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The Netherlands Drug Control Data and Policies

  1. (Drug Use and Crime Indicators - Comparison Between The US and The Netherlands)

    Social Indicator Comparison Year USA Netherlands
    Lifetime prevalence of marijuana use 2009 41.5% (ages 12 and up)1 25.7% (ages 15-64)2
    Past year prevalence of marijuana use 2009 11.3% (ages 12 and up)1 7.0% (ages 15-64)2
    Lifetime prevalence of heroin use 2009 1.5% (ages 12 and up)1 0.5% (ages 15-64)2
    Prison Population Rate per 100,000 population Dec. 31 2011 (US) / Sept. 30 2012 (Netherlands) 716 3 82 3
    Per capita spending on criminal justice system (in Euros) 1998 €379 4 €223 4
    Homicide rate per 100,000 population 2012 4.75 0.95
     
    Source: 
    1: Substance Abuse and Mental Health Services Administration. (2010). Results from the 2009 National Survey on Drug Use and Health: Volume II. Technical Appendices and Selected Prevalence Tables (Office of Applied Studies, NSDUH Series H-38B, HHS Publication No. SMA 10-4586Appendices). Rockville, MD, p. 99, Table G.2, and p. 101, Table G.4.
    http://www.oas.samhsa.gov/NSDUH/2k9NSDUH/2k9ResultsApps.pdf
    2:  "The Netherlands Drug Situation 2011: Report to the EMCDDA by the Reitox National Focal Point" (Netherlands Institute of Mental Health and Addiction and the Ministry of Security and Justice Research and Documentation Centre, 2012), p. 40, Table 2.1.1.
    http://www.trimbos.org/~/media/English%20site/AF1130%20The%20Netherlands...
    3:  Walmsley, Roy, "World Prison Population List (Tenth Edition)" (Kings College, London, England: International Centre for Prison Studies, 2013), Table 2, p. 3, and Table 4, p. 5.
    http://www.prisonstudies.org/sites/prisonstudies.org/files/resources/dow...
    4:  van Dijk, Frans & Jaap de Waard, "Legal infrastructure of the Netherlands in international perspective: Crime control" (Netherlands: Ministry of Justice, June 2000), p. 9, Table S.13.
    5:  UNODC Global Study on Homicide 2013 (United Nations publication, Sales No. 14.IV.1), Table 8.1, p. 126 and p. 132
    http://www.unodc.org/documents/gsh/pdfs/2014_GLOBAL_HOMICIDE_BOOK_web.pd...

  2. Basic Data

    Prevalence and Trends

    (Drug Use Prevalence in The Netherlands) "The most recent survey on drug use in the general population was conducted in 2009. However, due to methodological changes, the data are not comparable with those of previous surveys (1997, 2001 and 2005). Hence, recent trends cannot be described. In 2009 last year prevalence of cannabis use in the population of 15-64 years was 7.0% and last month prevalence was 4.2%. Almost one-third (30%) of the last month users had used cannabis daily or almost daily in the past month. The percentage of recent users of cocaine and ecstasy was almost the same (1.2% and 1.4%, respectively). Amphetamine remained least popular with 0.4% recent users.
    "Cannabis use among pupils (12-16 years) from regular secondary schools showed a decreasing trend between 2001 and 2009. In 2009, 9% of the pupils had used cannabis in the past year against 14% in 2001. Four in ten recent users had used only once in the past year, and a minority was a frequent blower (40 times or more).
    "Prevalence rates of drug use are appreciably higher in (local) studies among various subpopulations, including pubgoers and nightlifers (cannabis, ecstasy, cocaine), neighbourhood and hang-around youth (cannabis, ecstasy, cocaine) and men who have sex with men (ecstasy, cocaine, GHB). However, no higher levels but even lower levels of drug use (cannabis, ecstasy, cocaine) were found among first-year students.
    "Various indicators strongly point at an increase in the (problem) use of GHB in some subpopulations both in and outside the nightlife scene. In 2009, 0.4% of the population between 15 and 64 years had used GHB and 0.2% reported use in the past month. These figures are comparable to those of amphetamine but much lower compared to ecstasy and cocaine. Higher percentages of GHB users are found among populations in the nightlife scene, although GHB is not by definition a club drug and use at home is also commonly reported."

    Source: 
    Van Laar, Margriet, et al., (2012). The Netherlands drug situation 2011: report to the EMCDDA by the Reitox National Focal Point. (Utrecht: Trimbos Institute, Netherlands Institute of Mental Health and Addiction), pp. 11-12.
    http://www.trimbos.org/~/media/English%20site/AF1130%20The%20Netherlands...

  3. (Prevalence Of Drug Use Among Youth In The Netherlands, 2011) "Since 1988, substance use is monitored every four years among pupils of primary education (7th and 8th grade) and all grades of ‘mainstream’ secondary education. The most recent survey was conducted in 2011. Among pupils from primary education, questions on illegal drug use were restricted to cannabis. Methodological details have been described in the 2012 National Report and in ST.
    "The results showed that primary-school children (7th and 8th grade) had little experience of cannabis. In 2011 only 0.3% of them had ever smoked a joint.
    "• Table 2.3.1 shows the trends in lifetime prevalence and table 2.3.2 the last month prevalence of drug use rates among pupils of secondary education of 12-18 years (see also ST02).
    "• The percentage of last month cannabis users declined gradually between 1996 and 2003, and remained stable in 2007 and 2011.
    "• Both lifetime and last month use was higher among boys than girls (lifetime 20.7% and 13.9%, respectively; last month: 10.5% and 4.8%, respectively). No differences were found between the various school levels.
    "• Overall, prevalence rates of the other drugs peaked in 1996, decreased afterwards and remained stable between 2007 and 2011. Lifetime use of ecstasy remained highest and use of heroin remained lowest over all years (2.6% and 0.6%, respectively in 2011)."

    Source: 
    Van Laar M.W., Cruts G, Van Ooyen-Houben M., Croes E., Van der Pol P., Meijer, R., Ketelaars T., (2014). The Netherlands drug situation 2013: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 34.
    http://www.emcdda.europa.eu/html.cfm/index228325EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_228332_EN_EMCDDA_NR%202...

  4. (Estimated Prevalence of Selected Drugs Among Youth In The Netherlands)

    Prevalence of Drug Use In The Previous Month Among Secondary Students (12-18 Years Old) In The Netherlands

    (Figures in Percent)
    Drug Year
    1988 1992 1996 1999 2003 2007 2011
    Cannabis 3.7 7.8 11.1 9.3 8.6 8.1 7.7
    Cocaine 0.4 0.4 1.1 1.2 0.8 0.8 0.8
    Ecstasy -- 1.0 2.3 1.4 1.2 0.8 0.9
    Amphetamine -- 0.6 1.9 1.1 0.8 0.8 0.6
    Heroin

    0.3 0.2 0.5 0.4 0.5 0.4 0.2

    "Source: Dutch National School Survey (Verdurmen et al. 2012)."

    Source: 
    Van Laar, M.W., Cruts, A.A.N., Van Ooyen-Houben, M.M.J., Van Gageldonk, A., Croes, E.A., Meijer, R.F., et al. (2013). The Netherlands drug situation 2012: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 37, Table 2.3.2.
    http://www.emcdda.europa.eu/html.cfm/index213775EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_213776_EN_2012%20Nether...

