CHAPTER 9 THE NETHERLANDS

The first governmental memorandum on drug policy after the new
Opium Act appeared in March 1977 and discussed assistance to drug
abusers (14 417, no. 1­2). In the introduction to the memorandum, the
situation was described in quite pessimistic terms. Drug use, especially
of drugs with unacceptable risks, caused considerable troubles.
Nowhere in the world had the problem been solved and it seemed that
there was no efficient strategy. For the Dutch part, it was hard to
suppress the supply of drugs because of its open borders and traditional
respect for the citizen's liberty. Demand for hard drugs pointed to
serious social problems. However, it was impossible to achieve social
changes to a degree that any preventive effects could be expected.
Information could influence attitudes and mentalities by enabling the
individual to make up his own mind on drug use in a responsible way.
Furthermore, the government stated that the drug problem seemed to be
of an epidemiological character: "The drugs themselves, the substances
are not new, but suddenly society has become more sensitive to them,
so that an explosive dissemination occurs" (Ibid. no. 1: 2).
This statement on the epidemiological character shows that the drug
as such was not perceived as a contaminating factor but that changes in
society were the cause of the drug problem. The relation between these
changes and drug use was a matter for behavioural research. In the
meanwhile, the number of users, regular users, and addicts had
increased to such a degree that a specific policy on assistance was
justified. The basic idea for this policy was that the organisation of
assistance on the one hand should be decentralised in order to comply
with demands for a differentiated supply of assistance. On the other
hand, assistance had to be centralised because it is a duty of the state to
ensure that care for the weak in society is guaranteed. Another reason
was that an appropriate and fair distribution of scarcely available
resources requires central guidance (Ibid. 2).
The statement that the memorandum would not lead to a fundamental
solution of the drug problem closes the introduction. It was not its goal
either; instead, the goal was to outline adequate assistance to the
victims of use and abuse, and addiction to drugs (Ibid. 3).
Two issues in the memorandum will be addressed below. The first
concerns the problem of co-operation and co-ordination between a-
specific assistance and specific treatment. In order to stimulate
concerted action at the local level the government established funds for
social assistance to adolescents and young adults. Municipalities and
provinces could apply for funds on condition that they had drawn up a
four-year plan. In the plan, first-line assistance and specialised
treatment activities should be balanced. In the latter, the CADs would
be the focal point. Secondly, the financing of CADs would be changed.
The ISD was preparing a regulation in which the main responsibility for
the CADs and their funding would be transferred from the Department
of Justice to the Department of Health. This would be in line with the
policy of playing down the involvement of Justice in approaching drug
users. However, the CADs would continue their probation tasks (Ibid.
20).
A statement from the Minister of Justice may illustrate the
importance of assistance to the action programme:

The goal for the governmental policy is twofold: by penal means to reduce the
supply of particularly drugs with an unacceptable risk and simultaneously by
assistance programmes to reduce demand for drugs in order to prevent as much as
possible the problems due to a reduced supply [such as increased criminality by
addicts] (BO stuk no. 30/10. 1977).

This quotation reflects the dilemma of actions against the drug problem.
Obviously, the government expected that it was possible to reduce
supply, which would have repercussions for addicts. The point here is
that the consequences of the action programme for addicts and society
were included in discussions.
It would be the last drug policy document from this government.
After the elections in 1977, a new government came into office in
December. It was a coalition with the confessional party CDA (the
three largest confessional parties had merged into one single party) and
the liberal VVD. The Prime Minister, van Agt (CDA), had been
Minister of Justice in the previous government and one of the architects
and defenders of the new Opium Act.


The severely addicted

While the former memorandum on assistance had the character of an
inventory of existing and planned assistance, the next memorandum in
1978 was an analysis of the situation of the severely addicted and was
worked out by the ISD (14 417, no. 6). It outlined a policy on assistance
to the severely addicted and for the first time relations between drug
addicts and assistance were discussed. Up to then discussions were
primarily about the structure and goals of assistance.94
The central goal for a policy on assistance to drug addicts had to be
in accordance with the central goal for the drug policy: the prevention
and care of risks that emanate from drug use. These risks were divided
into three categories:

· risks for the addict;
· risks for his or her immediate environment;
· risks for society (14 417, no. 6: 6).


