The Eye of the Needle

Elsewhere in this volume, Pates and Wichter (chapter1) trace the birth and development of the needle and syringe and the first medical and recreational experiences with this technical innovation—famous and infamous at once, because of its association with both the global eradication and diffusion of life-threatening infectious diseases. Recreational or non-medical drug injecting remained a primarily western phenomenon until late into the 20th century. But globalization and global drug prohibition have resulted in the world-wide diffusion of drug injection, most strikingly into drug production areas and adjacent sub-regions, where traditionally milder preparations of the same alkaloids (or their precursors) were being consumed through less hazardous modes of administration

From the Straw to the Needle?

The central focus of this article is the spread of heroin smoking in the Netherlands. Globally, injecting heroin users are outnumbered by those who ingest this drug by method of smoking or, more correctly, inhalation. It is argued that heroin adminstration patterns are determined by an interaction of primarily economic and socio-cultural factors, which are moderated by drug policy and enforcement. A theoretical diffusion model of the spread of this social phenomena is developed utilizing data from the Netherlands. Utilizing the concept of diffusion, other large scale transitions in route of administration of opiates that have occurred in the USA and in England will briefly be discussed. The article concludes with an assessment of future developments

Drug use as a social ritual

This dissertation brings together results of my NWO-funded ethnography --into the drug taking rituals of regular users of heroin, cocaine and other psychoactive substances--, resulting studies and some twenty years of puzzlement and subsequent pondering. The NWO study was initiated in the former Erasmus University Institute for Preventive and Social Psychiatry (IPSP) by professor Charles D. Kaplan and the late institute director professor Kees Trimbos. The work was completed within the walls of the new-born lnstituut voor Verslavingsonderzoek (IVO), Addiction Research Institute, and the safety of my home. The assumed failure of users of illicit drugs to conform with common standards of socially appropriate conduct is directly associated with the use of a substance which supposedly renders them powerless. This image is not only part of popular wisdom, but, in different forms also recognized in several scientific theories.' Many theories emphasize the powerful pharmacological properties of psychoactive drugs. others relate (problematic) substance use to f.e. deficient personality structures, ego problems, impaired psychological development, acute distress or psychiatric problems. Again other theories associate drug use with environmental deficits, such as poverty. All of these factors may, indeed, explain part of the phenomenon, but the frequent emphasis on only one aspect, be it a pharmacological, psychological or social factor, is in my opinion erroneous. Until now, none of these schools has produced specific correlations between cause and effect. A number of recent studies have questioned these (rather) mono-causal explanations and emphasized the multi· dimensionality of drug taking behaviors

Coffee Shops and Compromise

Building on a long history and culture of tolerance, the Dutch responded to illicit drugs with decades of pragmatic measures free of judgment. A central element of modern Dutch drug policy was a crucial decision to establish a legal and practical separation of cannabis— judged to pose “acceptable” risks to consumers and society—from hard drugs associated with unacceptable risk. This policy effectively decriminalized possession and use of cannabis and opened the door for tolerated outlets for small-scale cannabis sales that eventually took the form of the well-known Dutch “coffee shops.” By all measures, the coffee shops suc- ceeded in enabling cannabis consumers to avoid exposure to hard drug scenes and markets. Dutch cannabis consumers have also been spared the profound costs of carrying a criminal record, and the public has not had to bear the cost of incarceration for minor offenses. Drug policy in the Netherlands was characterized by a pragmatic bottom up development in which policies developed through trial and error at a local level often initiated by local officials in consultation with representatives from civil society who were supported by national policy makers. With respect to heroin and other hard drugs, the Dutch government at national and municipal level put a premium on reduction of individual and social harm. This commit- ment has been reflected in the government’s investment in comprehensive health and social services. Low-threshold methadone and safe consumption rooms as well as needle exchange programs proliferated earlier and with higher coverage than in most of Europe. Even before these services were established, however, tolerance for sale and consumption of illicit hard drugs in designated “house addresses” greatly reduced the dangers of an open drug scene, including exposure to uncontrolled criminal elements. It also contributed to a preference for drug consumption not involving injection. The Netherlands was spared the major drug- linked HIV epidemic that devastated drug users and their families in other European coun- tries. An important element of this success, at times, was not only pragmatic national policy but also the degree of autonomy that municipal officials had to exercise of practices that did not conform to the letter of the law. None of this was without its challenges. For example, while the coffee shops provided a venue for safe and controlled consumption of cannabis without exposing consumers to harmful hard drug scenes, successive governments have not successfully addressed the so- called back door problem—coffee shops being supplied with cannabis by an illegal market. While there were instances of popular support for the complete legalization or government regulation of the cannabis market, which would address this problem, there were always political challenges to securing such a policy. Though confidently preserving the core of their policy and continuing to focus on reduction of individual and social drug-related harm, suc- cessive Dutch governments have felt international pressure to not “step over the line” into areas such as legalization and regulation of drugs. In addition, attempts to address drug tourism by making coffee shops exclusive Dutch-only clubs seem to create more problems than they solve, evoking opposition from proprietors, patrons, civil society, legal experts and city mayors alike. Nevertheless, some municipalities continue to complain of drug tourism while enjoying the substantial revenue generated by coffee shops. This report is an in-depth analysis of the politics and the practicalities that enabled or led the Dutch authorities at national and local levels to make the drug policy decisions that have shaped the lives of people who use or are otherwise affected by drugs in the Neth- erlands. It is the authors’ hope that it will be of use to those outside the Netherlands, in government and civil society, who seek drug policy solutions that are respectful of human rights and based strongly in science and good public health practice. If there is one lesson to take away from the Dutch experience, it is that when taking steps toward regulating cannabis or other psychoactive substances meant for human consumption, these should include the entire chain of supply, from production to consumption

