Drug Addiction, Crime or Disease?

Interim and Final Reports of the Joint Committee of the American Bar Association and the American Medical Association on Narcotic Drugs.

APPENDIX B

An Appraisal of International, British and Selected European Narcotic Drug Laws, Regulations and Policies

SWEDEN

The laws of Sweden,30 last revised in 1933, impose controls on the import, manufacture, distribution and sale of narcotic drugs, by means of licensing and reporting requirements under the jurisdiction of special administrative units in the Royal Medical Board and the Division of Pharmacies. Penalties of up to two years are provided but in practice the courts give very light sentences, and offenses are in the petty misdemeanor category (forging prescriptions, failure to keep records, etc.). The administration of the laws and regulations is very loose and informal. There are only two inspectors to cover the country (500 pharmacies; population, 7 million). Prescriptions are supposed to be filed by the pharmacist and held for two years, but no registers are kept and there is no supervision over medical practitioners except that incidentally given by the chief medical officer of each of the twenty-five counties (a doctor who has general responsibility for supervising the providing of all medical services).

In Sweden the pharmacist (Apotek) is a professional man of considerable standing, and such control as exists is principally exercised through him. He is also a semi-official functionary under the national health laws, with certain duties as a civil servant. There are supposedly 500 to 600 addicted persons in the country, and according to a 1954 survey, approximately 20% of these are medical doctors.

In that year 130 addicted persons received treatment in hospitals, and public health institutions.

In the official view, addiction in the ranks of the medical profession itself is a serious problem. Doctors also sometimes become "easy prey," in prescribing freely and becoming, in effect, peddlers. When this is discovered (through reports from the chemists or inspection of their records) the Royal Medical Board sends for all prescriptions issued by the doctor for analysis, interrogates him informally, and if he is found to be offending, may refer his case to the Board of Medical Discipline. If found guilty by the Board, the doctor may be warned, or sometimes his right to prescribe narcotics may be limited to the issuance of prescriptions to be filled by one or two chemists, or it may be cut off completely. For flagrant offenses the Board may suspend his medical license.

Doctors cannot dispense drugs directly to patients except in case of emergency, and seldom do so. They do not buy drugs from a wholesaler, but must file prescriptions with the chemist, showing whatever purchases they wish to make as destined for use in their own practice. Regulations fix maximum dosages which may be dispensed per one prescription, and the chemists are held strictly accountable for delivering any drug in violation of these prescription regulations.

A Swedish doctor may prescribe narcotics to a known addict in the course of a bona fide attempt to effect a cure, but ordinarily the doctors recommend hospitalization, and it is possible to commit an addict by medical order. There are no special institutions for treating addicts, but the facilities of Sweden's excellent mental hospitals are available for this purpose. Doctors are not permitted to prescribe stabilizing dosages for addicts, so that, besides the loose prescription practices of a number of doctors, there is considerable amount of dissembling by addicts, forging of prescriptions, etc. And there is believed to be a small black market in drugs. It is noteworthy that there is practically no diversion of drugs from the seven companies which manufacture them, or through the chemists (one offense in the latter category every two or three years).

Heroin has never posed a special problem, but Sweden imposed a ban upon it in 1952, and this has caused continuing dissatisfaction among some members of the profession. Some doctors assert, however, that heroin is much more dangerous in terms of addiction liability than the other opiates.

Outpatient treatment of addicts in the open departments of public health hospitals is not regarded as a success because, "the drug peddlers are right in the lounge waiting." In sum, Sweden seems to illustrate the consequences of a policy which neither vigorously represses drug addiction nor yet seeks to alleviate it by vigorous health measures.

The problem remains small-scale, but abuses and the illicit traffic have made their appearance.