Co-ordination, monitoring and evaluation of drug policies · Co-ordination, monitoring and...

Trimbos-instituut 2006 110-6-2008

Co-ordination, monitoring and evaluation of drug policies

•Bob Keizer

• Senior Drug PolicyAdvisor


What is drug policy?

• Interdependencies and incompatibilites

politics

science practice


Current situation

• Politics: ad hoc, no knowledge, top down, emotional

• Science: no budget, no programming, ivory tower

• Practice: lack of capacity, knowledge, quality; no signals to politics, science


Dangers

• Drug policies can be inefficient, inconsistent, incredible

• Widening gap between citizen – policy


Co-ordination of drug policies

• Identifying, improving and bridging elements

politics

science practice


Priorities for policy makers

• Raise awareness amongst politicians, scientists, practitioners of interdependencies

• Improve communication; stop inventing wheels: improve transfer of knowledge

• Create intellectual space (discussions, innovation)

• Co-ordinate policy cycle


Policy Cycle

• Political decisions

• Monitoring

• Evaluation

• Innovation/research

• implementation


Co-ordination of co-ordination

International drug policy makers

National drug policy makers

Local/regional policy makers


International policy makers:

• Need input from national policy makers

• Must be independent

• Must provide national policy makers withworkable tools


International drug policies: who does what?

• EU: HDG, Action Plan, EMCDDA, Europol

• Council of Europe: Pompidou Group

• UN: CND, UNODC, INCB

• WHO


National Policy makers

• Need input from local/regional level

• Intellectual leadership

• Must provide local/regional level withadeqate tools


Local/regional policy makers

• Need the input from day-to-day practice

• Must be facilitated to do their work

• Must be taken seriously


Experiences in the Netherlands

• The ideal form of policy making?

• National coordination (AWUD)

• Monitoring and reserach

• Local responsibilities


Conclusions on co-ordination

• Collect and balance signals from politics, science, practice

• Pay attention to policy cycle

• Pay attention to all levels

• Pay attention to all parties

• Pay attention to interdependencies and incompatibilities


Role of Monitoring in Drug policy

• Contribution to process of policy makingby assessing practice

• Basis for evaluation

• Basis for innovation, research

• Inform poltics


Monitoring What?

• Prevalence

• Mortality/morbidity

• Criminality

• Seizures

• Public nuisance/public order

• Quality of drugs

• Etc.


How to manage streams of information?

Drug use

Quality

Criminality coordination

Seizures

etc


National Drug Monitor(The Netherlands)

Goals:

• Promote quality and cohesiveness

• Improve planning

• Co-ordinate streams of information


Objectives & tasks of the NDM

• Acting as a co-ordinating body for monitoring projects on substance use.

• Promoting standardisation of methods.

• Compiling data from a variety of drug use indicators.

• Reporting to national authorities and international organisations (e.g. EMCDDA, UN).

• To advise on gaps in data.


Ministry of Health, Welfare and Sports

Ministry of Justice

Bureau NDM at Trimbos Institute

•Co-ordinator•Permanent staff

Scientific Committee•Chair•Members

Working Group

InfectiousDiseases

EMCDDA

Working Group

Prevalence Estimates of Problem Use

Working Group

Drug-RelatedDeaths

EditorialBoard

Monitoring projects on use, treatment demand, health, market, criminality

Data collection Draftreports

Finalreports

Comments

and

advice

Organisation of the NDM


Annual Report of the NDM• Facts and figures on the use of cannabis, cocaine,

opiates, ecstasy & amphetamine, alcohol and tobacco in the Netherlands

• Based on five epidemiological key indicators of the EMCDDA:

1. Use in the general population and youth

2. Prevalence of problem use

3. Treatment demand

4. (Infectious) Diseases

5. Mortality

6. Price/purity

• Since 2002, also data on drug-related criminality

• International comparisons


Monitoring Sources (1)

• Inventory of surveys and registrations in the field of alcohol and drugs in 2004 (Ti/NDM and IVO)

• Result: 60 monitors

• Report (in Dutch): Cruts, Lempens, Ketelaars, Van Laar, Van de Mheen (2004): www.trimbos.nl/ndm and www.ivo.nl

Theme Number of

monitors

Use and problem use 24

Treatment demand 13

Morbidity & mortality 7

Drugs market 3

Law enforcement & criminal justice 13


Drug use stable between

2001 and 2005

Source: National prevalence Surevy on substance use, IVO

0.00.00.0Heroin

0.10.0-LSD

0.30.40.4Amphetamine

1.2 *1.10.8Ecstasy

0.60.70.7Cocaine

5.45.55.5Cannabis

200520011997

LAST YEAR PREVALENCE (%)among population 15-64 years


Recent (% last year) use of CANNABIS among young adults

(15-34 years old) in the EU and USA. Source: EMCDDA

International comparison

0

5

10

15

20

25

Gre

ece

Bulg

aria

Lith

uani

aSw

eden

Pola

ndPo

rtuga

lFi

nlan

dH

unga

ryLa

tvia

Irela

ndSl

ovak

ia

Net

herla

nds

Nor

way

Esto

nia

Aust

ria Italy

Den

mar

k

EU a

vera

geG

erm

any

UK

(E&

W)

