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Cohen, Peter (1989), Cocaine use in Amsterdam in non-deviant subcultures. In: Peter Cohen (1990), Drugs as a social construct. Dissertation. Amsterdam, Universiteit van Amsterdam. pp. 45-60.
© Copyright 1990 Peter Cohen. All rights reserved.
V. Cocaine use in Amsterdam in non-deviant subcultures
Peter Cohen
0. Summary and Conclusions
Table of contents
0.1 Introduction
The original goals of this investigation were to gain more insight into
patterns of cocaine use among groups not normally associated with problematic
drug consumption. The intention was to find out how such patterns developed,
what mechanisms for controlling cocaine consumption (if any) could be observed,
and if problems with cocaine use could be detected. In the Netherlands until
now no systematic data relating to these topics was available.
This was a serious gap during a period of regular media reports of increased
cocaine use, increased cocaine confiscations, and repeated predictions since
1982 of ever increasing national cocaine use following saturation of the
U.S. market.
It was decided by the local coordination group for drug policy in Amsterdam
that a survey should be undertaken among hitherto invisible cocaine user
groups. Funding was requested from the Ministry of Health. It was moreover
decided that the health of respondents would simultaneously be researched.
This cocaine research project was designed to clarify the relevance of two
contrasting views of the relation between the use of cocaine, behavioural
problems and policy options in the Netherlands (cf Cohen, 1987). These views
were:
- Cocaine use will inevitably develop into problematic use patterns
because of pharmacological characteristics of the substance, irrespective
of the nature of the user groups where cocaine consumption is found. Therefore
an increase in efforts to reduce supply is needed, plus an increase in treatment
facilities.
- Cocaine use is seen as acceptable in different social environments.
Most users do not experience social or physical problems with the effects
of the substance because they either use cocaine sparingly, or they have
learned to diminish possible ill effects to an acceptably low level. Special
efforts in supply reduction or increase of treatment facilities are not
needed. On the contrary, increased law enforcement efforts will lead to
increased criminalisation of cocaine users with exactly opposite effects
to those which are the goals of present drug policies in the Netherlands.
Central in present drug policies is not only prevention of drug use itself,
but also reduction of risks inherent to drug use. Since criminalisation
is one of the most serious risks of illegal drug use, increased efforts
against cocaine would possibly result in greater harm.
An extensive overview of available literature, lent greater support to the
second view (Cohen, 1987). The proposed cocaine survey would enable policy
makers to discuss both views in the light of recent Dutch empirical data.
Even, if data resulting from this survey was insufficient to be conclusive,
the research would have to clarify what additional kinds of data would be
needed, and how it should be collected.
On top of this, the proposed research would enable policy makers and researchers
to discuss problems of generalisability of data from outside the Netherlands
to cocaine users within the country. Throughout this report comparisons
have been made between research data obtained form cocaine users abroad
and in the Netherlands, showing that comparibility is not yet fully possible
on a scientific basis.
This introductory chapter will now offer a short summary of our findings
in the same order as they are presented in the following chapters. Finally
an overview will be given with concluding remarks, in which the results
of this survey are discussed in the light of its initial goals for policy
discussion. Some comparisons are made between the prevalence of cocaine
and cannabis use in Amsterdam and New York City.
Summary
0.2 The sample
In the months February, March and April 1987, 160 persons with a minimum
cocaine use of 25 life time instances were interviewed. Users from so called
deviant sub cultures (junkies, criminals, prostitutes) were excluded. The
sample was selected by means of a snowball method with random selection
of the next respondent from a list of nominees made by the interviewed person.
Males constituted 60% of the sample, and females 40%. This is very close
to the gender distribution of previous 12 months cocaine users in a representative
sample from the population of Amsterdam in 1987, drawn from a household
survey.
Mean age was 30.4 years. This is younger than mean age in the group of previous
12 months cocaine users in the general household survey (34.5 years). General
level of education was relatively high. Economically the respondents do
not belong to an elite stratum of the Amsterdam community: 50% of the respondents
had a net income of Ÿ 1,500[1]
or less, average income is about 10% lower than the income of the same age
cohort in the general household sample. Almost one third of our sample was
living on income provided by social security institutions. However, compared
to a representative sample of previous 12 months cocaine users in the Amsterdam
population, the average economic situation of our snowball sample is very
similar. The same holds for educational level. Age excepted, our sample
was demographically similar to the group of previous 12 months cocaine users
in Amsterdam.
