NEW EMPHASIS IN DUTCH DRUGS POLICY Report of the Advisory Committee on Drugs Policy Contents Preface 1 Introduction 2 Developments

and objectives 2.1 Developments in demand 2.2 Developments in supply 2.3 Goal and methods 3 Young people, drugs and alcohol 3.1 Arguments for a more restrictive policy 3.2 More rigorous and embedded action 3.3 Prevention and care 4 Coffee shops 4.1 Current situation 4.2 Framework for solutions: development and dynamic 4.3 Further development of national coffee shop policy 4.4 Further development of coffee shop policy through experimentation 5 A dynamic drugs policy 5.1 The search for consistency: a dynamic drugs policy 5.2 Classification of drugs according to risk 5.3 Limiting damage 5.4 Care of addicts 5.5 Tackling the illegal market 5.6 Authorities Appendix 1: Order establishing the Advisory Committee on Drugs Policy Appendix 2: List of individuals consulted Appendix 3: Literature

Preface Dutch drugs policy is currently the subject of debate. The clear successes achieved with the policy risk being overshadowed by a number of negative side effects that necessitate changes to the instruments of drugs policy, reconsideration of some of the objectives, and a reformulation of responsibilities. In the present report the committee presents a diagnosis of the situation based on recent studies and makes recommendations for improvements to policy, as requested by the Minister of Health, Welfare and Sport, the Minister of Justice and the Minister of the Interior and Kingdom Affairs. The committee has concluded that such improvements are needed as a matter of urgency, and that some provision is required to ensure that policy and leadership in this area keep pace with the sometimes complex and rapid developments occurring in this highly dynamic and increasingly international field. Closed doors must be opened what we need now is decisive action. The committee was established in February 2009. Since then, we have talked to a large number of stakeholders and experts, and paid several working visits in order to form an opinion of current Dutch drugs policy. We also studied the Dutch and international literature, and were able to draw on the studies and evaluations listed in the order establishing the committee. The committee also received a large number of memoranda, as well as more detailed studies specifically requested from relevant parties (local authorities, the police, the Public Prosecution Service and the Tax and Customs Administration). We would like to thank Professor A. Klip of the University of Maastricht and many others (listed in Appendix 2) for their support and advice. A.C. Berghuis and Ms W.M. de Zwart ran the committees secretariat. The committee owes them a great debt of gratitude for their expert support and dedication. Wim van de Donk, chair Piet Boekhoud Wim van den Brink Cyrille Fijnaut Liesbeth Horstink - von Meyenfeldt Dike van de Mheen Henk Rigter Albertine van Vliet-Kuiper

1. Introduction An intractable problem: one hundred years of drugs policy The first international conference on drugs was held in Shanghai in 1909. Thirteen countries, including the Netherlands, met to consider the international implications of the Emperors ban on the growi ng and smoking of opium in China. Some aspects of the deliberations of the Shanghai Opium Commission, as it was known, echo todays drugs debate: major differences of opinion on whether drugs should be banned, made freely available or regulated; the need to reach international agreement; acknowledgement of the risks to the health of users; and the use of drugs for medical purposes. In the century that has passed since that conference, peoples desire to use psychoactive substances has created a difficult policy issue. While the main concerns a hundred years ago were opium and morphine, in recent years national and international policy has come to focus on other natural and synthetic substances. Some of these have been used for centuries, but the problems now associated with them have made them the focus of scientific and public attention. The sometimes fierce debate on the best way to tackle drugs continues unabated. Should we make them freely available or ban them or should we take one of the many middle roads, and regulate their use in some way? The Advisory Committee in Drugs Policy (referred to here as the committee) realises that the mere fact that the use of psyc hoactive substances has always been with us suggests that we could not ban drug use outright even if we wanted to there is no magic wand that can simply make these substances disappear. Solutions to the problems associated with drug use will lie in balancing respect for peoples freedom to make their own personal choices in such matters with measures to prevent and limit the dangers to the individual and to society. Terms of reference and procedure The committee was asked to advise the government as to whether all or part of Dutch drugs policy needs to be reviewed and, if so, to set out possible scenarios (see the Order establishing the committee, Appendix 1). The Ministers who commissioned this report wanted to see a broadbased approach that would encompass both the national and the international perspective. In addition, the Ministers asked for advice on four specific subjects: the scheduling of drugs under the Opium Act, improvements in care and prevention, ways of limiting the Netherlands role in drugs trafficking and production, and ways of reducing drug related nuisance. This advisory report commissioned by the Minister of Health, Welfare and Sport, the Minister of Justice and the Minister of the Interior and Kingdom Affairs is intended to serve as a basis for a policy document setting out plans for drugs policy, which the government will present to the House of Representatives in September 2009. To ensure that the report and policy document are supported by as much factual evidence as possible, the government commissioned a number of studies. The committee was asked to consider the results of these studies in its deliberations, along with the study of drugrelated organised crime in the MeuseRhine Euregion (see sidebar).

Background studies

Van Laar et al. (2009) Evaluatie van het Nederlandse drugsbeleid. Trimbos/WODC. (www.trimbos.nl) This study examines the development of drugs policy, particularly in the period since the policy document was published in 1995. It considers trends in drug use, looks at the role of coffee shops in separating the markets for soft and hard drugs, as well as at prevention and harm reduction, the care and treatment of addicts, the crime and public nuisance associated with the use of and trafficking in drugs, international cooperation and research and monitoring in support of drugs policy. Van Amsterdam et al. (2009) De ranking van drugs. RIVM/AIAR (www.rivm.nl). This study assesses alcohol, tobacco and a large number of drugs and the degree to which they differ in terms of the harm they cause. CAM (2008) Risicoschatting cannabis 2008. CAM, (www.rivm.nl) Assesses various aspects of the harm caused by cannabis. Fijnaut en de Ruyver (2008) Voor een gezamenlijke beheersing van de drugsgerelateerde criminaliteit in de Euregio MaasRijn A study of different forms of serious organised crime in the MeuseRhine Euregion, with recommendations for further improvements in measures to tackle transnational organised crime.

The committee also consulted a broad range of Dutch and international literature. It spoke to many parties concerned with the issue (Appendices 2 and 3 list the individuals and literature consulted), in an attempt to obtain a broad, uptodate picture of the drugs issue and the policy issues it raises. The committee was constrained by the time available, with less than five months to prepare its report. It was therefore forced to focus on subjects that it felt most urgently necessitated a change of strategy. The other questions put to the committee were considered in more general terms, and some require further study.

Basic principles The committee took an openminded look at current drugs policy. This policy, and the principles on which it is based, date from the 1970s. In 1995 it was reviewed in a broadranging policy document on drugs, and in the intervening years only certain sections have been modified. The Trimbos Institute/WODC evaluation report mentioned above gives a detailed description of the history of the policy and recent changes to it. The committee does not intend to repeat this exercise here, preferring instead to refer readers to the report itself. The changes have mainly involved a tightening up of measures and guidelines, and of the introduction of new statutory instruments for tackling public nuisance and crime more effectively (such as Damocles and Victor, which enable local a uthorities to tackle the negative impact of coffee shops and other premises used to sell drugs, and the Public Administration (Probity Screening) Act). The role of prevention and treatment has not really changed in recent years, though efforts have been made to provide a more varied service, and to raise standards. The committee believes that after almost 15 years there is indeed an urgent need for a thorough review of the policy, if only because more scientific information is now available about the negative impact of substance use (particularly alcohol and drug consumption). Changes are also needed in view of the shift in the social context in which drugs are used (resulting from open borders, the involvement of criminal organisations in the production and trafficking of drugs, public nuisance, the rise of the Internet, mobility etc.). This has given rise to a need for reconsideration not only of the instruments of policy, but also of its objectives. It is clear that drugs policy has become increasingly interlinked with other policy areas, such as policy on public nuisance, organised crime, young people and education. All these fields have their own dynamics, but because they overlap, any intervention (or failure to intervene) in one area can have farreaching implications for another. The interrelated nature of all these different areas of policy will colour the recommendations of the committee. Drugs policy focuses on substances that are banned or may be used only under specific conditions for medical purposes. The committee is of the opinion that, in view of the developments mentioned above, we must consider the policy in a new, broader perspective. Attention must be explicitly refocused on the objectives of policy, and the social values and interests at stake. The committee believes that, in this respect, drugs policy must form part of a broader policy on substances that also covers alcohol and tobacco. It is also likely that new drugs will continue to appear on the market. The committee will, where necessary, identify the relevant links in its report, particularly with issues surrounding alcohol use. The committee is aware of the moral dimension of drugs policy. It is keen to take account of the freedom of individuals who are perfectly capable of making their own decisions to behave as they see fit, as long as they do not harm others. However, freedom is never absolute and, like alcohol and tobacco, drugs require government policies that adequately reflect the need to restrict or ban their use in certain circumstances. Constraints on personal freedom may be necessary where the use of substances causes serious harm to the individual and/or to society. This is particularly the case with young people, or adults who are not capable of making sensible decisions and properly estimating the risks of substance use (in the long term, for example). From the very outset, drugs policy has had an important international dimension, not least because international agreements commit their signatories to joint action, and also because of the role the Netherlands plays in the production, import and export of drugs, as well as the sharp rise in drug tourism in recent years (though in border areas, in particular, the term tourism is not alwa ys appropriate). This international element has grown over the years, partly as a result of globalisation and increased European cooperation on drugs policy. Although the international dimension must be explicitly taken into account in shaping policy, the committee believes that a onesided view of the issue, based only on international commitments, is not appropriate. The first international treaty on which our policy is based (the Single Convention on Narcotic Drugs) dates from 1961. Almost half a century later, the world has changed radically, and we now know much more about all kinds of aspects of drug use and the problems associated with it. Furthermore, many countries now view the issue in less blackandwhite terms, and take account of other points of view, showing more interest in ways of limiting the risks to individuals (harm reduction), for example, alongside efforts to ban drugs. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in Lisbon has observed a de facto convergence in the implementation of drugs policy by European member states in recent years.

International legal framework

The Netherlands is party to: the Single Convention on Narcotic Drugs 1961, as amended by the 1972 Protocol amending the Single Convention on Narcotic Drugs 1961; the Convention on Psychotropic Substances 1971 and the 1988 United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances; the Maastricht Treaty 1992 and the Schengen Agreement 1985, and the Schengen Convention 1990. (See the Trimbosinstitute/WODC report for details of international cooperation)

Structure of the report In chapter 2 the committee presents a brief summary of the latest developments involving drugs and the objectives of drugs policy. It then sets out proposals for possible adjustments to those objectives, and the means that might be used to achieve them. In chapter 3 the committee sets out its views on the links between drugs and alcohol policy and issues affecting young people, and the need for an intersectoral approach. Chapter 4 is devoted entirely to coffee shops. In the view of the committee, the current policy on coffee shops urgently needs to be reviewed. In chapter 5 the committee briefly addresses the other questions it was asked to consider. Chapter 6 contains the committees conclusions and recommendations.

2 Developments and objectives

The committee examined the broader developments surrounding Dutch drugs policy, drawing partly on information in the studies mentioned above. At issue is not merely the demand for drugs (drug use, problems) but also the supply (production and trafficking), and the context in which they arise. This chapter first briefly outlines the latest situation in terms of supply and demand, and the associated problems. This is then used as a basis for the committees reflections on the future aims of policy and how they ca n best be achieved. 2.1 Developments in demand A balanced view of drug use Levels of consumption and damage to health are still lower for drugs than for alcohol and tobacco. Drug use seems to have stabilised on average in recent years. In pointing this out, the committee is by no means seeking to trivialise the problems associated with drug use. It does however believe it is important to see them in perspective, to help avoid the onset of moral panic and prevent calls for unnecessarily drastic general measures in response to the concerns about drug use expressed by many citizens of Europe. Though many of those concerns are entirely justified, they appear to be prompted more by a concentration of intractable problems among vulnerable groups of mainly young people who use drugs, than by figures on average use.

Eight out of ten European citizens regard drug abuse as a cause for concern. Among the Dutch public, the figure is seven out of ten. As such, this issue one of their chief areas of concern, alongside tackling organised crime and terrorism (Euroflash). One in eight Dutch 15 to 16yearolds said they had were currently using cannabis (i.e. had used it within the last month), and one in 16 use it frequently. The level of use among Dutch adolescents is higher than in Ireland, France, the UK, Belgium, Italy and Germany, but lower than in Scandinavia, Portugal, Austria and Greece (ESPAD 2008). See the National Drug Monitor, which shows that, after a large increase in the preceding period, the proportion of 12 to 18yearolds currently using cannabis (within the last month) fell from 14% to 10% between 1996 and 2003. The rate has since stabilised at this level. Recent figures from Amsterdam appear to confirm this trend (Nabben et al., 2008).

