It may be surprising to some that in the Netherlands, possessing and trafficking in drugs, including cannabis products, are illegal activities.

The Netherlands is a small country. Bounded by the North Sea on the West and North, by Germany on the East and by Belgium on the South, it covers a land area of almost 13,000 square miles — about one-fourth of the size of New York State. Within this territory live more than 14.5 million people, including some 600,000 foreigners, making the Netherlands one of the most densely populated countries of the world. In the past hundred years the country has developed into a modern industrial society. The city of Rotterdam exemplifies the importance of foreign trade in that it is the largest port in the world. Even such a seemingly ahistoric factor as geography should be interpreted in the light of history and culture.

To foreign observers the most striking feature of the Netherlands has always been the abundance of water: water constituting both a threat and a means of livelihood, necessitating the building of dams and dikes, and drawing the people toward seafaring and trade. The Dutch have never conquered the sea but succeeded in controlling this enemy. A parallel can thus be drawn between the Netherlands' response to the sea and its often misunderstood drug policy.

Effects of Prohibition

In the Netherlands we hold the view that drug use is not primarily a problem for police and the courts, but rather a matter of social well-being and public health. Therefore, we have opted for a realistic and pragmatic approach to the drug problem. The aim of our policy is the reduction of health damages and risks.

From the beginning of the 1980s, Dutch political leaders have acknowledged the existence of primary and secondary effects of illicit drug use. Primary effects, such as tolerance, mood swings and addiction, are those caused by drug use itself. Secondary effects, such as drug-related crimes, prostitution and AIDS, are at least partly induced by the mere illegality of the drug. Unfortunately, the secondary and primary effects of drug use are often confused with one another. In other words, the effects of drug use are often mistaken for the effects of drug policies.

On the social level, the international community faces the problems of organized crime, erosion of the judicial system and high costs for police, justice and the prison apparatuses. In the Netherlands and elsewhere, the nature of the secondary effects of the drug problem has also blinded our view of the primary effects of drug use. Not surprisingly, this confusion has made the fight against international drug trafficking the main focus of national and international drug policies.

Social Security System

Under the Dutch system of social security, the State ensures the social rights of its citizens. It guarantees a minimum income to every citizen on the basis of the National Assistance Act and on the basis of several other Acts by supplying old age pensions, widow's and orphan's pensions, family allowances, and insurance benefits in case of sickness, disability, or unemployment. It sets minimum standards of housing and food and sees to it that these standards are met. The State also sponsors a system of medical care covering health insurance for all wage earners below a certain income level. Furthermore, the Dutch government provides school education at minimum costs, and it grants scholarships if necessary.

All these arrangements are not regarded as açts of charity that might be revoked at will, but as inalienable attributes of social justice. The more a society succeeds in protecting its members from poverty and hopelessness, being a breeding ground for drug use, the more it will succeed in reducing the demand for drugs.

The high level of social security in the Netherlands contributes to the overall efforts in containing the level of addiction and to the relatively good health of Dutch drug addicts. The position of the Dutch is that if these multifactorial socio-economic aspects are not taken into account, efforts to reduce demand will have little chance of success. In effect, the symptoms would be treated while the sickness would be ignored. Consequently, rather than waging a "war on drugs," the Dutch prefer to wage a "war against underdevelopment, deprivation, and lack of socio-economic status."

General Principles of Dutch Drug Policy

Dutch drug policy is often considered as an "experiment" by foreigners. Although Dutch drug policy is deliberately designed, it should not be seen as a specific policy that is different from policies of other areas in society. For instance, nonconformity in thought and be havior, such as pros-titution and homosexuality, is tolerated as long as it does not harm other citizens. The drug policy of the Netherlands is just an example of the way in which the Dutch try to control or to solve their social and medical problems. This approach fits into Dutch culture and society and that is why it works in the Netherlands. If the Dutch would give up their drug policy, they would give up their historical and cultural identity. Because the Dutch see the problem of drug abuse not as a concern of the police and the justice system, but as a matter of public health and social well-being, the responsibility for coordinating drug policy in the Netherlands lies Welfare and Public Health.