A majority of the respondents were living in their own quarters by themselves,
even if they have a 'steady' partner.
0.3 Inititation of cocaine use
Although a 'typical' age of initiation for cocaine use is not a fruitful
concept we found that our sample showed a mean age for initiation of 22
years. In comparison with a Miami sample this is almost three years older,
but almost equal to mean age of initiation in a Toronto sample. Friends
were the main company at initiation, and location of initiation was most
frequently own home or friend's home. Average dose at initiation was 104
mg of black market cocaine, the equivalent of four 'lines'. Snorting was
the typical route of ingestion.
0.4 Level of use through time
One of the conditions for a rational discussion of drug use is that the
concept of 'use' has to be clearly defined, and where possible quantified.
We investigated use through time of our respondents and found this to vary
considerably during the cocaine using career. We distinguished four career
stages for measuring cocaine use: initiation, first year of regular use,
period of heaviest use (top period) and last three months. Average dose
taken at these four measuring points were, respectively, 104 mg, 184 mg,
406 mg and 188 mg.
Comparing dose, consumed in Amsterdam (at three months prior to interview)
with dose in a Toronto study (average typical dose) and in a Miami study
(at three months prior to interview) we found that 53% of the Miami users
averaged doses higher than 500 mg vs 8.5% in Amsterdam and 2.7% in Toronto.
By multiplying dose by frequency of use per week for each respondent, we
computed their 'level of use'. For each respondent we computed use level
in three periods (excluding initiation). Levels of use were defined as low
(less than 0.5 g per week), medium (between 0.5 and 2.5 g per week) and
high (more than 2.5 g per week). These levels are approximately two to three
times lower than similar definitions by Chitwood for his Miami sample. Reasons
for this difference are explained in paragraph 3.5.
We found level of use varied considerably over time, with a maximum of 20.9%
of all respondents consuming at a high level during their period of heaviest
use. Although Chitwood's criterion for high level use is three times higher
than ours, he found 41% of his sample used at a high level during their
top period. We assume that the nature of his sample (more than half of whom
recruited through drug treatment programs) is responsible for this difference.
In the Amsterdam sample 48.7% never exceeded a low level of use, period
of heaviest use included.
Daily cocaine use occured with 33.7% during their period of heaviest use,
but with only 1.2% during three months prior to interview. Looking exclusively
at high level users, 93.9% used at a daily rate during their top period.
Only 1.3% of the low level users have a daily use pattern during their top
period.
There was one surprising similarity between the groups that used at low,
medium or high level during their period of heaviest use. In each of
these 3 groups, approximately 25% were abstinent at the time of the interview.
The most frequent general description of use pattern development is 'up-top-down',
meaning that from the onset of cocaine consumption, level steadily rises
to a certain top level and then steadily declines to present lower level
or abstinence. This overall description was given by 39.4% of the sample.
Checking these general descriptions with computations of level of use at
three measuring points it was found that 43.7% of all users could be described
as following the up-top-down pattern. Of all users, the use pattern of only
3.1% matched a 'slowly more' pattern. This pattern, associated with a possible
development of dependence, is also found with 3.1% of all users via computations
of level of use. This indicates a high level of reliability of use pattern
reports.
We conclude from the data presented in this chapter that the dependency
producing characteristic of cocaine may have been overstated.
0.5 Abstinence from cocaine use
Periods of cocaine use abstinence of one month or longer were reported by
86.2% of the respondents. Just half of the sample (50.6%) reported 6 or
more periods of abstinence. The most often mentioned reasons for abstinence
were lack of money, and lack of desire to use.
Respondents were also asked about the length of their longest period of
abstinence. For 43.6%, the longest period ranged from 2 to 6 months. For
40%, the longest period ranged from 7 to 24 months. The most often mentioned
reasons for having the longest period of abstinence were lack of desire
to use, and the absence of friends that use.
To diminish one's level of use was reported by 69.4% of the sample, with
almost a third of these (35 persons) mentioning financial reasons. Negative
effects were mentioned by sixteen as their most important reason for cutting
back, and 'no desire' by thirteen.
