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Is Sweden's zero-tolerance approach to drugs a failing model?

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Sweden has one of the highest fatality rates from opioid overdoses in Europe. Photo: Matt Rourke/AP
10:58 CEST+02:00
Sweden is accustomed to being praised for its forward-thinking approach, but there's one area where many feel it lies behind the curve. The country's "zero tolerance" policy towards drugs is an increasingly isolated one compared to its neighbours, and has even been subject to criticism from the UN. The Local's Sweden In Focus series looks at why Sweden takes such a hard-line stance on drugs, what the consequences are, and if it will ever change.

Sweden's long-standing zero-tolerance drugs policy is based on the fundamental vision of a "drug-free society", and was shaped by lobbying group The Association for a Drug-Free Society (RNS). The group, founded by psychiatrist and "father of Swedish drugs policy" Nils Bejerot in 1969, pushes for the prevention of drug use through penalties rather than treatment of drug addiction. This has led to tough policing with a focus on small crimes of possession.

As the Swedish government's website explains, the zero-tolerance policy makes no distinction between "hard" and "soft" drugs. Police can detain and give a compulsory urine test to anyone they suspect of being high – followed by a criminal charge if proven to be true.

When it comes to cannabis, the Swedish model can claim success: the country has one of the lowest consumption rates of the drug in Europe, though it has increased since 2000 and many countries have insufficient data in the area, which makes broad comparisons difficult.

When it comes to opioids however, Sweden's hard-line approach looks increasingly ineffective and dated. In 2017, the World Health Organization called for the decriminalizing of drug use and possession of drugs for personal use, saying current laws have "proven to have negative health outcomes and counter established public health evidence". That followed a WHO report from three years earlier which called for wide-ranging drug policy reforms including decriminalization of drug use and a focus on harm reduction measures like needle exchanges.

Successive Swedish governments have had a very different opinion, and were criticized for as much in 2015 by the UN, whose deputy commissioner for human rights Flavia Pansieri said she was "surprised to see that Sweden lags behind a number of other countries in terms of its policies on drugs". In particular, a lack of needle exchange programmes – something Sweden was traditionally resistant to and viewed as doing more harm than good – was highlighted as a key problem.

READ ALSO: Sweden's drug rules violate human rights, UN says

Pansieri's criticism is supported by evidence. In a 2016 report by the European Monitoring Centre for Drugs and Drug Addiction, Sweden registered the second highest rates of death due to overdoses in Europe (93 people per million, behind only Estonia), with the rate among adults (15-64) steadily increasing from 2006. In the same report Sweden was one of the European nations with the lowest totals of syringes provided through specialized programmes.

Malmö University's Torkel Richert, whose research specializes in drug overdoses and usage, says Sweden is not performing well:

"The bigger picture is that Sweden has for a long time had a big increase in overdoses. And if you compare it with Europe in general we're doing badly."

"You have to be very careful when comparing stats between countries as different countries compile them in different ways. Some are better at reporting than others, and Sweden is generally very good. So there's an argument that it's not as bad as it looks, but I would say that we are in a very bad position in any case, even if it's perhaps not the highest. And if you look at Sweden at a national level you can also see a significant increase. So you can be clear about seeing Sweden as having a very bad situation when it comes to drug-related fatalities," he adds.

SWEDEN IN FOCUS: An in-depth look at what makes this country tick


Torkel Richert. Photo: Malmö University/Håkan Röjder

According to Richert, Sweden's failure to mirror other European countries' focus on harm reduction and overdose prevention methods, combined with an increase in use of opioids, could create a lethal outcome.

"The attitude towards drug addicts in Sweden has been embarrassing in many ways. They're a very stigmatized group. The phrase here in Sweden was 'it should be difficult to be a junkie'. And politically the idea is that if it is tough, more will want to stop. So there has been a hard policy with police playing a central role in order to fight narcotics at street level. That has impacted the vulnerability of that group: for example you don't dare call an ambulance when a friend has overdosed because you're worried police will also come and there's a penalty as a result. So drug policies can impact the vulnerability and life situation for those who have a problem."

In 2015 there were only nine needle exchange programmes across the entirety of Sweden, a consequence of a prevailing sentiment that they enabled drug users rather than solved problems. In 2016 however the Swedish government made a significant change to legislation in the area as part of a new four-year national drug strategy, removing the right for municipalities to veto the creation of syringe exchange programmes, and dropping the minimum age for access to exchanges to 18. By 2017 the number of needle exchange programmes in the country had increased to 14, with more planned to open this year.

Sweden's minister for Health and Social Affairs Annika Strandhäll says the country's drug policy needs to evolve.

"Swedish drug policy needs to be developed, and we're in the middle of that work. During the current mandate period we've increase access to needle exchanges and put greater emphasis on reducing harm and fatalities caused by narcotics. Efforts we know are effective. We've also mapped mortality and developed measures to reduce it. There's still a lot left to be done, but I feel sure we're on the right track and have taken important steps in the right direction," she tells The Local.

According to Sweden's National Board of Health, in 2016 the number of narcotics-related deaths in the country reduced for the first time in ten years, suggesting the increase in needle exchanges has had an impact – though it is too early to say if a real trend change has occurred. The agency emphasizes however that the fatality rate remains high.


Health and Social Affairs Minister Annika Strandhäll. Photo: Fredrik Sandberg/TT

"We have a comparatively high narcotics fatality rate in Sweden, and that's very serious. Every person who dies as a result of drugs is one too many, and that's also one of the key reasons why we've brought in several important changes during our mandate period," Strandhäll notes.

