The academic report "The Belgian politics concerning drugs - year 2000: situation" of professors B. Of Ruyver (Rijksuniversiteit Race) and J. Casselman (Katholieke Universiteit Leuven) raises the inventory of the recommendations already concretized of the parliamentary group Drugs that made report to the Room (Doc. Parl. Room, 1996-1997, 1062/1 to 1062/3) June 5, 1997. This chapter is based on aforesaid academic report.
3.1. An integrated and global approach
A general conclusion imposes itself: at the present time, one can hardly speak of a harmonized politics, in spite of the accomplished progress progressively in some domains.
3.1.2. Vertical political harmonization
In the domain of the general politics (public health, justice, social business), he/it appears that such a harmonization of the action led by the diférents competent Ministers to the communal and federal level has not been achieved. The interdepartmental Conference only met one time. The Room of the Representatives voted a resolution insisting on the necessity of the creation of a "Cell Drugs" understanding representatives of all departments federal and other competent departments.
With regard to the prevention, the situation changed however deeply. However, seen the absence of a politics univocal, different initiatives to the clean and specific objectives are taken the independently some of the other. A clear coordination structure has been conceived in Flemish Community that must guarantee the collaboration and harmonization between the various levels of prevention but there is not a formal mandate to achieve the aimed harmonization. . Since the new decree on the promotion of the public health, he/it doesn't exist anymore in French Community of official coordination with regard to the prevention on the communal plan. The coordination takes place to the local level, in a decentralized manner, by the local centers of health.
The communication always makes defect between the judicial intervening parties who orient the drug addicts and the general services of aid and catégoriels. The offer of aid remains very badly known.
On time present, different task groups unite various actors of the sector around the table but they don't have any power of decision often. If a dialogue exists on the land and if, in some cases, a constructive result is reached, the merit comes back from it mainly to a few strong personalities and not to structural initiatives. There always is not inventory of the existing structures of dialogue.
3.1.3. Horizontal political harmonization
It is necessary to note that some cities undertook to develop the dialogue in a constructive manner and this so much to the level of the development of a politics plan that with regard to the harmonization of the actors concerned in the domain of the aid and the prevention. At the head of list, there is the city of Antwerp with the "Stedelijk Overleg Drugs" (SODA). But the cities of Genk ("Limburgs Luik Drugsplan"), Ghent ("Stuurgroep Drugbeleid"), Bruges ("Drugoverlegplatform Brugge"), Alost ("Regionaal Drugoverlegplatform"), Charleroi (Coordination drugs), Liege (Coordination of the actions in addiction), Malines ("Drugpreventieplatform Mechelen") develop a local politics associating all partners also. The development of a local politics concerning drugs and a Plan strategic Drugs perfectly appear in the philosophy of the recommendations of the parliamentary task group Drugs and deserve the support of all authorities concerned. It is necessary that the politics grants a real support to these initiatives.
There is always a big diversity for what is sources of finance. Projects concerning Drugs are subsidized by the social Business (INAMI), the Public health, the inside (the contracts of security and society) and the federate governments.
This diversity is not favorable to the clarity. An attempt of clarification of the question to know that finances what learns us that the results of research ordered by the SSTC and that carries on the politics with regard to the illegal drugs, the implied services, the costs and the population of consumers of drugs concerned" are waited with impatience. This research will only start in 2001. The preview is below therefore rudimentary and incomplete, and certain numbers are unreliable. An uniform registration and quality is required of emergency. We can affirm however, with one degree of probability close to the certainty, that the INAMI is, as one could foresee it, the main source of finance.
Financing of the aid to the drug addicts: global preview
Mental hospitals, psychiatric sections of the general hospitals, houses of psychiatric care and formula protected Habition (numbers 1998: linked unrests to the addiction like main diagnosis)
total: 2.735.000432 BEF¨ Psychiatric sections of the general hospitals:
total 665.805.954 BEF (= 12.814 treatments *10 days of hospitalization *5511 BEF (price of day)¨ Mental hospitals:
total: 1.866.225.582 BEF (=15.552 treatments * 27 days of hospitalization *4453 BEF (price of day)¨ Houses of psychiatric care:
total: 122.355.896 BEF (=152 treatments *247 days of hospitalization *3259 BEfs (price of day)¨ Protected dwellings:
total: 80.613.000 BEF (=568 treatments *175 maintenance days * 811 BEF (price of day)INAMI conventions (numbers for 1999)
total: 908.892.600 BEF¨ 659.250.102 BEF for the welcome in institution (8 centers of crisis intervention and 14 therapeutic communities)
¨ 249.642.498 BEF for the ambulatory centers (8 MASS and 6 centers of day)The residential centers treated 1134 patients, the ambulatory centers 3248 (of which 2672 in the MASS); 477 patients have been treated so much in institution that in an ambulatory manner in 1999.
General practitioners
total: unknownGlobal plan (numbers 2000)
total: 314.669.400 BEF¨ 67.500.000 BEF for the contracts drugs and the shutters drugs of the prevention contracts (16 in Flanders, 12 in Wallonie and 1 in Brussels)
¨ 247.169.400 BEF for the shutters drugs of the contracts of security and society (11 in Flanders, 5 in Wallonies and 6 in Brussels)Flemish Community (numbers 2000)
total: 92.600.000 BEF
77.600.000 BEF: VAD coordination and order of projects
15.000.000 BEF: provincial platforms of prevention (6*2.500.000)SPP (numbers 1999)
total: unknown (total budget for all missions: 104.800.000 BEF)French Community (numbers 2000)
total: 50 millions BEFVlaamse Centra voor Geestelijke Gezondheidszorg (numbers 2000)
total: 20 millions BEF + an unknown amount20 millions BEF: CGC conventions concerning the regional harmonization (alcohol and other drugs)
1,27 billions: budget global CGC pleasures of which 10 workers of prevention
Walloon region (numbers 2000)
total: 50 millions BEFRegion Brussels Capitale
total: unknownReitox: (European epidemiology, numbers 2000)
total: 12.293.000 BEFOf which:
2.127.000 BEF for the European observatory10.166.000 BEF for the Communities
Commission Communal French
Total: unknownGerman-speaking Community (numbers 2000)
total: 6.900.000 BEF¨ ASL (Arbeitsgemeinschaft Suchtvorbeugung für / asbl primary prevention of drugs): 3,7 millions BEF
¨ SPZ (Sozial-Psychologisches Zentrum / center of mental health, secondary prevention): 2,8 millions BEF¨ Mondorfer Gruppe / Task group Mondorf of the Saar Lor-Lux region: 0,4 millions BEF
Commission Communal township (numbers 2000)
Total: 6.475.00 BEF (Dialogue Addiction Brussels - Overleg Druggebruik Brussel)We don't have any numbers concerning the financing of other types of care to the drug addicts (CPAS, centers of consultation for the young, centers of general social work, help to youth, provinces, townships, Fund of social impulse,…. and well of others).
