over the entire
population this amounted to between approx. 30,000 and 80,000 people. The majority of these
28
cannabis users was not older than 22 years.
• Problem cannabis use is very common in certain groups of young people, such as youths who end
up in juvenile correctional facilities, play truant on a frequent basis and display delinquent
behaviour (see Table 2.7).
31
Table 2.7 Problem cannabis use in different groups
Group Year Age Definition of problem use Percentage of problem
(year) users
I
General population in the 1996 18 – 64 DSM-III-r diagnosis cannabis 0.3% - 0.8%
Netherlands dependence in the last year in the last year
General population in 1999 16 – 50 Cannabis use on a minimum of 15 days 0.5%
Midden-Holland in the last month and presence of the in the last month
psychological, social and financial
problems related to the use
Youths in juvenile 1998/ 12 – 18 DSM-III-r diagnosis cannabis 30%
correctional facilities 1999 (mean age16) dependence in the last 6 months prior to in the last 6 months
detention
High-risk juveniles 1998 14 – 17 Cannabis use on a minimum of 11 days 20%
(truancy and delinquent (mean age16) in the last month and presence of use- in the last month
behaviour) in Rotterdam related problems
13;28-30
I. Average of 0.5%. DSM-III-r=Diagnostic and Statistical Manual, 3rd edition. References: .
Cannabis use is increasingly associated with psychological problems.

• There is growing evidence that cannabis increases the risk of a psychotic disorder later in life.
31
• The risk increases with the frequency of cannabis use.

32;33
• People with a history of psychotic symptoms are particularly vulnerable.

• It is not known to what extent other vulnerability factors increase the risk of psychosis.
• Studies are currently underway regarding the connection between cannabis use and the
34;35
development of depression.
The role of the increasing concentration of THC in Nederwiet (Dutch-grown cannabis) in the
occurrence of (health) problems is not clear.
• Recent research among coffee shop clientele, however, has shown that there is a specific group
36
of especially young users with a clear preference for ‘strong cannabis’. They use it relatively
often and in large quantities and run a large risk of becoming dependent.
2.5 USE: INTERNATIONAL COMPARISONS
General population
Data on drug use in the EU Member States are provided by the European Monitoring Centre for Drugs
37;38
and Drug Addiction (EMCDDA). Organisations in the United States (USA) and Australia also
39;40
publish outcomes of surveys on drug use on a regular basis.
• Differences in survey year, research methods and sampling complicate precise data comparisons.
Of particular influence is the age group. Table 2.8a shows consumption figures (re)calculated in
accordance with the standard age group of the European Monitoring Centre for Drugs and Drug
Addiction (EMCDDA) (15 to 64 years incl.). Data on the other countries are listed in Table 2.8b.
• The percentage of recent cannabis users in the general population is lowest in Finland, Portugal
and Sweden and highest in Canada, England and Wales, the United States and Australia. Of the
EU countries stated in Tables 2.8a and 2.8b, the Netherlands seems to take a position around the
middle or slightly higher.
32
Table 2.8a Cannabis use in the general population of various EU Member States and
Norway: age group from 15 to 64 years incl.
Country Year Ever use Recent use
Spain 2001 25% 10%
France 2000 23% 8%
The Netherlands 2001 21% 6%
Ireland 2002/2003 18% 5%
Northern Ireland 2002/2003 17% 5%
Norway 1999 11% 5%
Greece 1998 13% 4%
Luxembourg 1998 13% -
Sweden 2000 13% 1%
Finland 2002 13% 3%
Belgium 2001 11% -
Portugal 2001 8% 3%
37;38
Percentage of ever and recent (last year) users. - = not measured. References:
Table 2.8b Cannabis use in the general population of various EU Member States, the United
I
States and Australia: other age groups
Country Year Age (year) Ever use Recent use
Canada 2002 15 and over 41% 12%
United States 2003 12 and over 41% 11%
Australia 2001 14 and over 33% 13%
Denmark 2000 16 - 64 31% 6%
England and Wales 2002/2003 16 – 59 31% 11%
Italy 2001 15 – 44 22% 6%
Germany 2000 18 – 59 19% 6%
Percentage of ever in lifetime and recent (last year) users. I. Drug use is proportionally low in the youngest (12-
15 years) and the older age groups (>64 years). Consumption figures in studies with respondents who are
younger and or older than the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) standard
may turn out lower than the figures in studies applying the EMCDDA standard. The opposite is true for studies
37-42
with a more limited age range .
Young people
Better suited for comparison are the figures from the European School Survey Project on Alcohol and
Other Drugs (ESPAD). The last surveys were conducted in 1999 and 2003 among secondary school
43
pupils aged 15 and 16.
• Table 2.9 portrays the consumption of cannabis in a number of EU countries and Norway.
Belgium, Germany and Austria only participated in 2003. The United States did not take part in the
ESPAD, but conducted comparable research.
• The percentage of pupils that had ever used cannabis in 2003 was highest in Ireland, closely
followed by France, the United Kingdom and the United States. Belgian pupils took the fourth and
Dutch pupils the fifth place.
• France had the highest current use figures, followed by the United States, the United Kingdom
and Ireland. The Netherlands and Italy came next.
• In the United Kingdom and Portugal the percentage of current users rose by four and three
percentage points, respectively, in 2003 compared with 1999. Elsewhere differences of two or
fewer percentage points were found.
33
• The percentage of pupils who had used cannabis six times or more in the last month was lowest in
the Scandinavian countries and highest in France, the United States and the United Kingdom.
Dutch pupils shared a fourth place with their Irish and Italian peers.
• In most of the countries there was a correlation between ever use of cannabis and the degree of
truancy, lack of parental control and the presence of older brothers or sisters who used cannabis.
Table 2.9 Cocaine consumption among pupils aged 15 and 16 in EU Member States, Norway
and the United States. Survey years 1999 and 2003
Country Ever use Current use Six times or more in the
last month
1999 2003 1999 2003 1999 2003
United States 41% 36% 19% 17% 9% 8%
Ireland 32% 39% 15% 17% 5% 6%
France 35% 38% 22% 22% 9% 9%
United Kingdom 35% 38% 16% 20% 6% 8%
Belgium - 32% - 17% - 7%
The Netherlands 28% 28% 14% 13% 5% 6%
I
Germany - 27% - 12% - 4%
Italy 25% 27% 14% 15% 4% 6%
Denmark 24% 23% 8% 8% 1% 2%
Austria - 21% - 10% - 3%
Portugal 8% 15% 5% 8% 2% 3%
Finland 10% 11% 2% 3% 1% 0%
Norway 12% 9% 4% 3% 1% 1%
Sweden 8% 7% 2% 1% 0% 0%
Greece 9% 6% 4% 2% 2% 1%
Percentage of ever in lifetime users, current (last month) users and six times or more in the last month users. I.
Six of sixteen Member States. - = not measured. The United States did not take part in the ESPAD, but conducted
comparable research. Source: European School Survey Project on Alcohol and Other Drugs (ESPAD).
2.6 TREATMENT DEMAND
Outpatient care organisations for addicts
The National Information System on Alcohol and Drugs (LADIS) records the number of people seeking
assistance from (outpatient) care organisations for addicts, including the probation and after-care
services. (See in Appendix A: Client LADIS.)
• The number of clients registered for a primary cannabis problem more than doubled between 1994
and 2003 (see Figure 2.5). Between 2002 and 2003 the increase was 21 percent.
• The proportion of cannabis in all drug-related registrations increased also, from 10 percent in 1994
to 15 percent in 2003.
• Characteristics of the primary ecstasy clients in 2003:
- The majority was male (83%); the proportion of women increased somewhat, from 15 percent
in 1994 to 17 percent in 2003.
- The average age was 28. Most of these clients were in the age group 20-24 years (see Figure
2.6).
- Four in ten were new clients (40%). They had not sought drug-related help from (outpatient)
care organisations for addicts before.
• The number of clients in (outpatient) care organisations for addicts who mentioned cannabis as a
secondary problem increased also between 1994 and 2003 (see Figure 2.5).
34
• For this group, alcohol (40%), cocaine or crack (36%), or heroin (14%) was the primary problem.
Figure 2.5 Number of clients in (outpatient) care organisations for addicts with primary or
secondary cocaine problems, from 1994
5000
4000
3000
2000
1000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Primary 1951 2274 2659 3264 3291 3281 3443 3432 3701 4485
Secundary 2846 2668 2718 2820 2844 3063 3144 3300 3697 4291
Source: National Information System on Alcohol and Drugs (LADIS), Organisation Care Information Systems
(IVZ).
Figure 2.6 Age distribution of clients in (outpatient) care organisations for addicts with
cannabis as primary problem. Survey year 2003
30%
25%
25%
21%
18%
20%
15% 14%
10%
10%
6%
5%
3% 2%
1%
0%
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59
Percentage of clients by age group. Source: National Information System on Alcohol and Drugs (LADIS),
Organisation Care Information Systems (IVZ).
35
Inpatient care organisations for addicts
There are no recent countrywide data about the treatment demand at the inpatient care organisations
for addicts. In the near future these data will become available from Zorgis, the new information
system for the umbrella organisation Netherlands Association for Mental Care (GGZ). Until 1997, the
old registration system, the Patients Admission Tracking System for Intramural Mental Health Care
(PiGGz) recorded the annual drug-related admissions in drug treatment clinics and drug units of
psychiatric hospitals.
• The number of admissions for cannabis abuse and dependence rose from 71 in 1990 to 309 in
1996 (ICD-9 codes: 304.3, 305.2; see Appendix C).
• The proportion of cannabis in all drug-related admissions rose slightly between 1990 and 1996,
from three to seven percent.
• The situation since then is not really known, because record keeping has been incomplete from
1997 (see Appendix B).
General hospitals; incidents
In 2003, the National Medical Registration (LMR) recorded nearly 1.6 million clinical admissions in
general hospitals. Drug problems hardly played a role in these admissions. In that year, drug abuse
and drug addiction were determined 402 times to be the primary diagnosis and 1,986 times as the
secondary diagnosis.
• Eleven percent of the primary diagnoses involved cannabis (37% dependence, 63% abuse; see
Figure 2.7). It is not known whether the complaints that led to the admission were psychological or
physical in nature.
• Cannabis-related problems played a greater role in terms of secondary diagnoses (30%
dependence, 70% abuse). The slight rise until 1999 did not continue in the last few years.
• In 2003, these secondary diagnoses were mostly associated with the following primary diagnoses:
- psychoses (29%)
- accident-related injuries (13%, e.g. fractures, wounds, concussion)
- abuse or dependence on alcohol and drugs (13%, mainly alcohol)
- poisoning (10%, by drugs, alcohol, prescription drugs)
- respiratory illnesses and symptoms (8%)
- heart and vascular diseases (7%)
36
Figure 2.7 Clinical admissions in general hospitals related to cannabis abuse and
dependence, from 1994
300
247 249 246
230
250
193 195 193
184
200
160 154
150
100
39 46
38 38 33
50 26 29 29 24
21
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Main diagnosis - clinical Secondary diagnosis - clinical
The number of diagnoses, not adjusted for double patient counts or more than one secondary diagnosis per
admission. ICD-9 codes: 304.3, 305.2 (Appendix C). Source: National Medical Registration (LMR), Prismant.
• A person can be admitted more than once in a given year. Moreover, more than one secondary
diagnosis can be made per admission. Adjusted for double counts, 262 patients were admitted in
2003. They were admitted at least once this year with cannabis abuse or dependence diagnosed
as primary or secondary problem. The average age was 29 years and 79 percent were male.
• In 2003, cannabis-related problems also played a role as primary or secondary diagnoses in 69
day-treatment admissions. In addition, in 2003, the National Medical Registration (LMR) recorded
16 admissions with “accidental poisoning with hallucinogens” as secondary diagnosis (ICD-9 code:
E854.1). In 2001 and 2002, there were 15 and 8 such cases respectively. This may involve
cannabis, but also LSD or magic mushrooms.
The Central Ambulance Service of the Amsterdam Area Health Authority (GG&GD Amsterdam) keeps
a record of the number of drug-related emergency calls.
• Cannabis use was involved in 257 cases. That is somewhat less than in the two previous years,
but represents twice the number compared to the years 1998 up to 2000 incl. (see Table 2.10).
• More than one in three (35%) cannabis cases required transport to hospital casualty. The rest
could be treated on-site.
Table 2.10 Cannabis incidents recorded by the Amsterdam Area Health Authority (GG&GD
Amsterdam), from 1992
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Smoking cannabis 82 40 130 137 165 211 107 118 106 243 226 196
Eating space cake 40 11 34 73 58 47 28 21 35 46 59 61
Number of annual incidents. Source: Central Ambulance Station (CPA), Amsterdam Area Health Authority
(GG&GD Amsterdam).
37
Most of the complaints of the people arriving in Casualty with a cannabis-related problem are not
serious.
• In 2000, Onze Lieve Vrouwengasthuis in Amsterdam mostly registered patients feeling unwell and
44
anxious (44%), with heart palpitations (20%), or nausea (15%).
• Psychotic complaints were observed in four percent of cannabis patients.
• Injuries as a result of a slip/fall accident were noted in 14 percent of the cases. These accidents
may be connected with the (lowering) effect of cannabis on the blood pressure and motor
coordination.
2.7 MORTALITY
45
The toxicity of cannabis is minimal.
• In the past twenty years, the Statistics Netherlands (CBS) has not recorded one single death
directly related to the consumption of cannabis.
• No such directly related deaths are known in other countries.
2.8 SUPPLY AND THE MARKET
Coffee shops
The number of coffee shops in the Netherlands has decreased (see Table 2.11).
• 46
Between 1997 and 1999, Bureau Intraval registered a decrease of 28 percent , with the most
significant decrease in the smaller towns and in Rotterdam.
• Since 1999, the annual decrease was less significant: four percent between 1999 and 2000, one
percent between 2000 and 2001, three percent between 2001 and 2002 and four percent between
47
2002 and 2003.
• In late 2003, the Netherlands had 754 officially ‘tolerated’ coffee shops, about half of which (52%)
are located in the large cities with more than 200,000 inhabitants.
• In 2003, of the 489 Dutch municipalities, 79 percent had no coffee shop at all.
• Three quarters (78%) of the municipalities maintained a ‘zero tolerance’ policy, meaning that
coffee shops are not permitted. Nearly a quarter (23%) of the municipalities maintained a
‘maximum policy’, meaning that a limit has been set to the number of coffee shops that are
tolerated.
• Other ‘sales sources’ such as deal houses and street dealers are not included in the last two
surveys.
38
Table 2.11 Number of coffee shops in the Netherlands by municipality, from 1997
I
Municipalities by number of 1997 1999 2000 2001 2002 2003
inhabitants
< 20,000 inhabitants ± 50 14 13 11 12 12
20-50,000 inhabitants ± 170 84 81 86 79 73
50-100,000 inhabitants ± 120 115 109 112 106 104
100-200,000 inhabitants 211 190 168 167 174 168
> 200,000 inhabitants
- Amsterdam 340 288 283 280 270 258
- Rotterdam 180 65 63 61 62 62
- The Hague 87 70 62 55 46 41
- Utrecht 21 20 18 17 18 18
II
- Eindhoven 16 16 15 15
Total ± 1 179 846 813 805 782 754
I. An estimate. II. Fewer than 200,000 inhabitants up to 1999. Source: Tilburg Institute for Social Policy
Research and Consultancy (IVA), University of Tilburg.48
THC content and price
The Trimbos Institute gathers information about the potency of cannabis, i.e., the concentration of the
active substances, particularly THC (tetrahydrocannabinol). Since 1999, samples of different cannabis
49;50
products have been bought regularly in coffee shops and chemically analysed.
• All surveys showed that Dutch-grown marihuana contained more THC on average than imported
varieties.
• Figure 2.8 shows that the average THC content in Nederwiet (Dutch-grown marijuana) has
strongly risen since 1999.
• The percentage of THC in imported hashish rose until 2001/2002. In the years thereafter no
further increase was measured. The percentage of THC in imported weed increased slightly over
the years.
• Most of the Nederwiet originates from the intensive and professional indoor cultivation, which,
compared to outdoor cultivation, results in weed with a higher THC percentage.
• In so far as data are available, no significant increase is noticeable in other European countries.
37
However, it is hard to compare international figures, due to the large differences in research
methods.
39
Figure 2.8 Average percentage of THC in cannabis products
25%
20%
15%
10%
5%
0%
1999/2000 2000/2001 2001/2002 2002/2003 2003/2004
Nederwiet 9% 11% 15% 18% 20%
Imported weed 5% 5% 7% 6% 7%
Imported hash 11% 12% 18% 17% 18%
51
Source: Drugs Information and Monitoring System (DIMS), Trimbos Institute.
The price of one gram of Nederwiet or one gram of imported weed fluctuated slightly in the past years.
• In 2002/2003 the price of Nederwiet was somewhat higher than in 1999/2000 and 2000/2001, but
this trend did not continue in the last measurement.
• Imported weed was somewhat more expensive in 2003/2004 than in 1999/2000 and 2000/2001.
• Imported hashish was more expensive in 2000/2001 than in 2002/2002 and dropped again
somewhat in the period from 2002/2003 to 2003/2004 (see Table 2.12).
Table 2.12 Price (€) per gram of cannabis product

1999/2000 2000/2001 2001/2002 2002/2003 2003/2004
Nederwiet 5.83 5.86 6.28 6.45 5.97
Imported 3.87 3.80 4.16 4.32 4.86
marijuana
Imported hashish 6.29 6.36 7.14 7.56 6.46
Source: Drugs Information and Monitoring System (DIMS), Trimbos Institute.
• Marijuana growers in the Netherlands sometimes use pesticides to protect the plants against
diseases. There are no current data about the presence of these substances in Nederwiet.
Chemical analyses done in 1999 found pesticide residues in half of the Nederwiet samples.
52
However, the concentrations were so low that they did not pose a health risk.
40
3 COCAINE
Cocaine has a stimulating effect. Many cocaine users are able to combine this drug with a ‘normal’
lifestyle without getting into problems. They use cocaine for recreational purposes. Nonetheless,
cocaine use can lead to dependence. Moreover, cocaine may manifest itself as part of a problematic
use pattern involving the simultaneous use of several drugs.
53
Cocaine can be administered in various forms. Cocaine in salt form (hydrochloride powder)
is mostly sniffed but rarely injected in the Netherlands. Every once in a while powder cocaine is
smoked in a cigarette. Freebase or crack cocaine is particularly popular among problem users of hard
drug. Freebase or crack is obtained by heating a solution consisting of cocaine powder, sodium
bicarbonate (baking soda) or ammonia, and water. Crack cocaine is smoked in a small (crack) pipe or
placed on aluminium foil and inhaled through a tube. Crack is impure crack cocaine with residues of
sodium bicarbonate. It gets its name from the cracking sound of the ‘rock’ when smoked. In the
eighties, crack was prepared by the consumers themselves. Nowadays it is mainly sold on the street
in the form of ready-to-use ‘rocks’.
The information below pertains to all forms of cocaine unless indicated otherwise.
The main facts and trends about cocaine in this chapter are:
• The number of current cocaine users in the general population doubled between 1997 and 2001.
The largest increase was noted in adolescents aged 20-24 (see Chapter 3.2).
• Among school-aged youngsters (12-18 years) the percentage of cocaine users remained stable
between 1996 and 2003 (see Chapter 3.3).
• Dutch pupils score average on cocaine use compared to their peers in many other EU Member
States (see Chapter 3.5).
• Sniffed cocaine is fairly popular among young clubbers, in particular in trendy clubs, discos and
pubs.
• Among young people in trendy clubs in Amsterdam, consumption dropped between 1998 and
2003 (see Chapter 3.3).
• Cocaine – especially in the form of crack cocaine – enjoys great popularity among problem opiate
users (see Chapter 3.4).
• The strong increase in the number of cocaine users in (outpatient) care organisations for addicts
continued between 2002 and 2003 (see Chapter 3.6).
• The number of admissions in general hospitals for cocaine-related problems increased between
1996 and 2002, but did not rise further in 2003 (see Chapter 3.6).
• The rising trend in the number of registered acute deaths from cocaine use between the mid-
nineties and 2001 did not continue in 2002 and 2003 (see Chapter 3.7).
• In 2003, cocaine powder of consumers had often been mixed with phenacetin (see Chapter 3.8).
According to the NPO the number of Dutch people aged 12 and above with cocaine experience rose
10
between 1997 and 2001 (see Table 3.1).
• The percentage of ever users who have consumed cocaine 25 times or more in their lifetime – i.e.
experienced users – grew; from 23 percent in 1997 to 29 percent in 2001.
• The percentage of current users doubled in the same period but remained far below one percent.
In absolute figures this represents an increase from nearly 28,000 to 55,000 current cocaine users.
41
However, these figures most certainly are an underestimation, as problem hard drug users are
a
underrepresented in the National Prevalence Survey (NPO).
• Cocaine is used mostly by adolescents aged 20 to 24. This same age group showed the highest
increase in users between 1997 and 2001 (see Figure 3.1).
• The number of current users who used cocaine (almost) daily rose from 1.8 percent in 1997 to 4.5
percent in 2001.
• Men outnumbered women in both survey years as regards experience with cocaine. Furthermore,
more men than women were current users in 1997, but female users had caught up by 2001 (see
Table 3.1).
Table 3.1 Cocaine use in the Netherlands among people aged 12 and above. Survey years
1997 and 2001
1997 2001
Has used ever in lifetime 2.1% 2.9%
• Men 2.9% 3.9%
• Women 1.3% 1.9%
I
Used currently 0.2% 0.4%
• Men 0.3% 0.4%
• Women 0.1% 0.4%
Used for the first time in the past year 0.3% 0.3%
Mean age of current users 29 years 29 years
I. In the last month. Source: National Prevalence Research (NPO), Centre for Drug Research (CEDRO).
Figure 3.1 Cocaine users in the Netherlands by age group. Survey years 1997 and 2001
%
10
0
12-15 16-19 20-24 25-29 30-34 35-39 40-49 50-59 60-69 >69 Age
Ever 1997 0.1 2.3 3.9 4.8 3.6 3.1 2.4 0.5 0.4 0.0
Ever 2001 0.1 2.7 8.6 4.6 5.0 4.2 3.8 1.2 0.1 0.0
Current 1997 0.0 0.3 0.7 0.7 0.1 0.2 0.2 0.0 0.0 0.0
Current 2001 0.1 0.9 1.6 0.8 0.6 0.2 0.3 0.2 0.0 0.0
a
The number of problem users of opiates in the Netherlands is estimated at 32,000 on average. Field studies
show that 70% to 90% of them also uses cocaine (mainly crack) (see Chapter 3.4). In absolute numbers it
concerns therefore between 22,000 and 29,000 cocaine users in this group. The degree of overlap between these
figures and those of the NPO is unknown.
42
The large cities
Cocaine use is not spread out evenly across the Netherlands (see Figure 3.2).
• In 2001, the percentage of current users was four times higher in Amsterdam than in rural areas.
• In other, highly urbanised areas including Rotterdam, the proportion of current cocaine users was
three times higher than in rural areas.
• The rise in the percentage of ever and current cocaine users occurred all across the country but
was moderate in Amsterdam.
Figure 3.2 Cocaine use in large cities and rural areas among people aged 12 and above.
Survey years 1997 and 2001
%
12
10
10 9.4
6 5.4
5.2
4 3.4 3.3
1.6
2 1 1.2 0.9 0.9 1
0.4 0.4 0.1 0.3
0
Amsterdam Rotterdam Highly urban, Rural
other
Ever 1997 Ever 2001 Current 1997 Current 2001
Percentage of ever (lifetime) and current (last month) users. Definition (Statistics Netherlands (CBS)): Other
highly urbanised municipalities: more than 2,500 addresses per square kilometre, with the exception of
Amsterdam and Rotterdam, namely Delft, The Hague, Groningen, Haarlem, Leiden, Rijswijk, Schiedam, Utrecht,
Vlaardingen and Voorburg. Definition of rural municipalities: fewer than 500 addresses per square kilometre.
Source: National Prevalence Research (NPO), Centre for Drug Research (CEDRO).
Special groups
Compared with the average population, cocaine use frequently occurs among the homeless and
detainees.
• In 2002, nearly half (47%) of the homeless in twenty Dutch municipalities had smoked crack in the
11
last month; one in five (20%) sniffed cocaine.
• In 2002, one in three male detainees (32%) in eight penitentiaries used cocaine/crack daily in the
12
last six months prior to detention.
43
3.3 USE AMONG YOUNG PEOPLE
To categorise the use of cocaine among young people, figures from the National Prevalence
Research are available, as stated in Chapter 3.2. In addition, in the last few years, numerous local and
regional surveys have been conducted commissioned by municipalities. In Appendix F you will find an
overview of recent figures concerning the use of cocaine among young people in nine municipalities or
regions in the Netherlands based on representative samples from the population.
These figures provide a picture of the surveys that are conducted throughout the country. However,
methodological differences, in particular in respect of age groups, complicate comparison of the
figures. The number of municipalities and regions for which information is available is considerably
smaller than for cannabis, because the use of hard drugs is often included in one single question, due
to which differentiation by substance is not possible.
In this paragraph we also present the data of the Dutch National School Survey and data from (often
local) surveys among special groups of young people.
Pupils
According to the National Representative School Survey conducted by the Trimbos Institute,
15
considerably fewer secondary school pupils use hard drugs, such as cocaine, than cannabis.
• Between 1988 and 1996, however, this number increased.
• The 1999 measurement showed a stabilisation in the percentage of pupils with ever or current
cocaine experience (see Figure 3.3). This stabilisation continued in 2003b.
• More boys than girls were ever or current users of cocaine.
• The percentages of cocaine users seem slightly lower among pupils of a higher school level (pre-
university education - VWO, senior general secondary education - HAVO) compared to peers of a
lower school level (pre-vocational secondary education - VMBO), but these differences are not
statistically significant.
b
The decrease in ever use observed in Figure 3.3 was not significant.
44
Figure 3.3 Cocaine use among pupils aged 12 and above, from 1988
%
3.5
3
3
2.8
2.5
2.2
2
1.6
1.5 1.2
1.1 1.2
1
0.4 0.8
0.4
0.5
0
1988 1992 1996 1999 2003
Ever use (%) Current use (%)
Percentage of ever (lifetime) and current (last month) users. Source: National Representative School Survey,
Trimbos Institute.
Special groups
In certain groups of young people cocaine use occurs quite often. Table 3.2 summarises the result of
various studies. The figures are not suitable for comparison due to differences in age groups and
research methods.
• According to data from the Antenne Monitor, the numbers of current cocaine users among club,
party and disco-goers in Amsterdam rose from 14 to 24 percent between 1995 and 1998. This
54
mainly involved cocaine sniffing. Between 1998 and 2003, current use of cocaine dropped again
to the level of 1995 (14%).
• The Hague doe not signal a decreasing popularity of cocaine among young people visiting clubs
21;24
and parties, but there are no hard trend data. According to observations of key persons,
cocaine is on the up and up elsewhere in the country as well, particularly in trendy clubs, discos
20
and pubs.
• In the clubbing circuit, cocaine is often used together with alcohol.
19-21
• In other countries, such as Austria, Belgium, France and the United Kingdom, visitors of raves have
55
considerably more experience with cocaine than the average population.
• Young homeless people have the highest rate of cocaine use (see Table 3.2). A survey among
young people without fixed address in five Dutch municipalities showed that one in three had used
cocaine just recently. The most common route of administration was sniffing or smoking (crack)
22
cocaine; (current smokers: 32%, sniffers: 11%, IDUs: 1%). Among young homeless people in
23
Flevoland, lower percentages were found in 2004 (see Table 3.2).
45
Table 3.2 Use of cocaine in special groups
Location Survey Age Ever use Current
year (year) use
I
Young people in special education Nationwide 1997 12 - 18 4% 2%
Young people in truancy programs Nationwide 1997 12 - 18 14% 5%
III
Marginalised young people The Hague 2000/2001 16 - 25 23% 9%
Young clubbers The Hague 2003 15 - 35 23% 10%
III
Pub visitors Amsterdam 2000 Mean age 25 26% 9%
Visitors of trendy clubs Amsterdam 2003 Mean age 28 39% 14%
IV
Coffee shop visitors Amsterdam 2001 Mean age 25 52% 19%
V
Young homeless people Nationwide 1999 15 - 22 66% 36%
VI VI
Flevoland 2004 13 - 22 29% 10%
VII VII
19% 6%
Percentage of ever users (in lifetime) and recent users (last month) per group. The figures in this table are not
comparable due to differences in age groups and research methods. I. MLK, LOM, ZMOK. II. Young people with
insufficient care and or unable to sustain in their own existence. Recruited in places for young homeless people,
low-threshold day and night shelters and (other) temporary living accommodations. III. Select samples of young
people and adolescents visiting mainstream, student, gay and trendy pubs, so not representative for all pub
visitors. III. Little response (15%). V. Young people up to 23 years without a fixed address for three months or
17;18;22;24-
longer. VI. Snortable cocaine in powder form. VII. Smokable cocaine in the form of crack. References:
26 21;23
.
3.4 PROBLEM USE
Reliable estimates of the number of problem users of cocaine are not available.
• Seven to nine in ten opiate addicts also use cocaine, often in the form of crack. Freebase (or crack)
c 56-58
leads to compulsory behaviour and addiction faster than sniffed cocaine.
• For many hard drug users cocaine meanwhile is the most important drug. They have quite a hard
59
time to stop or reduce their use and their whole day is filled with procuring the drug.
• Nearly 10 to 15 percent consume cocaine without the additional use of heroin. In Utrecht this group
59
is mostly composed of young Antilleans and Moroccan users without a prior history of heroin use.
• Frequent cocaine use, especially crack, is being observed in certain groups of hard drug users,
57;58
such as among the (young) homeless, immigrants and street prostitutes.
• Intravenous use of cocaine (and heroin) has decreased strongly in the last few years and with it the
risk of infections. Smoking of cocaine (and heroin) on the other hand has increased.
• The percentage of ‘hard core’ cocaine injectors of all problem hard drug users in Parkstad Limburg
decreased from 40 percent in 1996 to 4 percent in 1999. The percentage of problem users who
both injected and smoked cocaine fell from 30 to 17 percent. Between 1999 and 2003 this situation
56-58
showed no significant change.
• At present, for seven to nine in ten problem users of hard drugs, the most current use of cocaine is
smoking (see Table 3.3).
• Health problems, especially as a result of frequent freebasing, are lung complications, exhaustion
53
and a weakened immune system, extra strain of the feet, anxiety and paranoia. Heavy coke users
also find it more difficult to keep their aggression under control.
c
However, users of shiff cocaine can also get into problems (see Chapter 3.6.1).
46
Table 3.3 Route of administration of cocaine by problem hard drug users
Route of administration Rotterdam Utrecht Parkstad Limburg
2003 1999 2003
Always injects 4% 1% 7%
Smokes and injects 10% 10% 19%
Always smokes 86% 86% 71%
Percentage of problem users by route of administration in the last 6 months. The figures in the columns do not
add up to 100 percent entirely; the disparity represents other methods of consumption (sniffing). Source: Regions
and Towns Monitor for Alcohol and Drugs (MAD).
General population
In the general population of Western countries the number of people using hard drugs such as
cocaine is considerably lower than the number of people using cannabis.
• Differences in survey year, methods of measurement and random samples make precise
comparison difficult. Of particular influence is the age group. Table 3.4a shows consumption figures
for cocaine which are (re)calculated in accordance with the standard age group of the European
Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (15 to 64 years incl.). Data on the
other countries are listed in Table 3.4b.
• The percentage of people up to the age of 60 or 70 who have experience with cocaine is by far the
highest in de Unites States.
• In the oldest Member States of the European Union the ever use varies from nearly zero percent to
six percent, with the highest percentages in England and Wales and in Spain. In the Netherlands,
nearly four percent of the population aged 15 to 64 years incl. has ever used cocaine.
• Of the above EU Member States, Sweden has proportionally the lowest number of recent cocaine
users (0%) and Spain the highest (2.6%). In the Netherlands over one percent used cocaine in the
past year.
47
Table 3.4a Use of cocaine in the general population of several EU Member States and
Norway: age group from 15 to 64 years incl.
Country Year Ever use Recent
use
Spain 2001 4.9% 2.6%
The Netherlands 2001 3.6% 1.1%
Ireland 2002/2003 3.1% 1.1%
Norway 1999 1.2% 0.6%
Northern Ireland 2002/2003 1.7% 0.4%
France 2000 1.6% 0.2%
Greece 1998 1.3% 0.5%
Sweden 2000 0.7% 0.0%
Portugal 2001 0.9% 0.3%
Finland 2002 0.7% 0.3%
Luxembourg 1998 0.2% -
37;38
Percentage of ever in lifetime and recent (last year) users. - = not measured. References:
Table 3.4b Use of cocaine in the general population of several EU member states, the
I
United States, Canada and Australia: other age groups
Country Year Age (year) Ever use Recent use
United States 2003 12 and over 14.7% 2.5%
Canada 2002 15 and over 8.0% 1.3%
England and Wales 2002/2003 16 – 59 6.2% 2.1%
Australia 2001 14 and 4.4% 1.3%
above
Italy 2001 15 – 44 3.4% 1.1%
Denmark 2000 16 – 64 2.5% 0.8%
Germany 2000 18 – 59 2.3% 0.9%
Percentage of ever in lifetime and recent (last year) users. ? = unknown. I. Drug use is proportionally low in the
youngest group (12-15 years) and older age groups (>64 years). Consumption figures in studies with respondents
who are younger and or older than the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
standard may turn out lower than the figures in studies applying the EMCDDA standard. For studies with a more
37-41
limited age range the reverse applies. References: .
Young people and adolescents
In the European School Survey Project on Alcohol and Other Drugs (ESPAD) in 1999 and 2003
among pupils aged 15 and 16, the respondents were interviewed about the ever use of cocaine. In
2003 they were also interviewed as to their recent use. The figures from this survey can be compared
better than the figures from surveys among the general population.
• Table 3.5 portrays the consumption of cocaine in a number of EU countries and Norway. The
United States did not take part in the ESPAD, but conducted comparable research.
• American pupils have more often experience with cocaine than their peers in the EU, despite the
drop in the percentage of ever users between 1999 and 2003.
• Italy and the United Kingdom scored highest in ever use in 2003 (4%). With 3 percent, the
Netherlands, Belgium, France, Ireland and Portugal rated above the middle, but the differences
with other countries are small.
• In Italy, the United Kingdom and the United States, proportionally most recent users are found
(3%). In the other countries, not more than 1 to 2 percent of the pupils had recently used cocaine.
48
Table 3.5 Cocaine consumption among pupils aged 15 and 16 in a number of EU Member
States, Norway and the United States. Survey years 1999 and 2003
1999 2003
Ever use Ever use Recent use
United States 8% 5% 3%
Italy 2% 4% 3%
United Kingdom 3% 4% 3%
Belgium - 3% 1%
France 2% 3% -
Ireland 2% 3% 1%
The Netherlands 3% 3% 1%
Portugal 1% 3% 2%
Denmark 1% 2% 2%
I
Germany - 2% 2%
Greece 1% 1% 1%
Norway 1% 1% 1%
Sweden 1% 1% 0%
Finland 1% 0% 0%
Percentage of ever in lifetime and recent (last year - 2003) users. I. Six of sixteen Member States. - = not
measured. The United States did not take part in the ESPAD, but conducted comparable research. Source:
European School Survey Project on Alcohol and Other Drugs (ESPAD).43
The National Information System on Alcohol and Drugs (LADIS) records how often people seek help
from (outpatient) care organisations for addicts. (See in Appendix A: Client LADIS.)
• The number of recorded admissions with cocaine as primary problem increased nearly four-fold
between 1994 and 2003. Between 2002 and 2003 the increase was 19 percent (see Figure 3.4).
• The proportion of cocaine users among all the drug users seeking assistance from outpatient care
organisations rose also considerably, from 13 percent in 1994 to 30 percent in 2003.
• The increase in the cocaine-related treatment demand occurred in the entire country, but was
strongest in the regions of Eindhoven, Twente, the Achterhoek and the IJsselmeerpolders.
• Characteristics of the primary cocaine clients in 2003:
- Most of them are men (82%).
- The average age is 33. Nearly half the primary cocaine clients are between 25 and 34 years
old (see Figure 3.5).
- A quarter (24%) consisted of new clients, so they had never before been registered with the
(outpatient) care organisations for addicts because of a drug problem.
- Most of the cocaine clients smoke or sniff the drug (see below).
• Cocaine was also indicated often as a secondary problem (see Figure 3.4).
- For this group the primary problem is heroin (67%), alcohol (22%), or cannabis (5%).
- Between 1994 and 2001 the number of clients with secondary cocaine problems increased.
The increase between 2000 and 2001 is partly due to the fact that the figures of the
Amsterdam Area Health Authority (GG&GD) were included for the first time.
49
Figure 3.4 Number of clients of (outpatient) care organisations for addicts with primary or
secondary cocaine problems, from 1994
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Primary 2468 2928 3349 4137 4607 5689 6103 6647 7774 9216
Secundary 6020 6391 6503 7015 6699 6932 7111 8426 8281 8388
The increase in secondary cocaine clients between 2000 and 2001 is partly due to the supply (since 2001) of data
of opiate clients of the Amsterdam Area Health Authority (GG&GD Amsterdam). Source: National Information
System on Alcohol and Drugs (LADIS), Organisation Care Information Systems (IVZ).
60
An analysis of LADIS data up to 2000 incl. gives the following picture:
• For two in three ‘primary’ cocaine clients crack (smoking) is the main means of use and for one in
three ‘sniff cocaine’.
• The proportion of crack users among the cocaine clients grew from 57% percent in 1994 to 65% in
2000.
• More than half the cocaine clients - primary and secondary problems together - have problems
with both cocaine (usually crack) and heroin (56%). Next are problem users of only crack without
opiates (20%), of both sniff cocaine and alcohol (13%), of both sniff cocaine and cannabis (6%) or
only of sniff cocaine (6%).
50
Figure 3.5 Age categories of primary cocaine clients in the (outpatient) care organisations
for addicts. Survey year 2003
%
25
23
21
20
17
15 14
11
10
6
5 3
2
1
0
15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 Age
• In 1990 there were 106 admissions and in 1996 there were 364 (ICD-9 codes 304.2 and 305.6;
Appendix C).
• The percentage of cocaine-related problems in all drug-related admissions rose also in this period,
from 4 to 8 percent.
• The situation since then is not known, because record keeping has been incomplete from 1997
(see Appendix B).
In general hospitals, upon admission, cocaine abuse and dependence abuse are often not recorded
as the main diagnosis.
• In 2003, eighty cases were counted, 70 percent of which for cocaine abuse and 30 percent for
cocaine dependence (see Figure 3.6).
• These cocaine problems more often play a part as a secondary diagnosis. Between 1996 and 2002
the number of admissions with cocaine abuse or dependence as secondary diagnosis increased.
This trend seems to have come to a stop in 2003.
• The most commonly diagnosed problems that were registered in 2003 in case of cocaine abuse or
dependence as secondary diagnosis were:
- accident-related injuries (21%, e.g. fractures, wounds, concussion)
51
- poisoning (12%)
- abuse or dependence on alcohol and (other) drugs (6%)
- psychoses (5%)
Figure 3.6 Clinical admissions in general hospitals for cocaine abuse and dependence,
from 1994
700
562
600
506
500 451
371 383 377

352 363
400
285
300 246
200
81 84 80
53 55 65 67
100 38 50
24
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Cocaine as primary diagnosis Cocaine as secondary diagnosis
admission. ICD-9 codes: 304.2, 305.6 (Appendix C). Source: National Medical Registration (LMR), Prismant.
2002. They were admitted at least once that year with cocaine abuse or dependence diagnosed as
primary or secondary problem. The average age was 34 years and 73 percent were male.
• In 2003, the National Medical Registration (LMR) counted also 16 cases of unintentional poisoning
with local anaesthetics (mainly cocaine) as secondary diagnosis (ICD-9 code E855.2).
Exact figures about the number of persons who become unwell after the use of cocaine are not
known.
According to the Injury Information System of the Consumer and Safety Foundation, annually 2,300
people on average are treated at emergency first-aid departments of hospitals after an accident,
violence or self-harm related to the use of drugs (comp. 14,000 because of alcohol, Chapter 6).d
• Nearly one in three (32%) drug victims reports to have used cocaine, more than one in five
cannabis (22%) and one in eight ecstasy (12%). Of over a quarter (27%) of the cases it is not
known which drug(s) is/are involved.
• These figures probably are an underestimation of the real number of drug-related accidents.
d
The drugs concerned are cocaine, heroin, cannabis, ecstasy, paddo's and speed. The data are the averages
over the period 1999 to 2003 inc.
52
The National Poison Information Centre (NVIC) of the National Institute of Public Health and the
Environment (RIVM) registers the number of requests for information from physicians, pharmacists
and governmental institutions about (potential) acute poisoning due to antigens, such as drugs.
• The number of reported drug-related incidents rose from 656 in 2000 to 1,210 in 2003. For cocaine
an increase from 150 to 247 incidents was registered.
• However, these figures do not provide an insight in the absolute number of intoxications.
3.7 MORTALITY
The Cause of Death Statistics of Statistics Netherlands (CBS) still counts very few (acute) deaths that
are — believed to be — directly attributable to cocaine.
• However, there does appear to be an increase. From 1985 to 1994 incl., the total number of
cocaine-related deaths was 21, compared with 143 from 1995 to 2003 incl. (see Figure 4.9).
• The rising line from 1996 to 2001 incl. (10 and 26 cases, respectively) did not continue in 2002 and
2003 (34 and 17 cases, respectively).
• Figure 3.7 shows that most of the deceased were between 25 and 49 years old. Nearly three in ten
were women.
• Fatalities in which cocaine plays a role are sometimes recorded under the code of deaths from
natural causes, for example heart problems. This makes it difficult to establish the number of cases
in which cocaine has actually contributed to the person’s death.
• The total number of deceased 'drug mules' is not known, one of the reasons being that the Cause
of Death Statistics Agency does not include deceased persons who are not listed in the Dutch
population registration system. In 2002 and 2003, the Amsterdam Area Health Authority (GG&GD
Amsterdam) recorded 8 and 3 cases, respectively.
Figure 3.7 Age categories associated with cocaine-related deaths from 1996 to 2001 incl.
25 %
20 19
17
15
14
15
13
10 9
5
5
3
2
1 1 1
0
<15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 >64
age (years)
Percentage of deceased per age group. ICD-10 codes primary causes of death: F14 and X42*, X62*, Y12* (* in
combination with code T40.5). Source: Cause of Death Statistics, Statistics Netherlands (CBS).
53
3.8 MARKET
Composition of cocaine samples
The Drugs Information and Monitoring System (DIMS) examines the substances in drug samples that
are turned in by consumers to care organisations for addicts. Part of these samples are identified by
the services. Samples of unknown composition and all the samples in powder form are forwarded to
the laboratory for chemical analysis.
• In 2003, 229 powders were supplied that were bought by the consumer as cocaine. Of those, 217
(95%) contained actually cocaine (mainly hydrochloride) with a concentration of 65% on average
(by weight).
• Amphetamine was found twice, caffeine ten times and heroin once. Two powders did not contain
any psychoactive substance.
• Most of the powders also contained cocaine-related residual products, which are included when
cocaine is extracted from the plant, such as tropacaine and norcocaine (87%).
• The percentage of powders that (also) contained phenacetin nearly doubled from 9 percent in 2002
to 16 percent in 2003. Phenacetin is a substance that, until 1984, was registered as a painkiller, but
was withdrawn from the market because of its possible carcinogenic characteristics. The quantities
of phenacetin that are used as a cutting agent are many times smaller than the therapeutic
quantities. However, the risks of phenacetin as a cutting agent of cocaine, such as the effects of
heating when ‘smoking’ crack, are not known.
Prices
Trend data about the prices paid by consumers for a gram of cocaine are not available. Recent figures
from the Antenne Monitor and the Drugs Information and Monitoring System (DIMS) project, however,
give an indication of the current situation.
• Clubbing young people and adolescents in Amsterdam, who bought cocaine in 2003, paid between
46 and 52 euros per gram on average, depending on the type of dealer (house dealer or dealer in
the clubbing circuit).
• These data correspond with the price that consumers paid in 2003 for cocaine samples supplied to
the DIMS project (minimum 40 and maximum 50 euros per gram, with an average of 45 euros per
gram).
54
4 OPIATES
The category of opiates includes many drugs. Some, such as heroin, are known for their illegal use.
Others, such as methadone, function as replacements of heroin or are (also) otherwise applied in
medicine: morphine, codeine and the like. This chapter deals mainly with heroin and methadone.
Opiates may cause a high, but may also have a subduing effect.
Heroin is administered in many manners. At present the most current use in the Netherlands is
smoking (‘Chinese-style’, smoking from aluminium foil). Less often, heroin is injected.
People whose opiate use has gotten out of hand often use additional drugs (polydrug use) in a
way that is hard to combine with a ‘normal’ lifestyle. The collective term ‘hard drugs’ used in this
chapter mainly refers to at least one type of opiate, as well as mainly to cocaine.
The main facts and trends regarding opiates in this chapter are:
• The use of heroin is not very frequent in the general population (see Chapter 4.2).
• Heroin is still not very popular among pupils and young people who visit clubs and pubs (see
Chapter 4.3).
• The number of opiate addicts in the Netherlands remains stable and is low compared with other
European countries (See Chapter 4.4 and Chapter 4.5).
• Intravenous injection of opiates has decreased. Opiates are now mostly smoked (see Chapter
4.4).
• The number of opiate clients of the (outpatient) care organisations for addicts decreased slightly
between 2001 and 2003. The proportion of young opiate clients decreased further (see Chapter
4.6).
• The average methadone dose increased over the years, but still a minority of the methadone
clients receives (therapeutic) doses of 60 mg or more (see Chapter 4.6)
• The percentage of injecting drug users contaminated with HIV remained fairly stable in
Amsterdam (1993-1998), Rotterdam (1994-2002/03), Maastricht (1994-1999) and Arnhem
(1991/92-1997). In Heerlen their percentage increased between 1994 and 1999 (see Chapter 4.7).
• The majority of injecting drug users in Rotterdam and Heerlen/Maastricht are contaminated with
hepatitis B and C. For The Hague the figures are somewhat more positive (see Chapter 4.7).
• Needle sharing among injecting drug users was less and less common, but in some regions (The
Hague and Twente) this is still done often. Sexual risk behaviour remains a problem (see Chapter
4.7).
• Acute death (‘overdose’) due to opiate use decreased slightly between 2001 and 2003 (see
Chapter 4.7).
• Acute death due to drug use is low in the Netherlands compared to other countries (see Chapter
4.7).
55
The use of heroin is not widespread in the general population.

