Proposition 50K1749

Projet de loi visant à la reconnaissance légale des traitements de substitution et modifiant la loi du 24 février 1921 concernant le trafic des substances vénéneuses, soporifiques, stupéfiantes, désinfectantes ou antiseptiques.

General information ¶

Submitted by

The Senate

Submission date

July 14, 1999

Official page

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Status

Adopted

Requirement

Simple

Subjects

drug addiction criminal law public health

Voting ¶

Voted to adopt

Groen Ecolo LE PS | SP Open Vld MR

Voted to reject

CD&V FN VB

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Discussion ¶

July 10, 2002 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. The Minister of Consumer Protection and Public Health recalled that the bill under consideration derives from a bill initially submitted to the Senate.

The draft law takes back the decisions taken at the consensus conference in 1994. The federal government policy note on the drug issue emphasizes the need to legalize replacement treatments, including methadone.

The Minister recalled the benefits of methadone replacement treatment: reduced use of other opioid substances, better integration in society, reduced risk behavior, better contacts with assistance services, improved physical and mental health associated with reduced mortality.

The bill provides that a royal decree will draw up a list of products that can be used for replacement treatment. A royal decree will also determine the conditions of issuance and administration, the number of patients that can be taken care of by the doctor, the accompanying treatment and the continuing training of the doctor, as well as the relationship that the prescribing doctor will establish with a specialized center or a care network.

Substitution treatment provided by a healing arts practitioner may only be continued if different conditions are met. by Mr. Vandeurzen recalled that his bill No. 71 was drafted when his party had a majority following the 1994 Ghent Consensus Conference. An agreement was reached between all the majority parties.

As a result of this agreement, it has submitted a bill that has been re-submitted during this legislature. by

by Mr. Vandeurzen recalled that following the work of the Parliamentary Working Group on Drugs, a consensus has emerged on the need to legislate on substitutes. While he welcomes the legislative initiative, he regretted the differences that persist between the draft and its proposal. He recalled the very strict conditions that the 1994 Conference had issued with regard to methadone replacement treatments, namely the psycho-social approach to drug addicts. This approach must be adapted to the individual needs of the patient. The patient should also be treated in a multidisciplinary center or by a general practitioner or specialist. Doctors should be in contact with a psycho-social network of guidance in order to prevent the isolation of the practitioner from having a detrimental influence on the practice. Finally, there must be a uniform recording of all methadone treatments in order to avoid "shopping", this being the biggest problem encountered by practitioners who prescribe replacement treatments. Indeed, it is unfortunate to know if the addict does not already receive methadone elsewhere.

According to M. Vandeurzen, all these conditions are reflected in his bill. This is precisely what makes the fundamental difference between the bill and the bill under consideration. by

According to the member, the draft submitted by the Senate contains provisions completely contrary to the note. In fact, the draft disjoined the provision concerning the linking of doctors to a specialized centre and the limitation of the number of patients per doctor, the training and the accompanying provision concerning the establishment of the list of substances authorised for substitution treatment.

by Mr. Vandeurzen also introduced Amendment No. 1, which aims to add the conditions he mentioned in the aforementioned paragraph. He believes that replacement treatments must be possible under the conditions defined at the Consensus Conference and reflected in the Federal Drug Notice.

Finally, he added that, in all cases, the King must first determine that it is a substance authorized for replacement treatments and specify whenever this substance can be administered, provided that there is psychosocial accompaniment of the patient and mandatory training for the practitioner who, in addition, must be attached to a specialized center.

According to Mr. Vandeurzen, this bill does not reproduce these conditions. by Mr. Vandeurzen concluded by stating that the establishment of projects for controlled delivery of heroin also allows for heroin replacement treatments. In light of these statements, the implications of this project become much wider.

As for mr. Bacquelaine, the author of the proposal law 135/1, was pleased that the topic of substitution treatments was finally addressed concretely in a committee and that a solution was developed.

He said he misunderstood the arguments. Vandeurzen and that, for his part, the text of the project was a little too binding. He regrets that the text of the draft does not specify that replacement treatments are provided only to patients and heroinomans who are dependent on opioids. Substitution treatments are only justified in the case of metabolic dependence caused by heroin. The delivery of replacement products to a non-dependent drug addict can precisely make him dependent.

by Mr. Bacquelaine also noted that for a doctor, taking care of a drug addict is no more difficult than taking care of a cancer patient. Therefore, specific training is not justified, the medical course is sufficient. At the same time, the compulsory passage of the doctor through a specialized center also risks having a perverse effect. Indeed, the obligation to go through a bureaucratic structure risks reducing the accessibility of drug addicts to substitute treatments. by

The speaker also believed that since there is no uniformity of replacement treatments in Europe, it is necessary to impose a residence in Belgium on the patient who is undergoing a replacement treatment, in order to avoid a certain tourism to methadone. by Mr. Bacquelaine finally regretted that this condition was not reintroduced in the law. by

by Mr. Mayeur, for his part, recalled that the project aimed, through replacement treatments, not only to improve the drug addict’s health but also to stabilize his social situation. by

He also stated that this bill aims to protect doctors from criminal prosecution when they deliver methadone as part of a replacement treatment and highlighted the fact that it guarantees adequate legal treatment for this type of practice. by

To conclude, Mr. Mayeur said his group was seeking a wider debate on cannabis use and the release of heroin. by

by Mr. Germeaux, for his part, emphasized that in terms of drug addiction and replacement treatments, mentality and medical approach are different in the north and south of the country. Both institutionalization and individualization of treatments are not ideal solutions. by Mr. Germeaux thinks he can say that patients sometimes feel prisoners in specialized centers. by

Van de Casteele, on the other hand, stressed that it is not appropriate to extend the present project to the problem of controlled release of heroin, although the discussion on this topic is inevitable. Regarding the modalities, it is considered that a solution should be found combining both the institutionalization of treatments and their individualization. If a multidisciplinary approach is necessary, it does not necessarily have to be provided by a multidisciplinary team. Through their courses — as Mr. said. Bacquelaine — practitioners need to learn how to treat drug addicts. There is no need to force them to stay in contact with a center, Ms. Van de Casteele said. The latter also defended the idea of the release of methadone in pharmaceutical offices, which are more accessible to patients, mainly in the countryside, as specialized centres are more suited to treat drug addicts in cities. A reliable registration system is essential if you want to avoid duplication of jobs. Finally, the speaker confirmed that there is an objective difference between the north and south of the country in terms of the approach to the problem. by

Ms. De Meyer considered that the bill under consideration perfectly reflects the decisions of the 1994 Consensus Conference. by

Ms. Leen requested that law enforcement be strictly monitored and that the parents of drug addicts are not forgotten when communicating information. by

Mrs Avontroodt emphasized the importance of providing training and accompanying practitioners. Treatments must be provided in a therapeutic framework by practitioners trained for this purpose.