A Candle Lit from Both Sides

Until 1995 central and eastern Europe as well as the Asian republics of the former Soviet Union have been more-or-less devoid of epidemic outbreaks of HIV infection. In this region with more than 450 million inhabitants (United Nations 1997), the total number of HIV infections was estimated lower than 30.000 (WHO 1995; UNAIDS 1996). Most of these infections resulted from sexual and nosocomial transmission. In 1995 this epidemiologically soporific picture started changing drastically in two ways. Firstly, reports on rapid HIV outbreaks in various parts of the former Soviet Union started to surface, and, secondly, these new infections were almost exclusively associated with another major public health crisis that until then had gone largely unnoticed: the rapid diffusion of drug injecting. Indeed, the social networks of drug injectors have provided an almost custom-tailored infrastructure for the virus to spread through the former Soviet Union and most HIV cases are reportedly related to illicit drug injecting. Except for Poland and Yugoslavia, the countries in central and southeast Europe have not yet experienced epidemic HIV spread, although in many of these countries drug injecting has become a major public health concern as well

The fast and furious

Cocaine and amphetamines (‘stimulants’) are distinct central nervous system stimulants with similar effects (Pleuvry, 2009; Holman, 1994). Cocaine is a crystalline tropane alkaloid extracted from coca leaves. Amphetamines are a subclass of phenylethylamines with primarily stimulant effects, including amphetamine, methamphetamine, methcathinone and cathinone and referred to as ‘amphetamines’ in this review (Holman, 1994). MDMA (3,4-methylenedioxy-N-methamphetamine or ecstasy) is a substituted amphetamine known for its entactogenic, psychedelic, and stimulant effects (Morgan, 2000). Stimulants can produce increased wakefulness, focus and confidence, elevated mood, feelings of power, and decreased fatigue and appetite; stimulants also produce nervousness or anxiety and, in some cases, psychosis and suicidal thoughts (Holman, 1994; EMCDDA, 2007f; Hildrey et al., 2009; Pates and Riley, 2009). Although there is little evidence that stimulants cause physical dependence, tolerance may develop upon repetitive use and withdrawal may cause discomfort and depression (EMCDDA, 2007f; Pates and Riley, 2009). Users may engage in ‘coke or speed binges’ alternated with periods of withdrawal and abstinence (Beek et al., 2001)

Experiment Perspectief aanpak voormalig alleenstaande minderjarige vreemdelingen

Het experiment op basis van de Perspectiefaanpak ex-amv’s is gericht op het realiseren van daadwerkelijk vertrek (terugkeer) van ex-amv’s, het terugdringen van het vertrek met onbekende bestemming (MOB) en het terugdringen van illegaliteit. Voor het onderzoek zijn de volgende ‘resultaten’ van belang: (begeleide) terugkeer naar land van herkomstverkrijgen van een (tijdelijke) verblijfsvergunning nog in begeleiding met onbekende bestemming (MOB) vertrokkendoormigratie  Het doel van dit onderzoek is om de resultaten van de bij het experiment betrokken steunpunten onderling te vergelijken, aan de hand van onderscheidende kenmerken van deze steunpunten. De volgende probleemstelling is daarbij aan de orde: Hoe zien de organisatievormen en werkwijzen van de lokale steunpunten Perspectief er uit? Welke deelnemers en resultaten hebben ze? Hoe hangen de resultaten samen met overeenkomsten en verschillen in de gehanteerde organisatievormen en werkwijzen? INHOUD: 1. Inleiding 2. Onderzoeksmethoden 3. De perspectief aanpak: organisatorisch spectrum 4. De deelnemers aan het experiment Perspectief: voormalig Alleenstaande Minderjarige Vreemdelingen 5. De Perspectief aanpak: een methodische regenboog 6. De Perspectief aanpak: resultaten 7. Relatie tussen organisatievormen, werkwijze & kenmerken van ex-AMV's en de behaalde resultate