• According to the National Prevalence Survey (NPO) conducted in 2001, 0.4 percent of the Dutch
10
population aged 12 and over had experience with heroin. In 1997 this was 0.3 percent.
• In 2001 the percentage of current users was 0.1 percent.
• These figures are probably an underestimation, as problem hard drug users are underrepresented
in the National Prevalence Survey (NPO). Many illegal opiate users and methadone clients are not
included in general population surveys, because they have no fixed address (homelessness), are
detained, or are inaccessible for other reasons. However, they can be charted to a certain degree
through other research methods (see Chapter 4.3).
Special groups
Among certain adults the use of heroin is more current than in the general population.
• In 2002, one in five male detainees (21%) in eight remand centres used heroin daily in the six
12
months prior to detention.
• In that same year, 40 percent of the homeless in twenty Dutch municipalities had used this drug in
11
the month previous to the survey.
These groups may show an overlap with the problem users described in Chapter 4.4.
4.3 USE IN THE YOUNG PEOPLE
Heroin is unpopular among secondary school pupils of secondary school aged twelve years and
15
above (see Table 4.1).
• In 2003 more boys than girls had ever or currently used heroin (ever: 1.5% versus 0.7%; current:
0.8% versus 0.3%).
• Since 1988, the percentage of ever users fluctuated around one percent. In all those years, not
more than half of them had currently used heroin.
Table 4.1 Heroin use among pupils aged 12 and over, from 1988
1988 1992 1996 1999 2003
Has used ever in lifetime 0.7% 0.7% 1.1% 0.8% 1.1%
Used currently 0.3% 0.2% 0.5% 0.4% 0.5%
Trimbos Institute.
• According to somewhat older figures, the percentage of current heroin users is higher among
young people in special education and participants in truancy programs, than among pupils in
‘regular’ education, but even this higher percentage remains below 1 percent (see Table 4.2).
• A number of recent local and regional studies show also that heroin has not advanced very much
among young people. In Almelo, Apeldoorn, Drente, Groningen and South-Holland North the
percentage of ever users remains under one percent (see Appendix F).
• In certain circles, a minority of young people experiment with heroin (see Table 4.2). In 2001, for
17
example, nearly one in ten coffee shop visitors had ever tried heroin.
• Among visitors of trendy clubs in Amsterdam the percentage of ever users dropped from six
18;21
percent in 1998 to two percent 2003. Current use is not (very) frequent in the clubbing circuit.
• A 1999 survey among young homeless people in five municipalities (Amsterdam, Breda,
Hilversum, Tilburg and Zaanstad) shows that this group had experience with heroin relatively often.
56
More than one in ten young homeless people were current users of this drug. The most common
22
route of administration in this group was smoking (current smokers: 11%, IDUs: 1%, sniffers: 0%).
In 2004 lower percentages were found among young homeless people in Flevoland, eight percent
23
had ever used heroin and two percent were current users.
Table 4.2 Heroin use in special groups

Location Survey year Age Ever use Current
(year) use
I
Pub visitors Amsterdam 2000 Mean age 25 1% 0,2%
Young people in special Nationwide 1997 12 - 18 2% 0,8%
II
education
Visitors of trendy clubs Amsterdam 2003 Mean age 28 2% 0%
Young people in truancy Nationwide 1997 12 - 18 4% 0,9%
programs
III
Coffee shop visitors Amsterdam 2001 Mean age 25 9% 0,9%
IV
Marginalised young people The Hague 2000/2001 16 - 25 13% 7%
V
Young homeless people Nationwide 1999 15 - 22 21% 11%
Flevoland 2004 13 - 22 8% 2%
Percentage of ever users (in lifetime) and current (last month) per group. The figures in this table cannot be
compared with each other because of differences in age groups and research methods.
< means ‘less than’. I. A selective sample of young people and adolescents visiting mainstream, student, gay and
trendy pubs. This sample is therefore not representative for all pub visitors. II. Special School for Children with
Learning Difficulties (MLK), Special School for Children with Learning and Behavioural Difficulties (LOM), Special
School for Children with Severe Behavioural Learning Problems (ZMOK). III. Low response (15%). IV. Young
people receiving inadequate care and/or cannot provide sufficiently in their own livelihood. Recruited at locations
for young homeless people, low-threshold day- and night accommodation and (other) temporary accommodation.
V. Young people up to 23 years of age without a fixed address (homeless) for three months or longer.
17;22;23;25;26
References: .
4.4 PROBLEM USE
The available estimates usually do not allow us to make a clear distinction between problem opiate
a
users on the one hand and other hard drug users on the other hand. The estimates in Table 4.3,
therefore, refer to problem users of illegal opiates, or methadone, who usually use additional
substances, such as (crack) cocaine, alcohol, and sleeping tablets or tranquillisers.
• According to the latest estimates, the number of problem users of hard drugs amounts to approx.
32,000. This number is accompanied by a fairly large margin of uncertainty, varying from approx.
22,000 to 42,000 problem users. Compared with earlier years, no significant change has taken
place.
• The Netherlands has approximately three problem hard drug users per thousand inhabitants aged
15 to 64 years incl.
• Per thousand inhabitants, most of the problem users are located in Amsterdam, Rotterdam and
The Hague (see Table 4.1).
a
For the definition of problem user: see Appendix A.
b
In 2001 the Amsterdam Municipal Medical & Health Service (GG&GD Amsterdam) brought in 1,869 clients with
a primary heroin problem, 1,304 clients of whom were not known to other bodies participating in the National
Information System on Alcohol and Drugs (LADIS).
57
Table 4.3 Estimates of the number of problem hard drug users
Scope Year Number
Nationwide 1993 28,000
I
Nationwide 1996 25,000 – 29,000
I
Nationwide 1999 26,000 -30,000
II
Nationwide 2001 32,000 (22,000 – 42,000)
Amsterdam 2003 4,530
Rotterdam 1994 3,500 – 4,000
The Hague 1998 2,600 – 2,700
Parkstad Limburg 2002 800
Leeuwarden 2001 389
Enschede 2003 600
Utrecht 1999 570
I. Based on different estimation methods. II. Average (and 95% reliability interval) of two methods. References:
57;61-66
Figure 4.1 Estimates of the number of problem hard drug users per 1,000 inhabitants aged
15 to 64 incl.
12.0
10.0 9.4
8.9
8.5
8.0
6.3
5.7
6.0
4.5
4.0 3.4
3.0
2.0
0.0
Nationw ide Amsterdam Rotterdam The Hague Utrecht Parkstad Leeuw arden Enschede
(2001) (2003) (1994) (1998) (1999) Limburg (2001) (2003)
(2002)
Average of highest and lowest estimates (if applicable). References: see Table 4.3.
Figure 4.2 portrays the development in the number of problem opiate users in Amsterdam according
to estimates of the Amsterdam Area Health Authority (GG&GD Amsterdam).
• The size of this group peaked in 1988 (8,800) and then decreased. This decline was mainly
attributable to foreigners, especially Italians and Germans, leaving Amsterdam. The decline
levelled off since 1998.
• In 2003, Amsterdam still had an estimated 4,500 problem opiate users. 38 percent were born in
the Netherlands, 25 percent in Surinam, the Netherlands Antilles, Morocco or Turkey and 37
percent originated from elsewhere.
58
Figure 4.2 Problem opiate users in Amsterdam, from 1985
Number
10000
8000
6000
4000
2000
0
1985 1987 1989 1991 1993 1995 1997 1999 2001 2003
Born in the Netherlands

Born in Surinam, the Netherlands Antilles, Morocco, or Turkey
Born elsewhere
Total
Source: Amsterdam Area Health Authority (GG&GD Amsterdam).
Opiate use is particularly precarious when injected intravenously.

• In the course of the years, users of opiates injected the drug less frequently (see Table 4.4). The
percentage of ‘hard core’ heroin injectors of all problem hard drug users in Parkstad Limburg
decreased from 33 percent in 1996 to 13 percent in 1999. This trend did not continue between
1999 and 2003. In Rotterdam the proportion of hard core injectors dropped from 15 percent in
56-58
1999 to 10 percent in 2003.
• In 2003, 10 percent of the opiate clients of (outpatient) care organisations for addicts were known
to inject and 72 percent to smoke. The rest used other routes of administration. In 1994, 16
percent still injected the drug.
The population of heroin users is becoming old and has to cope increasingly with health problems.
• In Amsterdam, the average age of methadone clients increased from 32 in 1989 to 44 in 2003. In
Rotterdam and Parkstad Limburg, the average age of problem hard drug users rose from 37 to 39
61;67
years between 1998 and 2003.
• Many opiate users have to cope with both drug addiction and (another) mental disorder, such as
social phobias or depression (‘dual diagnosis’). According to somewhat older estimates of the mid-
68;69
nineties, this pertains to between 30 and 50 percent of the opiate users.
• According to the Amsterdam Area Health Authority (GG&GD Amsterdam), the ageing process is
accompanied by the occurrence of old age diseases, such as diabetes and cancer. Pulmonary
diseases due to sustained heavy tobacco consumption and heroin smoking are becoming
70
increasingly frequent.
59
Table 4.4 Route of administration of heroin by problem hard drug users
Route of Rotterdam Utrecht Parkstad Limburg
administration
2003 1999 2003
Always injects 10% 1% 19%
Smokes and injects 10% 10% 16%
Always smokes 80% 86% 63%
Percentage of problem users by route of administration in the last 6 months. The figures in the columns do not
add up to 100 percent entirely; the disparity represents other methods of consumption (such as sniffing). Source:
Regions and Towns Monitor for Alcohol and Drugs (MAD).
Use by pupils
• According to the European School Survey Project on Alcohol and Other Drugs (ESPAD), in 2003
the percentage of ever users of heroin among pupils aged 15 and 16 in Europe did not exceed two
43
percent. An exception was Sweden where four percent of the pupils had experience with heroin.
• The percentage of recent users was not higher than one percent, except in Italy (3%).
Problem use
• The old EU Member States have an estimated 1.5 million problem hard drug users, or three to ten
37;38
per thousand inhabitants aged 15 to 64 incl. It involves mainly (also) opiates.
• The estimates are calculated with different statistical methods. Table 4.5 shows the lowest and
highest figures per country. Because of differences in definitions and methods, the data should be
interpreted with caution. This is particularly true for Luxembourg for which the estimates vary
widely.
• With two to three problem hard drug users per thousand inhabitants, Greece, the Netherlands and
Germany are at the bottom of the list of all the old EU Member States.
60
Table 4.5 Problem hard drug users in several EU Member States and in Norway
Country Year Number per thousand inhabitants aged 15 to 64 incl.
Lowest – highest estimate Average
Luxembourg 2000 6.2 – 13.6 9.9
United Kingdom 2000/2001 9.0 – 9.8 9.4
Italy 2002 6.7 – 8.4 7.5
Portugal 2000 6.0 – 8.5 7.3
Denmark 2001 6.7 – 7.7 7.2
Austria 2002 5.4 – 6.2 5.8
Ireland 2001 5.2 – 6.1 5.6
Spain 2000 5.3 5.3
Sweden 1998 4.2 – 4.8 4.5
France 1999 3.9 – 4.8 4.3
I
Belgium 1997 3.5 – 4.2 3.9
Finland 1999 3.1 – 4.1 3.6
Germany 2000 2.7 – 3.5 3.1
The Netherlands 2001 2.0 – 3.9 3.0
Greece 2002 2.1 – 2.9 2.5
Because of differences in definitions and methods, the data should be interpreted with caution. The estimates
relate in most countries to opiate users, with the exception of Sweden, where amphetamine injectors are in the
majority (at any rate in the early nineties).
I. Figures for Belgium relate only to intravenous drug users and are an underestimation of the actual number of
problem hard drug users. Source: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).
• The number of clients with primarily opiate-related problems increased slightly until 1997 (see
Figure 4.3). This increase was partly real and partly a misrepresentation, as more drug services
joined the National Information System on Alcohol and Drugs (LADIS). From 1997 to 2000 incl. the
number of opiate clients remained fairly stable. The increase in 2001 is mainly due to the entry of
b
the Amsterdam Area Health Authority (GG&GD Amsterdam) into LADIS.
• Since 2001 the number of opiate clients has decreased. Between 2002 and 2003 the decrease was
five percent.
• The proportion of opiates in all the requests for drug-related aid decreased from 71 percent in 1994
to 30 percent in 2003. This is mainly due to the increase in the number of clients with another drug
problem, such as cocaine and cannabis.
• Characteristics of the primary opiate clients in 2003 are:
- Most of them (80%) are men.
- The average age is 40, considerably higher compared to the cannabis and cocaine clients.
Eight in ten opiate clients are aged between 30 and 49 years (see Figure 4.4).
- Most of the clients appealed before to the (outpatient) care organisations for addicts because
of a drug problem. One in twenty (5%) was a newcomer.
- Opiates are not often mentioned as a secondary problem (see Figure 4.3). For this group the
primary problem is cocaine or crack (69%), alcohol (26%), or cannabis (2%).
61
• The proportion of young opiate clients decreased further. In 2002, 13 percent of the primary opiate
clients were aged between 15 and 29 years, in 2003 this was 9 percent. In comparison: in 1994,
this age group contained 39 percent of the opiate clients.
Figure 4.3 Number of clients of (outpatient) care organisations for addicts with primary or
secondary opiate problems, from 1994
20000
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Primary 14002 14936 15247 15865 15491 15606 15544 17786 16043 15195
Secundary 804 913 985 1112 1101 1313 1387 1761 1912 2056
I. The increase in the number of people in 2001 compared to 2000 is due to the first supply of data from the
Amsterdam Area Health Authority (GG&GD Amsterdam). Source: National Information System on Alcohol and
Drugs (LADIS), Organisation Care Information Systems (IVZ).
62
Figure 4.4 Age group categories of primary opiate clients in the (outpatient) care organisations
%
25
23
22
20
17 17
15
10
8
7
5
2 2
1
0
20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 Age
An estimated 13,500 opiate-dependent persons in the Netherlands receive methadone. The main
providers of methadone are the (outpatient) care organisations for addicts, the Amsterdam Area
c71
Health Authority (GG&GD Amsterdam), GPs and medical specialists.
• The number of methadone clients of the (outpatient) care organisations for addicts increased
slightly until 2002 (see Table 4.6). Besides due to an actual increase, this is also due to the larger
number of institutions that take part in the LADIS.
• Methadone is prescribed as maintenance treatment in over 97 percent of the cases. In the other
cases, it is used for heroin detoxification purposes.
• The average daily methadone dose increased since 1995 (see Table 4.6). In 2003, 37 percent of
72
the clients received a (therapeutic) dose of 60 mg methadone or more. The amount of methadone
prescribed to a client per time largely depends on the methadone policy of the respective drug
service/GP, or on the case worker.
c
GPs and specialists provide an estimated 2,750 persons with methadone, 900 of whom do not appear in the
71
National Information System on Alcohol and Drugs (LADIS).
63
Table 4.6 Methadone distribution by the (outpatient) care organisations for addicts, from
1994
Year Number of people Daily averaged dose (milligrams)
1994 8 882 46
1995 8 817 37
1996 9 068 38
1997 9 838 40
1998 9 754 42
1999 10 666 45
2000 10 805 48
I I
2001 12 538 54
2002 12 805 57
2003 12 048 57
I. The increase in the number of people as compared with 2000 is due to the first supply of data from the
Amsterdam Area Health Authority (GG&GD Amsterdam). The increase in the average methadone dose may also
be (partially) related to this. Source: National Information System on Alcohol and Drugs (LADIS), Organisation
Care Information Systems (IVZ).
psychiatric hospitals. Of all drugs, opiates make up the majority of admissions in the inpatient care
organisations for addicts (Patients Admission Tracking System for Inpatient Mental Health Care
(PiGGz), Mental Health Service (GGZ Netherlands)/Prismant).
• The number of admissions for opiate addiction and opiate abuse rose in the first half of the
nineties from 2,089 in 1990 to 3,128 in 1995 and decreased slightly, namely to 3,055 admissions
in 1996 (ICD-9 codes: 304.0, 304.7, 305.5, Appendix C).
• The proportion of opiate patients in the total of the inpatient care organisations for addicts
decreased from 75 percent in 1990 and 77 percent in 1991 to 67 percent in 1996.
• Due to the absence of recorded information after 1996, developments with respect to the
treatment demand can no longer be reflected reliably.
Opiate abuse and dependence are rarely diagnosed as the primary problem in general hospitals. In
2003 Dutch Hospital Registration (LMR) recorded 51 admissions (63% dependency and 37% abuse,
see Figure 4.5).
• These conditions are more often diagnosed as secondary problems (85% dependence, 15%
abuse). The main diagnoses of these secondary problems differ widely. In 2003, the principal
problems in secondary diagnoses were given as:
- accident-related injury (16%; fractures, wounds, concussion)
- digestive system diseases (8%)
- poisoning (8%; especially benzodiazepines)
- skin diseases (6%; abscesses).
64
2003. They were admitted at least once this year with opiate abuse or dependence diagnosed as
primary or secondary problem. Their average age was 39 and seven in ten were men (69%).
Three in ten patients came from the four big cities: Amsterdam (21%), Rotterdam (6%), The
Hague (5%) and Utrecht (3%).
• Accidental opiate intoxication was recorded as a secondary diagnosis in 26 hospital admissions.
11 such admissions involved methadone.
Figure 4.5 Clinical admissions in general hospitals for opiate abuse and dependence, from
1994
900
800 751 742

674
700 627 627 634
607 596 606
558
600
500
400
300
200
74 71 71 71 76 79 75 81 88
100 51
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Opiates as primary diagnosis Opiates as secondary diagnosis
admission. ICD-9 codes: 304.0, 304.7, 305.5 (Appendix C). Source: National Medical Registration (LMR),
Prismant.
In 2003, the Central Ambulance Station of the Amsterdam Area Health Authority (GG&GD
73
Amsterdam) recorded 226 emergency calls for suspected non-fatal hard drug overdoses.
• Emergency calls mainly involved opiate and cocaine use, sometimes in combination with other
substances.
• More than three-quarters (79%) of the above cases required transportation to a hospital. This is a
considerably higher percentage than for ambulance calls involving cannabis (35%).
4.7 ILLNESS AND MORTALITY
HIV
Needle-sharing or practising unsafe sex puts hard drug users at risk of infection with HIV, the virus
that causes AIDS. Between 1994 and 2003, the National Institute of Public Health and the
Environment (RIVM) conducted sixteen surveys among injecting hard drug users in nine regions in the
Netherlands. Figure 4.6 shows the most recent figures.
• There are large regional differences in HIV infection among drug users who ever injected the drug.
65
•
74
Of the big cities, Amsterdam leads. The Hague has the lowest percentage.
• In most cities participating more than once in the survey, the percentage of HIV-infected IDUs
(intravenous drug users) remained stable.
• Heerlen is an exception. In this city this proportion doubled from 11 percent in 1994 to 22 percent
75;76
in 1999.
• In a long-term survey in Amsterdam, the number of new HIV infections among IDUs dropped from
9 percent in 1986 to 1-2 percent in 1999. Between 1999 and 2002, the number of new cases
68;69
fluctuated between zero and 0.2 percent annually. In 2003 not a single new case of HIV
77;78
infection was found.
Figure 4.6 HIV infection among injecting drug users
30%
26%
25%
20%
15% 14%
10%
10%
5% 5%
5% 3%
2%
1% 1%
0%
Amsterdam South- Rotterdam Utrecht Brabant Twente The Hague Arnhem Groningen
1998 Limburg 2002/2003 1996 1999 2000 2000 1997 1997/1998
1999
Percentage of ever injecting hard drug users infected with HIV. An ever injecting hard drug user is a person who
has intravenously injected a drug once or more times in his or her life and used hard drugs at least once a week
in the past 6 months. Percentages in previous surveys: Amsterdam 26% in 1993 and 1996; Rotterdam 11% in
1994; Arnhem: 2% in 1991/1992 and 1995/1996; South-Limburg 10% in 1994 and 12% in 1996 (in Maastricht: 8%
in 1994, 3% in 1996, 5% in 1999); in Heerlen, 11%, 17% en 22% respectively. Brabant includes Eindhoven,
Helmond, Den Bosch. Twente includes Almelo, Hengelo, Enschede. Source: the National Institute of Public
74;76
Health and the Environment (RIVM).
Statistics about HIV infection in a number of EU Member States originate from diverse sources and
differ with respect to their degree of coverage. The figures are therefore not suitable for comparison
37
and provide only an indication of the degree of infection.
• Figure 4.7 shows that percentages of HIV-infected injecting drug users vary from approx. 1
percent or less in Finland (data from needle exchange programmes) and from 10 to 35 percent in
Spain (data from the care organisations for drug addicts, the centres for HIV screening and clinics
for sexually transmitted diseases (SOA)).
• In Italy and Portugal, just as in the Netherlands, there is a considerable regional or local dispersion
of HIV infection.
• According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), the
available figures suggest that the percentage of injecting HIV-injected drug users is stable or going
down, at any rate in the old EU Member States. In a number of new Member States and their
neighbouring countries, such as Estonia, Latvia, Russia and the Ukraine, there are indications of a
fast growing HIV epidemic, with a peak in Estonia and Latvia in 2001. However, in many countries
66
no reliable trend data are available and the situation at a local level may differ strongly from the
general domestic picture.
Figure 4.7 Percentage of injecting drug users (IDUs) infected with HIV in several EU
Member States and Norway
The data originate from several sources (samples, treatment centres, prisons, needle exchange). The
percentages between brackets refer to local sources. The colours indicate the degree of infection in accordance
with the average of the highest and lowest measured value. Source: European Monitoring Centre for Drugs and
Drug Addiction (EMCDDA).
Hepatitis B and C
Hepatitis B and C are serious forms of liver infection caused by the hepatitis B or C virus, HBV and
HCV respectively. HBV is transmitted through blood contact, for example as a result of an intravenous
injection with used needles, or through unsafe sexual contact. HCV can practically only be transmitted
67
by direct blood-blood contact. HCV is much more contagious than HIV and can also be transmitted via
contaminated (injection) utensils other than needles.
• Data about HCV and HBV among injecting hard drug users are not systematically collected in the
Netherlands. Information is available for a number of locations.
• At the latest examination, approximately three quarters of IDUs in Rotterdam and
Heerlen/Maastricht appeared to be infected with hepatitis HCV and a slightly lower percentage
79;80
with HBV (see Table 4.7).
•
81
The picture in The Hague was better. There is no immediate explanation for this.
Table 4.7 Hepatitis B and C infections among samples of hard drug users in Rotterdam,
Heerlen/Maastricht and The Hague
I
Year HBV-positive HCV-positive
Rotterdam 1994 56% of the IDUs 79% of the IDUs
27% of the non-IDUs 13% of the non-IDUs
Heerlen/Maastricht 1996 63% of the IDUs 74% of the IDUs
II
1998/1999 67% of the IDUs
The Hague 2000 35% of the IDUs 47% of the IDUs
IDG = ever injecting hard drug users, recruited on the street and at the aid organisations. HBV = Hepatitis B virus.
HCV = Hepatitis C virus. I. positive for anti-HBc, a marker for an earlier or current infection with hepatitis B. II.
Seven percent were positive for HbsAg, indicative for a current hepatitis B infection. Source: National Institute of
Public Health and the Environment (RIVM).
For Amsterdam data are available of 116 clients of a methadone centre who were screened in 2002
82
for contagious diseases.
• Table 4.8 shows the percentages of infections with HBV and HCV by injection status. About eight
in ten currently injecting methadone clients were (ever) infected with HBV and or HCV. A slightly
lower percentage of HBV infections was found among clients who had ever injected, but did not
do so any longer at the moment of measurement.
• More than a quarter (27%) of those who had never injected were infected with HBV. This
indicates sexual risk behaviour.
• One in ten drug users who, so they said, had never injected had ever been infected with HCV.
83
This figure corresponds with an earlier survey in Amsterdam and Rotterdam (see Table 4.7).
This finding may indicate non-reporting of the injection of drugs and or another manner of
infection, like via attributes that are used for smoking cocaine.
Table 4.8 Hepatitis B and C infections among methadone clients in Amsterdam. Survey year
2002
Ever injected, not Currently injecting Never injected
currently
HBV 55% 85% 27%
HCV 90% 77% 10%
It concerns here percentages of users who were ever infected with HBV or HCV, so both old, chronic and current
82
cases. Source: Amsterdam Area Health Authority (GG&GD Amsterdam).
• In the old EU Member States, HCV infection is common among IDUs. According to various
sources, the percentage of HCV infections varies between 40 and 80 percent, with an average of
65 percent.
•
37
Figures for HBV infection show much variation - between 17 and 85 percent.
68
Risk behaviour
• Needle-sharing among drug users has decreased compared to five to ten years ago. In most of
the cities and areas about which information is available report occasional needle-sharing by 8 to
84
30 percent of IDUs (see Table 4.9).
• In addition to sharing used needles, other used utensils, such as spoons, swabs, filters, or water
for rinsing syringes are also shared occasionally. An estimated one in four IDUs do this. Sharing
these utensils increases the risk of infection with hepatitis B and C, but not with HIV.
• Sexual risk behaviour remains widespread. Practising sex without condoms is most found among
permanent partners (76-96%), followed by casual partners (39-73%) and customers (13-50%, see
Table 4.9).
Table 4.9 Needle sharing and sexual risk behaviour among IDUs
Region Survey year Needle or No condom No condom No
II lI
syringe use use condom
I lI
sharing permanent casual use
partner partner customers
Amsterdam 1996 18% 76% 40% 30%
1998 12% 85% 47% 29%
Rotterdam 1994 18% 91% 47% 20%
1997 10% 84% 54% 31%
2002/2003 8% 85% 43% 32%
South- 1994 19% 86% 61% 13%
III
Limburg 1996 17% 87% 39% 17%
1999 10% 89% 49% 25%
Utrecht 1996 17% 84% 45% 17%
Arnhem 1991/1992 42% - - 40%
1995/1996 39% 90% 51% 21%
1997 16% 96% 53% 22%
Groningen 1997/1998 11% 89% 57% 24%
IV
Brabant 1999 17% 88% 61% 17%
The Hague 2000 21% 84% 73% 40%
V
Twente 2000 30% 92% 68% 50%
I. Percentage of ever injecting hard drug users who had borrowed syringes or needles from others in the last 6
months. II. Had not always used condoms in the last 6 months. III. Heerlen and Maastricht. IV. Eindhoven,
Helmond, Den Bosch. V. Almelo, Hengelo, Enschede. = unknown. Source: National Institute of Public Health and
85
the Environment (RIVM).
AIDS
• The number of AIDS cases reported to the Health Care Inspectorate (up to 1999 incl.) and the
HIV Monitoring Foundation (from 2000) rose from 325 in 1988 to 533 in 1995 and fell since to
between 230 and 280 cases in the past few years. One of the reasons of this is the introduction of
effective anti-viral licit drugs. These prevent fewer HIV cases from turning into AIDS or delay the
onset.
• Intravenous drug injection as a contributing factor to AIDS in the Netherlands remained moderate
throughout all these years; expressed in percentages: an average of 10%, with a peak of 14% in
1995. In 2003 three percent (8 cases) of the reported aids cases concerned IDUs.
• The number of reported AIDS cases differs in the old EU Member States. Figure 4.8 shows the
development for countries that in any year reported more than ten new cases of AIDS among
IDUs per million of inhabitants. In Belgium, Denmark, Germany, Greece, the Netherlands, Austria,
69
Finland, Sweden and the United Kingdom the number of cases did not exceed ten per million of
inhabitants annually.
• In the mid-nineties, Spain and Italy reported by far the highest numbers. In the following years,
these numbers reportedly fell sharply in those two countries. In Portugal the number of reported
AIDS cases rose from the early nineties onwards, but did not increase in 2000. These three
Member States comparatively have the highest numbers of IDUs infected with AIDS.
Figure 4.8 New cases of AIDS among IDUs per million of inhabitants in a number of EU
Member States, from 1985
140
Spain
120 Italy
Portugal
100
France
Ireland
80
Luxembourg
60
40
20
0
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Numbers of new cases per diagnosis year per million of inhabitants, adjusted in respect of previous years
because of delays in reporting. The figures reported until 31 December 2003 incl. Figures for 2003 are
incomplete for Spain and Italy. Trends are only reflected for the old EU Member States that reported more than
ten new cases per million of inhabitants in any year. Source: The European Centre for the Epidemiological
Monitoring of AIDS (EuroHIV), Statistical Office of the European Communities (Eurostat).
Mortality
According to the Cause of Death Statistics of Statistics Netherlands (CBS), few people in the
Netherlands die annually as a direct result of opiate consumption. When death does occur, it is mostly
the result of a drug overdose. In accordance with the European Monitoring Centre for Drugs and Drug
Addiction (EMCDDA) standard for the calculation of the acute death from drug use, these figures
include all the cases of unintentional and intentional (suicide) poisoning and poisoning that may or
86;87
may not have been intentional.
Between the mid-nineties and 2001 the number of registered deaths from all kinds of overdoses
showed a rising trend, so not just for opiates (see Figure 4.9).
• This trend is partially due to the increase in death from cocaine (see Chapter 3.7).
• In addition, due to the transition of the classification system ICD-9 to ICD-10, more cases may
have been included in the ICD-10 system from 1996 than in earlier years in the ICD-9 system.
• Between 1996 and 2001, the number of cases of "poisoning by other non-specified narcotics" and
“poisoning by other or non-specified psychodysleptics” increased. It concerns here often
70
(combinations of) hard drugs, whether or not together with other substances, but sometimes also
(combinations of) prescription drugs and/or alcohol.
The number of registered deaths due to an overdose of opiates is low in the Netherlands.
• Until 2001 this number of deaths varied from 47 to 77 cases annually. The two following years
showed a decrease.
• Just as the heroin users, the overdose victims are increasingly older. In the years 1985 up to 1989
incl., only 16 percent of the deceased were older than 35 years, compared to 63 percent in the
years 2000 up to 2003 incl. (see Figure 4.10).
Figure 4.9 Deaths from drug overdoses in the Netherlands, from 1985
160
140
120
100
80
60
40
20
0
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Totaal 57 68 54 51 56 70 80 75 75 87 70 108 108 110 115 131 144 103 104

