Auteur: Henk Jan van Vliet

Organisation: Metropolink

1/ In the mid-1960, when the consumption of cannabis, LSD and other drugs became a high-profile element of a world-wide youth culture, the Netherlends' authorities generally responded in the same way as their colleagues in other western countries did panicky about the unknown new phenomenon and falling back on judicial repression conformable to iternational prohibitive legislation. Important sections of the population, however, considered this preconceived reaction as ineffective and even dangerous. In some industrialized and wealthy countries, such as the United States, Canada and the Netherlands, and possibly some others, the public debate about drug use and drug policy round the turn of the decade culminated in the establishment of high-level official committees: the Shaffer-Commission in the USA, the Le Dain-Commission in Canada, the Baan-Commission in the Netherlands (1,2,3). Some other countries, such as France and the UK, followed with high-level commissions at a later stage.

In 1972/73 the commissions in the Netherlands, the USA and Canada issued their reports. All three had made in-depth analyses of the drug problems in their respective countries and all three advised in favour of more sophisticated drug policies, which would take the new social and cultural circumtances into account, and would rely on education rather than on repression.

The Netherlands, however, has been the only one of these countries where the distinguished Commission's conclusions and recommendations have become the steady foundation of the government's domestic drug policy for almost two decades now. This is quite a unique position in the world.

These two elements alone an undogmatic and scientific policy-foundation, and an identifiable and unique national position, vouch for an uneasy relationship not only with the international drug prohibition-system and its administrators, but also with governments, organizations and media which advocate a war on drugs. The drug policy relations between the Netherlands and especially the Federal Republic of Germany and the USA have been troubled for a long time, and they still are fairly ambiguous and vulnerable.

However, plicy-development under heavy external pressure has also led to a relatively high level of integration and consistence of the whole of Dutch drug policy, to the effect that at present the Netherlands can be described as a social laboratory for drug policy on a national scale, and its drug policy as a management strategy to prevent and contain problem drug use, and to reduce the idividual and social risk of drug use.

It is not an anti-prohibitionist policy, though; it rather explores, uses and stretches the margins and loose ends of the global prohibition system; it is a policy of compromises. Drug policy pays tribute to both Dutch norms and values and traditions of problem solving, especially and practice of prohibition, notably in its attitude towards international drug trafficking and production.

Dutch thinking about drugs and drug policy have developed in a norther European welfare state at the peak of its potence, pretence and experimentalism; both thinking and policy towards drug cosumers aim at the social integration of the drug phenomenon and of drug consumers. Domestic drug policy tends to be cost-effective (wich does not mean: cheap): aiming at long-term and lasting results through a strong emphasis o education and on a public health approach. Law enforcement and repression, though maybe cheaper and more spectacular in the short run, have never been favourite Dutch istruments for domestic problem solving.

On the other hand: the Netherlands has ratified the Single Convention on Narcotic Drug of 1961, is preparing the ratification of the Convention on Psychotropic Substances of 1971, and has signed the UN-Convention against Illicit Traffick in Narcotic Drugs and Psychotropic Substances of 1988. The Netherlands is part of the international control structure and Dutch officials are part of an expanding bureaucracy of policeman, civil servants and diplomats which tries to direct a global fight agaist drug producers, traffickers, and consumers. In the Netherlands all non-medical drugs are illegal, and law enforcement and repression are principal ingredients of Dutch drug plicy.

Much of Dutch drug policy is not very different from most other cuntries' drug policies, although even Dutch repression and Dutch law enforcement may be different. The flexible criminal law system, the low-profile policing and the high level of cooperation between the traetment and the criminal la systems certainly have contributed to the specific features of Dutch drug policy. Some high-ranking Dutch police officials are among the most vocal advocates of drug legalization.

What I am referring to in this paper, are three basic concepts which underlie the educational and public health approach of Dutch drug policy, and which may be regarded as examples for others: the Risk Criterion, the Harm-Reduction concept, and the concept of Normalization of Drug Problems. each of these, and the three in connection, have given birth to social experiments at various in connection, have given birth to social experiments at various levels in cities and nationwide; in prevetion, traetment and the management of drug problems.

