APPENDIX 1 2005 NATIONAL REPORT (2004 data) TO THE EMCDDA by the Reitox National Focal Point Sweden New Development, Trends and in-depth information on selected issues REITOX FOREWORD This Report on the Drug Situation in Sweden is produced for the European Monitoring Centre for Drugs and Drug Addiction in accordance with the decisions of the Management Board of the Centre. The report has been prepared in cooperation with a number of national agencies, institutions and experts. Main authors are Mr Bengt Andersson, Ms Kajsa Mickelsson, Mr Bertil Pettersson, Ms Jenny Sandgren and Ms Sara Ullman at the National Institute of Public Health. The report is mainly an update of previously delivered data in areas where new information has developed or where the guidelines are changed in relation to previous reports. Chapter 11 is written by Ms Karin Trulsson and Ms Ulla-Carin Hedin and the major part of chapter 13 by Mr Philip Lalander. Gunnar Ågren Director General National Institute of Public Health 2 Table of Contents Summary ................................................................................................................... 4 Part A: New Developments and Trends.................................................................. 6 1. National policies and context ......................................................................................... 6 2. Drug Use in the Population............................................................................................10 3. Prevention.......................................................................................................................13 4. Problem Drug Use ..........................................................................................................19 5. Drug-Related Treatment.................................................................................................24 6. Health Correlates and Consequences ..........................................................................29 7. Responses to Health Correlates and Consequences ..................................................33 8. Social Correlates and Consequences...........................................................................36 9. Responses to Social correlates and Consequences ..................................................38 10. Drug Markets ................................................................................................................41 Part B – Selected Issues ........................................................................................ 46 11. Gender Differences ......................................................................................................46 12. European Drug policies: extended beyond illicit drugs ............................................63 13. Developments in drug use within recreational settings ............................................68 Part C- Bibliography, Annexes .............................................................................. 77 14. Bibliography .................................................................................................................77 15. Annexes ........................................................................................................................88 3 Summary Most of the indicators used to monitor the drug situation in Sweden indicate that the problem with illicit drugs is serious but also that positive changes are observed in some areas. Prevalence figures are levelling of or decreasing, public attitudes to drugs support a restrictive policy, the need for treatment and rehabilitation is recognised and is given priority, the local level is integrated in the work and a multitude of efforts are initiated within the scope of the national action plan on drugs. Drug use as measured in various surveys is usually stable or levelling of. Cannabis life time prevalence (LTP) in the general population has in the last four surveys (98, 00, 04 and 05) been 19%, 16%, 18 % and 15% (men) and 10 %, 9 %, 10 % and 9% (women). In the school population (age 15-16) the rapidly increasing LTP during the 1990s (peak 10% in 2000 and 2001) has turned and for the years 2002 and 2003 there is a decrease. In the survey 2003, LTP was 7 % for both boys and girls and this holds true also for 2004. The last 30 days prevalence for boys decreased from 3 % to 2 % between 2002 and 2003 and was in 2003 the same for both sexes. In 2004, an increase to 3% was noted for both sexes. Also in the group military conscripts (age 18), there was a decrease in LTP between 2002 and 2004, from 18% to 15% and a slight decrease in the last 30 days prevalence from 3% to 2%. Regarding attitudes to drugs there is a continuous support for a restrictive drug policy as reported previously. From the studies initiated by the National Drugs Policy Coordinator (NDPCo) under the title “to take drugs occasionally” a liberal view is expressed in the youth groups interviewed regarding cannabis but simultaneously the support for the Swedish restrictive policy prevails. This is also mirrored by the section 13 review on recreational drug use. It can be seen from the qualitative studies that a large majority of those who have tried illegal drugs consider drug use as an exception, not as a central or normal part of their lives. Most of them are aware that drugs can have a negative impact on their future if they let their drug-taking become more frequent or long-term. For this reason, they develop risk- management strategies such as taking drugs only at particular occasions, never using in their hometown or never buying drugs – only accepting when offered. Most young people have been influenced by society’s message that drugs are a bad thing, and this guides their decisions and actions to some extent so that they either do not try at all or, if they decide to do so, impose certain limits on their drug use. Taking drugs is not a normalised action, but rather an exception. The problematic drug use is difficult to estimate and studies are not performed regularly. Most recent data as presented in this report shows a decrease in problematic drug use over the last years giving a central rate/100 000 of 4.5 in the 15-64 intervals in 2003. Sweden is primarily a market for illegal drugs produced abroad and smuggled into the country. Mirrored as seizures cannabis is the dominating drug followed by amphetamine, illegally obtained pharmaceuticals (tranquilisers and pain killers) heroin and cocaine. Mirrored as prevalence in different surveys cannabis is by far the drug most experienced. A worrying and possibly increasing problem is the not uncommon use of GHB or some of its analogues (GBL, 1,4-BD). GHB is most likely the only illegal drug found to be clandestine manufactured in Sweden (from GBL or 1,4-BD) at a scale intended for sale at the illegal market. GHB was classified as a narcotic drug in 2000 and since September 2005 GBL and 1,4-BD are controlled under act on prohibition of goods dangerous to health. The implication is that permission is needed for all use. An investigation of the price development for illegal drugs over the last 15 years shows that the price at street level (adjusted to the 2004 monetary value) is about halved for hashish and cocaine since the end of the eighties. In 2004 one gram of hashish was reported to cost around 8 € and one gram of cocaine around 80 €. For amphetamine and brown heroin prices 4 are about 60 per cent lower today than 15 years ago. Prices per gram of amphetamine and brown heroin in 2004 were around 25 € and 100 € respectively. The implementation of the national action plan on drugs (introduced in 2002) is run by the national drugs policy coordinator (NDPCo). A marked increase in drug prevention activities, mainly due to initiatives from the coordinator is noted. By government support, the majority of the 290 local authorities in Sweden have been able to appoint local drug coordinators for the alcohol- and drug preventive work in order to strengthen the local mobilisation. The NDPCo has also initiated a wide variety of activities in the areas of research, supply and demand reduction, opinion forming, treatment and rehabilitation - including the prison and probation area, training and mobilisation at the local level as well as interventions in the recreational area. Some results are presented in this report but most activities are still running. The responses to health correlates and consequences of drug abuse have been down-sized for a long period. Based on a series of reports the NDPCo highlights the unfulfilled needs of drug abusers in the 2004 annual report. Some of the conclusions from the NDPCo are: - A functional treatment system has a positive effect on health development and on decreased mortality, - The problematic abusers and immigrants with drug problems do not receive the kind of treatment they need, - Outreach work is nearly extinct. The NDPCo proposes that there should be a strengthening of resources in several areas, and among them, a guarantee securing treatment for those in need, and professional drug treatment within the prison system. Two other areas of priority for the NDPCo are to i) develop the Prison and probation system to a high-qualitative treatment system for drug abusers and ii) to upgrade and coordinate the efforts against the organised crime in drugs, commonly international. In the bill for 2005 the government allocated 90 million € to drug related treatment for the period 2005 – 2007. It is further proposed that an agreement should be