Select Committee on Home Affairs Minutes of Evidence

Examination of Witnesses (Questions 800 - 819)



  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 there?
  (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 opiates—methadone and heroin—to 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 expected—and 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 cushions—or something really stupid—which 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 public—think about the EU—even 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.

Bob Russell

  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 larger picture.

David Winnick

  814. Having noted with much interest what you say about cannabis not necessarily—both of you—leading 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 drink—moderate drinking, science tells us, is desirable—you 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, alcohol—those killers in our society.

Angela Watkinson

  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 crime.

  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 experiment—adolescents—by taking something that is a little risky. However, you can—as is demonstrated now—prevent 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 lower.

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