The Minister responded to the objections expressed by Mr. Vandeurzen specified that the medicinal substances referred to in paragraph 2, §2 are those included in the list established by the King in paragraph 3, §4. There is absolutely no question of limiting the application of the conditions to certain products on this list. The Minister recalled that the text was modified precisely to take into account all the decisions taken during the consensus conference. It is thus provided that the doctor must be in contact with a reference center and a network but it is not mandatory to make the patient pass through that center after being passed to the doctor.

The Minister confirmed that it is of paramount importance to develop a reliable registration system in order to avoid the shopping phenomenon. He confirmed Mr. Bacquelaine that the treatments will be addressed only to patients residing in Belgium.

Regarding the controlled release of heroin, the minister wanted from the beginning to clarify that it is completely excluded to resolve this problem in catimini through this bill. Heroin is not considered a substitute product. The minister recalled that it is mentioned in the Federal Drug Notice that the government will carry out an evaluation of the scientific experiments conducted abroad on the controlled distribution of heroin. She also ⁇ that she had read the results of an evaluation conducted in the Netherlands in 2002 and from which it clearly shows that, subject to a certain approach, controlled delivery of heroin could give positive results. The same applies to experiments conducted in Switzerland, as a representative of this country explained in a symposium.

The Minister said that in a well-defined context, when precise data is available on the population concerned and that it is heroinoma patients for whom no other treatment has proven effective, she was willing to consider the possibility of setting up a pilot project in Belgium. Such a project should be mandatory within the legal framework of the INC.

In conclusion, Mr. Speaker, the entire bill was adopted by 10 votes against one and 3 abstentions.

Mr. Speaker, Mrs. Minister, colleagues, the legal framework for the treatment with substitute products, mainly methadone, has been a dormant existence in this Parliament for some time now. The bill submitted to the House and Senate — which also occurred during the previous legislature — testifies that it is also our wish that the problem of treating especially heroin addicts with substitute products be given a legal regulation. This remains our ambition. The reason for this is well known to many colleagues: if one accepts that the administration of a maintenance dose of a drug can create dependence, it risks to be a criminal offence for the prescriber. Hence the need to provide for legal regulation and legal protection in the case of such treatment. I repeat that this is also our starting point.

The work in the committee has experienced a turbulent course. This also has to do with the problem of systematic administration of heroin at the time. This fact is not directly related to the present bill. I would like to agree with those well cited by the rapporteur. I will therefore limit myself to the problem that concerns us, namely the substitution products.

I remember the Minister’s indignation during the committee work on the idea that the bill would not fully meet the federal drug note, more specifically on a number of points. Because of that outrage, I began to doubt my modest legal understanding and that is also why I remain silent on the text.

After all, gradually my conviction has grown that I was at the right end and that in the present bill a shift is noticeable that our group does not want to endorse. Colleagues, the debate has been positively engulfed by the Consensus Conference of 8 October 1994 concerning whether and under what circumstances maintenance treatments with methadone were medically appropriate. This consensus conference was an initiative of the then Minister of Public Health, Mr. Santkin. The ideological discussions that were previously held around the subject have become much more business-related and through the conference a broad consensus has emerged on the belief that a methadone treatment can be medically appropriate in a number of circumstances.

However, I would like to quote the limit conditions that were then cited by the eminent doctors and scientists in order to be able to weigh on a responsible use of methadone. I quote this short text to test the draft law to the frame conditions. Does this draft law ⁇ that when there are substitution products, including methadone, the essential marginal conditions are secured? I quote: “Psychosocial approach and support are essential factors for the outcome of a methadone maintenance treatment. This support should be adapted to the individual needs of the patient. He can be treated in a multidisciplinary center, either by a general physician or a specialist."

A first condition, the psychosocial approach and support are essential factors. A second condition, the doctors must have received and maintain the necessary training through, for example, clinical interview. Important marginal conditions are permanent training and interviews. A third condition that was then pushed forward, the doctors should be supported by a functional relationship with a specialized center or a network for the provision of care to drug addicts, in particular to prevent isolation that could adversely affect the practice of the doctor. There must be a connection with a centre. Finally, it was also pledged for a very good registration, of course, taking into account the problem of patient privacy.

Colleagues, I do not hide that our group was very satisfied when in the Federal Drug Notice the points that were also considered essential by the Consensus Conference were rearranged. The Minister has very rightly emphasized in the drug note that the doctors will be part of a frameworking psychosocial network, that a registration will indeed be developed and that investment will be made in the mandatory training and further training of doctors.

Until then, the consensus was large. We have criticized a number of points of the federal drug note. However, it would not be correct to shave all that over a chest. There are also very good things. We fully agreed with the direction of the Federal Drug Notice regarding the vision of substitutes. The Federal Drug Note provided for the start of the registration of the substitute products on 1 January 2002. That timing has not been met. There will come a time when we can evaluate some elements from the drug note. The timing may be problematic, but materially we were able to reconcile with it.

Colleagues, we know that in the north and south of our country about drug aid, as in many other topics, it is thought differently. It is not a coincidence that the demand for heroin experiments in Wallonia is rising. It has been repeatedly confirmed in the committee, including by the doctors present in the committee, that there has been a very large difference in culture and in use in the two parts of the country. This is a very serious matter. Contrary to what some argue, the treatment methods in the South and the North will be equally good, but the question is whether the treatment method, in practice, meets the conditions of the consensus conference. This consensus conference has a federal scope. I can therefore suspect that it is respected or at least tolerated throughout the country. The committee had to repeatedly admit that there are very different practices in this area in our country. This makes us as Flemish Christian Democrats very concerned. We know that opinions in our country about the problem of registration, both of the distribution of methadone and of the care path of drug addicted aid seekers, vary greatly. In Flanders, in practice, a much greater willingness has grown to multidisciplinary cooperation, to registration, to approaching the patient in a path. It should also be possible to follow the trace if one wants to avoid shopping. The sensitivity and willingness to cooperate on this is manifestly greater in Flanders than in Wallonia. There is liberalism in Wallonia. It would be a matter of the doctor; the multidisciplinary centers and registration would not belong to the essence of treatment. That this gives rise to washing, everyone knows. The stories about methadone being distributed in the most unlikely forms and quantities and where it is also unclear where the methadone ends, have also appeared in the media in the last year. With that cultural difference, the government was confronted in the discussion about methadone in the Senate. The discussion began in the Chamber. It was suspended in the House until the government took an initiative. This initiative took the form of an amendment in the Senate. That is where the discussion took place.

