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Illicit use of methadone and buprenorphine among adolescents and young adults in Sweden

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The drug policy of Sweden is based on zero tolerance focusing on prevention, treatment, and control, aiming to reduce both the supply of and demand for illegal drugs. Penalties are divided into four degrees. If the offence is deemed minor, the penalties range from fines to a maximum of six months in jail. The normal grade of narcotics crime may result in penalties ranging from fines to a maximum of three years in jail. If the crime is deemed a serious narcotics offence, the penalties range from at least two years in jail to a maximum of seven years in jail. Exceptionally serious offences can result in a prison sentence of at least six years and a maximum of ten years. There is also related legislation for mandatory health care that can be used in conjunction with a sentence for a drug-related offense. A study conducted in supported the view that the new tougher policy had a preventive effect on drug use. Two Swedish cities topped the rank in illicit amphetamine use out of the 25 European cities tested in a residual water analysis study in According to the European Monitoring Centre for Drugs and Drug Addiction EMCDDA , in , the rate of drug-related deaths per capita in Sweden was more than twice that of the Netherlands and there were more persons addicted to severe narcotics 'heavy drugs' than in other countries. Between and , the EMCDDA recorded a more than doubling in the rate of drug-induced mortality among adults 15—64 in Sweden, with the country moving from having the ninth to having the second highest rate in Europe. There are several other causes behind the increase in the reported number. Historically, Sweden had been a poor country with a comparably low standard of living. Although it is a member of the vodka belt and has a tradition of widespread tobacco use, other drugs were rarely used until the midth century. The 19th century saw the rise of the temperance movement , alongside free churches and the labour movement. This resulted in low levels of alcohol use throughout the s. The temperance boards continued to exist after alcohol rationing ended in The law regulated the import and export of some opiates and cocaine. In , the law was extended to include more opium derivatives and cannabis. Possession was restricted as well. Initially, the punishments consisted of fines. Non-medical drug use was rarely seen, but did exist among medical personnel, bohemian artists, writers and jazz musicians. Often the drugs used were supplied by prescription. In , amphetamine was introduced in Sweden, and a year later required a prescription. Gradually the supervisory authority, the Royal Medical Board, made more stringent recommendations for prescribing narcotic drugs. Sometime in the late s, a group of artists began dissolving amphetamine tablets in water so that it could be purified and injected intravenously. In the s, there were signs of emerging drug use in Stockholm. On 27 April , the first debate was held in the Riksdag, the Swedish parliament, regarding drug use. The center-right opposition had filed an interpellation about the drug problem. The issue discussed was whether the government considered that drug use justified an increased vigilance by society and, if so, if it was considering a change in the laws to rectify the problem. The Riksdag believed that further debate was unnecessary since information, collected from the Royal Medical Board and the Police, stated that drug abuse was not a serious problem in Sweden. In , the punishments became harsher, setting a minimum fine and introducing up to six months imprisonment as a possible penalty. Amphetamines became the primary illicit drug until the late s, when cannabis became more popular. In , the maximum term was reduced to one year. There were signs of increasing drug use; hashish was smoked openly in major cities in the late 60s. The National Board of Health and Welfare , the agency that superseded the Royal Medical Board, argued that police would use the resources better than the prison system. The intention was to arrest more drug offenders, given the hope that a higher risk of getting caught in itself would have a more preventative effect then a long sentence. In , the legal prescription of drugs began in Stockholm, after a campaign strongly supported by Expressen , the biggest newspaper in Sweden in the s. Some doctors received the right to prescribe drugs, such as amphetamine and morphine, to addicts. The idea was that doctors would have the right to prescribe the drug to chronic addicts in order to reduce their propensity to commit crimes. More than 4 million normal doses were prescribed. He believed the patients should control their dosage and he allowed patients to take their prescriptions home asking for more whenever they ran out earlier