Opiates 51 67 49 47 54 62 76 72 68 77 56 81 71 71 63 68 75 37 53
Cocaine 3 1 3 2 1 3 1 2 3 2 6 10 8 11 12 19 26 34 17
Number of deaths. From 1985 to 1996 ICD-9 codes: 292, 304.0, 304.2-9, 305.2-3, 305.5-7, 305.9, E850.0,
E850.8*, E854.1-2, E855.2, E858.8*, E950.0*, E950.4*, E980.0*, E980.4* (*In combination with codes N965.0
and/or N968.5 and/or N969.6 and/or N969.7). From 1996 to 2002 ICD-10 codes: F11-F12, F14-F16, F19, X42*,
X41*, X62*, X61*, Y12*, Y11* (*In combination with the T-codes T40.0-9, T43.6). For a definition of the codes:
see Appendix C. Source: Cause of Death Statistics, Statistics Netherlands (CBS).
71
Figure 4.10 Age group categories involved in death from an opiate overdose between
the periods 1985-1989, 1995-1994, 1995-1999 and 2000-2003
100%
80%
60%
40%
20%
0%
1985-1989 1990-1994 1995-1999 2000-2003
>=65 1 4 3 5
35-64 15 35 50 58
15-34 82 61 47 37
0-14 1 0 0 0
Death percentage per age group. Source: Cause of Death Statistics, Statistics Netherlands (CBS).
Amsterdam
The Amsterdam Area Health Authority (GG&GD Amsterdam) publishes annual reports on the number
of deaths among drug users (see Figure 4.11). These mortality figures for death due to an overdose
differ from those published by the Cause of Death Statistics of Statistics Netherlands (CBS), as the
Amsterdam Area Health Authority also includes drug-related deaths of illegal immigrants and tourists.
The Area Health Authority ( also records the number of opiate users in Amsterdam who died from
other causes.
• In 2003, 21 drug users in Amsterdam died after taking a drug ‘overdose’, often opiates whether or
not in combination with other substances. Once ecstasy (MDMA) was involved. Nine of the
overdose victims were Dutch and twelve were foreigners.
• Opiate clients usually died from other causes than an overdose (see caption Figure 4.11).
Twenty-one deceased drug users were infected with HIV, but this did not necessarily contribute to
their deaths.
• The average age of the deceased drug users (all causes) who were born in the Netherlands was
51 years. The average age of the drug users born abroad was 43 years.
• The decrease in the number of recorded deaths at the beginning of the nineties did not continue
in the mid-nineties. From 2001, there was a slight increase in the category of ‘other’ causes of
death (see Figure 4.11). With the increasing age of opiate users, underlying problems such as
pulmonary, liver and heart diseases play a larger role in these deaths.
72
Figure 4.11 Mortality among drug users in Amsterdam, from 1992
160
140
120
100
80
60
40
20
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Overdose 52 37 39 26 26 22 25 27 31 32 29 21
I
Other causes 83 102 86 92 90 76 67 73 76 112 96 126
Total 135 139 125 118 116 98 92 100 107 144 125 147
I Other causes of death (such as endocarditis, sepsis, pulmonary disorders, cirrhosis of the liver, suicide,
accidents, violence, AIDS) involving opiate users who were ever registered as clients of the Amsterdam Area
Health Authority (GG&GD Amsterdam). Source: Amsterdam Area Health Authority (GG&GD Amsterdam).
International comparisons
• Annually, between eight thousand and nine thousand people in the old EU Member States die
from a drug overdose; often from opiates in combination with other substances. This is a lower
37;38
limit, because not all cases of death from drug use are recorded.
• International comparisons of the number of ‘drug deaths’ are made more difficult due to
differences in the definition of the term ‘drug death’.
• Figure 4.12 shows the proportion of deaths directly related to drug use for five EU Member States
and Norway per 100,000 inhabitants. The same ICD-10 codes were used here. Included are
opiates, hallucinogens, cocaine, amphetamine and cannabis. The majority of cases (also)
87
involved opiates.
• According to these calculations, Norway and Denmark head the list. The Netherlands are at the
bottom.
• According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), since
2000 a modest decrease in the number of acute drug-related deaths is noticeable at a European
level.
73
Figure 4.12 Acute deaths from drug consumption: a comparison between five EU Member
States and Norway
Number per
100,000 inhabitants
9
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Norway 4.3 3.9 5.9 5.0 7.7 8.2 6.0
Denmark 5.5 4.1 4.6 4.8 4.5 4.5 4.5
Finland 2.1 1.9 1.7 2.3 2.6 2.1 1.9 1.9
Sweden* 1.5 1.6 1.8 2.2 1.9 1.8
Germany 1.6 1.6 1.8 1.5 1.4
The Netherlands 0.7 0.7 0.7 0.7 0.8 0.9 0.6 0.6
ICD-10 codes: F11-F12, F14-F16, F19, X42*, X41*, X62*, X61*, Y12*, Y11* (*In combination with the T-codes
T40.0-9, T43.6). I. With a view to better comparability, T40.4 is not taken into account in Sweden. Source:
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).
74
5 ECSTASY, AMPHETAMINES AND RELATED SUBSTANCES
The official name for ecstasy is 3,4-methylenedioxymethamphetamine (MDMA). Substances with a

chemical composition similar to that of MDMA — such as MDA, MDEA, MBDB and amphetamines, —
a
are also sold as ‘ecstasy’, quite often without the user being aware of the difference. Unless stated
otherwise, by ‘ecstasy’ we refer in this chapter to substances that are experienced or recommended
as ecstasy. By amphetamine we refer to 'ordinary' amphetamine and methamphetamine, the stronger
version, unless stated otherwise.
Ecstasy has a stimulating and entactogen effect. As a result of the entactogen effect of
ecstasy, people feel connected with one another and they find it easier to make contact. This
combination of characteristics contributes to the reputation of ecstasy as a party drug. The addictive
effect is probably light. Ecstasy is usually taken in the form of pills. Amphetamine has a stimulating
effect, stronger than ecstasy, without having an entactogen effect. Amphetamine is also used in trendy
clubs, but also used by opiate or polydrug addicts. When used frequently, it may result in dependence.
This risk is higher for methamphetamine than for ‘ordinary’ amphetamine. In the Netherlands,
amphetamine is usually swallowed or sniffed and sometimes injected or smoked.
The main facts and trends regarding ecstasy and amphetamine in this chapter are:
• The percentage of ever use of ecstasy and amphetamine in the general population rose between
1997 and 2001. Current use of ecstasy increased particularly among women (see Chapter 5.2).
• Between 1996 and 2003 the percentage of pupils who have experience with these substances fell
slightly. The percentage of current users decreased also (see Chapter 5.3).
• Current use of ecstasy and amphetamine among Dutch pupils is not higher than that of other
European peers (see Chapter 5.5).
• Ecstasy is still popular among young clubbers, although the use is showing signs of moderation. In
Amsterdam, the percentage of users among visitors of trendy clubs dropped (see Chapter 5.3).
• The number of ecstasy users seeking help from the (outpatient) care organisations for addicts is
low and has been stable in the past four years. The number of primary amphetamine clients is
also small, but increased between 2001 and 2003 (see Chapter 5.6).
• Health problems at house parties as a result of ecstasy and amphetamine use have been less and
less frequent since 1996 (see Chapter 5.6).
• The number of recorded acute deaths as a result of ecstasy and amphetamine use is low (see
Chapter 5.7).
• The use of ecstasy may have a long-term negative effect on brain functions, in particular of the
memory, the capacity to concentrate and mood (see Chapter 5.7).
• Ecstasy tablets nowadays almost always contain MDMA. The proportion of ecstasy tablets with a
high dose of MDMA increased slightly between 2000 and 2003 (see Chapter 5.8).
5.2 USE: GENERAL POPULATION
• The number of Dutch people aged 12 and over with experience of ecstasy or amphetamines (ever
10
use) rose between 1997 and 2001 (see Table 5.1).
• The percentage of current users remained far below one percent for both substances combined.
a
Substances that are not similar to MDMA at all are also recommended as ecstasy.
75
• In absolute figures, the number of current users of ecstasy was 67,000 and the number of current
users of amphetamine was 30,000. These estimates are probably rather low, because problem
users of hard drugs were underrepresented in that particular survey.
Table 5.1 Ecstasy and amphetamine use in the Netherlands among people aged 12 and
over. Survey years 1997 and 2001
Ecstasy Amphetamines
1997 2001 1997 2001
Has used ever in lifetime 1.9% 2.9% 1.9% 2.6%
• Men 2.7% 3.7% 2.7% 3.4%
• Women 1.0% 2.1% 1.1% 1.8%
I
Used just recently 0.3% 0.5% 0.1% 0.2%
• Men 0.4% 0.5% 0.2% 0.2%
• Women 0.1% 0.5% 0.1% 0.3%
First use in the past year 0.4% 0.5% 0.2% 0.2%
Mean age of current users 25 years 26 years 30 years -
I. In the last month. - = Not sufficient users for a reliable estimate of the average age. Source: National
Prevalence Research (NPO), Centre for Drug Research (CEDRO).
Figure 5.1 Ecstasy and amphetamine users in the Netherlands by age group. Survey year
2001
%
15
10
0
12-15 16-19 20-24 25-29 30-34 35-39 40-49 50-59 60-69 >=70 Age
Ecstasy ever 0.5 5.5 13.6 7.1 5.0 2.6 1.0 0.6 0.0 0.0
Amphetamines ever 0.2 3.9 9.5 4.2 3.8 3.1 2.2 1.1 0.5 0.5
Ecstasy current 0.2 1.6 2.5 0.8 0.7 0.3 0.1 0.2 0.0 0.0
Amphetamines current 0.2 0.7 0.9 0.2 0.4 0.1 0.1 0.2 0.0 0.0
• Ecstasy is especially popular among adolescents aged 20 to 24 incl. (see Figure 5.1). The
increase in the proportion of ever users was also largest in this group: from six percent in 1997 to
thirteen percent in 2001. Current use rose from more than one to nearly three percent. The
percentage of current users also doubled among young people aged 16 to 19 incl. (an increase of
0.8% to 1.6%).
• The percentage of amphetamine users also peaked among young adolescents aged 20 to 24 incl.
(see Figure 5.1). In this group, ever use rose from four percent in 1997 to nearly ten percent in
2001. Current use rose in this period from 0.3 to 0.9 percent.
76
• The increase in current users of ecstasy and amphetamines was larger among women than
among men. In 2001 nearly as many women were current consumers as men.
• In 2001, nearly one in three (30%) ever users aged twelve and above had used ecstasy 25 times
10
or more in life. In 1997 this was 25 percent.
The large cities
Large cities and other primarily urban areas have a comparatively higher percentage of ecstasy and
amphetamine use than the rest of the Netherlands. Amsterdam leads in both survey years (see Figure
5.2).
Figure 5.2 Use of ecstasy (figure above) and amphetamines (figure below) in large cities
and rural areas among people aged 12 and over. Survey years 1997 and 2001
% ecstasy
10
8.7
8
7.0
6 5.3
4.3
4
2.6
2.2
2 1.2 1.4
1.1 1.1 1.0 0.9
0.5
0.1 0.1 0.3
0
Amsterdam Rotterdam Highly Non-urbanised
urbanised, other
% amphetamines
10
8
6.6
6.0
6
4.2
3.8
4
2.7 2.8
2 1.1
1.4
0.2
0.3 0.3 0.1 0.3
0.2 0.1 0.2
0
Amsterdam Rotterdam Highly Non-urbanised
urbanised, other
Ever 1997 Ever 2001 Current 1997 Current 2001
Percentage of ever (lifetime) and current (last month) users. Definition (Statistics Netherlands (CBS)): Other
highly urbanised municipalities: more than 2,500 addresses per square kilometre, with the exception of
Amsterdam and Rotterdam, namely Delft, The Hague, Groningen, Haarlem, Leiden, Rijswijk, Schiedam,
Utrecht, Vlaardingen and Voorburg. Definition of rural municipalities: fewer than 500 addresses per square
kilometre. Source: National Prevalence Research (NPO), Centre for Drug Research (CEDRO).
77
5.3 USE: YOUNG PEOPLE
Figures about the use of ecstasy and amphetamines among young people are shown in Figure 5.1, in
which the percentage of users among the general population, resulting from the National Prevalence
Research, has been classified by age group. In the last few years, information about the use of
substances has also become available from numerous local and regional youth monitors carried out
for cities and towns. For amphetamine and ecstasy the information is more limited than for cannabis
and legal substances, because questions about the use of ‘hard drugs’ are often not classified by
substance. The tables in Appendix F show the results for eight (amphetamine) and eleven (ecstasy)
municipalities or regions. It is difficult to compare the figures due to methodological differences, such
as the manner of measuring use and age groups.
In addition to these general data, information is available from the Dutch National School Survey and
(often local) surveys among special groups, such as visitors of clubs and pubs. These data will be
described below.
Pupils
• The percentage of ecstasy and amphetamine users among secondary school pupils increased
16
between 1992 and 1996.
• The percentage of ever users of the two drugs decreased by fifty percent between 1996 and 2003.
The decrease took place in particular between1996 and 1999.
• The percentage of current users of ecstasy and amphetamine dropped also between 1996 and
2003 (see Figure 5.3).
Figure 5.3 Ecstasy and amphetamine use among pupils aged 12 and over, from 1992
% Ecstasy % Amphetamines
7 7
6 6
5.8
5.3
5 5
4 4
3.8
3.4
3 2.9 3 2.8
2.3 2.2 2.2

2 2 1.9
1.4
1 1.1
1 1.0 1 0.8
0.6
0 0
1992 1996 1999 2003 1992 1996 1999 2003
Ever Current Ever Current
Trimbos Institute.
78
Special groups
In certain groups of young people, proportionately more users of ecstasy and amphetamines are
found. Table 5.2 summarises the results of a broad spectrum of studies. The figures in this table
cannot be compared with one another because of differences in age groups and research methods.
• According to less recent data, ecstasy and amphetamine use is more frequent among pupils in
special education and participants in truancy programs than among 'regular' pupils (see Table
5.2). However, the figures should be interpreted with caution in view of the recent decrease in
25
(ever) use among ‘regular’ pupils and young clubbers (see below).
Table 5.2 Ecstasy and amphetamine use in special groups

Location Survey Age Ecstasy Amphetamines
year (year)
Ever Current Ever Current
Young people in special Nationwide 1997 12 - 18 9% 4% 7% 3%
I
education
Young people in truancy Nationwide 1997 12 - 18 30% 15% 25% 9%
programs
Visitors of trendy clubs Amsterdam 2003 Mean age 26 33% 19% 34% 7%
II
Pub visitors Amsterdam 2000 Mean age 25 34% 10% 17% 2%
Young clubbers The Hague 2003 15 - 35 35% 17% - -
III
Young homeless people Nationwide 1999 15 - 22 55% 18% 47% 10%
Flevoland 2004 13 - 22 38% 8% 26% 2%
IV
Coffee shop visitors Amsterdam 2001 Mean age 25 63% 23% 39% 5%
Percentage of ever users (in lifetime) and current (last month) per group. The figures in this table cannot be
compared with one another because of differences in age groups and research methods. - = not measured.
I. Special School for Children with Learning Difficulties (MLK), Special School for Children with Learning and
Behavioural Difficulties (LOM), Special School for Children with Severe Behavioural Learning Problems (ZMOK).
II. A selective sample of young people and adolescents visiting mainstream, student, gay and trendy pubs. This
sample is therefore not representative for all pub visitors. III. Young people of up to 23 years without a fixed
17;22-25
address for three months or longer. IV. Low response (15%). References: .
Ecstasy continues to be (after cannabis) the main illegal drug for young people in the clubbing circuit,
in particular parties, although there are indications of a tendency to moderate the use.
• According to the Amsterdam Antenne Monitor the percentage or current ecstasy users among
18
visitors of trendy clubs dropped from 41 percent in 1998 to 19 percent in 2003. The proportion of
users during the night out dropped from 27 to 8 percent. In 2003, they took 1.9 pills per night: this
does not differ (significantly) from 1998 (2.4 pills per night).
• In The Hague the percentage of ecstasy users among young clubbers was at the same level as in
21
Amsterdam.
• Elsewhere in the country, key figures in the partying circuit also noted that young clubbers handled
ecstasy ‘more prudently’ and were better informed of the risks. Visitors of discotheques in rural
20
areas in the eastern part of the country do not seem to be an exception.
• The experience or expectation of negative physical and emotional effects of ecstasy use, such as
headaches, dizziness, feelings of anxiety or depression, seem to discourage the use of it by young
188
people.
Amphetamines are less popular among young clubbers than ecstasy.

• In Amsterdam the percentage of visitors of trendy clubs who had ever used this drug dropped from
45 percent in 1998 to 34 percent in 2003. The percentage of current users dropped from 13
percent to 7 percent.
79
• At hardcore parties and in certain (alternative) scenes, amphetamines are used somewhat more
20
frequently (punk, electro, trance, underground, rock and techno) than in trendy clubs.
5.4 PROBLEM USE
• The number of problem users of ecstasy and amphetamines — i.e. people whose drug use leads
to role limitations or even dependence — is not known. However, the number of individuals who
seek drug treatment or counselling is known (see Chapter 5.6).
General population
Table 5.3 presents information about the use of ecstasy and amphetamines in a number of EU
Member States, Norway, Australia, Canada and the United States.
• Differences in survey year, methods of measurement and random samples make precise
comparison difficult. Of particular influence is the age group. Table 5.3a shows consumption
figures (re)calculated in accordance with the standard age group of the European Monitoring
Centre for Drugs and Drug Addiction (EMCDDA) (15 to 64 years incl.). Data for the other countries
can be found in Table 5.3b.
• As regards ever use of ecstasy, England & Wales, Australia and Ireland beat them all with values
over five percent. In Denmark, France, Portugal, Greece and Sweden, the percentage of ever
users does not exceed one percent.
• The percentage of people who ever used amphetamines varies from less than one percent in
Portugal and Greece to nine percent in Australia and the United States, while England and Wales
peak with twelve percent.
• Australia tops the list of the countries shown in Tables 5.3a and 5.3b with the highest percentage
of recent users of both drugs. The Netherlands takes one of the highest positions for use of
ecstasy.
80
Table 5.3a Amphetamine and ecstasy use in the general population of
several EU Member States and Norway: age group from 15 to 64 years incl.
Country Year Ecstasy Amphetamines
Ever Recent Ever Recent
Northern Ireland 2002/2003 5.9% 1.7% 3.9% 0.8%
Spain 2001 4.2% 1.9% 3.0% 1.2%
Ireland 2002/2003 3.8% 1.1% 3.0% 0.4%
The Netherlands 2001 3.6% 1.5% 3.1% 0.6%
Finland 2002 1.4% 0.5% 2.2% 0.5%
Norway 1999 2.4% 0.7% 2.6% 1.2%
Belgium 2001 - - 2.1% -
Luxembourg 1998 1.2% - - -
France 2000 0.9% 0.2% 1.5% 0.2%
Portugal 2001 0.7% 0.4% 0.5% 0.1%
Greece 1998 0.3% 0.1% 0.6% 0.0%
Sweden 2000 0.2% 0.2% 1.9% 0.2%
37;38
Percentage of ever in lifetime and recent (last year) users. - = not measured. References:
Table 5.3b Ecstasy and amphetamine use in the general population of several EU Member
I
States, the United States, Canada and Australia: other age groups
Country Year Age Ecstasy Amphetamines
Ever Recent Ever Recent
England and Wales 2002/2003 16 - 59 6.6% 2.0% 12.3% 1.6%
Australia 2001 14 and 6.1% 2.9% 8.9% 3.4%
above
United States 2003 12 and 4.6% 0.9% 8.8% 1.2%
above
Canada 2002 15 and 2.9% 0.8% 4.6% 0.5%
above
Italy 2001 15 - 44 1.8% 0.2% 1.5% 0.1%
Germany (‘West’) 2000 18 - 59 1.6% 0.7% 2.3% 0.6%
Denmark 2000 16 - 64 1.0% 0.5% 5.9% 1.3%
Percentage of ever in lifetime and recent (last year) users. I. Drug use is proportionally low in the youngest (12-15
years) and the older age groups (>64 years). Consumption figures in studies with respondents who are younger
and or older than the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) standard may turn
out lower than the figures in studies applying the EMCDDA standard. For studies with a more limited age range
37-41
the reverse applies. References:
Young people
Better comparable are the data of the European School Survey Project on Alcohol and Other Drugs
(ESPAD) among pupils aged 15 and 16 in European countries. Table 5.4 portrays ecstasy and
amphetamine use in a number of EU countries and Norway. Belgium, Germany and Austria only
participated in 2003. The United States did not take part in the ESPAD, but conducted comparable
43
research.
81
• The number of pupils who tried ecstasy in 2003 was lowest in Finland, Greece, Denmark, Norway
and Sweden (2% or less). The United States topped the list with six percent, followed closely by
the Netherlands, Ireland and the United Kingdom with five percent. In none of the countries
current use of pupils exceeded two percent.
• Of the countries listed in Table 5.4, Germany, Austria and Denmark scored highest for current use
of amphetamines (4 - 5%). The United States scored exceptionally higher with 13 percent. The
Netherlands shared the lowest position with Finland, Greece, Ireland and Sweden. In most of the
countries, maximum one percent of the pupils recently used amphetamines, with the exception of
the United States (2%), Austria (3%) and Spain (2%).
Table 5.4 Ecstasy and amphetamine use among pupils aged 15 and 16 in a number of EU
Member States, Norway and the United States. Survey years 1999 and 2003
Country Ever use ecstasy Ever use amphetamines
1999 2003 1999 2003
United States 6% 6% 16% 13%
Austria - 3% - 4%
Ireland 5% 5% 3% 1%
Belgium - 4% - 2%
The Netherlands 4% 5% 2% 1%
United Kingdom 3% 5% 8% 3%
France 3% 4% 2% 3%
Germany - 3% - 5%
Denmark 3% 2% 4% 4%
Norway 3% 2% 3% 2%
Italy 2% 3% 2% 3%
Greece 2% 2% 1% 0%
Portugal 2% 4% 3% 3%
Finland 1% 1% 1% 1%
Sweden 1% 2% 1% 1%
Percentage of ever users (in lifetime). The United States did not take part in the ESPAD, but conducted
comparable research. - = not measured. Source: European School Survey Project on Alcohol and Other Drugs
(ESPAD).
Ecstasy
• The number of recorded admissions in the (outpatient) care organisations for addicts primarily for
ecstasy rose until 1997(see Figure 5.4). This was partly due to an improved registration system.
From 1997 this number started to decline, followed by a stabilisation from 1999. Between 2002
88
and 2003 the number increased by eleven percent.
• With one percent, ecstasy problems accounted for a small proportion of the total number of
requests for drug treatment or counselling.
• Characteristics of the primary ecstasy clients in 2003 were:
- About three quarters (74%) were men.
82
- The average age was 25.
- Over one-third (38%) were new clients of the (outpatient) care organisations for addicts.
• There were more clients stating ecstasy as a secondary than as a primary problem.
- The primary problem for this group of secondary ecstasy clients was cocaine (42%), cannabis
(25%), alcohol (15%), or amphetamines (14%).
Figure 5.4 Number of recorded admissions in the (outpatient) care organisations for
I
addicts because of primary or secondary ecstasy problems, from 1994
1000
900
800
700
600
500
400
300
200
100
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Primary 29 208 398 457 340 252 241 225 250 277
Secundary 32 321 552 672 607 549 573 563 622 655
I. In 1994, not all the ecstasy-related problems were fully recorded yet.
Amphetamines
• The number of admissions primarily for amphetamine-related problems increased until 1998 but
declined again from 2001. Between 2002 and 2003, the number of amphetamine clients increased
by 35 percent (see Figure 5.5).
• With three percent of the total of drug-related treatment requests in 1999 and two percent in 2000
to 2003 incl., amphetamine-related problems remained all those years below the treatment
requests of other drugs.
• Characteristics of the primary amphetamine clients in 2003 were:
- Over three quarters (78%) were men.
- The average age was 28, slightly higher than that of the ecstasy clients.
- About a third (37%) of amphetamine clients who sought help from the (outpatient) care
organisations for addicts were new clients.
• Amphetamines were a secondary problem for over six hundred clients.
- The primary problem for this group was cocaine (35%), alcohol (20%), heroin (18%), cannabis
(17%), or ecstasy (6%).
83
Figure 5.5 Number of recorded admissions in the (outpatient) care organisations for
addicts because of primary or secondary amphetamine problems, from 1994
1000
900
800
700
600
500
400
300
200
100
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Primary 497 566 667 794 870 810 623 482 543 735
Secundary 489 566 558 610 590 560 498 474 481 552
(IVZ).
• This dated information shows that the use of ecstasy or amphetamine rarely leads to admission in
a drug treatment clinic or general psychiatric hospital.
• Between 1996 and 1999, the Patients Admission Tracking System for Intramural Mental Health
Care (PiGGz) recorded 58, 51, 39 and 25 admissions respectively for ecstasy and amphetamines
combined (ICD-9 codes 304.4 and 305.7; see Appendix C).
The National Medical Registration (LMR) registers few admissions annually in general hospitals for
amphetamine-related problems, including ecstasy (See Figure 5.6).
• In 2003, it concerned ten percent of all primary diagnoses for drugs. Most of the admissions (87%)
related to abuse; 13 percent related to dependence of amphetamines.
• The percentage of admissions in which these disorders were diagnosed as secondary problem
was slightly higher. The main disorders diagnosed — where amphetamine abuse and dependence
were diagnosed as secondary problem — were very diverse. A quarter of the admissions in 2003
involved alcohol abuse and dependence.
84
2003. They were admitted at least once this year with amphetamine abuse or dependence
diagnosed as primary or secondary problem. The average age was 30 years and 72 percent were
male.
• Accidental amphetamine overdose was listed as secondary diagnosis (ICD-9 code E854.2) in 25
hospital admissions.
Figure 5.6 Clinical admissions in general hospitals for amphetamine abuse and dependence,
from 1994
Number
100
80
80 69 70
66
61 63
58
60
46
40 33
29 30
33 36
29 29 29
20 24 25
23 21
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Amphetamines as primary diagnosis
Amphetamines as secondary diagnosis
admission. ICD-9 codes: 304.4, 305.7 (Appendix C). Ecstasy and amphetamine are recorded under the same
codes. Source: National Medical Registration (LMR), Prismant.
The Amsterdam Area Health Authority (GG&GD Amsterdam) records the number of calls for
emergency aid received by the Central Ambulance Service.
• In 2003, calls for emergency aid were 39 times ecstasy-related, approximately the same as in the
previous years. Exceptionally high was 1996, with 66 calls (see Table 5.5).
• In 2003, twenty-five ecstasy users (64%) required transportation to hospitals.
• The most common complaints in ecstasy-related incidents noted by the Amsterdam hospital Onze
Lieve Vrouwengasthuis were heart palpitations and fainting, ‘feeling unwell’ and anxiety. Fainting
44
only occurred in people who had consumed ecstasy in combination with alcohol and/or GHB.
Table 5.5 Amphetamine- and ecstasy-related drug incidents recorded by the Amsterdam
Area Health Authority (GG&GD Amsterdam), from 1995
1995 1996 1997 1998 1999 2000 2001 2002 2003
Amphetamines 6 1 7 7 7 30 6 5 7
Ecstasy 38 66 41 35 43 36 42 39 39
Number of incidents (people) per year. Source: Central Ambulance Station (CPA), Amsterdam Area Health
Authority (GG&GD Amsterdam).
According to Stichting Educare, an organisation that provides first aid at house parties in the
Netherlands, the number of acute health problems as a result of drug use is relatively small and is
89
decreasing.
85
• From 1996 to 2002 incl., Stichting Educare provided care to 15,000 people in total at 134 parties.
• The number of visitors who sought assistance for health problems from the First Aid decreased
from 1.2 to 0.8 percent in this period.
• In the course of years, amphetamines and ecstasy were increasingly less involved in these
incidents and alcohol increasingly more.
- The proportion of amphetamine-related incidents in all substances-related incidents
decreased from 17 percent in 1996 to 2 percent in 2002.
- For ecstasy, Stichting Educare recorded a decrease from 47 percent to 20 percent.
- As distinct from this downward trend for drugs, an increase in alcohol-related health problems
from 4 to 17 percent was recorded.
• In the case of both ecstasy and amphetamine users, mainly light complaints were reported, such
as feeling unwell, headaches, nausea and dizziness.
• Recent observations by health workers who are active at parties confirm the downward trend of
20
ecstasy-related incidents.
Illness
The latest state of the art indicates that ecstasy use may cause long-term brain function disorders, in
90
particular of the memory, the capacity to concentrate and moods.
• This disorder may continue for more than a year after discontinuation of the use. It is unknown
whether full recovery is made.
• These changes are probably connected with damage to serotonergic nerves in the brain, but the
use of other substances in addition to ecstasy may also come into it.
• In laboratory animals the chance of brain damage increases with an increase in body temperature
after MDMA use. It is assumed that the same is true for human beings.
• The chance of overheating, resulting in (long-term) brain damage increases, if a consumer takes
larger quantities of MDMA in a warm environment (over 18-20 degrees). It is not known which
quantity exactly results in damage. It is assumed that damage is already done in case of intake of
highly dosed pills containing twice to three times the average dose.
• Research at the University of Amsterdam will show in due course whether short-term use may
also cause damage to and a decrease of brain functions.
Mortality
The exact number of deaths caused as a result of amphetamine or ecstasy use is not known.
• According to the Cause of Death Statistics of Statistics Netherlands (CBS), use of these
substances is not often the primary cause of death. In the period 1996 - 2002, a maximum of four
acute deaths annually were recorded. In 2003, Statistics Netherlands (CBS) recorded seven
cases (ICD-10 codes F15, X41*, X61*, Y11* [* together with code T43.6]; for an explanation of the
codes see Appendix C). These codes do not only include amphetamines and MDMA(-like)
substances, but also other stimulants, such as caffeine, ephedrine and khat.
• In 2002, the Amsterdam Area Health Authority (GG&GD Amsterdam) reported two deaths in which
MDMA may have been involved. There is no national survey.
According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), ecstasy plays
a minor part in drug-related deaths in other European countries as well, at least in so far as
37;18
information is available.
86
• An exception seems to be the United Kingdom, where an increase in ecstasy-related deaths was
91
recorded from 12 cases in 1996 (from August) and 1997 to 72 cases in 2001 to April 2002.
• In the United Kingdom, from August 1996 to April 2002 incl., a total of 202 deaths were recorded
that were allegedly ecstasy-related. In seventeen percent of the cases, only MDMA or an MDMA-
like substance was found in a toxicological examination. In the other cases, other substances
were also found, in particular opiates, alcohol, cocaine and amphetamine.
• Other factors that may have contributed to these deaths are overheating, water intoxication or an
underlying decease.
• The increase between 1996 and 2002 may also have resulted from a changed registration
practice. Autopsists are said to report ecstasy increasingly as possible cause of death.
The Drugs Information and Monitoring System (DIMS) examines the substances in drug samples that
are turned in to care organisations for addicts. Part of these samples (pills) is identified by the
organisation itself on the basis of characteristics like logo, weight and diameter. Samples of unknown
composition and all the samples in powder form are forwarded to the laboratory for chemical analysis.
The number of samples that consumers hand to DIMS annually has strongly decreased since 1997.
This is probably connected with the discontinuation of participation of the Safe House Campaign at
parties (Drug Consultation Bureau - Stichting Adviesburo Drugs), the increased consumer confidence
in the fairly stable composition of pills and a reduction of the number of pills that a user can have
89
tested each time.
Composition of ecstasy pills
The number of pills sold as ecstasy that were recognised at test locations dropped from 4,320 in 1997
to 688 in 2003. The number of ‘ecstasy’ pills that were analysed in the laboratory remained fairly
stable. Table 5.6 shows the percentage of the analysed pills containing MDMA and or another
substance.
• In the last few years, the proportion of pills containing only MDMA or a MDMA-like substance
increased strongly, whereas the proportion of pills containing (also) another psychoactive
substance, such as amphetamine, decreased.
• In 2003, over 95 percent of the 'ecstasy’ pills actually contained MDMA, MDEA or MDA, or a
combination of these substances.
• In that year, the average concentration of MDMA in ecstasy pills was 78 mg, approximately the
same as in the previous years. Figure 5.7 shows, however, that the proportion of ecstasy pills with
a high quantity of MDMA (more than 140 mg) rose slightly from one percent in 1997 and 1998 to
six percent in 2003. The highest measured quantity in 2003 was 215 mg.
87
Table 5.6 Number and composition of (ecstasy) pills handed to the Drugs Information and
Monitoring System (DIMS), from 1997
Substances (% of pills) 1997 1998 1999 2000 2001 2002 2003
MDMA 44.6% 75.2% 82.0% 89.5% 91.4% 88.7% 91.2%
MDEA 8.2% 1.3% 1.4% 0.9% 1.2% 0.4% 0.5%
MDA 1.5% 2.2% 2.8% 2.0% 0.7% 1.4% 0.9%
Combination of MDMA, MDA and or MDMA 2.6% 1.6% 1.0% 3.0% 3.0% 1.7% 2.1%
Combination of MDMA, MDA and or another 9.0% 4.3% 3.3% 1.2% 0.9% 3.7% 2.1%
I
psychoactive substance
Pills without MDMA, MDEA and or MDA:
II
Amphetamine 15.5% 6.5% 3.9% 0.9% 1.0% 1.7% 1.0%
Methamphetamine 0.3% 0.3%
I
Another psychoactive substance 14.7% 4.5% 2.7% 1.6% 1.2% 1.3% 0.7%
No psychoactive substance 3.9% 4.3% 2.9% 0.8% 0.5% 0.8% 0.8%
Total number of analysed pills 2,434 2,713 2,306 2,497 2,402 2,149 2,187
Percentage of pills that contain a specific substance or combination of substances. Categories are mutually
exclusive.
I. E.g. 2-CB, MBDM, DOB, PMA, caffeine, ephedrine etc. II. Until 2002 no distinction was made between
amphetamine and methamphetamine. Source: Drugs Information and Monitoring System (DIMS), Trimbos
Institute.
Figure 5.7 Concentration of MDMA in ‘ecstasy’ pills handed to DIMS
100%
80%
60%
40%
20%
0%
1997 1998 1999 2000 2001 2002 2003
>140 mg 1 1 1 2 4 4 6
106-140 mg 6 5 6 9 14 11 12
71-105 mg 36 27 29 35 49 42 38
36-70 mg 39 53 52 45 28 39 38
1- 35 mg 17 15 11 9 5 5 7
Percentage of pills with a certain quantity of MDMA. It relates to pills that were tested in the laboratory and
contain at least 1 mg MDMA. Source: Drugs Information and Monitoring System (DIMS), Trimbos Institute.
Other substances
Table 5.7 shows the number of samples (ecstasy pills, powders or otherwise) found by DIMS to
contain substances that are continuously examined in a European framework and or may be a danger
to public health.
88
b
• Most of the substances in Table 5.7 had virtually disappeared from the market by 2003 .
• The presence of pills containing atropine and DOB led to health warning campaigns in 1997/1998
and 1999. In 2000, a health warning campaign was launched in response to pills with harmful
levels of strychnine.
• Another campaign was launched in 2001, after a pill with dangerous levels of PMA was found
(over 50 milligrams).
• The former anaesthetic agent GHB is also regularly handed to DIMS. In 2001 it concerned 102
samples (usually liquids) and, in 2002 and 2003, 72 samples were involved annually. In the last
few years, GHB has become popular in certain circles. Meanwhile the use seems to have
stabilised and in Amsterdam there are indications that the interest in this substance is decreasing
18;20
again.
Table 5.7 Number of samples with other psychoactive substances

1997 1998 1999 2000 2001 2002 2003
2C-B 317 12 25 12 11 2 2
4-MTA 9 16 8 6 1 5 0
Atropine 128 52 0 1 0 0 0
DOB 1 15 26 5 5 0 0
Ketamine 0 16 1 2 1 2 3
MBDB 113 12 0 0 0 0 0
I
PMA/(PMMA) 1 8 0 0
Strychnine 1 0 0 0
I. Pills containing more than 1 milligram. Source: Drugs Information and Monitoring System (DIMS), Trimbos
Institute.
Composition of (meth)amphetamine samples
DIMS receives also samples (mainly powders) that were sold as ‘speed’. In 2003, it involved 393
samples.
• Most of them (85%) contained (also) amphetamine; three percent contained both amphetamine
and methamphetamine and three percent contained only methamphetamine. Methamphetamine is
stronger and has a more prolonged effect than amphetamine.
• The average percentage of amphetamine was 33 (by weight).
• The proportion of samples in which caffeine was found rose from 32 percent in 2002 to 54 percent
in 2003.
Prices
The prices paid by consumers for ecstasy and amphetamine are not systematically recorded. Trends
in prices can therefore not be reported. Recent figures from the Antenne Monitor and the Drugs
Information and Monitoring System (DIMS) project, however, give an indication of the current situation.
• In 2003, young clubbers in Amsterdam paid over three euros on average per pill when buying
18
several pills in one time from a house dealer. Per single pill the price was somewhat higher: 4.25
euros on average. Dealers in the clubbing circuit demand higher prices: 5.52 euros on average
per pill when buying one.
b
End 2004 cocaine samples were found to have been mixed with harmful quantities of atropine. In the
Netherlands a warning campaign was started after people had been hospitalised in various places - also in Italy,
Belgium and France - with cocaine/atropine intoxication.
89
• Consumers who had pills tested by DIMS paid in 2003 between 1 and 7.5 euros per pill with an
average of 3.50 euros.
90
6 ALCOHOL
Alcohol is produced through the yeasting of grains and grapes. Alcohol is drunk as beer, wine or
distilled spirits. A glass of beer, a glass of wine and a glass of distilled spirits contain each
approximately the same amount of alcohol.
In social situations, consumers experience alcohol as having a relaxing effect and promoting a
good mood. In less social situations, alcohol may increase an aggressive mood. Alcohol is an
addictive substance. Regular use results in habituation and tolerance. Excessive use of alcohol may
lead to several diseases, in particular liver diseases, cardiovascular diseases and cancer.
The main facts and trends regarding alcohol in this chapter are:
• Sales figures indicate that the per capita consumption of alcohol dropped slightly in 2003. This
drop can be attributed to the drop in the consumption of distilled spirits (see Chapter 6.2).
• Alcohol use among pupils increased between 1999 and 2003, particularly among young girls aged
between 12 and 14.
• Compared to pupils in other countries, Dutch pupils are frequent drinkers. (See chapter 6.5).
• In spite of a legal ban, it is relatively easy for young people under the age of 16 to purchase
alcoholic beverages, particularly in hotel and catering establishments, supermarkets and groceries
but also in off licences (see Chapter 6.3).
• Heavy drinking is proportionally more prevalent among male adolescents aged 18 to 24 incl.
Adolescent males relatively often are involved in traffic accidents, in which alcohol is a contributing
factor or the cause (see Chapter 6.4).
• Ten percent of the Dutch population aged 16 to 69 are problem drinkers.
• Between 2001 and 2003, the number of recorded admissions in the (outpatient) care
organisations for addicts for alcohol problems increased (see Chapter 6.6).
• The number of traffic-related fatalities and injuries caused by alcohol use fell slightly in the last few
years (see Chapter 6.6).
• Total mortality due to alcohol-related disorders (primary and secondary causes of death together)
increased slightly between 2001 and 2003 (see Chapter 6.7).
• Excessive alcohol consumption is the main determinant of loss of quality of life (see Chapter 6.7).
Alcohol consumption is widespread in Dutch society.

