Cocaine: an increasing health risk in Europe
In its 2010 Annual Report, the EMCDDA signals increasing concerns over health problems due to cocaine usage. Statistics supporting this include an increase in the number of cocaine-related deaths (1,000 in 15 countries) and cocaine users’ demand for treatment.
In the Netherlands, the number of people who die from an ‘overdose’ of cocaine is relatively limited: 30 cases in 2009, or roughly 20% of all acute deaths due to drug use. However, it should be noted that this could be an underestimation of the actual number of deaths from cocaine. Chronic cocaine use can cause cardiovascular diseases and neurological conditions, which often mask the use of this drug as an (additional) cause of death.
Similarly to Spain and Italy, the demand for treatment from addiction services has stabilized in recent years in the Netherlands, after a strong increase since the beginning of the century. The number of hospitalizations stating cocaine misuse or dependency as a secondary diagnosis has grown in last few years in the Netherlands (over 600 in 2008). Cocaine is involved in approximately one in three drugs emergencies in hospital accident & emergency wards (3,500 to 4,000 annually).
One percent of Dutch people aged between 15 and 34 is a recent cocaine user, which is below the European average (2.2%). However, cocaine is much more popular in certain sectors of the population: in 2008/2009, 10% of people who frequented clubs, and 19% of people who frequented organized parties were recent cocaine users. However, ecstasy remains nightlife’s uncontested ‘market leader’.
The EMCDDA also reports on the increasing level of contamination or adulteration of cocaine, in order to increase its ‘street value’. The Netherlands was the first European country to report an increase in the percentage of cocaine samples in which levamisol was found (70% at the start of 2010). In the Netherlands, this substance was used until 2004 in the treatment of human cancer. In the United States, several dozen cases of agranulcytosis, a serious blood condition, were linked to cocaine/levamisol use. To date there are no known cases yet of agranulocytosis among cocaine users in the Netherlands(CAM, 2009).
New drugs
According to the EMCDDA, a record number of ‘new’ substances were reported in 2009 by the member states. These have (generally) been found in batches of confiscated drugs. In most cases these involved synthetic drugs. However, it is often unknown whether, and to what degree, these substances reach the end users, the consumers. It is thought they are being produced to circumvent legislation and that they are a response to the criminalization of drugs that produce similar effects.
In Netherlands, ‘new’ substances are also identified regularly in samples which drug users have submitted to addiction care facilities for testing. This rarely concerns significant amounts of the new substances, but sometimes a substance is found more than just incidentally. Mephedrone, for instance, turned up in 12% of pills being sold as ecstasy in 2009. This development can probably be linked to the fact that the ‘quality’ of ecstasy pills decreased greatly that year because of a scarcity of the raw materials needed to produce MDMA (Brunt et al, 2010). Only 50% of ecstasy pills actually contained MDMA in that year.
Many other substances (both pharmacologically active and inactive) were found as replacements, including mephedrone. According to users, the effects of mephedrone are similar to those of ecstasy, but they induce much stronger cravings for the drug. This could indicate a higher risk of addiction. ‘Fortunately’, there are signs that as the ecstasy market is experiencing an upturn, mephedrone is disappearing again, in the Netherlands at least.
There is no data to be found on the availability or the use of synthetic cannabinoids in the Netherlands. In the Netherlands, where there is a widespread availability of cannabis in ‘coffee shops’ and where (adult ) users can generally acquire their cannabis without hassle, these substances would seem to play a smaller role compared to other countries where stricter action is taken against ‘cannabis use’. The necessity to circumvent legislation and to seek legal alternatives is therefore smaller (leaving aside some exceptions, e.g. cannabis users with an interest in producing a negative urine or blood test).
Ageing
The EMCDDA has identified increased ‘ageing’ among drug users. This is also the case in the Netherlands, as can be concluded from statistics about the age of drug users in the healthcare system or at the time of death. In the Netherlands almost six out of ten victims of a drug overdose are over 40 years of age, which is the highest percentage in Europe. This ageing is most pronounced among heroin addicts. Heroin clients were on average 45 years old in the Netherlands, where this figure was 37 years old in 2000 (IVZ, 2010).
Addictions, often lasting many years, and life on the streets both take their toll on users; by age 40, many addicts already experience problems related to old age which usually only occur in people over 60. Some addiction care facilities in the Netherlands are responding to this trend, such as the residential facility Woodstock, opened last year in The Hague. This serves older addicts (mainly over 50 years old) who cannot be housed in regular care homes.
Heroin
From the mid-1990s there was a decrease in heroin problems, but the EMCDDA warns that this trend has come to a halt. A slight increase could even be the case. This can be seen from developments including a growing number of heroin users seeking help, a slight increase in the mortality rate due to heroin overdoses, an increasing number of violations of the drug laws involving heroin, as well as more confiscations of this drug. According to the EMCDDA, these trends mirror a growing opium production in Afghanistan, and consequently a greater availability of heroin on the European markets.
In the Netherlands, however, most indicators signal a decrease/stabilization of heroin abuse, Estimates of the number of people addicted to opiates indicate a decrease in the last decade. The number of heroin clients in addiction care facilities and addiction rehabilitation facilities has also decreased. Police statistics also show a decline in property-related crime, which is partly ascribed to heroin users. Nonetheless, there are signs that indicate an increase of (injected) heroin usage due to an influx of (mainly homeless) Eastern European immigrants. However, no statistics are available to support this trend.
More information: Margriet van Laar
Sources
European Monitoring Centre for Drugs and Drug Addiction. Annual report 2010: the state of the drugs problem in Europe. Lisbon: EMCDDA; 2010.
European Monitoring Centre for Drugs and Drug Addiction. Selected Issue: treatment and care for older drug users. Lisbon: EMCDDA; 2010.
Laar M van, Cruts G, Gageldonk A van, Ooyen-Houben M van, Croes E, Meijer R et al. The Netherlands drug situation 2009: report to the EMCDDA by the Reitox National Focal Point. Utrecht: Trimbos Institute, Netherlands Institute of Mental Health and Addiction; 2010
Laar MW van, Cruts AAN, Ooyen-Houben MMJ van, Meijer RF, Brunt T. Netherlands National Drug Monitor: NDM Annual Report 2009. Utrecht: Trimbos-instituut; 2010
Coordination point for the assessment and monitoring of new drugs [Coördinatiepunt Assessment en Monitoring nieuwe drugs]. CAM Quick Scan rapportage levamisol. Bilthoven: National Institute for Public Health and the Environment [RIVM]; 2010.
Brunt TM, Poortman A, Niesink RJ, Brink W van den. Instability of the ecstasy market and a new kid on the block: mephedrone. J Psychopharmacol 2010, Published online September 8.
Wisselink DJ, Ouwehand AW, Kuijpers WGT. Ouderen (55 plus) in de verslavingszorg in Nederland (2000-2009): Ladis Bulletin. Houten: IVZ; 2010.
Ouwehand, AW, Kuijpers, WGT, Wisselink, DJ., Delden, EB van. Kerncijfers Verslavingszorg 2009: Landelijk Alcohol en Drugs Informatie Systeem (LADIS). Houten: IVZ; 2010.
