For Safe and Effective Drug Policy, Look to the Dutch

The country has virtually eliminated injecting drug use as a transmission of HIV and enjoys the lowest rate of problem drug use in Europe.

Why has the Netherlands—a country sometimes viewed as having a permissive approach to drugs—had better results than so many governments with much more strict policies?

A new report by the Open Society Global Drug Policy Program shows how the Netherlands maintained low rates of HIV among people who use drugs and comparatively low cannabis use among young people, all while avoiding the enforcement-heavy measures of its neighbors.

And while the Netherlands’ coffee shops, where cannabis is openly sold and consumed, command the most attention, the benefits of the Dutch model have not received enough focus.

The report includes the following findings:

  • Far fewer arrests for minor drug offenses occur. While it was recently reported that someone is arrested for marijuana possession in the U.S. every 42 seconds, Dutch citizens have generally been spared the burden of criminal records for minor, nonviolent offenses. According to one comparison, in 2005 there were 269 marijuana possession arrests for every 100,000 citizens in the United States, 206 in the United Kingdom, 225 in France, and just 19 in the Netherlands.

  • Lighter enforcement did not lead to more drug use. About 25.7 percent of Dutch citizens reported having used marijuana at least once, which is on par with the European average. In the comparatively strict United Kingdom, the rate is 30.2 percent and in the United States it is a whopping 41.9 percent.

  • While coffee shops generate about €400 million ($512 million USD) in annual revenue their main purposes were public health and social inclusion. Thus, the Netherlands invested heavily in treatment, prevention and harm reduction.  

The logic behind the coffee shops is simply not well understood: they were introduced to protect cannabis users from exposure to harder drugs. The theory was that indiscriminate prohibition created a subculture in which users of drugs with vastly different risks are lumped together. Moreover, it was thought that saddling young people with criminal records might push them toward harder drugs.

Because different drugs carry different risks, the government surmised that they should be treated differently. This is known as a “separation of markets.”

Dutch policymakers realized that buying illicit marijuana put users in contact with dealers who also sold harder drugs. As designated commercial sources for marijuana evolved, drug users became much less likely to buy harder drugs from their cannabis sources.

For example, in Sweden, 52 percent of marijuana users report that other drugs are available from their usual cannabis source. In the Netherlands, only 14 percent of marijuana users can get other drugs from their cannabis source, according to European drug monitors. This is largely because the vast majority of cannabis users buy from coffee shops.

In addition, the country has virtually eliminated injecting drug use as a transmission of HIV and enjoys the lowest rate of problem drug use in Europe. 

However, the Dutch approach is as vulnerable to politics as any policy. In a climate ripe for populism, interparty squabbles can lead to regressive drug policy approaches. In recent years, ambitious lawmakers or candidates have used drug policy as a wedge issue, attempting to establish more restrictive laws.

Proponents of the international status quo might claim that debates about drug policy in the Netherlands reflect an admission of failure on the part of Dutch lawmakers. This ignores the fact that the policy never failed. In some cases reforms were introduced as a means of dealing with local difficulties. In others, coffee shops represented an easy campaign platform. Yet none of this has undermined the accomplishments of Dutch drug policy or its broad public support.

The report shows the conversations currently underway about marijuana policy in the Netherlands have very little to do with success, failure, public health, or criminal justice. They are about politics. 

And that is where the main questions about next steps arise. What comes next may depend on leadership, rather than results in public health and safety. Does the international community have the political will to learn from the lessons of the Netherlands and carry them even further? 

26 Comments

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If it works & it does, don't bugger it up!!

In a nation where proponents of a change in philosophy labels you as a part of a group that is anti- government, anti American. It is time for people to realize that a difference of law enforcement initiatives based on credible utilization of proven methods will yield benefits similar to the successfully

I lived in Amsterdam and used cannabis extensively while there. I do not drink or use other intoxicants. One of the nicest things about using cannabis in Amsterdam was the lack of social exclusion and its accompanying alienation and isolation. I could smoke in public in a social place (coffeeshop) with like-minded people, safely and happily. There was none of the violence and horror associated with other sorts of drugs or with the drug market in other countries. I now live in another country where the use of Cannabis is rife but it is lumped with all other drugs - as a result there are such violent gang wars in my city that they are contemplating calling the army in to try and stop the killings. I would far rather live in a society like Holland than the one I now live in where I am demonised for smoking a herb as though I was shooting up heroin. However, I no longer believe in governments - they appear to always choose the stupidest way of doing things no matter how many experts advise differently.

Hilary, I couldn't agree more. So much of what government does is some heavy handed or convoluted way to solve problem. More often it's something that makes a splashy headline, but fails a common sense test.