• According to a Statistics Netherlands (CBS) survey of 2003, 85 percent of the population aged 16
and over has ‘the occasional drink’. This represents an increase compared to the middle of the
nineties, when only 79 percent of the population consumed alcohol. In the last few years,
92
however, this percentage has been fairly stable.
• National Prevalence Surveys (see Appendix B) confirm the use of alcohol in all segments of Dutch
10
society.
- In 2001, 92 percent of the Dutch population aged 12 and over had ever used alcohol and 75
percent had used alcohol recently (in the last month). 20 percent of the recent consumers
drank (almost) daily.
- In 1997, 90 percent had ever consumed alcohol and 73 percent had used alcohol recently. 24
percent of the recent consumers drank alcohol every day.
91
a
• Research conducted in The Hague (2001) and Amsterdam (1999/2000) suggests that alcohol use
b 93;94
is considerably lower among Moroccan and Turkish people than among native Dutchmen.
- The percentage of alcohol consumers among Moroccan and Turkish men was between 6 and
12 and between 23 and 28 percent respectively. The percentage of men of Dutch descent was
between 82 and 88 percent in both cities.
- The percentage of alcohol consumers among Moroccan and Turkish women was between
zero and two percent and between two and eleven percent respectively. Among women of
Dutch descent this was 70 to 71 percent.
Sales figures give an indication of the annual per capita alcohol consumption (see Table 6.1).
• Alcohol consumption in the Netherlands was highest in the second half of the seventies and in the
eighties. This was followed by a slight decline, which trend discontinued from the early nineties.
However, from 2001 a slight decrease in alcohol consumption is apparent.
• In 2003, the per capita consumption was 7.9 litre of pure alcohol. This was 0.1 litre less than in
2002.
• This drop can be attributed to the drop in the consumption of distilled spirits. This dropped in 2003
by nearly ten percent compared to the previous year. This may be connected with the increase in
excise duty on distilled spirits per 1 January 2003 (see Chapter 6.8).
• The sale of premixes decreased in 2003 to over 200,000 hectolitres, a drop of one third compared
to 2002.
• Per person the Dutch drank 79 litres of beer, 20 litres of wine and 4 litres of distilled spirits.
Table 6.1 Beer, wine and distilled spirits per capita (in litres of pure alcohol), from 1960
Year Beer Wine Distilled spirits Total
1960 1.2 0.2 1.1 2.6
1965 1.9 0.5 1.9 4.2
1970 2.9 0.8 2.0 5.7
1975 4.0 1.5 3.4 8.9
1980 4.8 1.4 2.7 8.9
1985 4.2 2.0 2.2 8.5
1990 4.1 1.9 2.0 8.1
1995 4.1 2.2 1.7 8.0
2000 4.1 2.3 1.7 8.2
2001 4.0 2.3 1.7 8.1
2002 4.0 2.3 1.7 8.0
2003 4.0 2.4 1.5 7.9
95;96
Source: Commodity Board for Distilled Spirits (PGD) 2002; Commodity Board for Wine.
a
The Amsterdam figures only refer to Moroccan and Turkish persons aged 35 and over. Because of the absence
of an adequate number of younger respondents, reliable figures could not be presented. The percentages of
alcohol consumers most likely are higher among the younger Moroccan and Turkish persons.
b
For the definition of ethnic backgrounds, the Amsterdam Area Health Authority (GG&GD Amsterdam) follows
the definition of the Ministry of the Interior / Association of Dutch Municipalities (VNG): see Appendix A.
92
Special groups
• In 2002, over one-third (35%) of the homeless in twenty Dutch municipalities were risk drinkers
(defined here as consuming more than 25 glasses per week); 23 percent drank more than 56
11
glasses per week and 13 percent drank more than 112 glasses per week.
• Approximately 4 percent of the drinking working labour force drinks alcohol sometimes just before
97
or during work: one percent does this at least once a week.
- 38 percent consume sometimes alcohol immediately after work and 12 percent do this weekly.
In the hotel and catering business the proportion of those drinking immediately after work is
highest (31% weekly), in health care and public welfare work and in public administration this
97
is lowest (5% and 4% weekly).
For the classification of alcohol consumption among pupils aged twelve and over, figures are available
from the National Representative School Survey (see Appendix B). In addition, in the last few years,
numerous local and regional surveys have been conducted commissioned by municipalities. In
Appendix F an overview is given of recent figures concerning the use of alcohol among young people
in 29 municipalities or regions in the Netherlands based on representative samples from the
population.
nevertheless, the figures give an impression of difference in alcohol use between the various
municipalities.
In this paragraph we shall also present the data from (often local) surveys among special groups of
young people.
Pupils
Since the mid-eighties the Trimbos Institute has monitored the extent to which secondary school
pupils aged 12 and over have experience with alcohol, tobacco, drugs and gambling. This is done in,
what is called, the Dutch National School Survey.
• In 2003, 85 percent of the pupils of ‘regular’ secondary schools had experience with alcohol. That
was more than in 1999, when still 74 percent had experience with alcohol. However, this
16
percentage fluctuated over the past fifteen years (see Figure 6.1).
• In 2003, 58 percent of all interviewed pupils had consumed alcohol in the month prior to the
survey, about the same as in 1999.
• Among young girls aged 12 to 14 incl. in particular, an increase in ever and previous month use
was apparent compared to 1999.
- In 1999, 57 percent of the girls aged 12-14 had ever drunk alcohol, in 2003 this had risen to 78
percent.
- In 1999, 32 percent had used alcohol in the last month, in 2003 this was 44 percent.
• Fifteen percent of the pupils reported they consumed their first alcoholic drink at age 10 or
younger, nearly twice as many boys (19%) as girls (10%). Most pupils start drinking between the
age of 11 and 14.
93
Figure 6.1 Alcohol consumption among pupils aged 12 and over, from 1988
%
90
85
80
79 79
74
70
69
60
58
54 55 54
50
Ever Current
45
40
1988 1992 1996 1999 2003
The percentage of consumers who ever used alcohol (in their lifetime) and in the month before the survey
16
(recent). Source: Dutch National School Survey, Trimbos Institute.
• In 2003 the percentages of boys and girls who ever or currently consumed alcohol did not differ.
There are differences, however, in drinking patterns. Boys drink alcohol more frequently than girls.
They also drink larger quantities than girls. All this concerns in particular older boys:
- Of the boys aged 16 who drank in the past month, 29 percent did this more then ten times in
that month compared to 19 percent of the girls.
- Also 29 percent of these drinking boys aged 16 drink more than ten glasses on average on a
weekend day. For the girls this is 9 percent.
• In 2003, nearly half the pupils (47%) aged 12 had already once drunk an alcoholic drink, while
those aged 15 consumed alcohol weekly (52%).
• Among pupils of Moroccan descent (aged 12-16) current alcohol consumption is significantly lower
c
than among pupils of Dutch descent (8% versus 63%). Pupils of Turkish or Surinam descent take
16
an intermediate position, with 15% and 47% respectively. However, there is no difference
98
between ethnic groups with respect to the quantity that is consumed per occasion.
• Alcohol use is often combined with smoking cigarettes. In 1999, one quarter (26%) of all the pupils
(12-16 years) had smoked cigarettes in the past month. Among drinking pupils this was 42
99
percent.
16
Among secondary school pupils, beer and breezers/premixes are most popular.
• Among boys, beer is the most popular drink: of the boys who used alcohol in the past month, 42
percent report they drink beer weekly.
• Among girls breezers are most popular: of the girls who had used alcohol in the past month, 30
percent drink breezers weekly.
Special groups of young people
In certain groups of young people and adolescents alcohol use is widespread.
c
For the definition of ethnic background: see Appendix A.
94
• University or college students drink more alcohol than other young people. In 1999, these students
consumed an average of 16 glasses per week (men 20 and women 8 glasses). Members of
student’s associations averaged 23 glasses per week (men 27 and women 12 glasses). Young
people of comparable ages consumed an average of 10 glasses per week (men 13 and women 7
glasses)0.100
• Holiday periods in particular are times in which much alcohol is consumed. A survey at youth
camp sites (average age 17.4) shows that more than 80 percent of the boys and nearly half the
girls use alcohol every day of the holiday. Boys drink daily seventeen glasses and girls seven on
101
average.
• Young people in a truancy program in Amsterdam are more often current drinkers (over 50%) than
18
their peers who do not play truant but go to school (40%).
• A survey in five municipalities in the Netherlands (Amsterdam, Breda, Hilversum, Tilburg and
22
Zaanstad) shows that one in ten young homeless drinks alcohol daily.
• Young people at ZMOK schools (special education for children with severe behavioural learning
problems) do not differ significantly in respect of frequency and intensity of alcohol use from young
people in regular education. When only young people of Dutch descent are compared, however,
102
young people at ZMOK schools drink more frequently and in larger quantities.
Many young people drink when they go out. Table 6.2 summarises the results of a number of surveys
among young clubbers. The figures in this table are not comparable due to differences in age
categories and research methods.
• In 2003, one fifth of the young clubbers aged 13 consumed alcoholic drinks when going out on the
town, two thirds of those aged 14 and 15 and nine in ten of those aged 16 and 17. These
103
percentages are lower for those aged 13 up to 15 incl. than in 2001.
• Nine in ten young people in The Hague (aged 15-35) who visit clubs and pubs consumed alcohol
21
in the past month and six in ten in the past week.
• Among fans of Hiphop/Rap/+R&B, alcohol consumption is lower than among fans of Pop/Rock or
Dance/House/Techno. This may be connected with the preference of Moroccan young people for
21
this type of music. Alcohol use is less common among Moroccans
• In Amsterdam, one third of both pub visitors, coffee shop visitors and the visitors of trendy clubs
17;18;104
drink alcohol daily or at least four or five glasses several times a week.
95
Table 6.2 Alcohol consumption among young clubbers
Population Location Survey Measurement for alcohol Age Percentage
year consumption (year)
I
Young clubbers general Nationwide 2003 in the past year 13 18
14-15 64
16-17 89
2001 13 39
14-15 74
16-17 91
II
Young clubbers general The Hague 2003 in the past month 15-35 88
in the past week 60
II
Hiphop/Rap/R&B The Hague 2003 in the past month 15-35 75
Pop/Rock 88
Dance/House/Techno 92
III
Pub visitors Amsterdam 2000 at least four or five 25 years on 33
glasses daily or several average
times a week
IV
Coffee shop visitors Amsterdam 2001 at least four or five 25 years on 30
times a week
V
Visitors of trendy clubs Amsterdam 2003 at least four or five 28 years on 33
times a week
The figures in this table cannot be compared with one another because of differences in age groups and research
103 21 104
methods. I. Source: Intraval. II. Source: Survey of clubbers in The Hague. III. Source: Antenne. . IV. Source:
17 18
Antenne. V. Source: Antenne.
6.4 PROBLEM USE
The scope of the alcohol problem depends on the applied definition. Research sometimes
differentiates between heavy drinking, problem drinking, irresponsible drinking and alcohol
dependence or alcohol abuse.
Heavy drinking
Statistics Netherlands (CBS) defines heavy drinking as consuming at least six glasses of alcohol on
one or more days per week.
• According to this definition, eleven percent of the population aged 12 and over consisted of heavy
drinkers in 2003. This is the same percentage as ten years ago. Since 2001, however, the
percentage of heavy drinkers has slightly decreased (see Figure 6.2).
• In 2003, four times more men than women were heavy drinkers.
• Young people aged 18–24 lead in the measurement heavy drinking. In 2003, the percentage of
heavy drinkers among adolescent men and women was 39% and 12% respectively (see Table
6.3).
• This is slightly lower than in 2002. Then 42 percent of the young adolescent men and 18 percent
of the adolescent women appeared to be heavy drinkers.
96
Figure 6.2 Percentage of heavy drinkers of alcohol among people aged 12 and over, from
2000
16
14
14
13
12
12 11
10
0
2000 2001 2002 2003
Source: Permanent Survey on Living Conditions (POLS), Statistics Netherlands (CBS).
Table 6.3 Heavy drinkers among people aged 12 and over by gender and age. Survey year
2003
Men Women Total
12-17 years 6% 6% 6%
18-24 years 39% 12% 25%
25-34 years 25% 4% 14%
35-44 years 16% 4% 10%
45-54 years 24% 3% 14%
55-64 years 14% 4% 9%
65-74 years 7% 1% 4%
75 years and over 4% 0% 2%
Total: 12 years and over 19% 4% 11%
The percentage of people consuming six or more glasses of alcohol on one or more days per week.
Source: Permanent Survey on Living Conditions (POLS), Statistics Netherlands (CBS).
Problem drinking
Problem drinkers are people whose alcohol consumption exceeds a certain threshold value, and who
report all kinds of effects of alcohol consumption.
• Ten percent of the Dutch population aged 16 to 69 are problem drinkers, more men (17%) than
women (4%).
Alcohol abuse and alcohol dependence
• According to dated data from the 1996 Netherlands Mental Health Survey and Incidence Study
(Nemesis), eight percent of the Dutch population aged 18–64 met the diagnostic criteria for
alcohol dependence or alcohol abuse (alcohol abuse 4.6% and alcohol dependence 3.7%). In
97
absolute numbers, 820,000 people annually were involved, approximately 4.5 times more men
28
than women.
• Alcohol abuse and dependence is most found among young men aged between 18 and 25; in
1996, eighteen percent met the criteria for alcohol abuse and thirteen percent met the criteria for
alcohol dependence.8
General population
• In 2002, alcohol consumption in Western Europe varied from 4.9 to 11.9 litre per capita (see
Figure 6.3). Compared with the other Western European countries, the Netherlands seems to take
a low middle position.
• Per capita alcohol consumption here is determined on the basis of alcohol sales figures. There are
considerable differences between individual countries as regards ‘unrecorded’ consumption, such
as private import, ‘duty-free’ purchases, and homebrewn alcohol products. Consequently, the
105
figures cannot be compared completely.
Figure 6.3 Alcohol consumption levels in a number of EU Member States, measured per
capita and in litres of pure alcohol. Survey year 2002
Luxembourg 11.9
Ireland 10.8
Germany 10.4
France 10.3
Portugal 9.7
Spain 9.6
United Kingdom 9.6
Denmark 9.5
Austria 9.2
The Netherlands 8
Belgium 7.9
Greece 7.8
Finland 7.7
Italy 7.4
Sweden 4.9
0 2 4 6 8 10 12 14 16
Source: Commodity Board for Distilled Spirits (PGD), Spirits Committee.
98
Young people
The European School Survey Project on Alcohol and Other Drugs (ESPAD) carried out among pupils
43
aged 15–16 included questions about the level of alcohol use and the frequency of intoxication.
• Table 6.4 portrays the consumption of alcohol in a number of EU countries and Norway. Belgium,
Germany and Austria only participated in 2003. The United States did not take part in ESPAD, but
conducted comparable research.
• In 2003, the Netherlands was in the top section of the list in the measurement 'consumed alcohol
forty times or more ever in life’.
• The Netherlands had a leading position in the measurement 'consumed alcohol at least ten times
in the month prior to the survey'.
• Dutch figures on pupils were significantly lower in the measurement ‘intoxication’. Approximately
one in eight pupils reported having been drunk at least twenty times ever in life.
• Between 1999 and 2003, the percentage of pupils who had consumed alcohol 10 times or more
increased in the Netherlands and Italy. This percentage decreased in Denmark.
• Twenty times or more drunkenness ever in life only decreased in Denmark in 2003, whereas it
remained stable in the other countries.
Table 6.4 Alcohol consumption and drunkenness among pupils aged 15 and 16 in a
number of EU Member States, Norway and the United States. Survey year 2003
Country Consumption: 40 Consumption: 10 Drunkenness: 20
times or more in times or more in times or more in
life the last month life
1999 2003 1999 2003 1999 2003
Denmark 59% 50% 18% 13% 41% 36%
Austria - 48% - 21% - 21%
The Netherlands 37% 45% 20% 25% 8% 6%
United Kingdom 47% 43% 16% 17% 29% 27%
Ireland 40% 39% 16% 16% 25% 30%
Germany - 37% - 11% - 12%
Belgium - 36% - 20% - 7%
Greece 42% 35% 13% 13% 4% 3%
Italy 17% 24% 7% 12% 2% 5%
France 20% 22% 8% 7% 4% 3%
Finland 20% 20% 1% 2% 28% 26%
Sweden 19% 17% 2% 1% 19% 17%
Norway 16% 15% 3% 3% 16% 14%
Portugal 15% 14% 6% 7% 4% 3%
United States 16% 12% 5% 4% 11% 7%
Percentage of the pupils. - = not measured. The United States did not participate in the European School Survey
Project on Alcohol and Other Drugs (ESPAD), but conducted comparable research. Source: European School
Survey Project on Alcohol and Other Drugs (ESPAD).
99

from (outpatient) care organisations for addicts. (See in Appendix A: Client LADIS.) In 2003, 26,874
persons were registered at the (outpatient) care organisations for drug addicts with alcohol use as
106
primary problem.
This is an estimated three percent of all the people showing alcohol abuse or alcohol dependence.
• The absolute number of clients with a primary alcohol problem in the (outpatient) care
organisations for drug addicts increased between 1994 and 1999 by twelve percent and stabilised
in 2000 and 2001. After 2001, however, an increase is apparent (see Figure 6.4). In 2002, the
number increased by seven percent and in 2003 by thirteen percent compared to 2001 and 2002,
respectively. This increase may be the effect of the Alcohol Action Plan of the care organisations
107
for drug addicts of the Mental Health Service (GGZ Netherlands).
• Characteristics of these clients in 2003 were:
- Most of them were men (75%). The percentage of women increased slightly in the last few
years.
- The average age was 44. Two thirds of the alcohol clients were aged forty or over. This made
the alcohol clients older than the drugs clients (see Figure 6.5).
- A quarter of the registered clients in 2003 were newcomers, i.e. they had not been registered
before for an alcohol-related problem at the (outpatient) care organisations for drug addicts.
- Only ten percent were immigrants (for the definition see Appendix A).
• Alcohol was indicated less often as a secondary problem.
- For this group the primary problem was cocaine (43%), heroin (23%), or cannabis (17%).
- The number of secondary alcohol clients has risen since 1997. In 2003, the number of
secondary alcohol clients increased by twelve percent compared to the year 2002.
• When comparing the period 2000-2003 to the period 1996-1999, an increase of the number of
alcohol clients is apparent in Brabant, Limburg and the northern half of the Netherlands. The other
regions show a decrease.
Figure 6.4 Number of clients in the (outpatient) care organisations for addicts for primary
or secondary alcohol problems, from 1994
30000
25000
20000
15000
10000
5000
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Primary 20085 20175 20939 21134 22378 22554 22365 22388 23849 26874
Secundary 2441 2473 2465 2622 2718 2847 3007 3945 4121 4631
Source: National Information System on Alcohol and Drugs (LADIS), Organisation Care Information Systems (IVZ).
100
Figure 6.5 Age categories of primary alcohol clients in the (outpatient) care organisations
20
%
17
16
15 14
13
10 10
10
6
5
5 4 4
0
15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 >64
age (years)
(IVZ).
Self-help via internet
On 23 November 2004, on www.MinderDrinken.nl a self-help site started for adult problem drinkers
(18+) who wish to lower their alcohol consumption independently. In two weeks’ time, 11,000 unique
visitors visited the site. Of those, 2,150 registered for the self-help program and 1,230 persons
108
effectively started using the interactive self-help module.
There are no recent nationwide data about the treatment demand at the inpatient care organisations
• In 1996, the Register of Inpatient Mental Health Care (PiGGz) recorded nearly 6,200 admissions
for problematic alcohol use, approximately the same order of magnitude as in the previous four
years.
• Alcohol dependence was diagnosed as the primary problem in over eight of ten admissions. Ten
percent of the admissions occurred as a result of alcohol abuse and six percent because of
alcohol psychosis, including Korsakov’s syndrome.
• Treatment in which patients participate in inpatient programs of a hospital/clinic as outpatients
(partial admissions) was limited, yet did increase until 1996.
101
General hospitals and incidents
• The number of clinical admissions in general hospitals with an alcohol-related disorder as primary
diagnosis rose slightly between 1994 and 2003 (see Figure 6.6).
d
• In 2003, 4,239 admissions took place with an alcohol-related disorder as primary diagnosis. The
most common diagnoses related to:
- alcoholic-related liver disease (29%, 1,245 admissions)
- alcohol abuse (27%, 1,151 admissions)
- alcohol dependence (17%, 719 admissions)
- alcohol poisoning and toxic consequences of alcohol (14%, 610 admissions)
- alcohol psychoses (10%, 412 admissions)
• Alcohol-related problems are more often diagnosed as a secondary problem. Between 1994 and
2003 the number of times that alcohol figured in secondary diagnoses rose (see Figure 6.6).
• In 2003, 10,899 alcohol-related problems were diagnosed as a secondary problem. In order of
prevalence it concerned alcohol abuse (44%), alcohol dependence (23%), alcohol-related liver
disease (14%), alcohol poisoning and toxic consequence of alcohol (9%) and alcohol psychoses
(7%).
• The primary problems diagnosed for these secondary problems were:
- accidents (other than poisonings, 26%)
- digestive disorders (17%)
- poisoning (15%)
- psychoses (4%)
diagnosis can be made per admission. Adjusted for double counts, 11,255 patients were admitted
in 2003. They were admitted at least once that year with one (or more) alcohol-related problem(s)
as primary or secondary diagnosis. The average age of these patients was 47 years, and 70
percent were men.
• It is probable that these figures are an underestimation, as hospitals quite often fail to recognise
and record the role of alcohol as cause or the particular illness.
d
In 2003, 415 day-treatment admissions for a primary alcohol diagnosis were also recorded.
102
Figure 6.6 Clinical admissions in general hospitals with an
alcohol-related problem, from 1994
12000
10000
8000
6000
4000
2000
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Alcohol as primary 3378 3531 3406 4011 4076 4079 3923 3880 4254 4239
diagnosis
Alcohol as secondary 7867 8677 8513 9973 9822 9652 10116 9949 10291 10899
diagnosis
Number of admissions, not adjusted for double counting of persons. ICD-9 codes: 291, 303, 305.0, 357.5, 425.5,
535.3, 571.0-3, 980.0-1, E860.0-2, E950.0*, E980.9* (*only included if 980.0-1 has been mentioned as
complication.). For a definition of the codes: see Appendix C. The figures refer to alcohol-related secondary
diagnoses. More than one secondary diagnosis per admission can be made. Source: National Medical
Registration (LMR), Prismant.
The Central Ambulance Service of the Amsterdam Area Health Authority (GG&GD Amsterdam) keeps
a record of the number of alcohol-related emergency calls.
• In 2003, the ambulance services in Amsterdam recorded 1,733 alcohol-related trips, a decrease of
109
nine percent compared to 2002.
- This was seven percent of all the urgent calls in Amsterdam.
- Most of the persons were men (71%).
- Over half the trips (54%) was for persons aged between 15 and 44.
- Approximately half the patients (49%) were transported to a hospital emergency ward. In the
other 51 percent of the cases, the ambulance staff gave first aid on the spot.
e
According to the Injuries Information System (LIS) of Consumer and Safety , approximately 13,000
people receive emergency treatment in a hospital annually for injuries sustained in an accident, or as
110
a result of violence or self-harm involving alcohol (see Table 6.5).
• Of the recorded victims 74 percent were men.
• Ten percent were aged between 15 and 19 (which means 1,300 children annually), 27 percent
were in the age group 20-29 and 41 percent were in the age group 30-49. Most of the treatments
are in the age category 20-24 (15%).
• Half the accidents occur in the private sphere, such as falling down under the influence of alcohol
or due to alcohol poisoning. Traffic accidents account for the second largest number of injuries
(particularly bicycle crashes). Next is self-harm, often involving a combination of alcohol with
drugs and/or medicines (see Table 6.5).
e
These figures are estimates for the entire country, based on data from a representative sample of hospitals.
103
• Many victims sustain head injuries (40%). Other conditions requiring treatment are alcohol
poisoning (26%), and shoulder, arm, or hand injuries (17%).
• Nearly one in three victims was hospitalised (32%). This is a higher percentage than that for all
types of accidents combined (8%).
• Annually, approximately 40 victims die who received emergency aid for an alcohol-related
accident.
• The direct costs of accidents involving alcohol amount to 22 million euros annually on average.
• These figures probably are an underestimation of the real number of alcohol-related accidents.
Table 6.5 Types of alcohol-related accidents treated in hospital emergency wards in the
Netherlands (average figures over the years 1999 -2003)
Type of accident Number Percentage
Private accident 6 400 51
Traffic accident 3 100 24
I
Self-harm 2 200 18
Act of violence 800 6
Total ±13 000 100
I. Such as suicide attempts with alcohol and licit drugs. Source: Injuries Information System of Consumer and
Safety (LIS).
The LIS data show that annually approximately 1,300 children receive emergency aid after an
accident involving alcohol. At the Leiden University Medical Center (LUMC) and at three hospitals in
The Hague, all the patients were selected who, in the period 1999-2001, were younger than
seventeen and who had been examined because of a blood alcohol concentration of at least 1.00
111
promille.
• It concerned in total 88 children, 58 boys and 30 girls, with an average age of 15.4.
• In 2001 it concerned 51 children. This number was higher than in previous years (19 and 18 in
1999 and 2000, respectively).
In 2003, the Institute for Road Safety Research (SWOV) counted nearly 2,700 recorded casualties,
f
both the hospitalised injured and outpatients, in which alcohol was involved (see Table 6.6).
• The total number of alcohol victims in traffic has fallen slightly from 1997 onwards, both as regards
fatalities and injuries (see Table 6.6).
• In 2002, over eight in ten of the seriously injured (hospitalised) or dead were men. Nearly a
quarter (23%) of these victims were men aged 18 to 24 incl.
Table 6.6 Number of traffic injuries and deaths as a result of alcohol use, from 1996
1996 1997 1998 1999 2000 2001 2002 2003
Severity of injury
Death 97 103 83 92 87 72 97 71
I
Hospital 1 204 1 188 1 154 1 166 1 129 1 036 1 096 1 028
II
Emergency first aid 1 048 1 012 962 939 911 876 702 596
III
Lightly injured 1 064 1 106 1 127 1 152 1 113 1 000 945 992
Total 3 413 3 409 3 326 3 349 3 240 2 984 2 840 2 687
I. Hospitalisations. II. Transported to a hospital, but received emergency help only. III. Not transported
to a hospital. Source: Institute for Road Safety Research (SWOV) / Transport Research Centre (AVV).
• The figures in Table 6.6 are an underestimation of the real figures, because not near enough all
traffic accidents are recorded. In addition, the police often does not carry out alcohol breathalyser
f
Figures overlap partly with those of the Injury Information System (LIS), Consumer and Safety.
104
tests when accidents have occurred. The Institute for Road Safety Research (SWOV) estimates
that the actual number is nearly three times higher, caused by DUI.
• Provisional figures of the SWOV show that of all injured drivers who are hospitalised 35% had
used alcohol and/or drugs: 13 percent consumed alcohol, 11 percent used several drugs and 11
112
percent of the drivers were found to have used a mix of alcohol and drugs.
• The percentage of DUI drivers decreased in 2003. Alcohol tests showed that 3.9 percent of the
checked drivers had a blood alcohol level of over 0.5 promille. In 2002, this percentage was still
4.3. The largest proportion of offenders is found among those aged 25 and over. Noticeable is the
decrease for men aged 18-24: from 4.1 percent in 2002 to 3.5 percent in 2003. However, women
113
aged 18-24 showed a slight increase compared to 2002 (from 0.5% to 0.8%).
The National Vaccine Information Centre (NVIC) of the RIVM provides information to physicians and
114
care providers about poisoning.
• In 2003, approximately 1,700 requests for information were made in respect of alcohol
intoxication, mostly through alcoholic drinks.
• In most of the cases adults aged 18 to 65 incl. were involved.
• In 76% of the cases it concerned a combination of alcohol with medicines, often intentional auto-
intoxication.
• The number of requests for information about alcohol intoxications in young people aged 13 to 17
incl. increased by 63%, from 57 requests in 2002 to 93 in 2003. Alcohol intoxications in young
111
people are usually the result of drinking distilled spirits with friends.
Illness
One to two units of alcohol per day for women and two to three units per day for men usually do not
115-118
present a risk for one’s health.
• Moderate alcohol consumers are less likely to contract coronary heart disease than complete
abstainers or heavy drinkers. This may be linked with an increase in the 'healthy' cholesterol type
HDL-C (high density lipoprotein cholesterol).
• Moderate alcohol consumers also are less likely to suffer a cerebral infarct. Among people aged
over 55, moderate alcohol consumption may reduce the risk of dementia due to blood circulation
in the brain.
• There are indications that premature deaths are less likely to occur among light to moderate
alcohol users than among abstainers or heavy drinkers. Moreover, moderate alcohol users feel
119
healthier.
115;116;120
However, the harmful consequences of excessive alcohol use are plentiful.
• Life style factors may lead to a considerable number of years spent without good health, resulting
in loss of quality of life. Excessive alcohol consumption is the main determinant of loss of quality of
121
life.
• Nearly 12.5 percent of the burden of disease for men and 2.3 percent of the burden of disease for
women may be blamed on excessive use of alcohol.
120
Excessive alcohol consumption increases the risk of various forms of cancer.
• The consumption of two or more glasses of alcohol a day increases the risk of oral and throat
cancer and a specific type of cancer of the oesophagus. The combination of drinking and smoking
increases this risk.
105
• There are very clear indications that the consumption of alcohol leads to a slight increase in the
risk of breast cancer, i.e. 7 to 9 percent with each glass of alcohol per day.
• There are clear indications for an increase in the risk of intestinal cancer, but only in case of
consumption of three or more glasses a day.
• There are also clear indications that alcohol consumption increases the risk, but only after
cirrhosis of the liver had already been caused.
Excessive alcohol consumption also increases the risk of cardiovascular diseases and damage to the
115;116
brain and the nerves.
• Daily alcohol consumption of five glasses or more increases the risk of damaging the coronary
arteries.
• The consumption of more than two glasses daily also increases the risk of strokes or cerebral
infarctions. This only applies to so-called ‘hemorrhagic’ cerebral infarctions.
• Prolonged and excessive alcohol use (more than eight units per day) may cause polyneuropathy
(damage to motor nerves, sensory nerves or both), brain shrinkage, and damage cognitive
functions (learning, memory, concentration and so forth).
• Binge drinking, i.e. consuming large amounts of alcohol in a short period, increases the risk of
heart and vascular diseases, acute kidney failure and brain damage.
Mortality
The number of alcohol-related deaths has increased slightly over the past years.
• According to the Cause of Death Statistics of Statistics Netherlands (CBS), nearly 1,900 people
died in 2003 from causes in which alcohol was explicitly stated, over forty percent more than in
1995 (see Figure 6.6).
• Between 2001 and 2003, the number of deaths for which alcohol was stated as primary cause of
death decreased somewhat and the number of deaths for which alcohol was stated as secondary
cause of death increased slightly. In total the number of cases increased by 5 percent in this
period.
• Dependency and other mental disorders due to the use of alcohol were the leading causes of
death: 61 percent, followed by alcohol-related liver diseases, 33 percent.
• The highest number of deaths as a result of the use of alcohol occurred in the age group 50-65
(see Figure 6.8). Most of the deceased were men (75% on average).
• Alcohol use as a contributing factor to the death is not always recognised. Consequently, these
figures do not reflect reality entirely.
• Based on epidemiological research, for example, 4 to 6 percent of cancer-related deaths is
estimated to be connected with chronically excessive alcohol consumption. This would mean that
there were between 1,500 and 2,300 alcohol-related deaths associated with cancer in 2002,
122;123
instead of the 150 cases recorded.
• In 2003, 71 traffic deaths involving alcohol were recorded (see Table 6.6). However, the real
number of alcohol-related traffic deaths is estimated at 250.
• Alcohol is the fourth leading cause of death of all 'lifestyle factors', after smoking, physical inactivity
124
and bad eating habits.
106
Figure 6.7 Alcohol-related mortality, from 1995
Numberl
2000
1800
1600
1400
1200
1000
800
600
400
1995 1996 1997 1998 1999 2000 2001 2002 2003
secundary 669 705 710 750 774 809 888 928 1090
primary 663 690 686 744 783 820 906 826 796
Number of deaths. 1995: ICD-9 codes 291, 303, 305.0, 357.5, 425.5, 535.3, 571.0-3, 980.0-1, E860.0-2, E950.9*,
E980.9* (* only included if 980.0-1 has been mentioned as complication .) From 1996-2003: ICD-10 codes F10,
G31.2, G62.1, I42.6, K29.2, K70.0-4, K70.9, K86.0, X45*, X65*, Y15*, T51.0-1 (* only included if T51.0-1 has
been mentioned as complication). For a definition of the codes: see Appendix C. Source: Cause of Death
Statistics, Statistics Netherlands (CBS).
107
Figure 6.8 Alcohol-related mortality among males and females by age category.
Survey year 2003
350
300
250
200
150
100
50
0
<40 40-45 45-50 50-55 55-60 60-65 65-70 70-75 75+
female 20 28 55 81 78 61 48 40 66
male 54 89 145 214 206 214 172 128 187
Number of deaths. ICD-10 codes: F10, G31.2, G62.1, I42.6, K29.2, K70.0-4, K70.9, K86.0, X45*, X65*, Y15*,
T51.0-1 (* only included if T51.0-1 has been mentioned as complication). For a definition of the codes: see
Appendix C. Source: Cause of Death Statistics, Statistics Netherlands (CBS).
Alcohol can be easily obtained in groceries, supermarkets, off licences and hotel and catering
establishments. The (Dutch) Licensing and Catering Act prohibits the sale of low alcohol beverages to
young people under the age of sixteen. For high alcohol beverages, the minimum age limit is eighteen
years. A 2003 survey shows that, despite these legal provisions, pupils have no problem in buying
103
alcohol. ). .
• In the past month, 18 percent of young people aged 14 and 15 bought low alcohol beverages in
hotels or catering establishments and 12 percent in groceries or supermarkets (see Table 6.7).
• Strong alcoholic beverages are bought less often. In the past month, 8 percent of the group aged
16 and 17 bought strong alcoholic beverages in hotels or catering establishments and another 8
percent in off licences.
• The probability that young people under the age of sixteen succeed in buying alcoholic beverages
turns out to be 90 percent or higher in both hotels and catering establishments and in groceries
and supermarkets. Nevertheless, approximately 90 percent report they always observe the age
limits.
108
Table 6.7 Percentage of young people who succeeded in buying weak and strong
alcoholic beverages at various sales outlets in the past month.
aged 13 aged 14 and aged 16 and
15 17
Weak alcoholic hotel and catering 1.8 18.4 -
beverages establishments
off-licence 0.6 2.6 -
grocery and 4.1 12.2 -
supermarket
Strong alcoholic hotel and catering 0.4 1.3 7.9
beverages establishments
off-licence 0.1 1.5 8.1
103
Source: Intraval.
• At ten percent of the workplaces of the labour force, alcohol is for sale in the canteen or the
company restaurant. Thirty-four percent report that alcohol is occasionally available otherwise at
the workplace, e.g. in the refrigerator or brought by a colleague. Eleven percent report that at least
97
once a week a gathering is organised where alcohol is served.
Excise duty
• Effective 1 April 2002, the excise duty on beer was raised by eighteen percent and that on wine by
125
21 percent. The proceeds were used for lowering excise duties on soft drinks by 39 percent.
• Effective 1 January 2003, the excise duty on distilled spirits was also raised by eighteen
126
percent.
• Excise duty on one litre of distilled spirits (35 percent proof) is 6.2 euros, on a litre of wine 59 euro
95;96
cents and on a litre of beer 25 euro cents (see Table 6.8).
• This represents an increase of six euro cents for a 0.25 litre glass of beer or a 0.1 litre glass of
wine, and 22 euro cents for a 0.035 glass of distilled spirits.
• EU Member States have different tax policies. Tariffs vary considerably between individual
countries. For example, on a litre of distilled spirits (35 percent proof) an excise duty of three euros
is levied in Italy, compared with nineteen euros in Sweden (see Table 6.8).
• Seven wine-producing countries levy no duties at all on wine.
• Table 6.8 shows that Dutch excise duty tariffs are in the medium range.
109
Table 6.8 Excise duty tariffs on alcoholic beverages in a number of EU Member States per
hectolitre. Survey date December 2003 - spring 2004.
I II III
Member State Beer Wine Distilled spirits
Sweden 81 242 1 932
Ireland 99 273 1 374
Finland 143 235 989
United Kingdom 97 253 972
Denmark 47 95 707
The Netherlands 25 59 621
Belgium 21 47 581
France 13 3 508
Germany 9 0 456
Luxembourg 10 0 364
Austria 25 0 350
Greece 14 0 331
Portugal 15 0 314
Spain 10 0 259
Italy 17 0 256
Amounts in euros per hectolitre consumption. I. 5 volume percent alcohol; survey date December 2003. II. 11
volume percent alcohol; survey date December 2003. III. 35 volume percent alcohol; survey date spring 2004.
Sources: Commodity Board for Distilled Spirits (PGD), Commodity Board for Wine, Central Brewery Agency,
European Commission.
110
7 TOBACCO
Tobacco is made of the dried leaves of the tobacco plant (Nicotiana). Tobacco is usually smoked in
the form of a cigarette or cigar or in a pipe and rarely sniffed or chewed.
Consumers experience tobacco as having a stimulating (improvement of capacity to
concentrate) and calming effect. Nicotine, the main psychoactive ingredient, is addictive. Regular use
results in habituation and tolerance. During inhalation of tobacco smoke various substances are
released, such as nicotine, tar and carbon monoxide, and many more products that are harmful to
one’s health.
The main facts and trends regarding tobacco in this chapter are:
• The percentage of smokers in the general population fell slightly from the early nineties to 2001.
Between 2001 and 2003, the percentage of smokers remained stable (see Chapter 7.2).
• The percentage of heavy smokers decreased between 2000 and 2003 (see Chapter 7.2).
• The proportion of smokers among pupils dropped between 1999 and 2003 (see Chapter 7.3).
• In respect of smoking among pupils, the Netherlands were in the middle range in the EU (see
Chapter 7.5).
• Lung cancer mortality was still declining among men, but continued rising among women (see
Chapter 7.6).
Smoking — particularly among men — was quite common in the sixties and seventies. This was
followed by a considerable decline in the late sixties that lasted up until the early nineties. Since then,
this decline has levelled off.
• Surveys of the Dutch Institute for Public Opinion and Market Research (TNS NIPO) may point at a
decrease in the number of smokers from 2000 (see Table 7.1), but because of a change in the
127
manner of research, this is not certain.
• The TNS NIPO figures indicate a decrease in smoking conduct from 30 percent in 2003 to 28
128
percent in 2004. Figures of the National Prevalence Research also show a downward trend. In
1997, 33 percent of the Dutch population aged 12 and over had smoked in the month prior to the
10
survey. In 2001 this had dropped to 30 percent.
• According to the TNS NIPO, in 2003, 30 percent of Dutchmen aged 15 and over were smokers. In
127
that year, 29 percent were ex-smokers and 41 had never smoked.
• Extrapolated over the entire population, nearly four million people smoked.
- The gap between men and women narrowed (see Table 7.1). Nevertheless, there were still
differences in the smoking behaviour of men and women. Women smoked fewer cigarettes
per day than men. They preferred light filter cigarettes to hand-rolled cigarettes.
- Smoking was highest in the group aged 35 to 49 incl. (see Figure 7.1).
• Approximately 1.6 percent of the population quit smoking each year. An equal number of people
started smoking. These new smokers included a relatively high number of young people under the
age of 19, people with a low level of education, and women aged 30 to 34. This latter group
included women who stopped smoking during pregnancy and took it up again after the
129
pregnancy.
111
Table 7.1 Actual smokers in the Netherlands among men and women aged 15 and over, from
1970
Year Men Women Total
1970 75% 42% 59%
1975 66% 40% 53%
1980 52% 34% 43%
1985 43% 34% 39%
1990 39% 31% 35%
1995 39% 31% 35%
1996 39% 32% 35%
1997 37% 30% 33%
1998 37% 30% 34%
1999 37% 31% 34%
2000 37% 29% 33%
I
2001 33% 27% 30%
2002 34% 28% 31%
2003 33% 27% 30%
Percentage of smokers. I. In 2001, the research method was changed: from a personal interview with a poll-taker
at home, to completing a questionnaire via a modem or the internet. This change may affect the outcomes.
Source: Defacto, for a smoke-free future (previously STIVORO), the Dutch Institute for Public Opinion and Market
Research (TNS NIPO).
Figure 7.1 Percentage of smokers in the Netherlands by age group and gender. Survey
year 2003
%
50
men
40 women
40 37
34
31 31
30 26 26 25
20 16 15
10
0
15-19 20-34 35-49 50-64 >64
age (years)
Source: Defacto, for a smoke-free future (previously STIVORO), the Dutch Institute for Public Opinion and Market
Research (TNS NIPO).
According to Statistics Netherlands (CBS), the percentage of heavy smokers has decreased over the
past years.
• In 2003, eight percent of the population aged 12 and over smoked at least twenty cigarettes on
average per day (9.6% of men and 6.9% of women). In 2000 this was still ten percent (10,4% of the
92
men and 8.7% of the women).
112
• Relatively many heavy smokers live in North-Brabant and the four big cities, with exceptionally
130
many living in and around the regions The Hague, Nieuwe Waterweg North and Eindhoven.
Although the number of smokers had decreased in the seventies, an increase in the level of tobacco
consumption per smoker was noted. Since the eighties, the average number of cigarettes or hand-
rolled cigarettes smoked per day fluctuated around 20.
• In 2003, almost 30 billion cigarettes and hand-rolled cigarettes in the Netherlands literally went up
in smoke (see Table 7.2).
• Hand-rolled cigarettes dropped in popularity since 1990, compared to manufactured cigarettes.
127
Table 7.2 Consumption of manufactured and hand-rolled cigarettes in the Netherlands,

from 1967
Average
Cigarettes Hand-rolled Total tobacco sales
Year (billion) cigarettes (billion) per smoker per
I
(billion) day
1967 16.6 9.1 25.7 12.9
1970 18.7 9.9 28.6 14.0
1975 23.9 13.1 37.0 18.6
1980 23.0 13.9 36.9 21.3
1985 16.3 17.8 34.1 20.7
1990 17.3 16.6 33.4 22.4
1995 17.2 14.4 31.6 20.1
2000 16.7 13.7 30.4 19.9
2001 16.3 12.4 28.7 20.1
2002 16.9 13.2 30.1 20.5
2003 17.0 13.1 30.1 20.9
I. Average number of cigarettes or hand-rolled cigarettes. Source: Defacto, for a smoke-free future.
The percentage of young people who smoke has dropped in the last few years.
• According to the Dutch National School Survey, the percentage of pupils that had ever smoked
en the percentage that had smoked in the past month dropped between 1999 and 2003 (see
Figure 7.2).
• The figures of the TNS NIPO survey show that the percentage of recent smokers among young
people aged 10-19 was stable from 1992 to 2002 incl. (between 27% and 31%). In 2003 the
127
percentage of recent smokers in this group of young people dropped to 24%.
113
Figure 7.2 Smoking among school-aged youths aged 12 and over, from 1988
%
65
59
55 55 55
55
45
45
35 30
26 27
23
25
20
Ever Current
15
1988 1992 1996 1999 2003
The percentage of smokers ever in their lifetime and in the month before the survey (current).
Source: National Representative School Survey, Trimbos Institute.
People begin to smoke at an early age.

