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Antenne Nederland 2022-2023 schetst een actueel beeld van risicojongeren en hun middelengebruik, verteld door (ambulant) jongeren- en straathoekwerkers. Vanaf de frontlinies van het sociale domein vertellen ze over de huidige leefwerelden van minderjarige jongeren en jongvolwassenen in vinexwijken en arme volksbuurten, in dun- en dichtbevolkte delen van het land én over plekken waar ze elkaar treffen en soms ook alcohol en drugs gebruiken: van keet tot voetbaltribune, van de straat tot clubs en raves. De regiomonitor ondersteunt professionals en beleidsmakers in het sociale- en veiligheidsdomein bij het begrijpen en duiden van alcohol- en drugsgebruik in risicogroepen die beginnen te experimenteren of al fors gebruiken, met alle gezondheidsrisico’s van dien.
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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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In Antenne Amsterdam wordt sinds 1993 jaarlijks het middelengebruik bij jongeren en jongvolwassenen in de hoofdstad in kaart gebracht. Dit gebeurt op basis van een combinatie van kwalitatieve en kwantitatieve methoden. In 2023 verzamelden we informatie via (1) interviews met een 26-koppig uitgaanspanel die vanuit insidersperspectief of vanuit hun werk als beveiliger, manager of organisator vertellen over het trendsettende uitgaansleven; (2) interviews met een panel kwetsbare jeugd waarin zeven professionals zijn vertegenwoordigd die met buurtjongeren werken; (3) een anonieme survey (vragenlijsten) over middelengebruik onder voetballers en publiek bij twaalf amateurclubs; en (4) analyse van testuitslagen van meer dan vijfduizend vrijwillig aangeleverde drugsmonsters bij testservices. De Amsterdamse drugs- en gebruikersmarkt wordt gekenmerkt door golfbewegingen. Twintig jaar geleden werd in Antenne 2003 een 'nieuwe nuchterheid’ aangekondigd; tien jaar later zagen we in Antenne 2013 meer middelengebruik over de hele linie; en weer tien jaar verder lijken zich onder trendsettende uitgaanders in 2023 de contouren van een hernieuwde nuchterheid af te tekenen. De voetbalsurvey laat zien dat vrijetijdsdomeinen van sport en uitgaansleven overlappen. Sporten en middelengebruik zijn niet noodzakelijk tegenpolen, maar vaak twee kanten van dezelfde medaille. De meeste sporters en uitgaanders zijn mensen die gezonde en ongezonde gewoontes balanceren.
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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As in many other countries worldwide, the coronavirus pandemic prompted the implementation of an “intelligent lockdown” in the spring of 2020 in the Netherlands, including the closure of nightlife venues and cancellation of festivals. Such restrictions and social distancing could particularly affect people who use alcohol or other drugs in recreational settings and give rise to new challenges and additional needs in the field of addiction prevention and care. To monitor changes in substance use and provide services with practical directions for tailored prevention, an anonymous web survey was set up, targeting a convenience sample aged 16 years or older through various social media and other online channels. Between May and October 2020, a total of 6,070 participants completed the survey, mainly adolescents and young adults (16–24 years old). These data were used to explore and describe changing patterns in substance use. Overall results showed declined current use compared to “pre-corona,” but mask underlying variation in changing patterns, including discontinued (tobacco 10.4%, alcohol 11.3%, cannabis 16.3%, other drugs 30.4%), decreased (tobacco 23.0%, alcohol 29.1%, cannabis 17.4%, other drugs 20.7%), unchanged (tobacco 30.3%, alcohol 21.2%, cannabis 22.3%, other drugs 17.3%), increased (tobacco 29.6%, alcohol 32.1%, cannabis 32.9%, other drugs 25.3%), and (re)commenced use (tobacco 6.7%, alcohol 6.3%, cannabis 11.1%, other drugs 6.2%). Especially the use of drugs like ecstasy and nitrous oxide was discontinued or decreased due to the lack of social occasions for use. Increased use was associated with coping motives for all substance types. As measures combatting the coronavirus may need to be practiced for some time to come, possibly leading to prolonged changes in substance use with lingering “post-corona” consequences, timely and ongoing monitoring of changing patterns of substance use is vital for informing prevention services within this field.
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This article examines to what extent and how cannabis users in different countries, with different cannabis legislation and policies practice normalization and self-regulation of cannabis use in everyday life. Data were collected in a survey among a convenience sample of 1,225 last-year cannabis users aged 18–40 from seven European countries, with cannabis policies ranging from relatively liberal to more punitive. Participants were recruited in or in the vicinity of Dutch coffeeshops. We assessed whether cannabis users experience and interpret formal control and informal social norms differently across countries with different cannabis policies. The findings suggest that many cannabis users set boundaries to control their use. Irrespective of national cannabis policy, using cannabis in private settings and setting risk avoidance rules were equally predominant in all countries. This illustrates that many cannabis users are concerned with responsible use, demonstrating the importance that they attach to discretion. Overall, self-regulation was highest in the most liberal country (the Netherlands). This indicates that liberalization does not automatically lead to chaotic or otherwise problematic use as critics of the policy have predicted, as the diminishing of formal control (law enforcement) is accompanied by increased importance of informal norms and stronger self-regulation. In understanding risk-management, societal tolerance of cannabis use seems more important than cross-national differences in cannabis policy. The setting of cannabis use and self-regulation rules were strongly associated with frequency of use. Daily users were less selective in choosing settings of use and less strict in self-regulation rules. Further differences in age, gender, and household status underline the relevance of a differentiated, more nuanced understanding of cannabis normalization.
Cannabis is commonly characterized as the most normalized illicit drug. However, it remains a prohibited substance in most parts of the world, including Europe, and users can still be subject to stigmatization. The objective of this study is to assess to what extent and how cannabis users in different countries with different cannabis policies perceive, experience and respond to stigmatization. We conducted a survey in the Dutch coffeeshops among 1225 last year cannabis users from seven European countries, with national cannabis policies ranging from relatively liberal to punitive. Three dimensions of cannabis-related stigma were investigated (discrimination, perceived devaluation and alienation) and a sum score was used to reflect the general level of stigmatization. Perceived devaluation was the highest-scoring dimension of stigma and discrimination the lowest-scoring. The general level of stigmatization was lowest in the Netherlands and highest in Greece. This indicates that punitive cannabis policy is associated with stigma and liberal cannabis policy is associated with de-stigmatization. Besides country, daily cannabis use was also found to be a significant predictor of stigma, but gender, age, household type and employment status were not.
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