Examination of Witnesses (Questions 800
TUESDAY 18 DECEMBER 2001
800. So the position between Switzerland and
Holland is broadly the same?
(Dr van Santen) Yes, I think. I recognise a lot of
what my colleague has said.
801. On cocaine, what is the attitude in Holland
towards, particularly, crack cocaine? Is there any degree of tolerance
(Dr van Santen) No, cocaine is equally considered
a hard drug as opiates.
802. Nobody is conducting an experiment to see
whether the legal supply of cocaine or crack will make a difference?
(Dr van Santen) This is one of the challenges for
treatment centres. There is no pharmacal therapy for cocaine addiction.
Treatment is being considered with a recipe prescribing longer
active stimulants, such as coca leaves. You must have heard of
some experiments in South America on that, and we are thinking
of doing that, because it is a similar problem. We can be very
effective in prescribing opiatesmethadone and herointo
heroin addicts, but we do not have instruments or medications
for cocaine addiction which work.
803. Is the same true in Switzerland?
(Professor Rehm) I think there is one difference.
The municipality of Zurich decided last September to open, within
a shooting gallery, a separate room for cocaine users where they
can consume their cocaine. It is a somewhat absurd situation because
if the police see them outside the shooting gallery they may be
caught for possession of cocaine, but if they make it to the shooting
gallery they can consume their cocaine there.
804. It has been explained to us that taking
heroin has the effect of making you more lethargic, whereas taking
crack cocaine may make you quite aggressive, which clearly presents
quite a different set of problems. Is that your understanding?
(Professor Rehm) In general, yes. Overall, we have
done quite a lot of studies into prostitution in Switzerland.
For example, cocaine is the problem for most of the prostitutes.
It is true that a lot more of the incidents in Switzerland which
have to do with some kind of aggression or violent behaviour in
the drug scene are done by cocaine addicts, even though they are
only a much smaller part compared to heroin. The question of crack
cocaine, specifically, is not that prevalent in Switzerland; we
still do not have it even though it has been expectedand
articles have been written about it some ten years ago saying
"It must come now, it must come now". Some of these
things you cannot explain. We just have to admit we cannot explain
things. Crack cocaine does not feature in Switzerland that much.
So the forms of cocaine are still sniffing and injecting.
805. In Holland, Dr van Santen, is crack cocaine
a serious problem yet?
(Dr van Santen) Yes, we are confronted with consumers
of both substances and, of course, in the inclusion of the heroin
experience we have patients who are dependent on both. One of
the things of which I am very curious, in terms of the outcome
of the research, is that with the prescription of heroin we can
diminish their cocaine consumption together with illegal heroin
consumption. So that is one of the outcomes which is going to
be there after February.
806. Can I briefly touch on cannabis as well?
What is the attitude in Switzerland, Professor Rehm, to cannabis?
(Professor Rehm) Basically, a lot of the other responsibilities
in Switzerland are not that of law. The federal law exists but
the local norms on policing are very different. There is not one
attitude on cannabis in Switzerland. We have something like semi-legal
cannabis shops in the Swiss-speaking parts of Switzerland, where
they sell cushions which they say are smelling cushions. People
buying them have to sign that they do not open the cushionsor
something really stupidwhich basically means tolerating.
Whereas if you come with a cushion into a French-speaking part
of Switzerland, because it is a bigger cushion, you would be immediately
arrested. What Switzerland has tried to do is to make a unifying
law on narcotics. This effort has been going on for two years.
If the current draft of the law prevails we will have a situation
which will be very much like Holland, where cannabis is sort of
tolerated in order not to violate officially the laws of the United
Nations Drug Control laws.
807. Has Switzerland signed up to those?
(Professor Rehm) Yes, it has. It is one of the few
things Switzerland has signed up to. If this law comes into effect
then controllers from the Alcohol Control Board will control the
shops on cannabis. We have 5,000 people who are controlling distilleries
in Switzerland, because by an old law everybody, every farmer,
who has apples can, for example, make liquor. So we have lots
of small distilleries, and to control that system we have a lot
of control people. Of course, most farmers nowadays do not do
their own distilling any more, so this is a system which is still
in place in all of Switzerland and which worked. They want to
use those controllers, who basically have lots of knowledge about
economics and about people trying to take away from their usual
things, to control them. The last thing you should know is that
all laws in Switzerland which have any kind of potential conflict
will go to referenda. Heroin substitution trials have been in
referenda three times in the last ten years. In all cases the
public has voted to continue those things and to, actually, expand
them. So the public is on side. What may happen is that if there
is no law for narcotics the public may not be on side for cannabis.
So what I am telling you is that the law, as it exists right now,
is in the minds of the politicians. The Swiss publicthink
about the EUeven if 90 per cent of the politicians are
in favour of participating in the EU the public has voted them
down a few times. It may well be even though this law is now supported
by 70 per cent of the Parliamentarians that the public may vote
it down. It is something according to our public opinion polls
which is way more controversial than treatment for heroin.