We don't have either of numbers in our possession with regard to the cost of the penal reaction to the use of the drugs (police and justice).
Consequence of the fashions of short-term financing (such the contracts of security and society, that must be valued annually): no vision is developed long-term, there are not continuity and these projects don't offer any attractive jobs. Besides, different criterias of assessment are application for the different financings.
Funds are distributed mainly between the cities. In part understandably, since it is there that biggest problems arise and, in part, to wrong because it is not necessary to disregard the non urban regions, especially concerning dissuasion and prevention.
3.2. Assessment / Epidemiology
Few initiatives of study (that are in conformity with the recommendations of the parliamentary task group) are taken that would permit to make itself/themselves a precise idea of the use of illegal drugs. We can mention however on the one hand, a thesis of doctorate (K.U.Leuven) on the consumers of cocaine in the region anversoise that especially answers the requirement of a qualitative approach and, on the other hand, a survey on the health of the young, achieved for Flanders by the university of Ghent (Department social Health) and for the Wallonie by the U.L.B. This last survey that inquires notably of the consumption of legal and illegal drugs is repeated to regular intervals and enrolls in the setting of a survey international "Health Behaviour in Schoolaged Children", done under the aegis of the World Health Organization. It is certain that such initiatives must be encouraged.
In Belgium, the IHE, the institute of hygiene and epidemiology (become the ISSP, Scientific institute of the Public health) has been designated like focal point for the European observatory of the Drugs and Addictions (OEDT). In practice, these are the focal Under-Points that are in charge of the collection of the existing epidemiological data (the VAD - Vereniging Alcohol voor - in Drugproblemen andere - for Flanders, the CCAD - Committee of dialogue Alcohol and Drugs - for the French Community now replaced by Eurotox, the CTB-ODB - Dialogue Addiction Brussels / Overleg Druggebruik Brussel - for Brussels and the ASL - Arbeitsgemeinschaft Suchtvorbeugung für Lebenbewältigung und - for the German-speaking part of the country).
The financing of these research rather makes itself on an ad hoc basis, by a multitude of processes (the ministries, the universities, the local initiatives) and the most often by non governmental institutions. The studies are often about a short length and have a variable scientific value.
To the level of the registration of the consumption of drugs problematic, some initiatives deserve to be mentioned that aim the realization of an uniform registration in the setting of the aid.
By analogy with the RPM (minimum psychiatric Summary), the system of registration of the mental hospitals in Belgium, a specific registration form is put to the point for the consumers of drugs, that will permit to record some relative data to the patients at the time of the admission, during the hospitable stay and to the exit of the hospital, the Summary minimal Addiction - (RMT); it would become thus possible to value the effects of the treatment. It is necessary to take account in this respect of the annulment of the AR concerning the RPM by the Council of state.
The VAD coordinates the "Vlaamse Registratie Middelengebruik (VRM, the registration of the consumption of drugs in Flanders - registration of people that frequents the structures of aid), a project that is descended of the note Drugs of Demeester lady. He/it tempts to integrate the existing systems of registration of the groups of existing facilities in the new system with the help of a set of variables of the VAD. The goal of this registration integrated system is to know the features of the population treated in the sector of the aid better. This system started in 1996. The available data go until 1998. On this day, all facilities don't participate in this uniform registration.
Of other systems of registration Adibrus are (Brussels), Common Card of the CCAD (French Community) and Ginger (Flemish projects of prevention).
To the local level him there notably the survey under SODA (Stedelijk Overleg Drugs Antwerpen) that develops an uniform registration for four organisms that grant a help to the drug addicts in the city of Antwerp.
The pooling of the epidemiological data to the national level took a considerable delay. The attempts of uniform registration are again only at the stage of the stammerings.
3.3. Prevention, sensitization and reduction of the risks
To the national and international level, we note that the preoccupations are especially about the illegal drugs, it whereas the consumption of legal drugs causes again still well more problems of health and well-being than the consumption of illegal drugs.
Belgium counts 28% of daily smokers or 2% more than in 1998. In May 2000, a new campaign against the tobacco addiction has been organized via the pharmacists: the people who stopped smoking could win a journey to Kenya or a sum of considerable money. This country was organized by the association Pharmaceutical Belgian and the World Health Organization, with the support of the pharmaceutical industry.
The consumption of alcohol is decreasing since 1985 and rose to 8,9 liters of pure alcohol by Belgian in 1997. The Belgians occupy the thirteenth place thus to the hit song struts about world of the heavy drinkers. In 1997, 8% of the Belgians consumed the alcohol daily; 17.7% of the Belgians drank once in 1997 at least per month six glasses or more of alcohol in one day (what the World Health Organization qualifies abuse of alcohol).
The professionalization of the prevention of the problems bound to the consumption of alcohol and other drugs clearly appeared during the years ninety but we always note the same stumbling blocks, notably an attention especially targeted on the prevention of the use of illegal drugs and on the young; of the problems bound to the assessment of the efficiency of the different strategies of prevention; of the problems of coordination to the level of the politics; and a lack of stability and continuity for the intervening parties in the domain of the prevention. Different initiatives have been taken to the federal, communal, provincial and local level. The principles of the working of the preventive activities are based on models descended of the aid catégorielle to the alcoholics and other drug addicts, of the education to health and the social help. These currents have been synthesized in the work of prevention of the VAD (Vereniging Alcohol voor in Drugproblemen andere) that succeeded finally to a text dating de1990 that proposes a global approach: the mediator's principle as group target of the prevention work, the individual's autonomy, the involvement of the group targets and the planned approach occupies a central place. An analogous evolution occurred in the French-speaking part of the country, and more precisely within the CCAD (Committee of Dialogue on the alcohol and the other Drugs) - replaced now by Eurotox.
