Cannabis is the most common illicit substance used by the Dutch adult general population aged 15-64 years, followed at a distance by MDMA/ecstasy and cocaine. The gender gap regarding cannabis use remains: last year prevalence of cannabis use among young adults was approximately twice as high among males as among females. The use of all illicit drugs is concentrated among young adults aged 15-34 years.
The increasing trend in ecstasy use seems to have halted, at least in the general population, but prevalence rates remain high among young adults. In school-age children, the use of ecstasy decreased between 2015 and 2017. Available data suggest an increase in recent years in cocaine and amphetamine use among young adults in particular and in cocaine use among the general population. There is also some evidence that rates of cocaine use increased among Amsterdam clubgoers.
Studies among other sub-groups of young people indicate that the use of illicit substances is more common in recreational settings, especially in clubs and at festivals. Moreover, some new psychoactive substances (NPS), such as 4-fluoroamphetamine (4-FA), have gained popularity among this sub-group, although use of other NPS remains low.
Wastewater analyses can complement the results from population surveys, by providing data on drug use at a municipal level, based on the levels of illicit drugs and their metabolites found in wastewater. As part of the Europe-wide Sewage Analysis Core Group Europe (SCORE) analyses, analysis of wastewater in Eindhoven indicates that cocaine use remained stable between 2017 and 2018. In contrast, the results for Amsterdam point to an increase in cocaine use. The use of MDMA and cocaine seems to be more common in Amsterdam and Eindhoven than in Utrecht.
Data on the use of illicit substances among students aged 15-16 are reported in the European School Survey Project on Alcohol and Other Drugs (ESPAD). This survey has been carried out regularly in the Netherlands since 1999 and the most recent data are from 2015. The ESPAD studies indicate a decreasing trend in lifetime cannabis use among school-age children over the period 1999-2015. Nevertheless, in 2015, lifetime use of cannabis among students in the Netherlands was notably higher than the ESPAD average (based on data from 35 countries). However, lifetime use of illicit drugs other than cannabis and lifetime use of NPS were more or less in line with the ESPAD average. Data from the 2017 Health Behaviour in School-aged Children (HBSC) study also showed a decrease in lifetime prevalence of cannabis use among students aged 12-16 years from 16.5 % in 2003 to 9.2 % in 2017.
Studies reporting estimates of high-risk drug use can help to identify the extent of the more entrenched drug use problems, while data on first-time entrants to specialised drug treatment centres, when considered alongside other indicators, can inform an understanding of the nature of and trends in high-risk drug use.
In the Netherlands, high-risk drug use is mainly linked to use of heroin or crack cocaine. There are also reports of dependent gamma-hydroxybutyrate (GHB) users, but their total number is unknown. The most recent estimate suggested that there were 14 000 high-risk opioid users in the country in 2012 (1.3 per 1 000 inhabitants aged 15-64 years). Available data indicate a decline in the estimated number of opioid users in the last decade. Based on a study in the three largest cities, the prevalence of crack cocaine use ranged between 1.6 and 2.2 per 1 000 inhabitants aged 15-64 years in 2013. Many high-risk drug users, including opioid users, also use crack cocaine and a range of other licit and illicit substances. In 2016, a general population survey estimated that 1.4 % of people older than 18 years in the Netherlands were high-risk cannabis users.
Data from specialised treatment centres indicate that the number of new treatment entrants has remained stable in recent years, following an increase during the period 2006-11. In 2015, the largest group of first-time drug-treatment entrants comprised those who required treatment for cannabis use. Cocaine (crack) is the second most commonly reported primary substance among first-time clients, although the trend indicates a decline from 2008.
The number of primary heroin users requiring treatment for the first time has declined since 2007 and has remained relatively stable since 2012. Overall, heroin users entering treatment are older than other treatment clients. Injecting drug use is rare among those entering treatment.