2/ The first and still basic concept undoubtedly is the Risk Criterio, introduced in the Baan-Commission's 1972-report "Backgrounds and Risks of Drug Use" (3). In the Commission's view, starting-point for policy development should be the consideration that not all drugs and all drug consumption are equally dangerous; their relative risks must be taken into account. The Commission in this respect predominantly stidied cannabis, as marijuana and hashish still the mst widely used illicit drugs in the western world, and provided the scientific basis for the decriminalization of cannabis possession and retail trade in 1976, and for the development of onging education programs.

The revision of the Opium Act in 1976 primarily aimed at the prevention of the risks associated with illicit drug use. Considering the relative risks of cannabis and the other drugs, the law makes a distinction between "cannabis products" and "drugs presenting unacceptable risks" (heroin, cocaine, amphetamines, LSD, etc.). Whereas the latter ere primarily dealt with through legal repression, the former were transferred as much as possible (they remained illegal!) from the criminal into educational and public health sphere.

The legal decriminalization of cannabis included a considerable decrease in the penalties for possession and retail trade up to the amount of 30 grammes. "Guidelines for the investigation and prosecution for offenses under the Opium Act" (4) have been issued by the Ministry of Justice at the same time. These Guidelines set out the priorities to be observed by the police and the Ministry's Prosecution Department, and contain recommendations regarding the penalties to be demanded in Court. Possession and retail dealing score lowest on the Guidelines' priority scale.

Drug education in the Netherlands basically is not aimed at deterrence , it is comprehensive and integrated. This means that education is not aimed at singling out drugs and their dangers, but at the developmet of individual eresponsibility, of self control, and of healthy life-styles. Schools and drug services do most of the job in drug education; the police have learned to play only a minor role.

Low sentences, the lowest possible police priority, and education together, allowed a separate, visible, condoned, and, at best, managed cannabis retail market to develop over the years out of the formerly completely uncontrollable and underground drug market. At present the retail market for cannabis i the Netherlands is a safe, open and manageable risk situation for experimenting youth; a play-ground on which they can develop their own orientation towards drugs and drug use, and their own self-control machanisms. This is in complete coformity with the policy-objectives.

At the same time this state of the art implies a de-facto legalization of cannabis at the consumption and retail-trade levels, especially in Amsterdam and the western part of the country. The 250 or so Amsterdam coffee-shops in particular are visited by tens of thousands of young and older tourists every year. They don't have to worry about bad quality or deluted drugs, about getting other drugs than the ones they choose, or about the police harrassing or arresting them. In effect, they are allowed a quick glance into kind of a "better world", a situation that once might be a worldwide reality, and this idea especially is a great concern for many government officials and War on drugs-apologetes.

3/ A second basic policy concept is Harm-Reduction, or harm-minimization, as the foundation of the helping and treatment system.

The expression: "Harm-reduction" has been coined in Liverpool, U.K., and not in the Netherlands. The Dutch, in the late 1970's and early 1980's, have developed a concept and pratice named "low threshold drug help", as opposed to "high-threshold", or drug-free, treatment. In many, but not all, aspects the low-threshold and harm-reduction cocepts are similar or identical. Harm-reduction, however, is a more coherent and conprehensive strategy of social intervention. It has developed in the relative small social laboratory of the Merseyside region, where Liverpool is the central city, it has been explained and promted internationally quite effectively, and has virtually replaced the idea of low-threshold drug help in the Netherlands.

The fundamental principle of the model in Liverpudlian words is "that abstinence (preventing people from starting to use and getting users to stop taking drugs) should not be the only objective of services to drug users, because it excludes a substantial proportion of people who are commited to a life-style of long-term drug use"; "...abstinence should be conceptualized as the top-goal in a hierarchy of harm-reduction objectives - likes a series of safetynets" (5).

The most important principles underlying the Dutch concept are

" a) - a multi-functional network of medical and social sevices, ..., should be built up at local and regional level;

b) - aid must be easly accessible;

c) - the social rehabilitation of present and former drug users should be promted;

d) - the fullest use should be made of services not specifically geared to the drug problem, such as general practitioners and youth welfare services" (6).

