The available data suggest that the incidence of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among people who inject drugs (PWID) has remained at low levels in the Netherlands; however, prevalence of HCV among this group is higher than in the general population, and it remains the most common drugrelated infection in the country.
A recent study estimated that fewer than one third of the 28 000 people with chronic HCV infection had ever injected drugs. In recent years, men who have sex with men (MSM) and who inject crystal methamphetamine (slamming) are increasingly seen as a high-risk group with regard to new HCV infections. This pattern has been reported for Amsterdam in particular.
New HIV cases linked to drug injecting remain rare. For example, the Amsterdam Cohort Study, initiated in 1985, had recruited 1 661 (injecting) drug users by the end of 2012, but no new cases of HIV were reported after 2006. In addition, the presence of PWID in HIV treatment centres has declined over the years.
The Netherlands is considered a low-prevalence country for HBV, although the prevalence of chronic HBV among PWID is approximately 3-4 %, which is higher than in the Dutch general population. It is estimated that 420-560 opioid users have chronic HBV infection.
Although national data on absolute numbers of emergencies are not available, the ‘Monitor drug-related emergencies’ has been collecting information from a number of sentinel regions and emergency posts in dance and festival events since 2009, providing an insight into drug-related acute intoxications. The coverage of the data collection has changed over the years and remains incomplete. An injury information system collects data from the emergency departments of 14 hospitals.
In 2015, a total of 4 023 drug-related emergencies were registered by the Monitor, while the injury information system recorded 638 cases. At festivals, emergencies are predominantly related to the use of MDMA. Although the proportion decreased in 2015, it remains the case that approximately one third of affected individuals were reported to be moderately intoxicated. Emergency cases involving more than one illicit or licit substance have been reported increasingly frequently. Since 2012, emergencies linked to 4-FA have increased substantially, and the drug is often used in combination with other substances.
Ketamine intoxications do not form a large proportion in the Monitor, but, in 2015, a small increase was noted, as well as an increase in the severity of gamma-hydroxybutyric acid (GHB) intoxications.
Newly diagnosed HIV cases attributed to injecting drug use
NB Year of data 2015, or latest available year. Source: ECDC.
Prevalence of HIV and HCV antibodies among people who inject drugs in the Netherlands
NBYear of data 2015.
Characteristics of and trends in drug-induced deaths in the Netherlands
NBYear of data 2015.
In 2015, the general mortality register reported an increase in the number of drug-induced deaths in the Netherlands. The deaths were attributed to opioids in 64 cases, and to cocaine in 40 cases, while in approximately half of cases another substance was involved. The majority of victims were male, and most were aged 40 years or older. The data indicate that there was an increase in deaths linked to all substances, and among both males and females; however, the reasons for the rise in the number of druginduced deaths remain unclear. Some changes in the registration process of drug-induced deaths in the Netherlands were introduced between 2012 and 2013.
The drug-induced mortality rate among adults (aged 15-64 years) was 16.5 deaths per million in 2015, remaining, despite the recent increase, lower than the most recent European average of 20.3 deaths per million.
Drug-induced mortality rates among adults (15-64)
NB Year of data 2015, or latest available year.