Categorisation

To outline a policy, the ISD considered it meaningful to discern
categories of severely addicted. However, according to the ISD, such a
distinction is often artificial, and many addicts will show characteristics
that fit in more than one category. The categorisation was based on the
behaviour of the addicts which, according to the ISD was important
because: "The pluralistic character of the aetiology of addiction is
reflected by the behaviour of the addicts and determines to an important
degree the structure and methods of assistance" (Ibid. 3).
This statement meant that assistance was to be adjusted to the type of
addict and addiction, not the addict to assistance.
The first category is characterised by behaviour that does not
provoke reactions from police or justice and can be divided into two
sub-groups:
A. A relatively well socialised group. They are adults, with a job,
family, and home. Their social relations and responsibilities form a
counterweight to the escalation of the use and symptoms of social
exclusion. The aetiology of their addiction often determines the way
professional assistance is rendered. Some receive professional
assistance from their GP or psychiatrist combined with a prescription
for substitute drugs. Others get assistance from CAD or SPD (Social
Psychiatrist Service). The number of addicts in this category was
estimated at roughly 1000 and the GP was the main assistance contact.
B. Younger addicts, living together with their parents or a partner
and more or less isolated from the drug scene. They look like junkies in
their way of using drugs and clothing but their parents, partner, or
social security, finance their drug use. Complementary income comes
mostly from prostitution. Usually severe emotional and social tensions
are covered by drug use. The gravity of their situation is also a
contributory cause of the failure of treatment. For this group social
outreach work in co-operation with the GP is appropriate. Street-corner
work and community centres can fulfil a signalling function.
The second category more or less regularly encounters police and
justice and can be divided into two sub-groups as well:
C. Criminals for whom the origin of drug use emanates from a
craving for immediate satisfaction of needs and is symptomatic of a
lifestyle that is in essence asocial. Their standard of living is dependent
on the degree to which they succeed in making a living out of drug
trade and/or other illegal activities. Prostitution is common in this
group. Some are extremely aggressive, terrorise their environment, and
are very hard to affect in a penitentiary or intramural psychiatric
treatment setting. The risks surrounding this group are considerable,
probably not primarily concerning health problems as much as the risks
to the immediate environment and for society. The question is whether
assistance other than by justice and probation is possible.
D. Addicts whose criminal behaviour is mainly inspired by the need
to obtain the substance. They are characterised by pauperisation and
social isolation without a steady place to stay; often living in groups in
squatted apartments. Criminal activities are limited to petty crimes and
incidental acts of violence. Prostitution is common in this sub-group
too. CADs and street-corner work know them from previous treatment
and probation efforts. This sub-group shows serious contact
disturbances. Family relations are usually broken and relations to others
are just a means to obtain a substance. Addicts in this group are
undoubtedly most vulnerable. The risks for their health and for society
are huge. It is unrealistic to expect that they can become drug-free
without drastically changing the environment in which they live in.
Separating them into small groups in sheltered day-care facilities could
reduce the risks. Supply of substitute drugs should be part of the
assistance programme. It seems quite realistic to presume that serious
mental disturbances will occur more frequently in this group than in
others. Admission to closed psychiatric care would be necessary in this
group (Ibid. 4).
Generally, addicts from sub-groups B and D are pointed out as
"junks". They have frequent contacts with dealers that can belong to
group C. The number of "junks" in Amsterdam and Rotterdam was
estimated at 1000­2000 (14 417, no. 6). Assistance facilities for group
B and D should be made attractive to them but not lead to situations in
which no demands are made at all. The goal of bringing addictive
behaviour under control and if possible ending addiction should be
maintained (Ibid. 14). It was also important to differentiate approaches
to A, B and C. Assistance to the first two categories should be a matter
for health and social care. For the third category, assistance in a
penitentiary setting would preferable (Ibid. 13).
This categorisation of drug-abusing populations is important to keep
in mind for two reasons. It shows the close co-operation between
assistance and justice (drug-related crime) and secondly it reflects a
basic idea for drug policy, namely, drug users are not a homogeneous
group but there are many different types of drug-use-related behaviour,
which would have implications for assistance.