In the Netherlands, low-threshold drug help/harm-reduction ideas about the improvement of the drug user's physical and mental wellbeing and about the accessibility of drug services, especially lie at the basis of the methadon maintenance programs, that developed since the 1970's and were endorsed by the government through a restatement of drug policy in the early 1980's (7). The preventio and management of drug use-related risks for the individual user, the community, and society as a whle, became the new policy-goal. Methadone maintenance programs, almst everywhere integrated in relatively easy accessible drug services, were increasingly subsidized and developed as the standard drug traetment modality in the country. Methadone dispension became linked to or integrated with other programs, such as job-training and social projects, ambulatory treatment, and day-care centers. Methadone even penetrated, slowly and partly, police stations, prisons, and the very outpsts of the drug-free therapeutic community syst

em itself.

The most important extension of this system of harm-reduction services was brought about in the mid-1980's, when organized drug users and public health authorities started syringe-exchange programs to curb the spread of Hepathitis, HIV and AIDS. The government followed quickly by declaring syringe-exchange a primary task, not only of public health service, but of the private drug services as well. At present there are at least 125 different syring exchange programs, dispensing only very small umbers or almost a million syringes a year, integrated in drug programs, separate, at phramacists, in drug dealers places or as mail-order service, and most of them neatly arranged in a handy brochure for drug users.

The Dutch drug help and treatmet system can be called a social experiment to the effect that it aimes at servicing and monitoring the majority of the country's active drug users, in cooperation with the drug users themselves, and thus keeping them visible for the public eye. In working at these aims, drug policy markers, the helping system, and the drug users themselves prepared the ground for the implementation of the third basic drug policy concept.

4/ The development of the concept of the Normalization of Drug Problems started as a government-sponsored research project. In 1982, researchers from the University of Groningen completed an extensive research report: "Heroin Users in the Netherlands; a Typology of Life-Styles" (8). It was the same year in which Dutch Parliament passed a motion, urging the government to accept both the so-called "Junky Unions" and the organization of parents of drug users, as partners in the drug policy making process at the national level.

The idea of the "cultural integration of drug use", the basic policy concept of the study, did not meet with easy acceptance at all government echelons. After lengthy discussions, the Inter-Ministerial Steering Group on Alcohol and Drug Policy, published a report in 1985 ("Drug Policy in Motion") (9), in which many of the research finding and policy recommendations of "Heroin Users in the Netherlands" were incorporated. The idea of the integration of drug use, however had been changed, or watered down, into the integration, or normalization, of drug problems another example of Dutch policy making by compromise.

Basic assumption of the normalization-concept is, that the quest for a drug-free world is an illusion, as is the case regarding alcohol and tabacco. 'Normalization of drug problems' means that society has to learn to cope with certain levels of illicit drug use, as it has done with alcohol, tabacco and prescription drugs, and to accept The Drug Problem as a normal social problem, instead of as a very special one. "There is a need for a gradual process of integration of the drug phenomenon in our society", State Secretary Joop van der Reyden staded. Society should take "a more buinesslike view" regarding drug problems, and "stress the pragmatic aspects of drug policy over the moral aspects" (10). This would mean: fighting international trafficking, organized crime and obtrusive retail trade in drugs, but at the same time the integration, or encapsulation, of drug users as members of society as well, would have to develop explicit opinions about what can and cannot, will and will not be tolerated, and about th

e rights and obligations of drug users.

The "Drug Policy in Motion"-report, and its journey through the official institutions and public opinion, can be seen as an example of normalization in itself.

State Secretary Van der Reyden presented the report to Parliament, expressing the expectation that it would provoke debate, wich it did. However, not so much in Parliament as in public opinion and public administration. parliament never discussed the report and even abandoned its special commission on drugs: at the national plitical level much of the drug problem had apparently been normalized already; the 'Drug Problem' had been depolitized to the extend that it could be dealt with primarily by judicial and local authorities and by the private health and social sectors.

