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TRENDS AND PATTERNS IN CANNABIS USE IN THE NETHERLANDS 
 
 Dirk J. Korf

University of Amsterdam 
(Bonger Institute of Criminology)
 
Oudemanhuispoort 4-6
P.O. Box 1030 
1000 BA Amsterdam
korf@jur.uva.nl

Paper to be presented at the Hearing of the Special Committee on Illegal Drugs
Ottawa, November 19, 2001


Abstract 

Conflicting predictions have been made to the influence of decriminalisation on cannabis use. Prohibitionists forecast that decriminalisation will lead to an increase in consumption of cannabis, while their opponents hypothesise that cannabis use will decline after decriminalisation.

Most probably cannabis use among youth in the Netherlands so far evolved in two waves, with a first peak around 1970, a low during the late 1970s and early 1980s, and a second peak in the mid 1990s.

It is striking that the trend in cannabis use among youth in the Netherlands rather parallels the four stages in the availability of cannabis identified above. The number of adolescent cannabis users peaked when the cannabis was distributed through an underground market (late 1960s and early 1970s). Then the number decreased as house dealers            were superseding the underground market (1970s), and went up again after coffee shops took over the sale of cannabis (1980s), and stabilised or slightly decreased by the end of the 1990s when the number of coffee shops was reduced.

However, cannabis use also developed in waves in other European countries. Apparently, general national trends in cannabis use are relatively independent of cannabis policy. To date, cannabis use in the Netherlands takes a middle position within the European Union. Apparently most cannabis use is experimental and recreational. The vast majority quits using cannabis after some time. Only a very small proportion of current cannabis users is in treatment. From international comparison, it is concluded that trends in cannabis use in the Netherlands are rather similar to those in other European countries, and Dutch figures on cannabis use are not out of line with those from countries that did not decriminalise cannabis. Consequently, it appears unlikely that decriminalisation of cannabis will cause an increase in cannabis use.    

The vast majority of cannabis users has never tried hard drugs. Moreover, with regard to the problematic use of opiates and drug related health problems, the Netherlands ranks relatively low within the European Union. 


Table of Contents

1.       Introduction

2.       Cannabis use among the general population

      –        National household surveys
–        Trends in cannabis use in Amsterdam
–        National school surveys 

3.       Decriminalisation and cannabis use in the netherlands

4.       International comparison of cannabis use

5.       Problematic use and treatment

      -          Out-patient treatment
-         In-patient treatment
-          General hospital admissions

6.       Other illicit drugs



1. Introduction 

A major question in the policy debate on illicit drugs refers to the relationship between legal control and cannabis use. We will discuss this question in the light of conflicting predictions made by prohibi­tionists and anti‑prohibitionists as to the influence of decriminalisation on cannabis use. Prohibitionism and anti‑prohibitionism have been presented here as the two foremost competing models in the discourse on legal regulation of illicit drug use. Prototypically contrasted, their predictions are as follow. Prohibitionists forecast that decriminalisation will lead to an increase in supply and hence in consumption of illicit drugs. Anti‑prohibi­tionists hypothesise that drug use will decline after decriminalisation, as this will do away with the fascination for drugs, which is created by sanctions. [Korf, 1995] 

To demonstrate the benefits of decriminalisation, both Dutch and foreign authors like to refer to the Netherlands. They argue that statistics show a substantial decline in cannabis use in the Netherlands since statutory decriminalisation in 1976 [for example: Alexander, 1990; Engelsman, 1989; Nadelman, 1989; Van de Wijngaart, 1991]. Their opponents counter with essentially the same argument, citing quantitative data that indicate drops in cannabis use in countries that have gone on criminalising cannabis. For example, during the 1980s Western European countries as Sweden and Germany claimed successes for their policies of sustained criminalisation [CAN, 1991; Reuband, 1992].  

Cannabis includes hashish and marijuana in various preparations. The quantities of hashish and marijuana seized by Dutch customs and police have risen in recent decades, and annual seizures are much bigger than those in surrounding countries [EMCDDA, 2001; Korf, 1995]. The question now is whether these figures point to a significant increase in cannabis consumption in the Netherlands, thus confirming prohibitionists' suspicions. More concretely, the core question in this paper is: How have the scale and nature of cannabis use evolved in the Netherlands, and to what extent is this development as­sociated with the decriminalising of cannabis? 

