Belgium

"The most recent published results of the BHIS on psychoactive substance use date from 2008 (Gisle, L., 2010; Gisle, L., 2010;Van der Heyden et al., 2010; Van der Heyden et al., 2010). The results of this national general population survey (N= 11,026 for the drugs section; 15-64y) are described in detail in the 2011 Belgian Annual Report (Deprez et al., 2012). In 2013, the Surveys, Lifestyle and Chronic Diseases (SLCD) research group of the Scientific Institute of Public Health (WIV-ISP) performed the data collection of a new BHIS. Different from previous waves, the 2013 BHIS used the computer-assisted personal interviewing (CAPI) method for the face-to-face part of the questionnaire, although drug use is still surveyed by the use of a self-completion part. The researchers maintained the same substance-related items of the 2008 survey, being the lifetime, last year and last month cannabis use; frequency of last month cannabis use; the age of first time cannabis use and the last year use of cocaine, amphetamines, ecstasy, LSD, heroin, methadone and buprenorphine. New for the 2013 BHIS is the inclusion of information on ‘legal highs’. Results for the 2013 BHIS are expected by the end of 2014.
"However, it is worth noting that the prevalence for illicit substance use (15-64 years old persons) found in general surveys, such as the BHIS, are probably underestimated, especially for drugs other than cannabis. Marginalized people (homeless, prisoners, institutionalized persons) are excluded from the sample because invitations to participate to this study are sent only to households after a prior phone contact. The self-completion questionnaire related to substance use is only filled out after having received the visit of the interviewer (Van der Heyden et al., 2010;Van der Heyden et al., 2010). It is highly likely that "hard" or “severe” users do not accept to receive the interviewer at home and/or do not take the time to complete the questionnaire (Demarest et al., 2012)."

"Results of the VAD school survey 2011-2012 show that the use of illicit psychoactive substances other than cannabis was rather limited in the population of school students (Melis, 2013). In the whole school population, only the older students mentioned ever use of these substances: 4.4% of the 15-16 year old students and 7.7% of the 17-18 year old students. The highest lifetime prevalence among the oldest school students (17-18y) of the Flemish Community were reported for ecstasy (3.8%), hallucinogens (3.5%), amphetamines (3.4%) and cocaine (2.5%). A lifetime prevalence of heroin use was found to be about only 0.4% among the oldest school students (Melis, 2013).
"For the school years 2007-2008 until 2009-2010, a stable prevalence of lifetime and last year use of psychoactive substance other than cannabis was found (Kinable, 2011).
"Compared to this, a gradual decrease was found in the school surveys of 2010-2011 and 2011-2012 (see Figure 2.2) (Melis, 2013).

"The prevalence found for cannabis use in the 2011-2012 VAD School Survey confirm the trend found in previous Belgian studies (Godin et al., 2011; Kinable, 2011; Lambrecht and Andries, 2013; Lombaert, 2011; Melis, 2013). The study shows that about one fifth (20.9%) of the 15-16 year old and one third (36.6%) of the oldest school students (17-18y) used cannabis at least once in their lives. About one fifth (21.1%) of the oldest age group also used cannabis during the last 12 months prior to the survey. Both the lifetime and the last year prevalence of the oldest students were about 10 times higher compared to those found in the youngest age group (12-13y: respectively 4.4% and 2.4%). There is a stabilisation of regular use to around 3% since the 2005-06 survey (see Figure 2.1). 'Regular use' was defined as use of cannabis 'once a week', 'more times a week' or 'daily'. The prevalence of regular cannabis use was 2.6% for all students (12-18 years of age) with 1.2% of the girls and 3.9% for the boys. Of the 15-16 year old students, 3.1% used cannabis on a regular basis compared to 5.4% of the oldest age group. A small but not trivial group of 12-14 year old students (0.7%) reported the regular use of cannabis.
"The mean age at which school students used cannabis for the first time was 15.4 years. Higher prevalence of ever, last year and regular cannabis use were found in students following technical or vocational educational programmes compared to students of general programmes. The most frequently reported reasons to use cannabis were “sociability”, “relaxation”, and “curiosity”. Important reasons not to use cannabis were: “they don’t need it”, “cannabis is dangerous”, “it’s unhealthy” (Melis, 2013).

