петък, 9 май 2014 г.

Drug use among the general population and young people

National prevalence surveys on drug use were carried out in the Netherlands in 1997, 2001, 2005 and 2009 among the general population aged 15–64. In 2009 some 25.7 % of respondents reported lifetime prevalence of cannabis use. The gender gap regarding cannabis use remains wide — last year prevalence of cannabis was about 2.3 times higher among males than females (9.8 % and 4.2 % respectively). Lifetime prevalence of ecstasy use was 6.2 %, and last year prevalence was 1.4 %. Cocaine was the third most popular ‘ever used’ drug, with lifetime prevalence of 5.2 %. However, due to methodological changes in the latest survey, prevalence data from 2009 are not comparable to those of previous years. Therefore recent trends in drug use cannot be determined.
European School Survey Project on Alcohol and Other Drugs (ESPAD) studies among students aged 15–16 have been carried out regularly for many years, with the latest survey carried out in 2011. The results for illicit drug use show an increasing trend in cannabis use since 1988, which stabilised between 1996 and 2007 at a lifetime prevalence of 28 %. In 2011 the lifetime prevalence rate of cannabis use was 27 %. The percentage of students using drugs such as ecstasy, amphetamines, cocaine or heroin is much lower. Inhalants were the most popular drug after cannabis, with lifetime prevalence reported at 7 %, followed by ecstasy at 4 %, cocaine and LSD at 2 % and heroin and amphetamines at 1 %. Results indicated 23 % for the last year prevalence of cannabis use (25 % in 2007; 23 % in 2007), and 14 % for the last month prevalence of cannabis (15 % in 2007; 13 % in 2003). With regard to gender, the reported lifetime prevalence of cannabis use was 34 % among males and 21 % among females.
The results of the Health Behaviour in School-aged Children (HBSC) 2009/10 survey among students aged 15–16 indicated a lifetime prevalence of cannabis use of 21 %, which is a significant decline when compared to 2002 data (26 %). Slightly more males than females reported cannabis use (23 % and 18 % respectively), while significantly more males than females reported heavy use (2.9 % and 0.4 % respectively).
Several national and local studies, inter alia, inquiring about cannabis use were carried out from 2005–09 among the general population. The Dutch National School Surveys on Substance Abuse is carried out every three or four years, with the most recent in 2007. The results of those studies are available in the reports on the Netherlands drug situation for 2010 and 2011.
In 2010 pilot projects were carried out to measure metabolites of illicit substances in wastewater in four major Dutch cities. The studies indicated that cocaine metabolites dominated in all cities, while the highest level of amphetamine was detected in Eindhoven.