Agreed. I grew up in the Netherlands and used cannabis since I was 16. Never faced any problems with it. And guess what, around 30 I started to lose interest. Much later I also lost interest in nicotine. Now smoke - and drug free. Not out of some moral pressure, but simply out of my own choice. The habit of alcohol seems much tougher to drop!

Live and let live.

Thank you for your article. Unfortunately, United States’ drug laws are constructed to benefit such nonproductive groups as pharmaceuticals, lumber, prisons (state-sponsored and private for profits), unnecessary law enforcers (DEA), etc, who employ substantial number of people. This practice decays economic growth and is a hazard to environment, as for example dangerous GMO products flooding food markets, and nonproductive prison employees, collecting substantial salaries and pension benefits, bringing collapsing budget in California. When lawmakers realize that prison guards would be more valuable for overall economy if they, for example, grow and sell industrial hemp, which would be legally taxed, the US may move ahead of Netherlands.

thank you for this great policy summary. It's extremely helpful to have the case laid out so clearly.

Isn't one of the key issues now to target both the decisionmakers and the public that are at the cusp of changing their opinion, and ideally find more allies among the GOP, so that policy change becomes more likely?

Pew's figures are instructive: http://bit.ly/Pew_GOP_Legalize

Thanks again, looking forward to more updates.

I couldn't agree more. Drug policy reform has bipartisan appeal these days and the public seems about ready to try lots of different things that were unthinkable a few years ago. The hard part may end up being how to implement the kinds of health programs that the Dutch rolled out that are proven to reduce overdoses, stop the spread of HIV and HCV, etc.

I cant see how you can simply compare what happens in the Holland (pop: 17m) to experience in the US (pop 300m) or even the UK (pop 60m). Also, I am sure downtown US is v different from rural US. Urban US and UK are the most fragmented of societies with weak sense of social cohesion and identity - one of the main drivers of drug abuse. By all means look at Holland but I dont believe changes in legislation is some kind of magic cure. Just because it has an effect in one setting is no guarantee it will have a similar effect somewhere quite different.

No argument there. I don't think any law would be copied from one environment and transplanted into another.

The Dutch experience (or the Swiss, Czech or Portuguese for that matter) shows some positive trends that can inform policymakers elsewhere. Local conditions will always dictate the policy itself.

your cynical approach to the briefing is somehow resonates with opinion of those who somehow beneficiary of the failing policies in other nations.

why overlooking possible proven solutions in place of an over- the- fence rhetorical argument with no alternative solutions on the table.

It would be a money well spent to further research the findings of the report with the view of finding applicable solutions to allay human and economic carnage that many countries have to deal with every day.

Illicit drugs have been used by the power elite to control populations for well over a hundred years. When the British first went into India, they dicovered that they could essentially enslave a whole nation by addicting it's population to opium. When the Brits got their first foot hold in China, they imported opium. The Boxer Rebellion was in part over Chinese citizens' outrage over the addiction that was super-imposed on their society.

Fast forward to the Vietnamese War and the CIA and military officers discovered how easy it was to make vast amounts of money by flying marijuana and heroin into the US using our military planes.

The Iran-Contra scandal of the Reagan administration was about the CIA taking drugs confiscated from Latin American dealers and sold on the streets of LA to raise finds to illegally send guns to the Contras in central America and then take that money to buy more guns to trade to the Iranians so that they would not let the American hostages go free until after Reagan won the election and was sworn into office.

That was so lucrative that the CIA never stopped running drugs and guns through central America. It has been going on all this time.

Every time we start another war, the drug cultivation sky rockets in the lands that we go into. Afghanistan's poppy feilds were almost irradicated under the Taliban. Well, those fields now produce more than 200% more than before the US invaded.

So, while too many of those in positions of great power and influence can make such a great deal of money off of illicite drugs, we will continue to have a "war on drugs" which accomplishes nothing except to create more pathways for a select few to grow ever richer.

Please look for me on Facebook. I'm running for California State Assembly and I'm the ONLY candidate who has voiced support for legalization. It's time to take marijuana away from the drug cartels and to stop associating it with harder stuff. It has helped so many in the community to suffer pain or the horrible side effects from chemo. Taxation could bring in millions for programs that have been cut to the bone and drug treatment for those who are addicted to other drugs - legal and otherwise. Let's save prisons for REAL criminals!

Thank you for making my case clearer. If the Jamaican Government would get rid of the cowardice and do like the Dutch, what a BEAUTIFUL country this would be.

Errol

I started smoking at age 15 and i stop smoking after ten years am fine now and then. But am oppose to smoking in public places and am oppose to the restriction also.

Since the Magna Carta, democracy is about puting limits to power. If there is a rational solution to a problem, no parliament vote should take place on the subject.Dutch policy on drugs is ok, let's have national/regional versions of it.