In this paper we firstly discuss long term trends in cannabis use in the Netherlands, both among the general population and among students at secondary schools. In addition trends and patterns in cannabis use in the Netherlands are compared with those in some other countries. Then we focus on cannabis use among groups at risks and give an overview of cannabis users in treatment and care. Finally, we discuss the nature and extent of the use of other illicit drugs and the associated problems.

 

2. Cannabis use among the general population

Today, cannabis is the most commonly used of all illicit drugs in the Netherlands. Prior to the Second World War, cannabis use had scarcely been heard of in the Netherlands, and this did not change much in the early post‑war years. The 1950s can be seen as the introduc­tory phase of cannabis use in the Netherlands. Researchers have uncovered small groups of creative artists (painters, writers and musicians) who had learned to use it while abroad [Cohen, 1975]. In Amsterdam, drug control authorities also recorded the use of marijuana by seamen and by German­-based US military personnel [Korf & De Kort, 1990].

In the course of the 1960s, cannabis use in the Netherlands rapidly gained popularity. An increasing number of adolescents began smoking it on a regular basis, but not till the end of the decade was a users' subculture in evidence. Cannabis spread forcefully in the wake of the hippie movement. Smoking hash at the national monument in Dam Square or in the Vondelpark in Amsterdam became a must for a burgeoning international youth 'counterculture’ [Leuw, 1973]. Drug use was seen as a form of protest against dominant bourgeois culture in general and against the US war in Vietnam in particular [Cohen, 1975; Tellegen, 1970]. By the end of the 1960s the number of cannabis users in the Netherlands was estimated at between 10,000 and 15,000 [Geerlings, 1975].

The empirical basis far the last figure was still weak, but that soon changed. From the late 1960, onwards, regular surveys have been conducted to collect data on the scale and distribution of cannabis use.[1] We shall compare here the findings of general household surveys and school surveys.

 

National household surveys

Between 1970 and 1991 six national household surveys have been held in the Netherlands among people from adolescence upwards. The findings reveal a growing percentage of people that report having used cannabis at least once in their lives: from 2‑3% in 1970, to 6‑10% during the 1980s and to 12% in 1991 [Overview in: Korf, 1995]. Due to non-uniformity of target populations and methodologies, the survey data permit no definitive conclusions as to the scale of the increase.

Despite fluctuations in prevalence rates, both face‑to‑face and written interviews point to a rising number of ever cannabis users in the Netherlands since 1970, and there is certainly no evidence of any decrease in the wake of statutory decriminalisation in 1976. The fact that lifetime prevalence rates are cumulative, however, goes a long way towards explaining the increase. Still included in the figures are those who admit to having smoked marijuana or hashish only once during adolescence and who are now in their forties or fifties. In other words, to a large extent this increase is a generation effect. Since the 1960s, again and again new youth generations start using cannabis. The first generation of users belongs to today’s senior citizens; in the near future lifetime prevalence rates will most probably stabilise.

 

In 1997, a new series of general population studies was initiated, using large representative samples of people aged 12 years and over. This National Prevalence Study (NPO) is carried out by the Amsterdam research centre CEDRO in co-operation with CBS (Central Bureau of Statistics Netherlands).[2] In addition to figures on lifetime use of - amongst others - cannabis, this study also includes data on current use [Abraham et al., 1999]. The core figures for 1997 are (Figure 2):

·        The vast majority has never tried cannabis.

·        One in six respondents has ever used cannabis (15.6%).

·        One in forty respondents (2.5%) used cannabis in the month prior to the interview (current use), with an estimated total of 323,000.

 

The 1997 National Prevalence Study also shows that most people do not use cannabis for prolonged periods of time. The majority of cannabis consumers use the substance for experimental and recreational purposes.

·        Two in three ever users have used cannabis less than twenty-five times.

·        One in six ever users is a current user (15.8%). The remainder has stopped consumption. According to other Dutch studies, people generally stop because their curiosity is satisfied, and because they no longer have a desire for cannabis, or no longer enjoy its use [van der Poel & van der Mheen, 1999; Cohen & Sas, 1998].

·        Almost half of current users consume cannabis 1-4 days per month; a quarter of current users take cannabis daily or almost daily (0.7% of general population). (Figure 3)

 

 

 

With regard to age, the 1997 National Prevalence Study shows that cannabis use occurs mainly among young people and young adults. The peak of the national ever use is between 20 and 29 years; and that of current use between 16 and 24 years (Figure 4).