Prevention

The recent trend in Dutch drug policy is a shift towards stricter legal measures against cannabis-related criminality and a stricter policy against nuisance associated with coffee shops, although the focus on health promotion remains an important aspect of the drug policy. Particular attention is given to promoting evidence-based prevention interventions through external assessment of prevention programmes submitted to a national database hosted by the Centre for Healthy Living of the National Institute of Public Health and the Environment, and annual reports are produced by the Trimbos Institute detailing the latest thinking on prevention in mental health and addiction care. A new development in the area of prevention is a clear focus on implementation rather than researching new interventions. Prevention activities are funded mainly by the Ministry of Health, Welfare and Sport. However, local municipalities are responsible for carrying out the prevention programmes in close cooperation with the schools and national entities involved in health promotion and substance prevention. Health prevention activities are mainly directed at the general public, but the focus is shifting gradually towards young people and people with low socioeconomic status; and activities in recreational settings, especially those tackling party drugs, are a high priority.
Universal prevention is carried out in schools through the programme The Healthy School and Drugs, and outside schools by the Going Out, Alcohol and Drugs programme. The Healthy School and Drugs programme was established more than 10 years ago and remains the leading school-based prevention programme in the Netherlands. An evaluation of the programme’s effectiveness was recently completed. The programme comprises several lectures in secondary school on alcohol, tobacco and cannabis. There are several e-learning modules for lower vocational education and on driving under the influence, and the programme includes basic and expanded courses for teachers on the early identification of drug use among students. A Swedish programme, Preventing Heavy Alcohol Use in Adolescents (Örebro programme), implemented under the Healthy School and Drugs programme, provides combined interventions to target adolescents and their parents. A study of the long-term effectiveness of this approach was carried out by randomly assigning 19 schools to four actions: (i) parent interventions; (ii) student interventions; (iii) combined parent–student interventions; (iv) usual school curriculum (control group). The results of a 34-month follow-up confirmed that targeting adolescents and their parents through combined interventions proved to be effective in the long term in delaying the onset of (heavy) drinking. Going Out, Alcohol and Drugs tries to prevent or reduce health and safety problems related to drug use among young people in recreational settings. Increasingly, electronic media and new applications are used to provide information and counselling on drug-related issues, for example The Drugsinformation line and an addiction app.
More attention has been given in recent years to a shift towards selective prevention interventions. These interventions, carried out by non-governmental organisations in cooperation with government services, are mostly targeted at children of addicted parents, youths on the streets, from socio-economically deprived neighbourhoods, in special institutional settings (such as child residential care or custodial institutions), and in recreational settings. The programmes in recreational settings focus on the implementation of safe clubbing regulations and person-to-person interventions in club premises (e.g. the Centre on Safe and Healthy Nightlife). Recently, prevention programmes for young people with a slight mental retardation and those who hang around on streets have been piloted. In 2011 a new initiative, based on the Australian Adolescence Cannabis Check-Up, was launched in 19 locations to target young cannabis users with a low motivation for abstinence. The programme uses a non-offending motivational enhancement technique to encourage the participants to re-evaluate their cannabis use practices.
In the indicated prevention area, activities focusing on early identification of substance use or dependence are on the increase. A special guide for professionals working with young people was published in 2010. Apart from information, the guide also provides several tools, such as a step-by-step identification process, a screening card and motivational enhancement. In 2012 new interventions targeting GHB users and young people from immigrant communities (e.g. Turkish) were launched.
In 2011 a national mass media campaign, Smoking, Alcohol and Cannabis Education: Advice and Support to Parents, was implemented to target parents with children aged 12–18, but by the end of 2011 funding for all mass media campaigns was discontinued at the national level. However, some municipalities continued to provide their own funding for local campaigns in 2012.
View ‘Prevention profile’ for additional information.

Problem drug use

Several national studies have estimated the number of problem opiate users in the Netherlands over the past 20 years using different methods (treatment multiplier, regression imputation, multiple imputation). The most recent, calculated in 2008 using the treatment multiplier, estimated that there were 17 700 opiate users (95 % CI: 17 300–18 100). Available data indicate a decline in the estimated number of opiate users since the beginning of the century. The ageing of the opiate user population and the low popularity of opiates among younger drug users are suggested as reasons for the trend.
Up to 2012 the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) defined problem drug use as injecting drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis were not included in this category. Details are available here.

Treatment demand

The National Alcohol and Drugs Information System (LADIS) is the most comprehensive information system on treatment demand clients in the Netherlands. LADIS contains data from the regular drug treatment services, and provides nationwide coverage. However, some private clinics and some addiction units in general and psychiatric hospitals do not participate yet, and in 2011 probation services discontinued their participation in LADIS. In 2011 a total of 200 of the 212 outpatient and inpatient units and low-threshold agencies submitted treatment demand data to LADIS.
Data showed that in 2011 a total of 13 109 clients entered treatment, of which 7 671 were new treatment clients. Some 48.3 % of all treatment clients reported cannabis as their primary drug, followed by 24.6 % for cocaine and 12.8 % for opioids. A slightly different distribution was identified among new treatment clients, with 58 % requesting treatment for cannabis, followed by 20.3 % for cocaine and 6.0 % for opioids.
With regard to age and gender, 34 % of all treatment clients in 2011 were over the age of 35 and 32 % were under the age of 25. Among new treatment clients, 25 % were over 35 and 42 % were under 25. The majority (78.7 %) of all clients entering treatment were male. A slightly lower percentage of males was reported among new treatment clients, at 75.6 %.

