From: [r--p--a] at [dataweb.nl] (Ferry) Newsgroups: alt.drugs,rec.drugs.cannabis Subject: Re: Failure of the Dutch drug experiment Date: Fri, 19 Apr 1996 01:29:14 GMT To give everybody a little insight in the idea's from the Dutch in drug matters, is here a conference piece from out "House of commons" or "tweede kamer" . Actually TWO of those pices! 1 About drugs in general and nr. 2 about the prescription of heroin to older heroin users. No bullshit just what was said in debate. One remark: Just before this debate, the French president Mr J Chirac had started his blackmail campagn against the Dutch coffee shops. As you can see, he was a bit succesfull: Holland is not as bold anymore. They desperately want to be in the Europe-game so, they are trying to play ball..... See for yourself:.......... Drugs Policy in the Netherlands Future Policy 1. Introduction and definition of problem 1.4. Principles of future policy Given the relatively good results which have been achieved, we do not believe that there is any reason for a fundamental re- examination of drugs policy in the Netherlands, which is primarily geared to controlling the harm done to people's health. Equally there is no need for any major amendments to it. Radical amendments might even have the reverse of the intended effect and harm health. However, the three complications discussed above - the nuisance problem, the involvement of organised crime in drug trafficking, and foreign criticism of certain external effects of the policy - do mean that a careful analysis of the problems which arise from the way in which the policy is implemented must be carried out, and adjustments made where necessary. It was agreed in the government policy accord that the relatively successful Dutch approach to the drugs problem should be continued, although new nuances should be introduced and new avenues explored. The control of nuisance was to receive particular attention. The policy also needs to be amended in line with the constantly changing circumstances as regards both supply and demand in the various drugs markets. Changes in the composition and social background of user groups and the arrival of new drugs mean that new measures are required. The stabilisation of the heroin addict population in the Netherlands now means that care for addicts must be directed at older clients with serious physical and psychological problems. As has already been said, the popularity of heroin among young people has declined enormously; at the same time, the number of people addicted to primary cocaine appears still to be small. Designer drugs, such as ecstasy, on the other hand, are increasing in popularity, both at events such as raves and elsewhere. These drugs require a different approach. Finally, the attitude of the general public to drug addicts also appears to have changed. On the one hand, people have to some extent got used to certain forms of drug use; on the other, drug addiction is less and less regarded as an excuse for causing damage or harm to others. People are now less tolerant of crime, nuisance and other anti-social behaviour from drug addicts. Precisely because drugs policy in the Netherlands is so pragmatic we must be very open, critical and flexible in our response to these changes. Appropriate - that is to say realistic - answers must be found to the complications which have arisen and to the new trends. As part of the debate in the Netherlands on the complications arising from drugs policy, it has been suggested by various commentators that the sale of both soft and hard drugs should be largely or even totally legalised.The government has consulted on the desirability and feasibility of the legalisation proposals and has reached the following conclusions. In accordance with Dutch views on the harmfulness of the various forms of drugs, a distinction should be made between the legalisation of hard drugs and that of soft drugs. The harmfulness of hard drugs means that there must be overwhelming objections to any policy amendment which might result in an increase in the number of users, on account of the health risks. Those in favour of legalisation are too inclined to ignore this objection. Although we cannot be certain about this, there must be a danger that legalisation, irrespective of how it was carried out, would increase the availability of the drugs in question and act as a signal to young people that such drugs were not so harmful after all. There would then be a risk that more young people would start to use hard drugs and so become addicted. The government is not prepared to take that risk. There are other arguments against legalisation too. After any form of legalisation it is probable that prices on the legal and any remaining illegal markets for hard drugs in the Netherlands would be considerably lower than in neighbouring countries. In such a situation it is inevitable that the drug tourism, which is already so bitterly resented by the governments of neighbouring countries and indeed by local authorities in the Netherlands, would increase. The nuisance caused by drug addicts would not then fall but might even increase further. It must also be feared that the aim of reducing criminal drug trafficking by selling hard drugs legally would turn out to be unattainable if it was only in the Netherlands that such drugs were legalised. At present, supplying the domestic market in the Netherlands is only one of the activities of the large criminal organisations. While a lucrative market for illegal drugs continues to exist elsewhere in Europe, the Netherlands, as a centrally situated transit country, will continue to have to deal with illegal drug trafficking by Dutch and international criminal