It should be emphasized that the role of the penal system and law enforcement in the Netherlands is not as prominent as in many other countries. In the Netherlands, criminal law and its enforcement are meant to reduce the supply of drugs, not to criminalize use. In general, the Dutch do not rely heavily on criminal law and law enforcement. They prefer a policy of encirclement, adap tation and integration to a policy of criminalization, stigmatization and punishment. Drug legislation remains supplementary to informal mechanisms which for centuries have been established on traditional family structures and Calvinistic lifestyles. Present day drug policy in the Netherlands has largely been determined by the 1972 publication of the recommendations of the Narcotics Working Party, entitled Backgrounds and Risks of Drug Use. The Working Party concluded that the basic premises of drug policy should be congruent with the extent of the risks involved in drug use. These risks, or the likelihood of harmful effects, are categorized according to the properties of the substances taken. However, the social background of the users, the circumstances in which the drugs are taken, the subjective expectancies and the reasons why people use drugs are at least as important as the pharmacological properties. Especially the reasons of use are of decisive importance as it makes a big difference whether one takes a drug for relaxation and recreation (think of alcohol and marijuana) or with the aim to overcome problems or to cope with a hard life, as a form of self-medication. The effects are also different.

The function of Dutch criminal law is an instrument of social control rather than an instrument for expressing moral values. Therefore, the Dutch make a distinction between policies aimed at drug users and policies aimed at drug traffickers. The Dutch believe that for drug users, the penal approach should be left aside as much as possible and ought to be substituted by other methods of prevention, such as health education.

The 1976 Opium Act and Prosecutorial Discretion

The differentiation in risks is reflected in the amended 1919 Opium Act, which came into force in 1976. Thus the Amended Opium Act draws a distinction between "drugs presenting unacceptable risks" such as opiates, cocaine, LSD, amphetamines on the one hand, and "hemp products," such as hashish and marijuana on the other hand. The maximum penalties for illicit trafficking in drugs with an unacceptable risk were considerably increased to a maximum of 12 years imprisonment and/or a fine approximating $600,000; (under certain conditions, e.g. when a crime was committed more than once, this maximum may go up to 16 years or higher). Maximum penalties for possession of small quantities (up to 30 grams) of cannabis preparations for personal use were reduced from an offense to a misdemeanor, that is one month detention or an approximately $3,000 fine.

The Dutch do care about the related health hazards and therefore try to address the next obvious question: what policy could lead to the lowering of drug consumption? In this regard the Dutch are very pragmatic and try to avoid a situation in which consumers of cannabis suffer more damage from the criminal proceedings than from the use of the drug itself.

This requires a restrained attitude on the part of the state. The pragmatic intentions enable such attitudes to be effectuated. Prosecutors are empowered to refrain from instituting criminal proceedings if there are weighty public interests to be considered. New guidelines with priorities have therefore been established for investigating and prosecuting offenses under the Opium Act. Investigation of the import and export of "drugs presenting unacceptable risks" takes priority above investigation of the possession of "hemp products" for personal use.

In a nutshell, the application of the expediency principle implies a pragmatic prosecution policy. If criminal proceedings against cannabis users do not eliminate the drug problem but aggravate it, the law steps aside. The same principle accounts for the sale of limited quantities of hashish in youth centers and coffee shops. This aims at a separation of the markets in which hard drugs and soft drugs circulate. According to the Minister of Justice, this restraint policy succeeds in keeping the sale of hashish out of the ambit of "hard" crime as much as possible.

This practice also prevents young people from going underground. If that were the case, the social surroundings in which hashish circulates and those in which heroin and cocaine appear, would mix up. This somewhat controversial Dutch practice should not be misinterpreted as a tolerant or lenient policy. It is, on the contrary, a well-considered and a very practical policy. The Dutch do not want to hide the problems of their society as they do not want them to get out of control.