Drug-related infectious diseases

The Dutch HIV surveillance within the National Institute of Public Health and the Environment uses repeated surveys among drug users in four fixed cities (Amsterdam, Rotterdam, Heerlen-Maastricht and Arnhem) and two optional cities. Since 2001 one fixed city has been studied per year. Users of heroin, cocaine, methadone and amphetamines are recruited for the surveys in methadone centres and on the street.
The National HIV/AIDS Registration of the HIV Monitoring Foundation monitors HIV/AIDS positive people attending HIV treatment centres. In 2011 some 811 new HIV diagnoses were reported in the treatment centres. In four cases injecting drug use was the most likely route of transmission. Injecting drug users were defined as those who had injected at least once in their lifetime and who had used hard drugs at least one day per week in the past six months.
In Amsterdam, one out of the 27 injecting drug users in methadone substitution treatment tested in 2011was HIV positive.
In 2011 there were no notifications of acute hepatitis B infection among injecting drug users out of 157 reported cases (118 cases with known transmission route). In 2011 three of 1 092 chronic hepatitis B infections with a known transmission route were linked to injecting drug use. About 65 acute hepatitis C infection cases were reported in 2011, and 53 had a known transmission route. For one cases, injecting drug use was reported as the likely transmission route. Available data from the Amsterdam and Rotterdam Municipal Health Service suggests hepatitis C prevalence rates of 50–67.4 % among tested injecting drug users.
In general, available information suggests that the incidence of HIV, hepatitis B virus and hepatitis C virus has remained at low levels for many years in the Netherlands, which is attributed to the widely available harm reduction services.

Drug-related deaths

The main source providing the official Dutch statistics on drug-related deaths is the General Mortality Register or Causes of Deaths Statistics managed by Statistics Netherlands (CBS). The register has national coverage and includes only residents of the Netherlands. Cases are classified according to ICD-10 and refer mainly to direct or acute deaths (drug overdoses). Data about drug-related deaths among non-residents are available from a separate database.
In 2011 some 103 drug-related deaths were registered (94 in 2010; 139 in 2009; 129 in 2008; 99 in 2007; 112 in 2006; 122 in 2005). With regard to distribution by age and sex, the majority of cases were male (72.8 %) and the mean age at death was 42 years.
Between 1996 and 2011 the total number of recorded drug-related deaths fluctuated between a minimum of 94 cases in 2010 and a maximum of 144 cases in 2001. Despite some fluctuations over the years, the total number of drug related deaths in the Netherlands has remained relatively low. This might be explained by low numbers of socially marginalised problem drug users, widely available prevention measures targeting problem drug users and a low rate of injecting drug use.

Treatment responses

In the Netherlands, responsibility for the organisation, implementation and coordination of addiction care is delegated to regional and local authorities, and it is part of the broader mental health care agenda. Drug treatment is mainly delivered by non-governmental organisations on a regional level, and also by private organisations including physicians, hospitals and private clinics. Drug treatment is also provided in regional public hospitals. In the past decade, however, the number of addiction service providers has reduced considerably due to the many mergers that took place in the Dutch mental healthcare and addiction care services, for economic reasons. Addiction care is provided by 13 regional organisations. Municipal public health services, general psychiatric hospitals, several religious organisations, and 10 private clinics, also offer care for people with addictions. Addiction care is also available in the criminal justice sector, and within the probation services.
Funding for drug treatment is mainly provided by health insurance, while the public budget for social support at the national and local levels is mainly provided for special projects, such as heroin-assisted therapy. In 2012 out-of-pocket payments for addiction treatment were raised, which reduced the number of outpatient treatment clients, and resistance from care providers. As a result, in October 2012 the measure was cancelled.
The options for drug treatment interventions in the Netherlands are diverse. Outpatient substitution treatment is dominant for opiate dependence. Psychosocial interventions are more frequently provided to complement substitution treatment in order to achieve longer-term effectiveness, reduce relapses and promote social reintegration. In recent years, however, new treatment options for young cannabis users, people with multiple (addiction and mental health) problems, and crack and GHB users have been introduced. Additionally, new treatment settings for homeless drug users in several municipalities have been opened. In 2012 agreements were reached among main stakeholders and funding institutions in mental health to gradually reduce the number of beds in long-term residential mental health care settings, including addiction services, and to expand outpatient services, services through general practitioners and e-health interventions (e.g. Drogsondercontrole).
Psychosocial treatments frequently used in drug treatment centres include motivational interviewing, relapse prevention techniques, cognitive-behavioural therapies, family, community and home-based treatment therapies.
Methadone has been the most commonly prescribed substitution substance since 1968. Heroin-assisted treatment (HAT, introduced in 1998) and high-dosage buprenorphine treatment (introduced in 1999) are also available. HAT is provided at municipality treatment units and is meant for a restricted and controlled group of treatment-resistant opiate users. In 2011 there were about 740 treatment places for HAT at 18 units in 16 municipalities. Methadone, on the other hand, is available via various outpatient treatment providers, including office-based practitioners and mobile units.
According to the latest available data (2010), a total of 10 085 clients were in opioid substitution treatment, most of them in methadone maintenance treatment.
View ‘Treatment profile’ for additional information.