New users, new solutions

The situation concerning heroin had deteriorated rapidly in the
Netherlands in the mid-1970s. A development that complicated the
matter was that at the end of the seventies an explosive growth of
heroin use had occurred among ethnic minorities. An event that
contributed to this development was the independence of the Dutch
colony of Surinam (neighbouring on Brazil) in November 1975. People
living in Surinam had to choose between Dutch or Surinam nationality.
Many Surinamese travelled to the Netherlands and became Dutch
citizens. During 1975, 40,000 Surinamese arrived in the Netherlands.
At the end of a five-year transitional period in 1980, another 40,000
moved to the Netherlands (Metze 1996: 33). The majority were young,
single, poor, and uneducated with problems in finding employment and
housing. Many of these immigrants became addicted to heroin and took
an intermediate position in the heroin infrastructure as dealers between
wholesale trade and street-level dealing (Grund 1998). For many
immigrants this was a way to survive. However, this new category of
drug users also confronted authorities and the treatment system with a
new challenge. The existing facilities for assistance to drug users could
not attract Surinamese addicts at all.
While the ISD and parliament discussed a policy on assistance to
severe addicts, developments in the cities took a new course. In 1978, a
group of addicts of Surinamese origin squatted a building in The
Hague, which soon became a centre for drug dealing (Kooyman 1986).
Two weeks later local authorities stationed a bus in the neighbourhood
from which the squatters could receive methadone and closed the
building. Within a year, the number of addicts visiting the bus had
increased from 70 to more than 700, of both Surinamese and Dutch
origin. Amsterdam and Rotterdam followed suit and methadone buses
started their daily rounds. The buses were mobile low-threshold
methadone-dispensing facilities under the responsibility of municipal
health services (GGD).95
Another minority group in which heroin use became a problem was
the Moluccans, who had moved to the Netherlands from the Moluccas
when the Dutch Indies became independent 1949. Special assistance
was established for them as well. A decade later members of Turkish
and Moroccan minorities would show up in the assistance system. At
the same time, the phenomenon of drug tourism was flourishing. In
particular Amsterdam was attractive to heroin users especially from
Germany and Italy. During the first years of the eighties the number of
drug tourists was estimated at one third (approximately 1500) of the
total number of heroin users in the city.


Methadone

Against the backdrop of the difficulties in encountering different
categories of severe heroin addicts, the subject of methadone was an
issue for discussion in the ISD. In the memorandum, the aims and
practice were discussed in detail. According to the ISD, methadone
programmes that do not aim for abstinence can have a cementing effect
on drug use. They should therefore only be open to addicts whose
personality and social antecedents justify the conclusion that ending
their state of addiction in the short term would be unrealistic.
Dispensing substitute drugs would be an ultimum remedium and be
grounded on the observation that in individual cases the existence of
risks is demonstrated and it would be reasonable to expect that
dispensing could contribute to the reduction of those risks. Accessibility
to the programmes should (if possible) be restricted; capacities should
not exceed the manifested need, and be combined with social assistance
to the addict. Furthermore, it was emphasised that methadone dispensed
by programmes that aimed for abstinence should be kept separate from
maintenance programmes. The ISD suggested that the local GGD
should operate the latter (14 417, no. 6: 15).

In order to prevent clients from obtaining methadone simultaneously
from different facilities, a central registration was to be established with
access restricted to GPs and physicians employed by assistance
facilities. The decision to dispense a substitute drug is ­ obviously ­ a
medical responsibility, the ISD stated, but judging the related-risk
components would include the social and criminal antecedents of the
addict. Hence, the ISD proposed a single local body for the selection of
clients/patients, for example, municipal or regional health services.
Another possible solution could be a central selection procedure in co-
operation between assistance agencies. Involvement of GPs and
pharmacies seemed to be indispensable in this procedure (Ibid. 15).
Last but not least, the question arose whether heroin should be
dispensed. Already during the plenary discussion on the Opium Act in
1976, several MPs had suggested prescription of heroin. In February
1977, Amsterdam had presented a memorandum on dispensing heroin
to reduce drug-related crime. The ISD and the government rejected the
plan. The pharmacological qualities of heroin (flash), the frequency of
taking the substance and the obsession with the drug were according to
the ISD contradictory to the idea that heroin could contribute to the
reintegration of the severely addicted in society (Ibid. 17).
It was the first occasion that dispensing substitute drugs (methadone)
to opiate users was discussed in detail in a governmental policy
document. Substitute drugs were also discussed a great deal at the
meeting of the extended standing committee on drug policy (OCV 12
June 1978). A hot item was whether substitute drugs should be
prescribed only on medical indications or on social indications as well
(Ibid. 658). By social indications was meant protecting society from
drug-related nuisance, a phenomenon that had received increased
attention from the public during the previous years.