The primary prevention (to avoid the problems due to the use of drugs) is again still major whereas an attention less pronounced are granted to the secondary prevention (the precocious tracking and the accompaniment of people presenting a risk increased of problems due to the use of the drugs).
The pursuit of the development of the work of the street educator is an evolution to signal in the setting of the secondary prevention that goes to some at risk groups as the young in marginalized some districts. The educators of street attachés to the specialized centers of day are more and more often gathered under a municipal expertise what often gets used to the detriment of the specialization. In 1995 already, the Action plan Addiction - Drugs proposed a program of struggle against the recreational consumption of drugs (legal or illegal). To the exception of a project thrown by the SPPP (permanent Secretariat to the politics of prevention) in 1997 and some projects of street work exists, the initiatives are rare in this domain. The project of the SPPP has not been pursued besides since the program, as it had been proposed, didn't prove to be the most adequate approach.
The development of the initiatives of reduction of the risks is, in a large measure, remained limited to the creation of the socio-sanitary welcome Houses for the consumers of drugs (MASS). The reduction of the risks has its place however to all echelons of the aid (of the educator's level from street to the therapeutic community).
Some services of aid to the drug addicts note that age to which starts the consumption of drugs is decreasing. The young would have their first contact with the illegal drugs at the age of 13 years, sometimes same 11 years.
The politics concerning the drug with regard to the young is centered mainly on the prevention. The prevention is organized, on the one hand, by the Communities, on the other hand, by the slant of the contracts of security and society. In this context, one elaborates or adapt school regulations, of the agreements with the police and the public prosecutor's office and the formation for the advisers for the young (peer education).
For what is struggle against the precocious consumption, we note that most initiatives of prevention are targeted on the dissuasion of the young. The preventive actions aiming the adults are too little numerous. In Belgium, most subsidized actions concern (besides help to the adults), the prevention in the secondary education. Projects of prevention for the primary education exist for years, but would not benefit a sufficient support always.
The consumption of the medicines psychoactifs, so much by youngsters that by adults, merit more of attention. The production of these substances (inciting, calming, soporifics) doesn't decrease. The implementation of the recommendation of the task group Drugs - the reduction of the production of the medicines psychotropics until their increment for the public health - remained until now letter-dead. In this case, a certain number of initiatives has been taken in view of the reduction of the abuses (for example for the Rohypnol: the simple over-the-counter possession is penal, the elevated dosages are defended and the addition of a stain is obligatory). The commercial advertisement for the medicines psychoactifs is limited et,de more, strictly controlled.
In Belgium, the population has not been informed again sufficiently on the effects of the smart drugs, The royal decree of relative August 1997 29 to the manufacture and to the trade of food products composed or containing of the plants or preparations of plants bar the use of a certain number of plants (used often for the manufacture of the smart drugs) because of the serious harmful effects that they can have on the health of the consumers. The general inspection of the Food products does sporadic controls. The civil servants of the General inspection of the Pharmacy are, them also, loaded of the control of the respect of arrangements of the A.R. Research led to Netherlands reveals that the smart drugs is often consumed by the consumers of illicit drugs. The number of retail outlets of the smart drugs seems to have lowered.
3.3.5. Influence of the legal and illegal drugs on the behavior to the wheel
The countries dedicated to the influence of the drugs on the behavior to the wheel are especially targeted on the consumption of alcohol. Testify countries "VODKA" and "BOBSLED" of it. It is especially the concept "BOBSLED" that seems to produce some effects.
The law of March 16, 1999 modifying the relative law to the police of the road circulation is coming into force April 9, 1999. This law penalizes the driver having consumed the cannabis, the amphetamines and the amphetamines of synthesis, morphine and the cocaine. These statutory provisions remain however without effect if they are not put in practice and it is precisely this realization on the land that is subject to controversy. Some questions have been formulated thus by the "Middelengebruik task group in verkeersveiligheid" to the convention national "Drugbeleid 2000" that took place from October 1999 26 to 27 in Ghent. The effects of the use of legal and illegal drugs on the behavior to the wheel must be the subject of more advanced research. It is besides there about a strategic theme importing the European observatory of the Drugs and Addictions. Let's signal, in this context, the project European ROSITA (Road Side Testing Assessment) thrown in 1999, with for objective the critical assessment and founded scientifically of the consumption of drugs by the road-users. In the same way to the repressive approach, a growing attention must be granted to the preventive approach.
3.4. Aid, reduction of the risks and reinsertion
It is necessary to become aware because the problematic consumption of drugs so much legal that illegal represents a weak percentage of the total consumption of the population only.
Besides, it is not necessary either to pass under silence makes it that the polytoxicomanie (legal and illegal products) wins the land. It is essential that the aid and the prevention concentrate on this multiple consumption. For it, a survey deepened of the phenomenon is also necessary.
The difference between the consumption and the problematic consumption is bound to another factor destabilizing; wonder for example to a problem personality and/or a problematic environment. He/it remains however extremely important that the aid and the prevention don't worry solely about the consumption but target their efforts, maybe more again, on the set of the problematic of the drug addict on the medical, psychological and social plan.
The capacity of the aid services to the drug addicts spread this last time in our country. Besides the extension of existing initiatives, new projects have been thrown, notably for the formulas of aid down doorstep (MASS). It has been made mainly possible by a supplementary financing by the sector of health (the INAMI) and via the contracts of security and society. The coordination of the different initiatives difficult rest, notably because of the absence of a global politics concerning the drugs and the disparity of financing.
Belgium has a large range of facilities therefore to the different echelons of the aid. Distribution between these echelons and on the territory of the country is unequal enough. The aid down doorstep (as the work of the street educators and the reduction of the risks) is underrepresented always.
Harmonization sometimes deficient between the ambulatory aid and in institution remains a spiny point. For the sharp problems in the domain of the addiction, it would be necessary to put in place of emergency a supplementary capacity of crisis welcome in institution.