The UK needs to apply a commonsense approach to current drugs strategy. Why ever not pilot a longitudinal study on the concept of Amsterdams healthy and social inclusive approach to coffee shops? Personall I would support and run such an establishment here in the UK. Primarily to prevent criminal activities and promote individual health and well-being, create community cohesion as a capacity building project that would link into other harm minimisation and recovery orientated related services.

That's a great idea. There is a debate around supporting a cost-benefit analysis of UK drug policy. The petition is here.

http://epetitions.direct.gov.uk/petitions/45969

Certainly all the services you mention require a much better supportive environment than currently exists in the UK.

I am not sure that you will publish my comment, but I will still write it.
First of all, I would like to ask employees of Open society foundation, that are advocating legalization of drug use : Do you, in your hearts, really believe that you are doing the right thing? If your answer is “yes”, please look again.
I can understand that big money is at stake in your advocacy. If you succeed, business opportunities worth of millions of dollars would be opened. Furthermore, jails would be “saved” for “real criminals” and not for drug dealers. Social cohesion would benefit, etc…
Let’s be honest. Who would benefit the most from decriminalization of producing and dealing drugs? Those that have money to invest in such business, of course. As a risk free investment it would be a business opportunity par excellence for investors, especially very rich investors. For them, it would be an ideal occasion to get richer then they already are. As in other businesses, they would, by definition, tend to maximize their gains in this business as well. How can gains in drug business be maximized? By augmenting the number of drug consumers, and by addicting the largest number of them. Who are the consumers with the highest propensity to become addicted to drugs? Adolescents and children.
But, when millions of dollars are out there waiting to be legalized (and multiplied), who cares about health and lives of adolescents and children? Well, I care about them and I am sure that I am not the only one. This may come as a surprise to some of you, but there are people who do not think that money is the most important thing in the world. Money is important, but there are limits that should be respected.

Thank you for your comment but I’m afraid you’ve badly misread the report. The whole point of Dutch drug policy is that it successfully reduced problematic drug use. Any policy should consider problem drug use as one barometer of success or failure, in addition to prevention of the spread of blood-borne viruses and bacterial infections. The Netherlands succeeded in averting the kinds of drug-related HIV epidemics that devastated many neighboring countries, through its pioneering public health interventions. Finally revenues were never the point. Dutch policy is not perfect. The report acknowledges some challenges. But it does have a number of lessons that could be instructive to other countries. That said, if you have any other models that reduce problem drug use, prevent the spread of epidemics, increase security and spare vulnerable communities from harmful criminal sanctions, please share.

That said, another model that reduces problem drug use, prevents the spread of epidemics, increase security and spare vulnerable communities from harmful criminal sanctions, could be oral substitution and, maintenence therapy for hard core injecting drug users. I have been part of the service provision as well as a recipient of the Methadone and Buprenorphine programmes for mostly injecting heroin users and it really seems to facilitate lifestyle change and behaviour change provided the dosing is done at optimum levels.

Definitely! Harm reduction, including substitution therapy, is a critical part of any health system. Do you have any views on where it is done best?

It's perfect, dear friend. Continue !

Patrick, your question: "The hard part may end up being how to implement the kinds of health programs that the Dutch rolled out that are proven to reduce overdoses, stop the spread of HIV and HCV, etc." can be answered via economics 101, negating some of the above comments of "profits thru legalization."

Both US and UK already have the huge infrastructure of state and private prisons, some of which legally trade on major stock exchanges. Because their profits are enormous and labor force they employ is nonproductive (their “consumers” are those who they guard in exchange for salaries/benefits/pensions), why not convert 70% (estimated drug offenders) of this infrastructure into state/private run medical facilities with the purpose of “implement[ing] the kinds of health programs that the Dutch rolled out…”? Thus, all the current locked up drug offenders’ spouses, children, relatives, former and future employers, etc. would anticipate medical and psychological recovery vs current system’s getting this segment of population back into same confinement so that current salaries, benefits and pensions of employed prison force stay running due to current drug laws. The hard part perhaps would be to re-train the currently employed prison guards into future employed medical/psychological personnel with the same salaries/benefits/pensions in exchange for productive services.

“My son is in federal prison. He’s been a drug addict for a large part of his life. Part of the punishments — if you happen to have a slip, and this is for a prisoner who is nonviolent, as about a half-million of our drug-addicted prisoners are — he’s spent almost two years in solitary confinement. Right now I’ve been told that I can’t see him for two years. It’s been over a year now. And I’m questioning the system.”
“Obviously at first, I was certainly disappointed in my son. But I’ve reached a point now where I’m very disappointed with the system. And as you can see from what Attorney General Eric Holder has been doing regarding our prison system, I think things are going to be revived, regarding nonviolent drug addicts. My last comment on that is the United States represents 5 percent of the world’s population and we have 25 percent of the world’s prisoners.” - actor Michael Douglas, reported by Huffington Post Sept 23, 2013

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