0.6 Routes of ingestion
A very large majority used cocaine intranasally. Only 18.1% of the sample
had ever tried free base cocaine. Life time prevalence of injecting cocaine
was 6.2%.
Our respondents associated free basing and injecting cocaine with negatively
valued user groups. About 15% of the respondents saw either free basing
or injecting also as disadvantageous because these routes of ingestion were
considered to lead to dependence.
0.7 Combinations of cocaine with other drugs
Of all respondents in our study, as many as 36.2% had ever used opiates.
Compared with 12.7% of legal plus illegal opiate (life time) use in a representative
sample from the age cohort between 20 and 40 years in the city of Amsterdam,
this is relatively high.
Life time prevalence of opiate use in combination with cocaine was
9.6%.
Life time prevalence of the use of cannabis was 91.2% in our sample. (vs.
41.5% in the age cohort 20-40 in a representative sample from the Amsterdam
population). Cannabis use in combination with cocaine had a life time prevalence
of 70.2%.
Drugs reported to be often used in conjunction with cocaine were
tobacco (80.5%), alcohol (72.3%) and cannabis (27.2%). Tranquillizers, opiates
or hypnotics were used very little in combination with cocaine.
0.8 Buying cocaine
Only 79 persons in our sample knew how much money they had spent on cocaine
during the four weeks preceeding the interview. Average value of cocaine
used was Ÿ 243. Average value of cocaine respondents paid
for turned out to be Ÿ 246. Average price of cocaine turned out
to be Ÿ 180 a gram. Friends were the most often mentioned category
of persons from whom cocaine was bought. Bars were a purchase location for
a minority of our respondents (8.7%) and so are discotheques (12.7%).
0.9 Set and setting of cocaine use, some rules
of use
Social gatherings were the situations in which cocaine was most often used.
The most mentioned situations in which cocaine is explicitly not
used were work or study. In our sample the emotional state that most often
generated an appetite for cocaine was the desire to feel joyful. Feeling
depressed and not well created an emotional background of not wanting
to use cocaine. Partners and members of the family are the most often mentioned
persons with whom cocaine is not used.
Often mentioned rules of use related to periods within a week or a day that
are 'fit' to use. The lack of rules that relate to dose or to effects was
surprising.
Half of our respondents reported having upper limits on monthly cocaine
purchase, with an average value of Ÿ 233. This is very close to the
average expense of Ÿ 246 during the last four weeks preceding the interview
reported in chapter 7. Having or not having a financial limit to monthly
cocaine purchase does not predict level of use (during top period). However,
if a limit was set to monthly purchase of cocaine, the level of this limit
related significantly to level of use during top period.
0.10 Advantages and disadvantages of cocaine
When asked to state in their own words advantages and disadvantages of the
use of cocaine, our respondents gave a large number of each. Per user, 2.9
advantages were mentioned and 2.5 disadvantages. The most often mentioned
advantages were 'gives more energy' (110 times) and 'makes one high, relaxed'
(69 times). The most mentioned disadvantages were 'expensive' (64 times)
and 'unpleasant physical effects' (57 times). In the answers about advantages
less differentiation and more agreement between users was found than in
the answers about disadvantages.
We asked our respondents if dose and/or circumstances played a role in the
probability of occurrence of both advantages and disadvantages. For the
occurrence of disadvantages dose clearly plays the most important
role. For the occurrence of advantages of cocaine circumstances play a more
important role than for the occurrence of disadvantages.
0.11 Effects of cocaine
The extensive interviews with respondents included showing each three separate lists of 'cocaine effects', with a total of 91 items. Respondents were asked
if they had ever experienced any of these 91 possible symptoms as a result
of cocaine use. Only five of these symptoms were not associated with cocaine
use by anyone. All the other symptoms were, but rarely by more than 75%
of the users. The low and medium level users scored 75% prevalence or more
with 9 positive effects, and with 3 negative effects. With high level users,
75% prevalence or more was also shown for 9 positive effects but for 11
negative effects. We infer from these data that above a use level of 2.5
grams of cocaine per week the balance between positive and negative effects
of cocaine is changed in a negative direction.