Apparently there was and is a much of a consensus in both government and society, across the politica, social, cultural, religious spectrum, about the necessity of normalization. The actual implementation, however, the cultural integration of drug problems and drug users in society, is a major social experiment in itself. The concept has been roughly defined at the plicy level, but has to be continiously redefined while being implemented at the various levels of society and in different lcal circumstances.

One of the aspects of normalization has been mentioned in the principles underlying the Dutch version of the harm-reduction concept: the involvement of general medical and social services in the management of drug problems. It is the government's view that "services specifically for addicts must be limited to the absolute essential to avoid restricting the accessibility of aid services and to avoid stigmatising drug users" (11). In Amsterdam, for instance, this has led to the involement of general practitioners in drug help, and especially in the dispension of methadone; about one third of all methadone in Amsterdam is distributed by family doctors. A major institutional implementation of normalization has been brought about in Dutch AIDS policy. From the very beginning of the AIDS epidemic, when the disease itself seemed to affect the Gay community, representatives of all other at-risk groups have been involved in the developing AIDS prevention policy and the AIDS control structure. The bloodbanks, the drug

service system, the organized prostitutes, and other interest groups, were asked to participate. In 1985, after the detection of the first drug-related AIDS-cases, the Dutch Federation of Junky Unions joined the policy and control structure, which in this way became the first area of public administration in which the drug users have a formal say.

5/ Some outcomes of Dutch drug policy and of the social experiments which can be described as successful and not been brought up yet:

* Large parts of the drug use-culture has been brought above the ground, which is a basic prerequisite for the management and regulation of drug misuse and drug-induced problems.

* The vast majority of young people is not interested in drugs; they have been demythologized to a great extend. Of the age-group under 19 years, only 1.8% used drugs in the previous month. Last-month' prevalence for heroine and cocaine is less than 0.5%. Despite the high visibility and easy accessibility of cannabis in Amsterdam, less than 25% of all Amsterdam residents in the age group of 16 and up have ever tried it; less than 10% used cannabis in 1987 (12).

* Drug users who want help or treatment can get it almost immediately; an estimated 70 to 80% of the problem drug users are known to and monitored by the various drug services.

* Since about 1980 the number of problem drug users in the country has stabilized at about 15,000 to 20,000. Even Amsterdam, despite a rather disciplinatory and public order-oriented local policy, shows a steady downward trend, from about 9,000 problem drug uers in 1984 to about 6,000 in 1989 (13).

* In general, the health codition of Dutch problem drug users is good; apart from HIV/AIDS in Amsterdam the prevalence of epidemic disease is low, and so are the numbers of drug-related death in the whole of the country. The Amsterdam Municipal Health Service counted 42 overdose-deaths in the city in 1989, of which 28 were foreign drug misusers (mostly German) and only 14 Dutch nationals. Since 1985 there is a clear downward trend in OD-deaths (14).

The Central Bureau for Statistics counted 46 drug-related deaths in the whole country in 1983 (15).

* The incidence of HIV/AIDS among drug misusers outside Amsterdam is astonishingly low. Until July 1990, 120 out of total number of 1313 AIDS-cases were drug-related, which is about 9% (16). The percentage of drug users with AIDS has hardly increased since the beginning of the epidemic.

6/ What is the relevance, if any, of these elements of Dutch drug policy and of the Dutch experiences both from a European and anti-prohibitionist point of view?

Every country, every region, every city, to a certain extend has to develop its own drug policy, preferably in relation to its own social, cultural and drug use situations and traditions. Not taking this basic notion into account, explains much of the disastrous failure of the world-wide and internationally directed drug prohibition policy. Not taking this notion into account when explaining Dutch policy, and when taking Dutch policy as an example, would mean making a mistake of the same magnitude.

However: many Western European countries can be characterized as welfare-states, many of them have well-developed social security, public health and educational structures. In my opinion this is a major piece of common ground, necessary for the development of harm-reduction and normalization policies, neatly tailord to the specific national and local situations.

In effect, low-threshold and harm-reduction oriented drug services are on the increase in many EC-countries and beyond. Both the AIDS-crisis and the Dutch (and Merseyside) examples have contributed to this. It is possible to speak about a beginning European harm-reduction movement now.

