THE NETHERLANDS' DRUG POLICY: 20 YEARS OF EXPERIENCE

Drug use is a fact of life and needs to be discouraged in as practical a
manner as possible.

``The Dutch policy on drugs is a disastrous mistake. The Netherlands regrets
its liberal policy and is about to turn back the clock." " Drug use has
increased by 250 percent in two years, armed robberies by 70 percent,
shoot-outs by 40 percent, and car thefts by 60 percent." "In the
Netherlands, 1,600 addicts receive daily injections of heroin on government
orders." "In Amsterdam recently, a father who was addicted to cannabis
massacred his whole family." "There's plenty of heroin for sale in every
Dutch coffee shop."

Do you believe all this? I am quoting just a few statements by foreign
politicians and other "experts" who disagree with the Netherlands' drug
policy. There is evidently an audience willing to believe all this, which
gives such critics a reason to continue spreading these stories. Aside from
questioning the honesty of this approach, one should ask what purpose is
served by repeating such nonsense. It is certainly not in the interest of
drug users, their immediate neighbors, the government, or health-care and
social service institutions.

The drug problem is too serious an issue to be used as a political football
by ambitious politicians. Nor should it be the subject of speculations about
reality, making the facts of the matter irrelevant. As a representative of
the Netherlands government, I take this opportunity to present the facts.

To understand the Dutch drug policy, you need to know a little about the
Netherlands and the Dutch people. After all, a country's drug policy has to
fit in with the nation's characteristics and culture.

The Netherlands is one of the most densely populated countries in the world,
with around 15.5 million people in an area one-quarter the size of New York
State. Commerce and transport have traditionally been important sectors of
industry in our country. Rotterdam is the busiest port in the world,
handling almost 5 million containers a year. In fact, the Netherlands is
generally seen as the gateway to Europe.

The Dutch have a strong belief in individual freedom. Government is expected
to avoid becoming involved in matters of morality and religion. At the same
time, we feel a strong sense of responsibility for the well-being of the
community. The Netherlands has a very extensive system of social security,
while health care and education are accessible to everyone.

What is the Dutch drug policy? The main objective is to minimize the risks
associated with drug use, both for users themselves and those around them.
This objective was formulated in the mid-1970s and can be characterized as
harm reduction avant la lettre.

Many elements of the harm-reduction approach are very similar to Dutch drug
policy. Our policy does not moralize but is based on the idea that drug use
is a fact of life and needs to be discouraged in as practical a manner as
possible. This calls for a pragmatic and flexible approach that recognizes
the risks for both drug users and those around them.

Our policy focuses on reducing demand as well as supply. A combination of
these two instruments requires close cooperation with public health and law
enforcement authorities on all policy levels, Furthermore, we invest a lot
of money in cure and prevention. Since the 1970s and early '80s,
respectively, low-threshold methadone provision and needle exchange programs
have been important elements in our harm-reduction approach.

Our policy is based on two important principles. The first is the
distinction between types of drugs, based on their harmfulness (hemp
products on the one hand and drugs with unacceptable risks on the other).
The second legal principle is a differentiation according to the nature of
the punishable acts, such as the distinction between the possession of small
quantities of drugs for one's own use and possession with intent to deal.
This makes it possible to pursue a finely tuned policy based on the
application of criminal law.

The possession of up to 30 grams of cannabis is a petty offense punishable
with a fine. The sale of small amounts of cannabis, through what are known
as "coffee shops," subject to strict conditions, is not prosecuted. The idea
behind the policy on coffee shops is that of "separating the markets." The
reasoning is that if retailers of cannabis are not prosecuted under certain
conditions, the experimenting user will not be forced to move in criminal
circles, where higher profits are made by urging users to take more
dangerous drugs (such as heroin).

People often think that drugs are available legally in the Netherlands and
that we do not focus on combating the supply side of the drug market.
Nothing could be less true. Aside from the retail trade in cannabis, a high
priority is given to tackling all other forms of drug dealing. The police
and customs authorities seize large consignments of drugs almost every week,
working closely with other countries in the fight against organized crime.

Some people think that harm reduction and legalization are synonymous. I
disagree and would like to emphasize that harm reduction is not legalization
in disguise. Harm reduction is first and foremost concerned with reducing
the risks and hazards of drug taking. Harm reduction is meant to reduce the
risks for not only the drug user but the immediate environment (i.e., the
public) and society as well. This implies that intensive cooperation at all
times between those providing care for addicts, the criminal justice
authorities, and the government is an essential element in the harm
reduction approach.