We computed the probability that some effects of cocaine use will occur
with increasing dose, with increasing frequency of use, or with increasing
level of use. For 70 effects (e.g cotton mouth, restlessness) a correlation
could be found between occurrence and one or more of these parameters. This
means that a cocaine user can influence the probability of occurrence of
these effects by his choice of dose and/or frequency of use. For 21 effects
(e.g. mystic experiences, spontaneous orgasm) we could not find any correlation
between probability of occurrence and one of these parameters. This could
mean that these effects can be expected by any user of cocaine, independently
of his use pattern.
Prevalence (or probability of occurrence) of reported effects ranges from
98.2% (energetic feeling) to 1.3% (venereal diseases).
When we compared the influence of parameters of use on the probability of
occurrence of certain effects between respondents from Toronto, Miami and
Amsterdam similar outcomes for 27 effects (e.g. increased heartbeat) are
apparent. But for 14 effects no similarity can be found (e.g. teeth grinding).
This means that more research is needed to establish the impact of local
conditions and choice of user group samples on the occurrence of some alleged
pharmacological effects of cocaine. This applies also when we look at the
scores on effect scales. Between certain effects a clear correlation exists,
and some groups of intercorrelated effects can be rebatched as scales. But
variation in scores on these scales is not explained by the central variables
of cocaine use or cocaine career. The scales as they are presented here
are only applicable to the Amsterdam sample. For each new sample the scaling
procedure will have to be repeated. After many such repeat exercises it
might be that some scales seem to have a wider applicability. This investigation,
and the international comparisons, suggest that the issue of the subjective
effects of cocaine is still a large grey area.
0.12 Quality of cocaine
Most respondents said that cocaine they buy or use was adulterated. Amphetamine
was most often mentioned as an adulterant. Negative effects of this adulterant
were mentioned by 86.8% of all respondents.
We bought 45 cocaine samples from respondents, of which only 39 contained
cocaine. None of the samples contained any amphetamine. Average purity of
the samples containing cocaine was 65.1% cocaine hydrochloride. No dangerous
adulterants were found.
We have to assume that the reported negative effects of 'speed' in cocaine
are in many cases cocaine effects, or effects of cocaine in combination
with another drug.
0.13 Opinions, advice and cocaine policies
We asked experienced cocaine users if they still remembered the opinion
of cocaine they had before the onset of their cocaine use. Mainly negative
characteristics of cocaine were remembered. The most mentioned positive
aspect was cocaine's 'energizing' action.
School and the media were the only sources of information that were mentioned
a great deal more often by those whose old opinions about cocaine were that
it was 'dangerous or scaring'. For the opinion 'addictive', books also played
an important role. We have to treat these data with a great deal of caution,
because they relate to only very few people.
When asked about changes in opinion about cocaine after onset of use, 30%
reported changing to a more positive direction, 20% to a more negative one.
As one of the methods of understanding important personal rules on cocaine
use, we asked respondents to give advice to novice users on a number of
aspects.
The most often advised mode of ingestion is snorting small quantities. Circumstances
of use are clearly social (partying, being in good company). Cannabis and
opiates are hardly mentioned, both as drugs to use or as drugs not to use
in combination with cocaine. Alcohol plays a more central role in advice
to novice users, but opinions are rather ambiguous. About one quarter of
respondents say cocaine can easily be used with alcohol, and about the same
proportion suggest moderate use of alcohol with cocaine. Another quarter
of respondents suggest that no drug should be used with cocaine. Respondents
add that novice users should buy cocaine with a trusted person, or always
from the same dealer. To counter the potential disadvantages of cocaine,
moderate use is advised, or abstinence when ill-effects are experienced.
Further advice is not to use alone, and to rinse one's nose.
Asked about a preferred national policy regarding the control of cocaine,
a majority of respondents opted for a policy which resembles either complete
legalization (as for alcohol) or informal societal tolerance (as for cannabis).
The most mentioned arguments for this are: cocaine will be removed from
its criminal context; cocaine is just as (non) dangerous as cannabis and/or
alcohol. Users themselves are responsible for their drug use, not the State.
A majority (61.9%) of those respondents that reported to have stopped using
favoured a cocaine policy like the one we have for heroin. Of those respondents
who were still using at the time of interview, 34.5% supported a similar
policy for cocaine as we have for heroin. The main arguments for the latter
were the possible hazards of cocaine and its potential for habit formation.