organisations, and the need to take measures to combat this. Any advantages of legalisation would probably only emerge if other countries followed the same path. Moreover, it is anything but certain that even in that situation the criminal organisations would become less active. Many would simply shift their criminal activities to other sectors. In short, the government rejects the idea of legalising hard drugs. The Netherlands believes that the health arguments play a role in respect of soft drugs too but they are less serious than in the case of hard drugs. It has been demonstrated that the more or less free sale of quantities of soft drugs for personal use in the Netherlands has not given rise to levels of use significantly higher than in countries which pursue a highly repressive policy in this regard. The difference lies in the fact that cannabis users - often young people - are not regarded as criminals in the Netherlands. The effects of using cannabis are less harmful than those of using hard drugs. Nevertheless, there are dangers attached which can affect young people in particular. The obvious comparison is with substances such as nicotine and alcohol and this will have to be reflected in policy. We endeavour to curb the use of nicotine and alcohol by limiting supplies to a certain extent and by discouraging people from using them through information campaigns and in other ways, but there is no general prohibition. Nor do we considerable it desirable for all coffee shops to be closed, but the complete legalisation of the sale of cannabis would be equally undesirable. Policy will aim to discourage the use of soft drugs as far as possible, for example by limiting the number of coffee shops, imposing a minimum age for persons wishing to buy soft drugs, prohibiting the establishment of coffee shops near schools and by providing more public information on the negative effects of cannabis. Against this background, the preferred option might be a model in which supply was monitored by the state or strictly regulated in some other way. The analogy with the old opium monopoly of the authorities in the Dutch East Indies springs to mind. However, the introduction of any kind of permit system for the cultivation of cannabis would mean that it would have to cease to be a criminal offence - in other words, it would have to be legalised. After all, the Netherlands government cannot issue permits for or itself be involved in the commission of an offence. As explained in to this policy document, experts in the field of international criminal law are of the opinion that the international agreements ratified by the Netherlands leave no scope whatsoever for legalising the sale of drugs for recreational purposes. The 1988 UN Convention in particular compels states party to it to make the cultivation of cannabis a criminal offence. Under the terms of the Schengen Agreement the UN opium conventions must be complied with in full. Other states party to those agreements and the international organisations concerned cannot be relied upon to be accommodating in their interpretation of the Netherlands' international obligations. Legalisation would require the Netherlands not only to denounce the UN conventions in question, but also the Schengen Agreement, which requires that those conventions be adhered to. The introduction of a permit system is a route which cannot be followed on account of current obligations under international law. At the same time, it must be remembered that it is neighbouring countries which would be affected by the external effects of such a policy. For example, it is to be feared that some of the regulated supplies would always illegally be siphoned off to other countries. Legalisation of the cultivation of, trade in and sale of soft drugs would also, because entrepreneurs would no longer run any risk of prosecution, result in still lower prices on the Dutch market, which would in turn result in more drug tourism. For the municipalities along the borders that too is likely to be a prospect which is anything but attractive. Both because of international obligations and the high level of mobility of people within the European Union, which continues to increase, the degree of availability of drugs in the Member States can only continue to differ within certain limited margins. The debate on the legalisation of drugs has thus become an intrinsically European one and one which must also be pursued within the European framework. The Netherlands can of course play an active role in that debate, for example in cooperation with certain of the German "lander" and in response to the above- mentioned report from the French Henrion committee. We will continue to do all we can in this context. Given the current situation, however, the government does not believe it would be acting responsibly if it were to go it alone and legalise the supply of soft drugs while neighbouring countries did not. We do believe, however, that the time has come for clarification of the limits within which people running coffee shops may carry on their activities, taking into account the options available under international law. The coffee shops have justified their existence in the Netherlands over the last twenty years and now need to be regulated. This does not only mean refining the Public Prosecutions Department guidelines on the detection of offences and prosecution of offenders under the Opium Act, but also the introduction of administrative regulations Tweede Kamer, vergaderjaar 1994-1995, 24077, nrs. 2-3Ministerie VWS Okay here's the second piece: sorry for the html format, didn't have a conversionprogram at hand. Have fun though! Provision of Heroin of medical grounds

