Introduction: Ecstasy (MDMA) is a popular recreational drug, but its illegal production and trade in the Netherlands have developed into a serious public order and ecological problem which endanger and question the harm reduction approach of the Dutch ecstasy policy.Methods: The market characteristics, adverse health effects, risk profile, and link to criminal activity of ecstasy were reviewed.Results: Ecstasy is often used in combination with other substances (i.e. polydrug use). Compared to several other illicit drugs and alcohol, ecstasy has a very low abuse and dependence liability and, as yet, there is little evidence of long-term harm. A potential health risk associated with ecstasy is acute hyperthermia, however this occurs at an unknown incidence rate and seems to be more prevalent when ecstasy is consumed in combination with heavy exercise at high ambient temperatures or when used in combination with other substances, including alcohol. Organized crime related to the production and trafficking of ecstasy in the Netherlands is a growing problem.Conclusions: This review provides a science-based summary that can be used to assist the public and political debate surrounding future Dutch ecstasy policy to reduce ecstasy-related organized crime while maintaining the principle of harm reduction.
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Background:Ecstasy (3,4-methylenedioxymethamphetamine (MDMA)) has a relatively low harm and low dependence liability but is scheduled on List I of the Dutch Opium Act (‘hard drugs’). Concerns surrounding increasing MDMA-related criminality coupled with the possibly inappropriate scheduling of MDMA initiated a debate to revise the current Dutch ecstasy policy.Methods:An interdisciplinary group of 18 experts on health, social harms and drug criminality and law enforcement reformulated the science-based Dutch MDMA policy using multi-decision multi-criterion decision analysis (MD-MCDA). The experts collectively formulated policy instruments and rated their effects on 25 outcome criteria, including health, criminality, law enforcement and financial issues, thematically grouped in six clusters.Results:The experts scored the effect of 22 policy instruments, each with between two and seven different mutually exclusive options, on 25 outcome criteria. The optimal policy model was defined by the set of 22 policy instrument options which gave the highest overall score on the 25 outcome criteria. Implementation of the optimal policy model, including regulated MDMA sales, decreases health harms, MDMA-related organised crime and environmental damage, as well as increases state revenues and quality of MDMA products and user information. This model was slightly modified to increase its political feasibility. Sensitivity analyses showed that the outcomes of the current MD-MCDA are robust and independent of variability in weight values.Conclusion:The present results provide a feasible and realistic set of policy instrument options to revise the legislation towards a rational MDMA policy that is likely to reduce both adverse (public) health risks and MDMA-related criminal burden.
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Background: Drug checking services (DCS) provide information about drug content and purity, alongside personalized feedback, to people who use drugs; however, the demographic and drug use characteristics of DCS clients are rarely reported. This paper describes these characteristics for clients of the Dutch DCS, the Drug Information and Monitoring System (DIMS). Methods: 1,530 participants completed a pen-and-paper questionnaire at one of eight participating DCS in the Netherlands in 2018. Results: The participants were mostly highly educated males in their twenties with no migration background. Experience with drugs prior to coming to the DCS was common. Only 0.7% indicated they had never used any of the twenty drugs studied. 93% of participants reported use of ecstasy or MDMA with an average of 6.3 years since first use. Conclusions: These results indicate that drug checking can be a valuable tool for public health services as it facilitates access to more difficult-to-reach communities who use drugs. It is unlikely that DCS encourage drug initiation, since almost all people who visit the Dutch DCS already report experience with drugs. However, DCS should be aware that their services might not be easily accessible or attractive to all demographic groups.
