Mirza GaticaCAPÍTULO
I. CRÉDITOS DE CONSUMO Y CAJAS DE COMPENSACIÓN EN CHILE
Between 1999 and 2001, samples of different cannabis products (about 1 gram each) were procured from coffee shops and chemically analysed (Niesink 2001; Niesink et al. 2001). • Dutch marijuana and hashish contain more THC on average than foreign varieties (table
5.4).
• Of the analysed cannabis products the THC content was found to be highest in Dutch hashish. However, this concerns a small number of samples of a type of hashish not often sold.
• The health consequences of cannabis with higher percentages THC are not known. Table 5.4: Average THC percentage in cannabis products
1999/2000 2000/2001 THC content No. of samples THC content No. of samples Dutch marihuana 9% 126 11% 131 Foreign marihuana 5% 56 5% 49 Dutch hashish 21% 18 16% 18 Foreign hashish 11% 90 12% 96
Source: THC-monitor, Trimbos Institute (Niesink et al., 2002).
5.3.3 Prices
According to the THC-monitor (see above), the average street price of a gram of Dutch as well as foreign marijuana remained stable over the years (table 5.5).
Table 5.5: Average price per gram of cannabis products (in €) 1999/2000 2000/2001 Dutch marijuana 5.83 5.86 Foreign marijuana 3.87 3.80 Dutch hashish 8.85 7.11 Foreign hashish 6.29 6.36 Source: Niesink (2001).
According to the USD, the retail price of a MDMA-tablet was 4 to 5 euro (March 2002).
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Main facts and trends per drug
This paragraph summarises the main facts and trends related to the consumption of cannabis, ecstasy/amphetamine, cocaine, opiates, and other drugs. Possible explanations and factors underlying trends have been mentioned in the corresponding paragraphs.
Cannabis
• The percentage of cannabis users in the general population increased between 1997 and 2001, especially among adolescents aged 20-24. The estimated number of current users increased from 326,000 to 408,000.
• Use among the age group 12–15 years (including students) remains limited and practically unchanged in the past years.
• Treatment demand related to problems with cannabis use has increased in the past decade until 1997, and levelled off since then.
• The sharp decline in the number of coffee shops between 1997 and 2000 has levelled off in 2001.
• The THC content of Dutch marihuana bought in coffee shops is higher than of foreign marihuana.
Ecstasy, amphetamines and other synthetic drugs
• The use of ecstasy and amphetamine in the general population is low, but increased between 1997 and 2001. Current use of ecstasy increased especially among women. • Ecstasy is still popular among visitors of (dance)parties, discotheques and clubs. • GHB has gained popularity in special (local) networks of users. Its use has been
associated with sexual offences, road traffic accidents and deaths, but precise figures are lacking.
• Treatment demand for ecstasy and amphetamine is low and decreasing. • The number of registered fatal ecstasy intoxications is relatively low. • The average percentage of MDMA in ecstasy pills has slightly increased. Opiates
• The number of problem users of opiates is estimated between 26,000 and 30,000. • Most problem opiate users also use cocaine (basecoke or crack).
• The average age of opiate users is increasing.
• The number of opiate overdoses registered at national level is stable, but the total number of acute drug-related deaths has increased in the past years. This may be partly due to a change in registration procedures.
• Overall mortality among drug users (methadone clients) in Amsterdam has increased since the eighties.
• The number of hard drug users injecting drugs intravenously is relatively low. • Sexual risk behaviour remains worrisome.
• Crimes among hard drug users and drug law crimes draw heavily on the resources of the police and the criminal justice system.
Cocaine
• The percentage of current cocaine users in the general population remained low but doubled between 1997 and 2001.
• Cocaine sniffing is fairly popular among visitors of coffee shops, pubgoers and
clubbers/ravers in Amsterdam; no information is available for the Netherlands in general. • Cocaine is very popular among hard drug addicts, especially basecoke/crack.
• Use of basecoke/crack as a primary drug increases, especially among (young) problem drug users.
• There are increasing health problems related to cocaine (and heroin) smoking.
• Treatment demand for cocaine has increased by 59% since 1994. Today, the majority of treatment demands concerns basecoke/crack.
• The number of registered acute cocaine deaths is low but slightly increased in the past years.
Multiple use
Users of the licit and illicit drugs often have experience with multiple substances, e.g. almost all consumers of cannabis also smoke tobacco, and the large majority also uses alcohol. Combined use of various substances is also a common phenomenon, especially among (young) people with an outgoing lifestyle (visiting bars, discotheques and parties) and among regular hard drug users.
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Discussion
7.1
Consistency between indicators
The increase in drug use in the general population, especially in age group 20-24 years, is difficult to explain. Young adolescents in this age group are relatively frequent visitors of cafés and dancings and the link between drug use and an ‘outgoing’ lifestyle has been established repeatedly. The stabilisation of drug use among young people (12-15 years and secondary students aged 12-18 years) is difficult to explain either. As far as cannabis is concerned, a change in policy might have played a role (increase of age limit for buying cannabis in coffee shops) or the influence of prevention activities or a general ‘ceiling or saturation’ effect in drug use. Other indicators, e.g. increase in cannabis treatment demand until 1997, which levelled off since then, and the reduction in the number of coffee shops since 1997, seem to be at odds with the slight overall increase in cannabis use.