"Drug use and possession are reported together as one offence since 2010, as individual drug use implies the possession of drugs. Before 2010, use and possession were often separately taken into account, which resulted in an overestimation of the total number of drug law offences. For this reason, numbers are only reported from 2010 on. In 2013, a total of 979,020 criminal offences were registered, of which 47,269 concerned drug law offences (possession (and use), trade, trafficking, or production of drugs). The proportion of drug-related offences raised to 4.8%. This was the first increase of prevalence in four years.
Every year, he Belgian federal police reports about drug law offences by specifying different categories such as use and possession, import and export, trade, production and trafficking of illicit drugs (Federale Politie - CGOP / Beleidsgegevens, 2013). Figure 9.2 describes the evolution between 2010 and 2013 of the drug law offences by category.
"The observed increase of drug-related offences registered in 2013 (n=47,269) in comparison with 2012 (n=44,108) is mainly determined by the evolution in drug law offences related to the use and possession of drugs. In 2013, the prevalence reached a record of 73.4%. Also the prevalence of production of drugs is increasing and reached 3.3% in 2013. The proportion of drug law offences registered by police forces related to import and export is declining. The registered drug law offences related to trade are stable.
"A case study about retail trade (the sale of user amounts) of cannabis, cocaine, amphetamines and ecstasy in Antwerp indicated that dealers are often carrying only very small amounts of drugs with them. They use this precaution as it is known that upon interference, when no evidence for dealing can be demonstrated, the police can only charge for possession of illegal drugs. However, the analysis of police charges and public prosecutor files revealed that dealers carry around more money in one's pockets than the average citizen. The presence of the money presumably refers to the illegal sale activities (Decorte and D'Huyvetter, 2014)."

"The Belgian prison population increased with 19.7% between 2000 and 2009 and this increase continues over the period 2009-2011 (Aebi and Delgrande 2011, p. 39). Where on the first of September 2009 the total number of prisoners is 10,901 (Aebi and Delgrande 2011, p. 39), the total number of prisoners on the first of September two years later, in 2011, is 11,913 (Directorate-general of Penitentiary Institutions 2011b). Belgium is not an exception and is confronted with the problem of prison overcrowding (Aebi and Delgrande 2011, p. 38). Especially the category of sentenced prisoners and prisoners on remand is increasing (Maes et al. 2011))."

"Based on the Space statistics (2011) 36.3% are sentenced for drug offences. This is a higher percentage compared to the latest data of the statistics of the Directorate-general showing that 31.3% of all the prison population is detained for drug offences (regardless their legal status).
"Space statistics for Belgium point to double counting since the main offence rule is not well defined in Belgium (Aebi and Delgrande 2011, p. 66). Consequently, this double counting also occurs with the latest data of the Directorate-general and cannot explain this higher percentage. Moreover, Space only includes sentenced prisoners, expecting not a higher, but lower percentage compared to the latest data of the Directorate-general, since the latter involves all categories of legal status. Compared to the self-reported data however, these figures show again a different result with 37.9% declaring to be in prison due to a drug offence (Van Malderen et al, in press). This item is examined by asking prisoners whether they are in prison for ‘drug possession’, ‘drug trade’, ‘for other reasons’ or ‘for other reasons and drugs’. Prisoners could give multiple answers. However, one would expect a result more in line with the 31.3 % of the Directorate-general since the same population is involved (all categories of legal status included) and also here double counting occurs.
"Nevertheless, taking into account the different data sources, one can observe that more than one in three is detained due to a drug offence. A distinction has to be made, however, between a drug offender and a drug using or drug-addicted offender. It is found repeatedly in 2008 and 2010, that the nature of the offence is not a predictable factor for drug use during imprisonment (Van Malderen et.al, in press). Both drug offenders and non-drug offenders take drugs while in prison and vice versa."