than expected. Eventually, police seizures showed that the drugs had become available to persons not involved in the project. Nils Bejerot opposed the prescriptions and worked as consulting physician to the Stockholm Remand Prison. He conducted studies of injections marks from drug abuse at the prison which indicated a strong increase in the number of intravenous drug users during the experiment. In , the municipal temperance boards merged in with the boards for social welfare and child social welfare \[ 31 \]. The Narcotic Drugs Penalty Code of , including an increase of the maximum penalty for sale of illegal drugs from 2 to 6 years in prison. The law distinguish between three grades of drug offences. Section 1 was applied for offences of normal severity: illegal production, offering for sale, transfer, and possession of narcotics were punishable by fines or imprisonment for not more than two years. Section 2 was applied for petty offences; punishable by fines only, nolle prosequi was easy to receive for minor drug crimes in the s. Section 3 was applied for gross offences, punishable by imprisonment for between one and four years. When determining whether the offence was gross, special attention was to be paid to whether it was committed professionally, on a large scale, involved large amounts of drugs, or whether it was especially dangerous. But these were only examples of relevant factors; their presence was not a guarantee the offence was gross, and their absence did not mean the offence could not still be gross. The preparatory works mention that transfer of drugs to young people could lead to the offence's classification as gross. The danger of the drug involved was also to be taken into consideration. The Prosecutor General expressed the view that substances which threaten life or rapidly debilitate the addict should lead to the application of section 3 of the Narcotic Drugs Penalty Code. This group included opium derivatives, like heroin, as well as LSD. In , fearing that low punishments would attract international drug traffickers, the government increased punishments for crimes involving the most gross degree, and the corresponding laws on smuggling were increased to a maximum penalty of six years. Hemp , which had been grown for industrial purposes, had not been affected by the opium conference in However, in cultivation of hemp was banned on the grounds that it was a drug. In , the Narcotic Drugs Penalty Code was strengthened again, increasing the maximum prison sentence to ten years for more severe crimes. In , about police took part in a short-term, fivefold increase in the numbers of officers engaged in drug enforcement. The resources allocated to drug work steadily decreased between and In —79, the Prosecutor General recommended that prosecutors lower the limit for drugs which could be ignored as personal use. Tougher prosecution policies were introduced by the chief prosecutor in Stockholm, and resources for drug law enforcement were again increased. In the s and s, lawmakers continued to make smaller modifications of the drug laws, expanding their coverage, increasing maximum sentences, altering early release rules, and introducing treatment options as an alternative to imprisonment to be used at the discretion of the courts. In , contract treatment for drug abuse as an alternative to imprisonment was implemented into the law. Contract treatment is a possible consequence of a clearly drug-related crime, and an option for any Swedish court; the option is not limited to special Drug courts. If the person misbehaves, the sentence can be transformed into a prison sentence. The minimum imprisonment for serious crimes increased from one year to two. In , the Misuser Act LVM made it possible for municipalities to place very seriously drug dependent criminals in mandatory treatment with restrictions for a number of months. The same type of law had been used only for very serious alcoholics in the past. Mandatory treatment, according to this law, has been used for a hundreds people per year; in , it was used for people with serious drug problems, and with both alcohol and drug problems. In , all use of drugs, even in very small quantities, became a criminal offense, punishable with fines, under The Narcotic Drugs Penalty Code of In the same year, a special form of probation, contract treatment , became available as an alternative to imprisonment in cases of alcohol or drug-related crime. This treatment was available only to offenders willing to undergo the drug or alcohol treatment as decided by the courts. This hurt the local economy with the cutting of tax financed social budgets. Many specialized drugs squads all over the country disappeared. In , the maximum sentence for illicit use of drugs was raised to six months in prison, though the normal punishment remained a fine. The reason for raising the maximum penalty for drug use to six months' imprisonment was to make it legal for