Normalization: The Dutch Compromise

The Dutch have adopted their own, alternative way within the boundaries of the internationally prohibitive approach. It is a compromise between legalization and the war on drugs. It should be stressed that this orientation is a desirable approach in the cultural circumstances of The Netherlands. The Dutch government feels the need to contain the additional (secondary) problems as much as possible. A gradual process of controlled integration of the drug phenomenon in society may teach its members to cope better with this happening. The addiction problem will continue to exist but it could be reduced from one on a collective, social level to one on the individual level. It is another way of looking at things, not by denying that drug addiction may cause severe individual and family problems, but by demystifying the popular views on drug use. Integration does not mean acceptance, but discouragement of use is not identical with criminalizing the consumer. This approach could be compared to the alcohol and tobacco control policies and particularly to Dutch policy on cannabis. During a recent year out of 145 million inhabitants in the Netherlands about 18,000 people died from tobacco smoking, about 2,000 deaths were directly related to alcohol abuse, and less than 100 Dutch citizens died from drug use. The reaction of society to these figures is rather surprising. It is able to cope with alcohol and smoking problems without emotional overtones and fear that the survival of our western civilization and society are at stake, but it is not prepared to accept drugs as the cause of an even insignificant number of deaths. The Dutch government wants to remain credible and does not want to encourage messages to youngsters such as "'your drugs are killers, but ours are pleasures." Young people are very sensitive to such moral double standards.

The above mentioned line of thought was worked out in the memorandum of the Interministerial Steering Group on Alcohol and Drug Policy, entitled: Drug Policy in Motion: Toward a Normalization of the Drug Problem. This policy has been adopted by the Dutch government. A process of normalization of the drug phenomenon was advocated, which could possibly lead to a destigmatization of drug users. This does not mean that this phenomenon has been spirited away, but it has been put in another perspective in order to enable society to face the problems from a realistic point of view, unobscured by moralistic coloring. The process of normalization implies a change of climate. The pragmatic aspects of drug policy must be emphasized: that is a more factual and realistic approach instead of an over-dramatized one. A sound approach also means that the drug problem should not be considered as a specific social issue.

International Concerns

The Netherlands are relatively alone in their explicit belief that drug addiction is a problem of public health and welfare. While we recognize that drug addiction is a permanent phenomenon in our society, it can be controlled.

The pragmatic question of efficiency which the Netherlands are accustomed to ask for in measures and instruments, therefore, is not the most important principle of policy in many other countries. It often is not a point of discussion; drug use is simply forbidden. In fact, drug use is seen more as a sin than as behavior involving risks and harm which may be decreased. The objective of almost all countries is that drugs should be banned from society. And a drug free society and a drug free life are only attained by aiming at a total eradication of drugs. Of course, it is realized that this is not completely attainable, but the higher goal may not be affected. In the United States the attitude of zero-tolerance against users, user accountability and the refusal to make the supply of clean syringes to intravenous drug users legal, are symptoms of such a stand.

Dutch Experiences

Criminal law enables the Dutch government, by means of so-called prosecutorial discretion, to pursue a pragmatic drug policy regarding the possession and sale of small quantities of drugs. Criminal proceedings against consumers would not solve the problem but would aggravate it. This policy prevents users from going underground and sliding into the fringes of society where we cannot reach them and where the risks may increase.

Much attention to all drugs is paid in school education programs, albeit as a part of an integrated approach aimed at the promotion of healthy lifestyles. It is apparent that youngsters are acting responsibly since the vast majority are not interested in drugs. In the age group between 10-18 years, current cannabis use was 2.7 percent in 1989. (Current use is expressed in last month prevalence.) For heroin and cocaine current use was less than half a percent (last month prevalence: respectively 0.35 percent and 0.25 percent).