Cocaine (sniffing) has increased in the general population (again most clearly in age group 20-24 years) and is fairly popular among young visitors of party- or clubgoers (in
Amsterdam). Moreover, in the past decade the consumption of basecoke/crack among problem users of hard drugs has sharply increased. This trend is consistent with the growing number of cocaine users seeking assistance at drug treatment services. Moreover, the number of registered acute cocaine deaths tends to increase in the past years. The
increased efforts to combat cocaine (and ecstasy) trafficking do not seem to have influenced drug use rates so far.
7.2
Methodological limitations and data quality
The National Epidemiology Working Group evaluates all output generated by the Bureau of the National Drug Monitor (NDM). The NDM integrates the function of the Dutch operational Focal Point. As such, the implementation of the five EMCDDA Key Indicators had high priority. Different expert groups have been established to support this work. In 2002, the Bureau NDM, together with the national experts, has developed a general research
programme to improve the quality of data on these five key indicators (Van Laar et al., 2002). Specific grants are needed to realise the different proposals. Briefly, the state-of
implementation of the key indicators is as follows: General population surveys
We have a fairly good picture on the prevalence of drug use in the general population owing to the National Prevalence Surveys in 1997 and 2001. The response rates were fairly low (about 50% and 47%, respectively) although common for such surveys. The questionnaire is largely compatible with the EMCDDA model questionnaire and most core variables are available. However, it remains to be seen whether the two surveys were fully comparable given the different methods of questioning (e.g. CAPI against multi-method). Information on drug use among students is obtained from the National Youth Health Surveys, which are compatible with the ESPAD and are carried out about every four years. The school surveys do not provide reliable data on drug use among youth above the obligatory school age (16 years) and among drop-outs. However, the impact of the last group is assumed to be limited since this group only constitutes 5% of the students at the most (Smit et al. 2002). Further, ethnic minorities are captured fairly well. Differences between schoolgoing and non-
schoolgoing youth will be studied in 2003 by secondary analayses on data from the general population and school surveys. Further, the methodology of the HBSC study (see 2.2) will be refined to be fully comparable with the National Youth Health Surveys. This means that in the future we will have prevalence data on drug use among students every two years.
Prevalence estimates
The number of hard drug users has been estimated in various Dutch cities and at the national level. In order to develop and implement an improved, reliable and efficient
monitoring instrument on prevalence estimates, the NDM sub working-group on prevalence estimates has developed a project poposal (Smit, Van Laar, Meijer, and Mol, 2002). This proposal focuses on testing the feasibilty of 1-,2- and 3-sample capture-recapture methods by using different data sources, e.g. on treatment demand and of the police or criminal justice system. It is also intended to discriminate between opiate (or poly) drug users and primary cocaine users. A secondary objective is to enhance insight into the group of drug users entering the criminal justice system.
Treatment demand
With regard to its data-storage facilities, the LADIS now meets the demands of the TDI protocol. Recently added items are "age of first use" and "self-reported first treatment". Current activities focus on improving the quality of the registration (data input, output). Special attention is also paid to maintain the coverage of LADIS, which was compromised recently by the implementation of a client monitoring system (cliëntvolgsysteem – CVS) by the Netherlands Probation Foundation (Stichting Reclassering Nederland). Further, because LADIS covers only outpatient centres, initiatives are required to ensure that the new system on inpatient treatment demand (ZORGIS) is also compatible with the TDI protocol.
Drug-related deaths
Data from the General Mortality Register (supplied by Statistics Netherlands) meet the requirements of the EMCDDA protocol for collecting data on drug-related deaths. There are, however, indications that these data underestimate the true number of drug-related deaths (De Zwart et al., 2001). Moreover, data on mortality among drug users obtained from the Municipal Health Service Amsterdam do not fully comply with the EMCDDA protocol on mortality cohort studies. Therefore, the NDM sub working-group on Drug-related deaths (which met 4 times in 2002), has developed a project proposal to improve both national statistics on drug-related deaths and local systems on monitoring drug-related mortality (Van Laar et al., 2002).
Infectious diseases
HIV prevalence data are available from repeated serosurveys among street samples of drug users at different locations in the Netherlands. The method is largely compatible with the (proposed) EMCDDA standard for collecting data on infectious diseases. However, the measurement density of the current HIV surveillance in the Netherlands has been decreased recently (see 3.3). Moreover, there is no systematic data collection on the prevalence of hepatitis C (and B) among drug users, which is the main focus of the EMCDDA infectious diseases indicator. The Netherlands Focal Point has recently nominated a new expert to examine the feasibility of implementing a protocol on routine screening of infectious diseases at drug treatment locations (based on a model of the Municipal Health Service Amsterdam) and to implement assessments of infectious diseases in the Drug Monitoring System of the Region and City Monitor on Alcohol and Drugs (MAD).
Criminal justice and law enforcement data
Finally, the EMCDDA is strengthening data collection in the field of criminal justice and law enforcement. Further to this, the Dutch Ministry of Justice has started activities to develop and improve data collection systems on this topic (see 4.2). Although the quality of some statistics is still questionable, a first overview of the solved drug-related crime has been given in the 2002 Annual Report of the National Drug Monitor. Working relationships have been established between the NDM/Focal Point and the Research and Documentation Centre (WODC) of the Ministry of Justice.