• In 2003, eleven percent of the pupils in the two highest groups of elementary school had smoked
ever in their lives. Of pupils of ‘regular’ secondary schools, 45 percent had smoked ever in their
lives. These figures are an average: the percentage increases with the age of the pupils (see
16
Figure 7.3).
114
Figure 7.3 Smoking according to age among pupils aged 10 and over. Survey year 2003
%
70 63
60
60 55
49
50
40 35
32
30
28
30 23
20
20
11 12
10 6 ever
1
current
0
PE 12 yr 13 yr 14 yr 15 yr 16 yr 17-18
yr
Percentage of smokers ever (in lifetime) and current (last month). PE = primary education.
Source: National Representative School Survey, Trimbos Institute.
• One fifth (20%) of secondary school pupils had smoked as recently as in the last month, while
nine percent smoked daily.
• These percentages also increase with age. Nearly one third in the highest age group (16 years
and over) were current smokers, compared to six percent in the group aged 12 and twelve percent
of the group aged 13.
• Approximately an equal numbers of boys (18%) and girls (22%) had smoked in the past month.
Level of smoking
• It is known how much the current smokers among pupils smoked on average per day. For one
third (34%) it was less than one cigarette and for a quarter of this group it was more than ten
cigarettes per day.
• Nine percent of the pupils smoked daily. More than one third of this group (36%) smoked over ten
cigarettes per day.
Regional dispersion
In the last few years, numerous local and regional surveys have been conducted commissioned by
municipalities. In Appendix F we give an overview of recent figures concerning the use of tobacco
among young people in 28 towns, cities or regions in the Netherlands based on representative
samples from the population.
nevertheless, the figures give an impression of the difference in tobacco use between the various
towns and cities. In the age group of 18 to 23 incl., for example, 17 percent in Leiden smoked daily
compared to 35 percent in Almelo.
115
Availability of tobacco
Since 1 January 2003, pursuant to the amended Tobacco Act it has been forbidden to sell tobacco
products to young people younger than 16.
• The number of young people aged 13-15 who sometimes buy tobacco products dropped between
131
1999 and 2003 from 26 to 9 percent.
• Of those who sometimes buy tobacco products, 56 percent reported in 2003 that they bought the
products for themselves, whereas this was still 43 percent in 1999.
• They bought the tobacco products in four kinds of sales outlets: specialised tobacco shops (46%),
groceries or supermarkets (50%), petrol stations (42%) and hotels or catering establishments
(31%). The trend is to buy more in shops for tobacco products.
• The chance for a person younger than 16 to succeed in buying tobacco products was, just as in
1999 and 2001, 90 percent or higher. Nevertheless 93 percent of the outlets claimed never to sell
131
tobacco products to people younger than 16. Another survey found that, after the
implementation of the amended Tobacco Act that forbids this, 84% of the smokers under the age
of 16 personally bought cigarettes at least once. Only 13% of them were asked for their age or a
132
remark was made to them about it by the salespeople.
Special groups
Smoking was considerably more prevalent among young clubbers and adolescents than among
17;18;104
pupils.
• 46, 37 and 70 percent of the visitors of Amsterdam pubs (2000), trendy clubs (2003) and coffee
shops (2001), respectively, were daily smokers.
• The daily smokers among the visitors of pubs and coffee shops smoked an average of 14 to 16
manufactured or hand-rolled cigarettes per day; 20 to 36 percent smoked more than one pack a
day (at least 20 manufactured or hand-rolled cigarettes).
• Between 1995 and 2003, the percentage of visitors of trendy clubs that ever smoked remained
stable (87% in 2003). The percentage that had smoked in the past year dropped from 77% in
1998 to 68% in 2003. The percentage that had smoked in the past month in this period dropped
from 67% to 55%.
7.4 PROBLEM USE
• A clear indication of the extent to which smokers consider their use problematic is the desire to
quit smoking. In 2003, 8% of the smokers in the Netherlands stated they wanted to stop smoking
within a month, 9% within six months, 8% within a year and 14% said they wanted to stop smoking
133
at one time in the future.
• In scientific circles, the term ‘nicotine dependence’ is sometimes preferred to ‘tobacco addiction’.
The level of dependence can be measured with the Fagerström Test for Nicotine Dependence, a
scale ranging from zero to ten (10 = severe nicotine dependence).
– Research showed that, in 1997, the result for Dutch smokers on this scale was 3.0 on average,
134
compared to 4.3 for American smokers.
– Men scored higher on average than women.
– Smokers who sought help with smoking cessation were more successful on average than
smokers who did not seek assistance.
116
The proportion of smokers among the population of EU Member States varies greatly, although the
comparability of the figures is doubtful. For example, some countries define the term ‘smoker’ and age
groups differently (see Table 7.3). Many countries understand this to mean daily smokers, whereas
the Netherlands defines ‘smokers’ as people who ‘smoke daily or occasionally’.
• According to the most recent figures, of the compared countries, Portugal had the lowest number
of smokers, and Greece — together with Germany — the highest number.
• With the exception of Sweden and Norway, more men than women smoked. In Portugal this
difference was largest.
Table 7.3 Smokers among adults in several EU Member States,

Norway and Switzerland
Country Year Age Men Women Total Criterion for smoking
(year)
Belgium 2000 18+ 36% 26% 31% daily
Denmark 2002 15+ 31% 27% 28% daily
Germany 2000 20-54 40% 32% 36% -
Finland 2002 15-64 27% 20% 23% daily or regularly
France 2000 18+ 33% 21% 27% daily
Greece 2000 - 47% 29% 38% -
Ireland 2002 18+ 28% 26% 27% regularly or
occasionally
Italy 1999 14-65 32% 17% 25% daily
Luxembourg 2000 15+ 34% 27% 32% regularly daily
The Netherlands 2003 15+ 33% 27% 30% daily or occasionally
Norway 2001/2002 16-74 30% 30% 30% daily
Austria 2000 - - - 29% -
Portugal 1995/1996 19+ 29% 6% 17% daily in the past two
weeks
Spain 2001 16+ 39% 25% 32% daily
United Kingdom 2002 16+ 27% 25% 26% current smokers
Sweden 2000/2001 16-84 17% 21% 19% daily
Switzerland 2000 14-65 37% 29% 32% regularly or
occasionally
135
Percentage of smokers. - = not measured/unknown. Source: World Health Organisation (WHO) , for the
127
Netherlands: Defacto, for a smoke-free future (previously STIVORO).
The European School Survey Project on Alcohol and Other Drugs (ESPAD) (see Appendix B) enables
comparison of the smoking behaviour of secondary school pupils aged thirteen and sixteen. Figure 7.4
43
gives figures for the percentage of pupils who smoked in the past month.
• Of the compared countries, Austria had the highest number of smokers among secondary school
pupils and Sweden the lowest.
•
132
The Netherlands were in the middle range.
• In most of the countries, more girls smoked than boys.
117
Figure 7.4 Smokers among secondary school pupils aged 15 and 16 in several EU Member
States, Norway and Switzerland. Survey year 2003
49
Austria 56
48
45
Germany 43
46
38
Finland 35
41
38
Italy 40
35
34
Switzerland 34
33
33
France 36
31
33
Ireland 28
37
32
Belgium 33
32
31
The Netherlands 31
32
30
Denmark 27
32
29
United Kingdom 25
34
28
Greece 30
27
28
Norway 24
32
28
Portugal 27
28
27
Spain 22
31
23
Sweden 20
26
%
0 10 20 30 40 50 60
Boys Girls Total
Percentage that smoked in the past month. Source: European School Survey Project on Alcohol and Other Drugs
(ESPAD).
• More than a quarter of Dutch pupils (27%) reported to have smoked more than forty times in their
lives. This percentage varied from 18% in Portugal to 42% in Austria.
• In October 2004, the European Network for Smoking Prevention (ENSP) published a report about
136
the effects of the Tobacco Control Policy in 28 European countries. This report showed how
each country scored on six cost-effective interventions that may lead to a reduction of tobacco
consumption: the price of tobacco articles, a smoking ban in public spaces and placed of work,
the height of the budget for the Tobacco Control Policy, a prohibition of advertisements for
tobacco articles, warnings on tobacco articles and the availability of treatments to stop smoking.
For the six interventions taken together, the Netherlands reached the seventh place among these
28 European countries. The date of this survey is 1 January 2004.
118
Treatment mainly involves self-help and seeking help from the general practitioner. The care
organisations for addicts occasionally offer smoking cessation programs, albeit not on a large scale.
• Approximately two thirds of all smokers who attempt to stop smoking do so without any means of
help. The remainder attend courses, seek advice from their GP, use nicotine substitutes (plasters,
chewing gum, lozenges), undergo acupuncture or hypnosis, etc.. The main reason for attempting
137
to stop smoking is for health reasons.
• In the recent past, the antidepressant bupropion (Zyban®) was registered in the Netherlands as a
non-nicotine aid for smoking cessation. According to IMS Health, in 2001, 2002 and 2003,
bupropion was prescribed 80,000, 70,000 and 73,000 times by physicians. This adds up to a total
of 3.0, 2.7 and 2.7 million tablets, respectively. The demand seems to be stabilising.
• The market of nicotine substitutes – plasters, chewing gum and lozenges – doubled in 2004
compared to 2003 to a total turnover of 16.7 million euros. This indicates a considerable increase
in attempts to stop smoking.
• People who wish to stop smoking can ask their general practitioner for advice. In 2003, an
estimated 65,000 men and 65,000 women consulted their GP about how to stop smoking. Most of
138
them were aged 40-60. The Minimal Intervention Strategy (MIS) has proven an effective
protocol for general practitioners, nurses and cardiologists to stimulate smoking patients to stop
139
smoking.
• The Counselling Centre of STIVORO also supports people who wish to stop smoking. In 2003,
1,118 people registered for coaching by phone and more than 8,000 coaching discussions took
127
place.
• Towards the year 2004, STIVORO held an intensive stopping campaign called ‘Nederland Start
Met Stoppen’ [The Netherlands Starts Stopping]. This campaign contributed to the attempts of
over 1 million smokers to stop smoking around 1 January 2004. In December 2004, 24 percent of
128
these people had not returned to smoking. Usually, five to ten percent of those who have
140
stopped persevere a year in doing that. As most important reason to stop is given the increase
in excise duty on tobacco. In 2003, besides a nationwide campaign, STIVORO conducted also a
127
campaign about passive smoking and smoking at the workplace.
• End 2004, an official guideline of the Dutch Institute for Health Care Improvement (CBO) for the
treatment of tobacco addiction was published. In this guideline, the approach of smoking patients
141;142
in medical practice is discussed and the effectiveness of various treatments is descibed.
The demand on the health care system for problems caused or aggravated by smoking is of entirely
different proportions. The number of hospital admissions for illnesses related to smoking amounted to
143
nearly 100,000 in the early nineties. Recent figures are not available.
7.7 MORTALITY
• Smoking is the leading cause of premature death in the Netherlands.

• In 2003, over 20,000 people died in the Netherlands from the direct consequences of smoking.
• In 2002, the direct mortality from smoking was estimated at 20,175 and in 2003 at 20,141 deaths.
144
In 2000, this number was still 20,718 deaths.
• Of all deaths in the Netherlands in 2003, approximately 14 percent was due to smoking (20% of
the men and 8% of the women).
• Smoking is connected with cardiovascular diseases, pulmonary diseases and cancer. Table 7.4
shows that lung cancer is mainly caused by smoking: in 74 percent (women) to 91 percent (men)
of all the cases in 2003.
119
• The actual mortality from smoking may be higher, because the effects of passive smoking were
145;146
not taken into account. It is unclear, however, to what extent passive smoking leads to death.
Table 7.4 Mortality from a number of illnesses among men and women aged 20 and over.
Survey year 2003
Total mortality Mortality from smoking
Illness Men Women Men Women
Lung cancer 6 156 2 706 5 627 2 002
Chronic obstructive 3 870 2 661 3 264 1 819
pulmonary disease
(COPD)
Coronary heart disease 8 895 6 638 2 577 865
Stroke (cerebrovascular 4 529 7 053 958 704
disorder)
Heart failure 2 538 3 849 461 224
Oesophageal cancer 971 376 771 235
Cancer of the larynx 200 39 157 32
Cancer of the oral 358 202 330 115
cavity
I I
Total 27 517 23 524 14 145 5 996
I. Per disorder first rounded off to whole numbers and subsequently added up. Source: National Institute of Public
Health and the Environment (RIVM), Statistics Netherlands (CBS).
As a result of the decline in smoking among men between 1960 and 1990, lung cancer mortality in
men has dropped. However, this trend is reversed in women who have started to smoke more. In
2000 and 2002, fewer deaths from lung cancer in men were reported than in previous years (see
Table 7.5).
•
The rising curve in the number of deaths from lung cancer in women is bound to continue for
147
several decades to come.
• The opposing trends in men and women balance each other out. As a result, the total number of
deaths from lung cancer has remained stable for years.
120
Table 7.5 Mortality with lung cancer as primary cause of death among people aged 15 and
over, from 1985. Deaths per 100,000 inhabitants
Year Men Women Total
1985 127 16 71
1986 130 17 72
1987 127 17 71
1988 128 19 72
1989 123 20 70
1990 117 20 67
1991 118 20 68
1992 117 22 69
1993 115 24 69
1994 113 26 68
1995 112 27 69
1996 109 28 68
1997 108 29 68
1998 106 30 68
1999 105 33 68
2000 99 34 66
2001 100 35 67
2002 96 39 68
2003 95 40 67
1985-1996: ICD-9 code 162, from1996: ICD-10 codes C33-34 (see Appendix C). Source: Cause of Death
Statistics, Statistics Netherlands (CBS).
• From 1 January 2004, employers have been obliged to guarantee their staff a non-smoking
148
workplace. From that date it has also been forbidden to smoke in public transport.
• In 2003, 46% of the rolling tobacco was sold in the general groceries and supermarkets, 22% in
specialised tobacco shops, 21% in petrol stations, 5% in hotels or catering establishments and 6%
elsewhere. Of the cigarettes 36% were sold via the general groceries and supermarkets, 6% via
hotels or catering establishments, 25% via specialised tobacco shops, 24% via petrol stations and
149
9% via other channels. This does not include sales from cigarette vending machines.
• From 1 February 2004, the price of a pack of cigarettes in the most popular price class has been
€ 4.60, including € 2.63 excise duty and € 0.73 VAT. A 50-gram pack of rolling tobacco costs also
149
€ 4.60, including € 2.08 excise duty and € 0.73 VAT (see Table 7.6).
121
Table 7.6 Price of cigarettes and tax burden, from 1970. Survey date: February 2004
Year Price Tax burden Tax burden in %
1970 0.86 0.60 69%
1975 1.02 0.68 67%
1980 1.36 0.98 72%
1985 1.88 1.35 72%
1990 1.97 1.37 70%
1995 2.56 1.84 72%
1996 2.61 1.87 72%
1997 2.79 2.01 72%
1998 2.93 2.11 72%
1999 3.04 2.19 72%
2000 3.15 2.27 72%
2001 3.43 2.50 73%
2002 3.54 2.58 73%
2003 3.54 2.63 74%
2004 4.60 3.36 73%
Price and tax burden in euros per pack of 25 cigarettes. Tax burden includes excise duty and VAT. Source:
Tobacco Manufacturers’ Association Netherlands (SSI).
The excise duty imposed on tobacco products varies considerably between individual Member States
of the European Union.
• In the 15 old EU Member States the excise duty is highest in the United Kingdom and lowest in
Spain (see Table 7.7). In the 15 old EU Member States the excise duty is highest in the United
Kingdom and lowest in Spain (see Table 7.7).
Table 7.7 Prices on cigarettes and tax burden in several EU Member States. Survey date 1
May 2004
Country Price Excise VAT Excise+VAT
United Kingdom 8.25 5.35 1.23 6.58
Ireland 7.65 4.74 1.33 6.06
France 6.25 4.00 1.02 5.02
Sweden 5.16 2.57 1.03 3.60
Finland 5.00 2.88 0.90 3.78
Denmark 4.97 2.70 0.99 3.69
Germany 4.74 2.86 0.65 3.52
The Netherlands 4.60 2.63 0.73 3.36
Belgium 4.45 2.54 0.77 3.31
Austria 3.75 2.14 0.63 2.76
Greece 3.13 2.82 0.48 3.30
Luxembourg 3.10 1.81 0.33 2.14
Portugal 2.75 1.70 0.44 2.14
Italy 2.58 1.50 0.43 1.93
Spain 2.44 1.41 0.34 1.75
Price, tax burden and VAT in euros per pack of 25 cigarettes. Source: European Committee.
122
8 RECORDED DRUG CRIME
At the heart of the Dutch drug policy is the public health aspect. In addition, the Dutch drug policy aims
also to reduce the harm caused to society by substance abuse: nuisance, crime and public order
problems. The Minister of Justice is responsible for criminal enforcement and the social rehabilitation
of offenders. The supply of drugs is combated by means of investigation, prosecution, and the
adjudication of the suspects involved in the production, (international) drug trafficking, and possession
of drugs. Drug treatment and counselling is made available for drug using offenders while in detention
with the aim to improve their situation and therefore reduce crime and nuisance.
This chapter provides a statistical overview of the nature and scope of the recorded drugs crime and
the penal response.
Drug crime is made up of two components:

• Drug law violations: as set out in the respective drug laws (Opium Act, Misuse of Chemicals
Prevention Act), or offences connected with drug law violations (e.g. organised crime, money
laundering, etc.).
• Crimes by drug users: crimes committed by drug users. It should be noted that there is no
persuasive evidence of a causal connection between drug use or addiction and crime: drug use or
addiction need not necessarily precede crime.
When drug users violate drug laws, an overlap between both crime components is involved.
In this chapter we shall report about recorded drug crime, to be exact: the crime recorded when a
suspect is arrested and booked. This is the crime that has been recorded and solved. The ratio of drug
crime in the volume of all recorded crime (in addition to solved crime, this also included crime that has
been recorded but has not been solved) and in the volume of all crime (both recorded and
unrecorded) is not examined here. Results can therefore not just be applied to the volume of total drug
crimes. The figures in this chapter express to some degree the efforts of the police and the criminal
justice system in fighting drug crime.
The data cover the years 1999 to 2003 incl. as much as possible. Where possible, a distinction is
a
made between hard and soft drug cases.
Appendix B contains a list of sources used in this chapter. For further information we refer to
www.trimbos.nl/monitors. Not all the data are of a good quality. This problem has been discussed
2;3 151;152
before. Especially data about seized drugs must be interpreted with caution. In addition, based
on the current data, the existence of addiction of individuals cannot be determined exactly in files of
the police and the criminal justice system. In this chapter we use, therefore, the term “drug user” or
3
“problem user of drugs” to indicate a possible addiction problem with the persons concerned. In the
text, details about the quality of the used sources are specified.
a
Most figures relate to drugs as defined in the Opium Act, which means: not to alcohol and tobacco. An exception
is formed by the figures of the probation and after-care service, in which the type of substance has not been
specified.
123
The main facts and trends regarding drug crime in this chapter are:
• Offences under the Opium Act added more to the workload of the criminal system in 2003 than in
2002; this also applied to all the phases of the criminal process.
- In 2003 more suspects were booked for offences under the Opium Act than in 2002. Most of
those offences were still related to hard drugs (see Chapter 8.2.1).
- Two thirds of the number of investigations into organised crime concerned violations under the
Opium Act: this is more or less the same as in 2002 (see Chapter 8.2.2).
- The number of cases taken in by the Public Prosecutions Department continued to increase
(see Chapter 8.2.2).
- In 2003, the Courts handled significantly more cases of violations under the Opium Act than in
2002 (see Chapter 8.2.5).
- The number of imposed community sentences and confiscation orders in cases under the
Opium Act increased strongly in 2003 (see Chapter 8.2.6).
- The number of unsuspended custodial sentences in Opium Act cases increased also in 2003.
This increase was due to hard drug cases (see Chapter 8.2.7).
- In terms of detention years, of the custodial sentences imposed in criminal cases, an
increasing proportion concerned drug cases (see Chapter 8.2.7).
- Offenders under the Opium Act repeated the offence more often than other offenders (see
Chapter 8.2.8).
• Criminal drug users increased the work load of the criminal system to about the same extent as in
2002.
- In 2003, the police recorded over ten thousand suspects as “drug users”. Of this group more
than 70 percent had a criminal record showing over ten offences (see Chapter 8.3.1).
- Over 70% of the ‘very high rate’ frequent offenders are regular hard drug users (see Chapter
8.3.2).
• In 2003, in general more activities of the Netherlands (Drug) Rehabilitation Foundation were
recorded in the criminal system (see Chapter 8.4.1).
• The number of compulsory admissions in the Judicial Treatment of Addicts (SOV) rose steadily in
2003 (see Chapter 8.4.3).
8.2 RECORDED DRUG CRIME
In this paragraph we shall describe the nature and volume of the recorded drug law violations -
specifically with respect to the Opium Act - and the profile of the drug offenders. This is done along the
criminal law chain. First the data from the police will be discussed: the number of booked suspects,
criminal investigations into criminal cooperation networks and confiscated drugs. Then the number of
cases and the manner of disposal by the Public Prosecutions Department will be discussed. In the
end, part of these cases found their way to Court. Figures will be provided of the number of cases in
which the Court pronounced sentence and of which sentences were passed. Finally, data will be given
about detention because of offences under the Opium Act and repeat offences by the offenders.
8.2.1 Suspects under the Opium Act
Table 8.1 shows the number of suspects against whom a police report was drawn up because of a
violation of the Opium Act (production, transport, trafficking and/or possession of drugs). This is based
on the number of suspects against whom a police report was drawn up once or more times in a
124
specific year because of a violation of the Opium Act. If the violation of the Opium Act involves hard
drugs, we shall refer to this hereafter as "hard drug offences". If soft drugs are involved, we shall
speak of ‘soft drug offences’.
• The (still provisional) figures for 2003 indicate that the police booked more than 14,000 suspects
because of offences under the Opium Act, more than in 2002.
• The increase is apparent for hard drugs and for soft drugs, as well as for the combination of both.
• In 2003, most of these offences still concerned hard drugs: more than half the suspects were
booked for hard drug offences. The proportion of suspects of soft drug offences was 38 percent.
This was slightly higher in 2003 than in the previous years.
I
Table 8.1 Number of unique suspects of Opium Act offences booked by the police by type
of drug, from 1999
II
Number 1999 2000 2001 2002 2003
Total 9 091 8 171 10 139 12 114 14 299
• Hard drugs 5 228 4 619 5 558 6 777 7 744
• Soft drugs 3 022 2 784 3 726 4 347 5 495
• Both 841 768 855 990 1 060
%
• Hard drugs 57% 57% 55% 56% 54%
• Soft drugs 33% 34% 37% 36% 38%
• Both 9% 9% 8% 8% 7%
I. Unique suspects: each suspect has been counted only once per year in the table, even if he/she was booked
more often than once in a year for violation of the Opium Act. II. Provisional figures. Source: Police Records
System (HKS), National Police Agency (KLPD)/National Criminal Intelligence Service of the National Police
Agency (DNRI), Research & Analysis group.
Besides the police, the Royal Military Police also makes arrests for violations under the Opium Act.
Although the Royal Military Police also handles other cases (e.g. of Dutch military abroad), most of the
cases concern suspects arrested at Schiphol Airport. Table 8.2 gives an overview of the number of
suspects who have not also been recorded by the police in the Police Records System (HKS).
I
Table 8.2 Number of unique suspects of Opium Act offences booked by the Royal Military
Police by type of drug, from 1999
Number 1999 2000 2001 2002 2003
Total 486 516 910 1 477 1 640
• Hard drugs 384 464 870 1 419 1 491
• Soft drugs 87 43 35 52 137
• Both 15 9 5 6 12
%
• Hard drugs 79% 90% 96% 96% 91%
• Soft drugs 18% 8% 4% 4% 8%
• Both 3% 2% 0.5% 0% 1%
I. Unique suspects: each suspect has been counted only once per year in the table, even if he/she was booked
more often than once in a year for violation of the Opium Act. Source: Police Records System (HKS), National
Police Agency (KLPD)/National Criminal Intelligence Service of the National Police Agency (DNRI), Research &
Analysis group.
It is apparent from Table 8.2 that in 2003 this concerned 1,640 suspects, mainly of hard drug offences.
The number of hard drug offences increased in the past five years, particularly in 2002 and 2003. The
number of soft drug offences increased especially in 2002 and 2003. The increase in the last two
125
years may be largely because, otherwise than in previous years, in 2002 and 2003 all reports at
Schiphol were drawn up and recorded exclusively by the Royal Military Police. Hard drug offences
always made up by far the larger part.
Table 8.3 shows the profiles of the suspects booked by the police for Opium Act offences in 2003.
• Most of them are men. Most suspects are aged 25 to 35.
b
• The soft drug suspects are the least frequently recorded as drug users and have relatively few
criminal records.
• The hard drug suspects live more often in the large cities, are younger and have more criminal
records than the soft drug suspects. Twenty percent have more than ten. Approximately a quarter
of the suspects of a hard drug offence are known as drug users.
• Suspects of both hard and soft drugs are usually well known by the police: nearly half of them
have more than ten criminal records. Compared to suspects of only a hard drug or soft drug
offence, they are more represented in the age group of 35-45 and more often men. They usually
live in middle-sized towns and relatively infrequently abroad. They are most often recorded at the
police as drug users.
• The profile of the suspects arrested by the Royal Military Police is different. Sixty percent of them
lives abroad, nearly half (46%) originate from the Netherlands Antilles. Most of the suspects have
only one criminal record (87%) and are relatively young: 35 percent is in the age group 18-24, 32
percent is aged between 25 and 34.
b
See for the restrictions of this classification of drug using suspects the remark to Chapter 8.3.1.
126
Table 8.3 Profiles of suspects of offences under the Opium Act by type of drug. Survey
year 2003
Soft drugs Hard drugs Both
Total number 5 495 7 744 1 060
Gender Men 83% 88% 93%

Women 17% 12% 7%
Municipality by Unknown 3% 5% 4%
I
number of inhabitants under 10 000 1% 1% 1%
10 000 – 20 000 8% 5% 7%
20 000 – 50 000 20% 14% 20%
50 000 - 100 000 19% 12% 23%
100 000 - 150 000 10% 10% 12%
150 000 - 250 000 11% 8% 9%
250 000 and over (four 14% 32% 19%
largest cities)
Abroad 14% 13% 5%
II
Danger classification addiction Alcohol 1% 2% 3%
Drugs 1% 23% 28%
Otherwise 2% 6% 9%
III
Number of criminal records in 1 46% 36% 10%
the total
recorded criminal 2 12% 12% 5%
history 3–4 13% 14% 12%
5 – 10 16% 17% 24%
11 – 20 8% 10% 23%
21 or over 5% 10% 25%
Age upon recording of 12-17 3% 4% 1%

latest offence 18-24 20% 32% 14%
25-34 33% 33% 34%
35-44 26% 20% 33%
45 and above 18% 11% 18%
I. The offences may have been committed in another town or city than where the suspect lives. II. See remarks to
Chapter 8.3.1. III. A criminal record is a police contact during which a report of one or more crimes was drawn up.
Source: Police Records System (HKS), National Police Agency (KLPD)/National Criminal Intelligence Service of
the National Police Agency (DNRI), Research & Analysis group.
8.2.2 Investigations into organised crime
The National Criminal Information service of the National Police Services Agency (KLPD), Research
and Analysis group, lists the investigations annually undertaken by the Dutch police in the field of
c
organised crime. Two comments to the figures should be given: In the first place, the data about the
investigations are not directly comparable from 2002 to those from the previous years. This is due to
the new recording method that the National Police Services Agency (KLPD) started to use in 2002.
The data of all the regional investigations are now requested through a new form, the “Criminal
c
This listing is done commissioned by the EU Justice and Home Affairs Council (JBZ Raad). Only investigations
that satisfy the criteria set for organised crime by the Council are included.
127
Cooperation (CSV) – manager”. On the basis of this form, the criminal cooperation from the listed
investigations are described. The registration of criminal cooperation is expected to be more complete
from 2002 than in the previous years. Investigation priorities, capacity and the possibilities of the
investigation services are here also important factors in the height of the numbers. For that reason, the
number of recorded investigations may fluctuate strongly from year to year. One single criminal
investigation may involve several types of drugs and various activities in the field of drugs.
Table 8.4 gives the figures in respect of the criminal investigations.

• In 2003 more criminal investigations were recorded than in 2002.
• Two thirds (66%) of the criminal investigations focused on drugs. That percentage is about the
same as that of the previous year.
• Forty percent of all the investigations focused only on hard drugs, 11 percent only on soft drugs
and 14 percent on both hard drugs and soft drugs.
• In 62 percent (91) of the criminal investigations into drugs only one type of drug was involved. In
the other criminal investigations, several types of drugs were involved.
• Cocaine figured in 60 percent of the criminal investigations into hard drugs. Fifty-four percent of
these criminal investigations concerned synthetic drugs and 17 percent heroin. The number of
criminal investigations into cocaine increased strongly compared to 2002. This may be connected
with more intensive inspections at Schiphol Airport.
• The criminal investigations into soft drugs were mainly focused on Dutch-grown cannabis (53%) or
hashish (39%). In the case of criminal investigations into Dutch-grown cannabis, not just trade was
concerned but also production.
• Figures from 1998 to 2002 incl. show that more than half the criminal investigations dealt with
various activities in the field of drugs. The investigated criminal groups dealt more often with
transport and trade than with production. In 2003 the division by production, transport and trade
could no longer be made.
Table 8.4 Criminal investigations into more serious forms of organised crime: proportion
of drug crime by type of drug, from 1999
1999 2000 2001 2002 2003
Number of criminal 118 100% 148 100% 146 100% 185 100% 221 100%
investigations
Involving drug crime 75 64% 78 53% 90 62% 117 63% 146 66%
• Hard drugs 24 20% 35 24% 53 36% 64 35% 89 40%
• Soft drugs 9 8% 14 9% 15 10% 20 11% 25 11%
• Hard and soft drugs 42 36% 29 20% 22 15% 33 18% 32 14%
Source: Police Records System (HKS), National Police Agency (KLPD)/National Criminal Intelligence Service of
the National Police Agency (DNRI), Research & Analysis group.
8.2.3 Confiscated drugs
The National Criminal Information service of the National Police Services Agency (KLPD), Research
and Analysis group reports annually about the quantity of confiscated drugs. This is done based on
reports from the police forces, core teams, customs and the Royal Military Police. The below overview
must be considered with a critical eye. Recording of seizure is not centrally organised within the police
forces and other investigation bodies, often it is not uniform and sometimes no records are made at
151;152
all. In the interpretation of the data one must take into account that the figures only indicate a
152;153
minimum limit of the total number of seized drugs. Moreover, the differences between the types
of drugs and between the years are not systematic to such an extent that it is very difficult to interpret
them. It is impossible to gather trends from them. The quantities of confiscated drugs may vary in
128
proportion to the investigation efforts, the number of cases that had to be dealt with, changes in the
market and/or accuracy in reporting.
Seven of the 25 regional police departments have not supplied data. De Miranda and Van der Werf,
who prepared the 2003 overview, have calculated an indication of the seizures for those lacking
152
regional police departments. To that end they consulted the Drug Seizure file of the National
Investigations Information Service (NRI). This file contains the seizures from a specific minimum
quantity. Table 8.5 includes the thus achieved 2003 figures. The authors (De Miranda and Van der
Werf, 2004) outline the following picture:
• “Heroin: the reported quantity of seized heroin was less in 2003 than in the previous years. In
2003 more than 417 kilograms of heroin were reported, whereas this was more than 1,000
kilograms in 2002, a decrease of 63 percent. The quantity of heroin that was confiscated in 2003
was the lowest since 1996. The number of seizures of heroin reported by the criminal investigation
bodies was 533.
• Cocaine: in respect of cocaine there was an increase compared to previous years. In 2003, more
than 17,000 kilograms of this drug were reportedly seized; an increase of over 120 percent
compared to 2002. The number of seizures reported is 3,917. Most of the seizures were carried
out by the Royal Military Police in collaboration with customs.
• Amphetamines: criminal investigation bodies reported to have seized more amphetamines in 2003
than in 2002, i.e. 843 kilograms and, in addition, 14,000 pills. Furthermore, for the first time the
seizure of amphetamines in fluid form was reported, i.e. 37 litres. The number of seizures reported
was 219.
• Ecstasy (MDMA): in the information of the criminal investigation bodies a decrease was noticeable
in the quantity of XTC seized in the Netherlands. In 2003, 435 kilograms of MDMA (powder and
paste) were seized, a fifty percent decrease compared to 2002. The quantity of seized tablets also
showed a decrease. The records mention more than 5.4 million of tablets in 2003, a decrease of
20 percent compared to 2002. The number of seizures is not mentioned.
• LSD: The figures for 2003 are not sensational. 1,642 tablets were seized. The number of seizures
was nine.
• Cannabis: Compared to the previous year, 2003 showed a decrease in the reported quantity of
seized cannabis products, such as (foreign) hashish, marihuana and Dutch-grown cannabis. In
2003, 19,103 kilograms of cannabis were seized, a significant decrease compared to the 46,675
kilograms confiscated in 2002. The number of reported seizures of cannabis products was 2,199."
129
I
Table 8.5 Quantities of seized drugs in the Netherlands, from 1999
Kind of drug 1999 2000 2001 2002 2003
Heroin
Kilogram Kilogram 770 896 739 1 122 417
Cocaine
Kilogram 10 361 6 472 8 389 7 968 17 560
Amphetamines
Kilogram 853 293 579 481 843
Tablets 45 847 II. 20 592 1 028 14 000
Litres - - - - 37
XTC (MDMA)
Kilogram *** 632 113 849 435
Tablets 3 663 608 5 500 000 3 684 505 6 787 167 5 420 033
Discovered production places 36 37 35 43 37
LSD
Trips 244 9 829 28 731 355
Tablets 2 423 143 - - 1 642
Methadone
Kilogram 50 16 - 1 4
Tablets 186 437 5 543 8 968 9 446 57 430
Litres 0,57
Cannabis
Hashish
Kilogram 61 226 29 590 10 972 32 717 10 719
Marihuana
Kilogram 47 039 9 629 21 139 9 958 7 067
Dutch-grown cannabis
Kilogram 2 076 701 1 308 - 1 179
Hemp plants 582 588 661 851 884 609 900 381 1 111 855
Total weight cannabis 110 341 39 920 33 419 42 675 19 103
Rounded-up hemp farms 1 091 1 372 2 012 1 574 1 867
Number of seizures 14 909 9 243 14 353 18 823 5 752
I. Not included: hashish oil (1 litre in 1999); paddo’s (278 kilograms in 2003); mescaline (1 kilogram in 2003) and
152
opium (0.1 kilogram in 2003). II. Indicates that there are no seizures or none are known.
8.2.4 Intake and disposal of Opium Act cases by the Public Prosecutions Department
The police send the police reports in respect of violations of the Opium Act to the Public Prosecutions
Department (OM). Not all the police reports are registered at the Public Prosecutions Department
(OM). Criminal cases, after all, are already ‘screened’ by the police, meaning that those cases that in
all likelihood cannot be prosecuted are already filtered out. Such cases do not always end up in the
records of the Public Prosecutions Department.
Table 8.6 shows the numbers of cases taken in by the Public Prosecutions Department for each type
of drug.
• The number of cases taken in by the Public Prosecutions Department continued to increase,
although the increase by 8 percent in 2003 was somewhat less than in the two previous years. An
increase was apparent in hard drug and soft drug cases, and also in the category hard and soft
drugs.
• The proportion of hard and soft drug cases remained virtually the same in those past five years.
• A closer analysis of the recent increase in the number of Opium Act cases shows that half the
increase was caused by the increase at the Haarlem district. In 1999 this district handled 12
percent of the total number of hard drug cases in the Netherlands. In 2002 and 2003 this more
than doubled (26%). Schiphol cases are dealt with by the Haarlem district; for a considerable part,
the increase will concern cases against drug couriers, including ‘drug swallowers’.
130
Table 8.6 Opium Act cases taken in by the Public Prosecutions Department by type of
drug, from 1999
1999 2000 2001 2002 2003
Hard drugs 6 407 6 397 7 672 9 246 9 989
Soft drugs 4 380 4 324 5 059 5 832 6 156
Hard and soft drugs 888 792 827 770 942
Total 11 675 11 513 13 558 15 848 17 087
Hard drugs 55% 56% 57% 58% 58%

Soft drugs 38% 38% 37% 37% 36%
Hard and soft drugs 8% 7% 6% 5% 6%
Total 100% 100% 100% 100% 100%
Source: Public Prosecutions Department Database (OMDATA), Research and Documentation Centre of the
Ministry of Justice (WODC).
Table 8.7 shows what the decision of the Public Prosecutions Department was in Opium Act cases
that were disposed in final and conclusive judgment between 1999 and 2003.
• In 2003, the number of criminal cases under the Opium Act was nearly 15,000. Compared to
2002, this is an increase of 13 percent.
• The Public Prosecutions Department issues a summons in the majority of drug cases. This means
that most drug cases are brought before the Court. In those last five years a slight drop in the
percentage of summons was apparent. The proportion of out-of-court settlements increased in
that period of five years, particularly in soft drug cases.
• In cases involving both hard and soft drugs, a summons was issued relatively often.
131
Table 8.7 Criminal cases disposed in final and conclusive judgement for Opium Act
offences by decision of the Public Prosecution Department and type of drug,
from 1999
1999 2000 2001 2002 2003
Total number of Opium Act cases 11 132 10 546 11 143 13 206 14 943
• Summons 72% 71% 67% 67% 68%
• Out-of-court settlement 9% 9% 16% 18% 17%
• Discretionary dismissal 6% 6% 6% 5% 5%
• Dismissal by reasons of likeliness of nonconviction 8% 9% 7% 6% 5%
• Joinder 5% 5% 5% 4% 5%
Hard drugs
• Summons 75% 76% 74% 75% 74%
• Joinder 5% 5% 5% 5% 5%
Soft drugs
• Summons 68% 64% 56% 53% 57%
• Joinder 5% 4% 4% 3% 4%
Hard and soft drugs
• Summons 89% 84% 78% 81% 80%
• Joinder 3% 3% 3% 3% 3%
Source: Justice Documentation Research Database (OBJD), Research and Documentation Centre of the Ministry
of Justice (WODC).
In respect of the Misuse of Chemicals Prevention Act (WVMC) the following appears.
• In the period between 1999 and 2003, annually some thirty cases involved offences against the
WVMC, usually in combination with hard drug offences. In 2003, 22 cases with such a
combination of offences were recorded; six cases only concerned an offence under the WVMC
(see Table 8.8).
Table 8.8 Number of final and conclusive judgments in cases concerning an offence
under the WVMC, from 1999
1999 2000 2001 2002 2003
Only WVMC 3 7 12 3 6
WVMC and Opium Act 20 18 27 29 22
Total 23 25 39 32 28
of Justice (WODC).
• More than 200 times a year, besides an offence under the Opium Act, charges also include
participation in a criminal organisation (Section 140, Netherlands Criminal Code). In 2003 this
happened 223 times (see Table 8.9).
132
Table 8.9 Number of final and conclusive judgments in respect of Section 140
Netherlands CC, from 1999
1999 2000 2001 2002 2003
Number of cases 292 230 215 132 223
Section 140
of Justice (WODC).
8.2.5 Disposal by the Court
As shown in Chapter 8.2.4, most of the Opium Act cases are brought before the Court. Table 8.10
shows the number of cases disposed by the Court.
• In 2003, the Courts disposed of over twelve thousand Opium Act cases. This is an increase of 21
compared to 2002. This increase was already shown for a number of years in respect of both hard
drug and soft drug cases, as well as in respect of cases with hard and soft drugs combined. This
picture is in step with the figures of intake and of disposed cases of the Public Prosecutions
d
Department (OM). Most of the cases here also concerned hard drugs.
• The proportion of hard drug cases steadily increased since 1999: from 54 percent in 1999 to 64
percent in 2003. The proportion of soft drug cases dropped since 1999 from 38 to 30 percent.
Table 8.10 Criminal cases disposed by the Court in first instance by type of drug, from
1999
1999 2000 2001 2002 2003
Hard drugs 4 558 4 720 5 321 6 543 7 883
Soft drugs 3 223 2 744 2 858 3 078 3 675
Hard and soft drugs 664 609 658 581 766
Total 8 445 8 073 8 837 10 202 12 324
Hard drugs 54% 58% 60% 64% 64%

