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.
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
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.
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.
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.
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.
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.
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.
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.