"Information about the trafficking patterns for drugs in Belgium is also provided by the Belgian federal police. During the past 4 years, more and more cannabis plantations were found in Belgium (see also Table 10.6), of which the production is often meant for export to The Netherlands. This could be a consequence of the more severe prosecution of cannabis-related organised crime in The Netherlands. Furthermore, Belgium is a trafficking country for cannabis resin. Belgium is also a meeting point for heroin traffickers rather than a heroin trafficking country. Seizures of more than 50 kg of heroin are rare in Belgium, but heroin traffickers meet in Belgium to stay out of the attention of the law enforcement in the countries were they are trafficking heroin.
"In addition, Belgium is known to be a transit country for cocaine with the Brussels airport and the port of Antwerp being used as a gateway to traffic the cocaine from South-America or Africa to Europe. Finally, each year, some illicit amphetamine and/or XTC laboratories are dismantled in Belgium (see also Table 10.5). There is a strong link between the Dutch and Belgian synthetic drug production with the same persons being often involved in the synthetic drug market in both countries (Dommicent, personal communication)."

"A recent overview of the research and police data on cannabis cultivation in Belgium and The Netherlands (Decorte 2010), pointed to the fact that the small-scale home growers constitute an important segment of the Belgian cannabis market. These small-scale home growers are more and more working in a professional way. However, they are not necessarily profit-oriented. Reasons for this increase in small-scale growing of cannabis could be the dissatisfaction with the cannabis products sold in the Dutch coffee shops (Decorte 2010)."

"The numbers of drug seizures based on the GND, are provided in Table 10.2 for the years 2006-2010. For all years, the majority of the drug seizures contained cannabis (herbs, plants or resin). This percentage of cannabis related seizures gradually increased from 67.9% (95%CI: 67.4% - 68.4%) in 2006 to 72.8% (95%CI: 72.4% - 73.2%) in 2009. This increasing trend stabilized in 2010 with 72.3% of the seizures being cannabis related (95%CI: 71.8% - 72.7%). This time trend is in line with the increasing number of cannabis related drug offences (see Chapter 9, Section 2.1).
"When looking at the types of the seized cannabis, different time trends were observed. While there has been a more or less steadily decrease in the percentage of cannabis resin seizures from 2006 (16.2%; 95%CI: 15.8% - 16.6%) until 2010 (13.3%; 95%CI: 13.0% - 13.6%), the percentages of herbal cannabis (2006: 51.5%; 95%CI: 51.0% - 52.0%; 2010: 56.4%; 95%CI: 55.9% - 56.9%) increased quiet steadily. The increase for cannabis plants (2006: 0.2%; 95%CI: 0.2% - 0.2%; 2010: 2.6%; 95%CI: 2.4% - 2.8%) is partly due to an increase in data quality of the GND (between 2006 and 2007) (Dommicent, personal communication), but is also related to the increasing number of cannabis plantations being discovered (see also Table 10.6). Another remarkable trend is the declining percentage of XTC-like substances in seizures. From 2006 to 2010, the percentage seizures containing XTC, decreased from 5.9% (95%CI: 5.7% - 6.1%) to 1.7% (95%CI: 1.6% - 1.8%). For heroin, cocaine, amphetamines and LSD, no clear time trends were observed."

"In 2010, the prevalence rate (per 1000 inhabitants, aged 15-64 years) of ever-IDUs was estimated to be 1.2 (95% CI: 0.78-1.90) and the total number of ever-IDUs in Belgium to be 8,796 (95% CI: 5,717-13,583). The uncertainty in the incidence estimates was large. A sensitivity analysis was carried out, revealing that this uncertainty was primarily due to the uncertainty associated with the estimation of the HIV-prevalence rate among IDUs rather than with the uncertainty resulting from the stochastic mortality model. Time trends of the national prevalence rate of ever-IDUs are graphically presented in Figure 4.3. Partly as a result of the large uncertainty in estimates, no significant time trends were observed. Nevertheless, the results suggest a stabilizing trend in prevalence rate of ever-IDUs from 2006 onwards. The current estimate of 8,796 IDUs in Belgium (95% CI: 5,717-13,583) in 2010 is (borderline not-significantly) smaller than the estimate of 20,000 IDUs (95%CI: 10,300-46,300) from 1995. However, this comparison should be made with caution as a result of methodological differences (age range, (not) accounting for non-AIDS mortality)."

