El romance vulgar

In the past decade, field studies among traditional groups of problem opiate users have shown a strong increase in the importance of crack cocaine, a reduction in injecting drug use and an increase in psychiatric and somatic comorbidity. Recent field studies employ- ing observational methods and interviews among key informants point at new groups of (young) problem drug users, including those consuming crack as their first and main drug, and daily cannabis users, who may be at risk of becoming problem hard drug us- ers. Moreover, these studies confirm the increase in comorbidity and poly drug use (in- cluding alcohol) among the traditional ageing population of hard drug users and suggest that the reduction in injecting drug use has halted now. Note, however, that treatment data still point at decreasing injection rates (see § 4.2). A summary of new studies is given below.

Field studies targeting problem drug users have been conducted recently in the provinces of North Brabant and Limburg. In North Brabant, field studies were conducted in the city of Den Bosch and its surrounding region (Stoele et al. 2005), and in the city of Eindhoven and its surrounding region (Van 't Klooster et al. 2006). In Limburg, field studies were conducted in the city of Maastricht (Coumans et al. 2005) and in Parkstad Limburg, which is the region of the city of Heerlen and its surrounding municipalities (Van der Dam et al. 2006a; Van der Dam et al. 2006b). Most studies applied qualitative methods and did not yield statistical data or trends. The qualitative methods implied that interviews were conducted with key informants and members from the target groups, and that par- ticipating observations were conducted at public places.

Den Bosch region

For the Den Bosch region, the organisation for addiction treatment Novadic-Kentron and the Addiction Research Institute Rotterdam (IVO) have set up the " Addiction Problems Monitor" (Monitor Verslavingsproblematiek). This monitor has recently focused on mar- ginalised hard drug users and cannabis users (Stoele et al. 2005). The marginalised hard drug users were operationally defined as the group of hard drug users that almost daily use heroin, methadone, and/or crack cocaine. The use of cannabis was especially moni- tored among young people. For most of the young people who use it, cannabis is a 'tran-

sition drug' that is only used between the age of about 15 and 25 years. However, apart from these still socially integrated cannabis users, there are young cannabis users show- ing behavioural disorders and/or psychological problems.

For the Den Bosch region, the Addiction Problems Monitor has spotted the following trends:

• Many of the young people that hang around on the streets use cannabis frequently. They are experimenting more often with drugs like cocaine, ecstasy, and ampheta- mines and more often cause public nuisance.

• There is a group of about 30 to 40 young recalcitrant cannabis users who are using

cannabis almost continually and are difficult to place within the existing treatment programs.

• People that have to rely on organisations for social relief more often have addiction

problems as well as psychological problems, i.e. they more often have a dual diagno- sis.

• Due to the hardening of society and the sharpening of policy, any mentally handi- capped people who use cannabis often and sometimes ecstasy, have become at a greater risk of being abused, marginalised, and criminalised.

• Among the hard drug users there is, on the one hand, the traditional group of ageing

users who started with the use of opiates and later on started to use crack cocaine as well. On the other hand, there is a new group of hard drug users who started with the use of crack cocaine. Some of these new hard drug users now start using heroin be- sides crack cocaine. All in all, there is an increasing use of crack cocaine and a de- creasing use of heroin.

Eindhoven region

For the Eindhoven region, the organisation for addiction treatment Novadic-Kentron and the Addiction Research Institute Rotterdam (IVO) have set up the "Region Monitor" (RE- GIO Monitor). With regard to drugs, this monitor focuses on marginalised hard drug ad- dicts and young people from 15 to 25 years who are already marginalised hard drug ad- dicts or are at risk for becoming a hard drug addict. The marginalised addicts are those who almost daily use heroin, methadone, and/or crack cocaine. Young people that use cannabis daily are at risk of ending up as marginalised hard drug users.

• For the Eindhoven region, the Region Monitor has spotted the following trends: • Most of the marginalised hard drug users are between 30 and 40 years of age and

belong to an ageing group. However, the proportion of young people among the mar- ginalised hard drug users is increasing. For the greying hard drug users it can no longer be expected that they will ever be able again to live on their own or to find regular employment.

• Among the ageing group, there are side-users of opiates who are partly replacing the opiates with alcohol. These greying users no longer seek a 'rush', but prefer being continually under the influence, and alcohol can be easily obtained to reach this goal.

• The use of crack cocaine started originally in the larger cities, then spread throughout

the country, and during the past years also reached the Eindhoven region. The rise of crack cocaine has also hardened the drug scene in this region.

• There is an increase in addicts who have a psychiatric disorder besides their addiction

problem, i.e. there is an increase in addicts that have a dual diagnosis.

• Among the problem youth (15 to 25 years of age), the problem use of cannabis is more frequent than the problem use of other substances. As a result of daily cannabis use, these young people have become very passive and no longer solve their prob-

lems. Some of these young people are at risk of becoming marginalised hard drug us- ers. An increasing proportion of the problem youth is female.

City of Maastricht

During the springtime of 2005, the Addiction Research Institute Rotterdam (IVO) con- ducted a Quick Scan research in the city of Maastricht among the marginalised hard drug users and the homeless.

For the city of Maastricht the Quick Scan has observed the following trends:

• Organisations for outreach work among young people and for social relief more fre-

quently come across marginalised hard drug users.

• The ageing group shows a high level of co-addiction to alcohol and has become physi- cally exhausted.

• Following the trend in the rest of the country, the use of crack cocaine has increased

during the past years. The marginalised hard drug users are poly drug users who often use two or more substances.

• There is an increase in dual diagnosis.

• There is an increase in the number of homeless youth.

• Among the problem youth there is frequent drug use and poly drug use. The young

people in this group have hardened and are thrown back on themselves.

• Among the young mothers who live on social welfare, the use of cannabis has become habitual.

Parkstad Limburg

Since 1998 the Drug Monitoring System (DMS) observes the hard drug users in the re- gion of Parkstad Limburg. From April 2004 to December 2005 an ethnographic field study was conducted during which participating observations took place and conversations we- re held with members from the target group.

The DMS has signalled the following trends for the region of Parkstad Limburg:

• Most hard drug users are now poly drug users and the trends of an increasing use of

crack cocaine and a decreasing number of injecting drug users may have stabilized.

• There are indications that a larger part of the hard drug users has started to use large quantities of alcohol in a way that causes public nuisance.

• There is a limited number of new young hard drug users, but the number of new

young hard drug users may be increasing. These young people are often abused by the older drug users and run the risk of ending up as marginalised hard drug users.

• Some female drug users earn their income by means of prostitution, but the number of street prostitutes has decreased and prostitution occurs less often in a visible man- ner in public places.

• There are indications that the drug users commit fewer crimes against property to

obtain money to buy drugs.

• The number of drug-tourists that come from Germany to Parkstad Limburg has de- creased.