Zwedenhb.qxd 6-12-97 12:53 Pagina 1 The Swedish Drug Control System Zwedenhb.qxd 6-12-97 12:53 Pagina 2 Zwedenhb.qxd 6-12-97 12:53 Pagina 3 Tim Boekhout van Solinge The Swedish Drug Control System An in-depth review and analysis uitgeverij jan mets cedro amsterdam Zwedenhb.qxd 6-12-97 12:53 Pagina 4 This study was financed by the Dutch Ministry of Health, Welfare and Sport and was made possible with the help of the Swedish National Institute of Public Health Zwedenhb.qxd 6-12-97 12:53 Pagina 5 Contents Foreword 8 Introduction 10 1 Relevance and Methodology 13 1.1 Background and Relevance 13 1.2 Methodology 16 2 Understanding Sweden 18 2.1 Introduction 18 2.2 Geography and the People 19 2.3 History and Economy 23 2.4 Social Democratic Tradition 26 2.5 The Role of Popular Movements 28 2.6 Conclusion 32 3 The Swedish Drug Experience 35 3.1 Introduction 35 3.2 Traditional Use of Central Nervous System Stimulants 36 3.3 The Experiment of Legal Prescription of Drugs: 1965-1967 41 The Experiment 42 Conclusions and Consequences 44 Discussion 45 3.4 The Definition of a Social Problem: 1968-1980 47 3.5 The Pursuit of a Drug-Free Society: the 1980s 52 3.6 Conclusion 58 Zwedenhb.qxd 6-12-97 12:53 Pagina 6 4 Understanding Swedish Drug Policy 61 4.1 Introduction 61 4.2 Alcohol in Sweden 62 Alcohol Consumption 62 Alcohol Policy 66 4.3 Popular Movements and Lobby Groups 72 4.4 Ideological and Scientific Foundations of the Restrictive Model 84 The Theories of Nils Bejerot 84 The Stepping Stone Hypothesis 86 The Dangers of Cannabis 89 4.5 The Function of a Restrictive Drug Policy 95 4.6 Conclusion 102 5 Swedish Drug Policy in Practice 106 5.1 Introduction 106 5.2 Drugs in Sweden 107 Amphetamine 107 Heroin 109 Cannabis 112 5.3 The Practice of Police and Justice 113 Police Activities 113 The Judicial Practice 118 Drug Seizures 120 5.4 The Treatment System 121 Methadone Programmes 127 Needle exchange 128 5.5 Conclusion 129 6 Is the Swedish Drug Policy Effective? 133 6.1 Introduction 133 6.2 Prevalence of Drug Use 134 Prevalence Figures 134 Estimations of the Number of Drug Addicts 139 Zwedenhb.qxd 6-12-97 12:53 Pagina 7 6.3 New Patterns of Drug Use 144 Skärholmen 147 Botkyrka 148 Angered 150 6.4 Police Activities 152 6.5 The Treatment System 157 Drug Treatment Programs 157 Compulsory Drug Treatment 165 6.6 Mortality and Morbidity 166 Mortality 167 Morbidity 170 6.7 The Debate on Swedish Drug Policy 172 6.8 The Future of Swedish Drug Policy 178 6.9 Conclusion 184 Notes 189 References 205 People Consulted 213 List of cedro Publications 217 Zwedenhb.qxd 6-12-97 12:53 Pagina 8 Foreword National drug control systems are complicated constructions. They devel- op in culturally – and historically – specific ways over years of experience and within boundaries shaped by other public concerns, social policies, and legal systems. In our series of studies on France, Germany, the United States of America, Belgium, and Sweden, we have tried to understand drug control systems from within. It is easy enough to read and summa- rise laws and policy documents, but this approach yields only a formal and superficial understanding of how drug control systems originate and operate. A much deeper understanding is possible when the many players within a drug control field are interviewed in person and in depth and when drug control is observed in action at the local level. This is the ap- proach we have taken. To understand a drug control system from within is to recognise that it is inextricably linked to a nation’s policies and ways of making policy in other fields. Drug control is only in part about laws; it is more impor- tantly about the application of laws. Further, health policy, social securi- ty, methods of managing deviance, and the judicial system are all more or less intimately connected to drug control. That is why a system of drug control can not be understood as autonomous from the institutional, socio-cultural, and political contexts that give it shape. The study of drug control systems is also complicated by the fact that drug policies serve functions far beyond drug control. In France, for ex- ample, public discourse about drug issues and drug control laws them- selves are symbols that help to continuously re-establish ideas about ‘civi- lity’.1 And, as in France, the Swedish drug control system is related to how the Swedish State in general has been defined. The specific form of the Swedish drug control system also may have been shaped by the develop- ment of the European Union. Closer economic relationships with the rest of Europe have led some