DEVELOPMENTS IN DRUG USE
Recently, a large part of the XTC research programme aimed at providing an authoritative survey of the medical and pharmacological effects of XTC', was completed. The Netherlands is the first country to carry out such a broad study. The Minister of VWS has sent an extensive summary of the results of the study to the Lower House under separate cover.
This Chapter begins by describing the core information of the study, followed by the policy conclusions.
Core information of the study
Among pupils aged between 12 and 18, the regular use of XTC in 1996 was 2.2%. However, the use of XTC in the specific group of young people who attend large-scale parties appears to be considerably higher. Approximately 65% of the party-goers (average age of 20) took XTC on the evening/night of the party.
XTC is used less frequently in regular clubs and discotheques than it is at parties. However, among those patrons of clubs and discotheques who use XTC, the excessive use of the drug occurs more frequently than it does among party-goers.
Despite the high use figures, the fact must be taken into consideration that the number of incidents at parties is low. Taking pills results in few casualties that end up at the First Aid post. Likewise, the extent and gravity of clinical incidents is limited.
Heat prostration, occasionally combined with muscular complaints or liver failure, is the most frequent of the few serious problems that occur.
In terms of limiting safety and health hazards, the large-scale parties score significantly higher than the regular clubs and discotheques. This positive result has to do with the implementation by city governments of the memorandum 'City Hall & House'.
XTC is a potentially toxic substance. The risk factors for acute complications lie in the questionable chemical composition of an XTC pill, the circumstances under which it is taken, and individual factors.
A literature study was carried out as part of the research programme. The results of this study raise concern about the possible neurotoxic effects of the drug in the long term.
There is also reason to believe that participating in traffic after taking XTC is extremely hazardous (concentration problems and fatigue).
The findings of the study do not support the hypothesis that testing pills at parties encourages the use of XTC. From a chemical point of view, testing pills on-the-spot is certainly not ideal, but given the circumstances, it is the best that can be done. At least it offers some insight into the gravity of the risks involved in using XTC. Moreover, testing offers a good opportunity for making contact with users to provide them with information and for taking preventive measures. The Drug Information and Monitoring System (DIMS), a project of the Trimbos Institute, also tests pills. The purpose of this project is to quickly trace new developments in the use of drugs, the way they are taken, combinations of substances, and the quality of drugs. The DIMS project has proved to give a reliable picture of the market.
Conclusions for policy
The study results are unequivocal about the fact that XTC use is never safe.
The results of this extensive study underline the importance of continuing the current integral approach which owes its strength to the balance between prevention and repression. This balance is quite delicate. One-sided policy changes could disturb this balance bringing with them all kinds of negative consequences.
For example, the considerable extent to which XTC is used at large-scale parties could be seen as a reason to simply prohibit these parties. This would eliminate an important structural opportunity for drug use. Moreover, in this way society would be making its disapproval very clear. However, a prohibition of this kind would not only ignore part of the youth culture, it would probably also result in a shift to illegal use, to use in regular clubs and discotheques, and use in the home.
In so far as that there is any limiting effect on the extent of XTC use, this probably goes hand in hand with increased health hazards and a decrease in the scope for public information and prevention efforts. Taking into account the fact that it is up to local government bodies to allow or prohibit parties, a national guideline to prohibit parties is not expedient.
The results of the study confirm the need for the XTC campaigns planned for 1998 aimed at both young people and the general public (particularly parents and educators). Preparations for the youth campaign have already begun. The tone will be probing.
The purpose of these campaigns is prevention in the general sense aimed at discouraging XTC use in a clear-cut way. The message is: even pure XTC is never safe - simply don't take it! This form of prevention is aimed particularly at young people who have not (yet) taken XTC, and at the general public.
On groups who already regularly use XTC (such as party-goers), we can expect that this deterrent message will, at the most, have a limited effect. Consequently, more specific prevention strategies aimed at the high risk population, focus mainly on limiting injury. On the basis of the study findings, various specific warnings will be incorporated in the information message.
The Support and Information Center for Drugs and Safety (SIDV) has produced an advisory paper with respect to updating the memorandum 'City Hall and House'. On the basis of this paper, the Minister of VWS will ask the SIDV, together with the National Support Center for Prevention, to initiate two studies. The first study will look at ways of making the implementation of the recommendations in this memorandum a matter of greater obligation. The second study will concentrate on finding ways of also implementing the recommendations in regular clubs and discotheques.