Also men use cannabis more frequently than women. (Ever use in males is 21 percent, in females 11 percent. Current use is 4 and 1 percent respectively.) Furthermore, other Dutch studies have concluded that cannabis consumption is correlated with educational status, employment status (i.e., unemployed or employed) and class or social status. People with higher education tend to have more experience with cannabis use than people with lower levels of education. Among current users, quite a large number receive social security benefits. Single people are over-represented in the group of current users [Verdurmen, Toet & Spruit, 2000; Lammers, Neve and Knibbe, 2000; Kuilman & van Dijk, 2000; Sandwijk et al., 1995].

 


Trends in cannabis use in Amsterdam 

Cannabis use is not distributed evenly across the Netherlands. Cannabis use is more prevalent in urbanised than in rural areas; Amsterdam tops the list with respect to ever use and current use. The composition of the population, for instance the number of students, most probably plays a role in the differences between urban and rural areas [Abraham, 1999]. Such an uneven geographical spread of cannabis use is not typical for the Netherlands, and can also be found in other countries [Partanen & Metso, 1999].  

 

Table 1   Cannabis Use in the Netherlands in the General Population Aged 12 years and above (1997)

 

 

National

Amsterdam

Rural

(Lowest density areas)

Has Ever Used

15.6%

36.7%

10.5%

Has Used Past Month

2.5%

8.1

1.5%

Source: [1]

 

Since 1997 four surveys have been conducted among the general population of Amsterdam 12 years and over, applying a similar methodology as in the NPO survey. Prevalence rates increased [Abraham et al., 1998].  Like in the national surveys, to a large extent, this increase is a generation effect. This generation effect also helps to explain why rates among ever use increase much stronger than those for current use (Figure 5). The majority of the adult ever users in Amsterdam has stopped using cannabis. While many young ever users are currently taking cannabis, only few older ones do so. For example: while almost half of the ever users among 16-19 year olds are current users, this holds for one out of seven ever users among 40-49 year olds (Figure 6).    

 

The impact of the generation effect on rates of cannabis use in the general population in Amsterdam is also illustrated by comparing these data with those from school surveys in that city. While rates for cannabis use among the general population increased, according to school surveys we conducted among ‘older students’ (mostly 16-17 years of age) in Amsterdam, cannabis use remained rather stable [Korf et al., 2000]. Consequently, increase in ever use among the general population does not necessarily mean cannabis use is growing among young people.

 

National school surveys 

The findings of national school surveys seem to confirm the rapid growth in the popularity of cannabis towards the end of the 1960s. In 1969 as many as 9% of the students in the final form at secondary schools reported having used cannabis at least once. Two years later this percentage had doubled to 18%. But rates did not go on rising in subsequent years: in 1973, lifetime prevalence was again put at 18% [Overview in: Korf, 1995].

It was more than a decade before the next national school survey was done in 1984. This survey yielded a much lower lifetime rate of cannabis use (5%) [Plomp, Kuipers & Van Oers, 1990]. To a considerable degree, however, the lower rate can be explained by inconsistencies in the samples [Korf, 1988]. If comparable age groups are examined, the difference between 1973 and 1984 rates is much smaller: 18% ever use of cannabis for students with a mean age of 17.5 years in 1973; 12% for students 17 years and older in 1984 [Plomp, Kuipers & Van Oers, 1990]. It should be noted that these school surveys did not address nationally representative samples.   

Since 1988 nationally representative surveys have been conducted by the Trimbos Institute,  on the extent to which secondary school students aged 12 and older have experience with alcohol, tobacco, drugs and gambling. From 1988 to 1996, experience with cannabis use among students rose, but stabilised in the late 1990s [Kuipers & De Zwart, 1999; De Zwart, Monshouwer & Smit, 2000].

·        The percentage of ever users increased from 8 percent in 1988 to 21 percent in 1996, and then stabilised at 20% in 1999.

·        Current use by students increased from 3 percent in 1988 to 11 percent in 1996, and was slightly lower in 1999 (9%).

·        Boys have higher rates than girls (ever use in 1999: 18.0% vs. 11.1%; current use: 8.8% vs. 4.1%).

 

 

3. Decriminalisation and cannabis use in the Netherlands 

In order to study the possible link between decriminalisation and the evolution of Dutch cannabis use, first of all we need to know the prevailing rates of cannabis use both before and after decriminalisation. Moreover, longitudinal trends in cannabis use in the Netherlands can only properly be ascribed to decriminalisation when it is made plausible that they are causally related.