What are the results of our policy? The Dutch government recently issued a
document discussing its drug policy, evaluating the policy of the last 20
years, and mapping out approaches for the future. This paper can be compared
with the yearly National Drug Control Strategies of the White House Office
of National Drug Control Policy. I will summarize the main outcomes.

Regarding the evaluation of Dutch policy on hard drugs, the document makes
the following points:

Our policy of harm reduction has been quite successful. Thanks to a high
standard of care and prevention, including extensive low-level and
nonconditional methadone prescription, social and medical assistance for
drug users, and a large-scale free needle-exchange program, we have reached
a situation that is matched by few other countries.

The number of addicts in the Netherlands is relatively low compared with
that in many countries. This implies that harm-reduction measures do not
increase the use of drugs.

The population of addicts is rather stable and rapidly aging. This suggests
that few new users are joining in. Heroin is not fashionable among
youngsters. The average age of Amsterdam methadone-provision clients
increases by almost one year every year, and the number of young heroin
users using services like methadone provision has shrunk over the years to a
handful. The average age of Amsterdam methadone- provision clients was 36.2
years in 1995. The average age of newly registered drug clients in the
Netherlands was 32 years in 1995.

The mortality rate among drug users is low, due to the low-threshold
methadone programs that provide protection against overdose.

The damage to health caused by the use of hard drugs has been kept within
limits. The number of addicts infected with HIV is exceptionally low. In the
Netherlands, the percentage of intravenous drug users (IDUs) among the total
cumulative number of AIDS cases is low. In addition, the incidence of HIV
infections among IDUs has decreased since 1986. An evaluation study
concluded that a combination of harm-reduction measures (i.e., methadone
provision, needle exchange, training, and counseling) has resulted in safer
sexual and drug-taking behaviors. Safe sex practices among addicted
prostitutes have increased as well.

Another result of our policy is that a comparatively large proportion of
drug users in our country has been integrated into society to a reasonable
extent.

The number of regular hemp smokers has gradually increased in recent years.
Lifetime prevalence and last-month prevalence have increased substantially
since 1984. An annual survey among older pupils in Amsterdam showed,
however, that the prevalence of cannabis use has stabilized since 1993--94.
This might indicate that we have reached the peak of the upward trend of the
past years.

Can the increase in cannabis use, especially among students, be attributed
to the existence of coffee shops in the Netherlands? An analysis of surveys
shows an upward trend in many other European countries. Since the late
1980s, cannabis use among youngsters (as well as the general population) has
increased in France, the United Kingdom, Germany, and the United States.

Compared with the U.S. prevalence, the figures for the Netherlands are
considerably lower. According to the results of the 1995 Monitoring the
Future Surveys, published by the University of Michigan, cannabis use has
increased tremendously among American youngsters. To my knowledge, this
increase cannot be attributed to any significant change of policy.

The fact that the rate of cannabis use in the Netherlands is comparable with
that in other countries (and even lower than in the United States) shows
that government policy probably has less influence on use than we think.
Other factors, such as trends in youth culture, social differences, and
other social influences, probably play a far more important role. In our
view, this does not mean that it makes no difference whether one pursues a
liberal or a restrictive drug policy. The difference is that a tolerant
policy prevents the marginalization of the user. A situation often
encountered in other nations, where the user--in most cases a minor--runs
the risk of getting into trouble with the police, is seen as highly
undesirable in my country.

Some conclusions

1.Comparisons with other countries show no indications that our policy has
led to an increase in the number of cannabis users. Therefore, there is no
reason to change our policy on cannabis.

2.Our policy on cannabis has not led to an increase in the number of
hard-drug users. In the Netherlands, the stepping-stone hypothesis cannot be
confirmed.

3.The wide range of provisions for care and prevention has held down the
number of hard-drug users, and has ensured that the health of these users
can be described as reasonable. Harm reduction actually works, if you invest
in it.

4.By definition, the Dutch drug policy requires an integral cooperation with
public health, law enforcement, and public order officials.

The Dutch drug policy, therefore, is not a disastrous experiment but a
serious effort to tackle a serious issue. Our policy has produced results
that are demonstrably better than those in many of the countries criticizing
us. While we realize that an ongoing dialogue with all those involved with
the drug problem is a precondition for any progress, we are not going to
change our policy on the basis of unjustified criticism.

Herbert P. Barnard is counselor for health and welfare at the Royal
Netherlands Embassy.