Soft drugs 38% 34% 32% 30% 30%
Hard and soft drugs 8% 8% 7% 6% 6%
Total 100% 100% 100% 100% 100%
Source: Public Prosecutions Department Database (OMDATA), Research and Documentation Centre of the
Ministry of Justice (WODC).
8.2.6 Penalties in Opium Act cases
Table 8.11 describes the penalty probability and the types of penalties: financial out-of-court
settlements by the Public Prosecutions Department and the orders for community service,
unsuspended custodial sentences, fines and confiscations imposed by the Court. I. The penalty
probability shows the likelihood whether or not an offender under the Opium Act will actually be
e
penalised.
d
The figures of the Public Prosecutions Department (OM) in Table 8.7 and the Court in Table 8.10 cannot be
compared just like that: there is a time difference between the moment of intake of a case, the disposal by the
Public Prosecutions Department (OM) and the moment of judgment by the court; the figures of the Public
Prosecutions Department in Table 8.7 relate to cases disposed in final and conclusive judgment, those of the
court in Table 8.10 relate to cases disposed in first instance.
e
The penalty probability is defined as the sum of all out-of-court settlements and guilty verdicts with penalties,
divided by the total number of disposed cases (excluding joinder of charges and transfer of criminal proceedings).
133
• The penalty probability increased slightly: from 86 percent in 2001 to 89 percent in 2002 and 2003.
This means that a penalty was imposed in 89 out of 100 cases. The remainder of the suspects
had their cases dismissed of had their cases acquitted. The increase may partly be due to
"screening" by the police. Criminal cases are presently assessed by the police for the probability
of prosecution. Such filtered cases do not always end up in the records of the Public Prosecutions
Department (OM).
• The number of imposed community sentences rose again strongly in 2002 (+34%). The number of
unsuspended prison sentences also continued to rise (+11%), although somewhat less strongly
than in 2002. The increase in the number of unsuspended prison sentences was probably to a
considerable extent due to the drug couriers arrested at Schiphol Airport (including what are called
“drug swallowers”) (see also Chapter 8.2.7).
• The number of out-of-court settlements and fines did not change.
• The number of confiscations, though relatively low in absolute numbers, increased strongly in
2003.
Table 8.11 Penalty probability and number of unsuspended penalties in Opium Act cases,
from 1999
1999 2000 2001 2002 2003
Penalty probability 86% 85% 86% 89% 89%
Kind of penalty
• Community service 2 129 2 138 2 382 2 985 4 008
orders
• Unsuspended 3 578 3 341 3 523 4 641 5 155
custodial sentences
• Financial out-of- 911 838 1 568 1 884 1 797
court settlements
• Fines 1 634 1 350 1 393 1 522 1 547
• Confiscation orders 74 73 46 58 105
of Justice (WODC).
• The average length of the imposed community sentences remained more or less the same
throughout the years (see Table 8.12). In 2003, the average length of a community service
sentence was 119 days.
• The average length of the unsuspended custodial sentences was relatively high in 2002 and again
somewhat lower in 2003. In 2003, the length of imposed custodial sentences was 357 days on
average.
Table 8.12 Average length (in days) of community service orders and unsuspended
custodial sentences in Opium Act cases, from 1999
1999 2000 2001 2002 2003
Community service 124 122 121 114 119
orders
Unsuspended custodial 369 348 356 382 357
sentences
of Justice (WODC).
134
• The amount of the imposed financial out-of-court settlements has increased in the course of years.
f
In 2003, the median amount was 320 euros (see Table 8.13). The highest amount of a financial
out-of-court settlement in 2003 was 50,000 euros.
• The amount of fines increased in 2002 and 2003. In 2003 the median amount was 500 euros. The
highest fine in 2003 was 900,000 euros.
• The amounts involved in confiscation orders varied considerably per year.
Table 8.13 Median amount in euros of financial out-of-court settlements and confiscation
orders in Opium Act cases, from 1999
1999 2000 2001 2002 2003
Financial out-of-court 183 163 214 293 320
settlements
Fines 459 459 458 509 500
Confiscation orders 4 018 3 511 6 112 619 2 616
of Justice (WODC).
8.2.7 Custodial sentences Opium Act
As a result of custodial sentences imposed, a number of offenders end up in prison. Table 8.14
describes the number and length of the (partly) unsuspended custodial sentences imposed because of
violation of the Opium Act.
• In 2003, 15 percent of the total number of custodial sentences were custodial sentences for
violations of the Opium Act. Since 1999, this number grew steadily.
• The increase is due to hard drug cases. In 2003 these made up 14 percent of the total number of
custodial sentences. The proportion of soft drug cases remained stable.
• Of the detention years, 29 percent could be attributed to drug cases, 28 percent of which for hard
drug cases, an increase compared to 2002. This increase in prison capacity requirement was
caused largely by the increased focus on drug couriers at Schiphol. This is evident from the
number of years of detention imposed for violations of the Opium Act in Haarlem, where these
cases are handled. In 2003, 14 percent of all the detention years imposed in the Netherlands were
related to drug cases in Haarlem.
f
The median is the value associated with the middle number in a set of ordered data (ascending or
descending).The median is less sensitive to extremely high or low values than the arithmetical mean.
135
Table 8.14 Imposed unsuspended custodial sentences under the Opium Act by number and
percentage of custodial sentences and length in years of detention, from 1999
1999 2000 2001 2002 2003
Number of custodial sentences 26 313 27 021 28 940 32 849 34 381
Total of Opium Act cases 12% 11% 12% 14% 15%
I
- hard drugs 11% 10% 11% 13% 14%
- soft drugs 1% 1% 1% 1% 1%
Other criminal cases 88% 89% 88% 86% 85%
II
Years of detention 9 441 9 442 10 517 12 512 12 235
Total of Opium Act cases 26% 23% 23% 27% 29%
I
- hard drugs 24% 22% 22% 26% 28%
- soft drugs 2% 1% 1% 1% 1%
Other criminal cases 74% 77% 77% 73% 71%
I. A case in which charges of a soft drug offence are brought, besides a hard drug offence, is classified under
hard drugs. II. The number of years of detention is calculated by deducting the suspended part (that does not
have to be served as a result of parole regulations) from the unsuspended prison sentence in each case. Source:
Justice Documentation Research Database (OBJD), Research and Documentation Centre of the Ministry of
Justice (WODC).
In 2003, over 14,000 persons were detained in total, part of them because of violations of the Opium
Act (see Table 8.15).
• A quarter of the prison population was made up of offenders under the Opium Act in 2003.
Compared to 2002 this is a decrease, whereas, over the period between 1999 and 2003, there
was in increase of 21 to 25.
I
Table 8.15 Number of persons in penal institutions by type of offence, from 1999
1999 2000 2001 2002 2003
II II
Total number 8 789 10 300 11 399 11 960 14 191
• Traffic offences 1% 1% 1% 1% 1%
• Vandalism/disturbance of 3% 2% 4% 4% 4%
the public order
• Property offences 22% 20% 20% 19% 20%
• Offences against the 21% 21% 24% 27% 25%
Opium Act
• Violent offences 43% 43% 42% 42% 43%
• Unknown/other offences 11% 12% 9% 8% 7%
• Total
III 101% 99% 100% 101% 100%
I. The figures do not include detention of aliens. II. 2002 does not include detainees in detention centres, 2003
does include these. III. Not always exactly 100% due to rounding differences. Source: Enforcement of custodial
measures in correctional institutions (TULP), National Agency of Correctional Institutions (DJI).
8.2.8 Recidivism of Opium Act offenders
Despite having been sentenced, part of the Opium Act offenders came into renewed contact with the
law. To get a picture of their recidivism, from the WODC Recidivist Monitor (see Appendix B) a
selection was made of all the people who had been at least once in contact with the law in 1997 for
136
g
violation of the Opium Act. This resulted in a group of 8,708 Opium Act offenders. Of these people,
the entire criminal record was subsequently requested. It was researched whether they came into
renewed contact with the law in 1997 and if so, after how much time. In this respect, three types of
recidivism have been distinguished. For the determination of the general recidivism, all the new
contacts with the criminal justice system are counted, with the exception of matters ending in acquittal,
dismissal by reason of likeliness of nonconviction or another technical judgment. We speak of serious
recidivism in the case of new contacts with the criminal justice system for offences that carry a
minimum sentence of four years. For the determination of the special recidivism of drug offenders,
only new contacts with the criminal justice system because of a violation of the Opium Act are
counted.
Table 8.16 provides an overview of the percentage of Opium Act offenders who were in renewed
contact with the criminal justice system within a period of one to five years. For purposes of
h
comparison, the recidivism in the entire population of perpetrators has been stated.
• The general picture is that drug offenders repeated an offence somewhat more often when
compared to their proportion in the total offender population, that is to say all the offenders added
up. Within one year after release, a quarter of all those convicted for drug offences against the
Opium Act came into renewed contact with the law. Within five years this increased to 45 percent.
• Counting only cases of serious offences, the percentage of frequent offenders for violations of the
Opium Act was 15 percent within one year, going up to 29 percent within five years.
• The proportion of frequent offenders under the Opium Act within five years (what is called special
recidivism) was 22 percent.
• These data prove that Opium Act offenders did not just repeat the violations of the Opium Act, but
also engaged in other forms of criminality.
• Male offenders under the Opium Act repeated the offence more often generally than female
offenders (not included in the table).
• The criminal past played an important role. For individuals who had contacts with the criminal
justice system for serious drug offences, the probability of recidivism after the initial case was
higher. Moreover, the younger the perpetrator was at the first contact with the law, the larger the
probability of recidivism at a later stage.
Table 8.14 Percentage of frequent offenders after having violated the Opium Act,
cumulatively over a period of five years
O b s e r v a t i on P e r i o d
1 year 2 years 3 years 4 years 5 years
I II I II I II I II I II
Type of repeat offence OA total OA total OA total OA total OA total
• General 25% 22% 34% 31% 40% 36% 43% 39% 45% 42%
• Serious 15% 14% 21% 19% 25% 23% 28% 25% 29% 26%
• Special 10% - 15% - 18% - 20% - 22% -

I. Perpetrators who were in contact with the law in 1997 for a violation of the Opium Act (OA). II. All the
perpetrators who were in contact with the law in 1997. Source: Recidivism Monitor, Research and Documentation
Centre of the Ministry of Justice (WODC).
Table 8.17 provides an outline of numbers of Opium Act offences in the distinguished phases of the
criminal law chain in 2003. The figures are based on various sources and their mutual relationship
g
Including 7 (0.1%) offences under the Misuse of Chemicals Prevention Act (WVMC).
h
Determination of the special recidivism or recidivism in the framework of the Opium Act is not meaningful,
because the nature of the initial cases of the perpetrators varies widely. This contrary to the initial cases of drug
offenders, which always concern a violation of the Opium Act or of the Abuse of Chemical Substances Prevention
Act (WVMC).
137
must be interpreted with caution. It is apparent once more that hard drug offences occurred more often
in all the phases than soft drug offences. This difference increased as we progress in the chain.
Table 8.17 Number of suspects at the police, Royal Military Police (KMar) and Public
Prosecutions Department (OM), persons sentences by the Court, prison
sentences and years of detention for Opium Act offences by phase in the
criminal law chain and hard and/or soft drugs, 2003
Phase in chain Police KMar OM Court in first Custodial Years of
I
instance sentences detention
Total Opium Act 14 299 1 640 17 087 12 324 5 137 3 600
• Hard drugs 7 744 1 491 9 989 7 883 4 618 3 298
• Soft drugs 5 495 137 6 156 3 675 370 145
• Both 1 060 12 942 766 149 157
%
• Hard drugs 54% 91% 58% 64% 90% 92%
• Soft drugs 38% 8% 36% 30% 7% 4%
• Both 7% 1% 6% 6% 3% 4%
I. Eighteen sentences and years of detention are missing: these cannot be categorised by kind of drug or the
duration of the sentence is unknown. Sources: Police Records System (HKS), National Police Agency
(KLPD)/National Criminal Intelligence Service (DNRI); Public Prosecutions Department Database (OMDATA),
Research and Documentation Centre of the Ministry of Justice (WODC); Justice Documentation Research
Database (OBJD), Research and Documentation Centre of the Ministry of Justice (WODC).
8.3 CRIMINAL DRUG USERS
8.3.1 Profiles of drug using suspects
Tables 8.18 and 8.19 display characteristics of suspects recorded as “drug users” in the Police
Records System (HKS). In the HKS, addiction of use of drugs is not recorded as such. Nevertheless a
rough description can be given of the group of suspected drug users by using what is called the
‘danger classification’ in the HKS. If it has become known that a suspect is a problem user of drugs, or
if the suspect has indicated this, that suspect is recorded in the system as “drug user” in what is
called “danger classifications”. The extent of drug addiction cannot be accurately established on the
basis of the available data. There are doubts about the completeness of the recording of drug use; it is
3
assumed that it concerns a minimum indication.
138
Table 8.18 Profiles of suspects recorded as “drug users”, from 1999
II
1999 2000 2001 2002 2003
Number of suspects 9 972 9 251 9 947 10 525 10 247
Gender Men 90% 90% 91% 90% 90%
Women 10% 10% 9% 10% 10%
Town or city by number Under 20 000 4% 4% 4% 4% 4%

I
of inhabitants
20 000 – 50 000 11% 11% 11% 10% 10%
50 000 – 100 000 12% 12% 12% 12% 11%
100 000 – 150 000 10% 10% 10% 11% 11%
150 000 – 250 000 9% 10% 10% 10% 10%
250 000 and over 46% 47% 45% 45% 44%
Abroad 6% 5% 5% 5% 4%
Unknown 2% 2% 4% 3% 6%
Danger classification Alcohol 11% 11% 12% 11% 11%

Drugs 100% 100% 100% 100% 100%
Otherwise 19% 20% 20% 20% 21%
Age upon recording of 12-17 0% 0% 0% 0% 0%

latest offence
18-24 9% 9% 8% 8% 7%
25-34 43% 41% 38% 36% 33%
35-44 37% 39% 40% 41% 42%
45-54 9% 10% 12% 14% 16%
55 years and over 1% 1% 1% 1% 2%
Average age (year) 34.4 34.8 35.4 36.3 36.8

I. Last known domicile or residence. II. Provisional figures: HKS data of the last year are retrieved once more after
a year. We know from experience that there will be an addition of approximately 6%. Source: Police Records
System (HKS), National Police Agency (KLPD)/National Criminal Intelligence Service of the National Police
Agency (DNRI), Research & Analysis group.
• Nine in ten suspects recorded as drug users were men. This proportion remained constant over
the years.
• The distribution of drug using suspects by size of the towns or cities in which the drug using
suspects live, also remained practically constant: nearly half the suspects (44%) lived in cities of
250,000 or more inhabitants.
• Of these drug using suspects, 11 percent were also recorded as addicted to alcohol and 21
percents also as addicted to other substances (such as licit drugs).
• Often the suspects who are classified as drug users got in contact with the police for the first time
at a young age: in 2003, nearly half (45%) were younger than 18 years at the time the first offence
was recorded, three-quarters (77%) were younger than 25 (not shown in the table).
• The average age at the most recent offence was slightly higher in 2003 than in 2002 and was
about 37.
139
Table 8.19 Characteristics of offences by suspects recorded as “drug users”, from 1999
1999 2000 2001 2002 2003
I
Criminal record 1 3% 3% 4% 4% 3%
2 3% 3% 3% 3% 2%
3-4 5% 5% 5% 6% 5%
5-10 16% 15% 15% 16% 15%
11-20 20% 20% 20% 21% 20%
21-50 31% 32% 32% 32% 32%
>50 21% 22% 22% 20% 20%
II
Type of offence Sexual assault 1% 2% 1% 1% 1%
Other violence 19% 20% 20% 22% 23%
Theft with violence / extortion 12% 12% 12% 12% 11%
Property offences 63% 63% 63% 63% 58%
Vandalism, disturbance of 20% 21% 21% 22% 22%
the public order / authorities
Traffic offences 10% 11% 11% 10% 10%
Offences against the Opium 20% 18% 19% 19% 22%
Act
Other offences 10% 11% 10% 10% 10%
I. Total number of criminal records in the entire prior criminal history. II. Suspects may have committed more than
one type of offence; consequently, the percentages should not be added up. Source: Police Records System
(HKS), National Police Agency (KLPD)/National Criminal Intelligence Service of the National Police Agency
(DNRI), Research & Analysis group.
• Against the vast majority of the suspects classified as drug users an earlier police record was
drawn up because of a criminal offence and 72% has more than ten earlier criminal records.
• Nearly six out of ten suspects were booked for a property offence. In 2003, this percentage was
lower than in 2002. The category "other offences" was slightly higher than in earlier years, as was
the category ‘Opium Act’.
8.3.2 Proportion of drug users in the population of frequent offenders on judicial level
A recent WODC report shows that the judicial system has to deal with a group of more than 6000 'very
154
high rate frequent' offenders. These are offenders who had more than ten valid penal cases in the
previous period of five years. The authors did additional analyses based on information, recorded in
i
the criminal files.
• An estimated 70 percent of the very high rate frequent offenders were regular users of hard drugs
and more than 10 percent had to cope with alcohol problems (see Table 8.20).
This analysis shows that the group of frequent offenders, at any rate the most active, corresponded to
a large extent with the group of regular hard drug users.
i
Sample from the Criminal Justice Monitor (SRM) (see Appendix B).
140
Table 8.20 Profile of frequent offenders on judicial level in the years 1993, 1995 and 1999
Low rate High rate Very high rate Total group
frequent frequent frequent of offenders
offenders offenders offenders
Number 252 248 145 2 480
Regular hard drug use 17% 36% 71% 14%

Alcohol problems 7% 10% 12% 4%
Source: Criminal Justice Monitor (SRM)/Recidivism Monitor of the Research and Documentation
155
Centre of the Ministry of Justice (WODC).
8.4 HELP FOR PROBLEM USERS IN THE CRIMINAL SYSTEM
Problem users of drugs in the criminal system can receive support and help in respect of their
(addiction) problems in several manners. The Netherlands (Drug) Rehabilitation Foundation offers
possibilities and, inter alia, contacts suspected or convicted users and prepares reports for the Public
Prosecutions Department and the Court about the possibilities for an individual care program. In
addition, there are possibilities for users to participate in a care program as an alternative to
prosecution and penalties. Programs in detention prepare users in a placement and selection phase.
Since 2001, it has become legally possible for the Courts to mandate drug users to undergo treatment:
Judicial Treatment of Addicts (SOV).
In this paragraph we shall describe which help was available in 2003 and how often problem users
made use of it:
• the Netherlands (Drug) Rehabilitation Foundation (see Chapter 8.4.1)
• alternatives for prosecution and penalties and placement and selection phase (see Chapter 8.4.2)
• intake in the Judicial Treatment of Addicts (SOV) (see Chapter 8.4.3).
The figures are based on the following sources:

• The Client Follow-up System (CVS) of the (addiction) probation service implemented in 2001 (see
156
Appendix B). This system does not give complete nationwide information about the nature of
the addiction of the clients (alcohol, drugs, gambling, etc.) or about the type of drug (heroin,
j
cocaine, etc.). The figures have therefore not been specified by type of addiction. Figures on
k
client level are not available either. It is not known how reliable the figures are.
• The National Agency of Correctional Institutions has provided information about Drug-free Units
(VBAs) in penitentiaries.
• Figures about the intake in and outflow from the Judicial Treatment of Addicts (SOV) are based on
data from the SOV locations and have been obtained via the Trimbos Institute.
j
Data from the National Information System on Alcohol and Drugs (LADIS) of before 2001 show that drug addicts
make up approx. 60% of the clients of the probation service for addicts. The second large category is made up of
clients with alcohol-related problems as a primary diagnosis. The drug clients were mainly users of hard drug:
opiates, psychoanaleptic drugs (including cocaine) and poly-drug use. The trend was in the direction of fewer
opiates and more psychoanaleptic drugs.
k
In the annual accounts 2003 the remark is made that the retrieval of overviews is very time-consuming and that
there is doubt about the reliability of the overviews.
141
8.4.1 The Netherlands (Drug) Rehabilitation Foundation
The Netherlands (Drug) Rehabilitation Foundation offers users in the criminal system various forms of
support, within budgetary and policy-related limits. It forms a bridge between the judicial authorities
and the care organisations.
• From the approx. 50 establishments, 15 care organisations for addicts recognised in the
138
framework of the Netherlands (Drug) Rehabilitation Foundation are active. These form a nation-
wide network.
• In 2002, 44 percent of the clients of the Netherlands (Drug) Rehabilitation Foundation were in pre-
detention, 41 percent served a prison sentence. No figures are available for 2003.
In 2003, the Netherlands (Drug) Rehabilitation Foundation carried out twelve key activities for
156;158
justiciable individuals. Table 8.21 shows how often these activities have been carried out. The
numbers relate to all kinds of problems (drugs, alcohol, gambling, etc). In 2003, the activity “diagnosis”
l
was defined anew. This was related to the implementation of a standard instrument - the RISC - that
was implemented in the framework of the judicial program Terugdringen Recidive [Reducing
Recidivism] and that must be applied and recorded by the Netherlands (Drug) Rehabilitation
Foundation and staff in penitentiaries.
Table 8.21 Number of times that the Netherlands (Drug) Rehabilitation Foundation carried
I, II
out key activities in 2002 and 2003
III
Products 2002 2003
Visit for early assessment of needs 3 629 4 305
Early assessment intervention report 995 922
Counselling for treatment 10 048 9 156
IV
Diagnosis 10 615
Placement and selection phase 1 568 2 115
Supervision 2 407 3 726
Reintegration program 1 696 2 566
Community service order 3 382 4 098
Training order 139 217
Social inquiry report 4 423 4 254
Recommendation report 2 989 4 408
Nonpunitive order report 175 84
I. No figures on client level or specified by the type of substance are available. II. Figures 2001 not given, figures
different, implementation process Client Follow-up System (CVS) took place that year. III. The figures relate to
established production after accounting audit. IV. Newly defined in 2003. Source: Netherlands (Drug)
140
Rehabilitation Foundation (SVG).
• Visits to make an early assessment of needs were made more than 4,000 times in 2003, which is
more often than in 2002. It concerns the first visit to a detainee, a suspect taken into police
custody or placed in a detention centre, more specifically on detainees who are actually expected
to be taken in by the care organisations. In the last few years, the number of visits to make an
early assessment of needs was between 3,600 and 4,000.
l
The RISC (Risk Assessment Scales) is an instrument for rehabilitation services and the prison service; it is used
to achieve an assessment of the chance of recidivism and to make the correct choice of intervention for the client.
Diagnostics through RISC makes an assessment possible of the risk of recidivism and of the danger that a client
poses for himself/herself and others. Moreover, it shows in which areas of life the client has needs or deficiencies
and which possibilities of lack thereof someone has to participate in specific interventions.
142
• In the case of early assessment intervention, a report is submitted to the Court recommending
whether or not the pre-trial detention should continue (and the manner in which). In 2003, this type
of intervention was carried out more than 900 times. This number hardly differs from that in 2002.
• Part of the counselling for treatment is the ‘systematic approach that is used for drawing up,
coordinating and evaluating a plan of action based on examination’. In 2003, counselling for
treatment took place more than 9,000 times, which is less often than in 2002.
• Diagnoses were recorded as such for the first time in 2003. Redefining and the new manner of
recording have to do with the development of a new diagnostic instrument (the RISC), which is to
be the standard in the future. In 2003, the number of diagnoses made by the Netherlands (Drug)
Rehabilitation Foundation was over 10,000.
• In the placement and selection phase it concerns the effort required to place a client in a care
institution. The placement and selection phase may take place at any stage of the criminal
process: from the stay in a police cell or the remand centre up to and including the stage of
159
detention. In 2003, more than 2,000 efforts for placement and selection were carried out, more
than in 2002.
• The Netherlands (Drug) Rehabilitation Foundation supervises clients in the framework of a judicial
decision in all the phases of the criminal process. In 2003, more than 3,700 supervision records
were made.
• In reintegration programmes, the Netherlands (Drug) Rehabilitation Foundation provides training
to teach clients insight and/or skills in the field of living, work, education, finances, behaviour,
relationships, etc. The activities within the Drug-Free Units (VBAs) in penitentiaries are part of this.
In 2003, activities in this framework took place more than 2,500 times, an increase compared to
2002.
• In 2003, the Netherlands (Drug) Rehabilitation Foundation was more than 4,000 times involved in
the execution of a community service order or training order. This is also more than in 2002.
The Netherlands (Drug) Rehabilitation Foundation prepares various kinds of reports: social inquiry,
recommendation and nonpunitive order reports (see Table 8.22).
• Social inquiry reports give written information to the Court in respect of the decision about
prosecution, adjudication or the enforcement of a sentence and/or (punitive) order. Social inquiry
reports are prepared during police custody, remand in custody or pre-trial detention. The number
of social inquiry reports, which are usually requested by the judicial authorities, fluctuated around
4,000 over the years.
• A recommendation report is a limited, written manner of giving information about the client to a
(judicial) authority in respect of a specific question or a decision to be taken Recommendation
reports are prepared throughout the entire judicial process. In 2003, the number of
recommendation reports increased by nearly 50 percent to more than 4,000.
• Nonpunitive order reports concern written information to the Ministry of Justice, the Forensic
Psychiatric Service (FPD), institution in the framework of a hospital order (TBS) and/or the Court
in respect of decisions about a nonpunitive order. These reports relate, inter alia, to the Judicial
Treatment of Addicts (SOV). In 2003, 84 reports were prepared.
143
Table 8.22 Number of reports prepared by the Netherlands (Drug) Rehabilitation
Foundation, from 1999
Year Social inquiry reports Recommendation reports Nonpunitive order
reports
1999 4 427 2 269 -
2000 4 113 2 555 -
2001 3 303 2 292 -
2002 4 423 2 989 175
2003 4 254 4 408 84
Source: Netherlands (Drug) Rehabilitation Foundation (SVG).
8.4.2 Treatment processes as an alternative for prosecution and penalties
Since the nineties, judicial policy has focused explicitly on leading criminal drug users to treatment
160
processes as an alternative for prosecution and penalties. This aims to improve the situation of the
user via a treatment process and - as a result - to reduce nuisance and criminal recidivism. In all the
phases of the criminal process, from the arrest up to their detention, there are possibilities to be
received into a treatment process. In the initial phase and the final phase, intake occurs only on a
voluntary basis. From remand in custody to detention, coercion is possible. In the case of coercion,
users have the choice between participation in a treatment process, on the one hand, and prosecution
or a penalty (often detention), on the other hand. The choice is not without commitment: if the user
does not satisfy the conditions and agreements, further prosecution, conviction or execution of
penalties is bound to take place. This is the coercion, the big stick. There are various judicial options
for intake in treatment processes from the criminal system (see Table 8.23). The table also includes
the compulsory measure of Judicial Treatment of Addicts (SOV).
• During the police phase, there are no options for coercion. Users may approach the treatment
service at their own initiative.
• During pre-trial detention, there is the option of (conditional) dismissal and suspension of the
detention under conditions, the condition being participation in a treatment process.
• While brought before the public prosecutor and during court hearing, the proceedings may be
stayed or a suspended sentence may be imposed under the condition of participation in a
treatment process.
• Since April 2001, it has been possible to impose the nonpunitive order Judicial Treatment of
Addicts (SOV), placing a drug user in a special custodial institution.
• During detention, it is possible to participate in detention replacing treatment pursuant to Section
43 of the Prisons Act (PBW). This section provides the possibility to transfer detainees to a
treatment facility, possibly outside of the penitentiary institution.
• At the last stage of detention, participation in a Penitentiary Program outside of the penitentiary
institution is possible. This program provides guided use of facilities outside of the penitentiary
institution, while the detainee may also participate in social activities without the care
organisations.
• At the end of the chain, at the end of the detention, any intake in the treatment services is on a
voluntary basis.
• In 2003, no changes were made to the criminal options compared to 2002.
144
Table 8.23 Criminal options for intake in treatment processes for drug users by phase in the
custody chain, situation 2003
Phase in custody chain Judicial option Coercion or compulsion
During police custody and • None No coercion possible; intake in
remand in custody without treatment process on a voluntary
extension (police phase) basis
During pre-trial custody • (Conditional) dismissal by the Public Intake in treatment process under
Prosecutions Department (OM) coercion; agreement of addict
(Section 167 of the Netherlands Code required
of Criminal Procedure)
• Conditional suspension of pre-trial
detention (Section 80 of the
Netherlands Code of Criminal
Procedure)
While brought before the • Staying of the court Intake in treatment process under
public prosecutor and during hearing/deferment of sentencing coercion; agreement of addict
court hearing (Sections 281 and 346 of the required
Netherlands Code of Criminal
Procedure)
• Awarding of a (partly) suspended
sentence with the condition to enter a
particular treatment or care program,
specified during the hearing (Sections
14a and 14c of the Netherlands Code
of Criminal Procedure)
• Imposing of nonpunitive order Compulsion, nonpunitive order may
Judicial Treatment of Addicts (SOV) be imposed without the agreement
(Section 38m of the Netherlands of the addict
Code of Criminal Procedure)
During detention • Participation in treatment process, if Intake in treatment process under
necessary outside of the penitentiary coercion; agreement of addict
institution in a residential clinic required
(Section 43 Prisons Act)
• Participation in a penitentiary
program (Section 4 Prisons Act)
Post-detention • None No coercion possible; intake in
treatment process on a voluntary
basis
160
Source: Research and Documentation Centre of the Ministry of Justice (WODC).
• In penitentiary institutions, detained problem users receive the possibility to be placed in the Drug-
Free Units (VBAs) on a voluntary basis. VBAs are meant as a placement and selection program to
a treatment process. In 2003 there were 12 VBAs with 325 places. In 2002, drug users
participated 758 times in a VBA compared to 680 in 2003.
• No figures are known about the use of the distinguished judicial options by problem users of
drugs. The application of coercion and the effectiveness of the treatment processes that the
161
judicial authorities use towards the care organisations appear capable of improvement.
• In 2003, 2,115 efforts for placement and selection were carried out (see Table 8.24).
• Not all the efforts for placement and selection that were started in 2003 have been realised.
Figures from the Netherlands (Drug) Rehabilitation Foundation show that of the over 3,000 efforts
for placement and selection that were started two thirds (67%) were actually realised according to
plan. In one-third of the cases the placement and selection phase for treatment was not completed
145
as planned. In these cases the process was broken off prematurely for one reason or other (e.g.
by the addict or by the care organisation). These figures are the same as in 2002.
• The various possible treatment processes are not specifically related to one of the (above
described) judicial modality. From the judicial system, a user may go to many possible facilities
that are not financed by the Ministry of Justice, as long as the decisive authority (usually the judge
or the selection official) finds this an appropriate and acceptable process.
• The influx from the judicial system into treatment processes takes place mainly into clinical,
outpatient and part-time facilities in the addiction care that are not financed by the Ministry of
Justice (see Table 8.23).
• The categories of clinical, outpatient and part-time care organisations for addicts comprise
services with various objectives and target groups (see Appendix D).
Table 8.24 Placement and selection efforts to treatment by the Netherlands (Drug)
I
Rehabilitation Foundation by type of treatment process in 2002 and 2003
II
Type of treatment process: 2002 2003
Clinical treatment of addicts 650 42% 889 41%
Outpatient and part-time treatment of 474 30% 726 34%
addicts
Social care 126 8% 171 8%
Psychiatric care by a General Psychiatric 123 8% 76 4%
Hospital (APZ)
Non-clinical psychiatric care 44 3% 83 4%
Psychiatric part-time treatment 28 2% 50 2%
Social pensions 24 2% 23 1%
Homes for the homeless 22 1% 25 1%
Psychiatric outpatient clinic 20 1% 35 2%
Crisis shelter 24 hours 19 1% 19 1%
Other facilities 38 2% 56 3%
Total 1 568 100% 2 153 101%
I. No figures available on client level, not specified by type of substance. II. Figures 2003 calculated based on
production overview 31-05-2004, production figures not yet audited. This is the reason for differences with Table
8.20. Source: Netherlands (Drug) Rehabilitation Foundation (SVG).
8.4.3 The Judicial Treatment of Addicts (SOV)
With effect of 1 April 2001, it has become legally possible for the courts to mandate criminal problem
users of drugs to undergo treatment in a special custodial facility with a partly inpatient and partly
outpatient program. The “Judicial Treatment of Addicts” (SOV) Order is presently implemented as a
temporary experiment in specially equipped correctional facilities.
• The order is imposed by a three-judge criminal section of the court at the request of the Public
Prosecutions Department, if the suspect has committed a crime that is subject to pre-trial
detention, is drug-dependent, has been sentenced to a custodial punishment at least three times
in the five years prior to the current offence, has participated without success in compulsory drug
treatment in the past and does not suffer from a serious psychiatric disorder. The SOV is only
meant for men who have the Dutch nationality.
• The Judicial Treatment of Addicts order has a mandatory term of two years. The Judicial
Treatment of Addicts program has a phased system with a closed phase, a half-open phase and
an open phase outside of the institution. The duration of each phase is six to nine months. The
order includes a "unit 4". There those persons are placed who do not (or temporarily not) wish to
cooperate with the program provided in the framework of the order. They will undergo minimum
treatment.
146
• The Judicial Treatment of Addicts (SOV) started in 2001 in four different locations: Rotterdam
(start date 1 April 2001), Amsterdam (start date 1 May 2001), Utrecht (start date October 2001)
and in the South (Arnhem, Nijmegen, Den Bosch, Eindhoven, Maastricht and Heerlen; start date
October 2001). The first participant was accepted in June 2001. The total capacity is 219 places.
• The number of participants in the SOV increased steadily in 1003, as it did in 2002: from 157 in
January 2003 to 178 in June and 192 end December 2003. Between July and November 2003 the
number was more or less stable (see Figure 8.1).
Figure 8.1 Number of participants in the Judicial Treatment of Addicts (SOV) per month in
2003
250
192
200
178 183 184 181 183 184
170 174
157 163 165
150
100
50
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Source: Judicial Treatment of Addicts (SOV) locations, Trimbos Institute.
• The degree of capacity utilisation increased also. In 2003 the degree of capacity utilisation
increased from 71 percent in January to 78 percent in June and subsequently to 85 percent in
December. End 2003, 15 percent of the available (inpatient) places were still empty (see Table
8.25). End 2002 this was still 32 percent.
• The degree of capacity utilisation varied per location. In December 2003, the degree of capacity
utilisation in Amsterdam was 94%, in Rotterdam 85 percent, in Utrecht 91 percent and in the
South (Arnhem, Nijmegen, Den Bosch, Eindhoven, Maastricht and Heerlen) 65%.
147
Table 8.25 Number of participants and degree of utilisation of the Judicial Treatment of
Addicts (SOV) by location Survey dates 31 January, 30 June and 32 December
I
2003
II
Amsterdam Rotterdam Utrecht South Total
Jan Jun Dec Jan Jun Dec Jan Jun Dec Jan Jun Dec Jan Jun Dec
Number of 65 69 68 47 54 61 23 25 32 20 22 26 155 170 187
participants
Degree of capacity 90 96 94 65 75 85 66 71 91 50 55 65 71 78 85
utilisation (%)
I. Counted exclusive of participants in phase 3. II. South in December 2003: Arnhem: 6, Nijmegen: 2, Heerlen: 5,
Den Bosch: 5, Eindhoven: 6, Maastricht: 2. Source: Judicial Treatment of Addicts (SOV) locations, Trimbos
Institute.
• End December 2003, 90 participants were in phase 1, 61 in phase 2 and 5 in phase 3; 28

participants were staying in unit 4 and 7 participants underwent treatment in another facility while
retaining their SOV status. Eight persons were already in the Judicial Treatment for Addicts (SOV)
before it was imposed (preventives or pre-SOVs; see Table 8.26).
Table 8.26 Participants in the Judicial Treatment for Addicts (SOV) by phase, stay in unit 4
and in another facility. Survey date 31 December 2003
Phase/unit Number of participants
Preventive or pre-SOV 8
Phase 1 90
Phase 2 61
Phase 3 5
Unit 4 28
In another facility while retaining SOV status 7
I
Total 200
I. Included: one participant who is a fugitive. Source: Judicial Treatment of Addicts (SOV) locations, Trimbos
Institute.
• In 2003, the outflow started on a regular basis, that is to say the outflow of drug addicts who had
completed the SOV program. On 22 April 2003, the first participant completed this treatment and
left. In December 2003, 22 participants completed the treatment and left. The Judicial Treatment
for Addicts (SOV) was ended seven times prematurely by the Court.
• Information about the processes and effectiveness of this drug treatment order is not yet available.
In September 2001, the process evaluation of the SOV commenced. The results will become
available at the beginning of 2005. The effect evaluation commenced in June 2002, with the final
results expected in late 2006.
148
Appendix A Glossary of Terms
This appendix consists of two parts. In the first part, concepts in the field of the use of substances and
addiction are explained. In the second part, concepts in the field of drug crime are explained.
I. USE OF SUBSTANCES AND ADDICTION
Abuse
A form of problematic use of a substance, whereas there is no addiction (yet). Abuse is established via
diagnostic classification systems, such as the Diagnostic and Statistical Manual of Mental Disorders
(DSM) and the International Classification of Diseases (ICD). Characteristics of abuse are: non-
fulfilment of obligations at home, at school or at work, use in dangerous situations (for example,
driving under the influence), being in contact with the criminal judicial system and continued use
despite the problems created by this.
Addiction
Problematic use of a substance while there is dependence. As a rule, in this Annual Report, by
"addiction" is understood the clinical diagnosis of dependence. However, for judicial monitors it is not
possible to make clinical diagnoses. Judicial monitors record, for example, additional danger because
of drug use or ‘clear indications for addiction’ (see Chapter 8.3.2., Criminal Justice Monitor (SRM)).
The clinical diagnosis of dependence is made via classification systems as the Diagnostic and Statistic
Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD).
Characteristics of dependence are: frequent use of large quantities or for a longer period of time, the
need of ever increasing quantities of the substance to cause the desired effect (habituation),
withdrawal symptoms, use of the substance against withdrawal symptoms, wanting to stop while not
succeeding, spending much time to obtain the substance or to recover from it, dropping important
activities at home, at school, at work or during leisure time and continuing the use in spite of the
realisation that this causes many problems.
Client LADIS
Client of the (inpatient) care organisations of drug addicts, of whom some details about his/her
background, treatment demand and received treatment are recorded anonymously in the LADIS, the
National Information System on Alcohol and Drugs. Clients are registered with the care organisations
for many forms of help, from a therapeutic treatment to help in the form of debt rescheduling,
methadone provision, social rehabilitation or controlled access to a users’ room. Clients who do no
longer use the aid organisation after some time are deregistered automatically and are no longer
included in the number of clients.
Clinical admission
Admission in a hospital while the patient stays for one or more nights in the hospital.
Current use
The use of a substance in the last month, irrespective of the frequency (from one-time to daily).
Current users are included automatically as part of the recent users (use in the past year), who are
again included automatically as part of the ever users (use ever in life).
Day-treatment admission
Admission in a hospital for maximum one day, while the patient does not stay overnight in the hospital.
Dependence
See: Addiction.
149
DSM
DSM stands for Diagnostic and Statistical Manual of Mental Disorders. The DSM is a manual to
determine from which mental disorder somebody suffers. According to the DSM, addiction is one of
the mental disorders. The DSM-III-r is the third revised version and the DSM-IV is the fourth version.
Ever use
The use of a substance ever in a life-time, irrespective of the frequency (from one-time to daily).
Hallucination
Perception (seeing, hearing or feeling) that someone has, but that is not shared by other people.
Hallucinations may be a symptom of a mental disorder, but are called up intentionally by some people
via hallucinogens.
Hallucinogens
Substances calling up hallucinations, such as paddo's and LSD. Are also called psychodysleptics.
Cannabis may also cause hallucinations sometimes.
Hardcore
Hard form of music at house parties.
Hard drugs
Drugs appearing in list I of the Opium Act. These drugs create an unacceptable risk to public health.
Hard drugs include heroin, cocaine, crack, ecstasy and amphetamine.
Hepatitis
A highly contagious disease in which the liver is affected by the hepatitis virus. The hepatitis virus
appears in various forms: the hepatitis A, the hepatitis B and the hepatitis C virus. HBV is the hepatitis
B virus and HCV is the hepatitis C virus.
ICD
International Classification of Diseases. The ICD is the diagnostic classification system of the World
Health Organisation (WHO) for physical diseases, accidents and mental disorders. Causes of death
are also recorded in ICD codes. The ICD-9 is the ninth and the ICD-10 is the tenth version. See also
Appendix C.
Immigrant, foreign, ethnic

Due to different definitions, figures about immigrants are not always comparable. Some definitions are:
According to the Ministry of Home Affairs, the Association of Dutch Municipalities, the National
Representative School Survey, the Antenne Monitor and as generally used in this Annual Report
(unless stated otherwise): "immigrant" is an inhabitant of the Netherlands who was born abroad, or an
inhabitant with at least one parent who was born abroad.
According to Statistics Netherlands (CBS): "immigrant" is an inhabitant of the Netherlands with at least
one parent who was born abroad, irrespective of the country of birth of the person himself/herself.
According to the Amsterdam Area Health Authority (GG&GD Amsterdam): "foreigner" is an inhabitant
who was born abroad.
According to National Information System on Alcohol and Drugs (LADIS): "immigrant" is a client who in
his own perception has a cultural origin from outside of the Netherlands.

Care of addicts in which the client is not admitted in a facility.
150
Mellow
Form of music at house parties that is melodious and less hard than hardcore music.
Narcotics
Drugs. General collective term for narcotic drugs.
Native Dutch
According to the Ministry of Home Affairs, the Association of Dutch Municipalities, the National
Representative School Survey, the Antenne Monitor and as generally used in this Annual Report
(unless stated otherwise): "native Dutch" is a person who was born in the Netherlands while both
parents were also born in the Netherlands.
Nederwiet
Weed (a cannabis product) grown in the Netherlands.