In this country, recent use among the general population is lower than the European average for all drugs except ecstasy. Figures presented to the committee suggest there has in fact been a slight downward trend in drug use among schoolchildren since 1996. Nevertheless, use of cannabis among young Dutch people exceeds the average for Western countries, in terms both of the proportion of current users and of more frequent users of cannabis. It appears that cannabis use has become normal, at least among certain sections of the young population. In comparison with their European peers, a relatively large number of young Dutch people regard cannabis as easy to obtain, and perceive the associated risks as less severe. However, the picture that emerges on the basis of average use statistics for certain age groups is less than reassuring. Drug use is associated with certain social groups. This is particularly the case with cocaine and ecstasy, which are used in pubs and clubs and, in combination with particular dress styles and musical preferences, form part of certain lifestyle trends. This is a dynamic process, in which hype and fashion play a big role. As we shall discuss later, the use of soft drugs among certain groups of young people has assumed problematically high levels, and is also associated with alcohol consumption. Problems: mixed picture Rates of illness and death from use of hard drugs are relatively low in the Netherlands compared with other EU member states. This applies both to deaths as a result of HIV infection from contaminated needles to deaths due to overdoses (though there are still around a hundred cases a year). More generally, problematic use of both hard and soft drugs is relatively low compared with other countries. For some time now, the problems associated with heroin consumption have been abating: the average age of addicts has risen, as fewer young people take up the drug, and the mortality rate remains fairly low. Both here and in other countries, the number of people seeking help for cannabis addiction has increased sharply over the past few years. The number of requests for help with cocaine addiction has also risen. There have also been recent indications of a rise in problematic use of GHB. Problematic use of cannabis appears to be particularly prevalent among young people who are disadvantaged by their background and/or situation. These youngsters display a combination of characteristics: they use cannabis, play truant, are likely to have frequent contact with care services or spend time in youth detention centres, have no stable home situation, and may even live on the streets. Crime and dropping out of school appear to be strongly associated with problematic use of drugs and alcohol. As we have said, this picture does not reflect the average Dutch youngster, but it is more prevalent, at problematic levels, among groups of young people who are vulnerable in several respects. Cannabis use is part of street culture in large towns and cities with a higher than average

proportion of ethnic minority youth. Drug use is linked to boredom, and often becomes problematic among young people who are vulnerable and already overburdened by other factors. This concentration of cannabis use and indeed alcohol use has implications for the education sector. Drug use is simply a part of daily life for pupils at some schools, albeit by no means all. This situation is particularly prevalent in large towns and cities. Pupils regularly attend class under the influence of drugs or alcohol, cannabis suppliers hang around near schools, and older pupils go to coffee shops during the day. Drug use has therefore assumed a significance that transcends individual consumption, affecting the ability of the school to impart knowledge to its pupils. Teachers trying to encourage pupils to go on to take vocational training sometimes have to compete with the apparently more lucrative option of drug dealing. It is sometimes very difficult for parents and carers to ensure that young people who get caught up in a negative spiral of problematic use and problematic performance at school receive the help they need in time. 2.2 Developments in supply Scaling up, professionalisation and criminalisation in the drugs market In line with the growing demand for drugs over the past forty years, the drugs trade has expanded, becoming more professional and commercial. Career criminals have discovered that drug dealing offers greater rewards, with less risk of arrest and long sentences, than traditional forms of crime. The market has professionalised partly as a result of the fact that measures to tackle illegal trafficking were slow to get off the ground, and were only stepped up at a much later stage. The commercialisation of the lucrative drugs market is a development that can also be seen in the soft drugs market, where grow shops and coffee shops have managed to raise their p ublic profile, despite the ban on advertising. Street dealing which can cause a great deal of nuisance for local residents has also taken on a bigger role. Drug tourism in the border areas and in large towns and cities (which is sometimes also associated with smallscale dealing) has risen sharply, fostering largescale cannabis production and trafficking in this country. Such operations have also developed into major, innovative export enterprises. Cannabis production has undergone major development, with the advent of modern technologies that allow highquality crops to be produced on a large scale for both domestic consumption and export. Cannabis production is now no longer concentrated in this country but has also spread to other European countries, often under the control of criminal organisations that are as enterprising as they are criminal. The Netherlands is a link in the international drugs trade, due both to its general role in transit (with important transport hubs like the Port of Rotterdam and Schiphol) and its good infrastructure, and to the presence of groups from countries where drugs originate, or through which they pass (North Africa, Turkey, the Caribbean). Both these factors facilitate and benefit the logistics and organisation of drugs trafficking. The relatively light sentences handed down for such crimes are also cited as an additional explanation for the Netherlands role in the production and trafficking of drugs, as is the high quality of the products (cannabis and ecstasy). Trade patterns have changed as new information and communication technologies have become available. At the retail end of the trade, physical points of sale (coffee shops and nontolerated points of sale) have become less important, as hard drugs are ordered by mobile and delivered by couriers on scooters just like pizza delivery services. The Internet is also playing an increasing role in the drugs market, including in the distribution of equipment for growing cannabis. Organised crime All these developments have resulted in a much greater role in the production and trafficking of both hard and soft drugs for organised crime. There is no separation of markets on the supply side. On the contrary: the two are becoming increasingly linked with serious crime. The same applies to delivery and support services, such as grow shops which supply seeds, expertise, lamps and other equipment for growing cannabis. There are indications that this is not a specialised crime. The organisations involved target anything from which (in this country) they can easily earn large amounts of money, from exporting cannabis to trafficking in women. The existence of organised criminal gangs means there is a great deal of violence (murder, physical abuse, intimidation of vulnerable neighbourhoods and groups, such as people who are dependent on debt counselling services or who work in sheltered employment), and poses major risks in terms of professional ethics (for notaries and lawyers, for example). The proceeds of crime are being successfully invested, enabling criminal organisations to accumulate power in certain parts of some towns and cities and in the formal economy (including the real estate sector). Drug-related crime Since the 1980s there has been a rise in drugrelated crime: addicts who steal from shops, cars and homes in order to buy hard drugs. This used to be associated largely with the highly addictive drug heroin, and for decades a few thousand marginalised heroin addicts were responsible for much of the drugrelated crime in this country. This type of crime is now declining sharply, as the addicts have grown older, their numbers have fallen and a policy of detention and care targeted at these individuals has begun to enjoy some success (thanks to the measures to tackle repeat offenders, the introduction of injecting rooms and treatment with methadone and heroin). There is no other direct, substantive link between drug use and crime. Only specific forms of multiple drug use, combined with alcohol consumption, potentially make users more likely to display aggressive behaviour (e.g. violence in the nighttime economy, which is also caused by the liberal supplies of alcohol on offer: for many police officers, patrolling town and city centres at night is anything but happy hour). Nuisance

Besides the nuisance caused by drugrelated crime, drug use and drug dealing can cause severe annoyance to the people living and working nearby. Street trading in drugs can also be a public nuisance, as can cannabisgrowing operations in residential properties (odour nuisance, illegal tapping of electricity, couriers), large amounts of rubbish in and around the premises where drugs are bought and sold, and traffic nuisance caused by visitors to drug houses and coffee shops. Although this can cause a great deal of annoyance to local residents and businesses and should be tackled, in terms of the bigger picture this is only a minor issue that has in fact declined in recent years. Public nuisance is currently associated mainly with drug tourism in the southern border regions, where drug runners also operate. For example, one in eleven residents of South Limburg say they experience nuisance from drug users (Veiligheidsmonitor). 2.3 Goal and methods Goal: to limit the damage to the individual and to society As a result of the developments described above, drugs policy has come to overlap more and more with policy on crime, public order, young people and education. Whereas, in the 1970s, it was virtually a matter of considering the health implications of indiv idual drug use, the context of drug use has now changed to such an extent that the policy needs to be thoroughly reexamined. The committee believes that a more integrated and comprehensive strategy is now required. This was already implied in the 1995 policy document on drugs, and is needed now more than ever.

The situation outlined by the Hulsman working party of 1971, which partly formed the basis of our drugs policy, was one in which [a] the use of cannabis was not known to lead to brain damage, [b] there was no organised drugs trafficking in the Netherlands, [c] criminal prosecution appeared to do more harm than good, and [d] drug use did not lead to social problems, but was more an expression of nonconformity in a society that was in itself unhealthy. Ruimte in het drugsbeleid, report by the Central Office of Public Mental Health. Meppel: Boom, 1971.

The committee believes that the goal of drugs policy over the next few years should be to prevent 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 the drugs trade. An integrated approach is certainly needed, to prevent one specific aspect (e.g. nuisance) from do minating decisionmaking, and overshadowing other aspects (e.g. health). This definition of the goal of drugs policy is in line with the traditional objectives of the policy, which has always focused on harm. Where there is no actual or likely harm, there is no need to make the use of psychotropic substances the subject of drugs policy. In such cases, the personal freedom to decide whether or not to use such substances should take precedence. The committee does however believe that the actual or potential impact on society must be more explicitly taken into account, alongside the actual or potential impact on the individual. Methods: balanced measures There is no magic bullet, no simple solution for the problems associated with drugs. The longstanding war on drugs has not been a great success (RAND Corporation, 2009). The same might be said of legalisation, which would not necessarily cause the personal and social problems to disappear as use became normalised (consider, for example, the effects of alcohol), and a legalised supply of drugs would not necessarily mean the end of the illegal market. It might indeed make it more difficult to combat. But legalisation does have certain advantages. A balanced drugs policy is a matter of moderation, and cannot be expected to produce major successes in a short space of time. Prevention, care, regulation and enforcement must be deployed in a wellconsidered mix. This country has undertaken certain commitments in signing the international agreements that provide the framework for our drugs policy. In recent years, actual practice in other countries has differed less from our policy than was previously the case. There has been a certain degree of convergence in Europe in terms of member states efforts to achieve a more balanced mix of prevention, care and criminal law measures in drugs policy, as the EMCDDA in Lisbon has observed. The same applies to countries like Australia and the US, where rates of cannabis consumption are high. In many states in the US, reforms have been introduced in drugs policy that have helped shift the emphasis to limiting the harm associated with drugs. New substances: a watchful eye People have an innate desire to use psychoactive substances, and therefore have a tendency to try new substances, or devise new uses for existing ones. One example of the latter trend is young people buying a cheap dose of GHB a substance that until recently was used only as a recreational drug and developing an addiction to it. Although this does not seem likely to quickly develop into a national phenomenon, at local level the trend is causing concern and needs urgent attention. Prescription opiates are becoming more and more prevalent on the drugs market in North America. This trend could spread to this country, though it is not inevitable. A wider problem is prescription drugs leaking onto the illegal drugs market.

Prescription drug abuse rises to epidemic level (Los Angeles Times, 11 July 2005) The explosion in the prescription of addictive opio ids, depressants and stimulants has, for many children, made the medicine cabinet a greater temptation and threat than the illegal street drug dealer, as some parents have become unwilling and passive pushers, according to a report published by Columbia University based on information supplied by doctors, pharmacists and members of the public. According to the Washington Post (7 July 2005), teenagers arrange 'pharming parties' where they swop drugs spirited from home or purchased off the streets or Internet.

A new class of substances is now emerging, known as cognitive enhancement drugs. They improve memory, and help users to thi nk faster or to comprehend complex problems. Similar to doping in sport, this is potentially attractive to students and highly educated professionals who wish to maximise their concentration levels and stamina. Students and scientists at American universities, in particular, are already taking substances to improve mental performance, and certain ethicists and lawyers who support such practices have argued against a ban. The drugs in question were originally intended mainly for medical purposes, such as the treatment of ADHD. They can easily find their way into areas outside medicine, however. Cognitive enhancement drugs are a new development which present Dutch policymakers, too, with the challenge of devising an appropriate policy in good time: either to declare them illegal and thus introduce enforcement measures under the criminal law, or take an approach based on harm reduction without criminalisation (as with tobacco and alcohol). Experiences with this new approach could help with the adjustment of policy responses to substances listed in the schedules of the Opium Act, if necessary. Traditionally, policymakers monitor developments in the field of drugs, though they tend to focus mainly on traditional drugs. They must also, however, be alert to new trends, and to the groups and subcultures where new uses emerge. Any futureproof drugs policy must be capable of detecting problematic aspects of use in good time, and responding appropriately. See chapter 5. Restraint in tackling possession of drugs One of the principles of Dutch drugs policy is that the use of drugs is not in itself a criminal offence. Possession of drugs is, however, an offence, though possession of a small quantity that is clearly for personal use is not usually prosecuted (at the public p rosecutors discretion). This principle was based largely on a desire not to criminalise drug users, which would give them a criminal record and damage their prospects. There was also concern that users would fail to seek help when they needed it for fear of being arrested. The committee has opted to retain this principle, because it clearly helps reduce the harm to individuals and society caused by drugs. In its view, however, it does not mean that possession of drugs may never be prosecuted. It might well be appropriate to prosecute for possession in certain circumstances, in order to stop young people sliding further into trouble, with timely interventions whereby both criminal prosecution and care serve the same purpose. The threat of prosecution can also be used to set a care programme in motion (see also chapter 3). Conclusions The committee concludes that the general trend in drug use does not give any great cause for concern. There are however major problems in certain areas that do need addressing: the concentration and social implications of cannabis use among young people; developments on the coffee shop scene, largely due to the numbers of foreigners they attract and to the links between some coffee shops and organised cannabis production in this country; the growing involvement of organised crime in the production and trafficking of cannabis, and links with the trade in hard drugs. The committee also believes that the dynamics of drug use and trafficking is such that the authorities must be more vigilant, to enable them to identify and respond to new trends in good time. The committee expects both researchers/academics and government to become more alert to such trends.