Nuisance

A new problem had appeared on the drug-political scene: nuisance.
From this period till today the concept of nuisance has been a main
theme in Dutch discussions about drug policy. It includes drug-related
petty crime (breaking into cars, shoplifting, burglary, and forgery) by
addicts. The number of addicts arrested for drug-related crime had
increased considerably since the last debate in the Lower House in
1976. It was estimated that about 1000 addicts passed through the house
of detention every year (Ibid. 665). Another important aspect of
nuisance is related to the lifestyle of groups of addicts gathering in
certain streets or neighbourhoods. The usual reaction by the police was
to chase away the addicts, which only moved the problem to another
neighbourhood and caused problems for the population that demanded
action from the city council.


Compulsory care

Apart from substitute drugs (including heroin) as a possible means to
counteract nuisance, the issue of compulsory care was also a much-
debated option. During the plenary discussions in 1976 about the
Opium Act, the Minister of Justice had promised to initiate a study to
investigate the possibilities of arranging compulsory care beyond the
domain of Justice. During the standing committee meeting in 1978, the
question was posed what had happened to that study (Ibid. 661). It
appeared that the study had got bogged down. However, the ISD had
not forgotten the issue in its memorandum. Compulsory care was
possible in two settings: psychiatric hospitals and the prison system.
The ISD discussed both practical and principal obstacles to compulsory
admission to psychiatric care. One practical obstacle was that addicts
were hard to take care of together with other mentally ill patients.
Establishing special small units could, according to the ISD, remove
this obstacle. The fundamental obstacles were more difficult to solve.
According to some psychiatrists and judges, addiction could not be
interpreted as mental illness. The next fundamental question was
whether compulsory admission also includes compulsory treatment.
Treatment was defined by the ISD as: "All kinds of approaches of the
patient that are systematically and methodically applied" (14 417, no. 6:
10). Another "formidable" obstacle was the lack of hard data that
convincingly prove that the appliance of means of coercion in treatment
do lead to an improvement in the pattern of social behaviour (Ibid. 11).
Against the backdrop of demands from parents of addicts for
extended possibilities for compulsory care, the under-secretary of state
for Justice discussed this issue in the plenary discussion in June 1978.
According to her, it would be extremely difficult to apply the Insanity
Act if the addict has no other problems than addiction. To this statement
she added, "One could of course go fantasising but that fantasy I think
is weird". "The question is if it possible to devise a law text that can
guarantee the individual characteristic of the human being and that
creates sufficient security that not would interfere in an unjust manner
when the opportunity is offered for compulsory care" (OCV 12 June
1978: 662).

The 4-G

The developments of the drug problem and its consequences for society
became most noticeable in the big cities and was the subject of
discussions in regular deliberations between the central government,
four big cities,96 commonly referred to as the 4-G, and the Association
of Dutch Municipalities (VNG). For the overall drug policy and in
particular matters of public order the major cities have had (and still
have) a large influence on the shaping of these drug policies. Because
drug use was concentrated in the 4-G, they wanted a direct line to the
government to discuss drug-related problems. The main problems on
the agenda were the house-dealer problem, drug-related crime, and the
relation between state and cities concerning the co-ordination and
financing of assistance (BO 1977, stuk no. 30/06).
In a meeting between the Government, the 4-G, and the VNG, on 13
December 1978, the issue of state subsidies was discussed once more
and it was agreed that the ISD would be a focal point for municipal
applications for subsidies. Special attention would be paid to the degree
of co-ordination in the applications. Advice from the ISD to the
Ministers would preponderate. Municipalities were also to outline a
four-year plan for assistance (BO 1978, stuk no. 30/43).


House dealers

A problem that was discussed in the meeting between the government
and 4-G in June 1977 was the problem of house dealers operating in
youth centres (BO stuk no. 30/10). The problem of smoking cannabis in
youth centres had been a dilemma for authorities since the late sixties.
When the government in 1972 announced its intention to make use and
possession of cannabis for personal use a misdemeanour and especially
after the government in 1974 singled out heroin as the no. 1 priority for
police activities, tolerating cannabis smoking in youth centres became a
common practice. However, the youngsters who smoked cannabis in
the centre had to buy their stuff somewhere, i.e. the illegal drug market.
As a solution to this problem, the staff of some youth centres allowed a
"house dealer" to sell small quantities of cannabis to youngsters. The
concept of "house dealer" implied that only one person appointed by
the staff was allowed to sell cannabis of reasonable quality and price to
visitors to the centre. This would be perfectly in line with the
governmental policy of separating the market for soft and hard drugs.
However, trade in cannabis was still a criminal offence. In 1975,
several house dealers were convicted to a harsh sentence (five months'
imprisonment) for selling cannabis in youth centres. The new Opium
Act from 1976 did not solve the problem. Possession of more than 30
grams of cannabis and trade were still a criminal offence. New
guidelines were needed that also included the new phenomenon of the
house dealer.


