Chapter 20 - Public Policy In Other Countries - Sweden

National strategy

Following the creation of a Commission on Narcotic Drugs, the Swedish government presented a new action plan in January 2002, which is to be valid until 2004. A total of SKR 325 million (approximately $50 million Canadian) has been allocated over the three-year period to combat illegal drug use. The action plan was presented as a means to reverse the disturbing trend in drug abuse. [1][107]

The policy's objectives are to:

··          reduce the number of new recruits to drug abuse (mainly through prevention directed at young people);

··          encourage more drug users to give up the habit (through care and treatment); and

··          reduce the supply of drugs (through criminal measures).

 

One of the key new features of the drug strategy is the creation of a national anti-drugs coordinator position. The position was created to have clear leadership in the drug policy area, make it possible to follow up on the plan’s goals, and determine whether new initiatives are required to combat new problems. The key tasks for the new anti-drugs coordinator are to:

··          develop cooperation with authorities, municipal and county councils, NGOs, etc.;

··          shape public opinion;

··          undertake a supporting function for municipal and county councils in the development of local strategies;

··          initiate methods development and research;

··          serve as the Government spokesperson on drugs issues;

··          evaluate the action plan; and

··          report regularly to the Government (at least once a year).

 

Of the SKR 325 million, 100 million (approximately $15 million Canadian) has been allocated to a special drugs initiative within the Swedish Prison and Probation Service. The goal is to offer care and treatment to all drug abusers in this system. In addition, the National Prison and Probation Administration is required to:

··          develop methods for preventing drugs being brought into institutions and detention centres;

··          investigate the obstacles to treatment outside institutions; and

··          produce special programmes for contract care, i.e. care in accordance with a contract between the person convicted and the community.

With respect to the police, the National Police Board and the National Council for Crime Prevention will be required to carry out their own review of police efforts to combat drug-related crime.

In Sweden, while the national policy is created at the national level, much of the responsibility for implementing the goals of the action plan remains with the municipalities. For example, they have responsibility for the care of drug abusers pursuant to the Social Services Act. In addition, prevention initiatives are also carried out at the local level. Thus, strategies in municipalities will be based on local concerns. Enforcement of the legislation remains at the national level, however, through the police and customs services.

Treatment is one of the three pillars of Sweden’s drug policy. One of the stated goals of Swedish drug policy is to rehabilitate the user rather than to punish them by way of the criminal justice system. Since 1982, it has been possible to force people into drug treatment (also applies to alcohol and other products) for a period of up to six months. The main reason for this type of treatment is to protect the user or others in cases of life threatening situations and to motivate the user to continue treatment on a voluntary basis. The use of compulsory treatment appears to be uncommon and its effectiveness has been questioned.[2][108] In the last several years, there has been a shift from compulsory treatment and institutional treatment towards out-patient treatment. It would appear, however, that treatment is less easily available today than it was 10 to 15 years ago. In addition, the time a user spends in treatment has shortened. These changes are due to cutbacks in social service spending at the municipal level that occurred in the 1990s. "Whereas in 1989 there were 19,000 people in treatment centres (for both alcohol and drugs), in 1994 this number had dropped to 13,000. In the same period, the number of people in compulsory care dropped from 1,500 to 900. Due to the budget cuts, 90 treatment homes were closed between 1991 to 1993."[3][109]

Methadone substitution programs have been available in Sweden since the end of the 1960s. Currently, approximately 600 people are involved in methadone substitution programs in Stockholm, Uppsala, Malmo and Lund. The programs are strictly regulated and are officially viewed as being experimental. Some of the conditions for participation include that: the patient must be aged over 20 and demonstrate at least four years of intravenous opiate abuse; he or she must have tried several forms of drug-free treatment; the person in question must have entered the program on a voluntary basis (for example, the person must not be detained, under arrest, sentenced to a term of imprisonment or be an inmate of a correctional facility). For those participating in methadone substitution programs, other drugs are not permitted and the patient must visit the clinic on a daily basis. At this time, the maximum number of people that may be in the program at one time is 800. Pilot projects are under way with Subutex.

While Sweden has spent large sums of money on treatment, few of its programs have been properly evaluated. Therefore, it is difficult to provide details of their effectiveness. "The official aim is to rehabilitate drug addicts and a lot of effort and financial means are allocated to achieve this; much more than in many other European countries. However, despite all these good intentions, the reality is that the effectiveness of these very expansive programmes is relatively low. In the long run, the Swedish drug treatment programmes do not show better results than what is found internationally."[4][110]

With respect to harm reduction initiatives, there are few low threshold services in Sweden and most are staffed by voluntary organizations. They offer a series of services, but no prescriptions. Needle exchange programs are operated at clinics for infectious diseases in hospitals in Lund and Malmo, and are thus fairly limited. Harm reduction initiatives, such as needle exchange programs, are difficult to promote under a vision of a drug-free society where drug use is not accepted. A proposal in the late 1980s to introduce needle exchange programs throughout Sweden was quashed by Parliament because it "was felt that a higher availability of needles would not stop the spread of HIV, on the contrary, it was thought to increase intravenous drug use."[5][111]

The criminal justice system also plays a role with respect to treatment. In 2000, more than 5,000 drug users were placed in prison. While in prison, offenders have access to treatment programs for drug abuse and some offenders are transferred outside prison for treatment. There are also initiatives to keep drugs out of prisons, for example by conducting searches and urine tests. While in prison, the offender is not offered syringes and substitution treatments are not available.

Swedish legislation allows, under certain conditions, that a sentence may be served outside prison. The necessity of drug treatment is one of the reasons that is often given. Another alternative to imprisonment is a probationary sentence combined with institutional drug treatment. An example of an alternative to prison is the following:

 

Since 1998, persons with drug addiction problems who have committed a drug offence can access treatment signing a ‘treatment contract.’ It is a real contract between the drug addict and the Court in which the two parties have rights and obligations like in all contracts. However, certain conditions must be fulfilled by the drug addict: the person must need treatment and he must be motivated to undergo treatment; he/she is a misuser of drugs; and the drug habit contributed to the drugs crime, which should not be serious (less than 2 years foreseen as penalty). The person is not sent to prison and a personalised plan of treatment is established. The health authorities are responsible for the treatment and shall report to the local prison and probation administration and to the public prosecutor if the probationer seriously neglects the obligations stated in the personal plan. [6][112]

 

With respect to prevention, drug education programs start early and regularly appear throughout the school curriculum. "Without exaggeration, this opinion-forming could be described as a process of indoctrination. Considering the magnitude of these programmes, the contents of them have gradually become something indisputable and conclusive that one incorporates them into one’s own value system."[7][113]

With respect to cannabis, it is viewed as a dangerous drug "and its use is regarded as the beginning of a career in drugs."[8][114] This is one of the reasons that prevention measures pay specific attention to cannabis as this should lead to less experimenting with the drug and thus prevent new recruits from joining the drug scene.