"Data on injecting drug users frequenting the syringe exchange programmes located in Flanders are collected using a structured, voluntary, anonymous questionnaire since 2001 (Windelinckx 2011). Every IDU contacting one of the syringe exchange programmes is asked to fill in a questionnaire, based on the Injecting Risk Questionnaire (IRQ) (Stimson et al. 1998) and additionally containing items on health status, drug use and access to health care. From 2006 onwards, a revised and improved questionnaire is used.
"In 2010, a total of 251 IDUs participated. The age of the participants ranged from 18 to 63 years, with an average age of 34.8 years. The majority of the participants were male (76%). Almost 25% of the IDUs live in an unstable environment (homeless, squads, ...). The vast majority of the participants reported non-concurrent poly drug use (on average 4 products). Opiates (57%) were the primary injected drug of choice, followed by stimulant drugs (32%) and drug cocktails (12%). Smoking of freebase cocaine was reported by 41% of the participants. Up to 40% of the participants reported to be initiated into injecting drug use before the age of 20 years and 64% reported to be injected by someone else during first injection. The majority of the participants reported not to have shared syringes (receptive: 79%, distributive: 77%), spoons (65%), water (62%) and filters (68%) during the last month. In total, 15% of the participants reported to have had at least one drug overdose the last year and 15% was never in treatment."

"In 2010, 13 persons newly diagnosed with HIV, reported intravenous drug use as the probable mode of HIV transmission, yielding a percentage of 1.5% (95% CI:0.71%-2.3%) of the persons newly diagnosed with HIV being probably attributable to injecting drug use. As a result of reporting delay, no new AIDS diagnoses related to injecting drug use were reported for 2010, so far. The percentage of IDUs among persons newly diagnosed with HIV were much lower compared to the beginning of the HIV epidemic in the mid eighties as can be seen from Figure 6.1. No clear time trends were observed regarding the proportion of IDUs among the newly diagnosed AIDS cases. However, with exception of the onset of the HIV-epidemic, the proportion of IDUs among AIDS-cases was found to be systematically (although not significantly) higher than the proportion of IDUs among the HIV-cases, indicating that IDUs are more rapidly developing AIDS compared to non-IDUs. It is hypothesized that this is due to the higher hepatitis co-infection rate among IDUs compared to non-IDUs and/or due to differences in treatment compliance."

"The hepatitis prevalence rates among ever-IDUs at treatment was obtained analogously to the HIV prevalence rate described above, and was also collected through Standard Table 9. An overview of the hepatitis B and C prevalence rates for 2003-2010 are given in Table 6.3 and Table 6.4, respectively (ST9P2_2003-2011_BE). Regarding Hepatitis B, 2.8% (Free Clinic) and 0% (De Sleutel) of the patients tested in 2010, tested positive for HbsAg, 56.3% (Free Clinic) and 0% (De Sleutel) for antiHBC and 55.2% (Free Clinic) and 20.0% (De Sleutel) for antiHBs. Regarding Hepatitis C, 80% (Free Clinic) and 28.1% (De Sleutel) of the patients tested positive for HCVab in 2010. The patient population of the Free Clinic is known to be a strongly marginalized population, explaining the high prevalence rates. Comparing the results for the 2010 prevalences with previous years, does not reveal significant time trends."

"In 2008, 78 drug-induced deaths were observed in the Flemish region, which is the highest number observed since 2000. The standardised (European Standard Population) drug-induced mortality rates per 1000.000 inhabitants are shown in Figure 6.3, indicating that the mortality rates are generally higher in the Brussels Capital Region compared to the Flemish Region. These differences (although being not significant, except in 2007) are explained by differences in urbanisation degree, with the Brussels Capital Region being the more urbanized. For the Flemish region, a recent increasing trend was observed, which is significant when comparing 2006 with 2008. On the other hand, a recent (however not significant) decreasing trend was observed for the Brussels Capital Region (see also ST5_2011_BE_01 and ST6_2011_BE_01)."