The AIDS-crisis has also reinforced the need to develop normalization as a major element in other countries' drug policy it is critical for all western European authorities to get in touch with as many of their drug users as they can possibly reach. To do this successfully, authorities and citizens will have to accept drug users as grown-up members of society, who have to get actively involved in society's efforts to prevent the further spread of HIV and AIDS. Drug users will have to be educated to prevent themselves from getting infected and from infecting others. If authorities and citizens do not accept and implement these kind of starting points, they are knowingly creating time bombs, not only for their own communities, but also for the other countries, as the free movement of drug users throughout Europe largely preceeded the EC's 1992- concept.

The decriminalization of cannabis use, and ongoing, integrated drug-education, can seriously contribute to decrease the attractiveness for young people of being a 'drug hero', and thus lay the basis for a more mature attitude of western citizens and societies towards what are still illegal drugs. Both the Dutch example and similar ones in several US-states, notably Alaska, are the living proof of this statement.

Moreaover the cannabis decriminalization-experiment has created one of the very few "legalization-models" that exist in the world nowadays.

When other coutries want to implement Dutch drug policy cocepts and elements, be it on the local or on the national level, there are of course scores of obstacles to overcome and accomodations to be made.

The involvement of at least parts of the law enforcent communities in the various countries, and changes in police and judicial principles and patices, seems to be both crucial and very hard to achieve. However, all over Europe, police and other law enforcement personel, often front soldiers in the war on drugs, are beginning to defect to the forces of reason. Most of them are not simply "going Dutch"; on the basis of their own practical experience they have reached the conclusion that kind of a civil war in their streets and cities is too high a price to be payed for the illusion of a drug-free world. However, most of them have in common that they have carefully examined the Dutch experiences.

In the world today, the Netherlands is the only (relative) experiment in drug policy on a national scale, and that is a political fact of great importance.

This experiment is being evaluated by lots of Dutch and foreign researchers, and visited by an ever increasing number of visitors, from professionals and politicians to tourists who want to enjoy the fruits of Dutch experimentalism.

They can all draw from our sources, and learn from our mistakes and successes. They should not, however, want to copy our policies, because these are tailored to Dutch circumstances and not even perfect in that respect.

What other countries need are not Dutch drug policies, but better drug policies than they have now - but the Dutch experiece can be and are already extremely helpful to achieve that goal.

Henk Jan van Vliet/Metropolink, Amsterdam/10 December 1990.

References (not yet complete)

1. Shaffer Committee

2. Le Dain Committee

3. Baan Working Party: "Background and Risks of Drug Use"; The Hague, Government Printing Office, 1972.

4. Ministerie van Justitie: "Richtlijnen voor het opsporings- en vervolgingsbeleid inzake strafbare feiten van de Opiumwet"; The Hague, Staatscourant, 18 July 1980.

5. Allan Parry & Russell Newcombe: ...

6. Ministerie van WVC: "Fact Sheet on the Netherlands; Drug Policy"; Rijswijk, 1989, p.3.

7. Leon Wever: ...; The Hague, Staatscourant,

8. Otto Janssen & Koert Swierstra: "Heroinegebruikers in Nederland; een typologie van levensstijlen"; Groningen, 1982, and Otto Janssen en Koert Swierstra: "Uitgangspunten voor een integraal heroinebeleid"; Groningen, 1983.

9. Interministeriele Stuurgroep Alcohol en Drugbeleid: "Drugbeleid in Beweging"; Rijswijk, 1985.

10. J.W. van der Reijden: "Speech of the State Secretary of WVC", Conference 'Local Authorities and Drug Policy'; The Hague, 23 October 1985.

11. Ministerie van WVC: "Fact Sheet", p.4.

12. E.L. Engelsman: "Het Nederlandse drugbeleid in West Europees perspectief", in M.S. Groenhuijsen & A.M. van Kalmthout: "Het Nederlands Drugbeleid in West Europees Perspectief"; Arnhem, 1989, P.18.

13. E.C. Buning: "De GG en GD en het drugprobleem in cijfers, deel 3"; Amsterdam, 1989, p.

14. Buning: "De GG en GD...", p.

15. Centraal Bureau voor de Statistiek:...