Cyp

rus

Cze

ch R

epub

licFr

ance

Spai

n US

US

EU -average


Recent (% last year) use of COCAINE among young adults



0.0

1.0

2.0

3.0

4.0

5.0

6.0

Gre

ece

Cze

ch R

epub

licLa

tvia

Lith

uani

aPo

rtuga

lFr

ance

Hun

gary

Finl

and

Bulg

aria

Slov

akia

Cyp

rus

Net

herla

nds

Esto

nia

Pola

ndAu

stria

Ger

man

yN

orw

ayD

enm

ark

Irela

ndEU

ave

rageIta

lyU

K (E

&W)

Spai

n

US

EU -average

US


Recent (% last year) use of ECSTASY among young adults



0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Gre

ece

Pola

nd

Italy

Fran

cePo

rtuga

lLi

thua

nia

Bulg

aria

Den

mar

kN

orw

ayFi

nlan

dAu

stria

Ger

man

yLa

tvia

EU a

vera

geIre

land

Slov

akia

US

Hun

gary

Net

herla

nds

Spai

nC

ypru

sEs

toni

aU

K (E

&W)

Cze

ch R

epub

lic

EU -average

US


International comparisonNumber of problem hard drug users per 1000 inhabitants of 15-64 yrs

Source: EMCDDA

2.42.6

4.44.8

5.35.6

5.8

6.3

7.1 7.27.5

9.3 9.4

3,1

0

2

4

6

8

10

Gre

ece

Ger

man

yN

ethe

rlan

ds

Fran

ceS

wed

en

Finl

and

Irel

and

Aus

tria

Spa

inP

ortu

gal

Den

mar

k

Italy

Luxe

mbo

urg

UK


Stabilisation/decrease in cannabis use among pupils

Age: 12-18 years. Source: National School Survey, Trimbos Institute

Last month prevalence (%)

7

910

12

14

5

4

78

2

0

2

4

6

8

10

12

14

16

1988 1992 1996 1999 2003

Boys

Girls


Cannabis: Stable Use

• Prevalence in population 15-64 is stable (no changes in 1997, 2001 and 2005)

– Last year prevalence 5,4%

– European average 7%

• Age at onset: – Among ever users 15-24 jaar: 16,4 jaar

– No change between 1997 en 2005


Cocaine: stabilisation?

• Prevalence of cocaine use in population of 15-64 years is

stable (no changes in 1997, 2001 and 2005)

– Last year prevalence (2005): 0,6%

– European average: 1,3%

• Incidence of new users decreased from 0.4% in 2001 to

0.1% in 2005

• But: continuing popularity in some scenes (crack:

marginalised hard drug; cocaine powder in nightlife

scene).


Ecstasy

• Increase in use among population (15-64 yrs) between 1997-2001; stable between 2001-2005

– Last year : 1,2%

– European average : circa 1%

• Treatment demand remains low – 293 primary ecstasy clients: less than 1% of all drug clients

– 781 secondary ecstasy clients

– Proportion of female clients increased from 19% in 2000 to31% in 2005


Amphetamine

• Prevalence in population 15-64 is stable and low between 1997, 2001 and 2005

– Last year prevalence 0,3%

– European average 0,7%


Number of problem hard drug users

• Opiates: 24.000-46.000 (midpoint: 34,000)

– Most opiate users also use crack

– Percentage injectors: 10-15%


Treatment demand

Source: LADIS 2005, IVZ

Number of clients by primary drug

31000

14200

9800

1120 290

6100

0

4000

8000

12000

16000

20000

24000

28000

32000

36000

Alco

hol

Opiat

es

Coca

ine

Amph

etami

ne

Ecsta

sy

Cann

abis


Cannabis: Increase treatment demand

Source: LADIS

1000

2000

3000

4000

5000

6000

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Number

Primary

Secondary


Increase cannabis and cocaine

Source: LADIS, IVZ

Number of clients

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

11000

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Cocaine primary

Cocaine secundary

Cannabis primary

Cannabis secundary


Amphetamine: Increasing treatmentdemand

Source: Ladis

0

200

400

600

800

1000

1200

1994 1996 1998 2000 2002 2004

Number

Primary

Secondary


Cocaine: Decrease in treatment demand afterlong term increase

Source: Ladis

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

11000

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Number

Primary

Secondary


Decrease opiate clients

Source: LADIS, IVZ

Number of clients

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

1994 1996 1998 2000 2002 2004

Primary

Secondary


Decrease in proportion of young opiate clients

Source: LADIS, IVZ

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

>=40 yrs

30-39 yrs

15-29 yrs


Infectious diseases

• Among drug users who have ever injected

– Prevalence of HIV: 0-26%

– Prevalence of HBV: 35% - 67%

– Prevalence of HCV: 47% - 79%

• Strong decline in HIV incidence


Infectious deseases

• Borrowing needles or syringes hasdecreased (but still between 8 and 30% of the IDUs did so in the past 6 months)

