Sweden’s drug policy with its goal of a "drug free society" is coming under closer scrutiny as a country that may hold the solution to Australia’s drug problems. What makes Sweden’s drug policy different and are there lessons for Australia when it is trying to grapple with the growing number of overdose deaths?

Sweden is one of the Scandinavian group of countries set to the north of most European countries with a population of about 8.8 million. At the turn of the century as it shifted from a largely agricultural country to an industrial one it was a country with widespread poverty. Its neutral stance in both the first and second world wars enabled it to develop its economy to become one of Europe’s richest and most industrialised countries. In the early 1990s the golden period came to an end , Sweden was faced with an economic crisis as GDP declined and unemployment rose from 1% in 1990 to 8.9% in 1993 where it roughly remains today. In 1995 Sweden joined the EU which heralded an end to the protected society that most Swedes grew up in.

In 1965 in Sweden a group of doctors, over a 2 year period from 1965 to 1967, undertook a project of prescribing some illicit drugs during which time 120 patients participated. This project that has been used as an example to extensively oppose the ACT heroin trial and to "prove" that prescription heroin is a catastrophe giving rise to an epidemic of illicit drug use. A report on the project by police doctor Nils Bejerot is the basis for every claim that Sweden's prescribing project led to a 'massive rise of the number of addicts' in the 1960's.

The facts are somewhat different to the claims. The project was never meant as a scientific experiment, but merely a project that grew out of some doctors’ practical work. The substances prescribed were primarily amphetamines for oral and injecting use, methadone and morphine. Heroin was never prescribed in this project.

In the beginning there were 10 doctors involved but by end 1965 only one continued. The project was mismanaged and poor medical practices were followed. The remaining doctor delegated part of his work to some patients who were permitted to prescribe and distribute. Drug doses were not consistent, there was over-prescribing, drugs leaked onto the black market and patient records were not kept. The project came to an end when a 17 year old girl who was not a participant of the project, died from amphetamine and morphine administered by one of the patients.

Nils Bejerot in a study of arrested drug users during 1965 – 1970 claimed to find data to support his hypothesis that "permissivity" of this project had led to an increase in intravenous drug use in what he claimed to be an epidemic like spread. He claimed the experiment had a triggering effect for his epidemic. His underlying assumptions have been questioned by the scientific community, in Sweden and abroad, since his ideas are rarely shared by that community but his arguments have been widely accepted by government officials.

His influence marked the beginning of Sweden’s gradual drug policy shift to increased criminalisation of drug use. Where once the possession of small quantities of cannabis were met with a fine they now are dealt with as a criminal offence. Its aim of a "drug free society" was introduced in 1977 by a new coalition government, the first non Social Democratic government since 1932. From that time drugs took on greater prominence in political debates. Disagreement with the policy is generally not tolerated. As Per Johansson of RNS magazine (Oct1996) said "if you want to stay in power, you can not say you want a more liberal approach to drugs. It would be your political death".

There is no distinction between 'soft' and 'hard' drugs. Cannabis, a relaxant with a low risk of dependence and for which no deaths have been recorded (but it is not a drug without risks) is given the same zero tolerance as harder drugs because the Swedes believe it can harm the psychosocial development of teenagers.

Special laws in the 1980's allowed forced treatment for adult drug abusers. According to Henrik Tham, professor of Criminology University of Stockholm, such treatment has never been shown to have any positive effect on drug abuse. He also states that imprisonment for drug related offences have tripled since the late 1970's and that the long prison sentences, together with application of harder drug laws, has contributed to the worsened situation in prisons. In recent year drug offences number about 30,000, of which about 7000 result in convictions with 69% minor drug offences. About 40% of people in prison are drug users.

In 1993, police were given authority to perform blood and urine tests on suspected drug users. No disturbance was necessary. Up to the end of 1997, 39,000 blood and urine tests have been taken at a cost of $A1.2 million per year. Despite some police not being convinced of the effectiveness of the law, the police are now waiting for a new law that will allow them to test any person without reason.

Since joining the European Union and through fear that it may be swept up by the EU's moves towards decriminalisation and legalisation of drugs, the Swedish government has been aggressively marketing their drug policy at drug forums throughout Europe and to visiting officials at home. In 1995, the European Parliament voted to decriminalise the possession of drugs for personal use.

A controversial part of the Swedish drug policy is police action against drug trafficking on the streets. While authorities admit that traffickers will simply move to another street, they believe the police action will make it harder for the traffickers to make contact with casual abusers and young persons. A special police unit visits nightspots and rave parties in Stockholm looking for drug sellers/users. The authorities also believe that such Police action shows the public that drugs are not tolerated.

Police activity is focused on the goal of a "drug free society". The downside of this focus is that the police are being swamped by other rising crime. The amount of solved crime is falling and the backlog of crime still awaiting investigation is rising. Police cannot keep up with crimes of violence, narcotics offences and economic crime.

Treatment

Another goal of Swedish drug policy has been not to punish drug users, but to offer help and rehabilitation, described as a "caring chain" of outreach services, detoxification, out-patient care and institutional care comprising abstinence based treatment, methadone maintenance. Syringe exchange programs are also available.

One controversial form of drug treatment is compulsory treatment. Nationally there are 1,360 people in compulsory treatment homes. The compulsory treatment of drug users is said to be uncommon and relatively rarely applied. However for drug using teenagers it is often used as a "threat" to force someone into "voluntary" treatment.

Has Sweden achieved a "drug free society" and will it ever achieve that goal? The answers are "no" and "probably not".

Deciding whether or not the Swedish policy is effective is problematic. In the case of treatment it is usually unclear what the statistics mean and they are not usually measured in terms that a long term chronic relapsing condition would normally be measured.

Measuring in terms of drugs seized by police has the effect of measuring police activity and not success of policies. Measuring in terms of drug users provides some answers but questionnaire responses (like our National Household Survey) are usually under-reported because of prevailing attitudes toward drugs and drug use.

In a 1992 study of 102 people who underwent compulsory treatment, after 6 months 9% were abstinent, 18% had reduced abuse, 28% had gone on voluntary treatment and 13% underwent compulsory treatment again. In that same period 7% of the clients had died. The mortality among the compulsory group is higher than those who undergo voluntary treatment. This provides a note of caution for NSW’s trial of drug courts and will also provide a useful yardstick.

Deaths from illegal drugs is one of the most significant indicators of success of drug policies. In Sweden there has been an increasing death trend since 1989, not downward as one would expect if the policy was successful.

When compared with other European countries Sweden’s death rate of 28.4 per million in 1997 shows that its policies are no more effective in reducing drug deaths. The size of the problem drug-using group is approximately the same and therefore does not account for the difference. (Australia is shown for comparison.)

One of the most critical comments of the Swedish Government's policy comes from Reto Scholl, MD, Erlinsbach, Chief of Aarau Hospital, Sweden. He believes this data cannot support the assertion that the restrictive drug policy is responsible for the country's low drug use. He said (International Journal of Drug Policy, Vol 6, No 2, 1995) that the official reports represent state expectation, not documented facts and "in spite of the Swedish government's rhetoric, there are no data upholding the contention that a permissive drug policy would increase the number of drug consumers."

In summary Sweden has not solved its drug problem and is in fact lagging behind many other European countries in terms of the harm caused by illegal drug use. There are nevertheless lessons to be learned if only to identify and eliminate those policies that do not work and are not based on the evidence. For a solution to the drug problem, Australia must look beyond the simplistic slogans of a "drug free society".