Guidelines

When the guidelines were adjusted to the new Opium Act, the "house
dealer" problem was left out because the Prosecutor-General first
wanted to discuss the matter with the Dutch Association of
Municipalities (NVG), the 4-G, and the Home Office. The question of
house dealers was settled at the end of 1977. In the adjusted guidelines
1978 a house dealer was defined as: "A dealer in hemp products who
with the trust and protection of the staff of a youth centre and with
exclusion of other dealers gets the opportunity to sell hemp products in
the centre" (Staatscourant, 18 July 1980, no. 137).
In principle, the house dealer falls under article II of the Opium Act
which prohibits unauthorised trade, but trade in drugs with an
unacceptable risk would have the highest priority. The lower priority
for prosecution of retail trade in cannabis implied that police only
reacted when trade advertised itself as such or acted provocatively in
other ways. It was also stated that house dealers could be prosecuted
only after consultation with other local authorities (Lord Mayor, chief
of police, and local prosecutor, known as tripartite deliberation). This
tripartite deliberation deserves further explanation because it plays a
central role when it comes to future local policies on coffee shops and
nuisance. The Lord Mayor is responsible for public order in his/her
municipality and can use local police ordinances to maintain public
order. This tripartite deliberation can be seen as an expression of the
Dutch pragmatism in drug policies but also of decentralised
governance. It was not an ideological stand that determined actions but
local circumstances.
For possession of drugs with unacceptable risks for personal use, the
limit was set at 0.5 gram for heroin/morphine, cocaine, amphetamine
and one trip for LSD. These quantities were based on the average daily
need of such substances. For such quantities, no specific tracing and
arrests by police were recommended (Ibid.). If police officers
encountered suspects with such quantities, the usual practice would be
to confiscate the drug and contact assistance.


Control

Six years after the Opium Act was adopted by parliament the
government presented a bill (17 975) to revise the Opium Act. The
backdrop to the bill was the unsuccessful struggle against trade in drugs
and the appearance of a new (for the Netherlands) phenomenon:
organised crime. Organised crime was also active in arms traffic,
prostitution, and gambling, but trade in drugs was the favourite branch
(Blom 1998: 127). In the new act a provision on conspiracy was
included that penalised preparatory acts of trade from or to the
Netherlands in drugs with an unacceptable risk. After 1976, resources
for criminal investigation were reinforced greatly. In 1976, a special
national drug brigade within the Central Intelligence Service (CRI) had
been established and manpower in local drug brigades in big cities had
increased as well. The new provision on conspiracy meant a switch
from reactive prosecution to proactive investigation and the
introduction of tapping telephones, undercover agents, and controlled
deliveries.


The international level

In January 1977, the Minister of Health, Vorrink, sent a letter to her
colleague on Foreign Affairs with the request to start an investigation
into the possibilities of changing the Single Convention. She proposed
initiating a dialogue with the US. In the federal establishment, a
movement existed with ideas that corresponded with the philosophy of
the Dutch government (ISD archive, letter 26 January 1977). His
answer must have been a disappointment to her. For several reasons, it
was undesirable to start such an initiative. Any attempt would almost
certainly be wrecked due to a lack of allies. It could also make the
wrong impression and further damage the already negative image of the
Netherlands on this issue (ISD archive, letter 9 March 1997).
In March 1977, the Dutch ambassador in Stockholm informed the
Minister of Foreign Affairs about the negative publicity in the Swedish
media concerning the Dutch drug policy. While information recently
had become more objective, the central position of Amsterdam in the
trade in heroin continued to give the Netherlands a bad name.
Especially the rejection of the stepping stone theory by the Dutch
government seemed to be a hot potato. According to the ambassador,
there was a tendency to regard addicts in Sweden as victims of drug
trafficking, especially from the Netherlands, rather than persons who
bear responsibility for their state of addiction (ISD 1977, 1057/206). At
an ISD meeting in May 1977, the letter from Stockholm was discussed.
According to an official, the Dutch ambassador seemed to feel
threatened by the public opinion. It was also noted that the Swedish
Minister of Justice had announced that he would put things right during
a visit the previous year but had not done so (ISD 1977; 136.138).