"I think we need to continuously consider what methods we can use to reduce drug-related fatalities – methods built on research and proven experience," she adds, pointing to not only increased needle exchanges, but also improved access to the drug Naloxone, which can counteract opioid overdoses and save lives.

Malmö University's Richert says there have certainly been positive developments in Sweden, but they should have happened earlier.

"If you compare us with many other countries, needle exchanges were considered a no-brainer for years. Naloxone has been given out in Norway and Denmark for quite a long time, as well as other countries. So we're behind there," he says.

So what could the next step be in modernizing Sweden's drug policy? One radically different approach being seriously considered not far from Swedish soil is the one pioneered by Portugal. There, possession for personal use and the consumption of drugs was decriminalized in 2001, with state funds shifting to education, care and treatment rather than putting people in prison.


Portugal changed its drug policy in 2001. Photo: Armando Franca/AP

The result? Use of illicit substances among the adult population has been in decline in Portugal over the last decade. The most recent comparative data shows that the drug-induced fatality rate among adults there was 5.8 per million in 2015 – well below the European average of 20.3 deaths per million, and a tiny fraction of Sweden's 100 deaths per million for the same year.

Portugal's success has not gone unnoticed in the Nordics. At the end of 2017 there was cross-party backing in Norway's parliament for decriminalizing drugs, where politicians are following Portugal's lead and changing focus towards providing help for those struggling with addiction. Safe consumption rooms, where drugs can be injected in a hygienic, controlled environment, already exist in Norway as well as Sweden's other western neighbour Denmark. Denmark's health ministry says the rooms have saved hundreds of lives since they were opened in 2012.

READ ALSO: Injection rooms save hundreds of lives, Denmark says

"You could argue that consumption or injection rooms like they have in those countries are a way of reducing the risks for vulnerable groups like homeless drug users. That's a controversial question in Sweden, but I think we need to consider in any case having a discussion about these kind of measures," Richert says.


An injection room in Copenhagen. Photo: Drago Prvulovic/TT

Going even further, like Portugal has and Norway plans on doing, is more controversial still. But Richert contests Sweden should at least look at the Portuguese model and see if there is anything it could learn:

"Many other countries are considering following at least parts of that model. Sweden should at least look at that, see what can be learned. You can't directly copy policy from one country to another, but you can look at what worked and see what would work in a Swedish context, which we're still bad at."

There are small signs bigger changes could happen in Sweden in the future. Youth branches of the Centre Party and Liberal Party have called for a loosening of the current hard-line model and the decriminalizing of some drugs, suggesting a generational shift in power may one day lead to different ideas in the area. Some sitting MPs are already calling for major changes, like Liberal MP Christina Örnebjär, who argues Sweden's current approach has failed.

"A zero tolerance against drugs has unfortunately become a zero tolerance against those who use drugs. It's rare that we take those who we're actually talking about with us when we talk about drugs and problematic use of them. We talk about people instead of with them. I think user associations being part of the discussions on these issues should be a no-brainer," Örnebjär tells The Local.


Christina Örnebjär. Photo: Liberalerna

Örnebjär backs decriminalizing drugs in Sweden, and is convinced a more serious conversation on the matter will happen in the future.

"It's on its way. A couple of weeks ago I held a seminar in the Riksdag where MPs from six parties were invited to speak about a forward-thinking drug policy. It was an historic seminar: we've never seen anything like it with as broad a backing. There are also more and more of us highlighting the issue in debates and articles," she says.

"At my own party's congress in November the issue of decriminalization was raised, and even if we lost the vote, many important steps forward were made, and even just the debate in itself was important. On top of that, it wasn't a big majority at all that voted against it, so I have good hope that at the next congress we can raise the issue again."

The Social Democrat government does not agree that decriminalization would be a solution to Sweden's high drug mortality rate however.

"I think it's too easy to say that decriminalizing or legislation would solve the problems we see. The drug issue is more complex than that. That doesn't mean we can't do more to give people with addiction and dependencies care and treatment. There's no contradiction there," Strandhäll argues.

"I think you have to be careful about thinking that the same solutions work in all countries. It's a different context and different starting point. We have different problems to solve."

Liberal MP Örnebjär would like to see an improvement in the level of debate on drug policy in Sweden going forward, where she feels discussions are still too easily shut down, and also called for more independent information to be made available.

"It's easy to communicate that it should be illegal to take drugs and that we should have a drug-free society. However anyone who tries to raise the problems, contrast use with abuse, or have a discussion on whether we should have information available on how drugs are used is certain to be labelled as a drug liberal," she says.

"We need more evidence in the debate. For teenagers who want to know more and are looking for information it's unbelievably difficult to know which sites are based on facts. It's difficult even for a member of parliament. More independent research and clear, independent information is needed."

Overdose resarcher Richert is ultimately optimistic that Sweden has turned a corner and will keep moving in a more constructive direction:

"If you look at what has happened in the last five years there have been a lot of positives. It's also not the case that everything about a restrictive model is bad. So you can combine it with a more humane policy which takes care of those who have serious drugs problems," he recommends.

"You can keep working with an attitude that we should have as few people as possible caught in drug problems, that's good. But what we've been bad at is taking care of people who for various reasons have a hard time dropping their drug problem – that group has been stigmatized by this hard line. That has to change."

This feature is part of The Local's Sweden in Focus series, taking an in-depth look at the issues that make Sweden tick. Click here to read more articles.

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