I invite you to review the report of the Senate debate. It shows very clearly how principled and ideological the sensitivities were again in drafting regulations. The resistance from Wallonia to a strict framework of framework conditions has been clearly discussed. It is very regrettable that the government and the majority in the Senate have done so. While initially the consensus was very large about the fact that methadone could be used as maintenance treatment, if a number of conditions were met—the conditions would be included in the law—it has been converted in the Senate into a law stating that the King can determine which substitution products are accepted. When the King accepts a substitution product, he must in any case determine how it is administered and how the administration is recorded. The other conditions, which were considered equally essential by the Consensus Conference, in particular the social guidance, the link of the doctor with a multidisciplinary center and the continuous further training of the doctor, may, however, be determined by the King according to the draft law, but must not be determined by the King for each substitute product. There was, therefore, a division on the legal level. A division is made between two conditions which must always be determined by the King, in particular registration and method of administration, and three conditions which the King may determine for the medicines of his choice.

Mr. Vandeurzen, it is not true that in the second set of provisions it would be indicated that the King can determine it. This was originally stated in the bill. On the basis of an amendment submitted by us, this has been deleted. So there is not stated: "The King can ..." There is stated: "The King determines ..." Then follow the three other conditions.

We have continued to work with the existing structure of the bill that was submitted to the Senate. What you suggest is that there would be two lists of narcotic drugs. There would be a list to which the first two provisions apply and a list to which the other three conditions apply. You suggest that it would be two different lists. In the committee I have made it clear that this is not the case and that it is a single list of narcotic drugs. I have also said that in order to meet the conditions formulated in the consensus conference, we have consciously submitted an amendment aimed at removing the word "can" so that in this bill the five conditions must indeed be met.

Mr. Speaker, I think it is important that the Minister clarifies the intentions that inspired the bill. This is also important for the report. However, this does not affect the letter of the text that precedes. I have repeatedly emphasized in our constructive discussions that there is a difference between intentions and statements and what is formally stated in the law. I was ⁇ well informed because I took your outrage seriously. Honestly, I believe that there can be no uncertainty. Your intentions may be good. The royal decree circulating for advice within the sector confirms that you intend to fulfill five conditions for methadone. I said in the committee that I understand that. However, when we make a law, that is not the point. The point is now that your law allows very explicitly and formally to distinguish between products recognized for substitution. Then we need to talk about administration and registration. For the medicines you select, you will impose additional conditions. This is the correct reading of the text. That doesn’t affect your intentions regarding methadone as evidenced by the pre-design that is circulating. However, it is not the letter of the text. It may not be because the genesis of the text on that subject in the Senate is very enlightening.

This text is the result of an amendment submitted by Senator Mahoux. I read the original text of his amendment: "For the medicines that he determines, the king may also impose stricter conditions as regards the number of patients, the guidance of treatment and the contacts that the prescribing doctor must maintain with the specialized center." The text of Mr Mahoux on the item "for the medicines he determines" is not amended by a sub-amendment and states explicitly that it is possible not to impose those three last conditions for each substitution product. For us, this is fundamental because it is precisely about the social support of drug addicts. I see that Mr. Erdman is listening with great interest. I challenge him to read the letter of the text. If he truly reads as a strict lawyer—which he, according to the reputation he has at all, will always do beyond the boundaries of majority and opposition—he will have to admit that the text now says that the king determines the substitute products, that then the administration and registration must be determined, and that three other conditions are also imposed on the medicines he determines. This is especially important to us because we know well that in Wallonia there is a distinctly different culture at that point. The response you receive to your royal order will confirm that one does not want to know about much control over the doctor there at all. I know this very well because I also experienced this discussion in the previous legislature. By the way, I am already strongly convinced that our French-speaking colleagues will point to this in their presentations. So it will only be the question of how your royal decision will come out of these negotiations. I deeply regret that.

Colleagues, if it is not intended that legal cessation to exist, if it is intended by the government and the majority to say that every time a replacement product is accepted five criteria — including the number of patients that a doctor may receive treatment, the social guidance and up-training of the doctor and the contacts that the doctor must have with a specialized center — must be determined, and if we find one decent lawyer who says that the reading of the draft may be different, then I wonder why one does not accept the amendment to include the five conditions successively in each provision of a replacement product.

At that time, intention and formal letter of the law would be consistent with each other. I have already confirmed in the committee that as far as we are concerned, the minister should not worry because there is no delaying manoeuvre behind this stance. We would like to commit ourselves for our colleagues in the Senate to say the last word in the House on this matter because the text would then perfectly match the amendment submitted by the senators Vandenberghe and Van Kessel.

I remain convinced that this is not a compromise and that the legislative text could be drawn up in a different way because otherwise I do not understand why it is not possible to bring the text in line with the intentions on a point in which we are not substantially different from each other. I find this very difficult because I find the social guidance and the doctor’s contact with the center essential for the proper organization of the methadone treatment. In fact, in my province, I see that they are de facto working in this way. That is also the reason for my principled objection to a law that allows a different track. (A conversation is taking place between Minister Aelvoet and Mr. Fred Erdman) The text is now subject to an exegesis.

Ladies and gentlemen, I will come to my decision.

I would like to ask for the opinion of the Justice Committee if that can provide a solution.

I see that the Chairman of the Justice Committee is talking with the Minister.

The [...]

Yes, that speaks book parts.

You are an expert in body language, Mr. Van Parys.

Mr. Speaker, for those who have not seen the images, I would still like the Integraal Report to include the description of Mr. Erdman’s consideration, who has, however, non-verbally indicated that another reading is possible. I would like to thank Mr. Erdman for this non-verbal advice on the interpretation of the text. He has, without really wanting it, only strengthened me in my conviction.

We cannot support this bill. There has been no debate about whether maintenance treatment with methadone is appropriate. There was no debate about the value of the consensus conference. However, there was a debate about whether the framework conditions of the consensus conference were included in this legislation for each substitution treatment. The answer to this question is no. I have no doubts about the minister’s intentions when she prepared the first version of the royal decree. Furthermore, I am very looking forward to the conclusion of this decision because I suspect that you will receive quite contradictory opinions on this subject from the two parts of the country. This law opens a door that was explicitly closed by the Consensus Conference. This is not a good law. Intentions are not enough. We must assume our responsibility for drafting a law that should determine the framework conditions. In this regard, this bill is in our shortage.