The attention granted by different actors concerned to the dialogue between the different facilities that the sector of the aid counts must be encouraged and must be developed. A coherent system describing all facilities lending aid to the drug addicts doesn't exist again to the federal level.
The integration of the specialized structures of aid in the general network of sanitary and social infrastructures (especially the CPAS, the CSM and of the physicians general practitioners) takes place more quickly than before in most cases. One notes, indeed, that the general medical and social services became more accessible to the drug addicts, what is a consequence of the numerous training schedules and retraining put in work. Of this fact, abstinence (the physical disintoxication) is not anymore a condition to get a lodging, an allowance or a formation. The regional differences are however important. It is why the development of networks must remain in the center of the preoccupations.
The collaboration between the aid and the justice in the setting of help to the customers of the justice remains a spiny problem. More and more, the points of contact between the aid to the drug addicts and the justice seem to exist to all echelons. The obligation of secret to which is held the intervening parties of the sector of the aid (art. 458 CP) in the justice-aid interaction must be specified. To this consideration, the structures of aid formulate some starting points: the customer must, again, to be in the center of the preoccupations (the measures must be imposed more in dialogue with the customer and his/her/its setting); some clear instructions must be elaborated for the intervening parties designated in the setting of the contracts of prevention and security;
a clear distinction must be operated between the activities of aid in the social optics, on the one hand, of the viewpoint of the security of the other; some protocols must finally be written specifying the exact content of information that must be communicated to the judicial processes. Similar protocols have, for example, been already elaborated by Centered them Alcohol voor in andere Drugproblemen Limburg (CAD), in dialogue with the local judicial services, in order to arrive quickly to a flexible collaboration without the obligation of the professional secrecy of the intervening parties is compromised.One notes, by the services of police and the justice, an awareness increased exclusively of the insufficiency of an intervention penal, especially in the case of a problematic consumption of drugs. The philosophy of the ultimate recourse wins the land even though it doesn't make the unanimity again and if it is especially in the big cities that the persons responsible of the justice tend the most often to resort to the sector of the aid.
The houses of justice play a more and more obvious link role in the relation between the penal justice and the aid the drug addicts. But, the network of justice houses as well as their operational setting being always limited currently, these structures are not again in state to concretize the recommendations of the task group Drugs (to know a fast regulation by the justice in case of social nuisances due to the drug).
The spiniest problems arise in the domain of the aid to the young. The dialogue is insufficient and the differences as regards to the methods and the clinical approach are pronounced too much within the facilities of aid to the drug addicts, on the one hand, and between the aid and the other infrastructures for the young, on the other hand. A multidisciplinary intersectorial accompaniment of course makes itself defect as cruelly, but this observation doesn't verify itself solely for the problematic of the drug. An accompanist should be able to follow and to come with a young and his/her/its family all along the course through the different services of health care.
The welcome of the young in the schools improved considerably thanks to the projects of prevention described here before (the sensitization as well as the clarification of school regulations and the strategy followed by the schools). But some young drug addicts are always excluded in some organizations non catégorielles (schools, residencies, hospitals, etc.). The reactions often intervene too quickly and are based solely on outside signs. One doesn't tempt to probe the underlying reasons of the behavior of these young sufficiently. If the establishment or the organization doesn't find a solution or if it made the tour of the internal methods, they often call too quickly on the centers of welcome of drug addicts. This is how get settled or are prolonged of real "careers" in institution.
These are not only the organizations say regular that refuse the young that have a problem of drug; the active institutions in the aid concerning drug also use some criterias to decide the admission of the young. When it is necessary to answer a demand of help (generally in situation of crisis), the young victims of drug problems often come up against a wall. He/it seems then there to have a waiting list because the team must first of all examine the case or then the profile of the young doesn't agree,… the young and their parents too often make themselves and too long to send back Caïphe to Pilate. The problem himself enlise and a lot of opportunities are missed that it will be necessary to tempt to seize again, later, in a lot more unfavorable circumstances. The existence of a black list is a crucial problem, for the young as for the adults. The services of aid generally refuse the young delinquents or the young presenting a psychiatric problem. So constitutes itself a group that risks to be put aside everywhere.
When a treatment is, eventually, all the same necessary, one notes within the ambulatory and residential structures the necessity to work in a specific manner with the miners of age. He/it is, indeed, advisable to separate the aid to the miners of the one given to the major adults. A first residential center of aid for drug-addicted miners has been accepted by the Flemish Community June 1st, 1999. In the extension of the treatment in institution, the follow-up dons a fundamental importance and it is precisely this follow-up that is not again enough often guaranteed.
The Services of help to Youth and the courts of youth are solicited to find an immediate solution. The absence of exam psychodiagnostique often clears on an inadequate and inefficient orientation decision. Some young drug addicts succeed thus in residential facilities as for example the communal institutions. If there is not any place in these institutions, they meet in jail. Of other youngsters affected by psychiatric syndromes clean to the youth and for which the use of drugs fact office of self-medication is sent in centers where the applied methodology is maladjusted. Already to this stage, the services and intervening parties who enter in action are so numerous that he/it becomes very difficult to accomplish an efficient clinical work and in depth.
These last years, new initiatives have been taken down in the setting of the so-called aid doorstep. The most important realization on this plan is the creation of the eight socio-sanitary welcome houses (MASS), distributed on the whole country. These centers guarantee a general access and are composed of multidisciplinary teams; they partially work "outreach." The necessity of such an aid down doorstep takes out again the considerable wage costs of several of these centers. A facet important of their action is the distribution of substitution products (especially the methadone), but this distribution is always associated to an accompaniment, psychological and social. They exercise a control on the distribution of methadone in the region while cooperating with the physicians and the pharmacists. On present hour, four universities value these centers; their assessment will be about the integration of the centers notably in the regional network of structures concerned. One waits for February-March 2001 for a synthesis of the results of the studies that will be accompanied by recommendations as for the politics to lead.