At the request of the Lower House, the Minister of VWS has also asked the SIDV to inform her about the possibility of imposing age limits for house parties. From the above-mentioned advisory paper it appears that, in practice, many cities and organizers of house parties are already themselves imposing an age limit for house parties.
The Ministry of VWS, the Ministry of Transport and Public Works, and the Ministry of Justice have begun talks to develop an integral approach to the problems caused by XTC and other drugs in the traffic. First, it is necessary to obtain more insight into the nature and magnitude of the problem. On the basis of further research, including a specific study on the effects of drugs on driving ability, these departments aim to develop a plan of action.
The possibility of a campaign to discourage drug use in the traffic is being looked into in consultation with the Dutch Road Safety Association (VVN) and the NIGZ.
Because of the indications of neurotoxicity, the Minister of VWS has asked the Center for Human Drug Research in Leiden to carry out further studies. The results of these studies will be available at the end of 1997 and will be incorporated in the public information campaigns.
The report underlines the necessity of adequate monitoring and further study. In particular, these will have to focus on maintaining the balance between efforts to discourage drug production and trafficking on the one hand and efforts to limit the injury to health and social status sustained by drug users and the people in their environment on the other hand. Furthermore, with respect to XTC, the question of the nature of the interaction between drug control and the appearance of 'dodgy' pills keeps cropping up. Over the past months, DIMS has drawn attention to a considerable deterioration in the quality of XTC pills. For the Minister of VWS this, also bearing in mind the developments that can be expected in the field of 'new' drugs, is cause to follow these developments closely and to analyze the trends and causes in greater detail.
The Public Prosecutor's Office will make use of the results of the XTC study in its deliberations about the development of policy with respect to XTC trafficking, use and testing at house parties and other entertainment venues.
1.2. Drug use among high school pupils
On 19 June 1997, the Trimbos Institute published the core data of the sentinel surveys on alcohol, tobacco and drug use and gambling among high school pupils2.
The use of cannabis has continued to increase, as was expected. Both the life-time prevalence and current use have risen. In 1996, 11% of all high school pupils had taken cannabis at least once during the four weeks leading up to the study. In 1992 this figure was 7%. These current users often do not 'blow' more than once or twice a month. However, 2.5% had taken cannabis more than 10 times in the previous four weeks.
However, in many other Western European countries, and in the United States, we see an increase in the use of cannabis. A review of studies carried out among high school pupils in various countries will be published at the end of 1997. From the data that is available so far, it is striking that young people in the Netherlands do not differ significantly in either a negative or positive sense from young people in other countries. Where, in the latest Trimbos survey, 13% of Dutch high school pupils had used cannabis in the preceding month, the corresponding figures for England and the United States were 24% and 21% respectively.
From the figures of the European Monitoring Center for Drugs and Drug Addiction (EMCDDDA) in Lisbon it appears that, as far as cannabis use is concerned, high school pupils in France and Spain are not (very) far behind their Dutch peers either.
XTC was and is the most popular hard drug in the Netherlands. Among high school pupils, 5.6% have had experience with this substance and 2.2% had taken it in the four weeks preceding the survey. Although amphetamines are taken less frequently than XTC (1.8% had taken it in the past four weeks), the rise in use is striking; in 1992 the percentage was 0.6%. XTC users in particular, are increasingly taking amphetamines, often in combination with XTC.
The number of young people who have ever tried hallucinogenic mushrooms is 4.2%, and those who had taken them in the past four weeks was 1.5%.
The use of tobacco and alcohol among high school pupils is increasing. In 1996, 28% of high school pupils smoked, which is 4% more than in 1992. It would seem that smoking has become more popular among young people than it was a few years ago. Given the fact that hashish and marijuana are usually smoked, an increase in the number of young people who smoke tobacco leads to a larger number of potential cannabis users.
Alcohol use in the past four weeks prior to the study had also risen from 42% in 1992 to 52% in 1996. It is striking and alarming that one out of three high school pupils consumed more than four glasses of alcohol at the last available opportunity, whereas in 1992 that was only 12%.