Mr. Speaker, Mrs. Minister, dear colleagues, the bill that is submitted to our vote today aims to no longer criminally sanction substitution treatments dispensed by a practitioner of the art of healing. The draft law gives the King the power to determine the list of replacement treatments and the conditions for the administration of such treatments. The replacement treatment ⁇ targeted by today’s bill is, of course, methadone.

Since the consensus conference on methadone held on the initiative of the Minister of Public Health in 1994, the reference framework for practitioners and authorities responsible for monitoring methadone and its use has been clear. Follow-up to the consensus conference, which brought together more than a hundred experts between 1997 and 1999, confirms the therapeutic effectiveness of methadone. The consensus conference and its follow-up advocate for access to increased methadone treatment based on needs and including front-line stakeholders, while respecting the need for responsible medical practice. We can only welcome the existence of a medical consensus on replacement treatments. This is part of a necessary expansion of the supply of care that can be done to people addicted to drugs. The unanimous recognition by the medical body of the appropriateness and effectiveness of methadone therapy should enable heroin addicts to offer alternatives to their dependence.

In any case, we are pleased to find that the recommendations of the Consensus Conference have been incorporated into the text discussed in the Senate and submitted to us today. However, the reading of the text of the bill raises some questions.

First, the bill provides that the King determines, on a proposal from the Minister of Public Health, the list of substances permitted for replacement treatments. However, the 1994 Consensus Conference and its follow-up in 2000 concerned a very specific product, namely methadone. According to the adopted definition, the bill does not specifically target methadone and it could also target other replacement treatments but also maintenance treatments such as heroin, treatments which at the moment are not the subject of any consensus in the medical-social sector. Recent debates on the usefulness of controlled heroin delivery projects show that there is no consensus on the usefulness of these treatments. The authority given to the King is very broad. In itself, this is not abnormal but, in such subjects, it is important not to improvise. We therefore insist that the expertise established in the context of the consensus conference should not be discarded but, on the contrary, formalized.

Furthermore, in the pre-drogue bill prepared by the Minister of Health, it is provided that the possible abuse of prescription, delivery or administration of substitute products is considered criminal. The bill does not adopt this view. Therefore, is the abuse of prescription, issuance or administration of substitute products possible, is it punishable and how? In corollary, one can question the binding value of the conditions...

Even if I don’t give the impression, I’m very close to you, Mr. Paque. You just said that the powers of the King to determine other medicinal substances could eventually involve heroin. These are obviously substitutes. How do you want heroin to be affected in one way or another? This is my first question.

The second question. If methadone is targeted, can it not be administered in different drug forms? Per ⁇ that is why this list should be made.

Methadone can eventually be provided in pure form but also combined with other components. Therefore, I do not understand your concern about the text you have quoted.

If I used the term heroine in my intervention, it is because that word was put on the table very clearly, some time ago. I expect the Minister to reassure me and confirm that this is not the case. But I do not doubt that she will do so soon when she answers.

It is also the responsibility of politics to fight against all forms of addiction, dependency and alienation that breach freedom and prevent the person from making responsible choices.

To the extent that methadone replacement therapy allows heroinomate people to get out of their dependence within a defined medical context, I can only support the legal recognition of this treatment.

But the remaining questions regarding the scope of the law worry me. Indeed, while it is the duty of the policy to combat taxation, it is also its duty to set legal and clear standards giving precise benchmarks to citizens, in particular to the most vulnerable, and to the institutions responsible for ensuring compliance with this standard.

The remaining ambiguities in the interpretation of legal provisions do not contribute to the message of a clear norm.

Finally, I would like to take advantage of my presence at this tribune to insist on the government to have a clear political action on drug addiction. Since the presentation of the government note in January 2001, few projects have been implemented.

If we could subscribe to most of the ambitions announced in this note, we can only regret the government’s attitude in this matter, which gives citizens promises that it will not be able to keep, given the multiplicity of projects announced.

As much as we can appreciate the majority of the ideas contained in this note at the level of the means announced for prevention, for the constitution of the inter-ministerial “Drug” cell and the end of the criminal prosecution procedures for the major non-problematic user, as much we regret the blur that is ⁇ ined around the consumption of cannabis.

The announcement created a sense of impunity among the population, but above all the risk of inducing in young consumers or potential consumers the image of a banal product without risk and whose use would be unnecessary.

Today, many questions remain unresolved and put both the affected individuals and the prevention actors in trouble. by

Therefore, it is high time that a thorough reflection be carried out on this subject and above all that clear and precise answers be given to all these questions.

Mr. Speaker, colleagues, I know that this is not really common, but in this house it is customary to expressly thank the reporter for his report. You will understand, dear colleague, that I find it difficult today to express my gratitude to you as a reporter. You issued a very exhaustive report, but you were apparently under the influence of an additional injection of methadone and, as a result, you forgot to mention the extensive speech of your Flemish Blok colleague. I think, Mr. Speaker, that we are slowly forced to agree on some rules of play for journalists and rapporteurs in this House.

I come to the essence of the bill. We note that this provides a legal basis with regard to treatment with replacement agents. Let me describe this in a broader framework. During the discussion in the committee, several colleagues expressly referred to the work of the Parliamentary Working Group on Drugs and to the so-called Ghent Consensus Conference of 8 October 1994. Of course, I do not have the ambition to address the entire drug debate here and now, but it seems appropriate to say on behalf of my group that we are not happy with the way this government and the previous, with the Christian Democrats, addressed the entire drug issue. The Flemish Bloc will always continue to insist on a strict policy on soft and hard drugs. You may ask yourself whether we do this from a so-called world alienation, or we do it because we would not know what is really moving on the ground. on the contrary. We do this out of honest and serious concern, as we find that the number of drug deaths increases every year in the cities in Flanders. We do this because we all, in turn, sometimes face the suffering of parents who lost a son or daughter as a drug death.

Some things are fashionable these days. I refer only to a colleague, Mr. Van Quickenborne, former Spiritsenator and now VLD politician. It claims that drugs would be an integral part of the so-called youth culture. Within his new party this already creates some animo, where a number of other colleagues from his own Senate faction already openly contradict him. This will undoubtedly be part of the open debate culture in the big house that has become the VLD of these days. In the face of this kind of politicians who think they have to choose the easiest path, the path of the popular boy without dossier knowledge, we and our group will continue to say that we are not giving the right signal to young people. We continue to assume that we as politicians must also have the courage to give a difficult signal to young people and to say very clearly that drugs cannot and should not. We will therefore continue to oppose the federal drug note, as we have repeatedly said on this tribune, which also indicates that this government is far too permissive toward drug use in general and cannabis in particular.