3 Young people, drugs and alcohol

Cannabis use among Dutch adolescents is above the average for Western countries. This applies both to the proportion of current users and of more frequent users. It would appear that use of cannabis is regarded as normal, at least among a certain section of the Dutch population. In comparison with their European peers, a relatively large proportion of young Dutch people regard cannabis as easy to obtain, and, as pointed out earlier, regard the risks as low. Use of alcohol by young people is also relatively high in this country, and excessive use is known to occur at a very young age. There would appear to be a climate in which heavy consumption of alcohol and drugs is seen as normal. This is sometimes fostered by the happy hour phenomenon. In some town and city centres, the combination of alcohol and drugs is a key factor in aggressive behaviour, notably towards police officers and care workers. The committee therefore believes that a more restrictive approach is needed, based on clearly defined social norms. It highlights a number of developments which have prompted it to call for protection of minors to be given greater priority in drugs policy. For the sake of clarity: young people and youngsters refers here to people aged 18 or under, with a particular emphasis on the yo unger end of the age range (12 to 16yearolds). 3.1 Arguments for a more restrictive policy Damage to personal growth In recent years, research has revealed more about the impact of substance use among young people. It was already clear that alcohol and drug use during puberty can cause harm, impairing cognitive capacity and concentration levels, and that alcohol can cause disinhibition of behaviour. More recently, it has been found that drug use and alcohol consumption can have a harmful impact on brain development, which continues until roughly the age of 24. There are also indications that cannabis use can increase the likelihood of psychotic episodes in individuals with a genetic predisposition. Finally, there is evidence that alcohol and cannabis use at a young age can increase an individuals likelihood of developing addictions, reduce their individual levels of happiness, and lead to lower social status in young adulthood. These effects may well be linked with those described in the previous paragraph. The younger a person starts using substances, and the more frequently they use them, the greater the longterm risks listed here. Both these aspects of use have unfortunately become more common in this country in recent years. The debate as to the causality between substance use and these negative effects continues in research circles. Nevertheless, the committee believes that there is enough evidence of harm, and that the potential seriousness of these effects is sufficient reason to take action. It advocates that we act on the basis of the precautionary principle, which is better known from environmental poli cy and physical safety issues. This principle holds that, where there is a risk of serious and irreversible damage, the absence of full scientific proof may not be used as a reason to delay action. Harm to society The second argument for taking measures is harm to society. Excessive use of substances by vulnerable young people can lead to psychological and behavioural disorders, truancy, failure to complete their education and contact with the world of crime. They develop multiple problem behaviour, which has a negative impact on their future prospects. Substance use among such youngsters is associated with stagnation in their development and social marginalisation. Drug use is not the cause of their social problems, but it does exacerbate them, and addiction makes it more difficult for these young people to find a way out of their problematic situation. Overburdened young people with few opportunities are most likely to face multiple problems, though they are by no means the only ones. In todays fastmoving, unpredictable and complex society, it is a great challenge for young people to strike a balance as they make their way along the road to work and active citizenship. This applies all the more when they lack structure in their lives (parents, school, friends and family), are exposed to bad influences (the temptations of street life, easy rewards from or inadequate punishment for certain behaviour) and apparently have no positive stimuli (membership of societies, sport, social activities, good educational performance etc.). They may then find themselves on the road to a deviant lifestyle, involving drug use and the rejection of institutions such as school and family, with no alternative structures or activities to take their place. The conclusion that this mainly affects the weaker members of society chimes with a statement made in a recent advisory report on intersectoral health policy: When it comes to health, it is the weakest who shoulder the greatest burden: people with lower socioeconomic status generally have more health problems. 3.2 More rigorous and embedded action The committee believes that much more rigorous action is needed to protect vulnerable young people and prevent them from turning to drugs and alcohol. Youngsters who nevertheless use drugs and alcohol, and thus develop problematic behaviour, must be given adequate help to curb the negative impact of use. Links with other policy areas Substance use among young people varies. Often, they use alcohol and drugs in the context of the experimentation that is a natural part of growing up. They usually stop using them quite quickly, and of their own accord. Some continue, however, because they grow accustomed to or dependent on the substance, or because it is part of the subculture to which they belong.

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Early and excessive use of substances appears to be associated with many other characteristics of the individual and his/her environment. At least half of young people with problem behaviour have problems in many areas, including excessive consumption of drugs and/or alcohol. Those problems, in turn, play a role in persistent problematic drug use. A majority of adolescents who commit crime, for example, have addiction problems (alcohol, drugs). The vast majority of young people being treated for addiction or in other forms of care have multiple problems. This requires a multifaceted strategy which takes into account the interaction between different factors associated with the young person (inherited or acquired behavioural tendencies) and their family, peers and the wider social and cultural context of their school, neighbourhood or workplace. The committee believes that, given this link between substance use and the personal characteristics of young people who are still in the process of maturing, any drugs policy targeting them will be unlikely to enjoy success unless it is embedded in a broader framework of policy on young people, education and crime. 3.3 Prevention and care It is best if use of alcohol and drugs by young people is prevented. This is especially true of excessive use, and use among the very young. Three approaches are theoretically possible (according to the categorisation used in health care, and recently introduced by the EMCDDA): universal prevention, targeting the entire population selective prevention, targeting groups and individuals who have more risk factors predisposing them to drug use than others indicated prevention for individuals who run a major risk and who are already showing the first signs (have started to use, for example). Universal and selective prevention: norms and education Universal prevention involves education campaigns in schools and in the mass media. Though they are useful in raising awareness, they do not have a direct impact on actual behaviour. Such campaigns are used mainly in support of a broader prevention strategy, enabling the authorities, for example, to provide the public with reliable information about the risks of substance use. At the same time, such campaigns can communicate a clear message to reinforce the efforts of parents and schools (and other institutions) in this area. The committee believes that the message that alcohol and drug use by young people is not desirable is best served by total avoidance of any ambiguity. The message must be that use at a young age is not normal, and that it should be identified and tackled more effectively, and at an earlier stage. It would help if there were a single minimum age for purchasing both alcohol and cannabis (in coffee shops). The minimum ages are now 16 and 18 respectively. The committee recommends, in view of the medical indications, that a minimum age of 18 be applied to both substances. To underpin this norm, the committee believes it is essential to take an active, rigorous approach to tackling vendors and intermediaries who help young people obtain drugs and alcohol. This will require adequate monitoring, and substantial penalties in the event of violations. It appears that young people (including the very young) are able to obtain cannabis and alcohol through various channels, despite official policy. The authorities must not tolerate illegal vendors who sell alcohol and drugs to young people, or mediate in purchases of such substances or, even worse, actively promote drug use among young people for commercial reasons. Minors often drink alcohol before they go out in the evening. It may be worth considering whether it is possible to take action against this under a General Municipal Byelaw or other legislation (such as the Road Traffic Act, as the Association of Netherlands Municipalities has suggested). The committee believes that drugs education for young people should tie in better with education on alcohol. Studies have shown that clear rules can reduce the risks (even genetically determined risks) of excessive alcohol consumption and addiction. Stricter rules within families have a preventive effect, particularly if children have not yet started drinking. Parents are currently much more strict about drug use than about alcohol: 64% regard drinking under the age of 16 as unacceptable, compared with 98% for cannabis use. The government uses the message no drinking under the age of 16 in its communications. It is however reluctant to use a sim ilar message for drugs, as this might imply that there is nothing wrong with using them above a particular age. To make the goal of protecting young people clear, a clear message on both drugs and alcohol would be more appropriate: use your brains, protect your brain: no drugs or alcohol under the age of 18. One targeted education programme for schools focuses on health and use of drugs, alcohol and tobacco. In international terms, it is one of the best on offer, but it is taught in only 60% of secondary schools and a third of primary schools. The committee believes that local authorities, and more specifically the municipal health services (GGD), should do more to improve prevention activities in schools. The GGD can advise schools on prevention programmes for substance use, and ways of tying them in with programmes to prevent truancy and improve safety in schools. Embedding alcohol and drugs prevention in a broader school programme can also help schools to avoid giving the impression that substance use is a specific problem in their particular institution (cf. the Safe Schools programme in Rotterdam:). Prevention is not, of course, a matter solely for the GGD and care organisations for addicts. It should also be a natural and inseparable element of broader policy on young people. This applies particularly when a certain type of drug use is associated with the identity of certain groups (street culture and the drugs that form part of it, such as cannabis use among ethnic minority youth in large towns and cities), and is often simply a way of dispelling boredom. Services such as youth work and recreational activities in the heart of urban areas have unfortunately been discontinued or cut back in recent years. There is much to be gained here in terms of the healthy

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development of young people: improvements in leisure activities and community work (recreational facilities, sport) can help prevent young people from turning to substance use, displaying other unhealthy behaviour or becoming a public nuisance. Greater focus on indicated prevention The committee believes that particular benefit can be gained by means of indicated prevention, in cases where young people or families have a specific risk of substance use (or continued substance use) which can still be averted. There is a general need for indicated prevention when problematic situations arise as children are growing up, to support the young person in question and his or her parents. Problem behaviour involving substance use does not generally occur until the final years of primary school and the first years of secondary school. A general preventive programme such as that on health and drugs, alcohol and tobacco use is not enough for these children. They need targeted prevention. According to the committee, this requires a structured approach that is lacking to some extent in the Netherlands, though the building blocks do exist here. This approach involves two components: identification and care. Step one is to identify the imminent development of problem behaviour. As soon as such a situation is identified by parents or teachers, it will often be possible to respond adequately at home or at school. In other cases, this will not be enough. Pupil support advisory teams in schools can play a key role in identifying and acknowledging the need for further action. Once problems have been identified, help is not always automatically sought. It can be difficult to provide care for young people when many different bodies are involved, each with their own rationale, leadership and logistical rules and constraints. This state of affairs does not favour alertness and rapid action, which are essential. Care workers must get together with the young person in question, the school and the parents as soon as possible to determine what can be done and to offer integrated care (targeted not at a single problem being experienced by the youngster or the family, but at all the problems that have a bearing on the situation). At the moment, things tend to go wrong because the different sectors (schools and various forms of youth care) are not sufficiently coordinated. What is more, many care workers who work with young people (from school doctors to youth probation officers; from municipal health service prevention workers to psychotherapists) know little about addiction problems. They also often have no knowledge of the impact of the most important systems in the life of young people on the emergence and perpetuation of prob lem behaviour (the young person him/herself, family, school, work, peers, leisure activities etc.), and of possible ways of intervening. This is unfortunate, as certain family and system approaches have proven effective in preventing and providing early treatment for multiple problems. It is by no means necessary for all care workers to be trained in psychosocial system therapy. The committee would however like to see local authorities train large groups of care workers (from the pupil support advisory teams, municipal health services, youth care offices, including youth probation officers and the Child Protection Board, and others working in youth care, mental health care, care of addicts and forensic care) in the principles of systembased care. Armed with this knowledge, they will be better able to identify potential problems and refer youngsters for further assistance. The municipality of The Hague has already adopted this approach. Municipalities can play a prominent role here, helping bring about more integrated youth care, with teams of care workers who could be rapidly deployed for preventive early care and for therapy, unhindered by compartmentalisation between different sectors of care. It is however important to guard against fragmentation by making a single body responsible for the care offered. Delinquency and care The committee has observed that, over the past ten years, a more integrated approach has been taken towards young people with problem behaviour who come into contact with the police and criminal justice system. Steps have been taken to ensure that the response in such situations not only consists criminal sanctions, but also includes collaboration with child protection services and youth probation officers to identify what approach would most effectively halt the young persons downward spiral, in line wi th the educational approach taken in juvenile criminal law. Any punishment takes the form of a disincentive (suspended sentence, conditional on cooperation with a care programme, and currently also measures designed to influence behaviour). The committee regards this as a useful development, particularly if discussion of cases where the delinquent behaviour is associated with a pattern of substance use involves professionals involved in the care of addicts. Links between care services, the municipality, police and criminal justice authorities in cases of youth delinquency have been strengthened by the introduction of community safety partnerships. The committee regards these partnerships as a promising development, involving coordination between various parties, particularly if they also involve specific and timely preventive and therapeutic interventions aimed at young people. Those with multipleproblem behaviour who have not yet committed any offence, or at least have not been arrested, also need this type of approach. The general principle of current policy, whereby use of drugs (or alcohol) is not regarded as an offence, and possession for personal use is not prosecuted, should be maintained, in the committees opinion. This approach has the advantage that it does not rai se extra barriers to accepting treatment. Nevertheless, there is sufficient reason to introduce a stricter and more compulsory approach in the case of people under the age of 18 (and, where necessary, their parents) who clearly and persistently abuse these substances. Criminal prosecution and care can serve the same purpose in such situations, supporting and complementing the efforts of the childs legal carers and the school. Such a binding approach must however be designed in such a way that it keeps the channel for communication on substance use open and lowers barriers to treatment as far as possible. A more stringent approach would also support parents and teachers, whose position would be strengthened by clear social norms enforced rigorously and without delay.

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Conclusions In the interests of healthy personal and social development, the committee believes it is necessary that steps be taken to counteract drug and alcohol use among young people, particularly where this occurs at a very young age, and at excessive levels. The committee envisages a combination of measures: clear and unambiguous norms concerning the undesirability of substance use, reflected in a single minimum age of 18 for drug and alcohol use, and an active approach to prosecuting those who supply alcohol and drugs to minors; a systemised approach to intervention as soon as young people display signs of developing problem behaviour involving substance use (indicated prevention); when young people engage in delinquent behaviour, the criminal law can be used as a powerful disincentive to prevent them descending further into harmful patterns of behaviour. In both education campaigns and other strategies, it often makes no sense to take action simply on drugs (and/or alcohol). A more integrated approach is needed, in the framework of general policy on young people.

