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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.

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V. Cocaine use in Amsterdam in non-deviant subcultures

0. Summary and Conclusions

Peter Cohen


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:

  1. 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.
  2. 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 NLG 243. Average value of cocaine respondents paid for turned out to be NLG 246. Average price of cocaine turned out to be NLG 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. $1.00 is approximately NLG 2.00.
  2. 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.
  3. Figure is for population of 18 years and older
  4. And maybe we could have seen such a doubling in Amsterdam as well had it beenmeasured in 1981.
  5. 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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Last update: February 9, 2010