Mr. Speaker, Mrs. Minister, the present bill should provide a legal basis for the substitution treatment with methadone. Based on the idea that a drug addict is a sick person who needs to be helped, we believe that temporarily administering substitutes in certain acute cases is indeed permissible. For example, I refer to pregnant women, I refer to people who have been severely addicted for years, I refer to addicts who show suicidal tendencies.

We say very clearly that if the administration of methadone gives heavy addicts more chances of withdrawal, this should be possible under very strict conditions. We therefore very specifically advocate for oral administration exclusively under supervision, coupled with in-depth psychomedical guidance.

I would like to reaffirm from this tribune that the administration of substitutes may only be temporarily. After all, Methadon is also addictive and harmful, Mrs. Minister. It makes no sense to give thousands of people a replacement drug for years. Per ⁇ the right time has come, Mrs. Minister, to ask you what you will do as Minister of Public Health against the problem of the large number of methadone addicts, because thousands of people are addicted to methadone.

Mr. Bultinck, how long is the Flemish Block "temporary"?

Colleague Germeaux, I don’t want to get stuck with an exact answer to the question of how long is “temporary”. You, as a doctor, know very well that this varies from individual to individual. Our group has clearly opted in its amendment to take a principled position. This does not mean that we know very well what we are talking about. We also realize that the provisions to be taken by royal decree should provide some space, because everyone knows that there are no two identical medical records. Therefore we do not need to make each other wise, and with this I have given a very clear answer to your question. Their

Short-term withdrawal and medium-term social adaptation should be and remain the ultimate consideration. Care should take place in a closed institution, where the patient should be regularly and unexpectedly monitored for so-called side-consumption. The current system, in which doctors give individual methadone to addicts who are, for the rest, completely free of movement, we reject very clearly for three reasons. Their

Chances are high that some doctors will develop a so-called industrial prescription behavior, as they are pressured or even blackmailed by junkies. Moreover, the chances of withdrawal in this proposal will be smaller anyway. After all, the addict continues to hang around in the drug environment and thus comes into contact with intrusive dealers and with junkies who really want to keep spraying.

As early as 1999, 90 cases of methadone overdose were recorded in the Brussels district in connection with the use of other medicines. In this regard, I refer to the report of the Committee on Justice of 5 December 2000.

In the French report-Henrion it was then again mentioned that with free methadone delivery a large proportion of patients did indeed decline. After all, side use of other drugs and criminal behavior of the addict remain possible in this free system. Let us draw lessons from other large-scale methadone delivery and projects abroad. I refer here to the methadone bus in the Netherlands and Great Britain. The project showed clearly that the criminality of the patients involved did not decrease. Many of the so-called customers of the methadone buses were also found to use speed, heroin, cocaine and even crack, for which they need money, very much money. Their

From the French report "Face à la drogue" of March 1995 it shows that no less than 58% of the junkies are polygam users. They use different types of drugs and therefore we say very clearly that closed institutions are more guaranteed for better hygiene, thus ultimately keeping the whole problem of AIDS and hepatitis infections much better under control. Their

From the above-cited considerations, colleagues, it is therefore very clear that the Flemish Bloc is not in favour of systems such as the methadone bus in the Netherlands, Great Britain or Switzerland. On the contrary, a real aid must be developed. It is precisely through the operation of centers such as De Key that in Flanders the methadone explosion is missing, as we know it in Brussels and Wallonia.

For the Flemish Bloc, therapy with replacement agents must therefore be strictly limited in time. The products should be supplied in closed centres in a highly controlled manner, provided that the person concerned is required to follow a withdrawal program. In that sense, Mr. Germeaux, we have indeed submitted an amendment on this subject.

We believe that the present bill does not provide for sufficiently strict control and allows for equally smooth delivery of methadone, which can give rise to shopping behavior. Too many elements are still left to decision-making through royal decrees. Considering the arguments of colleague Bacquelaine — who claimed that the text of the bill imposes a little too much coercion — we are strengthened in our belief that the present bill does not provide guarantees for a strictly controlled methadone supply. The fact that colleague Bacquelaine — I suppose he will later repeat his discourse from the committee in the plenary session — invited the discussion in the committee to hold a plea to include also controlled heroin delivery in the same bill, confirms once again that there is a huge difference in the way people think about the drug problem in the north and south of the country. The drug dossier is indeed a community dossier, like all cases in this country.

Colleagues, because French-speaking politicians have a different view on the drug issue, this bill also became a very vague compromise because one had to make the exercise that allowed all government members to rally behind the draft.

Mr. Speaker, Mrs. Minister, colleagues, this is one of the reasons — along with all the previous comments — why my group will with conviction oppose the present bill.

Mr. Speaker, Mrs. Minister, dear colleagues, I would like to look forward to the fact that we are finally taking an indispensable step in the care of drug addicts patients in this country. It was just reminded: it took 8 years to translate the methadone consensus conference into a bill. by

This is a necessary step, but it is not a panacea. This law will not solve the problem of opioid addiction; however, I think this is a significant advance. by

As has often been said, the approach to drug addiction requires a comprehensive consideration of the phenomenon, which is based on a triple composition of prevention, repression and a policy of risk reduction. It is within this policy that the project on the legal recognition of replacement treatments is included. by

It is well known that a large number of heroinomans are not sensitive to traditional withdrawal treatments. It is also known that it is after a series of forced withdrawals that the majority of deaths from heroin overdose appear; in fact, when people with heroin withdrawal finish their withdrawal period and return to their traditional daily living conditions that lead them to drug addiction, they are often victims of heroin overdose. That is, if the problem is complex and cannot be solved on the basis of more or less enchanting principles. by

Methadone replacement treatments aim to restore contact with the drug addict and make psycho-social accompaniment more interesting. This step allows a number of heroinomans to get out of clandestinity, from an extremely significant marginalization and sometimes total exclusion that make any possibility of social, socio-professional and family reintegration impossible. by

This possibility of regaining contact through substitute treatments is essential in dealing with this drug addiction phenomenon that is of all societies and of all epochs, and which cannot be contented with overwhelming solutions that claim to resolve the problem definitively. by

Replacement treatments are also a way to reduce public health and safety risks. Public health risks affect both the user and society as a whole. Heroin addiction is primarily intravenous and involves a number of contamination risks that affect not only the user himself but the overall epidemiology of society. They also say that the prevalence of AIDS and hepatitis C has increased since the 1970s and 1980s; they found that where methadone replacement treatments were introduced earlier — in the Netherlands and in some regions of England — the prevalence of AIDS and hepatitis C may have decreased much faster than in other countries where these replacement treatments were introduced later, such as in France, for example, where the prevalence of AIDS contamination was much higher than in the Netherlands, even though the number of heroin-named people was more important at some point in the Netherlands than in France.