Care of addicts in which the client is not admitted in a facility. In the case of inpatient care of addicts,
the client is admitted in a facility.
Parkstad Limburg
The cooperation between the South-Limburg municipalities of Brunssum, Heerlen, Kerkrade,
Landgraaf, Nuth, Onderbanken, Simpelveld and Voerendaal. (The municipality of Nuth has meanwhile
left the cooperation.)
Party drugs
Drugs used by some party-goers at parties, such as ecstasy, amphetamines, cannabis, GHB and
LSD.
Poly drug use

The use of various drugs one after the other, for example heroin and cocaine.
Primary cause of death

The direct cause of somebody’s death. If someone dies directly as a result of a drug overdose, then
this is the primary cause of death. If somebody dies as a result of an accident that took place while he
or she was under the influence of a drug, then the accident is the primary cause of death. The drug is
then a secondary cause of death.
Primary diagnosis
The primary disease for which someone is admitted in a hospital.
Primary problem
If someone has a problem with two (or more) substances, the primary problem is the substance
causing the largest problem. The other substance is then the secondary problem.
Problematic use
The use of a substance in such a manner that it causes physical, mental or social problems or in such
a manner that it causes social nuisance. Problematic use does not always mean addiction. "Abuse" is
a form of problematic use, whereas there is no addiction.
Psychodysleptics
See: Hallucinogens.
151
Psychosis
Mental disorder in which someone has hallucinations, i.e. sees, hears or feels things that are not
perceived by other people. If the disorder lasts less than one month, it is called a short term psychotic
disorder.
Smoking Chinese-style
Smoking of heroin from aluminium foil.
Secondary diagnosis
An additional or underlying disease for which someone is admitted in hospital in addition to the
primary disease (primary diagnosis).
Recent use
The use of a substance in the last year, irrespective of the frequency (from one-time to daily). Recent
users are included automatically as part of the ever users (use ever in lifetime).
Recreational use
Use of a substance (usually during leisure time) in which the substance is enjoyed without a question
of problematic use (abuse or addiction).
Schizophrenia
Mental disorder in which someone has hallucinations, i.e. sees, hears or feels things that are not
perceived by other people. As a result of this disorder, one's functioning at school, work and in the
family is affected. The disorder is only called schizophrenia if it lasts at least six months.
Secondary cause of death

A cause that contributed indirectly to the death. If somebody dies as a result of an accident that took
place when he or she was under the influence of a drug, then the drug is a secondary cause of death.
Special education
Special education for children with learning difficulties (MLK), special education for children with
learning and behavioural difficulties (LOM) and special education for children with severe behavioural
learning problems (ZMOK).
Secondary problem
If someone has a problem with two (or more) substances, the secondary problem is the substance
causing relatively the smallest problem. The other substance is then the primary problem.
Soft drugs
Drugs in list II of the Opium Act, such as cannabis and paddo's. Drugs with less risk for public health
than the hard drugs in list I of the Opium Act.
THC
Tetrahydrocannabinol, the main psychoactive ingredient of cannabis.
Use
The use of a substance ever in lifetime (ever use), in the past year (recent use), or in the past month
(current use). Current users are included automatically as part of the recent users, who are again
included automatically as part of the ever users.
152
a
II. DRUG CRIME
Acquittal
Judgment by the court in which the court does not consider it proved that the charge made by the
public prosecutor was committed by the suspect.
See also: Discharge from further prosecution, Conviction.
Appeal
Ordinary legal remedy granted to any party which appeared in the first instance and which was
partially or entirely unsuccessful; the reason for the proceedings is the judgment pronounced in the
first instance.
Bar to the prosecution

Final decision in which the court rejects the request or claim of a party or denies the right of the Public
Prosecutions Department to prosecute based on a ground that is not part of the case itself (for
example, a procedural error).
Coercion
Coercion means that a user who is dealt with by the criminal system because of the umpteenth
offence is ‘pushed' in the direction of a treatment process. The user has the choice between a
treatment process and a penal sanction. The choice has consequences: if the user opts for a
treatment process, not only can he improve his situation, but also further prosecution and penalty will
be suspended. If he does not opt for that, or if he does not satisfy the conditions of the judicial
authorities, execution of the penal sanction will follow.
See also: Compulsion.
Compulsion
Contrary to “coercion”, in the case of compulsion the user has no choice. He can be admitted without
his consent. In the case of repeat criminal offenders among hard drug users this can be done by
imposition of the nonpunitive order Judicial Treatment of Addicts (SOV).
See also: Coercion.
Conviction
Judgment by the court in which the court considers the fact charged by the Public Prosecutions
Department proved, considers it an offence and is of the opinion that the suspect is punishable.
Court of law
Court of justice that takes cognizance in the first instance of all the cases for which no other court has
been designated. There are 19 courts of law.
N.B. As of 1 January 2002 the subdistrict courts have become part of the organisation of the courts of
law.
Crime
Heavy kind of offence, named thus in criminal law; categorising offences as crimes and minor offences
is pertinent to procedural law (absolute competence and legal remedies) and to the penalization;
disposal in the first instance is usually carried out by the court
a
Source of list of concepts: Statistics Netherlands (CBS), Voorburg/Heerlen, 2003; Research and Documentation
Centre of the Ministry of Justice (WODC)
153
See also: Minor offence.
Criminal record
A criminal record is a police contact during which a report of one or more crimes was drawn up.
Criminal case
The police report in respect of one suspect that is registered at a public prosecutor’s office for
prosecution.
Custodial sentence
Prison sentence, for life or for a period of maximum twenty years, usually served in a prison.
See also: Detention.
Detention
Principal detention: custodial sentence for a period of maximum 1 year and 4 months, of a lighter
nature than imprisonment and usually served in a remand centre
Alternative imprisonment: custodial sentence because of non-payment or only partial payment of a
fine.
Discharge from (any) further prosecution

Judgment of the court in which, on the one hand, the court considers the fact charged by the public
prosecutor proved, but, on the other hand, is of the opinion that the fact or the suspect is not
punishable.
See also: Conviction, Acquittal.
Discretionary dismissal
Decision of the Public Prosecutions Department waiving prosecution of an established offence in the
public interest.
See also: Dismissal.
Dismissal
Decision of the Public Prosecutions Department waiving prosecution of an established offence on
policy-related or technical grounds.
See also: Discretionary dismissal, Dismissal by reasons of likeliness of nonconviction.
Dismissal by reasons of likeliness of nonconviction

Decision of the Public Prosecutions Department to waive prosecution of an offence, as the
Department is of the opinion that prosecution will not lead to a conviction (for example, because there
is not sufficient proof or because the offence or the suspect is not punishable).
Disposal by the court

Final judgment, by conviction, acquittal, discharge from further prosecution or one of the other final
judgments.
Disposal by the Public Prosecutions Department

Final judgment with respect to a police report registered with the public prosecutor’s office by
dismissal, joinder without charge, joinder with charge, out-of-court settlement or transfer to the court
cases department of a different public prosecutor’s office.
Early release
The early release in principle, by virtue of the law, from the penitentiary of persons convicted to a long-
term prison sentence.
154
Final judgement
Sentence by the court definitely ending a civil matter that started with a summons for a certain
instance.
See also: Interlocutory judgment.
First instance, (in the -)

Primary judicial authority where a case is disposed.
See also: Appeal.
Irrevocable judgment
Judgment of a court of law against which no (ordinary) remedy is available anymore.
Joinder in the hearing

Joining by the court of criminal cases that are registered under different public prosecutor’s office
numbers, with the objective of disposing these cases as one criminal case.
See : Disposal by the court
Joinder with charge

Joining by the Public Prosecutions Department of registered criminal cases with the objective of
having the court dispose several cases simultaneously in one sentence.
See: Disposal by the Public Prosecutions Department.
Joinder without charge

Joining by the Public Prosecutions Department of a criminal case without charge to another case that
is submitted to the court, with the objective of having the court take the joined case into account when
determining the punishment.
See also: Disposal by the Public Prosecutions Department
Minor offence
Light kind of offence, named thus in criminal law; categorising offences as crimes and minor offences
is pertinent to procedural law (absolute competence and legal remedies) and to the penalization;
disposal is usually through a settlement/out-of-court settlement via the Public Prosecutions
Department or disposal in the first instance by the subdistrict court.
See also: Crime.
Netherlands Rehabilitation Foundation (SVG)

Organisation aiming to make an effort and contribute demonstrably to the reintegration of the
rehabilitation clients into society. The aim is also to prevent a repetition of the punishable behaviour. It
does so by investigating and reporting the person and circumstances of the suspect or the convicted
person, drawing up action plans to achieve the objectives set, providing counselling and supervision
during the execution thereof and the supervision of the execution of community service. Only in those
cases in which there are clear starting points for behavioural change and the chance of success
seems to be considerable, intensive programmes will be used to this end.
Ordinary criminal action courts

Criminal case that is, in the first instance, within the competence of the court, except for fiscal and
financial offences.
155
Out-of-court settlement
Fulfilment, in certain circumstances, to prevent prosecution, of one or more conditions set by the
investigating officer (police) or the Public Prosecutions Department (public prosecutor), such as
payment of an amount of money (‘fine’), cancelling the right of prosecution.
Percentage of solved crimes

The total number of crimes solved in a certain period as compared to the total number of police report
drawn up in that same period in respect of the same or similar crimes, expressed in percentage.
Police custody
Deprivation of liberty for maximum four days at the instruction of the assistant public prosecutor, if the
period (six hours) that a suspect may be detained for questioning is not sufficient.
Police report
Written report drawn up by an investigating officer about the facts or circumstances noted by him/her.
Pre-trial detention
Deprivation of liberty in remand centre prior to disposal in court, generally applied upon suspicion of a
serious offence (criminal offence carrying a jail sentence of four years or more), because of a serious
risk of escape and/or for serious cause of public safety, for example, fear of repetition.
Public Prosecutions Department (OM)

Public authority with the following assignments: maintenance of the law, investigation and prosecution
of criminal offences, execution of sentences and informing the court insofar as the law prescribes thus.
Sentence
Reasoned binding judgment of the court in an action brought it.
See also: Judgment, Interlocutory judgment.
Solved crime
A crime in which at least one of the suspects became known to the police, even if he/she is a fugitive
or denies to have committed the (criminal) offence.
Summons
Official writ (bailiff’s notification) calling someone to appear at a certain time before the court in
connection with the prosecution of an offence charged to the person summoned (law of criminal
procedure).
Suspect
Before the commencement of the prosecution, this is the person who, based on facts or
circumstances, is reasonably supposed to be guilty of an offence, after which the suspect is the
person against whom the prosecution is directed.
Suspect who is a minor

Someone who is under 18 year of age at the time of committing an offence. Disposal of (juvenile)
cases of a simple nature takes usually place via Halt (Bureaus).
N.B. Nobody may be prosecuted for an offence committed before reaching the age of 12.
Suspect who is of age

Someone who is 18 year of age or older at the time of committing an offence.
156
Appendix B Sources
This appendix provides an overview of the main sources of the National Drug Monitor (NDM) for, successively, (I.) use and problem use, (II.) treatment
demand and treatment, (III.) disease and mortality, (IV.) market information and (V.) judicial data. For a more detailed description of the sources: see
www.trimbos.nl/monitors, or www.ivo.nl, or www.zonmw.nl.
I. USE AND PROBLEM USE
Source Target Group Substances Measurements Responsible organisation/

Homepage
Antenne Pupils and young clubbers in Amsterdam Alcohol, drugs, Annually since 1993, the Bonger Institute for Criminology
tobacco with varying choice of of the University of Amsterdam
target group (UvA) and Jellinek Prevention and
Consultancy
www.jur.uva.nl
www.jellinek.nl/
ESPAD Secondary school pupils aged 15 and 16 Alcohol, drugs, 1995, 1999, 2003 the Swedish Council for Information
in 35 European countries tobacco on Alcohol and Other Drugs (CAN),
the Pompidou Group,
for the Netherlands the Trimbos
Institute
www.can.se/
Survey of clubbers in The Hague Clubbers aged 16-35 in The Hague Alcohol, drugs Annually from 2002 Research Committee Monitoring &
Registration of Addiction Problems
(MORE)
www.denhaag.nl/
Health Behaviour in School- Pupils aged 11-17 Alcohol, cannabis, Four-yearly since 2001 World Health Organisation (WHO),
aged Children (HBSC) tobacco for the Netherlands: Trimbos
Institute, Radboud University
Nijmegen and Utrecht University
www.hbsc.org
www.trimbos.nl.
Homepage
Local and regional monitors General population and/or young people Alcohol, drugs, Usually annually, Municipal Health Services (GGDs)
depending on location and region, for tobacco, depending varies by location and in coordination with the GGD
young people: see also Appendix F on location and region Netherlands, municipal and private
region research bureaus
www.ggd.nl
The Dutch Institute for Public National population aged fifteen and over Tobacco Annually Defacto, for a smoke-free future
Opinion and Market Research (previously STIVORO)
(TNS NIPO) www.stivoro.nl
National Prevalence Research National population aged 12 and over Alcohol, drugs, 1997, 2001, Centre for Drug Research
(NPO) tobacco possibly also 2005 (CEDRO), University of
Amsterdam; in conjunction with
Statistics Netherlands (CBS)
www.cedro-uva.org
Netherlands Mental Health National population aged 16 to 64 incl. Alcohol, drugs 1996, 1997, 1999 Trimbos Institute
Survey and Incidence Study www.trimbos.nl.
(Nemesis)
National Representative School Pupils aged 10-18 in the two highest Alcohol, drugs, 1984, 1988, 1992, Trimbos Institute
Survey groups of the primary schools and the tobacco 1996, 1999, 2003 www.trimbos.nl.
'regular' secondary schools: first form
secondary school, pre-vocational Special schools,
secondary education (VMBO), higher projects: 1990, 1997
general secondary education (HAVO) and
pre-university education (VWO),
sometimes projects at special schools
Permanent Survey on Living National population aged 12 and over Alcohol, tobacco, Annually Statistics Netherlands (CBS)
Conditions (POLS) young people aged 12-29 for the young www.cbs.nl
people module also
drugs
158
II. TREATMENT DEMAND AND TREATMENT

Homepage
Central Methadone Registration Methadone clients in the Amsterdam Methadone Annually Amsterdam Area Health Authority
(CMR) region (GG&GD)
www.gggd.amsterdam.nl
Educare monitor Those requesting treatment at first aid Alcohol, drugs Annually from 1996 Educare Ambulant, Stichting
stations of dance events Nursing & Education Consultancy
www.educaregroningen.nl
National Information System on Clients of the (outpatient) care Alcohol, drugs Annually Organisation Care Information
Alcohol and Drugs (LADIS) organisations for addicts. In 2003, the Systems (IVZ), Houten
origin of the clients was as follows: 49% www.sivz.nl
outpatient, 6% clinical, 30% hospital
outpatient, 16% probation and after-care
services.
National Medical Registration Hospital patients Alcohol, drugs Annually Prismant
(LMR) www.prismant.nl
Injury Information System (LIS) Patients who receive emergency Alcohol, drugs Annually Consumer Safety Institute
treatment after an accident www.veiligheid.nl
Register of Inpatient Mental Clients of the inpatient care organisations Alcohol, drugs Annually, complete up Mental Health Service (GGZ
Health Care (PiGGz). Is for addicts to and including 1996 Netherlands), Prismant
replaced by Zorgis. www.ggznederland.nl
www.prismant.nl
III. ILLNESS AND MORTALITY
Source Target Group/Subject Substances Measurements Responsible organisation/

Homepage
Cohort study Amsterdam en Causes of death among methadone Opiates, Annually from 1976 Amsterdam Area Health Authority
monitor drug-related mortality clients and recreational drug users in recreational drugs (GG&GD)
Amsterdam www.gggd.amsterdam.nl
Central Ambulance Service Ambulance trips for the population of Alcohol, drugs Annually Amsterdam Area Health Authority
(CPA) Amsterdam and surrounding area (GG&GD)
www.gggd.amsterdam.nl
Causes of Death Statistics Causes of death of registered inhabitants Alcohol, drugs, Annually CBS
of the Netherlands tobacco www.cbs.nl
159
Homepage
HIV/AIDS recording People infected with HIV and aids patients Opiates Half-yearly Health Care Inspectorate (IGZ),
among injecting drug users HIV Monitoring Foundation (SHM),
National Institute of Public Health
and the Environment (RIVM)
www.hiv-monitoring.nl
HIV surveillance among drug Injecting drug users in various cities Opiates Since 1991 various National Institute of Public Health
users measurements in and the Environment (RIVM) and
various cities Municipal Health Services (GGDs)
www.rivm.nl/
ROI monitor Drivers Alcohol Annually from 1970 Transport Research Centre (AVV),
Ministry of Transport, Public Works
and Water Management
www.rws-avv.nl
IV. MARKET INFORMATION

Homepage
Drugs Information and Party drugs of recreational users Party drugs Annually Trimbos Institute
Monitoring System (DIMS) www.trimbos.nl.
Coffee shop monitor Coffee shop policy of municipalities and Cannabis Annually Research and Documentation
enforcement policy Centre of the Ministry of Justice
(WODC).
www.wodc.nl/
Monitor tolerated coffee shops Officially tolerated coffee shops Cannabis 1997, 1999, annually Bureau Intraval
since 2000 www.intraval.nl/
THC Monitor THC content and price of cannabis Cannabis Annually Trimbos Institute
samples from coffee shops www.trimbos.nl.
160
V. JUDICIAL

Homepage
Client Follow-up System (CVS) Production figures of the Netherlands All substances, no Daily file creation Foundation of Addiction Probation
(Drug) Rehabilitation Foundation and classification Services (SVG) in collaboration
their clients with Netherlands Rehabilitation
Foundation and probation and
after-care services of the Salvation
Army
www.ggznederland.nl
Police Records System (HKS) Police reports of complaints; police Danger Update end first The unit Knowledge and
records drawn up against suspects; classification ‘drug quarter of the entire Development, department
recorded criminal history of suspects user’ or ‘addicted to previous calendar Research and Analysis of the
alcohol’; Opium Act year; also extraction of National Criminal Information
offences final figures for the service of the National Police
classifiable by hard year before that Agencies (K&O/O&A/dNRI/KLPD,
and soft drugs (because of in collaboration with the regional
processing backlogs) police departments; the Research
and Documentation Centre of the
Ministry of Justice (WODC) has a
copy at its disposal
http://www.politie.nl/KLPD/
www.wodc.nl/
Seizures of drugs Seizures of drugs; number of All substances, Continuous recording, The unit Knowledge and
investigations, ‘rounded up’ cannabis classification by annual report Development, department
nurseries; discovered production places type of drug Research and Analysis of the
of synthetic drugs National Criminal Information
service of the National Police
Agencies (K&O/O&A/dNRI/KLPD),
in collaboration with the regional
police departments
161
Homepage
Locations Judicial Treatment of Figures about admissions in the SOV, All substances Monthly Locations Judicial Treatment of
Addicts (SOV). drug-dependent offenders who are Addicts (SOV)
accepted for participation in the SOV www.trimbos.nl.
process
Justice Documentation Policy information about the criminal Opium Act offences Four time per year Research and Documentation
Research Database (OBJD) procedure; anonymised copy of the classifiable by hard before update Centre of the Ministry of Justice
Justice Documentation System and soft drugs (WODC).
www.wodc.nl/
Public Prosecutions Department National database of the National Office Opium Act offences Three time per year Public Prosecutions Department
Data (OMDATA) of the Public Prosecutions Department classifiable by hard before update and Council for the Administration
with data on prosecution and disposal in and soft drugs of Justice; the National Office of the
first instance. Public Prosecution Service collects
and manages the data; Research
and Documentation Centre of the
Ministry of Justice (WODC) has a
copy at its disposal
www.wodc.nl/
Investigations into Organised Investigations by the Dutch police into Classification by Annual report The unit Knowledge and
Crime more serious forms of organised crime; hard and soft drugs Development, department
offenders of, inter alia, the Opium Act Research and Analysis of the
who work together in a criminal National Criminal Information
organisation service of the National Police
Agencies (K&O/O&A/dNRI/KLPD),
in collaboration with the regional
police departments
Enforcement of custodial Profiles of detainees, length of imposed Opium Act offences Continuous recording National Agency of Correctional
measures in correctional penalties and profiles of the institutions; classifiable by hard Institutions (DJI) of the Ministry of
institutions (TULP) judicial institutions for juvenile persons and soft drugs Justice
(TULP/JJI) and institutions in the www.dji.nl/
framework of a hospital order (TBS) are
recorded separately
162
Homepage
WODC Recidivist Monitor Long-term research project with Opium Act offences Reports based on Research and Documentation
standardised recidivist measurements classifiable by hard Justice Documentation Centre of the Ministry of Justice
among different groups of justiciable and soft drugs Research Database (WODC).
individuals (OBJD) www.wodc.nl/
163
Appendix C Definition of ICD-9 and ICD-10 codes
Definition of ICD-9 codes

ICD-9 code Definition
162 Malignant neoplasms of trachea, bronchus and lung
291 Alcoholic psychoses
292 Drug psychoses
303 Alcohol dependence syndrome
304 Drug dependence
304.0 Dependence to opiates and related substances
304.2 Cocaine dependence
304.3 Cannabis dependence
304.4 Dependence to amphetamines and other psychostimulants
304.7 Dependence to combinations of opiates with other substances
305 Non-dependent abuse of drugs or other substances
305.0 Alcohol abuse
305.2 Cannabis abuse
305.3 Hallucinogen abuse
305.4 Barbiturate and similarly acting sedative or hypnotic abuse
305.5 Opiate abuse
305.6 Cocaine abuse
305.7 Amphetamine or related acting sympathomimetic abuse
305.8 Antidepressant type abuse
305.9 Other, mixed, or unspecified drug abuse
357.5 Alcoholic polyneuropathy
425.5 Alcoholic cardiomyopathy
535.3 Alcoholic gastritis
571.0 Alcoholic fatty liver
571.1 Acute alcoholic hepatitis
571.2 Alcoholic cirrhosis of the liver
571.3 Alcoholic liver damage, unspecified
980.0-1 Toxic effect of alcohol
E850 Accidental poisoning by analgesics, antipyretics, and antirheumatics
E850.0 Accidental poisoning by heroin
E854.1 Accidental poisoning by psychodysleptics (hallucinogens)
E854.2 Accidental poisoning by psychostimulants
E855.2 Accidental poisoning by local anaesthetics (including cocaine)
E860.0-2 Unintentional poisoning by alcoholic beverages (ethanol/methanol)
E950.9* Suicide through self-inflicted poisoning by solid or liquid substances
E980.9* Poisoning by solid or liquid substances, undetermined whether accidentally or
purposely inflicted
* Only included if 980.0-1 has been mentioned as complication.
Definition of ICD-10 codes
ICD-10 code Definition
C33 Malignant neoplasms of trachea
C34 Malignant neoplasms of bronchus and lung
F10 Mental and behavioural disorders due to use of alcohol
F11 Mental and behavioural disorders due to use of opiates
F12 Mental and behavioural disorders due to use of cannabis
F13 Mental and behavioural disorders due to use of sedatives or hypnotics
F14 Mental and behavioural disorders due to use of cocaine
F15 Mental and behavioural disorders due to use of other stimulants
F18 Mental and behavioural disorders due to use of volatile solvents
F19 Mental and behavioural disorders due to poly drug use and use of other
psychoactive substances
G31.2 Degeneration of the nervous system due to alcohol consumption
G62.1 Alcoholic polyneuropathy
I42.6 Alcoholic cardiomyopathy
K29.2 Alcoholic gastritis
K70.0 Alcoholic fatty liver
K70.1 Alcoholic hepatitis
K70.2 Alcoholic fibrosis and cirrhosis of the liver
K70.3 Alcoholic cirrhosis of the liver
K70.4 Alcoholic hepatic failure
K70.9 Alcohol-induced liver diseases, unspecified
K86.0 Alcohol-induced chronic pancreatitis
T51.0-1 Toxic effect of alcohol, ethanol and methanol (only as secondary code)
X41 + T43.6 Accidental poisoning by psychostimulants
X42 Accidental poisoning by narcotics and psychodysleptics [hallucinogens], not
classified elsewhere
X42 + T40.5 Accidental poisoning by cocaine
X45* Intentional poisoning by and exposure to alcohol
X61 + T43.6 Suicide through psychostimulants
X65* Intentional auto-intoxication by alcohol
Y11 + T43.6 Poisoning by psychostimulants, undetermined whether accidentally or purposely
inflicted
Y15* Poisoning by and exposure to alcohol- undetermined whether purposely inflicted
* Only included if complication T51.01 has been mentioned.
165
Appendix D Overview of products Netherlands (Drug)
Rehabilitation Foundation and coercive treatment
processes
Current treatment processes as alternative for prosecution and detention
Type of treatment Characterisation by objective:

process:
Drug treatment clinic Aimed at abstinence and stability in psychological and social
functioning. Therapeutic, also crisis intervention.
Inpatient Motivation Low-threshold facility, aimed to motivate clients to undergo follow-up

Centre treatment or to improvement of welfare and well-being. Not aimed at
abstinence and therapy. Length of stay 3-4 months.
Long-term phased Aimed at reintegration (work/training, leisure time, living, finances,

programmes (SOV social relationships), abstinence and reduction of nuisance and crime
coercion, Triple-Ex) by the participants. Phased setup: closed - half-open - open phase,
duration 16-18 months.
Forensic drug treatment Clinic with national function. Phased setup. Strong security in the first
clinic closed phase. Aimed at abstinence, social stability and better
functioning, Therapeutic. Duration 6-18 months.
Living projects under Small-scale projects in which clients are trained and guided in living,
guidance learning and working. The objective is to guide addicts towards (the
highest possible degree of) living independently. Often in combination
with learning/work processes.
Outpatient and part-time Aimed at improvement or stabilisation of the situation of clients

treatment of addicts through guidance and counselling.
Source: 144.
Appendix E Internet addresses with information on alcohol and
drugs
Addiction Research Institute Foundation (IVO)

http://www.ivo.nl/
Addiction Treatment Centre North Netherlands

http://www.verslavingszorgnoordnederland.nl/
Amsterdam Area Health Authority

http://www.gggd.amsterdam.nl/
Australian Institute of Health and Welfare (AIHW)

http://www.aihw.gov.au/
Brijder Addiction Treatment Centre

http://www.brijder.nl/
CEDRO Centre for Drug Research (University of Amsterdam)

http://www.cedro-uva.org/
Consumer Safety Institute

http://www.consument-en-veiligheid.nl/
De Grift
http://www.degrift.nl/
DeltaBouman
http://www.deltabouman.nl/
Dutch Association for Mental Health Care (GGZ)

http://www.ggznederland.nl
Emergis Addiction Treatment Centre

http://www.emergis.nl/verslavingszorg/
European Centre for the Epidemiological Monitoring of AIDS

http://www.eurohiv.org/sida.htm
European Commission - Taxation and Customs Union

http://europa.eu.int/comm/taxation_customs/publications/info_doc/info_doc.htm#Excises
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)

http://www.emcdda.org/
Europol
http://www.europol.eu.int/home.htm
GGZ Group North and Central Limburg/Addiction Treatment Centre

http://www.ggz-groepnmlimburg.nl/
Health Care Inspectorate
http://www.igz.nl/productie/indexie.html
Institute of Food Safety (RIKILT)

http://www.rikilt.dlo.nl/
Intraval. Bureau for Research and Consultancy

http://www.intraval.nl/
Jellinek Centre (Amsterdam)

http://www.jellinek.nl/
Maliebaan Centre
http://www.centrummaliebaan.nl/
Mental Health Service Netherlands

http://www.ggznederland.nl
Ministry of Justice
http://www.justitie.nl/
Ministry of Public Health, Welfare and Sports (VWS)

http://www.minvws.nl/index.html
Mondriaan Care Group/Addiction Treatment Centre

http://www.mondriaanzorggroep.nl/
Municipal Health Service Netherlands

http://www.ggd.nl/
National Institute for Health and Prevention (NIGZ)

http://www.nigz.nl/
National Institute of Public Health and the Environment (RIVM)

http://www.rivm.nl/
National Police Agency (KLPD)

http://www.klpd.nl/
Novadic-Kentron, network for addiction treatment

http://www.novadic-kentron.nl/
Organisation for Care Information Systems (IVZ)

http://www.ivv.nl/
http://www.sivz.nl/
Parnassia, Psycho-Medical Centre

http://www.parnassia.nl/
Police
http://www.politie.nl/
170
Prismant
http://www.prismant.nl/
Public Prosecutions Department

http://www.openbaarministerie.nl/
Research and Documentation Centre (WODC)

http://www.wodc.nl/
STIVORO, for a smoke-free future

http://www.stivoro.nl/
Statistics Netherlands (CBS)

http://www.cbs.nl/
Substance Abuse & Mental Health Service Administration (SAMHSA)

http://www.samhsa.gov/
SWOV-Institute for Road Safety Research

http://www.swov.nl/
TACTUS, Institution for addiction treatment

http://www.tactus.nl/
Trimbos Institute
http://www.trimbos.nl/
World Health Organisation (WHO)

http://www.who.int/en/
171
Appendix F Data youth monitors and youth surveys
The percentages of the use of drugs, alcohol and tabak are based on reports of local youth monitors
or youth surveys in towns, cities, regions or provinces, throughout the Netherlands. Most of the young
people who are the subject of these surveys were selected via a representative sample taken from the
Municipal Personal Records Databse (GBA) or the Population Register. Most of the times these young
people were sent a written questionaire with the request to complete and return it. Sometimes the
possibility was provided to answer the questions via the internet.
With a view to comparability, the following critera were applied for the selection of the data. In the first
place, the maximum age margin was limited to young people aged 10 to 26 incl. Whenever youth
monitors also related to children below the age of 10, those data have therefore not been included. In
the second place, the overview has been limited to youth monitors that were carried out after 1-1-
2002. Thirdly, the results of all the youth monitors in which the sample consisted of specific secondary
school classes have not been included. This is the case, inter alia, in pupil surveys and in, what are
called, E-MOVO surveys (Electronic Monitoring and Information).
In the overview tables some distortion may have occurred. This is due to the varying use of the term
‘occasionally’ in the questions asked about alcohol, tobacco and drugs. The question Have you
smoked occasionally? is understood here as: Have you ever smoked? The question Do you smoke
occasionally? leaves the young people most room for their own interpretation. In the absence of a
subsequent question about the regularity of the use (in the past four weeks, the past week or daily),
this second variant of ‘occasionally’ has been equated with smoking in the past four weeks. The same
has been done with questions like Do you smoke occasionally? and Do you smoke? In nearly all youth
monitors, separate questions are asked about the use of soft drugs/cannabis. However, regularly ‘hard
drugs’ (ecstasy, cocaine, heroin, LSD, paddo’s and amphetaminen) are combined in one single
question. In case of absence of the separate ‘hard drugs’ percentages in a report, these data have not
been included in the overview tables.
CANNABIS
Town or Year Net number of Age Ever Recent Current/

city/Region/ respondents youngsters occasion-
Province ally
162
Almelo 2002 511 18-23 years 32% 9% 4%
163
Almere 2002 2.080 12-18 years 16%
19-23 years 50%
12-23 years 30%
Alphen a/d 2003 512 12-26 years 8%
164
Rijn
165
Amersfoort 2004 1.292 16-18 years 9%
19-22 years 14%
166
Apeldoorn 2003 7.085 12-14 years 2% 1%
15-17 years 20% 6%
18-21 years 32% 8%
22-24 years 37% 5%
167
Dordrecht 2003 900 12-22 years 18%
168
Drenthe 2002 1.234 19-23 years 38% 8%
of which:
- Assen 39% 15%
- Coevorden 38% 5%
- Emmen 39% 9%
- Hoogeveen 29% 6%
173
- Meppel 57% 7%
163
Dronten 2002 603 12-18 years 14%
19-23 years 38%
12-23 years 23%
169
Ede 2003 1.750 12-14 years 1%
15-17 years 10%
18-20 years 14%
21-24 years 10%
170
Eindhoven 2002 664 12-17 years 5%
508 18-24 years 14%
163
Flevoland 2002 6.087 12-18 years 16%
19-23 years 45%
12-23 years 27% 8%
Gooi and Vecht End 2001 1.025 12-18 years 18% 8%
171
Region
Groningen 2002 1.801 12-17 years 12,5% 5%
172
(city)
173
Heerhugowaard 2002 556 14-21 years 29% 8%
174
‘s-Hertogenbosch 2002 825 18-24 years 12%
163
Lelystad 2002 2.171 12-18 years 17%
19-23 years 50%
12-23 years 32%
175
Leiden 2003 1.023 12-14 years 5%
15-17 years 8%
12-17 years 6%
18-23 years 11%
24-26 years 11%
176
Maasbracht 2002 478 12-17 years 3%
Northeast and 2003 12.297 12-17 years 5%

177
Middle Brabant
Northeast Polder 2002 665 12-18 years 12%
163
(NOP) 19-23 years 35%
12-23 years 20%
178
Nijmegen 2003 1.600 12-17 years 16% 8%
179
Schiedam 2003 1.005 12-23 years 24%
180
Tilburg 2003 1.938 12-13 years 1%
16-17 years 11%
12-17 years 7% 5%
163
Urk 2002 285 19-23 years 16%
12-23 years 9%
181
Utrecht 2002 256 12-18 years 12%
182
West-Brabant 2003 6.862 12-17 years 4%
183
West-Friesland 2002 ? 12-17 years 14% 5%
163
Zeewolde 2002 337 12-18 years 14%
19-23 years 39%
12-23 years 21%
South-Holland 2003 3.697 12-14 years 2%
184
North 15-17 years 7%
12-17 years 5%
18-23 years 10%
24-26 years 10%
12-26 years 8%
174
COCAINE
Town or city / Year Net number of Age Ever Recent Current/
Province respondents youngsters occasion-
ally
162
Almelo 2002 489 18-23 years 2,3% 1% 0,4%
166
Apeldoorn 2003 7.085 12-14 years < 1%
15-17 years < 1%
18-21 years 4%
22-24 years 7%
168
Drenthe 2002 1.234 19-23 years 3%
170
Eindhoven 2002 664 12-17 years 1,1
508 18-24 years 2,1
163
Flevoland 2002 6.061 12-23 years < 1%
Groningen 2002 1.801 12-17 years 0,2%

172
(city)
173
Heerhugowaard 2002 556 14-21 years 2%
178
Nijmegen 2003 1.600 12-17 years 1% <1%
179
Schiedam 2003 1.005 12-23 years 3%
HEROIN
Town or Year Net number of Age Ever Recent Current/
city / respondents youngsters occasion-
Province ally
162
Almelo 2002 480 18-23 years 0% 0% 0%
166
Apeldoorn 2003 7.085 12-17 years < 1%
18-24 years < 1%
168
Drenthe 2002 1.234 19-23 years < 1%
Groningen 2002 1.801 12-17 years 0,1 %

172
(city)
South- 2003 3.697 12-26 years 0%
Holland
184
North
ECSTASY
Town or city / Year Net number Age Ever Recent Current/
Province of youngsters occasion-
respondents ally
162
Almelo 2002 490 18-23 years 3,2% 1,4% < 1%
166
Apeldoorn 2003 7.085 12-14 years <1%
15-17 years 2%
18-21 years 7%
22-24 years 10%
167
168
Drenthe 2002 1.234 19-23 years 4%
170
Eindhoven 2002 664 12-17 years 2,8%
508 18-24 years 5,1%
163
Flevoland 2002 6.061 12-23 years 1,6%
175
Groningen 2002 1.801 12-17 years 0,5%
172
(city)
173
Heerhugowaard 2002 556 14-21 years 4%
178
Nijmegen 2003 1.600 12-17 years 1,5% < 1%
179
Schiedam 2003 1.005 12-23 years 6%
183
West-Friesland 2002 ? 12-23 years 1%
AMPHETAMINES/SPEED
Town or Year Net number Age Ever Recent Current/
city / of youngsters occasionally
Province respondents
162
Almelo 2002 488 18-23 years 3% < 1% < 1%
166
Apeldoorn 2003 7.085 12-14 years < 1%
15-17 years 1%
18-21 years 3%
22-24 years 6%
168
Drenthe 2002 1.234 19-23 years 2%
170
Eindhoven 2002 508 18-24 years 1,3%
163
Flevoland 2002 6.061 12-23 years < 1%
Groningen 2002 1.801 12-17 years 0,1%

172
(city)
Heerhugowa 2002 556 14-21 years 3%
173
ard
179
Schiedam 2003 1.005 12-23 years 3%
ALCOHOL
Town or Year Net number of Age Ever Current/ Weekly
city/Region/Provinc respondents youngsters occasion-
e ally
162
Almelo 2002 528 18-23 years 83%
163
Almere 2002 2.080 12-23 years 82% 78%
164
Alphen a/d Rijn 2003 512 12-26 years 74% 68%
165
Amersfoort 2004 1.292 12-17 years 55%
10-22 years 55% 29%
166
Apeldoorn 2003 7.085 12-14 years 38%
18-21 years 84%
12-24 years 71%
167
168
Drenthe 2002 1.234 19-23 years 86%
163
Dronten 2002 603 12-23 years 82% 82%
169
Ede 2003 1.750 12-24 years 75%
170
508 18-24 years 85%
163
Flevoland 2002 6.083 12-23 years 81% 79%
176
Gooi and Vecht End 2001 1.025 12-18 years 67%
171
Region
Groningen 2002 640 12-13 years 23%
172
(city) 616 14-15 years 62%
545 16-17 years 84%
185
Haarlemmermeer 2003 700 18-24 years 70-80%
173
Heerhugowaard 2002 556 14 years 80% 20%
15-16 years 80%
17-21 years 90%
14-21 years 93% 66%
163
Lelystad 2002 2.171 12-23 years 81% 79%
175
Leiden 2003 1.023 12-14 years 22%
15-17 years 66%
12-17 years 43%
18-23 years 82%
24-26 years 82%
12-26 years 76% 70%
176
15-17 years 81%
12-17 years 53%
Northeast and 2003 12.297 12-17 years 59%
177
Middle Brabant
Northeast Polder 2002 665 12-23 years 82% 81%
163
(NOP)
178
Nijmegen 2003 1.600 10-11 years 13% 6%
12-17 years 54% 42%
? 18-24 years 88%
179
Schiedam 2003 1.005 12-16 years 47%
17-23 years 74%
180
Tilburg 2003 1.938 12-17 years 51%
163
Urk 2002 285 12-23 years 75% 70%
181
Utrecht 2002 256 12-18 years 39%
182
West-Brabant 2003 6.862 12-13 years 20%
14-15 years 60%
16-17 years 80%
12-17 years 53%
183
12-23 years 77%
163
Zeewolde 2002 337 12-23 years 80% 79%
South-Holland 2003 3.697 12-14 years 30% 24%