3. Prevention and the care and treatment of addicts

3.7. Provision of heroin on medical grounds

The nature of the problem of seriously degenerate and sometimes seriously ill addicts is different again. The constant presence of such addicts means that new methods of intervention are needed, especially in the Netherlands, where the average age of addicts is relatively high. There are those who advocate that such addicts should be admitted to clinics for treatment on a compulsory basis (on medical grounds) and there are others who believe that they should undergo compulsory treatment in prison on account of the drug-related crime they commit.

Experts consider that it would only be possible to admit a very small number of addicts to clinics under the terms of the Psychiatric Hospitals (Compulsory Admission) Act (BOPZ). Addiction in itself is not a mental illness. Most addicts could not be diagnosed as mentally ill on valid grounds. However, there is a relatively large number of psychiatric patients among the most degenerate addicts. On the other hand, mentally ill people who have been heavily addicted to drugs for a long time are usually difficult if not impossible to treat. The options for admitting more addicts to closed clinics for treatment are therefore extremely limited.

The amount and nature of the crime such people commit are not so serious as to warrant placement in a forensic addiction clinic or the coercion and dissuasion approach on the grounds of the criminal nuisance they cause.

On 7 June 1995 the Vice-chair of the Health Council presented a report to the Minister of Health, Welfare and Sport on prescribing heroin for addicts; the report was brought to the attention of the Lower House. The Committee on the Use of Medicines in Drug Addiction, which drew up the report, concluded that, in view of the fact that insufficient scientific data was available on the effectiveness/harmfulness of prescribing heroin on medical grounds to any type of addict within the current heroin addict population, it was desirable for research on the subject involving a medical trial to be conducted in the Netherlands. The Committee believed that addicts who were seriously addicted to heroin and who did not respond adequately if at all to the medicinal treatments currently available should be eligible to participate in such a trial. They did not believe the length of time a person had been addicted to be of decisive importance, though addicts wishing to take part should have participated repeatedly and without success in treatment programmes aimed at using medication to stabilise their condition and prevent them relapsing into addiction. The aim of the trial would be to examine whether such addicts can be stabilised through the prescription of heroin, whether their physical and psychosocial wellbeing can be improved, whether their use of additional drugs can be reduced and whether they can perhaps be motivated to give up their addiction.

The Committee advised that the medicinal use of heroin should be compared with the currently most common form of medication, oral administration of methadone. If desired, the heroin to be prescribed can be combined with oral methadone. The trial should involve both injectable and non-injectable heroin. This means that the research project must be structured in such a way that in interpreting the results account can be taken of the different forms of administration and the differences in the euphoria arising from them. Naturally, the trial must meet all the requirements of good clinical research.

The Committee recommended that the trial should be conducted by the existing care organisations. Consideration could be given to carrying out the research in a number of locations at the same time, and not only in the big cities; in principle, it would then be possible for the protocols to differ in parts one from another. Too many locations should be avoided to ensure that the project does not become unmanageable. Scientific evaluation of the trial should be carried out by an independent research organisation. The Committee considered it advisable that the research protocol should be submitted not only to a committee on medical ethics but also to an international committee of experts. In view of the importance of such a study and the need for coordination, the Committee also recommended the establishment of a national monitoring committee.

The Committee advised against giving addicts the heroin prescribed to take away with them and stressed that ceasing to prescribe the drug upon termination of the study could present problems. Experience had shown, the Committee added, that such problems could largely be avoided if a contract were concluded with each participant in the trial stating the purpose of the trial and its duration, plus the rights, obligations and responsibilities of both the patient and those treating him or her. The Committee also advised that research should be conducted into the possibilities that other opiates producing euphoria might offer in the treatment of heroin addicts, particularly those which are available or can be made available in a form which is easy to administer.

We share the Committee's basic idea, that a medical trial into the effectiveness and harmfulness of prescribing heroin to heroin addicts is desirable, given that insufficient scientific data on the subject is available.

