Zoekresultaten

Changing Patterns of Substance Use During the Coronavirus Pandemic: Self-Reported Use of Tobacco, Alcohol, Cannabis, and Other Drugs

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.

Voorstel voor rationeel MDMA-beleid

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.

Innovative water quality and ecology monitoring using underwater unmanned vehicles: field applications, challenges and feedback from water managers

With climate change and urban development, water systems are changing faster than ever. Currently, the ecological status of water systems is still judged based on single point measurements, without taking into account the spatial and temporal variability of water quality and ecology. There is a need for better and more dynamic monitoring methods and technologies. Aquatic drones are becoming accessible and intuitive tools that may have an important role in water management. This paper describes the outcomes, field experiences and feedback gathered from the use of underwater drones equipped with sensors and video cameras in various pilot applications in The Netherlands, in collaboration with local water managers. It was observed that, in many situations, the use of underwater drones allows one to obtain information that would be costly and even impossible to obtain with other methods and provides a unique combination of three-dimensional data and underwater footage/images. From data collected with drones, it was possible to map different areas with contrasting vegetation, to establish connections between fauna/flora species and local water quality conditions, or to observe variations of water quality parameters with water depth. This study identifies opportunities for the application of this technology, discusses their limitations and obstacles, and proposes recommendation guidelines for new technical designs

Developing a new national MDMA policy: Results of a multi-decision multi-criterion decision analysis

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.

Treatment Seeking Nitrous Oxide Users in Addiction Care

Introduction: Over the past decade, frequent use of large quantities of nitrous oxide (N2O) has become more common in the Netherlands. Although N2O poses several negative health consequences for a subgroup of problematic N2O users, there is a lack of knowledge on what characterizes these intensive users. This study therefore aims to provide the demographic and substance use characteristics and experiences during treatment of treatment seeking problematic N2O users and to compare this with a matched group of treatment-seeking problematic cocaine users. Methods: A retrospective chart review was performed of patients who were referred for treatment of problematic N2O use at a large Dutch addiction care facility from January 2020 to September 2022, extracting demographics, pattern of use and follow-up data. Additionally, a subgroup of N2O users was propensity-score matched (1:1) with a subgroup of treatment seeking problematic cocaine users, both groups excluding users with substance use disorders or frequent use of substances other than N2O and cocaine, respectively. Results: 128 patients with a N2O use disorder were included in the total sample and a subgroup of 77 N2O-only users was propensity-score matched on age and sex to 77 cocaine-only users. N2O users were typically young (mean age 26.2 years), male (66.4%), unmarried (82.9%), with a low education level (59.0%) and born in the Netherlands (88.2%), with parents born in Morocco (45.3%). N2O was used intermittently (median 10 days/month, IQR 4.0–17.5 days) and often in very large quantities (median 5 kg [ca. 750 balloons] per average using day, IQR 2–10 kg). Compared to the patients with a cocaine use disorder, matched N2O users were lower educated, more often from Moroccan descent, and less likely to be alcohol or polysubstance users. Despite receiving similar treatments, N2O users were twice as likely to discontinue treatment before completion compared to cocaine users (63 vs. 35%, p = 0.004). Conclusion: Treatment-seeking problematic N2O users are demographically different from treatment-seeking problematic cocaine users and are much more likely to dropout from psychological treatment. Further research is needed into the needs and other factors of problematic N2O users that relate to poor treatment adherence in problematic N2O users.

Cocaïne: wie gebruikt het en waarom?