There is therefore a decrease in public health risks — this is important — but also a decrease in public safety risks. Too often it is forgotten that heroin-related crime is essentially an acquisition crime. It is due to the fact that the heroin addict spends his whole day or night looking for ways to get his next dose. The advantage of methadone over heroin is obviously that it can be taken once every 24 hours, and by mouth rather than intravenously. Thus, public health risks are reduced, as are the risks of acquisition crime. There is therefore an obvious public safety interest in defending methadone replacement treatments. These are, of course, the two main reasons that drive us to support this proposal. With regard to the draft law itself, I would like to remind you of several remarks I made in the committee. These considerations will, in my opinion, have to be translated into royal decrees. by

The first observation. It must be heroin-dependent patients. It may seem banal to say this, but I ⁇ ’t want to distribute methadone treatments to extremely recent heroinoma patients, who have never been subjected to other types of care and who, in the end, do not yet have a complete metabolic dependence. Methadone is only justified, as a replacement treatment, if there is a complete metabolic dependence, which therefore exceeds psychological dependence. It is a physical, metabolic dependence that puts a patient in the condition of receiving another product that, too, will induce dependence, but nevertheless by means of a benefit for him and the society. But it should not be forgotten that methadone induces addiction that is sometimes even stronger than heroin addiction. It is therefore clear that it can only be addressed to patients who are highly dependent on opioids. The bill does not specify it in this way but I think the Royal Execution Decree should specify this in a very clear way.

My second observation concerns the link between the doctor and a socio-sanitary center of help to drug addicts. Substitution therapy should not constitute an interference with the freedom of therapy of physicians. While the threshold of accessibility to substitute treatments is low, the aim of increasing public safety and improving the quality of public health is obviously not met. General doctors should be allowed to practice replacement treatments. Of course, the general practitioner can maintain follow-up contacts with socio-sanitary centers in a given region, which partially centralize the health policy on drug addiction. But this should not be a compulsory passage. I will pay attention to the fact that this condition, which must be translated by a royal decree, is not contributing to a kind of monopoly that would eventually be reserved for certain centers in terms of replacement treatment.

My third comment is about the residence in Belgium. In the proposal I had submitted in 1995, I had introduced this condition in the text because it is obvious that the tourism of methadone must be avoided. Therefore, it is necessary to limit access to replacement treatment to persons residing in our country rather than allowing residents of other countries, which do not allow replacement treatment, to come explicitly to our country to receive this type of treatment.

Those are three considerations that I wanted to put forward when we are discussing this bill.

Finally, I would not want to make the impasse on the medically controlled distribution of heroin, since the problem has been raised several times. I am, for my part, extremely cautious and reserved in relation to the controlled distribution of heroin. Heroin is not a substitute treatment. Let us be clear! This is not a replacement treatment. I have never said that. This also does not mean that the problem of controlled distribution of heroin should not be raised. On the contrary, the problem exists and it will have to be discussed sooner or later.

With regard to products allowed as replacement treatment, it is necessary to be very careful. Moreover, Mrs. Minister, if methadone seems to me the best example, I would like to make reservations on other types of products that have been used in France, the bupremorphine, called in our country the Temgesique, which are products much more difficult to handle in terms of replacement treatment and which must resort to much more precise controls. The experiment of the Sobutex, which is the equivalent of the Temgesique in France, ended up in a fierce failure. Therefore, you need to be very careful about the type of products you are going to use.

As regards controlled distribution of heroin, it must first be subject to a scientific experimental protocol controlled by universities as scientific research before being used otherwise. So, I really believe that it is necessary, in this context, ⁇ to support the academic and scientific research initiatives that are taken in the matter, allowing experimental protocols. Obviously, this does not exactly fall within the scope of this law and it is obviously not about liberalizing, banalizing in anything, the use of heroin, even if it is controlled medically.

I do not necessarily have the experience of Mr. and Bacquelaine. What worries me is how we will avoid at the level of young people, especially in the school framework, the impression of banalizing the use of methadone and drugs in general. This is a problem for me, because I do not see what response we will be able to give in relation to these difficulties experienced by young people and especially to avoid this "banalization" of drugs at the school level.

Mr. Smets, I think your comment applies much more to cannabis than to methadone. Methadone is not a first-intention drug. First, it does not provide pleasure and therefore, it is not a drug that the consumer will use in the first intention. He is not interested in methadone. It is justified only in relation to the medical care of a patient already heroinoman. This is why I insisted on the need to clarify that these are patients who are highly dependent on opioids and that it is obviously not about putting patients under methadone who, by the way, could benefit from a treatment or would accept another type of treatment without too many problems. Therefore, the subject must be put back in a well-defined context. This is what we are doing through this bill.

Education is a community-oriented subject. However, in that context, can a community decide that such school or schools of the French Community, for example, can prohibit in a school regulation the use of methadone in school?

It is forbidden, of course. I think you are confusing the different aspects of the problem. The problem of methadone has not arisen in the school environment so far. Therefore, there is no risk of first intention consumption of methadone. The problem is not in these terms. It was very clear, especially in the French Community where a circular was produced by Minister Hazette in the matter, that the prohibition of drugs is still very relevant, a fortiori for minors.

In this regard, there are few problems with replacement treatments.

I would like to supplement the question that has just been asked. I know from my experience young people who take methadone, but thanks to methadone they can go to school. Heroin addicts often exhibit antisocial behavior as a result of their heroin emania. They no longer go to school, but thanks to a methadon project and its follow-up, they can go back to school. Their

So it is just the opposite. Methadon allows us to re-socialize and — in this specific framework — to return to school. If we prohibit patients from accompanying methadone and getting them to go to school, we will ⁇ the opposite effect. Thus, we force them back to the streets, to the heroin.

Mr. Speaker, with regard to the debate on controlled distribution of heroin and on substitute treatments, things can be simplified, with the risk that it entails, in the following way: Heroinoma patients are in two categories. There are those who will gradually be sensitive to a possibility of withdrawal and who will at some point decide to get out of it. There are those who fail to get out of it and who will benefit from a replacement treatment that will allow them to get out of marginalization, to reintegrate partially or completely their socio-professional or family environment. It is to this category that the bill addresses. Finally, there are those for whom methadone does not work. They exist . There are those for whom no withdrawal has been successful and for whom methadone treatments are not effective and are not followed. What should be done in this category? If someone has a perfect solution, let them say it because it will benefit everyone.