We are also able to agree in principle with the target group for such a trial, as formulated by the Committee, namely individuals who are seriously addicted to heroin and who do not respond adequately if at all to the medicinal treatments currently available. Partly in view of the undoubtedly strong attractions of participation in such a project for addicts, we do consider, however, that it should in the first instance be reserved for older addicts who have a long history of addiction and whose psychosocial situation is beyond remedy. On this point we therefore disagree with the Committee's standpoint that the length of time that an addict has been addicted is not of decisive importance. We also endorse the objective of such a trial, namely to see whether the condition of the kind of addicts involved can be stabilised by the prescription of heroin, whether their physical and psychosocial wellbeing can be improved, whether their use of additional substances can be reduced and whether they can perhaps be motivated to give up their addiction. The three aspects of wellbeing - physical, mental and social - are functionally linked, and measuring them will require different objective criteria for each. The multiplicity of factors which will affect the outcome of treatment - the Committee mentions the medication used, the dose and method of administration, the personality of the person treating the addicts, the setting in which treatment occurs, the rituals surrounding treatment, the expectations and the intentions of the person carrying out the treatment, the expectations, hopes and receptiveness of the patient and, finally, the interaction which occurs between the two in the course of the treatment - explains in part the Committee's view that trials should be conducted at a number of locations and that over a hundred addicts should be involved at each of them.

We believe that a trial period is necessary before an answer can be given to these practical, medical and organisational questions and a better estimate of the costs involved made. Such a period is also required in order to draw up a realistic research protocol and test its feasibility in practice. What is needed is a preliminary study, involving no more than 50 addicts. An initial period of six months might be involved, terminating with an evaluation, followed by another six months spent in drafting a strict medical protocol. Evaluation of that should in turn produce a definitive protocol structure for the medical trials to be carried out. Addicts such as described above should participate in the preliminary study and the criteria for their selection should be worked out carefully. As already indicated, the provision of heroin in this way is intended to improve the physical and psychosocial situation of the addicts concerned. This measure is not intended to reduce nuisance to others, though attention should be devoted to both nuisance and crime in the protocol on the data to be collected and in the evaluation study. What must be clear from the outset is that heroin can no longer be prescribed to addicts who have been placed in custody on account of having committed offences. The Minister of Health, Welfare and Sport will enter into consultations with the municipal authorities which have already submitted proposals for the provision of heroin to addicts, in order to establish where the preliminary study described above can be held. If the preliminary study proves successful a decision will be taken on the definitive medical trial. One condition will be that some form of co-financing must be involved to meet additional material costs, such as the costs of heroin preparations and medical reports and evaluation. The municipal health services could in principle be primarily responsible for the implementation of the trial. The Minister of Health, Welfare and Sport has asked the General Chief Inspector of Health to draw up a report on the subject. The use of heroin for experimental/therapeutic purposes during the preliminary study and the medical trials can be authorised by the first of the undersigned granting permission for the drug to be used for scientific purposes, in accordance with section 6 of the Opium Act. The necessary peer review of the medical activities involved can also be arranged in this context. The Public Health Supervisory Service would have to be responsible for supervising the project. Reports assessing experience to date could be submitted to the Minister of Health, Welfare and Sport and to the Lower House in the form of an annual report from the Supervisory Service.

In the meantime, the trials involving the prescription of heroin which are currently being carried out in Switzerland and which are being evaluated by the World Health Organisation, among others, can be examined to see whether they have yielded any information which could be of value to policy in the Netherlands in the future. At the moment, seven hundred addicts in Switzerland are being provided with heroin. Experience to date, it is believed, has been mainly positive. The Public Health Supervisory Service has been asked to follow the progress of these projects and to report on them in due course to the Minister of Health, Welfare and Sport. The report will be brought to the attention of the Lower House.

Under the provisions of article 12, in conjunction with article 19, of the Single Convention, full details must be given to the International Narcotics Control Board in Vienna, so that the current estimate of heroin consumption can be increased to the level required for the implementation of the prescription plans. This means that that level will have to be determined in cooperation between the medical services responsible for implementing the plans and the Public Health Supervisory Service.

Separately from the above, the Committee recommended making it easier in practice to provide heroin or other opiates equivalent to heroin, by way of a palliative, to seriously ill patients who have been permanently addicted to heroin for a long time and are expected to have only a short time to live. The Committee's recommendation was not accompanied by an explanation of the existing technical difficulties. The Public Health Supervisory Service has therefore been asked to set up a study on the subject and to present more detailed proposals on making such treatment easier. The availability of medicines containing heroin will in any event be a problem, as they are not registered in the Netherlands. The criteria by which patients should be selected for such treatment must be formulated carefully. The Minister of Health, Welfare and Sport is prepared to consider this aspect of the Committee's report more closely and to discuss it with the Lower House. Tweede Kamer, vergaderjaar 1994-1995, 24077, nrs. 2-3 Ministerie VWS Ferry