police to conduct a body search, which may only be implemented if someone is suspected of a crime carrying at least six months' imprisonment as the maximum punishment. In the same year, the law was amended to allow for early release of all prisoners, not only those convicted of drug crimes. Between and , in principle, prisoners were released after serving half the time. For those who were convicted after 1 July , the rule became two-thirds of the imprisonment term. After , early release became conditional. One effect of the EU's rules was reduced control of illicit drugs at the borders. The Swedish customs authority stop making random stops on the traffic and passengers who enter from EU countries; the number of employees in the Swedish customs authority is reduced by a third. Between and , professor Johannes Knutsson concludes after a study of drug use and drug policy in Sweden that the 'stricter enforcement contributed to Sweden by international standards has a lower percentage of young people who tried drugs. In , the government of Ulf Kristersson proposed increased criminal penalties, such as criminalizing attempts and the conspiring to commit a narcotics offense, as well as increasing the minimum penalty for narcotics possession where there is an intent to distribute to six months imprisonment. Attempting and conspiring to commit a narcotics offense with the goal of personal consumption would be left out of the criminalized area. The main focus of drug policy is focused and concerted efforts to limit both supply and demand of drugs. Strengthened efforts are needed to strengthen the political priority of the drugs, to improve cooperation between different authorities and between authorities and organisations, to improve the preventive work among other things through the method and skills development, development of care through, inter alia, methodology and skills development and research, develop treatment perspective of prison, streamlining operations in the field of control, improve the methods to comply with drug development and society's efforts, and to increase international cooperation. The government sets up a special national drugs coordinator with the task of implementing and monitoring the action plan and sets aside MSEK extra over three years to implement the Action Plan. In , in compliance with EU rules, cultivation of industrial hemp with less than 0. In , the Prosecutor General issued a recommendation containing more than pages to prosecutors about penalties they will require for drug offenses based on previous judgments of the Supreme Court in Sweden. The report also contained a classification of hazard of more than 50 different drugs. The recommendation was expanded for a revised edition in and The strategy was similar to the plan. The overall objective of the Swedish drugs policy is: a drug-free society. There are three sub-objectives:. In , an updated study showed a continued decline in drug use among pupils and high school students. As police efforts began to focus on demand reduction from to drug use of cannabis continued to drop. Drug experimentation was falling throughout the s, redoubling in the s, and falling again in the s. Estimates of heavy drug addicts have risen from 6, in to 15, , 19, , and 26, According to inpatient data, there were 28, such addicts in and 26, in , but these last two figures may represent the recent trend in Sweden towards out-patient treatment of drug addicts rather than an actual decline in drug addictions. Between and , drug-induced mortality rates in Sweden have risen steadily, with the country moving from having the ninth to the second highest rate in Europe. From 1 April , the police and customs may seize synthetic drugs that are not on the list of drugs covered by the anti-drug laws if the police suspect that the purpose of the holding is related to drug abuse. It's about synthetic drugs that manufacturers changed a bit in the recipe so that the drug therefore become lawful. See also designer drugs. Following a decision by a prosecutor, the police may destroy the seized. The reason for this change in the law are a number of deaths due to ingestion of unclassified synthetic drugs, often sold in online stores. The last decade, the treatment of drug addicts with Methadone and Subutex and the number of people in the syringe exchange programs increased significantly. The number of clinics that provide treatment with Methadone or Subutex has increased from one clinic to clinics. The downside of this development is much less control over who gets those drugs and how much. An increasing number of drug-related deaths can be linked to over-consumed prescribed drugs. This has led to claims that the number of doctors who can prescribe such drugs must be strictly limited to a minor number of specialist. Since , the police have had the legal right to take action against people they suspect of being under the influence of drugs even if they are not disturbing