The available data suggest that the incidence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among people who inject drugs (PWID) has remained at very low levels in the Netherlands. Still, prevalence of HCV among this group is much higher than in the general population, and it remains the most common drug-related infection in the country. In recent years however, men who have sex with men (MSM) are increasingly seen as a high-risk group with regard to new HCV infections. Special concern exists about the risk of infection in MSM who inject chemsex drugs (slamming), although the size of this group is unclear. This pattern was reported initially in Amsterdam, but has also appeared in other larger cities more recently.
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 infection were reported after 2006. In addition, the presence of PWID in HIV treatment centres has declined over the years.
|Year of data: 2016|
The Netherlands is considered a low-prevalence country for HBV infection, although the prevalence of chronic HBV among PWID is approximately 3-4 %, which is higher than in the Dutch general population.
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 in sentinel centres. A second source on drug-related emergencies is an injury information system collecting data from the emergency departments of 14 hospitals.
In 2016, a total of 4 894 drug-related emergencies were registered by the Monitor, while the injury information system recorded 760 cases. In recent years, the percentage of moderate to severe intoxication with MDMA/ecstasy (as the only substance present) has increased, and is probably explained by the availability of high-concentration MDMA tablets on the market: in 2016, more than half of ecstasy pills tested by the Drug Information and Monitoring System (DIMS) contained more than 150 mg MDMA.
Emergency cases involving more than one illicit or licit substance have been reported increasingly frequently. Since 2012, emergencies linked to 4-fluoroamphetamine (4-FA) have increased substantially, and the drug is often used in combination with other substances. Whereas no emergencies related to the use of 4-FA were recorded before 2012, 272 emergencies with 4-FA as the only drug were recorded in 2016, and another 184 patients had used 4-FA in combination with at least one other drug. The majority presented at the first aid posts. 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-hydroxybutyrate (GHB) intoxications.
In 2016, the general mortality register reported a further increase in the annual number of drug-induced deaths in the Netherlands. The majority of victims were male, and the mean age was 41.5 years. The reasons for the rise in the number of drug-induced deaths remain unclear, although ageing of the drug users, changes in drug use and emergence of medicinal opioids including oxycodone use could play a role, as well as changes in registration of drug-induced deaths.
The drug-induced mortality rate among adults (aged 15-64 years) was 18.84 deaths per million in 2016. This remains lower than the most recent European average of 21.8 deaths per million.