With regard to the treatment to the methadone, we note, on the one hand, a more and more open attitude on behalf of the physicians general practitioners with regard to this treatment, but, on the other hand, the absence of all legal regulation on the subject. On present hour, instructions of the conference of consensus of 1994 and a private bill of September 9, 1999 only exist. Instructions of the conference of consensus constitute a merely scientific basis of the methadone distribution. Although there is not anymore or whereas very rarely of the penal pursuits for the "penal maintenance of a dependence", the necessity to have a legal security on the subject makes itself feel all the same. It implies a general basis legislation so much that a regulation legal of the execution convenient of the distribution of methadone by the physicians general practitioners, pharmacists and competent centers. The collaboration of physicians and pharmacists with specialized centers down doorstep dons a big importance since the success of a treatment to the methadone often depends on the measure in which this treatment is framed by a psychosocial accompaniment. Let's note, besides, that the registration of the treatments to the methadone doesn't take place everywhere and that it is not certainly uniform.
The modification of the law governing the exchange of syringes, foreseen in an explicit manner in the Addiction-Drugs Action plan (1995) has been achieved finally. The decree of execution has also been published lately. The projects of exchange of syringes depend therefore more on the good will of the authorities and local processes. The first poles have been put in Flanders for what is concrete projects of exchange of syringes.. We also mention a project of prevention of the AIDS that applies to the drug addicts in the Eurégion to which are associated four organisms of aid of Liege, Aachen, Hasselt and of the province Dutch Zuid-Limburg. Such initiatives deserve to be multiplied.
For what is down the optimalisation of the aid offer doorstep, the discussion is not about the improvement of the offer anymore by the development of new initiatives, but well on the extension and the recognition of the existing offer.
A specialization according to groups target specific is developed itself within the structures of the INAMI. Thus, a section for the women with children, a program for the young and a section for the drug addicts presenting manifest psychiatric unrests saw the day. A MASS also orients with success his/her/its action on the prostitutes and the pregnant drug addicts. These are only some examples of projects enrolling in the present tendency that is feasible if the offer of aid is sufficient and if the policy makers wish it explicitly.
The recent developments in the sector of the aid to the drug addicts also create new needs. For the patients treated by means of high doses of methadone, that come from a crisis program, a handling adapted in institution is required. The drug addicts presenting, besides, a psychiatric syndrome (doubles diagnosis), find their place, that it is in the facilities of aid the drug addicts' with difficulty or in the psychiatric establishments. Besides, the number of projects appropriate to work for the people whose addiction is consolidated is insufficient and the specific programs for the drug-addicted convicts make defect.
3.5.1. Production and traffic of drugs
Ø The production of drugs
The internationalization of the production of legal and illegal drugs continues without interruption. More and more countries appear like states producers. This situation returns the proportionally more and more dependent economically vulnerable countries of the production and the trade of drugs. The illegal economy affects the socio-economic cloth and corrupts the political, financial and social institutions.
Internationalization encourages besides the increase of the production. This observation applies without a doubt to the synthetic drugs that knew, these last years and through the world, an exponential growth, so much to the level of the offer that as regards to the demand.
Another prominent observation is the increasing diversification of the production of illegal drugs in many states producers. The more and more lucrative character as well as the multiplication of the channels by which pass the traffic apparently plays in this respect a role activator.
The increase of the production of drugs especially observes itself in some regions characterized by the political instability, of the socio-economic problems and a bad working of the judicial and police processes. Many countries of central Europe and the East can be mentioned in this domain. Considering the proximity of the western market, this observation is menacing for the European union, especially in light of the widening projected of last lcette.
The respect of the international conventions that foresees a strict control of the trade of the precursors continues to pose problem. Besides, for the synthetic drugs for which the demand is considerable, the manufacture is not really very complicated. Some indications carry to believe that the production of stimulating products near of the amphetamines is controled, within the European union, by criminal organizations. Belgium doesn't escape unfortunately this evolution.
For what is cultures of substitution, the results remain very limited from a geographical viewpoint. Short-term, one can expect what the structural impact of the promotion of the substitution cultures remains reduces. However, the United Nations (PNUCID) and the European union (Action plan 2000-2004) pursue this strategy. With regard to the European union, all existing instruments (notably help to the development, the technical, financial and commercial instruments) are used, to the bilateral or regional level, to help and to put under pressure the states producers and/or the active states in the traffic of the drug in the setting of the implementation of initiatives valued by the United Nations and the European union concerning struggle against the drug. Belgium sustains the European politics concerning drug and therefore the action plan of the European union.
Ø The traffic of drugs
The annual pensions of Interpol and Europol permit to deduct the following tendencies with regard to the traffic of drugs to the European level:
· the growth of the production of illegal drugs (opiate, cocaine, cannabis, synthetic drugs) is translated by a proportional increase of the traffic of drugs. The most important growth especially concerns the synthetic drugs (ecstasy notably), and this so much to the level of the demand that to the level of the offer.
· The traffic of illegal drugs is controled by criminal organizations. One notices that the structure in cartel of the criminal organizations made the place to ad hoc groups, composed of members of various nationalities that weave some networks between them. Although numerous criminal organizations specialize in the traffic of a certain type of drugs, he/it develops himself/itself, in the same way to the polytoxicomanie, an increase of the phenomenon of the "polytrafic". To this consideration, the transportation of several types of illegal drugs takes place by a determined path. To the European level, one notes that the criminal organizations are in search of the shortcomingses of the legislation and the penal system of the countries of the European union.
With regard to Belgium, the following findings can be formulated, founded notably on the annual pension on criminality organized of 1998:
· On a total of 285 criminal organizations the object of an instruction or a judicial enquiry having made, 116 had like main activity the traffic and/or the production of drugs.
· A certain distribution exists in the trafic/la production of drugs. Of the Latin American groups, that essentially operate from Netherlands, control the market of the cocaine and partially the one of the cannabis. Some Turkish groups are to the head of the heroine's traffic. Some organizations criminal of Moroccan origin have a strong ascendancy on the market of the cannabis and the Nigerian organizations evolve so much on the market of the heroine and the cocaine that on the one of the cannabis. The market of the synthetic drugs (so much to Netherlands that in Belgium) is composed mainly by composed criminal groups of natives. The report of Europol notes that the criminal organizations to ethnic character often operate within their ethnic community. This last often acts as cover to their activities.