Apart from the poly-drug users, cocaine use in Amsterdam is embedded in non-marginalized social settings where confrontation with the police is rare. Consequently, since no additional risks are introduced to non-problematic users, enabling an open communication about drug use experiences, some kinds of informal use-control rules could be developed. There is very little violence. From 1983- 84, we saw waves of free base cocaine use; mainly among "regular" heroin users. But, very few problems have arisen from these "waves" and crack use is still very low.

The number of drug addicts has stabilized and in some cities even decreased. Today, approximately 0.15 percent of the population are drug addicts. Their state of health is reasonably good. This may be regarded as a result of our harm reduction approach, by which both users and addicts are taught how to diminish the risks of drug use. It is not so much a "don't-do-it" message, but rather the message: "it's better not to do it, but if you do, these are the things you should know." The result is more health consciousness and the majority of the heroin and cocaine-using popula don are not injecting drugs. In Amsterdam this is less than 40 percent. In some smaller cities injecting is an absolute taboo among users. Another indication is the number of Dutch drug related-deaths, which is stable at about 60 cases per year. In Amsterdam, the 1989 statistics showed only 11 deaths out of the estimated 5,000 to 7,000 drug addicts.

One of the most striking features is the wide range of treatment and counseling services, which is capable of reaching the major part of the population of addicts. This is a success in itselfl One can only succeed by adopting realistic treatment approaches, primarily directed at improving addicts' physical and social functioning, without requiring abstinence immediately. Low-threshold methadone-maintenance is one of the many modalities. Our entire system is sometimes called the harm reduction approach. Addicts are encouraged to try to retain relations with "normal" society as long as possible. The existence of harm reduction facilities does not prevent an increasing number of addicts who do want to kick their habit from making use of drug-free facilities, which are also widely available. The care-system has no waiting lists. It is easily accessible, free of charge and it treats addicts respectfully as fellow-citizens. Field studies among methadone clients and "street addicts" have shown that this approach has proved to be successful and that the "typical" addict is in no way an antisocial "junkie." It shows the importance of harm prevention strategies as primary mobilizers of health and harm reduction.

AIDS

Keeping close contact with drug addicts is also a prerequisite for an effective AIDS prevention policy; an important element in drug policy. I stress that action to contain the overall drug problem should go hand in hand with realistic, appropriate measures to stop the spread of AIDS. Our policy aims at changing the risky behavior of addicts as much as possible. The supply and use of sterile needles and syringes in exchange for used ones and the supply of condoms is one way of dealing with the problem, but is not a panacea. It must be embedded in a broader health care system. Persuasive face-to-face counseling is essential, if we are to change the addicts' behavior in favor of safer practices. Syringe programs do not lead to more drug use or to more injecting, but to less people sharing syringes. It may be surprising, but addicts are apparently able to act responsibly if the government allows them to do so. Addicts are indeed willing and able to change their behavior. The percentage of intravenous drug users among the total group of AIDS patients in the Netherlands is relatively low, namely 9.14 percent, or 120 people.

I don't know whether our experience is transferable to other countries. Our policy fits into Dutch culture and society and that is why it works in the Netherlands. But I think the experience is worth bringing to the attention of people in the United States. Although closer cooperation in this field is indispensable, we have to take into account the limitations posed by different legal systems, anchored in centuries of cultural and legal history. Attempts to reach an internationalization of drug policies in the sense of a single non-differentiated global approach is bound to prove counter-productive for many countries.

The problem of drug abuse is here to stay. I see no realistic prospect for its total eradication. But it can be successfully contained. This is an important fact, because it demonstrates that there is a feasible or possible middle ground between the extreme options of militarization and total legalization. Policy changes ought to be sought in this direction. Our thinking is that if demand re duction and realistic treatment approaches are given substantial attention, a more positive perspective would be created with regard to the future of drug policies.

*Eddy L Engelsman is the Head of the Alcohol, Drugs and Tobacco Branch; Ministry of Welfare, Public Health, and Cultural Affairs; The Netherlands. Mr. Engelsman rejects the title "czar" as inappropriate in a democratic nation. Certainly, no one calls him that, except an occasional American.