  5. (1997, 2001, 2005, and 2009 - drug usage in The Netherlands) Prevalence of drug use in the Dutch population 15-64 years of age:

    Lifetime Prevalence % Last Year Prevalence %
    1997 2001 2005 2009 1997 2001 2005 2009
    Cannabis 19.1 19.5 22.6 25.7

    5.5 5.5 5.4 7.0
    Cocaine 2.6 2.1 3.4 5.2 0.7 0.7 0.6 1.2
    Ecstasy 2.3 3.2 4.3 6.2 0.8 1.1 1.2 1.4
    Amphetamine 2.2 2.0 2.1 3.1 0.4 0.4 0.3 0.4
    LSD 1.5 1.2 1.4 1.5 - 0.0 0.1 0.1
    Heroin 0.3 0.2 0.6 0.5 0.0 0.0 0.0 0.1
    Source: 
    Trimbos Institute, "Drug Situation 2006 The Netherlands by the Reitox National Focal Point: Report to the EMCDDA" (Utrecht, Netherlands: Trimbos-Instuut, 2007), p. 26, Table 2.1.
    http://www.wodc.nl/images/1462b_fulltext_tcm44-75372.pdf
    "The Netherlands Drug Situation 2011: Report to the EMCDDA by the Reitox National Focal Point" (Netherlands Institute of Mental Health and Addiction and the Ministry of Security and Justice Research and Documentation Centre, 2012), p. 40, Table 2.1.1.
    http://www.trimbos.org/~/media/English%20site/AF1130%20The%20Netherlands...

  6. (Frequency of Marijuana Use by Gender and Age, Netherlands 2009)
    "Frequency of use
    "• In 2009, last month prevalence of cannabis use was 4.7%; 30% of these last month users reported daily or almost daily use. This is some 1.3% of the total population aged 15 through 64 years, or 141.000 (almost) daily cannabis users in absolute numbers.
    "• One quarter (25%) of the current users consumed cannabis a few times per week, 21% at least once per week and 24% less than once per week.
    "• For other drugs the number of past month users is too small to allow a further breakdown in frequency category.
    "Age and gender
    "• The numbers of users are only sufficient for cannabis to make a breakdown by age and gender of recent users.
    "• Cannabis use was highest in age group 25-44 years. In 2009 last year prevalence was twice as high in this age group compared to age group 25-44 (figure 2.1.1).
    "• The prevalence of last year cannabis use was more than 2 times higher among men than women (9.8% as against 4.2%)."

    Source: 
    Van Laar, Margriet, et al., (2012). The Netherlands drug situation 2011: report to the EMCDDA by the Reitox National Focal Point. (Utrecht: Trimbos Institute, Netherlands Institute of Mental Health and Addiction), p. 40.
    http://www.trimbos.org/~/media/English%20site/AF1130%20The%20Netherlands...

  7. (Prevalence of Problem Cannabis Use in The Netherlands 2009) "From April 2009 until December 2009 the general population survey also included questions on problems related to cannabis use. These questions were derived from the DSM IV criteria for cannabis dependence and may be considered as a proxy measure of problem cannabis but they do not yield a clinical diagnosis of dependence. As these questions were introduced in the second quarter of 2009, the net sample was slightly lower (n=4,638 instead of 5,769), but prevalence rates of cannabis use were virtually the same (e.g. last year prevalence was 7.0% in the full sample and 7.1% in the reduced sample). Questions on problems related to cannabis use were only completed by respondents who had used cannabis at least five times in the past 12 months. Table 2.1.2 shows the percentages of cannabis users fulfilling the criteria. Almost one quarter (23%) responded positive to three or more 'symptoms', which can be indicative of problem use."

    Source: 
    Van Laar, Margriet, et al., (2012). The Netherlands drug situation 2011: report to the EMCDDA by the Reitox National Focal Point. (Utrecht: Trimbos Institute, Netherlands Institute of Mental Health and Addiction), p. 41.
    http://www.trimbos.org/~/media/English%20site/AF1130%20The%20Netherlands...

  8. (Marijuana Use by Young People in The Netherlands, by Gender and Ethnicity) "Figure 2.2.1 shows that cannabis use strongly increases with age.
    "• At age 12 only few pupils have ever used cannabis, less than 1%. At age 16, one in five girls and one in three boys had ever tried cannabis.
    "• While boys have overall more ever and current experience with cannabis, gender differences are only significant for current use and only at age 16.
    "• While the Dutch National School Surveys on Substance use have shown a strong increase in the age of first cannabis use between 1988 and 1996, the HBSC studies showed that lifetime prevalence among 14 year old pupils decreased from 20% in 2011 to 11% in 2009.
    "Frequency of cannabis use
    "• Nine percent of the pupils of 12-16 years had used cannabis in the past year. Of this group, 42% had smoked cannabis only 1 time, 49% smoked between 2 and 39 times and 10% was a relatively heavy user (40 times or more in the past year).
    "Cannabis use: school level and ethnicity
    "• There were no significant differences between school types in the percentages of recent and current cannabis users.
    "• There were also no major differences in prevalence rates between Dutch and other ethnic groups, except for a lower rate of recent use among Moroccan pupils (4% against 10% among Dutch pupils). This difference remains significant after correcting for differences in school type and family situation between Dutch and Moroccan pupils."

    Source: 
    Van Laar, Margriet, et al., (2012). The Netherlands drug situation 2011: report to the EMCDDA by the Reitox National Focal Point. (Utrecht: Trimbos Institute, Netherlands Institute of Mental Health and Addiction), pp. 44-45.
    http://www.trimbos.org/~/media/English%20site/AF1130%20The%20Netherlands...

  9. (Access to and Availability of Cannabis in The Netherlands) "In the Netherlands, the sale of cannabis to individual users is tolerated by the mayor and not prosecuted by the Public Prosecutor if it takes place in a coffee shop which has a formal permit of the mayor and which adheres to criteria for non-prosecution which are defined in the Directive Opium Act of the Public Prosecutor (Aanwijzing Opiumwet, see www.om.nl). Municipalities can apply additional local criteria, for instance with regards to opening hours of location (Bieleman, Nijkamp and Haaijer, 2013).
    "• The number of coffee shops decreased in 2012 and 2013. At the end of 2011 there were 651 coffee shops, at the end of 2012 there were 617 and in April 2013 there were 614 coffee shops (Bieleman, Nijkamp, Reimer and Haaijer, 2013; see figure 10.1.1). After years of gradual decreases, there was a more substantial decrease of 5.2% in 2012 compared to 2011.
    "• Coffee shops were closed permanently, a.o. because the formal permit was withdrawn after a negative outcome of the screening on the basis of Public Administration Probity Screening Act (BIBOB) and because they violated the conditions.
    "• In 2012 the coffee shops were located in 103 (25%) of the 415 municipalities. Most municipalities (68%) have a ‘zero-policy’ with regards to coffee shops, which means that they do not permit any coffee shops. A quarter (25%) of all municipalities apply a ‘maximum policy’: they limit the number of coffee shops; 7% does not have any explicit policy with regards to the tolerance of coffee shops (Bieleman et al. 2013). This is largely comparable to 2011.
    "• Coffee shops are concentrated in the West of the Netherlands (the ‘Randstad’) and in medium sized municipalities in the provinces. Almost half (46%) of the coffee shops is located in the three big cities (Amsterdam, Rotterdam, The Hague). This situation is comparable to 2011.
    "• Municipalities with coffee shops have 31,523 inhabitants per coffee shop in 2012 (mean). This has not significantly changed compared to 2011. Amsterdam still has the highest coffee shop density per inhabitant: one coffee shop per 3,843 inhabitants."