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4 Coffee shops The committee paid working visits, studied the literature and obtained information from key individuals involved with coffee shops to gain an idea of how and in what context these facilities operate. The picture that emerged from this exercise differs markedly from what was originally envisaged: coffee shops as smallscale facilities with a largely local/regional role in the production and use of cannabis. The committee is convinced that the policy on coffee shops needs reviewing, in order to redress the balance between their positive and negative aspects. 4.1 Current situation Quiet and safe Coffee shops have a role chiefly as places where adult consumers can purchase and, if they wish, use cannabis in a quiet, safe setting, without coming into contact with individuals who deal in other drugs. In this sense, they play a role in the separation of the drugs markets. They do not apparently lead to a different level of cannabis use among adolescents or lower cannabisdependence in the Netherlands than in other European countries (Trimbos/WODC). It has also been found that minors, who are not allowed to use coffee shops, can easily obtain cannabis from these establishments via adults. The existence of coffee shops allows the authorities to keep an eye on consumers, make contact with them and provide information on the risks. Finally, coffee shops provide local government with a safety valve that allows it to influence part of the cannabis market. Its ability to set criteria whereby cannabis production and supply will be tolerated provides a way of reducing the public nuisance sometimes associated with coffee shops. Public nuisance and disruption In many of the 100 or more municipalities with coffee shops, they can be regarded as a relatively troublefree phenomenon, providing within the existing policy framework a manageable facility that mainly supplies local users. In the border areas, however, particularly in the south of the country, the presence of coffee shops causes problems, due to the large and evergrowing numbers of people crossing the border to buy drugs. The conflict this has caused has prompted a range of local, and sometimes regional, interventions: the closure of a large coffee shop in Terneuzen, the closure of all coffee shops in Roosendaal and Bergen op Zoom and plans in Limburg to impose major restrictions on access to coffee shops. The presence of large coffee shops causes public nuisance in terms of traffic and noise levels. The influx of consumers from Belgium, France and Germany has given rise to a market in which coffee shops have become permanent facilities serving customers from abroad, who come to buy drugs for their own consumption, and also to deal in them back home. In Amsterdam, on the other hand, where more than one in four of all coffee shops in the Netherlands are located, most tourists cause virtually no problems in or near coffee shops. The nature of drugs tourism is different there. Many foreigners visit a coffee shop during their stay in the city, with no intention of taking drugs home with them. The large number of coffee shops in Amsterdam has been prompted by this type of incidental tourism, which occurs on a fairly substantial scale. Though their numbers have been substantially reduced over the years, the concentration of coffee shops in certain areas of the city is so great, in the view of the city council, that they have a negative impact on the neighbourhoods where they are located. Over the past few decades Rotterdam has invested a great deal in counteracting major problems on the drugs market associated with the combination of coffee shops, drugs runners and drug houses, caused partly by their attractiveness to foreigners from countries to the south of the Netherlands. This brief summary highlights the major local and regional differences in the coffee shop situation. We should also add that measures in one municipality have an impact on others. The closure of coffee shops in one can, for example, cause the market to partially or even completely relocate to another. Or a more stringent approach in one place can cause more problems elsewhere. Many drug runners in Limburg, for example, have come from the Randstad conurbation in the west of the country. Enforcement Article 71, paragraph 2 of the Schengen Convention 1990 states that: The contracting Parties undertake to prevent and punish by administrative and penal measures the illegal export of narcotic drugs and psychotropic substances, including cannabis, as well as the sale, supply and handing over of such products and substances, without prejudice to the relevant provisions of Articles 74, 75 and 76.' Despite this, however, selling of cannabis in coffee shops is tolerated, under strict conditions. The distinction between soft and hard drugs was introduced by the Opium Act 1976. The phenomenon of house dealers, which so on developed into coffee shops as tolerated points of sale for cannabis, was seen mainly as a way of keeping cannabis users away from the world of hard drugs. The rules applying to coffee shops are laid down in Public Prosecution Service guidelines (see sidebar), which define the conditions under which the selling of cannabis technically a criminal offence will not be prosecuted. They include restrictions on the amount of cannabis that coffee shops are allowed to stock and the weight that may be sold, a measure which is designed to curb crossborder drugs tourism.

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Public Prosecution Service criteria The sale of soft drugs in coffee shops is tolerated, subject to strict conditions. Coffee shops that are tolerated on the basis of local tripartite consultations (between the mayor, public prosecutor and chief of police) will not in principle be prosecuted provided they comply with the following conditions: no advertising: this means no advertisements other than a brief notice on the premises in question; no hard drugs: this means that no hard drugs may be present or sold on the premises; no public nuisance: this includes inconsiderate parking near to the coffee shop, noise annoyance, waste and/or customers hanging around in front of or near the premises; no selling to or admittance of young people: given the increase in cannabis use among young people, it has been decided that the minimum age of 18 should be strictly enforced; no sales of large quantities in a single transaction: in other words, amounts larger than are suitable for personal use (= 5 g). Transaction is taken to mean any purchase or sale in a single coffee shop on the same day, involving the same purchaser. the tripartite authorities may determine the maximum quantity of cannabis that tolerated coffee shops may stock. In principle, no prosecutions will be brought against coffee shops stocking any amount up to the maximum. The stock may not in any event exceed 500 g. Opium Act guidance (2000A019) (see www.om.nl)

The drugs policy document 1995 opted to enforce these criteria primarily under administrative law, so that the police and Public Prosecution Service could focus on enforcing the criminal law to tackle hard drugs and organised crime. As a result of this choice, the focus of enforcement in the case of soft drugs has come to rest above all on the public nuisance caused by certain coffee shops. The Trimbos/WODC evaluation report states that compliance with and monitoring of the maximum permitted stock of 500 g causes particular problems. The criminal and fiscal enforcement agencies say the same. It is also difficult to ascertain whether drugs are sold to customers several times a day, and to prove that drugs have been sold on to minors. The committee observes that, due partly to problems with enforcement (which is sometimes neglected), the original aims have not been achieved. It has proved difficult to protect young people, some coffee shops are now much larger than was ever intended, and some systematically supply the foreign market. As a result, commitments under the Schengen Convention and other international agreements are not being fulfilled. Maastricht has attempted to keep away foreign customers by setting out rules on access to coffee shops in a General Municipal Ordinance. The Administrative Jurisdiction Division of the Council of State is currently considering an appeal against a decision by the mayor of Maastricht to temporarily close a coffee shop on the grounds that it had contravened the provision in the General Municipal Ordinance banning access to individuals who are not resident in the Netherlands. A request for a preliminary ruling has also been submitted to the European Court of Justice in Luxembourg. The issue at stake is whether the ban is compatible with the free movement of goods and services. The crucial questions are whether cannabis can be regarded as a good under EC law, and how this approach under administrative law relates to the EUs provisions on drugs in the Maastricht Treaty. It is likely to be some t ime before a ruling is handed down. Cannabis growing and organised crime Permitting sales of cannabis in coffee shops has unfortunately given rise to the idea that soft drugs are not a big problem, with the result that less priority has been given to investigating cannabis growers and traffickers. This has allowed hemp growing to develop on a large scale, facilitated by legitimate commercial services (finance, consultancy, money laundering) and improvements in growing techniques (agricultural science, industry), and with little hindrance from the police and criminal justice authorities, who were focusing on the hard drugs market. A report recently compiled by Breda city council highlights a prime example of these developments. The coffee shop sector is varied, and its character has changed dramatically. The image of small entrepreneurs who once opened coffee shops for idealistic reasons applies to only a small proportion of the sector these days. It is now dominated by largescale and often supraregional commercial operators, some of them with direct links to the world of organised crime. Largescale cannabis growers and dealers are not always too concerned about the quality of the cannabis, and in recent years, use of pesticides and growth enhancers that are damaging to the health of users has been on the increase. Substances added to the cannabis to increase its weight and so increase profits are also detrimental to quality. This increases the health risks to consumers. Coffee shop owners have little opportunity to screen the products supplied for this kind of contamination. It is also difficult for wellintentioned coffee shop owners to buy cannabis from smallscale producers (some of whom grow cannabis in their own homes), as they have largely been driven away or taken over by large producers whose objective is no longer to serve cannabis consumers but to protect their own financial interests, by violent means if necessary.

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Coffee shops have become just a small element in the world of cannabis dealing. Cannabis growing and the crime associated with it have become virtually autonomous, and most cannabis is sold outside the region where it is produced, to either domestic or foreign consumers. Coffee shop policy can therefore have only a modest impact on the production of cannabis and the organised crime that goes with it (see also chapter 5). 4.2 Framework for solutions: development and dynamic The committee has ascertained that coffee shop policy needs readjusting. The situation has got out of hand in several respects. Coffee shops have grown into something that was never intended, the original aim of protecting young people from hard drugs has met with only limited success, and there are considerable problems in specific regions and municipalities that cannot be adequately addressed at local level. National clarity with scope for difference and more rigorous enforcement The issues associated with coffee shops have given rise to a range of disparate actions, particularly at local level, designed to address the problems identified. The question is whether such local measures will ever be enough within the current framework, or whether the framework itself needs to be reconsidered. The committee believes that the scope for different approaches must be constrained by clarity on the desired direction of national policy. At the same time, the national framework must still allow for differences, given the fact that the committee has ascertained that the situation differs from one moment to another, from one place to another, and at regional and local level. The multifunctional objective of coffee shops to offer adults a safe, quiet place where they can use cannabis, to provide local administrators with a safety valve, and to give care workers an opportunity to identify problematic users must therefore be clear. They are not intended as retail outlets for absolutely anyone from at home or abroad, nor as a breeding ground for organised crime. This underlying intention can and must allow scope for local difference, for the parties in the tripartite consultations (the mayor, Public Prosecution Service and police, preferably with input from the municipal health service) to shape coffee shop policy as they see fit, in keeping with their circumstances. One essential precondition is that, more than in recent years, enforcement under the criminal law should be combined with administrativelaw measures to ensure strict compliance with the national and local conditions under which coffee shops are allowed to operate. The committee is thus saying that, no matter what form the regulation of coffee shops actually takes, enforcement including under the criminal law must be reinvigorated and tightened up to ensure that coffee shops once more become what they were intended to be. This requires an end to the current reluctance among the police and Public Prosecution Service to use prosecution to enforce the criteria under which coffee shops are tolerated, and to make administrative enforcement in the interests of public order the main concern. This onesided attitude has, in the opinion of the committee, been partly responsible for the excesses that have occurred in several places in this country. The problems associated with coffee shops must no longer be tackled solely or primarily by the mayor, in the interests of public order (nuisance), but also under the Opium Act 1976 and in line with international agreements. This means that, in accordance with the clause in the Schengen Convention 1990 quoted above, policy on investigation and prosecution must be brought back into line with and support the objectives of our drugs policy, as laid down in Public Prosecution Service guidelines and supported by measures under administrative law, and that the authorities responsible must work closely together to enforce the policy. If these general principles are observed, the committee believes it may be possible to further develop coffee shop policy. 4.3 Further development of national coffee shop policy Variation and scope for experimentation The committee has distinguished six possible options for the further development of coffee shop policy. Each has its advantages and drawbacks, which must be discussed in order to establish a national policy framework with scope for local variation. The six options are represented in the figure below. The most extreme options are legalisation of cannabis, and therefore also of coffee shops (I in the diagram) and an outright ban on coffee shops (VI). The latter would mean that coffee shops were no longer tolerated and would have to close down. Under the legalisation (or minimum regulation) option, coffee shops would b e regarded as normal enterprises and cannabis as a normal commodity, subject to general rules, and sometimes to specific rules such as a minimum age for purchase, as with alcohol. Four other forms of regulation lie between these two extremes. Regulation can be onesided, as it is now, since only sales of cannabis are regulated (II and IV), or it could be twosided, if supply were also regulated. In this case sales, production and trade would be tolerated, subject to certain rules (III and V). Under models II and III, it is assumed that the coffee shop would be an open enterprise, subject to certain rules, such as the Public Prosecution Services criteria. Any adult would be able to enter the premises. However, coffee shops could also become closed enterprises, accessible only to a limited, known set of clients, with regulation of sales (model IV) and possibly also supply (model V). Given the need for effective enforcement, the different circumstances that necessitate some variation in policy, and the different options that are theoretically possible, the committee feels it should indicate which course of action it would recommend. In order to do so, it will first discuss the current situation, then the different courses of action, highlighting which ones it regards as undesirable, and eventually pinpointing the option it regards as most appropriate.

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No ban, no legalisation The committee believes that a total ban on coffee shops (option VI) would not be a wise course of action, as it would mean the loss of the quiet, safe environment they offer adult cannabis users. They would then have to resort to the illegal market, bringing them into contact with other drugs and the crime associated with them. Nevertheless, an overall ban would make this country less attractive to foreign users. This can also be achieved by less drastic means, however. The other advantages of coffee shops (scope for monitoring users, role as safety valve) would also be lost if an outright ban were instituted. At the other end of the spectrum, the committee does not favour legalisation (option I) in the current circumstances. It is aware of the calls for legalisation, on the grounds that the problems associated with cannabis are caused mainly by the fact that production and trade are banned, and that full liberalisation of the market could be achieved without many problems. The committee does not however believe that the advantages of liberalisation and the drawbacks of a ban are as blackandwhite as this would suggest. Legalisation would not, for example, rid us of all the problems associated with substance use (cf. the major alcohol problem in this country). And unilateral legalisation by the Netherlands would only serve to attract more foreign users, and possibly also producers, since they could grow cannabis for export in this country freely and without risk. The debate as to whether to legalise or ban cannabis must be conducted at international level. The committee believes it would be unrealistic for our country to go its own way on this issue (by unilaterally withdrawing from the international agreements on the matter). In the current situation The current situation corresponds to option II: coffee shops are open to the general public but subject to one sided regulation (of sales, not of supply and the associated production and trade). As we have said, this causes few problems for many local authorities, other than the crimeinducing nature of a nonregulated supply side. Though this is not an ideal situation, it could in principle persist on condition that enforcement were tightened up. The committee does, however, have a few reservations. The first concerns enforcement. As we indicated above, better criminal law enforcement, alongside administrative enforcement, is needed to link toleration of coffee shops more closely to supervision of compliance with conditions, and more sanctions in the event of noncompliance. This of course applies to the ban on hard drugs on the premises, but also to the number of transactions per client and selling (or reselling) to minors. The second concerns the question of whether some general conditions currently applying at national level are actually appropriate in certain local circumstances. If not, the tripartite authorities must have the freedom to set local conditions within the national policy framework. This applies to the recently introduced condition that coffee shops must be situated a certain minimum distance from schools; having listened to the views of schools, the committee is not convinced that this national criterion is generally appropriate (or effective). Thirdly, there is the problem of how to enforce the maximum stock limit of 500 g. Both the coffee shop sector and the law enforcement authorities (police, Public Prosecution Service, Tax and Customs Administration) have highlighted problems with this rule. Measures to prevent coffee shops expanding in size and to reduce the influx of drug tourists will not resolve this issue, as variation in the size of coffee shops will persist, depending on the local situation. The maximum quantity would then have to be based on the size of the customer base and the coffee shops turnover. The tripartite authorities may agree to the introduction of a maximum below 500 g; they may not exceed this limit, however. But prosecutions are rarely, if ever, brought against coffee shops found to be exceeding the limit (on the basis of cannabis actually found, or deduced on the basis of transactions). Since the committee believes that criminal enforcement needs tightening up, it might be worth considering adapting the rules on the maximum quantity of cannabis kept on the premises to give the tripartite authorities some room for manoeuvre. Since the supply of cannabis to coffee shops is illegal, the owner and staff theoretically run the risk of prosecution if they pick up and transport cannabis to the premises. The halfway option would involve an undertaking that these individuals would be protect ed from criminal prosecution if it were clear they were acting in accordance with the conditions for the operation of the enterprise and only with the aim of selling within these constraints. This would tie in with current practice, though the rules would have to be made clearer, in view of the desire to enforce the law more rigorously. The committee strongly recommends that coffee shops once more become smallscale facilities. It is clear that the emergence of very large coffee shops, or even mega coffee shops, quickly causes problems (cf. Terneuzen). However, the committee regar ds it as the job of the local/regional tripartite authorities to strike the best balance between the size of coffee shops, their number and their distribution. Sometimes this will lead to the opening of more coffee shops, while in other cases coffee shops will have to close. Further development towards regulated supply not an automatic step (from II to III) The idea of proceeding from the current situation (option II) towards regulation of supply and also production of cannabis (option III) has been put forward in various quarters. This would give the authorities more of a hold over production, which in some parts of the country, like southeast Brabant, is occurring on such a huge scale that it is difficult to control. There would have to be a clear distinction between tolerated, regulated cannabis growing operations for similarly tolerated and regulated coffee shops, on the one hand and, on the other, the production of cannabis for the illegal market at home and abroad, which will have to be rigorously tackled. The committee rejects the idea of such a development in the current circumstances. Coffee shop owners would have to serve a large clientele (since there would be no restrictions on the number or type of visitors, who would include foreigners) from stocks supplied hopefully by bona fide producers, who would have to operate in a market dominated by criminal organisations. It is difficult to drive