Old and new problems

In the next governmental memorandum in 1981 the central goal for the
policy on assistance to drug addicts was reconfirmed: "The prevention
and care of the risks emanating from drug use: for the addict himself,
for his or her immediate environment and for society" (16 680, no. 2).
In the introduction, the issue of drug-related crime and nuisance of
public order had come into the forefront of attention. In several
meetings between the government and the 4-Gs, the cities again had
drawn attention to drug-related petty crime, which caused numerous
encounters between police and drug addicts. Another reason for
concern was that this type of crime caused anxiety among citizens,
which sometimes expressed itself in a cry for vigorous action.
In relation to the new problem of nuisance, the government again
pointed to the undesirable selective attention to the drug problem:

Although an increasing interest in the drug problem has been shown by the media
and governments at different levels ­ and appropriate measures have been taken in
different connected fields of police, justice, and assistance ­ the possibility that
increased social and political attention leads to isolation of the problem and to an
approach narrowed to taking special actions should be avoided The social
perspective of the (ex) addict is not served by such a stigmatisation (Ibid. 40).


Assistance

A possible solution to the nuisance problem was to bring addicted
suspects into contact with assistance as soon as possible. It was
essential, according to the memorandum, that assistance should be
available as soon as the police had completed their investigation. An
important starting point for assistance to drug addicts at police stations
should be to keep physical, mental and social damage within bounds.
Withdrawal symptoms should be obstructed. In principle a doctor or
medically trained assistance worker should examine every arrested
addict. At the same time, experiments with motivational work at the
houses of detention in Amsterdam and Rotterdam were conducted. Both
kinds of activities belonged to the commitments of the CADs.97 These
proposals intensified co-operation between the control system and
assistance, which, as described in Part II, had been a salient feature in
the traditional ambulatory assistance to alcoholics as well.
At the same time, the government discussed some fundamental
problems that assistance was facing. New experiences had brought
about a growing understanding of the nature and origins of the problem.
Especially addiction among minorities had set even more the light on
aspects such as social backgrounds and social problems: "The lack of a
realistic social perspective concerning jobs, training, education and
housing makes us realise more clearly that ever before the limits of the
effects of assistance" (16 680, no. 2: 5). Nevertheless, it was of great
importance to build up a network of connected assistance facilities.
The memorandum also evaluated the assistance policy as outlined in
1978 and concluded that an old problem had not been overcome. A
substantial number of addicts were not reached by assistance. The
problem was two-sided. On the one hand addicts were not reached by or
stayed out of reach of assistance, on the other hand assistance facilities
appeared to be inaccessible for addicts.98 Assistance held too much of a
"wait and see" attitude and was too one-sidedly approaching motivated
addicts, or used inappropriate methods. Other reasons were also
mentioned why some kinds of addicts were not reached by assistance:

· Insufficient attention to social recovery which was important to
attract drug users.
· Insufficient coherence and co-operation between assistance facilities
(Ibid. 7).

Obviously the government was not at all satisfied with the way
assistance to drug users had developed during the previous years. Policy
signals from the government could be a help to change this situation.

One signal was to lay stress upon the need for facilities that did not
immediately confront addicts with rigorous demands in order to get
access to treatment and the need for more low-threshold assistance such
as street-corner work was emphasised once more (Ibid. 7).
Another policy signal concerned methadone programmes. Since the
memorandum by the ISD in 1978, the number of methadone
programmes had increased in the whole country. Already in discussions
on the Opium Act in 1976, the issue of methadone prescription outside
treatment programmes was perceived as a problem. Governmental
initiatives had been taken to structure the prescription of methadone.
When judging applications for funding for local plans the ISD required
a supply of non-medical assistance (such as social support) in
methadone programmes.
Concerning the goal for methadone dispensation, the government
still held the view that maintenance programmes should ultimately be
aimed at ending dependency. Consequently, prescription of methadone
to heroin addicts outside the setting of a treatment programme was
regarded as undesirable because it would only maintain addiction.
Obviously, the government had problems in steering the practices of
physicians. In some cities, physicians were still prescribing substitute
drugs outside the context of a specialised assistance facility. The
Inspectorate of Health and Medicines and the police had repeatedly
been notified that prescribed methadone was available on the illegal
market. This was disturbing methadone programmes which had been
established with difficulty in a number of cities (Ibid. 8).
This development was the reason for the Chief Inspectorate for
Health to send a letter in March 1981 to all GPs containing guidelines
to regulate the prescription of methadone in an ambulatory setting (16
680: 28 Appendix II). The guidelines proclaimed, among other things:

· If the physician together with the prescription cannot offer social
assistance, he should refer the client to a specialised facility
· Prescriptions should be centrally registered in the region.
· Due to the diversity of assistance, it was recommended to decide
which physician or facility in the region should take care of the
registration. According to the memorandum, this could be a task for
the GGD or CADs.
· To obtain uniformity in the prescription of methadone and to avoid
illegal trade in substitute drugs and prescriptions the composition of
methadone would be standardised as regarding consistency (liquid),
dose units, durability, etc. (Ibid. 9).