    Source: 
    Van Laar M.W., Cruts G, Van Ooyen-Houben M., Croes E., Van der Pol P., Meijer, R., Ketelaars T., (2014). The Netherlands drug situation 2013: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 114.
    http://www.emcdda.europa.eu/html.cfm/index228325EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_228332_EN_EMCDDA_NR%202...

  10. Crime, Courts, and Prisons

    (Drug Offense Arrests in The Netherlands, 2011)
    "• There is an increase in the total number of police reports of Opium Act offences in 2011.
    "• There is an increase in both hard and soft drugs reports compared to 2010. The increase in soft drugs exceeds the increase in hard drugs offences. The number of reports of combinations of both hard and soft drugs has decreased. This type of cases forms a minority.
    "• The proportion of hard drugs and soft drugs offences remained more or less constant compared to 2010. In 2011, there are almost as many hard drugs as soft drugs reports. There is an increase in the proportion of soft drugs offences since 2009. This increase is confirmed by the Netherlands Police Agency, who assume that the increase is a result of the intensified enforcement efforts directed at cannabis production (Nationaal Netwerk Drugsexpertise 2012).
    "• 7% of all the police reports concern Opium Act offences in 2011. This proportion increased compared to 2010.
    "• Most arrestees for Opium Act offences are male. Most of the arrestees have more than one criminal report. For 42%, the 2011 offence is the first registered offence (of all possible offences, not only Opium Act offences; not in table)."

    Source: 
    Van Laar, M.W., Cruts, A.A.N., Van Ooyen-Houben, M.M.J., Van Gageldonk, A., Croes, E.A., Meijer, R.F., et al. (2013). The Netherlands drug situation 2012: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 121.
    http://www.emcdda.europa.eu/html.cfm/index213775EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_213776_EN_2012%20Nether...

  11. (Drug Offense Prosecutions in The Netherlands, 2011) "The next phase in the criminal justice chain is the Public Prosecutor. Note that a police report is a different administrative unit than a case registration of the Public Prosecutor.
    "• In 2011 the number of Opium Act cases increased compared to 2010, especially soft drug cases. The increase is substantial.
    "• The percentage of soft drug cases increased in 2011, while that of hard drug cases decreased. More than half of the cases (53%) concerns soft drugs now.
    "• The majority of the Opium Act cases (60%) concerns production, trafficking or dealing of drugs, 40% concerns possession of drugs (not in table). It is not known from the figures what the quantity of drugs was in the cases of ‘possession of drugs’. The general guideline for prosecution states that, if possession concerns ‘small amounts for own use’ police dismissal or prosecution aimed at diversion to care can follow. The drugs will always be seized. But if someone possesses more of a drug than the small amount that is considered ‘for own use’ – and which might be meant for dealing – or if there is also another, more serious offence involved, arrest and prosecution are the rule. The available data do not allow a distinction between possession of small amounts for personal use or larger amounts which might be meant for supply.
    "• In cases of hard drugs, 44% concerns production or trafficking and 46% concerns possession of hard drugs in 2011 (not in table). For soft drugs, these fractions are different: 74% concerns production or trafficking and 26% possession (not in table).
    "• The percentage of Opium Act cases of all cases in 2011 is 7.6%. This is the first increase since 2005."

    Source: 
    Van Laar, M.W., Cruts, A.A.N., Van Ooyen-Houben, M.M.J., Van Gageldonk, A., Croes, E.A., Meijer, R.F., et al. (2013). The Netherlands drug situation 2012: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 122.
    http://www.emcdda.europa.eu/html.cfm/index213775EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_213776_EN_2012%20Nether...

  12. Problem Drug Use

    (Estimated Prevalence of Problem Drug Use in The Netherlands, 2012) "The previous estimate of the total number of problem opiates users in the Netherlands pertained to the period 2008-2009. For that previous period, it was estimated that there were about 17,700 more or less problematic opiates users (Cruts and Van Laar 2010). This estimate has now been updated for the year 2012. It is estimated that in this year there were about 14,000 more or less problematic opiates users, a decrease of about 21% compared to 2008-2009 (Cruts, Van Laar, and Buster 2013). This updated estimate has been reported to the EMCDDA by means of the Standard Table ST7_2013_NL_01.
    "For both estimates, the method of the treatment multiplier was applied. From February until June 2013, a total of 401 more problematic opiates users were recruited in five Dutch cities to obtain the field sample required to perform the treatment multiplier. The 401 respondents were recruited in the cities of Amsterdam (100 respondents), Rotterdam (100 respondents), Utrecht (71 respondents), Eindhoven (70 respondents), and Haarlem (60 respondents). Their mean age was 47.7 years within a range of 23 to 74 years, 86% was male and 14% was female. These more problematic opiates users were contacted, recruited, and interviewed by experienced field workers who applied a structured questionnaire (Schaap and Kools 2013). The respondents used heroin (81.8%) or methadone (88.8%), or both substances."

    Source: 
    Van Laar M.W., Cruts G, Van Ooyen-Houben M., Croes E., Van der Pol P., Meijer, R., Ketelaars T., (2014). The Netherlands drug situation 2013: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 49.
    http://www.emcdda.europa.eu/html.cfm/index228325EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_228332_EN_EMCDDA_NR%202...

  13. (Injection Drug Use-Related HIV in The Netherlands, 2012) "The national HIV/ AIDS registration of the HIV Monitoring Foundation (SHM) was appointed by the Dutch Ministry of Health Welfare and Sport as the executive organisation for the monitoring of HIV in the Netherlands in 2002. This registration contains data on HIV-infected patients who are seen regularly by HIV/ AIDS treating physicians in one of the 26 collaborative HIV treatment centres throughout the country. It also includes data from a prior project on HIV positive patients treated between 1998 and 2001 (the AIDS Therapy Evaluation Netherlands, or ATHENA, cohort). The longitudinal, anonymous data are used to monitor changes in the HIV epidemic, the natural history of HIV and the effects of treatment (www.hiv-monitoring.nl). The latest available report of the SHM shows again that men who have sex with men (MSM) still account for the largest number of HIV diagnoses annually (Van Sighem et al., 2012). The number of new diagnoses is still increasing in MSM of 55 years or older. A steady decline, though, is now seen in younger MSM and in patients infected through heterosexual contact, which is attributable to the reduction of immigration from HIV-endemic countries. Since several years, the contribution of injecting drug users to new HIV diagnoses is less than 1%.
    "• In 2012, 843 new HIV diagnoses were reported in the treatment centres. In 4 men and 0 women injecting drug use was the most likely route of transmission (table 6.2.1) (Soetens et al., 2013).
    "• Up to December 2012 a cumulative total of 20,528 HIV-infected individuals were registered by the treatment centres and the HIV Monitoring Foundation (Soetens et al., 2013). The percentage of patients infected with HIV through injecting drug use is 3.6 (737 patients). Up to 2000, 8% of all new HIV-diagnoses was associated with injecting drug use, but since 2000 this has declined sharply. The main route of HIV-transmission in the Netherlands is sexual: through MSM contact in 57% of cases and through heterosexual contact in 31%.
    "• 72% of HIV-positive IDUs originated from the Netherlands and 23% from other Western European countries."

