Harm reduction and public health: the case of Sweden
The paper discusses drivers of change concerning policy measures aiming for harm reduction in the Swedish context. It is well known that even compared to its Nordic neighbours Sweden stands out for its restrictive drug policy. Focus has been placed on control, isolation, and punishment as policymakers strived for the long-standing policy goal of a “drug-free society”. Some consequences of this focus has been a public health agenda rather aiming for the protection and safety of non-users then the users, as addiction was believed to spread through the population. And a policy centred on the users becoming drug-free rather than staying healthy. In the Swedish context the aim for a drug-free society has for a long time been interpreted as an aim for a “harm reduction-free society”.
However, there still have, ever since the mid-1960s, been measures taken to reduce drug related harm. Empirically the paper analyses three harm reduction related events: a) the experimental Stockholm clinic prescribing drugs 1965-1967, which based on quite shaky evidence in Swedish drug policy tradition has been deemed to be a huge failure; b) the two policy defying needle exchange programs (NEPs) initiated in southern Sweden when the aids-epidemic hit (1986 & 1987), while public health policy instead focused on increased substitution treatment; c) the heated political debate preceding the 2017 reform of the needle exchange law, making NEPs mandatory where needed for the sake of an increased equality of health and for general public health reasons.
These events illustrate sudden as well as gradual changes in ideas, attitudes, and approaches towards illicit drugs, harm reduction, and public health. When analysing fifty years of drug policy, in particular concerning measures aiming for harm reduction, the analysis builds on Kingdon’s (1984) contextually sensitive three stream policy model. When turning towards the knowledge base of a policy field claiming to be evidence based the analysis builds on research done within the science-policy nexus framework. During the investigated period responses to research evidence spans from instrumental cherry picking of preferred results to research slowly seeping through and gradually changing what is held to be true, both when it comes to the reduction of drug-related harm and the health of the public.