The phenomenon of the tourism of the drug or narcotourisme continues. In spite of the adaptation of the Dutch politics concerning coffee-shops, whose objective is to discourage the tourism of the drug, the consumers of drugs of the neighboring countries and France continue to get a stock in Netherlands. To the exception of the collaboration agreement finished "Hazeldonk" between Belgium, Netherlands and France, harmonized no politics has been developed again to fight way more or less structured against the narcotourisme. In a certain number of eurégions, a dialogue takes place between the provincial, judicial and police authorities, but it is not really question of a systematic approach of the narcotourisme. The ad hoc controls having for goal to advise against the narcotourisme take place, but the success of such actions seems rather limited and at most likely to dissuade the occasional narcotouristes. Until now, he/it is not question of a politics concerning the drug integrated transfrontalière concerning drug that, besides his/her/its repressive dimension, grant a place to the prevention and to the aid - has been proposed like that in the recommendations of the task group Drugs.
In most big cities, where the probability to be confronted to linked nuisances to the drug is the strongest, the local dialogue concerning drug, between all concerned sectors, has been thrown and developed, in a variable measure. Some cities elaborate every year a political plan concerning the drug. The recommendation aiming to refine the means of action of the burgomaster in case of disruption of the law and order following linked problems to the drug has been integrated in the law of May 13 (introducing the local administrative sanctions). This law modified the local law notably. In his/her/its art. 134 quater, the new law local deal to the burgomaster the expertise to close an establishment immediately (that is the reason of a disruption of the law and order). From a political viewpoint, he/it appears desirable to regulate a certain number of these possibilities explicitly to take some measures, was not that that to help the administrative authorities in this type of circumstances and to aim a certain strategic uniformity.
Belgium ratified the treaties and conventions of judicial help concerned structural on the minor help, the extradition, the transfer of the pursuits and the transmission of the repressive judgments in the meantime
Ø Introduction
In Belgium, too few scientific studies are dedicated to criminality and the nuisances bound to the drug. The official statistics only give a partial picture of the problematic. It is the reason for which it is impossible to have an approximate very idea of the size of the problem.
One can deduct various sources that criminality bound to the drug has the tendency to increase however. To all echelons - investigation, instruction and pursuits, fixing and execution of the pains - one observed during the last years an increase of criminality bound to the drug.
Following the recommendations of the task group parliamentary Drugs, the Minister of the Justice and the College of the attorneys general established the circular of relative May 1998 8 to the politics of the pursuits concerning detention and retail trade of illicit drugs. An assessment of the application of the circular teaches us what follows:
Ø The public prosecutor's office
The politics of pursuits leans on two pillars: the nature of the product and the size of the consumption. For what is the size of the consumption, the guideline leans on a vast conceptual setting: "limited detention in view of a personal consumption", "unique consumption", "problematic consumption" and "social nuisance." These different concepts aim an approach differentiated of the different shapes of consumption of drugs.
The guideline remains extremely wave as for the description of the different categories and let a too big power of appreciation thus to the public prosecutor's office. The consequence being that the public prosecutor's office define the aimed concepts differently.
For what is the concept "limited detention in view of a personal consumption", the public prosecutor's office use the divergent criterias that vary from a precinct to the other. The main used criterias are: the quantity, the results of the investigation and the social status and economic of the concerned person. The judicial antecedents are processed in a least measure. With regard to the quantity, the numbers given for the cannabis vary from 5 to 50 grams.
Some similar criterias are set in motion with regard to "the unique consumption."
One generally speaks of "problematic consumption" when there are persistence of the consumption, deficient socioeconomic integration and presence of other infringements.
With regard to the concept "social nuisance", the criteria the more often used is the existence of a criminality bound to the drug. The other criterias are extremely divergent, the most important being the law and order and the visible character of the consumption.
The concept "blows drugs to finance the personal consumption" lends him also to confusion. The criterias the most fluently set in work are the realized profit and the result of the instruction. Other criterias are the number of purchasers, the declarations, the type of product, the alleys and arrivals to the concerned person's address.
The vague character of this conceptual setting constitutes the substratum of an approach broken up. Every public prosecutor's office interprets the guideline according to the politics that it leads. He/it is not therefore on no account question of uniformity of the pursuits. The particularity of the circular resides precisely in the fact that, in the setting of the consistent politics, all is always possible, of the closing to the direct quote, and this whatever is the product.
The direct quote is used mainly in case of repeated consumption or at the time of the failure of an alternative mode of payment, essentially when a therapeutic treatment failed. In the same way, most public prosecutor's office are going to pursue in the case of a criminality bound to the drug. In this sense, the consumption of drugs is often considered like an aggravation for the other facts committed. Sometimes the individual situation is consideration through social investigations and the alternative modes are proposed. These last are not located so much to the level of the public prosecutor's office but concern the release rather under conditions, the suspension or the reprieve probationary.
The public prosecutor's office lead a different politics with regard to the consumers of the by-products of the cannabis that in opposition to the consumers of other products. For the consumers of cannabis, one has the most often resort to the penal mediation. The consumers of other products are generally pursued. The main arguments justifying this different approach are the risk for health, the attack to the law and order and to the security as well as the degree of dependence.
The business implying miners of age is transmitted to the sections "youth" of the public prosecutor's office. Generally, the parents are sensible and orientation toward the sector of the aid is followed better than in the case of the adults. The sale, criminality bound to the drug and the dependence is the subject of a return before the judge of youth.
The circular finally foresees the possibility to depart, in a motivated way, to his/her/its arrangements. The most frequent derogation concerns the recourse to the simplified minutes, this method of work being considered like bothersome by many magistrates. Other exceptions are justified by the public prosecutor's office on basis of the lack of times and means, next to the necessity to take into account the "local particularities".
Ø The alternative modes of payment
The transaction
For a certain number of consumers of drugs, the transaction only offers few perspectives since their life style hardly let them of financial means.
Besides, the effect of the transaction in the sense of a modification of the behavior or a sensitization is practically hopeless at the drug addicts.
The probation prétorienne
Since the introduction of the mediation penal, practically no public prosecutor's office doesn't apply this mode if it is not in a sporadic manner, in reason notably of the important wage costs that it causes. The magistrate of the public prosecutor's office is held indeed to receive the guilty party personally immediately after the facts and to expose the proposition.
