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

<H3>3. Prevention and the care and treatment of addicts</H3>
<A NAME=37></A>
<H2>3.7. Provision of heroin on medical grounds</H2>
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.
<P>
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.
<P>
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.
<P>
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.
<P>
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.
<P>
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.
<P>
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.
<P>
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.
<P>
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.
<P>
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.
<P>
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.
<P>
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.
<P>
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