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organised crime out of such largescale, complex commercial processes, and it would take major efforts to keep them out. Given the problems currently associated with this, the risks would be too great. Furthermore, the regulation of cannabis supply on the larger scale referred to here would not be compliant with the international agreements to which the Netherlands is party, and such a development would as with legalisation mean that the Dutch had to withdraw from certain agreements, a prospect which the committee regards as unrealistic and undesirable. Towards a more closed type of coffee shop (from II to IV) As we have said, the committee would advise that coffee shops return to being smallscale facilities (or remain as such) serving the local market (i.e. residents of the municipality where they are located and the immediate surrounding area). Measures to restrict flows of customers to coffee shops are needed, as a matter of priority in regions where coffee shops systematically serve a crossborder market. Restricted access to coffee shops for crossborder consumers would reduce the influx of foreigners, many of whom come because coffee shops give them a quiet, safe environment in which to consume cannabis. If they were to stay away, the coffee shop market would shrink, and the associated sideeffects (drug runners, street dealing including in hard drugs and traffic nuisance) would be reduced. This could be tested in practical experiments such as those planned for Limburg, where the authorities hope to restrict access to coffee shops by introducing passes (other places are planning to use iris scans and other methods of identification), limiting opportunities to consume (daily limits), restricting opening hours, and introducing payment by electronic transfer, which would no longer be anonymous, etc. If the desired effect is to be achieved, the regulations will have to be properly and consistently enforced. An attempt to discourage drugs tourism using the Public Prosecution Service criteria failed. The committee is also in favour of experimenting with other methods. The impact and results of the tests will however have to be closely monitored, supervised by experts and nationally evaluated to establish whether they have been effective (a role that could be performed by the new drugs authority; see chapter 5). A more radical version of option IV would be to set up a coffee shop club. This would be a closed enterprise, and all customers would have to be members. The club would have a list of members (perhaps subject to a certain maximum) and nonmembers would not be admitted. If the club were truly to be closed, it would have to be prohibited from offering day membership. The club would therefore have a stable set of consumers who would all be members. One condition would be that membership would be open only to residents of the region. This would bring us close to the situation originally intended: coffee shops as local facilities for local or regional consumers. The committee believes this option is interesting enough for experiments to be set up. The possibility of introducing a more closed version of coffee shops would reduce the problems in border areas. However, it would take extra enforcement. It is not clear what implications this would have for the market in drug production. If it became less attractive for foreigners to come to the Netherlands because they could no longer visit coffee shops, the illegal domestic target might shrink. But this would require a clear, stringent policy; halfhearted attempts at regulation could in fact lead to more illegal production and trading for the Dutch market. The vast majority of production and trade is now intended for export. Coffee shops play no role in this. Closed coffee shops with regulated supply (option V) Only if closed coffee shops were introduced, along with checks on users, does the committee believe it would be possible to consider regulating cannabis supply and production. It believes such a step could be countenanced only if the club model, with a clearly defined and fairly stable membership, were successfully introduced and maintained. Under option V, several plants could be grown for the personal use of each member of the club, which would grow the cannabis independently in this country. This option would tie supply to customer access, with no scope for supply of cannabis from abroad. This idea is important, as it would help resolve one of the contradictions of current policy: the fact that coffee shops are allowed to sell cannabis, while production and distribution of cannabis are banned. Experimenting with this on a small scale would enable us to establish whether (in view of current developments in the market) this would be manageable, and identify any potential negative side effects. An experiment of this kind would provide an opportunity to see whether the idea of a coffee shop for the local market, supplied from smallscale growing operations, were viable. The results of experiments might lead to regulation of cannabis production in a broader sense, if developments were to occur at international level that made this possible, or even desirable (this would mean progressing from V to III). The committee recommends that the possibility of establishing coffee shop clubs with regulated supply be investigated further to reveal what legal conditions would need to be introduced, and how the production and consumption of cannabis and their supervision might be organised. If no insurmountable fundamental or practical problems were to arise, one or more experiments might be conducted, followed by scientific evaluation. 4.4 Further development of coffee shop policy through experimentation Recent years have seen mainly local initiatives in response to specific problems. While the committee understands the need for such initiatives, it would call for a more systematic approach, with further development of drugs policy in a more systematic and controlled manner than we have seen over the past few years, along the lines set out, and with more guidance from central government. Simply responding to local developments would not be consistent with this approach. National policy will have to be more actively shaped, and this will include the setting up and evaluation of experiments. Such a development will require a national authority (s ee chapter 5) to initiate and supervise experiments in close consultation with authorities at local level; to help define consistent administrative,

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health and legal conditions for local initiatives; to investigate the impact (including any displacement effects); and to translate any information gleaned into further measures. Contacts with neighbouring countries will have a major bearing on any further development of coffee shops, if only because any changes to our policy will affect Germany, Belgium and France too. Our counterparts in those countries will have to be fully informed of our plans, and it would be useful to identify the implications for them of any changes to our policy. It might also be useful to involve them in evaluating our experiments, in view of the fact that this is a problem common to all EU countries. The committee not only regards it as essential that we work on a structural basis, but also that we take an integrated approach to the entire issue, to ensure that the concerns of the administrative authorities (public nuisance, administrative enforcement), police and criminal justice authorities (crime and enforcement of the criminal law) and the health care sector are considered in a balanced way both in setting up the experiments and in identifying their implications. Local coffee shop policy does not always comply with the necessary conditions at present (these include input from and deployment of the police, and coordination of care and prevention). It is also essential that the conditions under which coffee shops are tolerated be enforced more frequently under the criminal law, in line with the relevant international agreements, to avoid proceedings against the administrative authorities. Finally The committee has concluded that coffee shop policy needs to be reinvigorated along the lines set out above, out of a desire to preserve their positive effects and counteract their negative effects, with local differentiation to allow for tailormade approaches. But even if we take this line, it will have only a modest impact on the production of and trade in cannabis, which has long outgrown the coffee shop scene. This issue will be dealt with in the following chapter.

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5 A dynamic drugs policy Beside the two particular issues of young people and coffee shops, the committee also considered drugs policy as a whole, since it was also asked to investigate prevention and care, the role of the Opium Act schedules, and measures to curb the production and trafficking of drugs. The committee does not intend to go into all these subjects individually in detail. Instead, it will examine them in relation to one another. 5.1 The search for consistency: a dynamic drugs policy The desired consistency can be viewed in terms of the concept of a dynamic model of drug initiation, as described by Jonathan Caulkins of the RAND Corporation. The central idea as shown in the figure below is that drug use rises like a wave and then disappears again after some time. It thus resembles an epidemic, such as a flu epidemic. A substance becomes available, spreads among a limited group of people and, once it passes a turning point, spreads rapidly (by means of a selfreinforcing feedback mechanism, as people imitate each other, often assisted by a fall in the price as production and trade become established). After a certain saturation point, there follows a period in which the negative aspects of the substance overdoses, addiction, crime become more apparent. The popularity of the substance comes under pressure in part, perhaps, as a result of interventions. A negative feedback mechanism then sets in, and consumption falls, leaving a hard core of problem users.

Heroin provides a good illustration of this phenomenon. After use rose sharply, heroin gradually came to be seen as a losers drug. Nevertheless, a group consisting of tens of thousands of hardened drug addicts remained, who need longterm help. The situation with cannabis is not entirely clear, and differs from one country to another. In the US, for example, use peaked in the hippy era, after which it declined, only to experience a new surge in the 1990s, and then decline slightly again. Little is known about the first period in this country, but the pattern since the 1990s resembles that in the US. According to this model, drug use is dynamic. Drugs policy must therefore also be dynamic, with measures that change over time according to the situation. The epidemic metaphor remains valid to a certain extent. Universal prevention measures are designed to provide information on the risks associated with a substance, and to prevent its use. During the first phase the key thing is to prevent use of the substance spreading, since such efforts have a double return in terms of fewer problems at a later stage. This requires a restrictive and, where necessary, repressive policy. Once use has become established, the emphasis is on harm reduction both harm to health (addiction, HIV infection) and to society (school dropouts, public nuisance, crime). This approach, which changes over time, puts the apparently stark contrast between harm reduction and prosecution into perspective. The committee has used this idea of a dynamic drugs policy, whereby the purpose of various measures would be made clear, as a framework for its deliberations on the various elements of policy it was asked to consider. Since the theme of prevention was discussed in chapter 3, it will not be examined separately here.

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5.2 Classification of drugs according to risk Designation as highrisk When a new drug emerges, it is assessed in terms of the risks it poses to public health. If those risks are considerable, it will be added it to Schedule I (unacceptable risk) or Schedule II (less serious risk) of the Opium Act, which effectively means it is banned. This allows criminal prosecution for possession, production and trafficking. The difference between Schedule I and Schedule II lies in the penalties imposed and in the specific acts that are criminalised (in this case preparatory acts).

Since 1976 the Opium Act has distinguished between drugs that pose an unacceptable risk to public health (Schedule I, which includes heroin, cocaine, amphetamines) and substances that pose a less severe risk (Schedule II, including cannabis). Since then, few changes have been made to the list. Ecstasy was added to Schedule I in 1988, GHB was added to Schedule II in 2002, and since 2008 fresh hallucinogenic mushrooms have been added to Schedule II, along with the dried version, which had previously been on Schedule I. Sentences for possession, production, selling and trafficking of drugs on Schedule I are considerably harsher than those for substances on Schedule II. See the Opium Act Instructions (2000A019), and the Guidelines for Prosecutions under the Opium Act, soft drugs (2000R004) and hard drugs (2000R005). www.om.nl

The committee was asked to examine whether there is any reason to reconsider the listing of drugs on Schedule I or II. In response to this request, the committee gave more fundamental consideration to the question of whether the current system, with two schedules, is still appropriate. It identified a number of problem areas. Updating and credibility The question is whether the inclusion of various substances in the schedules is still consistent with our current knowledge of the harm they can cause to public health. We now know more than we did in 1976 about the short and longterm risks to individual physical and psychological wellbeing, to social functioning and to society, including those associated with substances such as alcohol and tobacco, which are not covered by the Opium Act. If we were to draw up such lists on the basis of what we know now, some substances would probably be categorised differently, or might not be covered by the legislation at all. Our understanding deepens, and substances change (the Dutch cannabis or Nederwiet currently on the market is very different from that available in the 1970s and 1980s). Such changes are not, however, reflected in shifts from one schedule to the other, or the removal of substances from the schedules. This failure to update the schedules may also be influenced by the governments desire to send a message about harmfulness, i n response to a particular incident, for example. This has happened recently in the case of substances like cannabis, ecstasy and hallucinogenic mushrooms, both here and in the United Kingdom. It is understandable that, on topical issues, politicians are keen to prevent people from gaining the wrong impression about the risks associated with certain drugs. However, if this occurs systematically, it can undermine the credibility and therefore the usefulness of the categorisation. It is sometimes impossible to avoid imbalance, in cases where the Netherlands is obliged under EU or other international law to regulate certain substances under the Opium Act, even though they are rarely, if ever, found on the Dutch market, and the evidence of their potential harmfulness is not convincing. Grey area between illegal and prescription drugs The regime established under the Opium Act differs markedly from the system for prescription drugs. This can cause problems, since some prescription drugs on the market can be improperly used for recreational purposes, or to enhance performance. The applies for example to certain opiates, amphetamine derivatives, sedatives, tranquilisers and other substances used in psychiatric and psychological treatment. The dividing line between proper and improper use of prescription drugs is sometimes very thin, which makes it difficult to pursue a clear policy in such cases. There is also a very fine dividing line between the Medicines Act and the Opium Act. In the Netherlands, benzodiazepines are regulated by both Acts, because of their potentially addictive effect. The committee believes that the Opium Act is not the most appropriate instrument for regulating the prescription for medical purposes of drugs on the current schedules. But nor does the current Medicines Act provide a basis for determining when medical use becomes illegal consumption. These are issues to which the current legislation is unable to provide an appropiate answer. Substances marketed as prescription drugs are thoroughly researched and their pharmacological effects tested. Such research takes a great deal of time, and is very costly. Once a substance is on the market, it has to be monitored for years in case it causes side effects. In the case of illegal drugs, the substance is already on the market, and there are no producers who are prepared to invest in a research programme. Nevertheless, governments do put money into researching the harm caused by drugs. Collaboration with pharmacological researchers might produce benefits in terms of the knowledge acquired and of efficiency. The Coordination Centre for Assessment and