He/it is to note that since the introduction of the circular news on the drug, some magistrates of public prosecutor's office rediscover the probation prétorienne and this because the penal mediation is not proposed anymore like possibility of regulation in case of simple consumption (therefore without criminality there pertaining). For most magistrates of public prosecutor's office, the circular didn't bring any modification on this plan, what comes back to say that the penal mediation is always applied with regard to the drug addicts who limit themselves to the use of drugs
The penal mediation
The penal mediation is relatively little applied by practically all public prosecutor's office with regard to the infringements to the legislation concerning drug and the linked criminality has the drug. One observes besides again often a "reflex of prudence" that drives to not to apply the penal mediation to the heaviest files. Most customers having already committed before serious criminal facts, they enter in contact with the aid by the slant of the probation conditions. The number of customers following a treatment in the setting of a penal mediation remained besides in general relatively reduced in relation to the total number of drug addicts.
For a big majority of the magistrates the modes of application correct of the circular are not very fattening pond. Many magistrates of public prosecutor's office estimate that the recourse to the penal mediation for linked offenses exclusively to the drug is not reconcilable with the guideline. On the other hand, other magistrates remain convinced that the penal mediation also must can be applied exclusively with regard to linked offenses to the drug.
The selection of the files entering in consideration for the penal mediation is not done by police's services but well by the office of the Prosecutor. The magistrates grant the interest necessary to the distinct inter-office memorandums that is often joined to the minutes however. These propose a selection of the files susceptible to be the subject of a mediation. These are especially the relative data to the drug addict's social environment who are considered like important to be able to anticipate on the odds of success of a mediation.
Some magistrates consider that the introduction of the system of the simplified minutes implies that, to determine the drug addict's profile, it will be necessary to lean more on the declarations of this last whereas before a lot of information could be drawn in the minutes.
There is not an unanimity on the question to know if the maximal delay of the conditions leash sufficiently of possibilities to adjust the files concerning drug. It explains itself by the diversity in presence at the time of the selection of people entering in consideration for a penal mediation. In the precincts where the mediation is also proposed for relatively serious facts, most magistrates of public prosecutor's office estimate that a delay of more than six months are sometimes desirable. However, if one reserves the mediation to the least serious cases, the length of this delay doesn't pose any considerable problem. The drug addict can always pursue on a voluntary basis a treatment started under judicial incitement, what is often in practice the case.
Even though the voluntary character is often mentioned among the advantages of the mediation, it is right to relativize this aspect within sight of the few of appeal that the alternative offers seriously (pursuits and/or the deprivation of liberty). In this optics one speaks sometimes of an implicit constraint. This situation of constraint often entails a reduction of the incentive on behalf of the drug addict. One underlines however that it is precisely the task of the intervening parties that to inflect the negative attitude in order to make she positive. The requisite incentive can be generated therefore progressively during the treatment.
It is striking to note that many drug addicts refuse the penal mediation knowing that the short prison sentences are not anyway executed. One deplores from the moment the concerned person's agreement is always required and that the alternative measure cannot simply be imposed.
Some drug addicts admitted once for all confrontations with the justice as being part of their life style. They are not therefore really motivated to modify this life style and to stop the consumption of drugs.
The number of direct contacts between the intervening parties and the magistrates of the public prosecutor's office are reduced, but the presence of a mediation helper as mediator is lived like positive.
The drug addicts to which the office of the Prosecutor offers a proposition of mediation are in general of the young. For most of them, the consumption is experimental or social. It is necessary to notice however that these drug addicts often have a varied judicial past (it is mainly about patrimonial offenses and, in a least measure, of aggressions). The measure proposed by the public prosecutor's office is not often adapted to the aimed drug addict.
Ø Police's services
The Belgian services of police are not competent to classify without continuation a penal fact and even less to associate some conditions there.
Yet, the technique said of the therapeutic opinion allows police's services, under the surveillance of the office of the Prosecutor, to orient the concerned persons toward the sector of the aid.
He/it is evident from the practice that the immediate orientation by the services of police of drug-addicted delinquents toward the aid puts a certain number of convenient problems. The main being the fact not to know toward what center how to direct the concerned persons and the fact that the specialized organisms of aid don't have a permanence. To remedy these problems, the task group Drugs had already suggested the creation of transit exchanges, to know centers of crisis and welcome for drug addicts where one would tempt to find a solution to the problems serious of dependence and where orientation toward the services of aid would be assured.
With regard to the autonomy of police's services, it is necessary to evoke the system of the simplified minutes, introduced by the circular, essentially. The use that one makes this mode varies police's service to the other. All depends eventually of the existence or no of specific instructions elaborated by the different public prosecutors.
The negative remarks especially milked to the loss of control of the situation and to the loss of time that ensues some. Of no put also in doubt the conformity with the Franchimont law. The regenerative feedbacks are about the easiness and the speed of reading of these P.V mainly.
In the practice, these are police's services that interprets in first instance the concepts used in the circular ("problematic consumption", "social nuisance",…). They decide in fact if a simplified minutes is necessary or no. All as the public prosecutor's office, they apply a whole set of criterias at the time of the definition of this concept.
The criterias used to determine "the problematic consumption" milked mainly to an insufficient social insertion and to a regular consumption that sometimes accompanies but not always of criminal facts.
The criterias used to determine the "social nuisance" are more or less homogeneous and concern the visible side of the consumption and the consumer's situation above all. Here the existence of other offenses also, committed in this setting is considered secondary but however more important than in the setting of the problematic consumption.
If one compares the modes of "global" interpretation of the two concepts by police's services and by the public prosecutor's office, he/it clearly appears that police's services focuses more on the law and order and the security, while the public prosecutor's office rather try to pursue the authors of infringements.
Many services of police wonder about the message that to make pass the guideline wants. A first tendency pretends that because of his/her/its lack of precision, the guideline causes, by the drug addicts, a feeling of impunity and that the law must be applied. Other bodies estimate that the intervention of the police services is sufficient in itself to recall the norm. Finally, some ask the questions facing the relatively important investments agreed by police's services with regard to infringements that are finally judged less important.