0.14 Craving
Just over three quarters of all our respondents reported familiarity with
craving for cocaine. Although craving is reported less often for cocaine
that is not around, and more often for cocaine that is
around, the difference was not very large. Craving was significantly more
often found among female users than among male users.
Over one third of all respondents reported that cocaine was an 'obsession'
at some time in their use career. Here there was no difference between men
and women.
Criminal activities related to obtaining cocaine were engaged in by 31.9%
of our respondents. When we exclude 'selling cocaine' from criminal activity,
this figure is 15.7%. Reported frequency per person of these activities
was low. More than 10 individual criminal activities was rare. There was
a significant relation between having 'ever' been engaged in criminal activities,
('selling cocaine' excluded), and level of use during top period. We found
no difference between men and women.
Our data do not allow us to infer a causal relation between the (level of)
use of cocaine and engaging in criminal activities. In order to find out
what kind of relation exists between these two variables in our sample this
topic would have to be tested explicitly in a possible follow-up project.
0.15 Work and relations
Although half of those respondents that had been employed during the three
months prior to the interview reported to have been under the influence
of a drug during working hours at least once, we consider this as not especially
worrying for this type of population. Just over one third had hotel/bar
or artistic professions in which drug use during working hours is accepted
practice.
When asked about the influence of cocaine on the quality of work or social
relations, most respondents report both positive and negative effects. Negative
influences are dominant. A striking fact is that 20 persons reported cocaine
as the cause of divorce. This should be tested in follow-up research.
0.16 Health consequences of cocaine use
Part of the cocaine research project was an investigation into the possible
health consequences of long-term recreational cocaine use. Nine respondents
of the 117 who were non-abstinent at the time of interview were willing
voluntarily to participate in a physical examination. This took almost a
full day and was executed by two neurologists and a neuro-psychologist at
the hospital clinic and the psychiatry clinic of the Vrije Universiteit
in Amsterdam. The results of this examination are by no means definitive
because of the small number of participants. In order to find more respondents
to volunteer for this type of examination either substantial financial compensation,
or far less time consuming diagnostic tools must be chosen.
Of the nine volunteers, three were women. Their average age was 34 years
(range 27-41 years), and their use level was between 0.5 and 3 grams a week
during a period of between 3 and 10 years.
The results of the somatic examination were that no clinical or sub-clinical
aberrations were found. The neuropsychological part of the investigation
showed some ambiguity. No effects were found in memory tests, but six respondents
scored high on neuroticism tests. Four of nine respondents scored low on
mental concentration tests, and two complained of depressive moods. Two
persons reported emotional insensitivity as an effect of cocaine use, and
one nervousness. More research is needed with many more persons, where respondents
with similar life styles but where non-users of cocaine are contrasted with
cocaine users.
Conclusions
The two contrasting views presented at the beginning of this chapter
can now be discussed.
When we found that during interviews with 160 very experienced cocaine users
(their average period of cocaine use was over five years) 27.8% of these
were abstinent, 63.9% used at a level of less than 0.5 gram a week, 6.3%
used between 0.5 and 2.5 gram a week, and 1.9% used over 2.5 gram a week,
we have to conclude that use levels are very low. This picture changed somewhat
when looking at periods of heaviest use. In this period, 20.9% of the sample
had been consuming cocaine at a level of 2.5 gram a week or over. At this
level, the probability that adverse effects of cocaine will show up is considerably
larger than at medium or low levels. This probably explains why so few respondents
that ever used at a high level remained at that level. Another explanation
might be the cost of cocaine makes a continuous high level use difficult.
Both (and more) explanations might work together, possibly in different
proportions for different users.
Periodic abstinence of one month or longer is found during the cocaine using
career of over 80% of our respondents.
Many indications were found that experienced cocaine users controlled their
use by adhering to sniffing as their route of ingestion, by keeping cocaine
consumption at a moderate level, and by associating consumption to a limited
number of social circumstances and emotional states. The use of free base
cocaine, a commercialized version of this type of cocaine is called 'crack'
in the U.S., is not popular. Life time prevalence of this form of cocaine
use is 18.1% in our sample, individual frequency of this use when found
is low. It carries a negatively charged emotional connotation, like intra
venous drug use.