184
North 15-17 years 82% 77%
12-17 years 56% 50%
18-23 years 90% 87%
24-26 years 88% 82%
18-26 years 90% 85%
177
TOBACCO
Town or Year Net number of Age Ever Current/ Daily
city/Region/ respondents youngsters occasion-
Province ally
162
Almelo 2002 528 18-23 years 70% 9% 35%
163
Almere 2002 2.080 12-18 years 15%
19-23 years 39%
12-23 years 52% 19%
164
Alphen a/d Rijn 2003 512 12-26 years 53% 25% 16%
166
Apeldoorn 2003 7.085 12-14 years 27% 3% 3%
15-17 years 56% 8% 17%
18-21 years 67% 9% 25%
22-24 years 71% 9% 28%
167
168
Drenthe 2002 1.234 19-23 years 11% 33%
163
Dronten 2002 603 12-18 years 16%
19-23 years 48%
12-23 years 54% 21%
169
Ede 2003 1.750 12-24 years 33%
170
508 18-24 years 40%
163
Flevoland 2002 6.086 12-18 years 17%
19-23 years 43%
12-23 years 54% 20%
Gooi and Vecht End 2001 1.025 12-18 years 46% 9% 12%
171
Region
Groningen 2002 845 9-11 years 2%
172
(city) 640 12-13 years 3%
616 14-15 years 18%
545 16-17 years 30%
185
Haarlemmermeer 2003 700 19-24 years 32%
173
Heerhugowaard 2002 556 14-21 years 65% 11% 18%
175
Leiden 2003 1.023 12-14 years 7% 1%
15-17 years 20% 13%
18-23 years 26% 17%
24-26 years 37% 20%
12-26 years 57% 25% 15%
163
Lelystad 2002 2.171 12-18 years 17%
19-23 years 44%
12-23 years 56% 21%
176
15-17 years 29%
Northeast and 2003 12.297 12-17 years 22% 4% 8%
177
Middle Brabant
Northeast Polder 2002 665 12-18 years 18%
163
(NOP) 19-23 years 46%
12-23 years 55% 20%
178
Nijmegen 2003 1.600 10-11 years 7%
12-17 years 10%
? 18-24 years 24%
179
Schiedam 2003 1.005 12-16 years 25% 3% 5%
17-23 years 64% 9% 26%
180
Tilburg 2003 1.938 12-13 years 1%
14-15 years 13%
16-17 years 25%
178
12-17 years 36% 13,2% 9%
163
Urk 2002 285 12-18 years 28%
19-23 years 44%
12-23 years 69% 24%
181
Utrecht 2002 259 12-18 years 21% 11%
182
West-Brabant 2003 6.862 12-17 years 37% 5% 9%
183
12-23 years 39% 27%
163
Zeewolde 2002 337 12-18 years 18%
19-23 years 38%
12-23 years 50% 18%
South-Holland 2003 3.697 12-26 years 51% 25% 8%
184
North
179
180
REFERENCES
1. Tweede Kamer der Staten-Generaal, vergaderjaar 1997-1998, 24007 nr.68 (1998). Drugbeleid;
Brief minister met haar standpunt inzake het advies van een werkgroep van deskundigen over
de Nationale Drug Monitor (NDM). Den Haag: SDu Uitgevers.
2. Snippe, J., Hoogeveen, C., Bieleman, B. (2000). Monitor drugproblematiek justitie,
definitiestudie en ontwikkeltraject. Groningen: Intraval.
3. Meijer, R.F., Grapendaal, M., Van Ooyen, M.M.J., Wartna, B.S.J., Brouwers, M., Essers, A.A.M.
(2003). Geregistreerde drugcriminaliteit in cijfers: achtergrondstudie bij het Justitieonderdeel van
de Nationale Drugmonitor; jaarbericht 2002. Den Haag: Boom Juridische uitgevers.
4. Van den Berg, M., Ruiter, C., Schoemaker, C., Smits, C., Pijlman, F.T.A., Planije, M., Peterse,
A. (2004). Brancherapport GGZ-MZ 2000-2003. Den Haag: Ministerie van Volksgezondheid,
Welzijn en Sport.
5. Rigter, H., Van Gageldonk, A., Ketelaars, T., Van Laar, M. (2004). Hulp bij probleemgebruik van
drugs: stand van wetenschap voor behandelingen en andere interventies, 2004. Utrecht:
Trimbos-instituut.
6. Cruts, A.A.N., Lempens, A.L.F., Ketelaars, A.P.M., Van Laar, M.W., Van de Mheen, H. (2004).
Monitoring van alcohol en drugs onder de loep: een onderzoek naar opbrengst en lacunes van
informatiesystemen op het gebied van alcohol en drugs. Utrecht: Trimbos-instituut/IVO.
7. Monshouwer, K., Van Laar, M. (2003). Fact sheet Drugsbeleid. Utrecht: Bureau NDM.
8. Verdurmen, J., Monshouwer, K., Van Dorsselaer, S. (2003). Bovenmatig drinken in Nederland:
uitkomsten van de 'Netherlands mental health survey and incidence study' [Nemesis]. Utrecht:
Bureau NDM.
9. Rigter, H., Van Laar, M., Rigter, S. (2003). Cannabis: feiten en cijfers 2003: achtergrondstudie
Nationale Drugmonitor NDM. Utrecht: Bureau NDM.
10. Abraham, M.D., Cohen, P.D.A., Kaal, H.L. (2002). Licit and illicit drug use in the Netherlands,
2001. Amsterdam: Mets.
11. De Bruin, D., Meijerman, C., Verbraeck, H. (2003). Zwerven in de 21ste eeuw: een exploratief
onderzoek naar geestelijke gezondheidsproblematiek en overlast van dak- en thuislozen in
Nederland. Utrecht: Centrum voor Verslavingsonderzoek.
12. Vogelsang, B.O., Van Burik, A., Van der Knaap, L.M., Wartna, B.S.J. (2003). Prevalentie van
criminogene factoren bij mannelijke gedetineerden in Nederland. Den Haag: Adviesbureau Van
Montfoort/WODC.
13. Van der Poel, A., Van de Mheen, D. (1999). Softdrugs in Midden-Holland: een onderzoek naar
de omvang en achtergronden van softdrugsgebruik. Rotterdam: IVO.
14. Van den Bosch, L.M., Verheul, R., Van den Brink W. (2001). Substance abuse in borderline
personality disorder: clinical and etiological correlates. Journal of Personality Disorders, 15 (5):
416-424.
15. De Zwart, W.M., Monshouwer, K., Smit, F. (2000). Jeugd en riskant gedrag. Kerngegevens
1999. Roken, drinken, drugsgebruik en gokken onder scholieren vanaf tien jaar. Utrecht:
Trimbos-instituut.
16. Monshouwer, K., Van Dorsselaer, S., Gorter, A., Verdurmen, J., Vollebergh, W. (2004). Jeugd
en riskant gedrag: kerngegevens uit het peilstationsonderzoek 2003. Roken, drinken,
drugsgebruik en gokken onder scholieren vanaf tien jaar. Utrecht: Trimbos-instituut.
17. Korf, D.J., Nabben, T., Benschop, A. (2002). Antenne 2001: trends in alcohol, tabak, drugs en
gokken bij jonge Amsterdammers. Amsterdam: Rozenberg Publishers.
18. Korf, D.J., Nabben, T., Benschop, A. (2004). Antenne 2003: trends in alcohol, tabak en drugs bij
jonge Amsterdammers. Amsterdam: Rozenberg Publishers.
19. Nabben, T., Korf, D.J. (2000). De combiroes: gecombineerd gebruik van alcohol met cannabis,
cocaïne, XTC en amfetamine. Amsterdam: Thela Thesis.
20. Nabben, T., Korf, D.J. (2004). NL.Trend-watch: gebruikersmarkt uitgaansdrugs in Nederland
2003. Amsterdam: Rozenberg Publishers.
181
21. Van Gelder, P., Reinerie, P., Smitz, M., Burger, I., Hendriks, V. (2004). Uit (je dak) in Den Haag,
2003: uitgaande jongeren en genotmiddelengebruik. Den Haag: Parnassia.
22. Korf, D.J., Diemel, S., Riper, H. (1999). Het volgende station: zwerfjongeren in Nederland.
Amsterdam: Thela Thesis.
23. Korf, D.J., Van Ginkel, P., Wouters, M. (2004). Je ziet het ze niet aan: zwerfjongeren in
Flevoland. Amsterdam: Rozenberg.
24. Van Gelder, P., Reinerie, P., Burger, I. (2003). Uit (je dak) in Den Haag, 2002: uitgaande
jongeren en genotmiddelengebruik. Den Haag: Parnassia.
25. Stam, H., Mensink, C., De Zwart, W.M.. (1998). Jeugd en riskant gedrag 1997: roken, drinken,
drugsgebruik en gokken in het voortgezet speciaal onderwijs en spijbelopvangprojecten.
Utrecht: Trimbos-instituut.
26. Wolf, J., Zwikker, M., Nicholas, S. (2002). Op achterstand: een onderzoek naar mensen in de
marge van Den Haag. Utrecht: Trimbos-instituut.
27. Rigter, H., Van Laar, M. (2002). Epidemiological aspects of cannabis use. In: Spruit, I.P. (red.).
Cannabis 2002 report: a joint international effort at the initiative of the Ministers of Public Health
of Belgium, France, Germany, The Netherlands, Switserland: technical report of the
International Scientific Conference Brussels, Belgium, 25-02-2002, p. 19-45. Brussels, Belgium:
Ministry of Public Health.
28. Bijl, R.V., Ravelli, A. (1998). Psychiatrische morbiditeit, zorggebruik en zorgbehoefte: resultaten
van de Nederlands Mental Health Survey and Incidence Study (NEMESIS). Tijdschrift voor
gezondheidswetenschappen, 76 (8): 446-457.
29. Vreugdenhil, C., Van den Brink, W., Wouters, L.F., Doreleijers, T.A. (2003). Substance use,
substance use disorders, and comorbidity patterns in a representative sample of incarcerated
male Dutch adolescents. Journal of Nervous and Mental Disease, 191 (6): 372-378.
30. Wits, E., Spijkerman, R., Bongers, I. (1999). "Als je alleen blowt, is niet leuk man!"::
middelengebruik, tijdsbesteding en vrienden van jongeren uit risicogroepen in Rotterdam.
Rotterdam: IVO.
31. Smit, F., Bolier, L., Cuijpers, P. (2003). Cannabisgebruik waarschijnlijk oorzakelijke factor bij het
ontstaan van latere schizofrenie. Nederlands Tijdschrift voor Geneeskunde, 147 (44): 2178-
2183.
32. Van Os, J., Bak, M., Hanssen, M., Bijl, R.V., De Graaf, R., Verdoux, H. (2002). Cannabis use
and psychosis: a longitudinal population-based study. American Journal of Epidemiology, 156
(4): 319-327.
33. Henquet, C., Krabbendam, L., Spauwen, J., Kaplan, C., Lieb, R., Wittchen, H.U., Van Os, J.
(2005). Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic
symptoms in young people. British Medical Journal, 330 (7481): 11.
34. Bovasso, G.B. (2001). Cannabis abuse as a risk factor for depressive symptoms. American
Journal of Psychiatry, 158 (12): 2033-2037.
35. Patton, G.C., Coffey, C., Carlin, J.B., Degenhardt, L., Lynskey, M., Hall, W. (2002). Cannabis
use and mental health in young people: cohort study. British Medical Journal, 325 (7374): 1195-
1198.
36. Korf, D.J., Wouters, M., Benschop, A., Van Ginkel, P. (2004). Sterke wiet: een onderzoek naar
blowgedrag, schadelijkheid en afhankelijkheid van cannabis. Amsterdam: Rozenberg
Publishers.
37. European Monitoring Centre for Drugs and Drug Addiction (2004). Annual report 2004: the state
of the drugs problem in the European Union and Norway. Lisbon: EMCDDA.
38. European Monitoring Centre for Drugs and Drug Addiction (2004). Statistical bulletin 2004.
Lisbon: EMCDDA.
39. U.S. Department of Health and Human Services (DHHS), Substance Abuse and Mental Health
Services Administration (SAMSHA) (2002). Results from the 2001 National Household Survey
on Drug Abuse: volume I. Summary of national findings. Rockville, MD: DHHS.
40. Australian Institute of Health and Welfare (2002). 2001 National Drug Strategy Household
Survey: First Results. Canberra: AIHW.
182
41. Substance Abuse and Mental Health Services Administration (SAMSHA) (2003). The NHSDA
Report: comparison of substance use in Australia and the United States. Rockville, MD, DHHS.
42. Hibell, B., Andersson, B., Bjarnason, T. (2000). The 1999 ESPAD Report: European School
Survey Project on Alcohol and Other Drugs (ESPAD): alcohol and other drug use among
students in 30 European countries. Stockholm: CAN.
43. Hibell, B., Andersson, B., Bjarnason, T., Ahlström, S., Balakireva, O., Kokkevi, A., Morgan, M.
(2004). The ESPAD Report 2003: alcohol and Other Drug Use Among Students in 35 European
Countries. Stockholm: CAN.
44. Elshove-Bolk, J., Ibelings, M.G., Frissen, P.H., Simons, M.P. (2002). Drugsgerelateerde
problemen op een afdeling spoedeisende hulp in het centrum van Amsterdam, juni-november
2000. Nederlands Tijdschrift voor Geneeskunde, 146 (19): 903-906.
45. Gable, R.S. (1993). Toward a comparative overview of dependence potential and acute toxicity
of psychoactive substances used nonmedically. American Journal of Drug & Alcohol Abuse, 19
(3): 263-281.
46. Bieleman, B., Goeree, P. (2002). Aantal coffeeshops en gemeentelijk beleid in 2001. Groningen:
Intraval.
47. Bieleman, B., Goeree, P., Naayer, H. (2003). Coffeeshops in Nederland 2002: aantallen,
gemeentelijk beleid en handhaving AHOJ-G criteria. Groningen/Rotterdam: Intraval.
48. Pardoel, C.A.M., Van Haaf, J., Bogaerts, S., Van Kalmthout, A.M. (2004). Coffeeshops in
Nederland anno 2003: aantallen, lokaal beleid, handhaving en naleving. Tilburg: IVA/Universiteit
van Tilburg, Departement Strafrechtwetenschappen.
49. Niesink, R.J.M., Pijlman, F.T.A., Rigter, S. (2002). THC-concentraties in wiet, nederwiet en hasj
in Nederlandse coffeeshops (2001-2002). Utrecht: Trimbos-instituut.
50. Niesink, R.J.M., Planije, M., Rigter, S. (2001). THC-concentraties in wiet, nederwiet en hasj in
Nederlandse coffeeshops (2000-2001). Utrecht: Trimbos-instituut.
51. Niesink, R.J.M., Rigter, S., Hoek, J. (2004). THC-concentraties in wiet, nederwiet en hasj in
Nederlandse coffeeshops (2003-2004). Utrecht: Trimbos-instituut.
52. Traag, W.A., Gercek, H., Kloet, D., Wychgel, H.D., Faasen, I.S. (2001). Onderzoek naar
residuen van bestrijdingsmiddelen in nederwiet. Wageningen: RIKILT.
53. Boekhout van Solinge, T. (2001). Op de pof: cocaïnegebruik en gezondheid op straat.
Amsterdam: Stichting Mainline.
54. Korf, D.J., Nabben, T., Lettink, D., Bouma, H. (1999). Antenne 98: trends in alcohol, tabak,
drugs en gokken bij jonge Amsterdammers. Amsterdam: Thela Thesis.
55. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2001). Annual report on
the state of the drugs problem in the European Union 2001. Lissabon: EMCDDA.
56. Van de Mheen, D. (2000). De Rotterdamse drugsscene onder de loep: resultaten van 5 jaar
Drug Monitoring Systeem in Rotterdam. Rotterdam: IVO.
57. De Graaf, I., Wildschut, J., Van de Mheen, H. (2000). Utrechtse druggebruikers: een jachtig
bestaan. Rotterdam: IVO.
58. Coumans, A.M., Neve, R.J.M., Van de Mheen, H. (2000). Het proces van marginalisering en
verharding in de drugscene van Parkstad Limburg: resultaten van het Drug Monitoring Systeem
1998 - 2000. Rotterdam: IVO.
59. Vermeulen, K., Wildschut, J., Knibbe, R. (2001). 'Zo'n beetje alles staat in het teken van de wit':
een verkennend onderzoek naar (base)cocaïne in de Utrechtse gemarginaliseerde
gebruiksscene. Rotterdam: IVO.
60. Mol, A., Van Vlaanderen, J.L., De Vos, A. (2002). Ontwikkeling van de cocaïne hulpvraag in de
ambulante verslavingszorg periode 1994 - 2000. Houten: IVZ.
61. Coumans, A.M., Knibbe, R.A. (2002). Druggebruikers in Parkstad Limburg: trends en profielen:
resultaten van het Drug Monitoring Systeem 2001-2002. Rotterdam: IVO.
62. Smit, F., Toet, J. (2001). National prevalence estimates of problematic drug use in the
Netherlands, 1999: report to the European Monitoring Centre for Drugs and Drugs Addiction
(EMCDDA). Utrecht: Trimbos-instituut.
183
63. Bieleman, B., Snippe, J., De Bie, E. (1995). Drugs binnen de grenzen: harddrugs en criminaliteit
in Nederland: schattingen van de omvang. Groningen: Intraval.
64. Burger, I., Struben, H. (2001). Haagse harddruggebruikers: het bereik van politie en
verslavingszorg in 1996 - 1998 en veranderingen ten opzichte van 1993 - 1995. Den Haag:
GGD Den Haag.
65. Bieleman, B., Biesma, S., Jetzes, M., De Jong, A., Kruize, A., Snippe, J., De Valk, V. (2003).
Enschede van de straat: aard en omvang dak- en thuislozen en zichtbare alcohol- en
harddrugsverslaafden in Enschede. Groningen/Rotterdam: Intraval.
66. Biesma, S., Snippe, J., Oldersma, F., Bieleman, B. (2003). Inventarisatie harddrugsverslaafden
en dak- en thuislozen Leeuwarden, Noord en Zuid-West Friesland. Groningen/Rotterdam:
Intraval.
67. Van der Poel, A., Barendregt, C., Schouten, M. (2003). De leefsituatie van gebruikers in de
Rotterdamse harddrugsscene (resultaten van de survey 2003). IVO-bulletin, 6 (4): 1-19.
68. Eland-Goossensen, M.A. (1997). Opiate addicts in and outside of treatment: different
populations? Rotterdam: IVO.
69. Schrijvers, C.T.M., Abbenhuis, G.M., Van de Goor, L.A.M. (1997). De prevalentie van complexe
verslavingsproblematiek: resultaten van een onderzoek bij druggebruikers in Rotterdam en
Groningen. Rotterdam: IVO.
70. Van Brussel, G.H.A., Buster, M.C.A. (2002). OGGZ monitor Amsterdam: inclusief de jaarcijfers
over problematische opiaat verslaafden en uitgaansdrugs ongevallen. Amsterdam: GG&GD.
71. Van Alem, V.C.M., Mol, A. (2001). Aan vervanging toe?: Methadonverstrekking in de ambulante
verslavingszorg 1995 - 1999. Houten: Stichting Informatievoorziening Zorg (IVZ).
72. Ouwehand, A.W., De Vetten, L.J., Van Alem, V.C.M. (2001). Kerncijfers verslavingszorg 2000:
Landelijk Alcohol en Drugs Informatie Systeem (LADIS). Houten: IVV.
73. GG&GD Amsterdam (2002). Veranwoord uitgaan: integrale aanpak evenementen en party's
waarbij middelengebruik een rol speelt. Amsterdam: GG&GD Amsterdam.
74. Van de Laar, M.J., Beuker, R.J., Rijlaarsdam, J., Van Duynhoven, Y.T. (2000). SOA en AIDS in
Nederland. Bilthoven: Rijksinstituut voor Volksgezondheid en Milieu (RIVM).
75. Beuker, R.J., Berns, M.P.H., Van Rozendaal, C.M., Snijders, B.M., Jansen, M., Hoebe, C.J.P.A.,
Van de Laar, M.J.W. (2001). Surveillance van HIV-infectie onder injecterende druggebruikers in
Nederland: meting Heerlen/Maastricht 1998/1999. Bilthoven: RIVM.
76. De Boer, I.M., Op de Coul, E.L.M., Beuker, R.J., De Zwart, O., Al Taqatqa, W., Van de Laar,
M.J.W. (2004). Trends in HIV-prevalentie en risicogedrag onder injecterende druggebruikers in
Rotterdam, 1994 - 2002. Nederlands Tijdschrift voor Geneeskunde, 148 (47): 2325-2330.
77. Prins, M. (2000). HIV disease progression in injecting drug users: epidemiological studies.
Amsterdam: University of Amsterdam.
78. Krol, A. (2002). Overview of the Amsterdam cohort studies among homosexual men and drug
users. Amsterdam: GG&GD Amsterdam.
79. Carsauw, H.H.C., Van Rozendaal, C.M., Scheepens, J.M.F.A., Hoebe, C.J.P.A., Meulders,
W.A.J., Jansen, M., Dorigo-Zetsma, J.W., Houweling, H. (1997). Infecties met HIV, HBV, en
HCV onder injecterende druggebruikers in Heerlen/Maastricht. Bilthoven: RIVM.
80. Wiessing, L.G., Houweling, H., Spruit, I.P., Korf, D.J., Van Duynhoven, Y.T., Fennema, J.S.,
Borgdorff, M.W. (1996). HIV among drug users in regional towns near the initial focus of the
Dutch epidemic. AIDS., 10 (12): 1448-1449.
81. Beuker, R.J., Berns, M.P.H., Watzeels, J.C.M. (2001). Surveillance van HIV-infectie onder
injecterende druggebruikers in Nederland: meting Den Haag 2000. Bilthoven: RIVM.
82. Van Santen, G., De Wit, M. (2004). Serologie screening: drugsverslaafden in
methadonbehandeling: Lues, Hepatitis B, Hepatitis C, HIV: Ervaringen in polikliniek Zuidoost.
Amsterdam: GG&GD Amsterdam.
83. Van den Hoek, J.A., Van Haastrecht, H.J., Goudsmit, J., De Wolf, F., Coutinho, R.A. (1990).
Prevalence, incidence, and risk factors of hepatitis C virus infection among drug users in
Amsterdam. Journal of Infectious Diseases, 162 (4): 823-826.
184
84. Haks, K., Berns, M.P.H., Snijders, B.M., Watzeels, J.C.M., Van Regteren, A.J., Van de Laar,
M.J.W. (2001). Surveillance van HIV-infectie onder injecterende druggebruikers in Nederland:
meting Almelo/Enschede/Hengelo 2000. Bilthoven: RIVM.
85. Van de Laar, M.J.W., Op de Coul, E.L.M. (2004). HIV and Sexually Transmitted Infections in the
Netherlands in 2003. Bilthoven: RIVM.
86. Van Laar, M., Cruts, G., Vicente, J., Frost, N., Hartnoll, R. (2002). The DRD-Standard, version
3.0: EMCDDA standard protocol for the EU Member States to collect data and report figures for
the Key Indicator Drug-Related Deaths by the Standard Reitox tables. Lissabon: EMCDDA.
87. Van Laar, M., Cruts, G., Vicente, J., Hartnoll, R. (2002). Co-ordination of the implementation of
the EMCDDA standard guidelines on the drug-related deaths indicator in the EU Member
States, and the collection and analysis of information on drug-related deaths; EMCDDA project
CT.00.RTX.22. Lissabon: EMCDDA.
88. Ouwehand, A.W., Mol, A., Boonzajer Flaes, S. (2003). Kerncijfers verslavingszorg 2001:
Landelijk Alcohol en Drugs Informatie Systeem (LADIS). Houten: IVZ.
89. Pijlman, F.T.A., Krul, J., Niesink, R.J.M. (2003). Uitgaan en veiligheid: feiten en fictie over
alcohol, drugs en gezondheidsverstoringen. Utrecht: Trimbos-instituut.
90. Pennings, E.J.M., Eilering, J.B.G., De Wolff, F.A. (2004). Langetermijneffecten van XTC. Leiden:
LUMC.
91. Schifano, F., Oyefeso, A., Corkery, J., Cobain, K., Jambert-Gray, R., Martinotti, G., Ghodse,
A.H. (2003). Death rates from ecstasy (MDMA, MDA) and polydrug use in England and Wales
1996-2002. Human Psychopharmacology, 18 (7): 519-524.
92. Centraal Bureau voor de Statistiek (2004). Gerapporteerde gezondheid en leefstijl
Voorburg/Heerlen: CBS. [http://statline.cbs.nl/StatWeb/].
93. Gemeente Den Haag (2002). Gezondheidsmonitor 2002. Den Haag: Gemeente Den Haag,
Dienst Onderwijs, Cultuur en Welzijn.
94. Dijkshoorn, H. (2002). Ongezonde leefgewoonten in Amsterdam: verschillen tussen Turken,
Marokkanen en Nederlanders. Amsterdam: GG&GD.
95. Productschap Dranken (2004). Jaarverslag 2003. Rotterdam: Productschap Dranken.
96. Productschap Wijn (2004). Jaarverslag 2003. Den Haag: Productschap Wijn.
97. Schutten, M., Van den Eijnden, R.J.J.M., Knibbe, R.A. (2003). Alcohol en werk: een onderzoek
naar alcoholgebruik onder de werkende beroepsbevoling. Rotterdam: IVO.
98. Monshouwer, K., Smit, F., Spruit, I. (2002). Alcohol-, tabak- en cannabisgebruik bij scholieren
naar etnische achtergrond. Tijdschrift voor gezondheidswetenschappen, 80 (3): 172-177.
99. Smit, F., Monshouwer, K., Verdurmen, J. (2002). Polydrug Use Among Secondary School
Students: combinations, prevalences and risk profiles. Drugs: Education, Prevention & Policy, 9
(4): 355-265.
100. Maalsté, N. (2000). Ad fundum! Een blik in de gevarieerde drinkcultuur van het Nederlandse
studentenleven. Utrecht: Centrum voor Verslavingsonderzoek (CVO).
101. De Graaf, D., Poort, E. (2004). Evaluatie van de Zomercampagne 2003; 'Drank: de kater komt
later'. Haarlem: ResCon.
102. Van Zundert, R.M.P., Engels, R.C.M.E., Delsing, M.J.M.H. (2004). Alcoholgebruik van
scholieren in het voortgezet speciaal onderwijs: de rol van ouderlijk alcoholgebruik en
opvoeding. Gedrag en gezondheid: tijdschrift voor psychologie en gezondheid, 32 (5): 326-343.
103. Bieleman, B., Biesma, S., Kruize, A., Snippe, J. (2004). Monitor alcoholverstrekking jongeren
2003: naleving leeftijdsgrenzen 16 en 18 jaar: metingen 1999, 2001 en 2003. Groningen:
Intraval.
104. Korf, D.J., Nabben, T., Benschop, A. (2001). Antenne 2000: trends in alcohol, tabak, drugs en
gokken bij jonge Amsterdammers. Amsterdam: Thela Thesis.
105. Leifman, H. (2001). Trends in population drinking. In: T.Norström (red.). Alcohol in postwar
Europe: consumption, drinking patterns, consequences and policy responses in 15 European
countries; European Comparative Alcohol Study (ECAS), p. 45-77. Stockholm: ECAS.
106. Ouwehand, A.W., Van Alem, V.C.M., Mol, A., Boonzajer Flaes, S. (2004). Kerncijfers
verslavingszorg 2003. Landelijk Alcohol en Drugs Informatie Systeem. Houten: IVZ.
185
107. Thomas, J., De Vos, T. (2003). Actieplan Alcoholzorg: 'verslag activiteiten over het jaar 2002'
(http://www.ggzkennisnet.nl). Utrecht: GGZ Nederland.
108. Riper, H., Kramer, J. (2004). Veel belangstelling voor www.MinderDrinken.nl. Nieuwsflitsen van
het Trimbos-instituut, 2004 (13): 2.
109. De Bruin, K. (2005). Alcoholprobleem als monitorprobleem: de opzet van een Amsterdamse
alcoholmonitor. Amsterdam: GG&GD Amsterdam.
110. Ormel, W. (2004). Letsel Informatie Systeem van Consument en Veiligheid: ongevallen waarbij
alcohol of drugs betrokken zijn. Amsterdam: Stichting Consument en Veiligheid.
111. Wilsterman, M.E.F., Dors, N., Sprij, A.J., Wit, J.M. (2004). Kliniek en beleid bij jongeren met
alcoholintoxicatie op afdelingen voor spoedeisende hulp in de regio Den Haag, 1999 - 2001.
Nederlands Tijdschrift voor Geneeskunde, 148: 1496-1500.
112. Eenderde verkeersdoden door alcohol en drugs (24 september 2004). Telegraaf.
113. Jansen, W.K., In 't Veld, R. (2004). Hoofdlijnenrapport Rijden onder invloed 2002 - 2003. Den
Haag: Ministerie van Verkeer en Waterstaat, Adviesdienst Verkeer en Vervoer.
114. Van Velzen, A.G., Van Gorcum, T.F., Van Riel, A.J.H.P., Meulenbelt, J., De Vries, I. (2004).
Acute vergiftigingen bij mens en dier. Jaaroverzicht 2003 Nationaal Vergiftigingen Informatie
Centrum. RIVM rapport 348802021/2004. Bilthoven: NVIC/RIVM.
115. Poppelier, A., Van de Wiel, A., Van de Mheen, D. (2002). Overdaad schaadt: een inventarisatie
van de lichamelijke gevolgen van sociaal geaccepteerd alcoholgebruik en binge-drinken.
Rotterdam: IVO.
116. Single, E., Ashley, M.J., Bondy, S., Rankin, J., Rehm, J. (1999). Evidence regarding the level of
alcohol consumption considered to be low-risk for men and women. Canberra: National Health
and Medical Research Council.
117. Koppes, L.L., Twisk, J.W., Snel, J., Van Mechelen, W., Kemper, H.C. (2000). Blood cholesterol
levels of 32-year-old alcohol consumers are better than of nonconsumers. Pharmacology,
Biochemistry, and Behavior, 66 (1): 163-167.
118. Ruitenberg, A., Van Swieten, J.C., Witteman, J.C., Mehta, K.M., Van Duijn, C.M., Hofman, A.,
Breteler, M.M. (2002). Alcohol consumption and risk of dementia: the Rotterdam Study. Lancet,
359 (9303): 281-286.
119. San José, B. (2000). Alcohol consumption and health: contributions to the explanation of the u-
shaped curve. Rotterdam: IVO.
120. Signaleringscommissie Kanker van KWF Kankerbestrijding (2004). De rol van voeding bij het
ontstaan van kanker . Amsterdam: KWF Kankerbestrijding.
121. Van Oers, J.A.M. (2002). Gezondheid op koers? Volksgezondheid Toekomst Verkenning 2002.
Bilthoven: RIVM.
122. Van Leeuwen, F.E. (1999). Epidemiologie van kanker: inzichten en vooruitzichten. Amsterdam:
Vrije Universiteit.
123. Verdurmen, J., Van der Meulen, A., Van Laar, M. (2004). Ontwikkelingen in alcoholgerelateerde
sterfte in Nederland. Bevolkingstrends, 52 (3e kwartaal): 32-38.
124. Schram, D., Maas, I.A.M., Poos, M.J.J.C., Jansen, J. (2001). De bijdrage van leefstijlfactoren
aan de sterfte in Nederland. TSG: Tijdschrift voor gezondheidswetenschappen, 79 (4): 211-216.
125. Tweede Kamer der Staten-Generaal vergaderjaar 2001 - 2002 28380 nr.38 (2002). Financiële
verantwoordingen over het jaar 2001; Jaarverslag van het Ministerie van Volksgezondheid,
Welzijn en Sport (XVI). Den Haag: SDU Uitgevers.
126. Productschap Dranken (2003). Verslag van het jaar 2002. Rotterdam: Productschap Dranken.
127. STIVORO voor een rookvrije toekomst (2004). Jaarverslag 2003. Den Haag: STIVORO.
128. STIVORO voor een rookvrije toekomst (2005). Bijna een kwart miljoen rokers houdt het niet-
roken nog steeds vol. Den Haag: STIVORO.
129. Willemsen, M.C., Hoogenveen, R.T., Van der Lucht, F. (2002). New smokers and quitters.
Transitions in smoking status in a national population. European Journal of Public Health, 12 (2):
136-138.
130. RIVM (2004). Zware rokers geconcentreerd in Noord-Brabant en 4 grote steden. Bilthoven:
RIVM. [http://www.rivm.nl/vtv/data/atlas/lfst_rook_a006.htm].
186
131. Bieleman, B., Kruize, A. (2004). Monitor tabaksverstrekking jongeren 2003: naleving
leeftijdsgrens 16 jaar: metingen 1999, 2001 en 2003. Groningen: Intraval.
132. Willemsen, M. (2003). Sigaretten en de nieuwe wettelijke leeftijdsgrens: Hoe vaak wordt de
leeftijd gecontroleerd? Den Haag: STIVORO voor een rookvrije toekomst.
133. STIVORO - rookvrij (2004). Roken, de harde feiten: Volwassenen 2003. Den Haag: STIVORO -
rookvrij.
134. Willemsen, M. (1999). Nicotineverslaving: is 'harm reduction' mogelijk en wenselijk? Tijdschrift
voor Alcohol, Drugs en andere Psychotrope Stoffen, 24 (2): 57-73.
135. World Health Organization (2004). Tobacco control database: Country profiles: Smoking
prevalence in adults. Copenhagen: WHO Regional Office for Europe.
[http://data.euro.who.int/tobacco]
136. Joossens, L. (2004). Effective tobacco control policies in 28 European countries. Brussels:
ENSP.
137. DEFACTO-rookvrij (2002). Roken, de harde feiten: Volwassenen 2001. Den Haag: DEFACTO-
rookvrij.
138. Bartelds, A.I.M. (2004). Continue Morbiditeits Registratie Peilstations Nederland 2003. Utrecht:
NIVEL.
139. Bolman, C., De Vries, H., Van Breukelen, G. (2004). Evaluatie van C-MIS, een protocol om
hartpatiënten te helpen te stoppen met roken. TSG: Tijdschrift voor
gezondheidswetenschappen, 82 (7): 416-425.
140. Op de Weegh, J.M.J., Willemsen, M.C. (2003). Dat Kan Ik Ook! De stoppen met roken
milleniumcampagne. Den Haag: STIVORO.
141. Kwaliteitsinstituut voor de Gezondheidszorg CBO (2004). Richtlijn Behandeling van
Tabaksverslaving. Utrecht: Kwaliteitsinstituut voor de Gezondheidszorg CBO.
142. Van Weel, C., Coebergh, J.W.W., Drenthen, T., Schippers, G.M., Van Spiegel, P.I., Anderson,
P.D., Van Bladeren, F.A., Van Veenendaal, H. (2005). Richtlijn 'Behandeling van
tabaksverslaving'. Nederlands Tijdschrift voor Geneeskunde, 149 (1): 17-21.
143. Van Leeuwen, M.J., Sleur, D.G. (1998). De economische effecten van maatregelen ter
bestrijding van het roken. In: Netherlands School of Public Health (NSPH) (red.).
Tabaksontmoedigingsbeleid : gezondheidseffectrapportage, p. 87-137. Utrecht: NSPH.
144. Poos, R., Van Leent, J. (2005). Sterfgevallen door roken op basis van sterftecijfers 2003.
Bilthoven: RIVM.
145. Gezondheidsraad (2003). Volksgezondheidsschade door passief roken. Den Haag:
Gezondheidsraad.
146. Sturman, H. (2003). Leugens over passief roken. HP/De Tijd, 28 november 2003.
147. Bonneux, L.G.A., Looman, C.W.N., Coebergh, J.W. (2003). Sterfte door roken in nederland: 1,2
miljoen tabaksdoden tussen 1950 en 2015. Nederlands Tijdschrift voor Geneeskunde, 147 (19):
917-927.
148. Stb 2002/201: Staatsblad van het Koninkrijk der Nederlanden, Jaargang 2002, nr 362 (2002).
Besluit van 28 juni 2002, houdende vaststelling van het tijdstip van inwerkingtreding van de Wet
van 18 april 2002 tot wijziging van de Tabakswet. Den Haag: Sdu Uitgevers.
149. Bureau Voorlichting Tabak (2004). Tabak in Kerncijfers 2003. Utrecht: BVT. [http://www.bvt.nl]
150. European Commission, D.G.T.a.C.U.T.P. (2004). Manufactured Tobacco: Excise Duty Tables.
Brussel: European Commission. [http://europa.eu.int/comm/taxation_customs]
151. Bijkerk, R., Van der Werf, J. (2003). In beslaggenomen verdovende middelen 2002. Zoetermeer:
KLPD/DNRI, groep Onderzoek en Analyse.
152. De Miranda, H., Van der Werf, J. (2004). Inbeslagnemingen verdovende middelen 2003.
Zoetermeer: KLPD.
153. Van der Heijden, T. (2003). De Nederlandse drugsmarkt: een poging tot kwantificering van
import, export, productie en consumptie van verdovende middelen. Zoetermeer: KLPD-Dienst
Nationale Recherche Informatie.
154. Wartna, B.S.J., Tollenaar, N. (2004). Bekenden van Justitie: een verkennend onderzoek naar de
"veelplegers" in de populatie van vervolgde daders. Den Haag: Boom Juridische uitgevers.
187
155. Wartna, B.S.J., Baas, N.J., Beenakkers, E.M.T. (2004). Beter, anders en goedkoper: een
literatuurverkenning ten behoeve van het traject Modernisering Strafrechttoepassing. Den Haag:
Sdu Uitgevers.
156. Stichting Verslavingsreclassering GGZ Nederland (2004). Jaarrekening 2003. Utrecht: SVG.
157. Stichting Verslavingsreclassering GGZ Nederland (2002). Justitiële verslavingszorg in
penitentiaire inrichtingen. Utrecht: SVG.
158. Ministerie van Justitie, Stichting Reclassering Nederland (2001). Outputsturing Reclassering.
Den Haag: Ministerie van Jusititie/SRN.
159. SVG-werkgroep interventiematrix JVZ (2004). Interventies voor verslaafde justitiabelen. Utrecht:
SVG.
160. Van Ooyen-Houben, M. (2004). De drangaanpak van criminele harddruggebruikers: een
programmatheoretisch model. Justitiële Verkenningen, 30 (5): 49-63.
161. Van Ooyen-Houben, M. (2004). Drang bij criminele harddruggebruikers – een onderzoek naar
de toepassing van drang in Nederland. Tijdschrift voor Criminologie, 46 (3): 233-248.
162. Oelen, J., Torringa, A.M.M. (2002). Jeugdmonitor Almelo 2002. Almelo: Bureau Onderzoek en
Statistiek, Gemeente Almelo.
163. Hiddema, S. (2003). Jongeren in 't vizier. Jongerenenquête 2002 Flevoland. Lelystad:
Hulpverleningsdienst Flevoland.
164. Van de Laar, A., Paijmans, I., Tielen, H. (2005). Jongerenpeiling 2003: Alphen a/d Rijn. Leiden:
GGD Zuid-Holland Noord.
165. Boekenogen, M., Hilhorst, E., Huurdeman, M., Yesilgöz, D. (2004). Jongerenstadspeiling 2004:
Amersfoortse jongeren over zichzelf en hun vrije tijd. Amersfoort: Onderzoek en Statistiek,
Gemeente Amersfoort.
166. Last, T., Huizing, A., Huijgen, G. (2003). Jeugdmonitor Apeldoorn 2003: rendement voor jong
kapitaal. Enschede: I & O Research.
167. Sociaal Geografisch Bureau (2004). Jongerenmonitor 2003. Dordrecht: Sociaal Geografisch
Bureau.
168. Bos, C.A. (2002). Leefstijl van jongeren van 19-23 jaar. Assen: GGD Drenthe.
169. Onderzoek & Statistiek (2004). Jeugdmonitor 2003. Ede: Onderzoek & Statistiek (OO&S),
Gemeente Ede.
170. Vissers, M., Verheijen, C. (2003). De staat van de jeugd. Eindhovense jeugdmonitor 2002.
Eindhoven: Afdeling Bestuursinformatie en Onderzoek, Dienst Algemene Publiekszaken,
Gemeente Eindhoven.
171. Van Acker, M.B., Lamérus, I.C. (2003). Gezondheid van de jeugd in de Gooi en Vechtstreek.
Deel II Leefstijl: Omgang met genotmiddelen, gokken, seksualiteit en sport & bewegen. Bussum:
GGD Gooi & Vechtstreek.
172. Leefering, A.J., Kloosterman, K. (2004). Jeugdpeiling 2002. Groningen: Dienst OCSW,
Gemeente Groningen.
173. Rosendal, T. (2003). Gezondheid en leefstijl van jongeren in Heerhugowaard. Derde en laatste
onderzoek (2002) . Alkmaar: GGD Noord-Kennemerland.
174. Gemeente 's-Hertogenbosch (2003). Jeugd- en onderwijsmonitor 's-Hertogenbosch 2002-2003.
's-Hertogenbosch: Afdeling Jeugd en Onderwijs, Gemeente 's-Hertogenbosch.
175. Bertina, W., Mulder, M., Tielen, H., Paijmans, I. (2004). Jongeren peiling Leiden 2003. Leiden:
GGD Zuid-Holland Noord.
176. Custers, T. (2002). Jeugdmonitor Maasbracht. Sittard: Stichting Symbiose.
177. Van den Hoogen, P., Jansen, B. (2004). Jongerenenquête 2003: Brabantse Jeugdmonitor 2003:
GGD-infokaart. 's-Hertogenbosch: Afdeling Gezondheidsbevordering, GGD Hart voor Brabant.
178. O & S Nijmegen (2004). Jeugdmonitor 2003. Nijmegen: Afdeling Onderzoek en Statistiek,
Gemeente Nijmegen.
179. Bureau Onderzoek & Statistiek (2004). Jeugdmonitor 2003: grotestedenbeleid Schiedam.
Schiedam: Bureau Onderzoek & Statistiek, Gemeente Schiedam.
180. Gemeente Tilburg (2004). Jeugdmonitor gemeente Tilburg 2004. Tilburg: Afdeling Onderzoek &
Informatie, Gemeente Tilburg.
188
181. Van Eijsden, M., Bleeker, J., Van Bergen, A., Van Ameijden, E. (2002). De Utrechtse jeugd
gezond? Een onderzoek naar de gezondheid van de Utrechtse jeugd: trends en sociaal-
demografische verschillen. Utrecht: GG&GD Utrecht.
182. Jansen, B. (2004). Jongerenenquête 2003: Brabantse Jeugdmonitor: GGD-Infokaart. Breda:
Afdeling Gezondheidsbevordering, GGD West-Brabant.
183. Sociaal-Wetenschappelijke Bureau (2003). Jeugdmonitor 2002. Hoorn: Sociaal-
Wetenschappelijk Bureau, Samenwerkingsorgaan West-Friesland.
184. Van de Laar, A., Paijmans, I., Tielen, H. (2003). Jongerenpeiling 2003. Leiden: GGD Zuid-
Holland Noord.
185. Gemeente Haarlemmermeer (2004). Jeugdomnibus 2003-2004. Haarlemmermeer: Afdeling
Onderzoek & Statistiek, Gemeente Haarlemmermeer.
186. Monshouwer, K., Smit, F., De Graaf, R., Van Os, J., Vollebergh, W. (2005, in press). First
cannabis use: does onset shift to younger ages? Findings from 1988 to 2003 from the Dutch
National School Survey on Substance Use. Addiction (in press).
187. Jager, J., Limburg, W., Kretzschmar, M., Postma, M., Wiessing, L. (2004). Hepatitis C and
injecting drug use: impact, costs and policy options. Lisbon: EMCDDA.
188. Engels, R.C., Ter Bogt, T. (2004). Outcome expectancies and ecstasy use in visitors of rave
parties in The Netherlands. European Addiction Research, 10 (4): 156-162.
189. Van Dijck, D., Knibbe, R.A. (2005). De prevalentie van probleemdrinken in Nederland: Een
algemeen bevolkingsonderzoek. Maastricht: Universiteit Maastricht.
189
190

2004 Netherlands National Drug Monitor

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2004 Netherlands National Drug Monitor

Uploaded by

Copyright:

Available Formats

This file at the Trimbos Institute: <F:\N D M\JB 2004\Engelse vertaling\JB 2004 En versie 5.0 vastgesteld.

Annual Report NDM 2004

With the cooperation of

This publication can be ordered through www.trimbos.nl,

© 2005 Trimbos Institute, Utrecht

Prof. H.G. van de Bunt, Erasmus University Rotterdam

5 Ecstasy, amphetamines and related substances

8 Recorded drug crime

Prof. Henk Garretsen

Use of substances: general

Ecstasy and amphetamines

Recorded drug-related crime

The National Drug Monitor

The NDM promotes the following functions:

Annual Report 2004

Earlier publications of NDM are:

outcomes of the Nemesis household survey.

the state of science on cannabis.

2.1 LATEST FACTS AND TRENDS

2.2 USE IN THE GENERAL POPULATION

The frequency of cannabis use among current users varies strongly.

2.3 USE AMONG YOUNG PEOPLE

Ever use (%) Current use (%)

Boys Girls Total Boys Girls Total

School level and ethnic origin

Special groups of young people

2.4 PROBLEM USE

Cannabis use is increasingly associated with psychological problems.

• The risk increases with the frequency of cannabis use.

• People with a history of psychotic symptoms are particularly vulnerable.

2.5 USE: INTERNATIONAL COMPARISONS

2.6 TREATMENT DEMAND

Outpatient care organisations for addicts

General hospitals; incidents

2.8 SUPPLY AND THE MARKET

THC content and price

Table 2.12 Price (€) per gram of cannabis product

3.1 LATEST FACTS AND TRENDS

3.2 USE IN THE GENERAL POPULATION

Ever 1997 Ever 2001 Current 1997 Current 2001

Ever use (%) Current use (%)

3.4 PROBLEM USE

3.5 USE: INTERNATIONAL COMPARISONS

Young people and adolescents

3.6 TREATMENT DEMAND

Outpatient care organisations for addicts

Inpatient care organisations for addicts

General hospitals; incidents

371 383 377

Cocaine as primary diagnosis Cocaine as secondary diagnosis

Composition of cocaine samples

4.1 LATEST FACTS AND TRENDS

The use of heroin is not widespread in the general population.

4.3 USE IN THE YOUNG PEOPLE

Table 4.2 Heroin use in special groups

4.4 PROBLEM USE

Born in the Netherlands

Opiate use is particularly precarious when injected intravenously.

4.5 USE: INTERNATIONAL COMPARISONS

4.6 TREATMENT DEMAND

Outpatient care organisations for addicts

Inpatient care organisations for addicts

General hospitals; incidents

800 751 742