Harm reduction responses

In the Netherlands, the differences between outreach work, low-threshold services, harm reduction activities, and the term ‘social addiction care’ are difficult to define. The first goal is to make and maintain contact with difficult-to-reach drug users (hidden populations). All four attempt to motivate difficult-to-reach drug users to participate in some kind of treatment to prevent their individual and/or social situation from worsening. If this is not feasible, support is given to these drug users to help them reduce drug-related harm.
Most outreach work is carried out by low-threshold services in outpatient care facilities. These services are active in ‘street corner work’, offering daytime shelter in drop-in centres for street-based problem drug users, ‘living room’ projects for drug-using prostitutes and drug consumption rooms for chronic hard drug users. Other target groups are injecting drug users, extremely problematic drug users, and drug users from foreign countries. Outreach activities also feature in programmes for reducing drug-related public nuisance, which are often a collaborative venture between treatment and care facilities, police and civil groups. Outreach work is often ‘on the spot’ education (i.e. at places where young people meet), applying peer-support techniques. Another approach is targeting drug users who have been imprisoned, for example by offering pre-release counselling.
Facilities for needle or syringe exchange have been established for more than 20 years in the Netherlands and are available in all major Dutch cities. Needle exchange programmes are mainly implemented by street drugs workers, addiction care providers and, to a much lesser extent, by pharmacists. There are around 150 specialist agencies for needle and syringe programmes in the Netherlands. There are no national registration data on the number of syringes or needles exchanged. However, data from Amsterdam show that from 1990 to 1993 approximately one million needles were exchanged. Since 1993 there has been a sharp decline, to 169 000 syringes in 2011. In 2010 around 107 000 syringes were distributed in Rotterdam. There are also 37 drug consumption rooms targeting various audiences: injectors, smokers, and sometimes exclusively alcohol users.
A national hepatitis B vaccination campaign targeting behavioural risk groups has been implemented since 2002. This campaign offers screening for hepatitis B infection and vaccination for vulnerable people. Approximately 18 600 IDUs have benefited from the programme since its inception. However, from 2012 drug users no longer had access to this free programme, as it was thought that the hepatitis B risk rate had been substantially reduced among this group.

Drug markets and drug-law offences

The Netherlands has a pivotal position within international trade, and thus plays a major role as a drug market and, more importantly, as a transit country for heroin, cocaine and other illicit substances. The supply of heroin to Europe, including to the Netherlands, is mainly dependent on the production of opium in Afghanistan. The Netherlands is an endpoint of the Balkan route, while the northern route along the Black sea is used as an alternative. Heroin is distributed from the Netherlands to other western European countries. Cocaine is supplied from Latin America via African countries, from where it is delivered by boat to Antwerp or Rotterdam to be smuggled on to the United Kingdom, central European countries and Italy. Domestic production of cannabis products slightly increased between 2008 and 2012. It is assumed that a large proportion of the cannabis products produced in the Netherlands are intended for export to the United Kingdom, Germany, Italy and Scandinavian counties. In 2011 some 5 435 cannabis plantations were dismantled. Cannabis resin is smuggled to the Netherlands via sea from Morocco, in transit to other European Union countries.
In 2011 the National Crime Squad dismantled 30 synthetic drugs production locations while 19 of these facilities were seized in 2010. These sites mainly produced amphetamine, ecstasy, methamphetamine or other so-called ‘designer drugs’, while some ‘designer drugs’ and precursor chemicals are imported from other countries.
Data on drug seizures in the Netherlands are registered centrally by the National Police Agency. The registration includes data from the regional police departments, customs, the Royal Military Police and the Synthetic Drugs Unit (now part of the National Police Force). Not all departments report each year; this, and the lack of a uniform registration system, hamper the quality of the data collected and thus data are not fully complete and trends cannot be reported. In 2011 some 1 000 kg of cannabis resin, 5 000 kg of herbal cannabis, 2 million cannabis plants, 400 kg of heroin, 10 tons of cocaine, more than 1 million ecstasy tablets, 1 074 kg of amphetamine and 35 kg of methamphetamine were seized in the Netherlands.
In 2011 a total of 17 302 offences against the Opium Act were registered by the Public Prosecutor (14 865 in 2010). Around half of all reports are linked to cannabis. The increase in the number of offences is attributed to an intensification in police actions directed at cannabis production.