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Monitoring of New Drugs (CAM) could then use the knowledge thus acquired to assess whether the substances should be scheduled (or moved to another schedule) under the Opium Act. Broader assessment framework The guiding principle for scheduling substances under the Opium Act is their harmfulness to individual and public health. The committee believes it is important that harm to society also be considered. In 2007 a paper was published in the medical journal The Lancet about the relative harm caused by various substances. A panel of experts assessed 20 substances, considering not only pharmacological aspects, but also harm to society. Heroin came top of the British experts list of most harmful substances, followed by tobacco and alcohol. LSD came bottom of the list. The Dutch National In stitute for Public Health and the Environment (RIVM) performed a similar study for the Netherlands, at the request of the Minister of Health, Welfare and Sport. Again, a panel of experts assessed 19 substances, including tobacco and alcohol, in a similar way. Unlike the British experts, however, they based their assessment on reports compiled on each of the substances on the basis of literature studies. Nevertheless, the results of the two studies are very similar. In this country, too, heroin and tobacco came top of the list, cannabis was in the middle, and hallucinogenic mushrooms came bottom. The list of substances studied in the Netherlands differed slightly from the British list in one respect: it included only substances available on the user market (the Dutch study covered hallucinogenic mushrooms, for example, but not barbiturates). The convergence in the results of these two entirely independent studies has prompted the committee to conclude that the harm criterion must not be restricted to the toxicological risk, and that substances must be assessed in terms of relative risk if the lists are to be consistent. It is not wise to immediately schedule emerging substances under the Opium Act as a precaution, if only because as we observed above such a decision can rarely be reversed. This may well be unavoidable in the case of emerging drugs whose risks are not well known, however. Later in the dynamic process of drug use, the risks can be better assessed as more (and more reliable) data become available. It is thus important that the CAM, which is responsible for subjecting drugs to a multidisciplinary risk assessment, use a fourdimensional assessment model. Besides risks to individual and public health, it should also consider public order and safety, and criminal involvement. This model, which was recently applied to an assessment of cannabis, might form the basis of a broader assessment framework which would allow reassessment of substances after a certain time, once the actual risks were known. This might lead to a different decision on scheduling under the Opium Act. A single list? The categorisation into two schedules under the Opium Act suggests wrongly, as this was never the intention that there is reason to judge systematic criminal dealing in soft drugs differently from dealing in hard drugs. The major differences in sentencing regimes suggest that dealing in soft drugs is not as bad as dealing in hard drugs. In practice, however, it is not possible to draw such a distinction when it comes to production and trafficking: criminal organisations can easily move between substances on Schedule I (e.g. cocaine trafficking) and Schedule II (growing cannabis). The committee would call for the distinction to be abolished, and for a single list of banned substances to be used. This would also have the advantage of abolishing differences in the degree to which preparatory acts were regarded as a criminal offence. A move to a single list, better substantiated than the current ones, would not prevent the Public Prosecution Service allowing for some differentiation in practice in its guidelines (as is already the case under the Opium Act). The extent to which a specific drug is tackled as a priority under the criminal law, and how, should be determined less by its inclusion in a particular list, and more by its phase in the epidemic cycle. This can best be addressed at a practical level, rather than in legislation. It might be possible to institute some kind of hierarchy in the single list, for substances that require an exemption because they also need to be used in medical practice (Medicines Act), or on other grounds. The system must be flexible, as developments in drug use occur too rapidly for policy ever to keep pace. Conclusions The committee has its doubts about the current Opium Act with its two schedules, and suggests that a single list be introduced. However, such a change would involve complicated legislative drafting which is neither part of the committees mandate, nor achievable before the deadline. The committee only recommend that a committee of experts be established to look into this matter in more depth, and produce solutions and proposals for amendments to the legislation. 5.3 Limiting damage Once a certain level of drug use is reached, despite efforts at prevention and limiting its spread, it becomes extremely difficult to achieve any effect through policy measures. Society will then suffer the potentially harmful effects of use for some time. Damage to users, however can be prevented or reduced (harm reduction). Another form of damage is the crimes committed by users. Harm reduction Policy has been shown to have an impact on the health problems associated with substance use. Examples of harm reduction strategies include needle exchanges (to prevent infectious disease, HIV/AIDS, hepatitis), treatment with methadone (to prevent overdoses and reduce mortality rates), medical treatment with heroin for chronic addiction, and the setting up of injecting rooms (to provide a safe

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environment for users). These strategies work, and are being adopted by more and more countries. The committee believes that this policy has proved its worth and should be continued. Nevertheless, certain practical improvements could be made, for example in the quality of methadone treatment. The availability of extra financial resources since mid2008 has boosted efforts to improve matters. The committee would however like to highlight one problem area. Enforcement officers sometimes use employ farteaching methods in pubs and clubs, such as drug searches on entry, while health care professionals are also present to warn of the risks associated with drug use. In such instances, the government shows two different faces both help and punishment and this reinforces neither its message nor its credibility. The committee believes that neither a strict nor a relaxed approach deserves priority. What is needed is a coordinated approach based on the idea of a dynamic drugs policy. Sometimes strict will be appropriate, while at other times a more relaxed approach can be taken. Which approach is most appropriate will have to be decided by the tripartite authorities, based on input from local health care services. Tackling drugrelated crime In the cycle of heroin use, which arose in the 1970s and is now well past its high point, it took a long time for a structural approach to be taken to addicts who committed multiple offences and caused a public nuisance. The onesided approach focusing largely on harm reduction, prompted partly by a shortage of prison cells, has now made way for a much more rigorous approach in which the efforts of the criminal justice authorities are tied to those of the care services, and coercive measures such as compulsory treatment orders for addicts and later detention in Persistent Offenders Institutions have been introduced, alongside programmes such as medical treatment with heroin. If nothing else helps, addicts may be detained under the Psychiatric Hospitals (Committals) Act. In hindsight, such an approach would have been useful at an earlier stage, which shows that, when drug use and alcohol consumption are associated with crime, it should be tackled rigorously, not merely glossed over. Individuals must be made aware that, if they use substances (alcohol and prescription drugs, as well as illegal drugs), they can pose a danger to others. This should make users extra cautious, and education campaigns should be used to persuade them of the burden of this responsibility. Committing a crime under the influence of alcohol or drugs (including prescription drugs) counts as an aggravating circumstance, since the individual should be aware of the fact that substance use is associated with increased risks. 5.4 Care of addicts Addiction care in the Netherlands has been reoriented away from social welfare toward health care, with the aim of providing both care and cure. Addiction is firmly entrenched in both body and mind, and major improvements are difficult to achieve. The margins within which health care services can operate are therefore very narrow. The committee has the impression that addiction care services exploit the available potential well, in the case of adult addicts at any rate. The sector has clearly professionalised in recent years, partly as a result of the introduction of protocols as part of a programme entitled Results Score, and of a more evidencebased approach. More emphasis on addiction among minors and on services outside the addiction care sector (municipal health services, general health care services, youth care services, forensic care) is urgently needed, and there is much room for improvement in this area. The organisation of addiction care Care of addicts has been transformed from a patchwork of smaller and larger institutions into ten large institutions that provide not only addiction care, but also mental health care services and community shelters. They were set up in response to the introduction of the Health Care (Market Organisation) Act. This brought more care providers onto the market in 2006, increasing the supply of interventions by private service providers. They focus mainly on people with addiction problems who are still fully or largely able to function in society. This makes their treatment prospects much better than those of the generally socially excluded clients of regular addiction care services or other public health care sectors. There are no figures for the amount of private care on offer, because such institutions do not participate in the national registration system as regular addiction care providers do. The greater focus on market forces and client orientation brought about by the Healthcare Insurance Act also appears to be having an impact on regular addiction care services. They are now able to respond more rapidly to requests for help (as in the case of GHB and gaming addiction). On the other hand, the market orientation appears to have encouraged publicly financed institutions providing care for addicts to regard each other as competitors, which has made them more reluctant to share information and research results. Complexity Client organisations do not have the impression that addiction care has become more accessible. They have found less flexibility and a greater tendency to take a blinkered view. Client representatives also say that addicts partners and families have little in volvement in their treatment. This reduced flexibility will have been caused partly by changes to the healthcare system and the creation of larger merged institutions, which has made the funding of regular addiction care more complex in recent years. Care of a single client sometimes has to be paid for via several schemes: health insurance, the Exceptional Medical Expenses Act, the Social Support Act and, more recently, by the criminal justice authorities. Each system has its own criteria and registration procedures (e.g. Diagnosis Treatment Combinations, or DBCs), which has not only increased the administrative burden, but has also created barriers that hamper cooperation. In many cases, though clients can be rapidly diagnosed thanks to a central intake and needs assessment procedure, it has been suggested that some then find themselves on internal waiting lists for treatment for up to a year. By extension, policy cooperation between addiction care institutions and other services (criminal justice authorities, municipalities, care administration offices, police, labour organisations) is also still problematic, as a result of this blinkered attitude. Treatment

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should include interventionist care, with a single therapist acting as liaison for the client. The treatment must therefore be multidimensional. Funding flows should break down rather than reinforce the barriers between different care sectors. The committee regards it as undesirable for different government departments (Ministry of Health, Welfare and Sport, Minister for Youth and Families, Ministry of Justice) and other authorities to pursue their own policies when it comes to recognising, planning and funding different forms of treatment and institutions, for example. The committee simply intends to highlight a number of important problems and suggest possible solutions here. In areas where it has argued for an integrated approach to the problem among young people (chapter 3), in particular, gaps in the treatment of young people with addiction and other problems, must be taken seriously and where necessary remedied with the use of court orders. In view of the short time available to complete its task, the committee had no opportunity to devise and test possible remedies. 5.5 Tackling the illegal market Wherever there is a certain demand for certain drugs, an illegal market emerges to supply them. The committee was asked to consider what it would take to reduce the Netherlands role in the production, transit and distribution of ecstasy, cannabis and cocai ne. Approach to the market During the phase in which a new, harmful drug appears on an illegal market, this market has yet to crystallise. From the point of view of a dynamic drugs policy, the priority in this initial phase is to discourage users and influence availability (accessibility/price) to such an extent that use becomes less attractive. This requires an assertive approach to minimise the spread of the drug, with a view to limiting longterm damage, and avoidance by the government of any signals that might be construed as approval or tolerance. Once a certain level of drug use has become established, it is difficult to affect the supply of drugs enough to reduce demand. In the case of legal products, increasing the price can affect demand, as with alcohol and tobacco. The same will also be true of illegal drugs. Nevertheless, supplyside measures have little effect, because the market responds to barriers by seeking other ways of reaching the consumer. In other words, the market structure adapts to any change in conditions. It has, for instance, been suggested that a prolonged period of low priority in terms of law enforcement in the cannabis market, followed by a period during which mainly smallscale growers were tackled, fostered the largerscale organisation of the market. This may be the case, but the idea that measures to tackle the illegal drugs market somehow created organised drug crime is inco rrect. It already existed on a large scale before efforts to tackle it got under way. There is also evidence that some production of ecstasy and cannabis has been displaced to other countries in response to stricter enforcement in this country. A displacement effect to other trafficking routes has also been observed in the case of cocaine, resulting from the more rigorous checks in the Antilles and at Schiphol. A certain level of drug use in this country and elsewhere, therefore, combined with general infrastructural factors beneficial to the illegal drugs market in the Netherlands, make it difficult for the authorities to have any substantial influence on the supply market for drugs. This economic perspective means a certain degree of modesty is called for with regard to the potential impact of government measures on the supply and distribution of drugs in these later epidemic phases. The emphasis then has to shift to controlling the potential side effects: illegal dealers amassing wealth and influence, using violence and intimidation to control the market, and corrupting officials, commercial service providers and companies. A disorganised government against organised crime? The committee has observed a sharply increased focus on and greater investment in controlling the illegal market for drugs. The drugs trade and the production of ecstasy have for many years been key priority areas for the police and criminal justice authorities. Since the facts regarding organised cannabis growing were recently established, investigation of such operations has been given high priority, and measures have been introduced to tackle the worst cases. The committee regards this as a positive and necessary development, as there was much ground to be made up in this area. Recently, too, albeit late in the day, attention has been focused on the worst excesses associated with this phenomenon: murder, torture, intimidation, bribery and money laundering via legitimate enterprises. In this connection, the role of grow shops in the production of and trade in cannabis requires particular attention. These enterprises around 300 in number have a key role, not only in providing material to home growers, but sometimes providing all the equipment needed on condition that the resulting cannabis harvest is supplied in its entirety to the grow shop. The committee believes that their role must be reduced and that grow shops, like coffee shops, should be permitted only with a licence from and under the supervision of the local authority. The committee understands that the Minister of Justice is now working on a legislative proposal concerning the status of grow shops.

The Programme of Action on Organised Cannabis Cultivation was launched in early 2008, shifting the focus deliberately to the criminal organisations behind commercial cannabis growing operations. The programme was a response to the violent crime and huge profits associated with them, and the links between illegal and legitimate enterprises, which poses ethical risks. The aim is not only to tackle individual offenders and dismantle criminal organisations, but above all to destroy the structures that have allowed this development to occur. The programme is part of an effort to strengthen measures against organised crime, as set out in the governments policy prog ramme.