    Source: 
    Van Laar M.W., Cruts G, Van Ooyen-Houben M., Croes E., Van der Pol P., Meijer, R., Ketelaars T., (2014). The Netherlands drug situation 2013: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 64.
    http://www.emcdda.europa.eu/html.cfm/index228325EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_228332_EN_EMCDDA_NR%202...

  14. (Injection Drug Use-Related AIDS in The Netherlands, 2012) "Until 2001, AIDS cases meeting WHO criteria were registered in the national Information System on AIDS Statistics, maintained by the Health Care Inspectorate (IGZ). In 2002 this AIDS registration was replaced by the HIV/ AIDS registration of the SHM mentioned above. As the IGZ data appeared to be incomplete since 2000, the data below are based on the IGZ registration until 1999 and the SHM data from 2000 onwards. The year of AIDS diagnosis refers to the date of the first CDC-C diagnosis (classification C according to the Centres for Disease Control).
    "• Up to December 2012, the cumulative total of reported AIDS diagnoses was 8,875 and 5,442 HIV infected individuals had died (Soetens et al., 2013). The annual number of new AIDS diagnoses peaked in the first half of the nineties (around 500 cases per year) and then gradually dropped, to 154 cases in 2012 (Soetens et al., 2013). The observed decrease since 1996 is related to the availability of HAART, which slowed progression from HIV to AIDS.
    "• Of the 154 new AIDS diagnoses in 2012, 3 (1.9%) were among injecting drug users (table 6.2.2). In the same year, 131 AIDS patients died, among whom were 16 (12.2%) injecting drug users. Note that the data for 2012 are incomplete due to reporting delay (Soetens et al., 2013).
    "• Up until December 2012, 720 registered AIDS patients (8.1% of the total AIDS diagnoses) belonged to the transmission risk group of injecting drug users. The number of diagnosed AIDS cases related to injecting drug use peaked in 1995 (74), but remained at or below 15 cases per year since 1999, with the exception of 2005 (24 cases).
    "• Note that the percentage of IDUs among the total population of AIDS patients (8.1% over all years) is higher than the percentage of IDUs in the total population of HIV patients (3.6%), but that the percentage of IDUs among the AIDS deaths is even higher: 11% or over in the last decade (except for 9.4% in 2011). This indicates that the disease course in injecting drug users is less favourable than in other risk groups."

    Source: 
    Van Laar M.W., Cruts G, Van Ooyen-Houben M., Croes E., Van der Pol P., Meijer, R., Ketelaars T., (2014). The Netherlands drug situation 2013: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 67.
    http://www.emcdda.europa.eu/html.cfm/index228325EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_228332_EN_EMCDDA_NR%202...

  15. (Injection Drug Use and Hepatitis C Virus in The Netherlands, 2012)
    "• The PIENTER-2 study found a weighted national HCV seroprevalence of 0.30% (95% CI 0.05-0.55%) (Vriend et al., 2012).
    "• The study described that most HCV-positive persons (70%) were born in a HCV endemic country. Eight of the 6386 participating individuals reported having injected drugs and three of eight ever injectors were HCV-positive. However, the study concludes that 'limited information was obtained on the HCV prevalence among high-risk groups like IDU and HIV-positive MSM. Despite the high number of total participants, the number of HIV-positive MSM and of participants reporting IDU was very small. Moreover, information on (former) IDU and HIV status was missing in 3-10% of the total study population. A possible underrepresentation of these groups could have resulted in an underestimation of the national HCV seroprevalence.' (Vriend et al., 2012)
    "• Based on the HCV prevalence from the PIENTER studies and recent HCV data from specific risk groups (migrants, MSM and IDUs), a new HCV estimation was made using mathematical modelling, which took into account the changes in HCV dynamics in several risk groups (lower numbers of HCV infection in the “usual” HCV risk groups: IDUs and haemophilia patients; and more acute HCV infections in MSM) (Vriend et al., 2013). The estimated national HCV seroprevalence was 0.22% (min 0.07%; max 0.37%), equivalent to 28,100 HCV infected individuals (min n=9,600; max n= 48,000)."

    Source: 
    Van Laar M.W., Cruts G, Van Ooyen-Houben M., Croes E., Van der Pol P., Meijer, R., Ketelaars T., (2014). The Netherlands drug situation 2013: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, pp. 68-69.
    http://www.emcdda.europa.eu/html.cfm/index228325EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_228332_EN_EMCDDA_NR%202...

  16. (Drug-Related Mortality in The Netherlands, 2012) "Between 1996 and 2012, the total number of recorded drug-related deaths among residents fluctuated between a minimum of only 94 cases in 2010 and a maximum of 144 cases in 2001.
    "Despite some fluctuations over the years, the total number of drug-related deaths in the Netherlands has remained relatively low. This might be explained by a low number of socially marginalized problem drug users, successful harm reduction measures among the problem drug users, and protective factors, such as the nationwide availability of methadone-maintenance treatment, heroin-assisted treatment, and a low rate of intravenous drug use.
    "Opiates and cocaine
    "Cases of 'opiates' and 'cocaine' refer to cases in which these substances were explicitly stated as the primary cause of death on the death certificate. From 1996 up to including 2001, opiate intoxications were the most common causes of drug-related death recorded among Dutch residents. In this period, the casualty rate fluctuated between 81 and 75 cases. In 2002, the number of opiate deaths decreased and reached about the same level as the number of acute cocaine deaths, which had slowly increased since the late nineties. Since 2003 these trends have diverged again and each year there were more opiates deaths than cocaine deaths. However, in 2012 the number of opiate cases (28) came close again to the number of cocaine cases (22).
    "Psychostimulants
    "In 2012, there were only 3 cases that were coded to poisoning by psychostimulants (other than cocaine), compared to just four cases in 2009, two cases in 2008 and 2011, and only one case in 2007 and 2010. Whether these fatal intoxications concerned amphetamines, MDMA, or other psychostimulants is not known."

    Source: 
    Van Laar M.W., Cruts G, Van Ooyen-Houben M., Croes E., Van der Pol P., Meijer, R., Ketelaars T., (2014). The Netherlands drug situation 2013: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 81.
    http://www.emcdda.europa.eu/html.cfm/index228325EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_228332_EN_EMCDDA_NR%202...

  17. Treatment

    (Availability and Use of Opiate Substitution Treatment in The Netherlands) "There are no major changes in the substitution treatment in the Netherlands. Methadone substitution treatment is still the standard option. From 2001 to 2010, the number of methadone clients decreased with 13% from 11,597 to 10,085 clients (Ouwehand et al. 2011). However, the proportion of opiates clients receiving methadone treatment increased in this period from 69% to 82%. Buprenorphine is used in one organization of addiction care and elsewhere incidentally."