anyone. Many Swedish police officers have, since , received training in how to recognize the signs and symptoms of being under the influence of drugs. In such cases, the suspect may have to produce a blood or urine sample for analysis. About 27, drug use verification tests and 10, drugged driving and drug use tests two separate offences were carried out in If the sample contains drugs or traces of drugs, the person is guilty of a personal use minor drug offence. One of the justifications for this legislation was to make it possible to find and apprehend people to offer care and treatment at as early a stage as possible. The police have an obligation to inform the social services of all cases of drug use that come to their attention. The penalty for drug offences depends upon the seriousness of the offence. For minor drug offences, the court may impose a fine or prison sentence of up to six months. More serious offences always carry a prison sentence, usually up to a maximum of three years. If the offence is considered particularly serious, the sentence will be anything from a minimum of two to a maximum of ten years. In recent years, drug testing of suspected abusers has been used as a first step in motivating them to seek treatment. The anti-drug program also includes information and low cost treatment for any citizen with an addiction to drugs. Contract treatment instead of prison is primarily used for recurrent drug addicts where there is a clear link between a crime and the addiction. Instead of serving a prison sentence of up to two years, the convicted person signs a contract with the court to undergo a treatment programme at an institution or at home , to partake in non-custodial care, or both. Almost every municipality has its own local anti-drug coordinator to provide a broad drug preventive work directed at youths, in cooperation with politicians, police, church, educational associations and societies. In , Sweden had 84 people per , in either prison or remand prison. This is less than the average for the OECD people per , and much less than the number for the United States per , If the penalty was only fines the police erase the record after five years. This has helped to create a more calm situation, especially in high security prisons. By comparison the figures for the U. It can not be excluded that there also has been a real increase in the number of drug-related deaths. According to the EMCDDA standard definition that only counts deaths directly related to drug consumption, there were drug-related deaths recorded in , of a total Swedish population of 9. The reported drug-related death rate in U. In Sweden, drug-related deaths is counted in three ways. One is according to the EMCDDA definition for international comparisons presented above, but a general weakness of the EMCDDA's statistics is that many drug-related deaths are treated as death of natural causes even though the deaths are due to a disease that typically comes after a long period of substance abuse or due to an accident under influence of drugs. The other two take that in account and find usage in national comparisons over time. The longest series of statistics is from the register on Causes of Death , it includes cases where drug-related diagnoses is noted on the death certificate both as direct and underlying cause. There is also a line of statistics for which all cases where illicit drugs are detected in the blood of the deceased is registered, the so-called Toxbase. Using the definition for Toxbase, cases where drug-related in With the definition for the register of causes of death, cases were drug-related in The Swedish traffic police have a zero tolerance policy for driving influenced by drugs. Annually about 2. Sweden has among the lowest mortality rate in the world in road traffic, with 2. All Swedish citizens have the right to health care at a health clinic owned by the County Council or, in the case of a medical emergency, at hospital owned by the County Council. Most Swedes have therefore no private health insurance. For professionals in health care any information about a patient's drug abuse is confidential by law unless the patient is suspected of a crime that could result in at least two years imprisonment or of driving under the influence of drugs. A person who has developed a drug addiction can apply to the local social welfare board in his home community to become admitted to a treatment center for drug addicts in another part of the country. If the application is approved, the social welfare board pay the treatment including all cost for staying at the treatment center for several months. The social welfare board is financed by local taxes. This type of treatment is expensive but less expensive than a long imprisonment for crimes so only a few thousands of applications are approved per year. Treatment with drugs that are extracts or synthetic variants of cannabis are not legal to use in health care