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Higher education, as a catalyst for social progress and talent development, holds a unique position to foster mutual learning across sectors, disciplines, life-spheres and communities. By nurturing critical thinking and creativity, education can empower students to drive and take societal and environmental responsibility. Empathic co-design emerges as a crucial approach for navigating complexity and establishing change. Exposure to diverse perspectives encourages individuals, particularly students, to expand their empathy by challenging their preconceptions, fostering understanding, and promoting a deeper sense of interconnectedness with others. Recognizing the significance of empathy in educational co-design contexts and beyond, this paper introduces the Empathy Compass. Through two case studies on the societal impact of Ecstasy production and use, we demonstrate the Compass's utility in tracking students’ empathic awareness. The practice-oriented, three-dimensional tool highlights specific mindsets, activities and methodologies within each quadrant, its intersections and the ‘we-space’. The Empathy Compass emerges as a valuable tool for higher education, supporting the stimulation, facilitation and assessment of empathic awareness in multi-stakeholder collaboration. Om het arikel te kunnen lezen moet het aangekocht worden: https://www.tandfonline.com/eprint/ZT7WHUWNC5C3CTTZ7REH/full?target=10.1080/07294360.2025.2510670#abstract
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International students form a large subgroup of university college students in The Netherlands. Because little is known about substance use in this group, we investigated substance use and the perceptions thereof in a sample of 515 international students in a Dutch university city using an online survey. Results showed high prevalence rates of substance use, especially for cannabis andnitrous oxide balloons. Risk perceptions and attitudes mirrored prevalence (the most commonly used substances were perceived as the least harmful) and for each substance. Attitudes toward a particular substance were also indicative of recent use of that substance. Further, international students highly overestimated the prevalence of cannabis and ecstasy use in the Dutch adult population. The level of estimation of ecstasy use was also an indicator of recent ecstasy use. Regarding substance use and perceptions thereof, we found no clear subgroups among international students. As international students also appeared more reluctant to speak about substance use with (university) professionals than with friends and fellow students, these findings underline a unique opportunity for social networks of students to provide information about substance use, including associated norms, especially to new international students.
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The last decades have seen an increase in the use of illicit recreational drugs. In this article we take a detailed look at the current state of normalisation of the three most popular illicit recreational drugs among Dutch university students in the Netherlands (MDMA/Ecstasy, cocaine and amphetamine) by zooming in on five established aspects of normalisation and expanding on one of those aspects: social accomodation, by adding a behavioural subcomponent (setting of use). For this purpose, we used quantitative data, obtained from four studies (2016, 2017, 2019 and 2020) among Dutch university students in a prototypical university city in the Netherlands (Groningen). Results show that three aspects of normalisation are clearly observable. The drugs are perceived as highly accessible, the last year prevalence of use is high, and experimenting, especially with MDMA/Ecstasy, is common. Accurate knowledge of the drugs and acceptance of occasional use, account in some measure for social accommodation. However, as students do not talk openly about their drug use with everyone in their environment, one cannot speak of cultural accommodation. Thus, although clear signs of normalisation of illicit recreational drugs, especially MDMA/Ecstasy, are observable among Dutch university students, there is no full-scale normalisation of these drugs.
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ACHTERGRONDMDMA (ecstasy) is een relatief veilige drug en induceert weinig afhankelijkheid, maar staat desondanks samen met andere harddrugs op lijst I van de Nederlandse Opiumwet. Bezorgdheid over de aan MDMA gerelateerde criminaliteit, het aantal gezondheidsincidenten en de mogelijk onterechte plaatsing van MDMA op lijst I hebben geleid tot een voortdurend debat over het huidige Nederlandse ecstasybeleid.DOELOntwikkeling van een rationeel MDMA-beleid waarbij men rekening houdt met alle aspecten gerelateerd aan de productie, verkoop en gebruik van MDMA.METHODEEen interdisciplinaire groep van 18 experts formuleerde een wetenschappelijk onderbouwd MDMA-beleid door de verwachte effecten van 95 beleidsopties op 25 uitkomsten te