    Source: 
    Van Laar, Margriet, et al., (2012). The Netherlands drug situation 2011: report to the EMCDDA by the Reitox National Focal Point. (Utrecht: Trimbos Institute, Netherlands Institute of Mental Health and Addiction), p. 83.
    http://www.trimbos.org/~/media/English%20site/AF1130%20The%20Netherlands...

  18. (Heroin-Assisted Treatment in The Netherlands, 2012) "In 2012 there are still 740 treatment places for medical heroin prescription operational at 18 units in 16 different municipalities (Regulation Heroin Treatment). Since 15 October 2009 heroin (diamorphine) can be prescribed by physicians working at municipal treatment units for treatment resistant heroin addicts to addicts who are registered at that units. For this reason the Opium Act Decision was complemented with Appendix 2 (Stb 2009-348). Medical heroin prescription is legal on the condition that strict requirements are met. A 4-year follow-up study concluded that the physical and psychological condition of the patients who received heroin treatment was far better and they caused much less public nuisance than the heroin users who withdrew from the treatment (Blanken et al. 2010)."

    Source: 
    Van Laar, M.W., Cruts, A.A.N., Van Ooyen-Houben, M.M.J., Van Gageldonk, A., Croes, E.A., Meijer, R.F., et al. (2013). The Netherlands drug situation 2012: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 20.
    http://www.emcdda.europa.eu/html.cfm/index213775EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_213776_EN_2012%20Nether...

  19. Harm Reduction

    (Availability of Syringe Exchange in The Netherlands, 2012) "Estimates from Mainline (a grassroots organisation for drug users in Amsterdam) and the Trimbos Institute suggest that there are approximately 150 needle/syringe exchange programs in the Netherlands. This is a rough estimate because for some cities it has been reported that pharmacists are also exchanging syringes. There are also reports of merging of several sites as well as closure, which may cut down the estimated number, however, new estimates are not available. In Amsterdam and Rotterdam trend data on the numbers of syringes that were exchanged are available from the municipal health services. In both cities, a decreasing trend in the number of exchanged syringes is observed since many years (see figure 7.3.1). The small and unexplained increase observed in 2008 was not continued afterwards."

    Source: 
    Van Laar M.W., Cruts G, Van Ooyen-Houben M., Croes E., Van der Pol P., Meijer, R., Ketelaars T., (2014). The Netherlands drug situation 2013: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 86.
    http://www.emcdda.europa.eu/html.cfm/index228325EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_228332_EN_EMCDDA_NR%202...

  20. (Syringe Exchange Data And Trends For The Netherlands, 2012)
    "• In Amsterdam, figures are available since 1990. After a steady increase until 1993 (1,082,880 syringes were exchanged in that year), the number of exchanged syringes declined and slightly fluctuates below 200,000 syringes per year since 2007 (146,000 in 2012) (source: M. Buster, GGD Amsterdam).
    "• In Rotterdam, figures are available since 2000. The number of syringes ordered by the local distribution centres was reduced between 2000 and 2012 from 422,400 to 91,400 (source: R.A. Wolter, GGD Rotterdam). Data for 2011 are not available due to a change in the registration system. It is noteworthy that in Rotterdam during evening and nightly hours drug users can exchange needles and syringes at several police stations.
    "• The decline during many years in the number of syringes exchanged can be explained by several factors: a reduction of injecting heroin users in general; a reduction of drug users, often injectors, from neighbouring countries; a reduced popularity of injecting resulting from experienced health problems, in combination with an increase in the use of crack; and mortality among injectors. It is assumed that the far majority of drug users in need of clean needles are being reached with the current efforts.
    "• The municipal health service of Rotterdam also collects information on the distribution of other (clean) paraphernalia and condoms. In 2012, they distributed 25,000 condoms, 900 pocket containers (for needle and syringe disposal) and 10,550 stericups. Based on the assumption that the average drug users exchanges 10 syringes a week, this comes to a total of 176 injecting drug users reached (and probably present) in Rotterdam, a steady decline from the estimated 812 injecting drug users in 2000 (source: R.A. Wolter, GGD Rotterdam)."

    Source: 
    Van Laar M.W., Cruts G, Van Ooyen-Houben M., Croes E., Van der Pol P., Meijer, R., Ketelaars T., (2014). The Netherlands drug situation 2013: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 87.
    http://www.emcdda.europa.eu/html.cfm/index228325EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_228332_EN_EMCDDA_NR%202...

  21. (Drug Consumption Rooms in The Netherlands, 2012) "The first formal drug consumption room in the Netherlands opened in 1994 and since the beginning of this century the number has rapidly increased. An inventory in 2010 among a network of infectious disease experts in all addiction care institutions in the Netherlands identified 37 drug consumption rooms, located in over 25 cities in the Netherlands (Havinga and Van der Poel 2012). In the last decade, due to several developments, the organisation of these locations and the population using them changed. A major impact has had the decrease in homeless drug users. The majority of them is now living in social housing projects, which has reduced drug use on the street and the associated nuisance, including that of drugs dealing. Another important factor has been the decrease in injecting drug use, which further reduced the population using the drug consumption rooms. While in 2003 the average number of visitors per drug consumption room was 36, this has decreased to 22 in 2010 (Havinga and Van der Poel 2012). Since 2010, the number of drug consumption rooms has further decreased, but there is no new overview of the current number. Personal communications point to a shift towards an organisation of the consumption rooms more based on security and less on medical support. An increasing number of consumption rooms have an entrance guarded by security personal behind a glass wall, with whom it is not easy to discuss medical problems. For further information on the organisation of drug consumption rooms: see our National Report 2012."

    Source: 
    Van Laar M.W., Cruts G, Van Ooyen-Houben M., Croes E., Van der Pol P., Meijer, R., Ketelaars T., (2014). The Netherlands drug situation 2013: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, pp. 87-88.
    http://www.emcdda.europa.eu/html.cfm/index228325EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_228332_EN_EMCDDA_NR%202...

  22. (Anonymous Drug Purity Testing and Analysis in The Netherlands, 2011) "Twenty years ago the Ministry of Health, Welfare, and Sport (VWS) founded the Drugs Information and Monitoring System (DIMS). The DIMS explores the chemical content of drugs, the health risks, and monitors trends. The drugs are collected by means of those users who bring their drugs for control to an organisation affiliated with the DIMS. These organisations have weekly office hours. This method of collecting drugs brings along the possibility to exchange information between the personnel at the testing facilities and the users. The user is informed about the composition of the delivered drugs and is warned about the risks. The data that are collected this way are used for education, prevention, and drug policy. Next to this, the data are used to inform the network of organisations participating in the DIMS.
    "Acute health risks for users can occur, for example in case extra harmful substances are detected in the drugs. In case of such acute health risks, the DIMS will start a national or a regional warning campaign, a Red Alert. In 2011, the DIMS warned two times at a national level. The first national warning targeted the risks of using ecstasy pills contaminated with PMMA [Para-Methoxymethamphetamine], and the second national warning targeted pills with a high dose of MDMA. During the first six months of 2012, about 4,000 people visited the consulting hours of the DIMS-facilities, about 160 people every week. In total 4,421 samples were delivered, about 176 samples weekly (DIMS 2012) (see also § 10.3).
    "At the request of the present Cabinet, the DIMS has increased its tasks with regard to the "Reporting Desk New Drugs" (Meldpunt Nieuwe Drugs, MND). The MND monitors the new psychoactive drugs which appear frequently on the market, like mephedrone, 4-MEC, or MDPV. These new drugs raise questions about who are the users and about the (health) risks. At a special website (www.meldpuntnd.nl/) the users can report new drugs anonymously and eventually can describe their experiences with these drugs."