So far, I have not heard any political way to deal with it. What do we do with those? There is a possibility that is possibly delivering them medically certain products that allow them to continue to live. There is also the possibility of letting them die on the street. Some are supporters of this solution. It is not mine. When we talk about this category, it is no longer a substitution problem but a medical-social resuscitation problem. The problem of medical-social resuscitation of this category of heroinoman is a question that a responsible and evolved society must ask itself while setting the necessary benchmarks, while avoiding venturing into methods that would not be effective or that would do more harm than good. But one cannot at the same time avoid the question and not ask it.

This message is useful to remember when considering the problem of drug addiction. That being said, Mrs. Minister, my group will vote on this bill because it represents a step forward in addressing this societal phenomenon that constitutes drug addiction.

A lot has already been said, but I would like to add a personal note. The current design has a much longer history. A party fellow, Etienne De Groot, had already submitted a bill in this regard in 1985 — 17 years ago. Meanwhile, we are conducting a doctrine in the sense that since 1989 I myself — I do not want to out, but I am mandated to do so — prescribe methadon.

It is therefore a great moment, because this bill will eventually provide a solution to a situation that has been known for a long time. As just noted, the problem in the north and south of the country is not dealt with in the same way. This does not mean, therefore, that what is done in the South—I refer to the argument of Mr. Vandeurzen—would therefore be worse than what is done in the North. Only the approach is different.

Mr. Vandeurzen, in the committee I have tried to combine the two cultures regarding the prescription of methadone and not to turn them into an institutionalization in Flanders and an excessive liberalization in the South. I have sought to come to a combined form, involving both the primary physician ambulant and the center in the treatment. This is clearly stated in the draft law. I emphasize this — I have also done this in the committee — because by restricting the provision of methadone exclusively to a centre, it is often very difficult to “release” the patient from the treatment and especially from the atmosphere surrounding this center.

Please allow me to correct a misunderstanding. Colleague Germeaux, I do not think that they have been promoted — I have not done that at all — to distribute methadone only through multidisciplinary centers. The Consensus Conference expressly emphasized that a general practitioner or specialist who is not working in a centre can also be involved. I think the point or the difference is not there. If that were the case, I would be optimistic about a global arrangement.

Registration, route guidance, interview, limitation of the number of patients, link with a center and permanent training are the elements that the Consensus Conference has indicated for every doctor, whether one works in a center or not. In this regard, I think the opinions in the north and south of the country sometimes differ.

Mr. Speaker, I did not understand this. All this, by the way, is included in the text. In the committee — I have just cited it — there has been a discussion broken up regarding the scope of this proposal. Some fear that this will lead to the establishment of projects that will experiment with heroin treatments. I would strongly deny this. Eventually, heroin treatment would clearly no longer be a substitution therapy. Heroin is not a substitute product.

I think that this bill regulates, first of all, the legal recognition of the treatment, but also the registration. One of the biggest problems was that methadone has been used in the field since 1989, but that the method was not always followed in the same way.

In the long run, of course, it is essential — with this I return to what colleague Bacquelaine recently quoted on the possibility of treatment with heroin — that there is a registration and that the results of the methadone treatment are evaluated.

I would like to address his question of whether another treatment is possible for those heroin addicts — let me call them clochards — who have the choice between palliative heroin care or death on the street. I have no clear answer. What I can say is that until now we have not always been able to beg for methadon for 7 days. The result is a fairly free use or by-use in the weekends. We must strive for a daily arrangement, 7 days on 7, 365 days a year, so that we can make an evaluation over time. The conditions for entering a methadone program are much stricter within the MSOCs than what the bill requires. I am interested in knowing how many heroin clocks would remain at the evaluation if such a daily distribution was possible. At that moment, in my opinion, the question arises, to what extent one will attempt to give this group an extensive hand.

Colleagues, like Mr. Vandeurzen, I am a Genkenaar, a Limburger. It should not give the impression that we have not found each other in this problem. On the contrary, Jo Vandeurzen has played a leading role in both Genk and Brussels. Limburg, in my opinion, is not faced with the problem of heroin addicts in the big cities. Why Why ? That Genk is not a big city — I look at the Antwerpers — may be a reason. Another reason is that we have been better structured since the beginning. The succession of hard-drug addicts and ⁇ of heroin addicts in Limburg can be taken as an example.

Mrs. Minister, if one wants to give the operation and succession of heroin addicts and the substitution with methadone maximum chances of success, one must give the field workers in the sector a fixed status. Many services such as the MSOCs, CADs, and all the other VZWs engaged in the guidance of drug addicts — not just heroin addicts — turn to people with a false status. After a rich experience, many choose a better paid job or a better status and leave the sector. With them also disappears a piece of experience, experience of contacts and work with heroin addicts and other drug addicts. Everyone emphasizes that the doctors who prescribe methadone should be trained and up-trained. This is not only true for the doctor, but for the whole team. It is teamwork. The possibility of debriefing — a very important element I have little heard of — is crucial because burn-out is another threat. I'm breaking a lance so that efforts are made for the sector, not only for the doctors but for all those who work in a less safe status and that a solution is sought for this group.

Mr. Speaker, Mrs. Minister, colleagues, the SP.A group welcomes the breakthrough in the years-long discussions on a legal regulation of the treatment of addicts with substitutes. My group is pleased that we finally have a legal basis for this form of treatment that had already proven its important place in the necessarily differentiated supply of assistance and had already acquired a place in daily practice.

The persistent legal uncertainty among the concerned healthcare providers will thus be permanently removed. The potential benefits of these treatments are now well known: stabilisation and improvement of the addict’s physical and mental health status, reduced use of other opioids than the replacement agent, reduced risk behavior both towards one’s own health and towards society, greater reach of addicts through that low-threshold form of relief and better contact with that relief. All this provides a greater chance of social reintegration. Later, it can lead to withdrawal, although that is not a necessity. After all, addicts with good maintenance treatment can also take their place in society again. This confirms the practice of the workplace and also politically finally realizes that assistance that is unilaterally aimed at withdrawal does not work for many.

Finally, the persistent illusion is abandoned that drug addiction can only be remedied by either compulsory or non-compulsory withdrawal, no matter how good it may sound. Of course, it is not so simple. Some addicts benefit more from a harm reduction approach. Before combating physical addiction, it can first address other underlying social or psychological problems. Otherwise, for many, recurrence and marginalization is more a rule than an exception.

Mrs. Douifi, Mr. Bultinck wants to interrupt you.

Mr. Douifi, I would like to ask you one relevant question. Did I understand you correctly: do you say on behalf of the SP.A group that removing drug addiction is no longer a social necessity and a goal in itself?