• Sexual risk behaviour remains worrisome


Slight decrease deaths by opiateoverdose

Number of deaths

0

20

40

60

80

100

120

140

160

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Total drugs

Opiates

Source: Causes of Death Statistics, Statistics Netherlands


Cocaine deaths(underlying causes)

0

5

10

15

20

25

30

35

40

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Number

Source: Causes of death Statistics, Statistics Netherlands


International comparisonoverdose mortality

Number per 100 thousand inhabitants

0,0

1,0

2,0

3,0

4,0

5,0

6,0

Net

herla

nds

Ger

man

y

Swed

en

Finl

and

Uni

ted

Kin

gdom

Nor

way

According to the same selection of ICD-10 codes. Source: EMCDDA


Drugs markets

Main source:

• THC-monitor based on cannabis samples in coffee shops

• Monitor on (recreational) drugs deliveredby consumers (e.g. ecstasy, cocaine, amphetamine)


% THC in cannabis

Source: DIMS, Trimbos Institute

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Dutch-grown

marihuana

8.6% 11.3% 15.1% 18.1% 20.4% 17.7% 17.5% 16.0%

Imported marihuana 5.0% 5.3% 6.6% 6.2% 7.0% 6.7% 5.5% 6.0%

Imported hashish 11.0% 12.1% 17.5% 16.6% 18.2% 16.9% 18.7% 13.3%

2000 2001 2002 2003 2004 2005 2006 2007


Increase THC content until 2004, stabilisation in 2005-2006

0%

5%

10%

15%

20%

25%%

Dutch marihuana 9% 11% 15% 18% 20% 18% 18%

Imported marihuana 5% 5% 7% 6% 7% 7% 6%

Imported hashish 11% 12% 18% 17% 18% 17% 19%

2000 2001 2002 2003 2004 2005 2006



Ecstasy market• Most pills (90%) sold as ecstasy contain MDMA, MDEA and/or MDA

• Proportion of high dose (>140 mg MDMA) pills decreased in 2006

• Increase in 2006 of percentage off ecstasy pills containing mCPP

0%

20%

40%

60%

80%

100%%

>140 mg 1 1 1 2 4 4 6 10 9

106-140 mg 6 5 6 9 14 11 12 12 13

71-105 mg 36 27 29 35 49 42 38 34 28

36-70 mg 39 53 52 45 28 39 38 39 36

1-35 mg 17 15 11 9 5 5 7 5 13

1997 1998 1999 2000 2001 2002 2003 2004 2005


Drugs marketscomposition of pills sold as

ecstasy

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1997 1998 1999 2000 2001 2002 2003 2004

No psychoactivesubstance

Other psychoactivesubstance

Amphetamine

MDMA (-like) plus other

Only MDMA (-like)



MDMA content in ecstasy pills

0%

20%

40%

60%

80%

100%

1997 1998 1999 2000 2001 2002 2003 2004

>140 mg

106-140 mg

71-105 mg

36-70 mg

1- 35 mg


Percentage of ecstasy pills by dose (mg)


Cocaine market: Increaseadulterants

% of cocaine powders adulterated with

phenacetine

0

10

20

30

40

50

2002 2003 2004 2005 2006

Source: DIMS


Seizures in The Netherlands, 2005

• Cannabis (kg) : 10 000

• Nederwiet (plants): 1800 000

• 5600 nursery gardens dismantled

• Cocaine (kg): 14 600

• Heroin (kg): 900

• XTC (powder/paste): 400

• XTC (tablets): 1 900 000

• Amfetamine (powder/paste): 2 100


Early Warning Systems

National level:

• Drug information monitoring system

• THC monitor

• Seizures

• National Assessment Committee


Streams of information

National sources

National Assessment Committee

Focal Point

EMCDDA (Early Warning System)

European Commission


Criteria for assessment

• Individual health risks

• Public health risks

• Social risks

• Possible consequences of prohibition

• Options for control


Experiences with Monitoring(1)

• Improving quality of policy, by :

- Overall assessment of situation

- Measuring effects of policy, identyfyinginter-relationships of measures


Experiences with monitoring(2)

• Monitoring must be a structural activity, takes time and money

• Monitoring needs political support

• Support of researchers is necessary

• Separate monitoring and political policy-making


Experiences with monitoring(3)

• Products must be geared to the needs of target groups

• Collect as much data as possible or limit the number of data?


Role of evaluation in drug policy(1)

• Only possible on basis of adequate monitoring

• Independent?

• Must be realistic


Evaluation (2)

• Assessment of policy; cost-effectiveness

• Starting point for innovation, research

• Starting point for political debate

• Starting point for next policy cycle


Policy Cycle

• Political decisions

• Monitoring

• Evaluation

• Innovation/research

• implementation


conclusions

• Co-ordination, Monitoring and evaluationare indispensible elements of drug policy

• Takes time, money and political will


Recommendations for policymakers

• Be reliable, be realistic

• Listen, observe and communicate

• Invest in knowledge

• Respect political opinions but separate these from the facts!


More information

• NDM: www.trimbos.nl

• EMCDDA: www.emcdda.org

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