    Source: 
    Van Laar, M.W., Cruts, A.A.N., Van Ooyen-Houben, M.M.J., Van Gageldonk, A., Croes, E.A., Meijer, R.F., et al. (2013). The Netherlands drug situation 2012: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 54.
    http://www.emcdda.europa.eu/html.cfm/index213775EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_213776_EN_2012%20Nether...

  23. Economics

    (Law Enforcement Spending on Drug Offenses in The Netherlands, 2010) "Moolenaar, Nauta, and Van Tulder (2013) report on expenditures for prevention, investigation, prosecution, sentencing and support of offenders of different types of offences in 2011. The types of offences are categorized on the basis of the most serious offence. Opium Act offences are one of the categories, differentiated according to Schedule I drug offences (hard drugs) and Schedule II drug offences (soft drugs) (table 9.1.6). Figures for 2011 are preliminary.
    "• Expenditures for Opium Act offences in 2011 are estimated at € 395,0 million (in nominal amounts), of which € 287,9 million is spent on hard drugs and € 107,2 million on soft drugs.
    "• Expenditures for Opium Act offences account for 3.1% of the total of expenditures for all offences. Of all 8 types of offences, Opium Act offences rank seventh in amount of expenditures (see table 9.1.7).
    "• € 8,3 million is used for prevention activities, € 81,8 million for investigation, € 44,6 million for prosecution, € 16,0 million for sentencing, € 205,3 million for the execution of sentences, and € 38,9 million for support of offenders and other kinds of support and activities (not in table).
    "• Soft drugs expenditures are highest in the stage of prevention and investigation, but hard drugs are higher in all the other activities (not in table). From all drug expenditures, the execution of sentences for hard drug offences rank highest (its estimated costs are € 175,3 million)."

    Source: 
    Van Laar M.W., Cruts G, Van Ooyen-Houben M., Croes E., Van der Pol P., Meijer, R., Ketelaars T., (2014). The Netherlands drug situation 2013: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, pp. 101-102.
    http://www.emcdda.europa.eu/html.cfm/index228325EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_228332_EN_EMCDDA_NR%202...

  24. (Spending on Addiction Treatment in The Netherlands, 2011) "In the Netherlands, an institute for addiction care and/or mental health care is financed in a complex way by several sources. As a rule, regular institutes receive their funding from the Ministry of Health, Welfare, and Sport; the Ministry of Social Affairs and Employment; the Ministry of Security and Justice; the provinces; the municipalities; the health insurance companies; additional temporary funds; and some private funding.
    "Table 1.3.1 gives an overview of the expenditures of the institutes during the fiscal years 2010 and 2011. From this table it can be estimated that the annual expenditures of the main regular institutes for addiction care, together with the institutes for integrated addiction care and mental health care, in 2010 amounted to 1,545,241,886 euro, which increased with 4.4% to a total of 1,612,533,820 euro in 2011. Given a general inflation of 2.3% in 2011 (www.cbs.nl), this implies a real net increase of the expenditures by 2%. Unfortunately, it is not directly clear which part of the amounts is spent on treating addiction, let alone drug addiction, and which amount is still missing from the non-merged mental health care.
    "With regard to the annual growth of the mental health care (including the addiction care), the Minister of Health, Welfare, and Sport in June 2012 signed an agreement with the mental health care that in 2013 and 2014 the annual growth will be reduced from 5% to 2.5% (www.psy.nl, 18-06-2012)."

    Source: 
    Van Laar, M.W., Cruts, A.A.N., Van Ooyen-Houben, M.M.J., Van Gageldonk, A., Croes, E.A., Meijer, R.F., et al. (2013). The Netherlands drug situation 2012: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 32.
    http://www.emcdda.europa.eu/html.cfm/index213775EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_213776_EN_2012%20Nether...

  25. Laws and Policies

    (Cornerstones Of Dutch National Drug Policy) "All recent policy documents state that the Dutch drug policy has two cornerstones - and this was confirmed by the Minister of Health, Welfare and Sport during the major drug debate in the House of Representatives in March 2012: to protect public health and to combat public nuisance and drug-related crime (TK 24077-259; TK Handelingen 69-28 maart 2012). In the current Opium Act Directive the objective of the drug policy is described as: 'The [new] Dutch drugs policy is aimed to discourage and reduce drug use, certainly in so far as it causes damage to health and to society, and to prevent and reduce the damage associated with drug use, drug production and the drugs trade' (Stc 2012-26938)."

    Source: 
    Van Laar M.W., Cruts G, Van Ooyen-Houben M., Croes E., Van der Pol P., Meijer, R., Ketelaars T., (2014). The Netherlands drug situation 2013: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 17.
    http://www.emcdda.europa.eu/html.cfm/index228325EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_228332_EN_EMCDDA_NR%202...

  26. (Drug Law Offenses In The Netherlands) "The most important act with regard to drug law offences is the Opium Act, which defines the trafficking, production, cultivation, dealing and possession of illegal drugs as criminal acts, when these activities take place outside of the conditions mentioned in the Opium Act Decision and the Regulation Opium Act Exemptions. The drugs in question are named in schedule I (‘hard drugs’ like heroin, cocaine, amphetamines or ecstasy) and schedule II (‘soft drugs’ like cannabis or hallucinogenic mushrooms) of the Opium Act. The possession of drugs is a criminal act and therefore theoretically the use of drugs may be a criminal act as well. This reasoning was part of a verdict of the Council of State (Raad van State 201009884/I/H3 2011). The Prosecutor, however will never prosecute consumption of drugs per se.
    "Preparative activities for the illegal production, sale or export of hard drugs are also criminal acts according to the Opium Act (article 10a). These imply also possession of substances which are meant to be used for the illegal production of hard drugs (see for instance LJN: BW8614 2012).
    "The Prevention of Abuse of Chemicals Act is also of importance for the combat of drug-related crime, especially with regard to precursors of synthetic drugs. In addition, administrative law plays an increasing role in the combat of drug-related crime on the local and regional level."

    Source: 
    Van Laar, M.W., Cruts, A.A.N., Van Ooyen-Houben, M.M.J., Van Gageldonk, A., Croes, E.A., Meijer, R.F., et al. (2013). The Netherlands drug situation 2012: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 118.
    http://www.emcdda.europa.eu/html.cfm/index213775EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_213776_EN_2012%20Nether...