"Cannabis is the most frequently reported drug used in prison with a rate between 27% and 32%. Heroin as most frequently used illicit drug in prison after cannabis is a recurrent observation over the years with a rate from 12% up to 13% . A similar rate is observed for the use of benzodiazepines without prescription and is classified as the third product most frequently used in prison over the years 2006-2010.
"Since heroin use seems widespread in prison, respondents were asked, for the first time in the latest survey of 2010, about their mode of administration of heroin during detention. Most drug users in prison declare to inhale the heroin vapour (14%) in contrast to 2% of the prison population stating to inject it. In the case of initiation in the use of new substances during imprisonment, heroin is firstly reported in prison population (6%).
"To gain more insight into the profile of the drug users, prisoners declaring to use drugs during their detention were, also for the first time in 2010, questioned about their frequency of use in prison. It seems that an important part can be categorised as regular users. 11.8% of the prison population declares to use drugs from multiple times a month to weekly and daily use. When the definition of regular use is defined in a more broadly sense, even more than 20% can be defined as frequent users: from once a month to multiple times a month, weekly and daily use."

"The total number of patients registered in 2009 through the BTDIR [Belgian Treatment Demand Indicator Register] was 9300. Table 5.2 shows the number of patients in treatment by main substance and by gender. The unknown gender records were not indicated. A large majority of patients (78.3%) was registered in outpatient centres, 13.1% in inpatient centres and 8.6% in low-threshold agencies. The main substances were opiates (in 37.3% of the treatment demands) and cannabis (27.5%). The other substances were cocaine (14.1%), stimulants such as amphetamines (10.2%), hypnotics and sedatives (3.7%) and unknown or other substances (7.2%). Figure 5.1 represent the age category of patients in treatment by primary drug. Patients in treatment for hypnotics are the oldest: 41.4% of them are aged 40 years or older. On the opposite end of the spectrum, patients in treatment for cannabis are the youngest, with 76.0% of them being under the age of 30. The percentage of new patients under the age of 30 who are being treated for a stimulant-, cocaine- or opiate-related disorder, is 58.6%, 48.8%, and 40.6%, respectively.
"The gender distribution of patients by primary drug is presented in Figure 5.2. Patients entering treatment for the misuse of hypnotics are the group with the greatest percentage of women (36.3%), followed by patient in treatment for stimulants (29.9%). The percentages of women among patients in treatment for opiates, cocaine or cannabis are 18.4%, 20.7%, and 15.4%, respectively."

"Since April 2009, prescriptions for methadone and buprenorphine are registered in the Pharmanet-system of the National Health Insurance Institution (NIHDI). Before 2009, this National Registration of Substitution Treatment was hosted by the Belgian Institute for Pharmaco-epidemiology (IFEB /IPhEB). The objective of this registration is to avoid multiple prescriptions and allow warnings among concerned practitioners as requested by the Royal Decree of March 19th 2004. This database contains information from public pharmacies, hospitals pharmacies and specialized centres. Substitution treatments provided in prisons are not included in this database. There is also a lack of information regarding non-residents and people without health insurance. Recently, the Directorate General Inspection of the Federal Agency for Medicines and Health Products (FAMHP) was appointed to develop a real-time monitoring system that could serve both epidemiological and administrative objectives.
"Figure 5.11 represents the number of patients undergoing a substitution treatment in 2010, by age category and by substance. Of the 15,395 persons in treatment for methadone, 22.0% were younger than 30, 36.8% were between the ages of 30 and 39, and 41.2% were over the age of 40. Among those in treatment with buprenorphine (n=2,227), 29.6% were under the age of 30, 36.5% were between the ages of 30 and 39, and 33.9% were over the age of 40."