with one small exception. Nabiximols , trade name Sativex, a cannabinoid oromucosal mouth spray, was approved in December , for multiple sclerosis MS ; only on prescription as a third alternative to two other approved drugs for that condition to patients who not responded adequately to other medication for spasticity and show a clinically relevant improvement of symptoms related to spasticity during an initial trial treatment. Of the approximately 13, people in Sweden been diagnosed with multiple sclerosis MS , about 50 of them used Sativex \[ 76 \] in December The Pharmacy Company that sells Sativex state that the risk for drug dependence is lower for Sativex than the morphine based alternatives because the dose of THC so low that the patients cannot be 'high' on it. It is common for medium and large companies to have a zero tolerance policy for illegal drugs and demand a drug test for new employees. Those companies often also demand the same for subcontractors and consultants that visit them. Random drug tests among all employees has also become more common. Hemp is in Sweden a very small crop, grown on about ha. To be legal one must own at least four hectares of agricultural land and register the cultivation by applying for so-called 'farm aid' under EU rules on agricultural subsidies and also use approved seeds. Only hemp with less than 0. An often repeated criticism is that a decline in resources for treatment of drug addicts started in the s. If the person has not been convicted for a serious crime so must that person's home municipality pay a large part of treatment for drug addiction. The same committee in the municipality is also responsible for supporting other groups like old, the disabled, refugees, long-term unemployed and others within a limited budget. These other groups often have the support of relatives or strong local associations that speak for them against the municipality. Relatives of drug addicts do not have the same strong position. Information on a drug addict age 18 or older are covered by confidentiality. This confidentiality also applies to near relatives. Relatives of addicts has not, in practice, the same legal possibility, as some other groups, to appeal against the lack of care to any court. All these factors together end in that only a small proportion of drug abusers get more intensive treatment for their drug addiction or that treatment begins only after the abuse has become very serious. Despite Sweden having a zero-tolerance policy, Sweden's state-run liquor monopoly, Systembolaget , defines 'alcohol-free' as a beverage that contains no more than 0. Some people \[ who? Contents move to sidebar hide. Article Talk. Read Edit View history. Tools Tools. Download as PDF Printable version. In other projects. Wikimedia Commons. Overview of the drug policy of Sweden. Legal penalties \[ edit \]. Classification of drugs \[ edit \]. Effects \[ edit \]. History \[ edit \]. The first narcotics law \[ edit \]. Introduction of amphetamines \[ edit \]. Early changes in the drug laws \[ edit \]. This section needs expansion. You can help by adding to it. June The Legal Prescription Program \[ edit \]. Drug Commission of \[ edit \]. Subsequent policy changes \[ edit \]. This section is empty. May National Alcohol and Drug Action Plan \[ edit \]. Implementation \[ edit \]. Imprisonment for drug crimes \[ edit \]. Number of drug-related deaths \[ edit \]. Drugs and driving \[ edit \]. Health care for drug abusers \[ edit \]. Cannabis in health care \[ edit \]. Drug testing \[ edit \]. Hemp \[ edit \]. Criticism \[ edit \]. Alcohol policy \[ edit \]. See also \[ edit \]. References \[ edit \]. Archived from the original on 16 January Vansterpartiet in Swedish. Retrieved 7 May SVT Nyheter in Swedish. Accent in Swedish. Retrieved 21 August The Swedish Foreign Office. Archived from the original PDF on 12 June Retrieved 24 January Retrieved 23 May Cedro UVA. Archived from the original PDF on 11 February Retrieved 21 May Archived from the original on 21 February Retrieved 16 May An in-depth review and analysis. Archived from the original PDF on 27 September Retrieved 26 September Foreword by Dr. Robert L. Dupont, M. Henrik Tham: Forskare om narkotikapolitiken, \[ permanent dead link \] , p. Archived from the original on 4 October Retrieved 12 July Offices of the Government of Sweden in Swedish. Archived from the original on 15 March Transform Drug Policy Foundation. Retrieved 26 August Retrieved 18 August Archived from the original on 1 January Retrieved 10 July Archived from the original on 26 January Retrieved 21 December Archived from the original on 9 July Retrieved 8 July SE: Systembolaget. Archived from the original on 8 April Retrieved 5 February SE: The Local. Drug laws, policies, and regulations. Bangladesh India Laos South Korea. Canada cannabis United States alcohol , cannabis , harm reduction , psilocybin Mexico cannabis. 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