Swedes to fear that the cultural influence of Eu- 8 Zwedenhb.qxd 6-12-97 12:53 Pagina 9 Foreword rope will also increase; and some see the ‘urban’ or ‘cosmopolitan’ cultures of Europe as incompatible with Swedish norms and morals. Such concerns sometimes make it appear that the strict Swedish drug control system is rooted more in myth and orthodoxy than in scientific evidence and rea- soning. But if that system is considered in the light of the symbolic and other functions it serves, then we are in a better position to understand why Sweden has the drug policies it has and why many Swedes feel these policies are effective. In short, to begin to understand the Swedish drug control system from within, one has to take these and many other factors into account. Yet we do not believe one can fully understand a drug control system only from within. A full analysis cannot accept at face value local or cul- turally-specific notions of, for example, the ‘causes’ of drug use. In this re- port, therefore, we also attempt a critical analysis – not to ‘criticise’ the Swedes, but to stand far enough outside their assumptions and world views to see the modes of reasoning that inform their drug policies. To do any less would teach us very little, for a true understanding of any one society’s drug control system requires a comparative view of how drug policy ‘happens’ in other countries. Peter D.A. Cohen, Ph.D. cedro – Centre for Drug Research, University of Amsterdam 9 Zwedenhb.qxd 6-12-97 12:53 Pagina 10 Introduction The Swedish drug policy is one of the most debated drug policies in recent years, a development that has accelerated since Sweden became member of the European Union in 1995. Whereas formerly in the European Union a tendency towards more a liberal approach to the drug question could be observed, Sweden’s joining of the eu meant there now was a member that advocated a restrictive line and stated too that they were successful with it. Since Sweden has been promoting its drug policy on the European scene, repeated references are made to the ‘Swedish model’. The Swedish drug policy is restrictive, which means that drug use is not tolerated. In 1977 the authorities formulated the drug-free society as society’s objective. For the implementation of this goal, substantial sums of money have been allocated for prevention and information, control policy, and treatment; the three pillars of the Swedish model. The fact that other countries refer to the Swedish model, does no mean that this is done with any accuracy. References to the Swedish case in international drug policy discussions are rarely based on facts. Both prohibitionists and anti-prohibitionists often perpetrate inaccurate messages about the Swed- ish example, which obscures the issue. If you believe the prohibitionists, a drug addict in Sweden is taken from the street by the police, then direc- ted to a social worker who decides what kind of treatment programme is most appropriate. Then, after a long and intensive period of treatment and rehabilitation the person is brought back into society and becomes a ‘normal citizen’ again. On the other hand, if you give credence to the sto- ries sometimes told by anti-prohibitionists, cannabis smokers in Sweden are arrested by the police and put into compulsory treatment. The more widely-accepted image that exists of the Swedish drug policy is that it is only by a rare example of a principled, non-pragmatic policy of not wanting to accept drugs by any means, that the drug problem is effec- tively reduced, without developing the negative consequences for drug 10 Zwedenhb.qxd 6-12-97 12:53 Pagina 11 Introduction users that are usually associated with restrictive zero-tolerance policies. On the contrary, Sweden would have encountered negative consequences of its drug policy in the period when it had a more liberal approach. An experiment of legal prescription of drugs from 1965-1967 would have proved to be a disaster. Learning from this experiment, the policy was drastically shifted towards a more restrictive approach that would have proved to be more effective. Hence, after having tried several models, the restrictive option would have turned out to be the best: a low prevalence of experimental drug use, and the number of drug addicts would be relative- ly limited and have a low incidence rate. In this study it will be shown that the practice of the Swedish drug policy is much more complex than it is often perceived and presented. To begin with, the ‘drug situation’ in Sweden differs substantially from other European countries.