"Based on the Belgian Treatment Demand Indicator data of 2009, some indicators of social exclusion can be studied. More than one third (33.2%) of all persons entering treatment in 2009 had no school degree or only a degree of primary education (Table 8.3). The proportion of persons without school degree is considerably higher among persons between 45 and 54 years (45.0%) and those over 55 years old (52.6%) (Table 8.5), and among persons with cannabis as main problem substance (41.3%) (Table 8.4). One in two treatment demands concern persons who are unemployed (55.1%), and 2 in 3 persons over 35 years old are unemployed when they address a treatment agency (Table 8.5). Cocaine abusers are most likely to be employed at treatment entry (56.6%), while opiate abusers are least likely to be employed when they enter treatment (36.6%). No gender differences in unemployment rates were observed among persons entering treatment.
"About 15.4% of all treatment demands concern persons who are living in unstable circumstances (changing situations) and one third lived alone (with one or more children) at treatment entry. In particular opiate abusers (40.5%) and persons over 35 years old (>51.0%) were most likely to live alone (Table 8.4). Only small gender differences were observed, with 35.9% of the women and 32.7% of all men living alone."

"In the Flemish Community, 571,825 syringes were distributed in 2010, and 592,123 were returned, resulting in a “recuperation rate” of 103.6% (Windelinckx and Bosschaerts 2011) (see also ST10_2011_BE_01). In the Walloon region, 297,260 syringes were distributed through the 16 official fixed-site and mobile services and 286.866 were returned, resulting in a recuperation rate of 96.5% (Casero et al. 2010) (see also ST10_2011_BE_02). In addition, 38,220 syringes were dispatched to the network of pharmacists participating to the “Stérifix” project in 2010. However, there is no information available on the number of syringes effectively sold through this network. Compared to previous years, the number of distributed needles slightly decreased (Figure 7.2) whereas the recuperation rate increased (Figure 7.3), confirming the importance of the harm reduction programmes in reducing the risks (e.g. needle-stick injury and consequent infection) to the general population."

Laws and Policies

"By actualising the Federal Drug Policy Note of 2001, the Communal Declaration of 2010 currently provides the structure for the Belgian drug policy. The essence of this policy remains the recognition that the drug phenomenon primarily is an issue of public health. Therefore, repression, as a last resort (ultimum remedium), is preceded by prevention and treatment. By evaluating the accomplishments of the Federal Drug Policy Note and by stipulating action points for future improvements, the Communal Declaration pursues the global and integrated approach. This document can be seen as a confirmation of the Federal Drug Policy Note, rather than as its replacement. The Communal Declaration particularly represents the integrated efforts from the different policy levels, preceded by the Federal Drug Policy Note, the cooperation agreement, the GDPC and the Interministerial Conference on Drugs."

"The Federal Drug Policy Note of 2001 was based on the conclusions and recommendations of the Parliamentary workgroup Drugs of 1996-1997 and stated the five main principles of the Belgian drug policy: (i) a global and integrated approach; (ii) evaluation, epidemiology and scientific research; (iii) prevention for non-(problematic) users; (iv) treatment, risk-reduction and reintegration for problematic users and (v) repression for producers and traffickers. The action plans of 2001 an 2010 both start with an overview of the preceding measures on drug policy. In a second part, the current statement of affairs is assessed, resulting in specific action points for the future. As the Federal Drug Policy Note thoroughly describes its action points, the Communal Declaration mainly assesses to what extent they have been realised. Consequently, the latter stipulates the efforts which should be made in order to further execute the action points of 2001.
"The Federal Drug Policy Note of 2001 considers the use of psychoactive substances primarily as a problem of public health. Therefore, the action points concerning ‘Prevention’ mainly focus on the prevention of drug use as a health threat. The Communal Declaration of 2010 on the other hand, draws a clear distinction between the prevention aiming at public health and the prevention of drug-related public nuisance. On this matter, a few objectives are described, mostly in regard to the local authorities."

(Policy Regarding Treatment) "On the subject of ‘Treatment’, the Communal Declaration remains supportive of a diversified offer of treatment facilities, integrated in coordinating networks. In order to reach a wider range of drug users, the declaration states that an increase in treatment capacity is needed. The support for the cooperation between the criminal justice system and the drug treatment services continues, with special attention for the necessary conditions. In general, the action points on ‘Treatment’ are confirmed, as the Communal Declaration promises their continuous optimisation and development. The projects that were implemented as part of the Federal Drug Policy Note continue to be supported. The Communal Declaration differs on the subject of risk-reduction. Although it remains an objective of the Belgian drug policy, its confirmation is rather implicit."