Support for the hypothesis that the pharmacological characteristics of cocaine
make problematic (high) use patterns inevitable was not found. On the contrary,
there are no indications that our group of experienced cocaine users lost
control and developed into compulsive high level users with a marginalized
life style in order to support drug consumption. Clearly users are aware
of many adverse effects. Low and medium level users reported an average
of 3 adverse effects (vs. 9 positive effects) occurring with a prevalence
of 75%, but high level users reported 11 adverse effects with a prevalence
of 75%.
It should not be forgotten that we chose our respondents in a particular
manner. We started our 'snowball sampling' in circles of non-deviant cocaine
users, a long distance away from professional criminals, full-time prostitutes
or junkie-type drug users. But once a snowball had started, we let it take
its own course. Our chains were relatively short, and did not take us into
deviant social circles. It cannot be excluded however, that improved methods
of snowball sampling (with far longer chains) might eventually lead to deviant
user groups, enhancing the probability of finding problematic use patterns.
Such results would still make inferences of a causal type between cocaine
use and harmful use patterns quite difficult. Which factors cause people
to use a drug in a harmful way? Are these factors drug related, drug law
related, or related to psychological, social and economic determinants for
particular groups in the population?
The data for the group of experienced cocaine users interviewed for this
investigation show that cocaine users of the types we found can control
their use. It disproves the view that cocaine use does lead inevitably to
harmful patterns of use. Criminalisation is more of a threat to these users
than cocaine itself.
Policy option 1, which called for increase in drug treatment 'slots'
(because a high proportion of cocaine users will turn out to be addicts)
and stepped-up enforcement activities, can not be supported with data from
this investigation.
Policy option 2, which called for very restrained enforcement of the laws
against the use of cocaine is not contra indicated by the data from this
survey. We found life time prevalence of illegal income generation related
to cocaine use true for only a small minority (15.7%) of our respondents.
When selling cocaine is included, this figure rises to 31.9%. The generation
of illegal income on a regular basis (more than ten times during life time)
related to the use of cocaine is only true for 1%. This means that at the
time of interview, criminal involvement of this user group is low. The most
frequent illegal act related to cocaine consumption is selling cocaine to
other users, found with 23.1% of our respondents. If law enforcement proceeds
with cocaine selling charges at the private user levels, involuntary contacts
with police (and thus criminalisation) would become more frequent for this
user group.
In general the quality of cocaine we found in the homes of our respondents
was quite high, with an average cocaine hydrochloride content of 65.1%.
No dangerous adulterants were found. We have no empirically based
explanation for these phenomena. But possible explanations are that: the
relative absence of policing related to this user group lowers the risks
of obtaining cocaine. This, in turn, might influence competition in this
sub-cultural market in such a way that cocaine sellers who handle low quality
cocaine cannot maintain a market position. Another important factor might
be that under low police pressure the retail market for cocaine will not
be dominated or monopolized by established criminals who can handle the
risks of high police pressure who pass on the cost of doing so in the form
of highly adulterated drugs. This phenomenon of criminalisation of small
trading was described by Ashley (1975) for the United States. In Amsterdam
we have already seen small retailing of cannabis products moving away from
criminal gangs because of a policy of non prosecution of individual use
and low level trading. As long as domination by criminal gangs of small
scale selling of cocaine can be prevented, we may continue to see the absence
of violence and the absence of high levels of possibly dangerous adulteration.
A possible side effect of the high purity of black market cocaine might
be, that free basing keeps its low popularity among experienced users. The
need to purify low purity black market cocaine by freeing its alkaloïd
base remains low in circumstances of relatively good quality supply.
In spite of low law enforcement zeal directed at the level of the individual
cocaine user, life time prevalence of cocaine use in the city of Amsterdam
was no higher than 6.1% in 1987 although cocaine had been available since
the early seventies (Sandwijk, Westerterp, Musterd, 1988)[2] In New York City where policing on the individual user levels is very active, life time prevalence is 13% in 1986 and 7% in 1981 (Frank et al, 1988)[3]
Although we do not know if any causal relation exists between level of policing
and level of life time prevalence, these figures illustrate that a low
level of policing does not necessarily provoke high levels of life time
prevalence. Let us for the sake of argument continue a comparison between
NYC and Amsterdam, pushing aside all doubts about the validity of comparing
two so dissimilar cities and cultures. (NYC is the only city for which we
found detailed and non obsolete data on prevalence of illegal drug use.