At the same time, the government was outlining a structure and goal
for assistance and in particular methadone programmes, developments
in the field were taking another direction (which was neither the first
nor the last time). The mosaic of assistance facilities advocated by the
Baan Committee and governments had developed indeed. Due to this
diversity, there was no overview of assistance and its methods. This
was also the case with methadone.
In the autumn of 1981, all drug assistance facilities in the
Netherlands were required to fill in a questionnaire about methadone
treatment, and 95% replied. The survey showed that:

· Forty institutions had their own methadone programmes; 36
institutions had a total of 36 detoxification programmes and 20
maintenance programmes.
· About 3000 heroin addicts were receiving methadone, about 1300 in
detoxification programmes and 1600­1700 in maintenance
programmes. When prescriptions by GPs were included the total
number of clients was about 5000 (when the report was published in
1983 the total number of methadone clients was estimated at 6000).
· The majority of detoxification programmes controlled clients by
urine tests, while in only half of the maintenance programmes were
urine tests carried out.
· In both kinds of programmes, clients were expected to submit to a
medical examination.
· Counselling contacts were compulsory in detoxification
programmes. In maintenance programmes, clients were asked to co-
operate in a counselling contact but in practice, demands were not
very rigid.
· Criteria for admission to methadone programmes were relatively
vague. In most cases, there were no general norms for admission.
For detoxification programmes "physically dependent on heroin"
and for admission to maintenance programmes a "minimum period
of two years' heroin addiction" was a condition that could qualify
for admission.
· Programmes in the big cities had special facilities for addicts from
ethnic minorities and addicts with psychiatric disorders (Buisman
1983).

In the memorandum, the subject of social recovery of (ex) addicts to
function again in society was discussed (16 680, no. 3). In Dutch texts
about drug addicts, the prefix (ex) is commonly put between brackets.

The following statement from the under-secretary of state for CRM
explains why:

The concept of "social recovery" can be applied to addicts as well as ex-addicts. It
must be recognised that a group of addicts will remain that will never obtain a drug-
free existence. The question is, however, whether possibilities can be offered to this
category so that they can take a place in our society (or on the edge) in a
satisfactory way (Ibid. 43).

This statement reveals an acceptance of the fact that not all addicts
could or wanted to overcome addiction. Nevertheless, they would be
included in society, even if it were on the edge of society. This way of
reasoning is one of the signs of the fundamental change in Dutch drug
policy that was on its way. The question was what was meant by
"satisfactory". Whatever the answer would be, it was certainly not
abstinence.
In the meeting between the standing committee on drug policy and
responsible ministers, the situation was described as still troublesome
(UCV 26 March 1982). The number of heroin addicts was estimated at
10,000­15,000, of whom 40% were in Amsterdam. However, this
number seemed to be stabilising.
Concerning assistance, the situation was still confused. One MP, Mik
(D'66) described the situation as follows:

Reading the reports, an extremely complicated picture appears of a cluttered
situation around a serious problem involving great individual and social problems.
Aid workers disagree on methodology and ideology: intramural agencies clash with
ambulatory ones: juridical with non-juridical: the NVG is critical and the big cities
feel side-stepped in deliberations with the ISD. In short, it is an inconsistent
entirety, aimed at people who often act very inconsistently (Ibid. 14).