The data presented leave little room to doubt that cannabis use in the Netherlands spread rapidly around 1970. However, we did observe fluctuations that could be explained by methodological differences. Different survey methods yield different prevalence rates, for example face-to-face interviews generally result in lower self reported use of cannabis than written interviews [Harrison, 1997]. In addition, differences in target populations can generate diverging prevalence rates. We observed that cannabis use is strongly related to age; consequently non-uniformity of samples with regard to age can explain fluctuations in prevalence rates. Also we observed a significant association between cannabis use and urbanisation, cannabis use being higher in urban then in rural areas. While correcting for the influence of regional variation on cannabis use, secondary analysis of twenty school and household surveys – national, regional and local – held amongst adolescents revealed a parabolic development from 1969 through 1987. Ever use of cannabis showed a steep rise in the late 1960s and early 1970s, followed by a decline and then a slight though significant climb throughout the 1980s [Plomp, Kuipers & Van Oers, 1990]. National school surveys conducted between 1988 and 1999 indicate that the latter increase continued unto the 1990s, followed by a stabilised or slight decline by the end of that decade. Most probably then is that cannabis use among youth in the Netherlands so far evolved in two waves, with a first peak around 1970, a low during the late 1970s and early 1980s, and a second peak in the mid 1990s. Presumably, this peak will be followed by a low in the next decade.      

Rising or falling cannabis consumption need not be the unequivocal result of decriminalisation or criminalisa­tion. The Netherlands was one of the first countries where cannabis became the object of statutory regulation. The import and export of cannabis was introduced into the Opium Act in 1928. Possession, manufacture and sale became criminal offences in 1953. Statutory decriminalisation of cannabis took place in 1976. De facto decriminalisation, however, set in somewhat earlier. With regard to the cannabis retail market in the Netherlands four phases can be distinguished.

(1)   The Dutch cannabis retail market of the 1960s and early 1970s was a predominantly underground market. Cannabis was bought and consumed in a sub-cultural environment, which became known as a youth counterculture.

(2)   The second stage was ushered when Dutch authorities began to tolerate so-called house dealers in youth centres. Experiments with this approach were formalised in the statutory  decriminalisation in 1976. Official guidelines for Investigation and Prosecution (AHOJ-G criteria) came in force in 1979. By the end of the 1970s the house dealer had become a formidable competitor of the street dealer.

(3)   Today, hashish and marijuana are sold predominantly in café-like places, which have become known as coffee shops. During the 1980s coffee shops captured a bigger and bigger share of the Dutch retail cannabis market.

(4)   Since the mid 1990s, Dutch cannabis policy has been focussing on curbing the number of coffee shops. Also the minimum age for visitors has risen from 16 to 18 years.  

In terms of availability, the transition from the first to the second phase, the many underground selling points became consolidated in a more limited number of formalised sales outlets, publicly accessible yet shielded from public view. In the third phase, availability increased markedly in numerous openly accessible coffee shops [Jansen, 1989]. More recently, availability might have decreased because of the declining number of coffee shops (from 1,500 to about 800). [Bieleman et al., 2001]

It is striking that the trend in cannabis use among youth in the Netherlands rather parallels the four stages in the availability of cannabis identified above. The number of adolescent cannabis users peaked when the cannabis was distributed through an underground market during the late 1960s and early 1970s. Then the number decreased as house dealers          were superseding the underground market during the 1970s, and went up again in the 1980s after coffee shops took over the sale of cannabis, and stabilised or slightly decreased by the end of the 1990s when the number of coffee shops was reduced.

 

4. International comparison of cannabis use 

How do the Dutch trends in cannabis case compare to those in other Western nations? Such a question is not easy to answer. For one thing there are few countries where cannabis con­sumption has been consistently and systematically recorded over the years. Apart from that there is wide variation in the populations studied (in age composition, for example) and in the methods applied (such as face‑to‑face interviews and written questionnaires) [Bless et al., 1997].  