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These efforts are based on the principle that effective measures against organised crime require more than just criminal investigation and prosecution. They need joint action by municipalities, the Tax and Customs Administration, the police and the criminal justice authorities, sharing information and taking coordinated action. (see www.justitie.nl)

The committee believes that measures to tackle organised crime are still inadequate. Where crime becomes organised and professionalised in illegal markets, the government must not lag behind because of a lack of coherence. There has been a positive trend in recent years away from pursuing and arresting individuals and confiscating drugs towards a more wellconsidered, programmatic approach, linking criminal justice, administrative and fiscal measures to create systematic obstacles to organ ised crime. This type of approach was first tested in a human trafficking case (the Sneep case) and is now being applied to organised c annabis production. The authorities collaborate on such cases with energy suppliers and insurance companies, for example. Provided this approach is applied consistently and with enough support it could lead to a considerable reduction in cannabis production and the associated violence, corruption and accumulation of influence as the proceeds of crime are invested in legitimate enterprises. The committee believes that we need a consistent approach to organised crime. Efforts to introduce such an approach are only in their early stages, however. We currently have only test beds for ideas that still have to be translated into r egular practice. The committee would like to raise a further, more important, point. A sectoral approach (e.g. to cannabis growing) might overlook the links between different sectors of criminal activity, making it less effective than an approach where the spotlight is focused on criminal associations that constitute the biggest threat. Experience has shown that a firm, intensive, persistent and intelligent approach can substantially reduce the risks associated with organised crime,. The committee would therefore recommend such an approach be adopted. Law enforcement climate One factor in the Netherlands position is the relatively lenient law enforcement climate. Although there is no evidence that a more lenient enforcement climate fosters ordinary crime such as theft and vandalism, drug dealers are more calculating, and this probably does not apply to drug crime. An enforcement climate that differs sharply from other countries could quite possibly be a factor in decisions as to whether to become involved in the illegal market as a dealer, courier or intermediary. Earlier in this chapter the committee stated that there is reason to reconsider the difference in sentencing under Schedules I and II of the Opium Act, as this regime might hamper a dynamic drugs policy. After all, different approaches are needed in different phases of the epidemic, and organised dealing is often not limited to a single substance. The committee therefore believes that there is reason to review enforcement and sentencing for drug traf ficking, as advised in the Public Prosecution Services guidelines and elsewhere, partly with a view to convergence with other countries. In particular, a greater threat of prosecution and punishment could be introduced for supplying or even pushing drugs to young people, or supplying drugs commercially through courier services and the media. Finally, the committee believes that offenders, whether in prison or not, must no longer be able to continue their role in drug dealing from a distance (or, in the case of electronic tagging, from their home). This undermines the deterrent effect of custodial sentences and the credibility of and confidence in the public authorities. 5.6 Authorities The committee is convinced that any dynamic drugs policy must be an integrated policy, in which health care, crime fighting and measures to reduce public nuisance complement each other, and the emphasis shifts depending on the current phase of use. Public health policy might act as a coordinating force, and provide anchorage, but no single policy area could claim dominance. The committee is interested not so much in debates about what aspect is most important, as in adequate solutions to the problem at hand. It believes that the tripartite authorities at local/regional level the local authority, Public Prosecution Service and police must also receive input from the municipal health service on this matter. More needed at national level The committee has already observed that little has been done to update drugs policy since the drugs policy document published in 1995. Despite occasional studies and monitoring reports, we know too little about production and trafficking, in particular. This is particularly true of the police and criminal justice authorities. In view of the need for a dynamic drugs policy, and given the complexity and extent of developments in this area, this level of policy neglect is unacceptable. The committee saw many signs of inadequate collaboration between policymaking bodies. Its impression is that in some cases, separate policy regimes exist alongside and in isolation from one another, and operate independently. There has been too much indifference where consultation and action would have been more appropriate. The Ministry of Justice and the Ministry of Health, Welfare and Sport each have their own research policy, for example (implemented on their behalf by the Research and Documentation

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Centre or WODC and the Netherlands Organisation for Health Research and Development or ZonMw respectively), while a joint framework might be more efficient, effective and objective. While an institution like the National Drugs Monitor (NDM) is important, it has not been able to give us any idea of the actual developments behind the figures, such as those occurring in coffee shops, and in the world of organised crime. Drugs authority The committee has ascertained that a great deal remains to be done to adapt certain areas of drugs policy to changed circumstances, and to make it sensitive and responsive to the dynamics inherent in the world of drugs. It believes that the current configuration, with responsibility for policy divided among several ministries (not just the Ministry of Health, Welfare and Sport and the Ministry of Justice, but also the ministries of education, foreign affairs etc.) cannot be relied upon to develop and draw lessons for policy. The committee therefore recommends that coordination and direction be placed in the hands of a single authority (possibly consisting of senior civil servants), which has the power to develop and monitor drugs policy, and to take budget decisions where necessary. This might be a temporary arrangement, set up to develop policy along the lines recommended by the committee. However, it would make more sense to have a permanent body with clear political leadership, not least because of the importance of international coordination. The committee does not regard it as its responsibility to set out how this body should be structured, but would call for the currently isolated policy regimes to be integrated. Clashes of ideas and interests are important in any policy learning process, but as a result of the current division of responsibilities they tend to lead to paralysis and a lack of responsiveness. The committee therefore believes that a less than welldefined body like the current interdepartmental steering group on drugs has insufficient administrative clout. The scale and severity of the problem justifies a more binding level of ambition, based on political leadership, which would also encompass forging ties with neighbouring countries and with the US. Politicians will have a role in resolving impasses and providing strong guidance. The drug czar, a high ranking politicallyappointed official with his or her own office, for which countries like Germany and France (MILDT) and the US (ONDCP) have opted, might serve as an inspiration, precisely for the reason the committee has just noted. Whatever form is chosen, the essence is that sufficient political and administrative power must be mobilised for the body to be able to develop drugs policy further and keep its finger on the pulse (monitoring, research).

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Appendix I: Order establishing the Advisory Committee on Drugs Policy

The Minister of Health, Welfare and Sport, the Minister of Justice, and the Minister of the Interior and Kingdom Affairs, acting in accordance with the views of the cabinet; Having regard to section 6, subsection 1 of the Advisory Bodies Framework Act; Order as follows: Article 1 An Advisory Committee on Drugs Policy (hereinafter referred to as the committee) is hereby established. Article 2 It is the task of the committee, with due regard to the evaluation to be performed by the Trimbos Institute and the Research and Documentation Centre, to advise the Minister of Health, Welfare and Sport, the Minister of Justice and the Minister of the Interior and Kingdom Affairs as to whether all or part of the Netherlands policy on drugs must be reviewed and, on the basis of the under standing it has gained, to make recommendations to the Dutch government, in the form of scenarios, for a drugs policy that is futureproof from a broad social, national and international perspective. Article 3 The committee consists of the following members: Professor W.B.H.J. van de Donk, chairman of the Advisory Council on Government Policy (and chairman of the committee) P. Boekhoud, chairman of the Executive Board, Albeda College, Rotterdam; Professor W. van den Brink, Professor of Addiction Care, University Medical Centre, Universiteit Amsterdam; Professor C. Fijnaut, Professor of Comparative Law, University of Tilburg; Mrs S.J.E. Horstink von Meyenfeldt, State Councillor Extraordinary; Professor D. van de Mheen, Professor of Addiction Care, Erasmus MC Rotterdam; Professor H.G.M. Rigter, professor emeritus; senior researcher at the Department of Community Health Care, Erasmus MC Rotterdam; Mrs A. van VlietKuiper (Mayor of Amersfoort) Article 4 The committee will issue its recommendations to the Minister of Health, Welfare and Sport, the Minister of Justice, and the Minister of the Interior and Kingdom Affairs before 15 June 2009. The committee will be disbanded one month after it has issued its recommendations. Article 5 The committees archived records will be transferred to the archives of the Ministry of Health, Welfare and Sport, with a copy to the administrators of the archives of the Ministry of Justice and the Ministry of the Interior and Kingdom Affairs, after the committee is disbanded, or sooner if circumstances warrant it. Article 6 This order will take effect on the second day after the date of the Staatscourant (Government Gazette) in which it is published, with retroactive effect to 26 January 2009. The order will cease to apply as of 1 October 2009. Article 7 This order may be cited as: Order Establishing the Advisory Committee on Drugs Policy. This order and the explanatory notes pertaining to it will be published in the Staatscourant. A. Klink, Minister of Health, Welfare and Sport E.H.M. Hirsch Ballin, Minister of Justice Ms G. ter Horst, Minister of the Interior and Kingdom Affairs Explanatory notes On 6 March 2008 the Minister of Health, Welfare and Sport, the Minister of Justice, and the Minister of the Interior and Kingdom Affairs undertook to present to the House of Representatives a new, integrated policy document on drugs. They also undertook to evaluate drugs policy before doing so. The Ministers subsequently decided, in consultation, to request advice on the future of drugs policy from an independent body in the period between the completion of the evaluation and the publication of the new, integrated policy document. They initially planned to ask the Advisory Council on Government Policy for advice. However, the Council requires approximately a year to produce an advisory report of this kind. Given the desire of the House of Representatives to

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accelerate the publication of the policy document, this would have been too long. The Ministers therefore decided, in consultation, to ask a specially established committee to issue recommendations in the period specified above. The purpose of this order is to establish the Advisory Committee on Drugs Policy referred to below as the committee. The committee has the task of advising the Minister of Health, Welfare and Sport, the Minister of Justice, and the Minister of the Interior and Kingdom Affairs as to whether a review of all or part of Dutch drugs policy would be appropriate, partly in view of the international context and international agreements. On the basis of its understanding of the issue, it will make recommendations, in the form of scenarios, for a futureproof Dutch drugs policy. The committee will examine the drugs issue from a broad social, national and international perspective. It will consider drugs policy not only in terms of public safety and health but also, and more especially, from the social perspective, including the impact of drugs on young peoples educational performance, on families and on the cours e of peoples lives. The committee will base its conclusions on the report of the evaluation of drugs policy that is due to be completed in spring 2009. More specifically, the committee has been asked to consider the following questions when setting out its recommendations. 1) Is there reason to reconsider the listing of certain drugs in Schedules I and II of the Opium Act? 2) Can improvements be made in terms of addiction care, prevention and harm reduction? 3) What is needed to reduce the Netherlands role in the produ ction and transit of ecstasy/cannabis and the distribution of cocaine? 4) What specific public nuisance is caused by the production, trading and use of drugs, and how can this be effectively reduced? 5) What are the future prospects for coffee shop policy, partly in view of the European and wider international context? The committee is requested to consider the cannabis risk analysis performed by the Coordination Centre for Assessment and Monitoring of New Drugs (CAM) and the study of the relative harmfulness of different types of drugs, including alcohol and tobacco, performed by the National Institute for Public Health and the Environment (RIVM) in making its recommendations concerning the drugs listed in Schedules I and II of the Opium Act. The committee is requested to consider the report by Fijnaut and De Ruyver entitled Voor een gezamenlijke beheersing van de drugsgerelateerde criminaliteit in de Euregio MaasRijn and the debate that has been ongoing in the Netherlands for some time now, and includes calls on the one hand for the eventual full abolition of coffee shops, and for regulation of the supply of cannabis to coffee shops on the other, in making its recommendations concerning coffee shop policy. The committees report should include an ex ante analysis of both options, which are more radical than current policy. To gain the necessary understanding and to test its recommendations, the committee is authorised to gather information and consult with the Public Prosecution Service, the police, institutions offering addiction care and other experts. It may also, in consultation with the Ministry of Health, Welfare and Sport, the Ministry of Justice and the Ministry of the Interior and Kingdom Affairs, dispose of a budget to commission the research needed for it to produce a good, balanced report. The committee is requested to produce its report by 15 June 2009, and will be disbanded a month after it is published. If, due to unforeseen circumstances, the report cannot be produced within the designated period, the term of the committee may be extended once, for a period of two months, from 15 July 2009.