Ø The alternative mode of payment in the setting of the Law on the provisional detention: the conditional release
The application frequency of the conditional release varies very strong of a precinct to the other and an examining magistrate to the other. In a general manner, the committing magistrates are familiarized with this mode, but most setting in liberty only intervenes to the level of the Room of the Council. This recourse to the conditional release by the examining magistrate is yet more guarantor of a reaction adapted and especially sufficiently fast to the situation (of crisis) in which is the drug addict possibly. Most lawyers don't have the reflex unfortunately to ask for the release via the committing magistrate and generally wait for the opinion of the Room of the Council to get a liberation.
With regard to the conditions, the examining magistrates opt the most often for a treatment (of residential preference). This for the good and simple reason that a conditional release can only be proposed to the people entering in consideration for a detention awaiting trial that has, therefore, committed relatively serious facts. To this consideration, the examining magistrates estimate that the fact to be able to find not always in the 24 hours a suitable institution capable to shelter the accused constitutes a serious problem. He/it is a fortiori practically impossible in this delay to place the person concerned in a residential institution, especially as a preliminary interview is prérequis for this shape of aid. Since it is not possible to find a solution offering guarantees sufficiently immediately, one is often forced to go in a first time to the jail. It is only after one period of detention awaiting trial that the concerned person is transferred in a center of aid. This procedure is regrettable because it doesn't permit to use the potential of the conditional release maximally as immediate reaction to the situation of crisis of the drug addict.
The continuation reserved to the failure to respect of the liberation conditions constitutes a fundamental element. To this subject, it would be necessary to be careful to make at least appear the drug addict who didn't respect the conditions, so that the concerned person can always expect the judge's reaction. Although many examining magistrates try to react of the sort, the overcharge of work plays an important role in the big precincts.
The conditions are imposed for a length (extendable) of three months. In the practice, this delay is often extended, but rarely more than two times (except some precincts). It is necessary to underline nevertheless that the drug addict doesn't appear as a rule before the judge that after a long enough delay (one to two years). The one creates an emptiness concerning control and accompaniment of the drug addict, between the expiration of the delay of the conditional release and his/her/its appearance, on the occasion of which he/it could possibly see himself/itself imposing a measure of probation. He/it is underlined that, in some cases, the concerned person already leads quite another life style, what makes that the imposition of a possible pain doesn't have a lot of senses anymore. If the drug addict's situation is not himself even improved and that a treatment is imposed him in the setting of a measure of probation, there is not an interrelationship however with the treatment in the setting of the conditional release. This discontinuity has negative repercussions on the drug addict's treatment.
The collaboration with the institutions of aid varies from a precinct to the other. Some examining magistrates maintain narrow contacts with the sector, while others don't have practically any idea of the aid offer.
Most institutions of aid immediately warn the examining magistrate when a drug addict runs away. Other declarations seem more delicate. This is how the results of the analyses (interns) of urine are not practically ever transmitted and this because of the professional secrecy.
The first preoccupation at the time of the acceptance of the conditions seems to be to avoid the jail. One notes while the drug addict's incentive, that allows him to improve his/her/its situation really, grows as the treatment progresses. The drug addict's will must be met however of a manner corresponding to the concerned person's criterias: the drug addicts are often prepared to inflect the problematic aspect of the dependence, in other words to arrive to an use says controlled. The drug addicts don't see generally any objection to pursuing the consumption of by-products of the cannabis. This last observation is general and is worth therefore also in the context of the other modes of payment.
Ø The fixing of the pain
Next to the more aged clientele (mainly of heroine's consumers), many youngsters enter currently in contact with the services of probation. In their case, it is often about consumption of excitants (XTC, amphetamines, cocaine,…). This category must be the subject of a different approach. These young consider the use of these products indeed as "accepted by the society."
Although the wage costs improved this last time, only the problematic drug addicts are the subject of a permanent follow-up in most precincts. The important lapse of time that flows out between the facts and the efficient treatment of the business before the court constitutes a major problem. The drug addict have evolved effectively in the meantime and the aid can be indicated more after the condemnation. Besides, numerous sentences are not immediately executed. It can also have ominous consequences for the concerned person.
A certain competition between the different institutions of aid entails a real risk to see the sector of the aid undergoing the consequences of the "clean widening effect" (the number of drug addicts treaty is superior to what it should be actually).
In nearly all institutions, the recipients of a probation measure (probationnaires) constitute the biggest part of the total population of the customers of the justice. He/it would seem that the relation with the justice is already himself distinctly improved. Most institutions of aid mention the existence of reciprocal agreements that is about the obligation to establish some reports. The meetings take place regularly in some precincts, what is favorable to the understanding between the different concerned actors.
Compared to other drug addicts, the recipients of a probation measure are generally a little more aged. It is especially about consumers of hard drugs often having long antecedents of addiction and confrontations with the justice. He/it is almost always question of a criminality bound to the drug. These drug addicts often frequented already a large range of aid institutions.
Many drug addicts are always in progress worried as for the final result of orders of procedures having milked to other facts. A lot of between them fear to purge a pain again after the treatment. The fact to wait sometimes a long time for the execution of a pain pronounced returns some drug addicts a lot of insécurisés. The expenses of justice also cause them a lot of worries. The confrontation with these pains or these expenses often intervene unexpectedly (most consumers don't have the least idea of the number of orders of procedures in progress and, a fortiori, are not capable to anticipate the expenses of justice remaining to pay). It is therefore important to be informed correctly as for the state of advancement of the procedures. Even though the lawyers play an important role in this domain, he/it is also interesting that the helpers of probation inform as much that possible the concerned persons as for the possible future expenses.
Finally, the existence of a police record also causes some problems. Even though some feel little difficulty to find work by the slant of an interim agency, it is difficult to pick up a steady use when one possesses a police record.
The problem of the addiction is always as crucial in the jails. During the last two years, the development of a penitentiary politics of struggle against the drug has been relegated somewhat to the second plan because of the attention as a priority dedicated to the problematic of the sexual delinquency.
The penitentiary politics concerning drug is until now principelement targeted on the illegal drugs. The problems bound to the alcohol and the medicines are hardly evoked.