The US has a relatively long tradition of surveys on drug use and the American figures consistently appear to be higher then those in the Netherlands. A comparison with the Netherlands using identical measurement instruments revealed that in the 1980, US school children clearly were starting to use cannabis earlier and in far greater relative numbers than Dutch ones [Plomp, Kuipers & van Oers, 1988]. More recent figures show that ever use among Americans aged twelve years and above is over twice as high as it is in the Netherlands [16]. Clearly then, the US as the prototypical example of a prohibitionist approach towards cannabis is more in the lead with respect to cannabis consumption than the Netherlands, being the prototypical example of anti-prohibitionism.  

A first complication here is that marijuana use among youth in the US also evolved in waves, with a peak during the late 1970s, decline in the 1980s, rising in the 1990s and then stabilised.  Harrison [1997] concludes that such a wave-like development can be understood as a verification of Musto’s more general model on trends in drug use [Musto, 1987]. In addition structural factors (post World War II baby boom) and drug education (health risk perception) might help to explain the development in marijuana use in the US [Harrison, 1997]. Also in other European countries the development in cannabis use has been interpreted as a wave-like trend [Kraus, 1997]. Like the Netherlands, cannabis use spread rapidly in Germany (West) toward the end of the 1960s, followed by a stabilisation and decline in the early 1970s and then an increase in the 1980s [Korf, 1995; Kraus, 1997]. The rising use of cannabis in Germany (West) continued in the 1990s; among 18-39 year olds life time use increased from 16.7% to 21.0% in 1995 and last year use almost doubled from 4.9% to 8.8%  [Kraus & Bauernfeind, 1998; Kraus, Bauernfeind & Bühringer, 1998].    

A second complication is that cannabis use in some other countries with a prohibitionist approach towards cannabis - Sweden in particular – are substantially lower than in the Netherlands. Before we go into comparing cannabis use in member states of the European Union (EU), some remarks have to be made on the problems of cross-national comparability of surveys on drug use. National household surveys do not always apply similar methodologies (i.e. in terms of questionnaires and modes of interviewing), nor do they always target at the same populations, for example in terms of age distribution [Bless et al, 1997]. Moreover, countries may differ in general characteristics of their populations. For example, the level of urbanisation in the Netherlands is the highest within the EU (over 1,000 citizens per square mile). Since level of urbanisation correlates positively with cannabis use within countries, one might expect relatively high prevalence rates for the Netherlands when comparing between countries.           

From the available, but not precisely comparable data[3] from general population surveys in ten member states of the EU, the European Monitoring Centre for Drugs and Drug Abuse (EMCDDA) concluded that the level of cannabis use varies strongly within the EU; from 9.7% in Finland to 25.0% in the UK (England and Wales). The Netherlands took a middle position [EMCDDA, 2001]. 

Data from general population surveys in the UK (England and Wales) [Ramsey & Partridge, 1999] and Germany (West) [Kraus, Bauernfeind & Bühringer, 1998] allows a more precise comparison with Dutch data. The British and Dutch surveys applied computer assisted questionnaires, the German one a postal questionnaire. All three surveys were conducted in the same period (1997 or 1998) and have separate data for adolescents and young adults. Also, the three countries faced a similar trend of increasing cannabis use since the late 1980s. Ever use of cannabis in the Netherlands was higher than in Germany (West), but lower than in England and Wales. For all three countries ever use of cannabis was highest among those in their early twenties (Figures 9-11). Current use of cannabis (last month) was lowest in the Netherlands and highest in England and Wales (Figures 12-14).   

A growing number of European countries is conducting school surveys on drug use, applying a standardised methodology (ESPAD). The population here consists of students aged 15-16 years. Most countries show an increase in lifetime use of cannabis between 1995 and 1998. In 1999, eleven EU member states were included in this cross-national study [Hibell et al., 2000]. Lifetime use of cannabis ranged from 8% (Sweden, Portugal) to 35% (France, England and Wales), and current use from 2% (Sweden) to 22% (France). In both cases Dutch students took the fourth position (Figure 15).  

In conclusion, trends in cannabis use in the Netherlands are rather similar to those in other European countries, and Dutch figures on cannabis use are not out of line with those from countries that did not decriminalise cannabis. The U.S. figures consistently appear to be higher then those in the Netherlands. Over time prevalence of cannabis use show a wave-like trend in many countries, including the Netherlands. This supports Reuband’s earlier conclusion that trends cannabis use evolve rather independently from drug policy, and that countries with a ‘liberal’ cannabis policy do not have higher or lower rates than countries with a more repressive policy. [Reuband, 1995].

Consequently, it is unlikely that decriminalisation of cannabis will cause an increase in cannabis use.