Of course, withdrawal is still a goal in itself. The substitute, the manner in which it will be administered, and the manner in which it will be organized—which will be fixed in a royal decree, I will so soon return to it—will in any case promote the low threshold. In many cases, it will also be a way to get those involved out of crime. The social aspect of our bill aims at social reintegration. Doctors, specialized centres and general practitioners are now given the opportunity to prescribe methadone within a legal framework. Instead of searching for heroin in various ways and getting into the criminal sphere, the patient undergoing treatment will be able to work on his or her social reintegration in the meantime. Among them are housing and employment. As you can see, Mr. Bultinck, I am always willing to give more explanations.

Marginalization will be countered by controlled supply of methadone within a legal framework much better than in the current situation.

The fact that the legal arrangement has been waiting for so long has, of course, also to do with the historically grown differences between the north and south of the country. In the north, the treatment form was organized from specialized centers, while in the south, individual doctors, often in network, took their responsibilities in this regard. As already mentioned, both practices have their advantages and their limitations. Consequently, a balance had to be sought between, on the one hand, the concern to combat abuses such as shopping — through the registration that the royal decree will provide — and to optimise the possibilities of good psychosocial counselling from specialised centres, and, on the other hand, the need and desire for an optimal expansion of a low-threshold care offer.

In this, the primary care, i.e. the general doctor, can play an important role. As stipulated in the draft law, this will be done by a royal decree which, in addition to the list of replacement products, will also regulate a privacy-respecting registration, as well as the number of patients per doctor, the guidance of the doctor who must be in contact with a network or a specialized center, without the obligation to refer the patient to that center. That royal decision will be made in consultation with the field of work, so we can count on enough common sense in this matter.

That common sense will hopefully also determine the drug policy more politically. The final acceptance of the harm reduction approach within drug aid is a first step. That this has lasted so long is also due to the threshold fear within politics to depart from purely moralist approaches. As is often the case in drug cases, politics often lags behind the social developments: too anxiously fixed on the signal and too little engaged in reality. Hopefully, in line with the federal drug note, the concrete policy will also focus on the realistic approach to the drug problems instead of making problems with the yet so overestimated and importantly considered signal where there are none.

Mr. Speaker, I think that both in the plenary and at that time in the committee meeting we had an interesting debate about the bill that came from the Senate and grew there from a particular bill.

The fundamental point we should look forward to today is the fact that there is finally a legal basis for implementing what was achieved by consensus in 1994. So it took eight full years before that consensus could be poured out in the form of a law.

During the discussion in the Chamber Committee there was outrage over the question of what we actually look for behind the concrete design. This indignation is primarily related to the insinuation — and it still sounds a bit like this here today — that we do not want to give these five conditions a real shape. Nevertheless, this is indeed the case. These five conditions from the consensus conference are also set out in the royal decree.

Colleague Vandeurzen, I would like to point out that we have not admitted that there were partially different appreciations and different opinions. Even those who originally had a different opinion have never seen a system of two lists of resources, namely one list involving two conditions and another list involving three other conditions. You know that very well. Some people lived in the belief that there are only two truly binding conditions and that the other conditions are optional. However, there has never been any speculation about two different types of lists. It is, not even of those who have put another text on paper, never intended to have two categories of resources with two categories of conditions. The original intention was to create two mandatory and three optional conditions. In all clarity, I say that it is not about that. There are five binding conditions.

Colleague Paque asked concrete about the sanctions. The situation seems quite clear. When the Senate voted this project of law, it was clear in the spirit that, and beyond the conditions fixed, well understood, all the sanctions provided in the framework of the law of 1921 concerning drugs remain of application. Soons clairs, ce sont des sanctions avec lesquelles on ne ne rigole pas. Mr. Speaker, colleagues, I do not want to cut down the entire heroin file here. After all, this design has nothing to do with controlled administration of heroin; this is about substitutes and that is something else. Heroin is not and does not fall under that. Therefore, there can be no arrangement on this subject. Moreover, we have always made it very clear that we must first do one thing and then look at the other.

It is evident that the examples that were realized and the evaluations carried out in the Netherlands, at the moment, and in Switzerland exactly start from an accumulated experience around registration and so on with substitution. In both experiments, they have obtained approval from the INCB under the UN Convention. They have received that permission in a very precise conditioned framework that we do not even have yet. Let’s be very clear: this is about something else.

To the attention of colleague Bultinck, I would add that if a temporary administration of methadone for the Flemish Bloc is one of the possibilities, this party will stand outside the Consensus Conference. This conference decided otherwise, but it is your full right to place you outside that Consensus Conference.

Mr. Speaker, Mrs. Minister, I confirm here formally that we do not feel called to join that so-called Consensus Conference of 1994. At that time, we also stated that we do not feel called to endorse the work of the Drugs Committee. Let there be no uncertainty about this.

I would like to address the questions posed by Mr. and Bacquelaine. I would like to start by thanking him for his intervention, which I found very interesting, and this from two angles.

First, I think it was interesting to hear someone who knows a number of field practices. It is ⁇ striking to see that one recognizes, on the ground, that there are limits to withdrawal and that the conviction that one can at any time get anyone out of any condition of his dependence situation, this can actually lead to suicide. What happens when you create situations where you know that if you don’t give an adequate and differentiated response, you create terrible problems for those affected and also for their families? Those who commit suicide because of an imposed withdrawal are also the children of parents who weep for them.

I come to the conditions of the royal decree, a second approach that was well developed by Mr. and Bacquelaine. I would like to speak very quickly of the four elements he mentioned: - it must be dependent heroinomans - this is clearly provided in the royal decree; - as regards the link between the doctor and the center, the wording of the text is clear: it is the doctor who establishes a relationship with the center; therefore it must not be established a double job that would make every person who receives a replacement treatment with methadone must pass to a doctor and then be checked in a center; this is not the case, rather it is the doctor who must have a link with a center, to have a framework in which one can also exchange experiences; - residence in Belgium, it is clear; - in the type of products, of course, this will be the fact in unprotected health conditions; I will count the ministry experts on the field and establish a perfect list of experts. Mijnheer de voorzitter, ter attenta van collega Germeaux onderstreep ik nog de relatie tussen huisarts en centrum. I have also understood that you pay attention to ask for the person dated in these centers is working, where u wijst op de precaire statuten. Voor de preventiecontracten vertrekken wij nu alvast van een termijn van twee jaar, maar dit punt verdient zeker verder vervolg.

Finally, I would like to thank Ms. Douifi for the common sense with which she built up her intervention. If we could work this way, we would go much further.