National drug laws

The Netherlands Opium Act, which came into force in 1928 and was fundamentally amended in 1976, is the basis for the present drug legislation. It defines drug trafficking, cultivation and production, dealing and possession of drugs as criminal acts. The act and its amendments confirm the distinction between ‘hard’ drugs (e.g. heroin, cocaine, ecstasy, amphetamines) and ‘soft’ drugs (e.g. cannabis or hallucinogenic mushrooms). This distinction is determined by a ‘risk scale’, based on the medical, pharmacological, sociological and psychological properties of a substance. In 2011 a new article was introduced in the Opium Act to allow the penalisation of facilitating large-scale illegal cannabis cultivation. Furthermore, criteria defining ‘professional cultivation of cannabis’ for prosecution purposes were also revised in the Opium Act Directive. The new psychoactive substances are regulated through amendments of relevant Schedules of the Opium Act.
Drug use does not constitute a crime in legal terms. However, there are situations when the use of drugs is prohibited, such as at schools and on public transport. It is up to the responsible authorities — which is not the national government — to regulate this.
The possession of small quantities of drugs for personal use is accorded a much lower priority. Anyone found in possession of less than 0.5 g of Schedule I (i.e. ‘hard’) drugs will generally not be prosecuted, though the police will confiscate the drugs and refer the individual to a care agency. The threshold amount for cannabis is set at 5 g. However, a new formulation was introduced in the Opium Directive Act in 2012. In place of the wording ‘a police dismissal should follow if a cannabis user is caught with less than 5 grams of cannabis’, it now states that ‘in principle a police dismissal will follow if a person is carrying less than 5 grams of cannabis’, which opens the way to the arrest and prosecution of people in possession of less than 5 g of cannabis.
Drug users are convicted when they have committed a crime such as selling, theft, robbery or burglary. A special law — Placement in an Institution for Prolific Offenders (ISD) — was introduced in 2004, meant for the treatment of criminal drug users in prison-like institutions.
Importing and exporting any classified drug is considered a serious offence. The penalty for hard drug trafficking is between 12 to 16 years.
View ‘Legal profile’ for additional information.

National drug strategy

The 1995 white paper ‘Drug policy: continuity and change’ set out some of the basic principles of Dutch drug policy on illicit drugs. These included a distinction between ‘soft’ and ‘hard’ drugs and the white paper took a balanced and integrated approach. It also outlined four major objectives: (i) to prevent drug use and to treat and rehabilitate drug users; (ii) to reduce harm to users; (iii) to diminish public nuisance caused by drug users; and (iv) to combat the production and trafficking of drugs.
Following the publication of the 1995 white paper, other aspects of Dutch drug policy have been elaborated in different strategies and policy notes or letters to Parliament focused on specific drugs and issues.
In 2001 the white paper ‘A combined effort to combat ecstasy’ discussed the intensification of law enforcement efforts to tackle the production and trafficking of ecstasy. This policy was put on a continuing basis in 2007. Cocaine was addressed in 2002 through the ‘Plan to combat drug trafficking at Schiphol airport’, which was also given a continuous footing in subsequent years. In 2004 the ‘Cannabis policy document’ adopted a more restrictive approach to cannabis. The medical prescription of heroin to treat chronic and treatment-resistant opiate addicts was established as a regular part of the treatment system in 2009. Organised crime in relation to synthetic drugs, heroin, cocaine and the large-scale cultivation of cannabis were targeted as priority areas in the Police and the Public Prosecution Office policy letter for 2008–12. In 2009, a policy letter to the Parliament, ‘Letter outlining the new Dutch policy’, placed an increased emphasis on prevention and the reduction of drug use. It also adjusted the ‘coffee shop’ policy to make the establishments small, principally for local users and restricting the number of shops to reflect the local situation, and established an integrated approach for fighting organised crime.
In the current Opium Act Directive the objective of the drug policy is described as follows: ‘The [new] Dutch drugs policy is aimed to discourage and reduce drug use, certainly in so far as it causes damage to health and to society, and to prevent and reduce the damage associated with drug use, drug production and the drugs trade’ (Stc 2011–11134).
More recently, the ‘Drug policy letter’ of 27 May 2011 of the Rutte administration set out the two pillars of Dutch drug policy: (i) the protection of public health; and (ii) combating public nuisance and organised crime. This policy letter also outlined the alterations to the accessibility of coffee shops so they would become closed clubs, only accessible to Dutch adult residents. Follow-up policy letters in October and December 2011 further elaborated the changes to be made to the coffee shop system. This included altering the Opium Law to make the shops closed member-only clubs, and putting resident criteria in place. However, a policy letter from the Minister of Security and Justice in November 2012 confirmed that the additional closed club criteria would not be implemented, while the residence criteria remain in place. In a policy letter from April 2012 the Minister of Security and Justice established that the mayors of the municipalities are responsible for assessing if coffee shops are complying with the new rules.
View ‘National drug strategies’ for additional information.

