1. Introduction and definition of problem

1.2. Current situation and evaluation

In assessing drugs policy in the Netherlands the main consideration must be the results achieved in practice. Because of the illegal nature of drug use, statistics on it depend on estimates compiled on the basis of information from the police and care agencies, among others. However, there is an unknown "dark number" of drug users who have no contact with any official body. Estimates of the real extent of drug use are often based in part on population surveys. Those questioned may not always admit to drug use, however, again because of its illegality. Moreover, the most problematic groups in particular are often under-represented in the sample populations used.

In general, it can be assumed that the less illegal the use of a drug is, the more complete the picture will be which the authorities and researchers have of such use. As stated previously, the use of soft drugs was decriminalised in the Netherlands in the 1970s. It is true that the use of hard drugs does involve some illegality but care is easy to obtain throughout the Netherlands. Care agencies assume that they have regular contact with at least two-thirds of all drug addicts. As a result, the authorities in the Netherlands has a much better picture of the extent and nature of drug use than do those in other countries.

If one considers the available statistics on the use of drugs in various countries against this background, the following picture emerges.

The extent and nature of the use of soft drugs in the Netherlands does not differ from the pattern in other Western countries*. In recent years use has once again been considerably higher in other countries (including the United States) than in the Netherlands. This is also true as far as use among minors is concerned*. The decriminalisation which took place in the 1970s did not lead to an increase in the use of soft drugs among young people then either. The Dutch objective of protecting young adults who wish to use soft drugs at a certain stage in their lives from the world of hard drugs has also proved to be a realistic one. Only a very small proportion of the young people who use soft drugs make the transition to hard drugs.

The view held by some that the use of cannabis products alone causes a physiological or psychological need to use hard drugs as well - what is known as the stepping stone theory - has been belied by actual developments in the Netherlands*. Dutch young people who use soft drugs are perfectly well aware of the greater dangers of using hard drugs such as heroin and have no great desire to experiment with them. In the Netherlands the percentage of soft drugs users who also go on to use hard drugs is relatively low. In the light of these findings the stepping stone theory should be regarded as one of the many myths in circulation about the use of drugs, though one which under certain circumstances could become a self-fulfilling prophecy: by treating the use of cannabis products and hard drugs such as heroin and cocaine in the same way may in fact make it more likely that cannabis- smokers will come into contact with hard drugs. Moreover, equating the one with the other undermines the credibility of the information provided about drugs to young people.

No matter how much opinions on drugs policy may vary, there is a broad consensus on the ultimate criterion according to which the effectiveness of any national drugs policy should be measured. This is of course the number of hard drug addicts, especially the number of hard drug users under the age of 21, and changes in those numbers.

Tabel 1 provides an overview of the estimated number of hard drug addicts in various countries.

International comparative prevalence figures on hard drug addicts

Sources: Bosman and Van Es (1993); Bless, Korf, Freeman, Urban drug policies in Europe 1993 (1993); WHO regional office for Europe, European summary on drug abuse, first report: 1985-1990 (1992); Commis- sion of the European Communities, Second Report on drug demand reduction in the European Community (1992); Bossong (1994); Van Cauwenberghe et al. 1993 (Belgium).

Various experts estimate that there are about 25,000 hard drug addicts in the Netherlands*. This is equivalent to 0.16 percent of the population. As stated above, this estimate is reliable, partly because in the Netherlands care agencies manage to maintain contact with a relatively high proportion of drug addicts.

It is not possible to make a clear comparison with estimated numbers of hard drug addicts in other European countries because of methodological uncertainties but it is likely that the "dark number" is higher in certain other countries, where care agencies reach fewer addicts, than it is in the Netherlands. The estimates which do exist, however, suggest that the number of hard drug addicts per 100,000 inhabitants in the Netherlands is low in comparison with the European average of 2.7 and indeed considerably lower than in France, the United Kingdom, Italy, Spain and Switzerland, for example. Annex I contains an overview of the estimated numbers of drug addicts in a number of European countries, according to a number of sources. All estimates suggest that the number of addicts in the Netherlands is relatively low.

What is particularly pleasing is that in the Netherlands the number of heroin users under the age of 21 is relatively low, even among vulnerable groups, and has continued to fall in recent years*. Nor has the use of cheaper forms of cocaine made any real inroads as was feared a few years ago on account of developments in the United States and elsewhere*.

Increases in the numbers of young users are probably partly prevented by the "loser" image which has come to be attached to heroin addicts. The presence of older addicts who are in a serious state of degeneration in some socially disadvantaged neighbourhoods constitutes compelling propaganda against the use of heroin. The lack of repressive action by the police against addicts purely on account of their drug use and the ease with which they can obtain the substitute methadone prevent the lifestyle of addicts being seen by young people as an expression of social or cultural rebellion.

The number of fatalities resulting from drugs overdoses in the Netherlands is small. According to a report by the United Nations, 42 people died in the Netherlands from drugs-related causes in 1991. The figure for Belgium was 82, Denmark 188, France 411, Germany 2,125, Italy 1,382, the United Kingdom 307 and for Spain 479. In the United States there were 5,830 such deaths*. The number of deaths from drugs per 100,000 of the population is thus at least twice as high in other countries as it is in the Netherlands and here, unlike in other parts of the world, it is not rising.

The Netherlands also has a relatively small number of people suffering from AIDS among its drug addicts. In southern European countries in particular, the percentage of drug users who are infected is considerably higher. The accessibility of care services, including needle exchange systems, and the broad public information campaigns which have been conducted, have resulted in considerable risk reductions in intravenous drug use. The proportion of drug addicts in the total HIV positive population is relatively small*. Research has shown that almost 60% of heroin-addicted prostitutes now use condoms, as against 20% in 1986*. This also has the effect of helping to prevent the spread of AIDS outside high risk groups.

The Netherlands thus also compares favourably with neighbouring countries as regards mortality and morbidity among addicts. The harm reduction policy, including the large-scale methadone programmes and needle exchange systems, which was started in the Netherlands in the 1970s, has been relatively successful. It has also helped limit the spread of the AIDS epidemic.

All in all, it may be legitimately concluded that the Netherlands' policy on drugs has had some practical success in health terms.