Role of drug risk assessments in (Dutch) drug policy
Margriet van Laar1, , Leon van Aerts2, Jan van Amsterdam2
1 Trimbos Institute, 2 National Institute of Public Health and the Environment (RIVM)
On 1 December 2008, all hallucinogenic mushrooms, which contain the substances psilocin or psilocybin by nature (as well as mushrooms containing muscimol or iboteen acid by nature) were put on Schedule II of the Dutch Opium Act. With this decision the Minister of Health surpassed the advice of a Dutch risk assessment committee, which judged the overall risk of hallucinogenic mushrooms to be low.
The Dutch risk assessment committee supports the Dutch Co-ordination Center for the Assessment and Monitoring of new drugs (CAM), which was established in the framework of the European Early Warning Mechanism to assessthe risks of new psychoactive substances. On requestof the Minister of Health, the risk assessment committee also advises on existing drugs. The committee consists of toxicologists, representatives from customs and police forces, policy makers, criminologists, pharmacologists, sociologists,epidemiologists, physicians and psychiatrists working on the field of illicit drugs. In total sixteen criteria, covering the domains of individual health, public health, violation of civil order and criminal involvement, are used to score the overall risk within a three-step open Delphi approach. Between 1999 and 2008, eight assessments have been carried out (on 4-MTA, GHB, ketamine, PMMA, khat, two on magic mushrooms, cannabis). Risk assessments of GHB, magic mushrooms and cannabis will be presented as examples to illustrate how the assessments by the committee have affected the political decisions. The impact of other determinantswhich have influenced the policy decision will be discussed.
Recently, the relative risk or harm of 19 substances was assessed by an expert panel (Van Amsterdam et al., 2010 following essentially the same procedure as applied in the UK(Nutt et al., 2007).The scores for 16 substances given in the UK and the Netherlandsshowed a large similarity; divergent scores could be mainly attributed to differences in prevalence (e.g. ketamine, LSD) and greater risk awareness due to recentpublic anti-smoking campaigns in the Netherlands.
Currently, an expert committee in the Netherlands is preparing an advice on alternatives to the two tier system of the Dutch Opium Act and the classification of drugs on the different schedules. The pros and cons of using harm ranking studies for drug classification will be discussed.