This quotation reveals in a nutshell some of the problems at that time.
One can speak of a conflict between the central government and
municipalities. The original standpoint of the Department of Justice that
penal actions against drug users should be an ultimum remedium now
turned out to be an illusion. Justice and police had become more and
more involved in combating drug-related crime. The big cities were
made responsible for executing a drug policy on the local level but did
not have the finances. Governmental actions, such as the "methadone
letter" to GPs, had serious implications for the big cities. Many GPs in
cities or regions without methadone programmes stopped prescriptions
of methadone and heroin addicts moved to cities with methadone
programmes. The cities were also confronted with large groups of
heroin addicts who were not attracted by the abstinence-oriented
programmes operated by the CADs and they started to dispense
methadone in low-threshold programmes operated by the GGDs. These
low-threshold programmes were criticised for a lack of control of the
use of other drugs. The Minister of CRM could in principal share this
criticism but stated: "In order to keep the accessibility of assistance as
large as possible it is sometimes necessary to do urine tests on addicts
less frequently. Experience has taught us that persistent control chases
people away" (Ibid. 29).
The issue of house dealers was also discussed at the meeting between
the standing committee and the ministers. Lankhorst (PPR) pointed to
the fact that sale in youth centres was possible within the limits of the
guidelines. However, for adults who wanted to buy cannabis this was a
strange situation. If soft drugs were harmful then they would be even
more harmful to youngsters than to people in their forties. The Minister
of Justice rejected his request to create the possibility for older people
to buy cannabis in a responsible way. Such a practice would not only
violate international obligations but also the Dutch Opium Act.
Furthermore, it would start an uncontrollable process (UVC 26: 26).
Although not mentioned, it is likely that Lankhorst had coffee shops
in mind when he discussed facilities where the older public could
purchase cannabis. In 1980, there were about 20 coffee shops in
Amsterdam and in 1981, the police raided 18 coffee shops. Eventually,
coffee shops were tolerated and in 1991 regulated by new guidelines
from the Prosecutor-General (de Kort 1995: 257).
When analysing the documents from this period, some salient
features appear. The most frequently discussed substance was heroin.
Not all use was regarded as problematic, but in the first place use that
created a problem for society. Integrated use, including heroin, was
possible. Society should accept that some people were dependent on
drugs. This standpoint can explain the acceptance of the "junkiebonds"
that had been established in some cities. These issue pressure groups of
(ex) addicts defended the interests and rights of drug addicts and,
according to several MPs and the minister, local authorities on drug
policy matters should consult them. But while the government and
cities were experimenting to find a solution to the heroin problem that
was acceptable to government, justice, assistance, city councils, citizens
and drug users, Dutch drug policy on cannabis had not escaped
attention from the international community.

The "Kokerjuffer"

In October 1982, the Netherlands was reminded of the fact that
cannabis at home may not have been a big issue any longer, but this
certainly was not the case in other countries. What had happened? The
city council of Enschede, near the German border, had decided to allow
the sale of cannabis by a house dealer in the youth centre "de
Kokerjuffer" (the Caddis). As we have seen, this had been practice in
the Netherlands for at least four years and was regulated in a guideline
from the Chief-Prosecutor stating that no action would be taken prior to
a tripartite deliberation. The city of Enschede, however, was only
responsible for funding the youth centre and made the mistake of
sanctioning an activity it was not authorised to; the house dealer was a
matter for the prosecutor.
West Germany protested against this decision because German youth
would be tempted to purchase cannabis at the youth centre, only a few
kilometres from the German border. Germany also reported the event to
the INCB. In Stockholm, the Dutch ambassador was called to the
Ministry of Foreign Affairs. He was requested to deliver a demand to
the Dutch government for an explanation how it was possible to
purchase cannabis legally in the Netherlands. The Swedish government
was afraid of a contagious effect; i.e. if it was possible to buy cannabis
in a legal way in the Netherlands this idea could spread to Scandinavia.
This event did not contribute to better international relations concerning
drug policy matters. Bror Rexed, former Swedish representative on UN
Committees, held the view that, as regards the situation in Europe,
"Holland was an open sore. They had an ambivalent attitude towards
control" (Narcotics Commission, meeting 19 November 1982).
On 17 November, the local prosecutor stopped the sale of cannabis at
the Kokerjuffer and the government tried to explain that the Dutch
prosecution policy (the expediency principle) was in line with the
Single Convention, obviously with success. After a visit by a delegation
from the INCB (with Rexed 99) to the Netherlands, the control body
concluded that Dutch legislation complied with the Single Convention
and recent events could be considered exceptional and not likely to
recur (17 867, no. 7).

94 The memorandum from the ISD was delayed due to deliberations with the VNG
and big cities on relations between the cities and the central government (OCV 16,
1978: 657).
95 Municipal Health Services with the main task of preventing illness among the
general population.
96 Amsterdam, Rotterdam, The Hague and Utrecht. G refers to "gemeenten", i.e.
municipalities.
97 On 1 January 1979, increased subsidy for CAD was decided on. The Department
of Health would be responsible for treatment activities, Justice for probation.
98 The government probably referred to the CADs who were criticised for a lack of
contact with drug users from ethnic minorities.
99 In spite of this positive reaction the Netherlands was indirectly criticised by
Rexed, at a meeting of the UNDCP, a few months later (letter Jonker to UN
ambassador, 16 February 1984)