"The action points on ‘Repression’ of the Federal Drug Policy Note 2001 are confirmed in the Communal Declaration of 2010 as well. The latter plans to enhance the repressive measures on the production and traffic of illegal drugs, as part of the control of the supply. In addition to the request for a cross-border approach for drug tourism in the 2001 policy note, an intensification of the cooperation and consultation with the neighbouring countries was promised in 2010. With regard to the drug users, imprisonment remains an ‘ultimum remedium’ and alternative measures for drug using delinquents are stimulated. The penitentiary drug policy, as described in the policy note of 2001, is not discussed as part of the action points of 2010."

"Following the ambiguity regarding the legal status of cannabis use (Gelders and Vander Laenen 2007), the Communal Declaration chose to emphasise the actual intention of the Belgian drug policy. Rather than a tolerance policy, Belgium pursues a consequent dissuasion policy, in which the penalization of drugs shows the disapproval regarding the use of drugs."

"In Belgium, the legislative reform concerning the use of drugs and their possession for use took effect in June 2003 following the adoption of four new texts (⁴⁷). The underlying principle of this legislative reform is that the application of the criminal law as a response to illegal drug use should now constitute only a last resort. Cannabis use (possession of a quantity of cannabis that can be used on a single occasion or at most within 24 hours – i.e. 3 grams) will thus involve a police registration. The law provides that users shall be fined €75 to €125 for a first offence, or €130 to €250 for a repeat offence within a year of the first conviction. They may be sentenced to eight days’ to one month’s imprisonment and a fine of €250 to €500 in the event of a further offence in the same year. In the case of ‘public nuisance’ or ‘problem use’ (⁴⁸), a standard record (of the place, date and time of the relevant facts, type of substance and form of use) is drawn up and the substance is confiscated. For public nuisance stricter measures may also be imposed, such as three months’ to one year’s imprisonment and a fine of €5 000 to €500 000, or only one of these penalties. The law confirms that the possession and cultivation of cannabis remain offences, and provides for increased penalties for illicit production or trafficking. The law is based on the principle of deterrence from all drug use, including recreational use by adults. It is expressly stated that use by adults in the presence of minors will be treated more severely, with custodial penalties."

"In Belgium, a change in the law and a new prosecution directive were enacted in the first half of 2003. Cannabis was differentiated from other illicit substances, and the two concepts of problem drug use and public nuisance were introduced. The new status of cannabis allowed the public prosecutor not to prosecute if there was no evidence of problematic drug use or of public nuisance. After the Constitutional Court found that these concepts were insufficiently defined, a new directive issued in February 2005 called for full prosecution only in cases involving disturbance of public order or other aggravating circumstances. This includes possession of cannabis in or near places where schoolchildren might gather and also ‘blatant’ possession in a public place or building.
"For drugs other than cannabis, Belgian law punishes possession, production, import, export, or sale by imprisonment for between three months and five years and/or a fine. There is no separate offence of ‘trafficking’, but the term of imprisonment may be increased to 15 or even 20 years in the event of specific aggravating circumstances."