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Appendix 2: List of individuals consulted E. Apaire, chair, Mission Interministerille de Lutte contre la Drogue en la Toxicomanie (MILDT), Paris J. Beenakker, mayor of Asten Ms K. Bergacker, policy officer, Eindhoven City Council H. van Berkel, policy officer, Brabant Southeast police region R. Bik, chair, Board of Chief Commissioners B. Bieleman, director, Bureau Intraval Ms A.P.M. van Bolhuis, director at Ministry of Health, Welfare and Sport G.W. van der Burg, Chief Public Prosecutor, Den Bosch Ms E. Brekelmans, head, criminal investigations division, Brabant East police region H.M.F. Bruls, mayor of Venlo M.J. Cohen, mayor of Amsterdam A. Cohen, director, Centre for Human Drug Research LUMC M. Daniel, head, Cannabis Cultivation Task Force Ms R. Donders, mayor of GeldropMierlo C. Dorpmans, prevention worker, NovadicKentron C. Edwards, head, AntiDrugs Policy Coordination Unit, Europese Commission, Brussels V. Everhardt, Trimbos Institute R. van Gijzel, mayor of Eindhoven W. Gtz, director, EMCDDA J. de Groot, Ministry of Finance M. Heijmans, policy officer, Brabant Southeast police region R. Hermanides, director, NovadicKentron Ms A. Jorritsma, mayor of Almere, chair of Association of Netherlands Municipalities (VNG) M. Josemans, coffeeshop proprietor, Maastricht, chair of Association of Official Coffee Shop Proprietors Maastricht

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A. Klip, Professor of Criminal Law and Procedure and Crossborder Aspects of Criminal Law, Maastricht University Ms M.W. van Laar, head, National Drugs Monitor programme/Focal Point, Trimbos Institute G. Leers, mayor of Maastricht J. van Maasakkers, mayor of GemertBakel J. Mikkers, mayor of Veldhoven T. Nabben, criminologist, Bonger Institute, Universiteit van Amsterdam M. van Nimwegen, procurator general, The Hague Ms M.M.J.van Ooyen, senior researcher, Research and Documentation Centre (WODC), Ministry of Justice W. Panders, coffee shop proprietor, Bussum, chair of Dutch Cannabis Platform R. Pans, director, VNG Ms A. Pennte Strake, chief public prosecutor, Maastricht J.M.M. Polman, mayor of Bergen op Zoom Ms A. Roeters, InspectorGeneral, Education Inspectorate W. Rutten, director at NoordBrabant provincial authority R. Severijns, mayor of Oirschot H. Tromp, departmental head, Brabant Southeast police region M.P.M. Veling, coffee shop proprietor, Amsterdam, spokesperson for the Association of Cannabis Retailers K. van der Wolk, deputy director, Consular Affairs Department, Ministry of Foreign Affairs A. IJzerman, director at Ministry of Justice Anonymous: Cannabis grower, Eindhoven Coffee shop proprietor, Eindhoven

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Appendix 3: Literature Academy of Medical Sciences UK. Report highlights impact of future brain drugs on society. Press release 22 May 2008 ACMD Advisory Council on the Misuse of Drugs. Cannabis: classification and public health. UK Home Office 2008 AIHW 2007 National Drug Strategy Household Survey first results. Australian Institute of Health and Welfare. Canberra 2008 Amsterdam J.G.C. et al. Ranking van drugs. Een vergelijking van de schadelijkheid van drugs. Bilthoven, RIVMGBO/Amsterdam AMCAIAR, 2009. Asser Institute. Experimenteren met het gedogen van de teelt van cannabis ten behoeve van de bevoorrading van coffeeshops Internationaal rechtelijke en Europees rechtelijke aspecten. T.M.C. Asser Instituut, 2005 Bean, Philip. Drugs and Crime. Cullompton: Willan Publishing. 2008 Bennet, Trevor, Katy Holloway and David Farrington. The statistical association between drug misuse and crime: a metaanalysis. Agression and Violent Behavior 13, 2008, 107118 Bieleman, B. and J. Snippe. Coffeeshops en criminaliteit. Justitile verkenningen, 32,2006,1,4660 Bieleman, B., A. Beelen, R. Nijkamp, E. de Bie. Coffeeshops in Nederland 2007. Groningen: Bureau Intraval. 2008 BKA Narcotic Drugs. Annual Report 2007 Abridged Version Bundeskriminalambt, 2008 Blom, T. Coffeshops, gedoogbeleid en Europa. Justitile verkenningen, 32, 2006,1,1461156 Botvin, G.J., E. Balker, L. Dusenbury, E.M. Botvin and T. Diaz. Longterm followup results of a randomized drug abuse prevention trial in a white middleclass population. Br. J. of Psychiatry 180, 2002, 216221 Braithwaite, John. Markets in Vice. Oxford University Press 2005 Braithwaite, Valerie and John. Democratic sentiment and cyclical markets in vice. Brit. J. of Criminology, 46, 2006, 11101127 Bruinsma, Gerben and Wim Bernasco. Criminal groups and transnational illegal markets. Crim. Law and Social Change, 41, 2004, 7994 BrettevilleJensen, Anne Linne and Liana Jacobi. Climbing the Drug staircase: A Bayesian Analysis of the Initiatio n of Hard Drug Use. Bonn: Iza 2008 Brink, W. van den. Hoe schadelijk zijn softdrugs? Justitile Verkenningen, 32, 2006,1,7288 Brink, Wim van den. Forum: decriminalization of cannabis. Current Opinion in Psychiatry 2008, 21, 122126 Brink, W. van den and G.M. Schippers. Verslaving en verslavingszorg. Tijdschrift voor Psychiatrie 50,2008,9197 Bunt, H.G. van de. Hoe stevig zijn de fundamenten van het cannabisbeleid? Justitile Verkenningen, 32, 2006, 1023 CAM Risicoschatting cannabis 2008. Coordination Centre for Assessment and Monitoring of New Drugs. Bilthoven 2008 Caulkins, Jonathan P., Peter Reuter, Martin Y. Iguchi and James Chiesa. Drug Use and Drug Policy Futures Insight from a Colloquium. RAND Corporation 2003 Caulkins, Jonathan P., Peter Reuter, Martin Y. Iguchi and James Chiesa. How goes the war on drugs? An Assessment of U.S. Drug problems and Policy. RAND Corporation 2005 Caulkins, Jonathan P. The Need for Dynamic Drug Policy. Addiction. 102(1):47, January 2007 CBS Veiligheidsmonitoren Rijk 2006. Voorburg, 2008 Cleveland, H. Harrington and Richard Wiebe. Understanding the association between adolescent marijuna use and later serious drug use: gateway effect or developmental trajectory? Development and Psychopathology 20, 2008, 645632 Cleveland, Mary M. Economics of Illegal Drug Markets: What Happens If We Downsize the Drug War? In: Jefferson M. Fish (ed.) Drugs and Society: U.S. Public Policy, Rowman & Littlefield Publishers, Inc., 2005 Croes, M.T. Peace on drugs? Justitile Verkenningen, 32,1,2006,123134 Cuijpers, P., M. Scholten and B. Conijn. Verslavingspreventie, een overzichtsstudie. Den Haag, ZonMw, 2006 Dufour, R. . Drugs; van oorlog naar regulering. Justitile Verkenningen, 32,2006,1,1461156 Duncan B. Clark. Predictors of marijuana use in adolescents before and after licit drug use: examination of the gateway hypothesis. Am. J. of Psychiatry 163, 2006, 12, 21342140 Dijk, Jan J.M. van. The narrow margins of the Dutch drug policy: a costbenefit analysis. European J. on Criminal Policy and Research 6, 1998, 369393 EC Young People and Drugs among 1524 yearolds. Flash Eurobarometer. European Commission 2008 EC Rational Antidrug Policy. Informal Council of Ministers for Home Affairs Prague 15 January 2009 EC Awareness of Key Policies in the Area of Freedom, Security and Justice. Analytical report. Flash Eurobarometer. European Commission 2009 EU Organized Crime Threat Assessment 2008. Europol 2008 EU Action Plan on Drugs 20092012 EUROJUST Jaarverslag 2007. The Hague, Eurojust. 2008 EMCDDA Stand van de drugsproblematiek in Europa. Jaarverslag EMCDDA 2008 EMCDDA Drug use, impaired driving and traffic accidents. EMCDDA 2008 EMCDDA Monitoring the supply of heroin to Europe. EMCDDA 2008 EMCDDA: Special issue on drugs and groups of vulnerable young people. EMCDDA, 2008 EMCDDA Monitoring the supply of cocaine to Europe. EMCDDA 2008 EMCDDA Preventing later substance abuse disorders in atrisk children and adolescents a review of the theory and evidence base of indicated prevention. EMCDDA 2009 Fowler, Greg, Stuart Kinner and Leigh Krenske. Containing ecstasy: analytical tools for profiling an illegal drug market. National Drug Law Enforcement Research Fund, Australia 2007 Fijnaut, Cyrille and Brice De Ruyver. Voor een gezamenlijke beheersing van de drugsgerelateerde criminaliteit in de Euregio MaasRijn. Tilburg Gent, 14 November 2008 Fijnaut, Cyrille. Het vermeend verlicht karakter van het Nederlandse drugsbeleid. Socialisme en democratie (in production) Gageldonk, A. van. Verslavingszorg aanbod. Rivm.nl Gageldonk, Andr van, Toeine Ketelaars and Margriet van Laar. Hulp bij probleemgebruik van drugs. Utrecht Trimbos Institute 2006 Ganpat e.e. Oneigenlijk medicijngebruik onder Nederlandse jongeren: aard en omvang. Rotterdam: IVO, 2009 Gazzaniga, Kichael S. Smarter on Drugs. Scientific American, September 21, 2005 Grapendaal, M., Ed. Leuw, J.M. Nelen. De economie van het drugsbestaan criminaliteit als expressie van levensstijl en loopbaan. The Hague: WODC, Gouda Quint. 1991 Greeley, H. et al. Towards responsible use of cognitiveenhancing drugs by the healthy. Nature, Vol 456, dec 2008 Hibell, Bjrn, Ulf Guttormsson, Salme Ahlstrm, Olga Balakireva, Thoroddur Bjarnason, Anna Kokkevi, Ludwig Kraus (2009). The 2007 ESPAD Report substance use among students in 35 European countries. (www.espad.org) Holloway, Katy, Trevor Bennet amd David Farrington. The effectiveness of criminal justice and treatment programmes in reducing drugrelated crime: a systematic review. UK Home Office online report 26/05 Home Office UK Government response to the recommendations made by the Advisory Council on the Misuse of Drugs in its report Cannabis: Classification and Public Health (UK, 2008) INCB Report of the International Narcotics Control Board for 2008. New York, UN 2008 Keefer, Philip, Norman V. Loayza and Rodrigo R. Soares. The Development Impact of the Illegality of Drug Trade. World Bank 2008 King, Ryan. The Economics of Drug Selling: A Review of the Research. The Sentencing Project, Washington DC 2003 Klip, Andr. European Criminal Law An Integrative Apporoach. Intersentia Antwerpen, 2009, 426427 Klip, A.H.. Op weg naar minder opportuniteit? Delict en delinquent, 2009, 185196 KLPD Nederlandse criminaliteit met een georganiseerd karakter 20062007. KLPD, 2007 KLPD Het groene goud.

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KLPD, 2008 KLPD Nationaal dreigingsbeeld 2008 Georganiseerde criminaliteit. KLPD. 2008 Laar, Margriet van, Guus Cruts and Ingeborg Keij. Drugsgerelateerde sterfte. CBS Population Trends, 2nd Quarter 2003 Liccardo Pacula, Rosalie. What research tells us about the reasonableness of the current priorities of national drug control. RAND Testimony 2008 MacCoun, Robert J., and Peter Reuter. Drug War Heresies. Cambridge University Press. September 2001 Maris van Sandelingenambacht, C.W. Extase; drugs en het schadebeginsel. Justitile Verkenningen, 32,1,2006,89110 Marshall, E. Jane, Irene Guerinni and Allan D. Thomson. Introduction to this issue: The Seven Ages of Man (or Woman). Alcohol & Alcoholism, 44, 2009, 2, 106107 Matrix Knowledge Group. The Illicit Drug Trade in the United Kingdom. UK Home Office online report 2007 Matthys, W. et al Factoren die bij kinderen en adolescenten een risico vormen voor gebruik, misbruik en afhankelijkheid van middelen. The Hague, ZonMw, 2006 Mazerolle, Lorraine, David Soole and Sacha Rombouts. Drug Law Enforcement: The Evidence. Australian Drug Policy Modelling Project. 2005 Mazerolle, Lorraine, David W. Soole and Sacha Rombouts. Disrupting StreetLevel Drug Markets. Crime Prevention Research Review no 1. Washington DC: Department of Justice. 2007 McDonald, David, Gabrielle Bammer and Gabrielle Breen. Australian Illicit Drugs Policy: Mapping Structures and Processes. Australian Drug Policy Modelling Project. 2005 McLaren, Jennifer, Wendy Swift, Paul Dillon and Steve Allsop. Cannabis Potency and Contamination: a Review of the Literature. Addiction, 103, 2008, 11001109 McSweeney, Tim, Paul J. Turnbull and Mike Hough. Tackling Drug Markets and Distribution Networks in the UK. UKDPC 2008 Meerkerk GJ et al. Nieuwe verslavingen in zicht. Rotterdam: IVO, 2009 Midgley, Gerald, Ann Winstanley, Wendy Gregory and Jeff Foote. Scoping the Potential Uses of System Thinking in Developing Policy on Illict Drugs. Australian Drug Policy Modelling Project. 2005 Miron, Jeffrey A. The Economics of Drug Prohibition and Drug Legalization. Boston: New School for Social Research 2001 Mitchell, Ojmarrh, David B. Wilson and Doris L, Mackenzie. The effectiveness of incarcerationbased drug treatment on criminal behavior. Submitted to the Campbell Collaboration Criminal Justice Review Group. September 2008 Moore, Tim. Working Estimates of the Social Costs Per Gram and Per User for Cannabis, Cocaine, Opiates and Amphetamines. Australian Drug Policy Modelling Project. 2007 Murray, R.M., P.D. Morrison, C. Henquet, Marta di Forti. Cannabis, the Mind and Society: The Hash Realities. Nature Reviews, November 2007 Nabben, Ton, Annemarie Benschop and Dirk J. Korf. Antenne 2007 trends in alcohol, tabak en drugs bij jonge Amsterdammers. Amsterdam, juli 2008 NewburyBirch, Dorothy, Janet Walker, Leah Avery, Fiona Beyer, Nicola Brown, Katherine Jackson, Catherine A Lock, Ruth McGovern and Eileen Kaner, Eilish Gilvarry, Paul McArdle and Venkateswaran Ramesh, Stephen Stewart. Impact of Alcohol Consumption on Young People A Systematic Review of Published Reviews. UK Department for Children, Schools and Families. 2009 Newcombe, Russel. Attitudes to Drug Policy and Drug Laws A Review of the International Evidence. Liverpool John Moores University. 2004 NIDA A Progress Report on Marijuana Research and Dissemination Efforts. NIDA: 2004 NIDA Principles of Drug Addiction Treatment. NIDA: 2008 Nutt, David, Leslie A. King, William Saulsbury and Colin Blakemore. Development of a rational scale to assess the harm of drugs of potential misuse. Lancet, March 24, 2007, 10471053 Nutt, D. Equasy an overlooked addiction with implications for the current debate on drug harm. J. of Psychopharmacology 2009, 23, 3 OoijenHouben, M.M.J. van. 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