  27. (Personal Use Violations and Soft Drugs in Netherlands Criminal Law) "Police and Public Prosecutor give low priority to the investigation of possession of small amounts of a drug for own use. The Opium Act Directive of the Public Prosecutor state that, if the offence concerns possession of small amounts for own use of a hard drug, the drugs will be seized, but normally there will be no custody or prosecution. Diversion to care is the primary aim of custody or prosecution in cases of possession of hard drugs (Directive Opium Act 2011A021 2012, www.om.nl). ‘Small amounts’ of a hard drug are defined as one tablet, ample, wrapple or ball of the drug and in any case an amount of no more than 0,5 grams. With regards to cannabis (categorized as ‘soft drug’) small amounts are defined as no more than 5 grams and no more than 5 cannabis plants – under the condition that there is no professional or commercial cultivation of the plants (Stc. 2011 – 22936). For hallucinogenic mushrooms, also categorized as soft drugs, the small amounts for own use are defined as 0,5 grams (dried mushrooms) and 5 grams (fresh ones). In cases of possession of small amounts of soft drugs, the drugs will be seized but a dismissal by the police will normally (‘in principle’) follow, without custody or prosecution."

    Source: 
    Van Laar, M.W., Cruts, A.A.N., Van Ooyen-Houben, M.M.J., Van Gageldonk, A., Croes, E.A., Meijer, R.F., et al. (2013). The Netherlands drug situation 2012: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 118.
    http://www.emcdda.europa.eu/html.cfm/index213775EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_213776_EN_2012%20Nether...

  28. (Dutch Coffee Shop Policy Changes Post-2012) "Dutch coffee shop policy became more restrictive on 1 January 2012. Two new criteria coffee shops must adhere to in order for them to be tolerated were added to the Opium Act Directive for the Public Prosecutor: the private club [B] criterion and the residence [I] criterion. The new criteria were formally enforced in the three southern provinces of Limburg, Noord-Brabant and Zeeland between 1 May 2012 and 19 November 2012.
    "The B-criterion stipulated that coffee shops could only permit access to, and sell to, registered coffee shop members. The members had to be documented in a verifiable membership list. The I-criterion stipulated that only residents of the Netherlands would be allowed to become coffee shop members and hence to enter the Dutch coffee shops. These criteria were an addition to the existing AHOJG-drug tolerance criteria for coffee shops ([A] no advertising, [H] no hard drugs, [O] no nuisance, [J] no minors and [G] sale and stock of only limited quantities of cannabis in the coffee shop, which were already part of the Opium Act Directive. The new criteria were intended to counter nuisance and (organized) crime related to coffee shops and the trade in narcotics, to reduce the attraction of the Dutch drug policy on users from abroad and to make an end to the previous ‘open-door-policy’ of the coffee shops, making them smaller and more manageable."

    Source: 
    Van Laar M.W., Cruts G, Van Ooyen-Houben M., Croes E., Van der Pol P., Meijer, R., Ketelaars T., (2014). The Netherlands drug situation 2013: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 28.
    http://www.emcdda.europa.eu/html.cfm/index228325EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_228332_EN_EMCDDA_NR%202...

  29. (Changes In Cannabis Consumer Market Due To Changes In Dutch Coffee Shop Policies) "Considerable changes have taken place on the cannabis consumer market in the south of the Netherlands between 1 May (the start of the enforcement of the B- and I-criteria) and October-November 2012:
    "• Drug tourists mostly disappeared.
    "• The number of visits to coffee shops decreased drastically (Nijkamp & Bieleman, 2013).
    "• Cannabis users were purchasing their cannabis on the illegal market significantly more often. The cannabis users in the sample of the street survey purchased their cannabis less often from coffee shops and more often from mobile phone dealers, dealers selling from the street or buildings other than coffee shops and from or through friends (Korf, Benschop & Wouters, 2013).
    "• The degree and frequency of the nuisance experienced by people living in the direct vicinity of coffee shops changed little, but there was a shift in the nature of the nuisance. Prior to 1 May 2012, local residents attributed the nuisance they experienced mostly to the coffee shops. After six months, the nature had shifted to nuisance due to drug dealing on the streets (Snippe & Bieleman, 2013). These changes became apparent quickly in the southern provinces after the implementation of the new criteria, but were not observed in the comparison group."

    Source: 
    Van Laar M.W., Cruts G, Van Ooyen-Houben M., Croes E., Van der Pol P., Meijer, R., Ketelaars T., (2014). The Netherlands drug situation 2013: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 29.
    http://www.emcdda.europa.eu/html.cfm/index228325EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_228332_EN_EMCDDA_NR%202...

  30. (Government-Produced Medical Cannabis in The Netherlands) "The Bureau Medicinal Cannabis (BMC) only delivers the raw material, there is still no official 'cannabis medication' produced and registered by a pharmaceutical company. The BMC could be exploited cost-effective in 2010. In 2010, 102 kilograms of medicinal cannabis were delivered to pharmacies and it is estimated that about 558 patients were using it with an average of 0.5 gram per day per each person. Some Dutch health insurance companies reimburse medicinal cannabis in certain circumstances (TK Aanhangsel-2461). According to the Dutch Foundation for Pharmaceutical Statistics was medicinal cannabis in 2010 6,700 times supplied to 1,300 different patients. Every year there is an increase of about 10 per cent.2"

    Source: 
    Van Laar, M.W., Cruts, A.A.N., Van Ooyen-Houben, M.M.J., Van Gageldonk, A., Croes, E.A., Meijer, R.F., et al. (2013). The Netherlands drug situation 2012: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 20.
    http://www.emcdda.europa.eu/html.cfm/index213775EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_213776_EN_2012%20Nether...

  31. (Drugged Driving and DUII Laws in The Netherlands) "According to a European study, the prevalence in the Netherlands of the use of alcohol by car drivers is 2.2%, compared to 3.5% average in Europe. The use of cannabis by car drivers (1.7%) is above the European average of 1.3% (SWOV factsheet 2011). According to the Road Traffic Act it is forbidden to drive under the influence of a (illegal) substance affecting one's driving ability. The Ministers of Security and Justice and Transport are preparing a bill to change this Act in order to be better able to detect these drivers. Part of the bill is to give police investigators the authority to use an oral fluid screener as pre-selection method to detect drug use of traffic participants. The legal evidence will remain a blood test. The use of GHB is only detectable with a blood test. Like with driving under the influence of alcohol, threshold values will be defined for driving under the influence of drugs (e.g. 50 microgram per litre for amphetamine and cocaine and 3 microgram per litre for THC). A special commission has proposed limiting blood values per drug in accordance with international practices. Because some substances are occurring in the body and measuring instruments are not sensitive enough, zero limits are not feasible. The present bill uses behaviour-related limits, meaning that a limit is set above which driving skills are affected. There are fewer traffic casualties due to the use of drugs and medicines than to alcohol consumption (T.K. 29398-236; T.K. 32859-3; TK32859-7)."

    Source: 
    Van Laar, M.W., Cruts, A.A.N., Van Ooyen-Houben, M.M.J., Van Gageldonk, A., Croes, E.A., Meijer, R.F., et al. (2013). The Netherlands drug situation 2012: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 19.
    http://www.emcdda.europa.eu/html.cfm/index213775EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_213776_EN_2012%20Nether...