"In January 2001, the Belgian Government adopted a Policy Note in which it expressed the intention to modify the main drug law in order to reduce the penalty in the case of non-problematic use of cannabis. The main lines of the laws of 4 April and 3 May 2003, in force from 2 June 2003, are thus:
"Belgium is moving towards a policy of normalisation. This in no way means a policy of tolerance or legalisation of certain substances. It is based upon the following key points:
"Sanctions for illicit production or trafficking are strengthened;
"Possession or cultivation of cannabis remains an offence. In cases of personal use (ie possession of a quantity of cannabis which can be consumed in one time only, or at maximum in 24 hours, namely 3 grammes), a simplified police report (place, date and time of facts, type and use) will be made. In case of problematic use, the prosecutor will be notified and may recommend treatment. A case of public nuisance will be passed to the prosecutor. Problematic use would mean a degree of dependence which prevents the user from controlling his consumption, shown either by physical or psychological symptoms. Public nuisance would mean possession of cannabis in prison, in an educational establishment or in the building of a social service, as well as in their immediate surroundings or in other places frequented by minors that may be of an educational, sporting, or social nature.
"Dissuasion of all drug use, including recreational use by adults;
"No illicit drugs in any circumstances for minors. Indeed, even recreational use by adults in the presence of minors will be prosecuted in the most severe manner.
"Prohibition of driving under the influence of drugs, including cannabis;
"An integrated policy for the problematic user: at each step of the penal procedure, investigation, prosecution, passing and execution of the sentence, the magistrate has legal means to send problematic users to a drug treatment service."

"Policy changes in Belgium in relation to cannabis use, possession and cultivation may also have had some impact on the shift in production from the Netherlands to Belgium. In 2001, the Belgian government agreed to stop prosecution for use of cannabis and cultivation of cannabis for personal use, on the grounds that it did not constitute a nuisance and was not problematic (Decorte, 2007). However, it was not until 2003 that guidelines outlining what was permitted were implemented. Under the new guidelines, cultivation of cannabis for personal use (one female plant) and possession of up to 3 grams are no longer grounds for prosecution (Decorte, 2007). The action to be taken in cases of larger amounts is left to the discretion of the prosecutor, leaving the boundaries of cultivation limits unclear."

"The Act of July 31th 2009 which introduces the oral fluid drug testing in traffic, became operational the first of October 2010. This test replaces the former procedure of urinalysis, which was considered to be too complex and too time-consuming for the police authorities (see also Chapter 9). Besides these objections, questions were raised whether the urinalysis and the ensuing blood sample analysis were reliable. The former detected the presence of THC even when the subject was no longer in a state of modified consciousness. The blood analysis also revealed that 20% of the positive urine tests were ‘false positives’, consequently resulting in an unjustified suspension of the drivers licence.
"The implementation of the procedure on oral fluid analysis was accompanied by two Royal Decrees. The first Royal Decree regulates the checklist that precedes the oral fluid test to assess the indications of recent drug use; the second Decree regulates the ensuing blood analysis to determine the amount of drugs used.
"On September 29th 2010, the Minister of Justice and the Council of Prosecutors-general issued a circular to harmonize the investigation and prosecution policy on driving under the influence of drugs. It replaces the previous circulars on this matter and comes into force on October 1st 2010, at the same time as the oral fluid drug testing. The circular also elucidates the former mentioned Royal Decrees."

"To reduce the spread of infectious diseases and other health risks among injecting drug users, as well as to reduce the risk to the general population by recuperation of used needles, syringe exchange programmes distribute injecting material and additional prevention material (cf. SQ23_2011_BE_02 – 03).
"In the Flemish community, the syringe exchange programme, which started in 2001, has been carried out by one regional and five provincial coordinators (one per province in Flanders), working as independents at the Medical and Social Care Centres (MSOCs) for drug users. The provincial coordinator builds networks of health care professionals, and pharmacists, who help him/her to distribute the injecting material, including syringes, filters, ascorbic acid, spoons (Exchange©), alcohol swabs, flasks of injectable sterile water, foil, bicarbonate, and containers to recover syringes.
"In the French Community, the needle exchange programme has been coordinated by Modus Vivendi since 1994. In 2008, the organisation of the needle exchange programme was reorganised, resulting in a lack of data for that year. Since 2008, injecting equipment has been offered through 16 official fixed-site and mobile services (with accreditation) located in Brussels, Charleroi, Dinant, Arlon, Namur, Liège and Ciney. On top, more than 10 other services distribute injection equipment. However, the number of syringes distributed within the later services is unknown. Finally, a network of pharmacists participating in the “Stérifix” project distributes “Stérifix” bags at the cost of 0.5 euro, including two syringes, two alcohol swabs, two dry post-injecting swabs, two spoons, two flasks of injectable sterile water and harm reduction information."