 

 

5. PROBLEMATIC USE AND TREATMENT 

So far we have focussed on cannabis use among the general population. The percentage of current cannabis users is a little higher among students who attend schools for children with special educational or behavioural needs than among their peers in 'normal' schools. Nonetheless there are groups of youth for whom cannabis use is the rule rather than the exception (i.e. truancy projects, juvenile detainees, homeless youth) [Overview in: NDM, 2001]. For example, 96% of a national sample of homeless youth (aged 15-22 years) ad ever tried cannabis and 43% was using hashish or marijuana very day [Korf et al., 1999].   

While the majority of cannabis users in the Netherlands keep their use under control, there are also cannabis users who have problems associated with their use of cannabis. How many people do not succeed to control their cannabis use is not known precisely. Not nearly all of those concerned seek help or make their problems known. Furthermore, there is no general acceptable definition of 'problematic use'. Cannabis dependency, according to the psychiatric classification system DSM (Diagnostic Statistical Manual), is a controversial description [Soellner, 2000] 

The Annual Report of the National Drug Monitor [NDM, 2001] includes the following treatment indicators: out-patient treatment, in-patient treatment and general hospital admissions. 

   

Out-patient treatment 

Demand for out-patient addiction care for cannabis problems declines. LADIS registers how often people seek help in out-patient addiction care facilities. Many cannabis clients also have problems with other substances.

·        The number of out-patient registrations of people with a primary cannabis problem almost quadrupled between 1990 and 1996 and then remained relatively stable in the following years.

·        The proportion of cannabis in all assistance requests for drug-related problems, thus in all drug registrations is limited. This proportion rose until 1997 and is relatively stable in recent years (around 10%).  

People who approach out-patient addiction care primarily for cannabis use chiefly consist of fairly young, male adults (81%; mean age 26 years). In 1997, almost half of all cannabis clients had problems with this drug for at least five years before eventually registering for help. Only one in five sought help within two years after becoming aware of their problem [Cruts, Ouwehand & Hoekstra, 1998]. 

People seeking help for cannabis-related problems may also have other problems. One in three people seeking help in out-patient addiction care facilities for cannabis-related problems also have difficulties with one or more other substances, such as alcohol, cocaine, and ecstasy. These are not average cannabis users. These people often suffer from psychological disorders, even more so than new addiction care clients with heroin or cocaine-related problems: According to figures from the Jellinek Centre, four in ten cannabis clients suffer from depression [Wohlfahrt, Koeter & Palenéwen, 1997]. Here the question arises about what comes first: the drug problem or the psychological disorder. The scientific literature appears to suggest that the psychological disorder usually precedes the drug problem.

The opposite holds true as well: People seeking help for problems with other drugs will often also have problems with cannabis.

·        Compared to the 3,443 persons, who sought out-patient help in 2000 primarily due to concern about their cannabis use, there were over 3,144 people seeking help for whom cannabis was a secondary problem (in total: 6,587).

·        The main concern of this second group was alcohol (36 percent), followed by heroin (26 percent) and cocaine (25 percent).

·        Based on the estimated number of current cannabis users, about 20 per 1,000 are admitted to out-patient addiction treatment.

 

In-patient treatment

Admissions to in-patient addiction care due to cannabis problems have risen in the 1990s: from 71 in 1990 to 323 in 1997.[4] The number of cannabis cases in all drug-related admissions has slightly increased from 1990 to 1997 (from 3% to 7%). Based on the estimated number of current cannabis users, 1 out of every 1,000 is admitted to in-patient addiction treatment.

                                                   

General hospital admissions 

Cannabis problems are not an important reason for admission in general hospitals. There are about were 1.5 million admissions in general hospitals. According to statistics, drug problems hardly played a role in these admissions. In 2000 cannabis abuse and cannabis dependency were determined as primary diagnoses on 24 occasions, and 193 times as secondary diagnoses (in total: 217).[5] Based on the estimated number of current cannabis users, less then 1 out of every 1,000 is admitted to general hospitals for cannabis abuse or dependency.

 

6. Other illicit drugs 

According to the 1997 National Prevalence Study, the use of other illicit drugs is significantly lower than the use cannabis [Abraham et al., 1999]. While 15.6% has ever used cannabis, the lifetime rate for all illicit ‘hard drugs’ is 4.1%. Current use of hard drugs is 0.5%, versus 2.5% for cannabis. In general, the use of hard drugs appears to be even more often experimental; while 1 out of 6 ever users of cannabis are current cannabis users (15.8%), 1 out of 6 ever users of hard drugs are current users (12.2%).