Figures for European and more comparable cities are unfortunately not available).
For recent cocaine use the difference between New York City and Amsterdam
is substantial, although it only covers a small minority of each city's
population. Recent use in Amsterdam, defined as cocaine consumption in
the year prior to the interview is 1.7%. In New York City the figure
for recent use, defined as cocaine consumption six months prior to interview,
is 6%. This figure would probably be higher if cocaine use had been measured
for one year prior to interview. In spite of this measuring difference this
means that (one year) recent use in Amsterdam is only 28.6% of life time
prevalence, versus (6 months) recent use is 46% of life time prevalence
in New York City. The relatively low consumer use of cocaine in Amsterdam
is in spite of the fact that regular access to cocaine has quite probably
been less dangerous than in the gangster dominated retail market of NYC.
Of course we do not know which factors led to almost a doubling of life
time prevalence in NYC from 1981 to 1986.[4]
These data support a view that increased law enforcement activity does
not necessarily go hand in hand with decreasing prevalence. In Amsterdam
it could have a negative and risk provoking influence on the quality of
cocaine, could generate more criminalisation of users and small sellers
and could hardly have influence on lowering an already extremely low level
of recent use (1.7%).
Problematic patterns of cocaine use are reported to exist in Amsterdam,
but with a completely different population in quite different sub cultures.
Police efforts in relation to this group are more active. We have no means
of knowing whether this higher level of policing against this particular
group has lowered problematic use patterns. It is quite improbable though,
because the dynamics behind the development of problematic use patterns
are far more complicated than the absence or presence of strong policing
against a substance (although strong policing has influence on the generation
of life styles in which very high levels of drug use are instrumental).
Since Amsterdam already has long experience with an informal system of tolerance
of distribution of cannabis products which results in an almost complete
absence of policing and controlling of individuals' access to these products,
we will now compare cannabis consumption between New York City and Amsterdam.
Because in New York City a system of non criminal and commercial cannabis
distribution does not exist, one might expect lower prevalence figures there
because of greater difficulty and risk involved in finding access to cannabis
type drugs.
In reality prevalence figures for Amsterdam are lower again. In spite
of considerable differences in law enforcement activities between both cities,
prevalence of both cocaine and cannabis use in Amsterdam is lower. It
would be very interesting to see the prevalence figures of an American city,
about as big as Amsterdam but with a similar level of cultural and metropolitan
functions. In fact, an attempt to make a serious comparison between American
and Dutch effects of drug policy could not exist without such further analyses.
Table 0.1.a Prevalence of cannabis use in Amsterdam (1987) and NYC (1986) of adults of 18 years and older, in %.
Source: Sandwijk et al 1988;[5] Frank
et al 1988 |
But, looking at these figures from a point of view of drug use prevention,
the Amsterdam model in which a (very) low level of policing is dominant
is at least not less 'successful' than the NYC model in which strong law
enforcement is a key policy tool. When we add to these figures the perspective
of risk prevention, low or absent criminalisation of cocaine and cannabis
use is an advantage that at least under Dutch social-economic conditions
may make the local model of restrained drug control in Amsterdam more effective
than the NYC model.
Apart from the questionable comparison between NYC and Amsterdam, all data
taken together legitimise the conclusion that developing a cocaine policy
in Amsterdam that aims at tolerating a similar non criminalized distribution
model of cocaine as we already have for cannabis, deserves serious consideration.
Notes
- $1.00 is approximately Ÿ 2.00.
- Figure is for population of 18 years and older,computed by Sandwijk and given as personal communication. The figure mentioned in
Sandwijk et al 1988 (5.6%) is for the complete sample in the household survey
of 12 years and older.
- Figure is for population of 18 years and older
- And maybe we could have seen such a doubling in Amsterdam
as well had it beenmeasured in 1981.
- In Sandwijk et al 1988 a figure is given for the population
of 16 years and older (lifetime 23.6% and recent use 9.6%). Sandwijk computed
the data for 18 years and older and provided these as personal communication.
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