  32. (Discouraging Drug Tourism and Nuisance in The Netherlands) "In the city of Venlo (province of Limburg), on the Dutch-German border, the Hektor Project to combat drug-related crime and nuisance at the local level, started in 2001 and was extended several times, first by a combined contribution of the central and municipal government, but since 2010 Hektor is only financed by the local government. Its purpose was to diminish public nuisance mostly caused by German drug tourists. The project operated on three levels. One level aimed at diminishing public nuisance by tracking down and closing non-tolerated points of sale (administrative enforcement) and step up action against drug-related crime. The second level had to do with the redevelopment of parts of the city centre to make it more attractive to new investment. The third level of the project concentrated on redefining the local coffee shop policy. In 2007 three illegal drug trade venues were closed. The experienced drug related nuisance diminished significantly in the centre of the town since two coffee shops were relocated in 2005. Because the illegal drug trade shifted to other parts of the town, it was decided in 2007 to extend the Hektor-approach to all parts of the town of Venlo. The municipal authorities, the police, the Public Prosecution Service and the Tax and Customs are cooperating to tackle illegal drug trade and public nuisance caused by drug tourists. According to the third evaluation of the Hektor project, which was carried out before the introduction of new Dutch coffee shop policy, it is possible to diminish illegal street trade and drug related public nuisance in a Dutch border town by the approach chosen in Hektor (Snippe 2012).
    "Another project to combat drug related nuisance, which started as a pilot project but was continued since 2003, is the Courage Project of the municipalities of Roosendaal and Bergen op Zoom near the border with Belgium in the province of North Brabant. One of the results of this project was that the mayors of both municipalities decided in September 2009 to close down the four tolerated coffee shops. However, the Courage Project was continued among others with a monitor called the Drugsscan, in order to follow the developments. Since the closure of the coffee shops 95 per cent of the drug tourists disappeared from the street scene. The Courage Team shifted the emphasis from drug related public nuisance to investigating drug related criminality. In 2011 narcotics for the amount of 7 million euro were confiscated and dispossessions for the amount of 600,000 euro were collected (Courage 2012; www.courage.nu)."

    Source: 
    Van Laar, M.W., Cruts, A.A.N., Van Ooyen-Houben, M.M.J., Van Gageldonk, A., Croes, E.A., Meijer, R.F., et al. (2013). The Netherlands drug situation 2012: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 24.
    http://www.emcdda.europa.eu/html.cfm/index213775EN.html
    http://www.emcdda.europa.eu/attachements.cfm/att_213776_EN_2012%20Nether...

  33. (The Netherlands and Depenalization of Cannabis Use) "There is no evidence that the depenalization component of the 1976 policy, per se, increased levels of cannabis use. On the other hand, the later growth in commercial access to cannabis, after de facto legalization, was accompanied by steep increases in use, even among youth. In interpreting that association, three points deserve emphasis. First, the association may not be causal; we have already seen that recent increases occurred in the United States and Oslo despite very different policies. Second, throughout most of the first two decades of the 1976 policy, Dutch use levels have remained at or below those in the United States. And third, it remains to be seen whether prevalence levels will drop again in response to the reduction to a 5-g limit, and to recent government efforts to close down coffee shops and more aggressively enforce the regulations."

    Source: 
    MacCoun, Robert and Reuter, Peter, "Interpreting Dutch Cannabis Policy: Reasoning by Analogy in the Legalization Debate," Science (New York, NY: American Association for the Advancement of Science, October 3, 1997), pp. 50-51.
    http://www.scribd.com/doc/44564392/Interpreting-Dutch-Cannabis-Policy-Re...

  34. (US Assessment of Dutch Drug Policy) "The Netherlands is a significant transit country for narcotics. A sizeable percentage of cocaine consumed in Europe enters via the Netherlands. It remains an important producer of synthetic drugs, such as MDMA (ecstasy), although a sizeable amount of production appears to have shifted to other countries. The Netherlands has a large legal chemical sector, making it an opportune location to illicitly obtain or produce pre-precursor chemicals. Cultivation of cannabis is extensive with a high percentage believed to be for export. The government views domestic drug use primarily as a public health issue, but places a high priority on combating the illegal drug trade and has had considerable success. The Dutch Opium Act prohibits the possession, commercial distribution, production, import and export of all illicit drugs. The act distinguishes between 'hard' drugs that have 'unacceptable' risks (e.g., heroin, cocaine, ecstasy), and 'soft' drugs (cannabis products). Sales of small amounts of cannabis products (under five grams) are 'tolerated' (i.e., illegal but not prosecuted) in establishments called 'coffee shops' which operate under regulated conditions. Cultivation and distribution remain illegal and are prosecuted.
    "Bilateral cooperation with the United States is excellent. Law enforcement agencies maintain excellent operational cooperation, with principal attention given to South American cocaine trafficking organizations and drug-related money laundering activities."

    Source: 
    "International Narcotics Control Strategy Report: Volume I Drug and Chemical Control," Bureau for International Narcotics and Law Enforcement Affairs (Washington, DC: United States Department of State, March 2014), p. 244.
    http://www.state.gov/documents/organization/222881.pdf

  35. (Physician Acceptance of Medical Cannabis in the Netherlands) "According to a survey of 400 physicians, both general practitioners and specialists in the Netherlands, which was performed just before the legal introduction of medicinal cannabis, only 6% said that they were under no condition willing to prescribe medicinal cannabis, while 60% to 70% regarded medicinal cannabis sufficiently socially accepted and would prescribe it if asked for by a patient.46"

    Source: 
    de Jong, Floris A.; Engels, Frederike K.; Mathijssen, Ron H.J.; Zuylen, Lia van; and Verweij, Jaap, "Medicinal Cannabis in Oncology Practice: Still a Bridge Too Far?," Journal of Clinical Oncology (Alexandria, VA: American Society of Clinical Oncology, May 2005) Vol. 23, No. 13, p. 2889.
    http://jco.ascopubs.org/cgi/reprint/23/13/2886.pdf

  36. (Physician and Patient Attitudes Toward Medical Cannabis in The Netherlands) "Recently, a survey performed on 200 patients who were using medicinal cannabis during the first months after its introduction in the Netherlands was published.49 The survey showed that most of the respondents had previous experiences with cannabis use for medicinal purposes or with synthetic cannabinoids such as dronabinol, whereas a minority of 40% were “new” users. Most patients were satisfied using medicinal cannabis; only 10% of patients reported moderate to more severe transitory adverse effects. In about half of the users, the patients themselves took the initiative to suggest medicinal cannabis to their treating physicians as a therapeutic option, whereas in about 30% of users the initiative was taken by the involved general practitioner or medical specialist. In the remaining 20% of users, it was a joint initiative of both patient and clinician."

    Source: 
    de Jong, Floris A.; Engels, Frederike K.; Mathijssen, Ron H.J.; Zuylen, Lia van; and Verweij, Jaap, "Medicinal Cannabis in Oncology Practice: Still a Bridge Too Far?," Journal of Clinical Oncology (Alexandria, VA: American Society of Clinical Oncology, May 2005) Vol. 23, No. 13, p. 2889.
    http://jco.ascopubs.org/cgi/reprint/23/13/2886.pdf