beoordelen, waaronder gezondheid, criminaliteit, rechtshandhaving en financiën. Het optimale beleidsmodel werd gevormd door een combinatie van 22 beleidsopties met de hoogste totaalscore op alle 25 uitkomsten. RESULTAAT Het optimale beleidsmodel bestond uit een vorm van gereguleerde productie en verkoop van MDMA, beter kwaliteitsbeheer van ecstasypillen en intensievere bestrijding van de MDMA-gerelateerde georganiseerde criminaliteit. Een dergelijk beleid zou leiden tot een kleine toename in de prevalentie van ecstasygebruik, maar met minder gezondheidsschade, minder MDMA-gerelateerde misdaad en minder milieuschade. Om de praktische uitvoerbaarheid en de politieke haalbaarheid te vergroten werd het optimale model enigszins aangepast.CONCLUSIEHet ontwikkelde optimale model biedt een politiek en maatschappelijk haalbare set van beleidsinstrumentopties, waarmee men plaatsing van MDMA op lijst I kan herzien, wat de schade van MDMA voor gebruikers en de samenleving kan verminderen. Voor de psychiatrie betekent het bevordering van therapeutisch onderzoek en minder hinder door nodeloze stigmatisering bij de behandeling van patiënten.--English:SUMMARYThe development of a rational national MDMA policy and itsrelevance for psychiatry.J.G.C. van Amsterdam, T. Nabben, G.-J. Peters, F. van Bakkum, J. Noijen, W. van den BrinkBackground MDMA (ecstasy) is a relatively safe drug and induces little dependence, but is nevertheless scheduled as a hard drug (Dutch Opium Act, List 1). Concerns about MDMA-related crime, health incidents and possible inappropriate listing of MDMA on List I have led to an ongoing debate about current Dutch ecstasy policy.Aim To develop a rational MDMA policy that takes into account all aspects related to production, sale and use ofMDMA.Method An interdisciplinary group of 18 experts formulates a science-based MDMA policy by assessing the expected effects of 95 policy options on 25 outcomes, including health, crime, law enforcement and finance. The optimal policy model consists of the combination of the 22 policy options with the highest total score on all 25 outcomes.Results The optimal policy model consisted of a form of regulated production and sale of MDMA, better qualitymanagement of ecstasy tablets and more intensive fight against MDMA-related organized crime. Such a policywould lead to a small increase in the prevalence of ecstasy use, but with less health damage, less MDMA-related crime, and less environmental damage. To increase practicality and political feasibility, the optimal model was slightly modified.Conclusion The developed optimal model offers a politically and socially feasible set of policy instrument options, with which the placement of MDMA on List I can be revised, thereby reducing the damage of MDMA to users and society. For psychiatry, it means promoting therapeutic research and less nuisance from unnecessary stigmatization in the treatment of patients.
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De stuurgroep van de DenkTank MDMA-beleid publiceerde eind 2020 een rapport over de ontwikkeling van een rationeel MDMA-beleid. Het rapport is gebaseerd op een objectiverende wetenschappelijke benadering die zich losmaakt van ideologische politieke strijd. Uit een vergelijking van verschillende beleidsopties komt een Optimaal Model naar voren dat de minste schade blijkt op te leveren voor mens en maatschappij: regulering van de productie en van de aan- en verkoop van ecstasy, kwaliteitsbewaking, monitoring van het gebruik en een hardere aanpak van de misdaad. Minister van Justitie en Veiligheid Grapperhaus wijst dit model echter rigoureus af. Hij hamert op het gevaar van ‘ondermijning’ door de onderwereld van de legale bovenwereld. Wat pleit er voor en tegen invoering van het optimale model?
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In the 1990s, the popularisation of house music and ecstasy led to a shift in the focus of research into club cultures. Characteristic of club culture is the willingness to share on the social (network), cultural (taste and knowledge), and physical (location) levels. Drug researchers ascertain that, since the 1990s, there has been a normalisation of drug use in the entertainment areas of youth and young adults. In an ongoing panel study among Amsterdam’s trendsetters, club cultures prove eminently receptive to new trends in nightlife. This chapter focuses on the transformation of club cultures into screen cultures within the electronic dance music (EDM) domain and the influence of vernacular media. This development runs parallel to the flight from overregulated entertainment venues. A second development is that the growing influence of the vernacular media has stimulated and also democratised knowledge, opinions and discussions about drugs, and the role in the prevention and risk discourse has changed from of a top-down to a linear model. In the vernacular discourse, the dominating view is that it is normal to experiment with drugs as long as it is done responsibly.
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