Apparently, the majority of Dutch cannabis users does not try hard drugs. In Table 2 we have divided the number of hard drug users by the number of cannabis users. Assuming that all hard drug users are cannabis users as well, slightly lees than three quarters of the ever cannabis users has never tried hard drugs, and over three quarters of the current cannabis users are currently not using hard drugs.         

Apart from the fact that not every hard drug user has tried cannabis, the figures just presented can not simply be interpreted in terms of a causal relationship. The fact that cannabis use often precedes the use of hard drugs, does not simply prove that cannabis use is the cause of the consequent use of hard drugs.

Table 2 Prevalence of drug use in the Netherlands among the general population 12+ years (1997)

Drug

Lifetime Use

Last

Month

Use

Current Continuation

Ever Users per Ever Cannabis Users (unweighted)

Ever Users per Ever Cannabis Users (unweighted)

Cannabis

15.6%

2.5%

15.8%

-

-

Cocaine

2.1%

0.2%

10.0%

15.7%

9.0%

Amphetamines

1.9%

0.1%

7.2%

12.8%

5.8%

Ecstasy

1.9%

0.3%

14.0%

13.7%

10.5%

Hallucinogens

1.8%

<0.1%

12.6%

12.6%

2.5%

Heroin

0.3%

<0.1%

10.2%

1.4%

1.3%

All ‘hard drugs’

4.1%

0.5%

12.2%

28.8%

21.7%

 

 Problem drug use: international comparison

With regard to the problematic use of opiates and drug related health problems, the Netherlands ranks relatively low within the European Union. 

According to the EMCDDA [2001], the EU has 1.5 million problem drug users (mostly opiates), or 4 per 1,000 citizens (15-65 years). Among 13 member states[6] the Netherlands (2.5 per 1,000) ranks at the 11th position (Figure 17).

Within the EU 38% of all new AIDS cases are intravenous drug users. In the Netherlands this is 11%. The number of intravenous drug users with AIDS in the EU is 9 per 1 million citizens. The Dutch number is 1 per million [NDM, 2001].

The number of acute deaths after taking drugs has been compared by the EMCDDA, 2001] for seven EU member states.[7] The UK (England & Wales) ranks number one, with 2.7 per 100,000 citizens. The Netherlands takes the 6th position, with 0.5 per 100,000 (Figure 18). 



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[1] For licit drugs, extrapolations on consumption can be made from such direct parameters as production figures and tax data. Average consumption ‑ e g. litres of pure alcohol per capita per annum ‑ con be computed, and using mathematical formulas the number of frequent or problem users can be estimated. For illicit drugs this kind of macro data are not available. Extrapolations from amounts of confiscated illicit drugs could be used as an alternative, but such extrapolations are extremely hypothetical [Korf, 1995]. Self‑report surveys are the most common method of measuring cannabis use and trends in it. In the field of criminology, self‑report surveys are used (to find out about offences that go unnoticed in official crime data. They may thus help reveal the so‑called dark number, the difference between criminal acts being committed and official counts. A major drawback is that only a limited, selective portion of all criminality con be measured; more serious crimes, in particular, (end to remain obscured. Other weaknesses are memory lapses and deceit among subjects, vaguely formulated test items and indeterminate periods of coverage. Nonetheless, surveys have clearly demonstrated their utility in the field of criminology as an alternative to traditional procedures. The first surveys of cannabis use in the Netherlands were conducted by criminologists, too. At a later stage they were largely replaced by other types of social scientists and by epidemiolo­gists.

[2] This paper refers to the data from the first stage of the research.[1] The outcomes of the second measurement will follow by the end of 2001.

[3] Different methodologies. Age range from a minimum of 15-18 to a maximum of 49-69.   Survey years: from 1997 to 2000.

[4] ICD-9 codes: 304.3, 305.2. Source: PiGGz. The situation since 1997 is not clear; this rise has probably continued in 1997.

[5] ICD-9 codes: 304.3, 305.2. Source: LMR.

[6] No estimates available for Greece and Portugal.

[7] ICD-9 codes: 292, 305.2-9, 304, E850, E890.  Figures only include direct death after the use of opiates, hallucinogens, cocaine, amphetamines and cannabis.


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