Coordination mechanism in the field of drugs

Responsibility for the Dutch drug policy is shared between several ministries. The Minister of Health, Welfare and Sport is tasked with the coordination of drug policy, while the Ministry of Security and Justice is responsible for law enforcement and matters relating to local government and the police. The Ministry of Foreign Affairs is in charge of certain issues, including matters relating to HIV/AIDS and injecting drug use on behalf of the government at the international level. Regular coordination takes place through meetings between drug policy managers at the relevant ministries.

Public expenditure

In the Netherlands there is no budget associated with the drug policy documents and there is no review of executed expenditures. The number of estimations of drug-related public expenditures is also limited, with only one study in this area. (1) The methods used in the study are not fully explained, and information is sometimes fragmented or is a part of broader budgets. The study’s results were questioned by subsequent research. (2)(3)
The available study estimated that for 2003 total drug-related public expenditure (4) represented 0.5 % of gross domestic product. (1) Most of the expenditure was attributed to law enforcement (75 %), treatment (13 %), harm reduction (10 %) and prevention (2 %).
The available information does not allow the total size and trends in drug-related public expenditures in the Netherlands in recent years to be reported.
(1) H. Righter (2006), ‘What drug policies cost: drug policy spending in the Netherlands in 2003’, Addiction 101, pp. 323–9.
(2) D.E.G. Moolenaar (2009), ‘Modelling criminal justice system costs by offence: lessons from the Netherlands’, European Journal on Criminal Policy and Research 15, pp. 309–26.
(3) B. Nauta, D.E.G. Moolenaar and F.P. Van Tulder (2011), ‘Kosten van criminaliteit’, in S.N. Kalidien and N.E. De Heer-De Lange (eds), Criminaliteit en rechtshandhaving 2010: ontwikkelingen en samenhangen, Raad voor de Rechtspraak/WODC/CBS, Den Haag, pp. 241–70.
(4) ) Some of the funds allocated by governments for expenditure on tasks related to drugs are identified as such in the budget (‘labelled’). Often, however, the bulk of drug-related expenditure is not identified (‘unlabelled’) and must be estimated by modelling approaches. The total budget is the sum of labelled and unlabelled drug-related expenditures.
View ‘Public expenditure profile’ for additional information.

Drug-related research

Drug research in the Netherlands is extensive and covers many domains. Public funding of drug-related research is to a large extent delegated to intermediary agencies, although ministries and municipalities also directly fund a considerable number of research projects. Many academic institutions are involved in drug research, sometimes together with researchers from institutes for addiction care. A national meeting is organised annually for drug researchers to stay informed about recent developments. The number of publications in national and international scientific journals is extensive. The development and implementation of multidisciplinary evidence-based guidelines, protocols and training materials are the most important channels for disseminating drug-related research findings from the scientific community to practitioners and decision makers. The Netherlands national focal point maintains part of the website of the Trimbos Institute to disseminate reports on research findings. Recent drug-related studies mentioned in the 2012 Dutch National report mainly focused on aspects related to the consequences of drug use, responses to the drug situation, supply and markets, and prevalence, incidence and patterns of drug use.
View ‘Drug-related research’ for additional information.

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