Conclusions for policy
The gradual increase in the use of drugs - and also in alcohol and tobacco - among high school pupils is an alarming development. Notably, this development is also seen in many other countries, including countries with a much more repressive policy than ours. International trends in youth culture appear to have a significant influence on use patterns. Public information about the dangers of drug use is the most important policy instrument that can be used to try to reduce drug use. The message must be that all drug use is discouraged, including drugs that - apparently - do not cause extensive damage and degeneration. It is precisely with respect to the use of cannabis, XTC and the 'new drugs' such as mushrooms that this misunderstanding can occur in young people.
For this reason, high priority is given to intensifying and improving the quality of prevention work. For plans in this regard the reader is referred to Section 2.6.
In the course of the discussion of the 1996 Progress Report, the Minister for VWS was asked to comment on reports concerning the possibility that the use of cannabis by young people would lead them to switch to crack. As a result, a separate policy memorandum entitled 'Crack/Cooked Coke ' was submitted to the Lower House.
Because there is confusion about the terms crack and cooked coke, the policy document offers a more precise definition of these terms. The conclusion is that both terms refer to smokable cocaine, that both contain the same ingredients, and that both have the same effects. The policy document goes on to review the development of the use of crack/cooked coke in the Netherlands. From this review it appears that users have been making smokable cocaine themselves since the beginning of the eighties. However, from the beginning of the nineties, this cocaine variant has been available ready-made on the illegal drug market. Smokable cocaine is encountered more and more frequently within the group of marginalized drug addicts. There are indications that, to a very limited extent, crack/cooked coke is also consumed by people outside the group of multiple drug users. This concerns the fringe group of young people, homeless people, and male prostitutes. There is nothing to indicate that the intensive use of cannabis leads to the use of crack.
The Trimbos Institute has initiated a public information and prevention project to survey the control mechanisms employed by users and to find out which prevention strategies are effective and therefore necessary. Furthermore, the Rotterdam Health Authority (GGD) is developing a care project for the group of problem users in that city.
There are indications that, owing to the specific Dutch situation, the extreme consequences of crack use as seen in the United States are unlikely to occur in the Netherlands. In the Dutch situation, crack use is limited almost completely to multiple users who also take drugs that have a suppressant effect. Furthermore, the extent to which assistance programmes succeed in reaching users, the relatively limited repression in relation to individual users, and a certain stability on the drug market are important factors that contribute to limiting the risks.
1.4 Smart Drugs, Smart Products and Eco-Drugs
"Mankind has been using mushrooms with hallucinogenic effects for thousands of years, but their large-scale cultivation and sale is a new phenomenon..
Consequently, on no account did the Minister want to underestimate the use of mushrooms. After all, there is no such thing as a harmless drug."
Report, Parliamentary Debate on Drug Policy, 28 January 1997
Smart drugs are not drugs in the true sense of the word, smart drugs are medicines that are prescribed for various illnesses such as Alzheimer's disease, Parkinson's disease and Korsakov's syndrome, etc. These medicines come under the Medicines Act and are not sold in smart shops. Eco-drugs, such as hallucinogenic mushrooms, Kava Kava and Yohimbe are vegetable substances that can
produce a psychotropic or physical effect. The term 'smart products' refers to substances that are composed of multiple ingredients. Their effects can vary considerably. Some smart products are highly stimulating, and others induce a mild form of excitement and/or euphoria. Finally, smart shops sell energy drinks, vitamins, minerals and food supplements. Generally, smart drugs, smart products and eco-drugs are new substances for new markets. It is not always clear which laws and regulations apply to these substances or whether we can refer to them as 'drugs' in the usual sense of the word. In addition, there is often insufficient knowledge about the risks involved in using these substances.
The Cabinet is following the developments concerning the use of these new categories of substances closely, not in the least because their use is increasing.
For this reason, the Cabinet has assigned a committee the task of drawing up a memorandum which will clarify the situation with respect to the current regulations, possible health hazards and regulatory instruments. The cabinet will send this memorandum to the Lower House in the autumn.
1Unless stated otherwise references to XTC also include XTC-like substances
2 Data on smoking, drinking, drug use and gambling among school pupils of 10 years and older, from the 4th Sentinel Survey on the use of hazardous substances, Trimbos Institute, May 1997