808. Dr van Santen, can you tell us about the
Dutch experiment with cannabis? We are familiar with it, but can
you tell us whether, in your opinion, it has worked or is cannabis
a gateway to other forms of drug taking?
(Dr van Santen) Not so much in the experiments, since
the coffee shops are open since 1978. What it shows is that together
with the destabilisation of the heroin epidemic, which is diminishing
since the 1980s already, the City of Amsterdam has started from
1 per cent of the population with heroin addiction and has now
decreased to half of that. The mean age of the epidemic is 45.
What we see is that the incidence of new heroin addicts has been
stabilised. We think it is difficult to prove but we think it
has to do with the separation of the soft and hard drugs where
we offer the possibility of buying cannabis in the coffee shops
strictly separated from hard drugs, which is strictly controlled.
I must emphasise that we have seen semi-legalisation on this issue
because the production and trade of cannabis is still very much
illegal, so retailers have to buy their products among those people
within organised crime. So this still sort of stimulates organised
crime in Holland and this is one of the big disadvantages. Therefore,
we are waiting for a consensus on this issue because we would
very much like to legalise the production and trade also of cannabis.
809. What do you say to those who allege that
if you go into a coffee shop in Amsterdam and suggest that you
would like something slightly harder than cannabis, they will
pull something slightly harder out from under the counter?
(Dr van Santen) No, sometimes it is higher purity.
It is not for sale in the coffee shop.
810. You are saying, basically, that the change
of policy in Amsterdam in relation to cannabis has worked?
(Dr van Santen) Yes, we attribute the stabilisation
of the harder epidemics and the decrease in new addicts to the
separation of addicts, together with the other measures in the
prevention of social marginalisation, and you need a healthy society
to do that.
811. It is not true, in your opinion, that cannabis
leads you to harder drugs necessarily?
(Dr van Santen) No, on the contrary.
812. On that last point "on the contrary",
you were saying that cannabis users do not go on to harder drugs.
There has been a suggestion that it does lead on. How satisfied
are you with that statement "on the contrary"?
(Dr van Santen) I am supported by reviews and cohort
studies on the consumption patterns among adolescents in Holland.
There is evidence to show.
813. Professor Rehm?
(Professor Rehm) We conducted a meta-analysis of statistically
cooling-off data for the relationship between cannabis and other
drugs, and you can do that once on the individual level (meaning
you look into surveys of students) and once on the academic level.
There is, of course, a correlation of people going into cannabis
which later on take other drugs. That is there. The same correlation
is there for tobacco and other drugs, it is there for alcohol
and other drugs. The problem there is about causality. If you
look at the aggregate level, those countries which have changed
their cannabis regime and have actually allowed cannabis to be
tolerated in certain parameters did not have an increased incidence
of hard drugs afterwards. The incidence and the harm which has
been increasing in some of the countries were not in countries
which have tolerated cannabis. The harm levels of the Netherlands
or of Switzerland, in terms of overdosing and in terms of the
hard indicators which we see, are less than for those countries
which do not tolerate cannabis. Now, again, I refuse to make a
statement about correlation as a causality at the individual level,
and I do not think it is simply that this one single bit is influencing
the whole other harm indicators. I think it is just part of a
814. Having noted with much interest what you
say about cannabis not necessarilyboth of youleading
to harder drugs, insofar as you would give a view about the position,
would you rather people did not start on cannabis at all?
(Dr van Santen) I would rather people did not start
with tobacco and cannabis, and so forth.
815. You would agree that insofar as people
did not smoke to start with, or excessively drinkmoderate
drinking, science tells us, is desirableyou would rather
people did not suffer from any form of drugs at all?
(Dr van Santen) I think, together with the tolerance
of soft drugs, morally you are obliged to put a lot of emphasis
on the prevention of starting with tobacco, alcoholthose
killers in our society.
816. I am not sure if I misunderstood you, Dr
van Santen. Did you say that the cannabis supply that is sold
in the coffee shops is obtained by illegal dealers and that is
sanctioned by the Dutch Government?
(Dr van Santen) Yes.
817. Does that concern you?
(Dr van Santen) It concerns me, of course, and it
concerns every Dutch citizen, because it stimulates organised
818. There is no government policy to try to
reduce the use of cannabis? The level is not controlled at all?
(Dr van Santen) As I said, there is strong policy
to try to prevent people smoking, but cannabis mainly smoked has
its disadvantages; it also causes lung cancer, of course. But
tolerance means that you provide for it and people want to experimentadolescentsby
taking something that is a little risky. However, you canas
is demonstrated nowprevent people taking larger risks.
819. I understand that cannabis is much more
carcinogenic than tobacco. Do you have a higher rate of lung cancer
in Holland than you had before?
(Dr van Santen) No, no. I think it is a little bit