Policy Responses to Drug-Related Deaths: The power of numbers?

Background

As the EMCDDA European Drug Report 2017 was published, Sweden found itself at the top of the very unflattering statistics over drug-related deaths (DRD) – surpassed then only by Estonia. This rating stirred the waters of what had been a quite complacent restrictive, some might even say repressive, drug policy. The news even got international attention, not without some malicious delight. Perhaps because of the great confidence Sweden has displayed in its restrictive drug policy. Allegedly, according to some MPs, the best in the world. However, this news should not have come as such a surprise. National statistics showed a drastic increase in DRDs also before 2017. Between 2006 and 2015, DRDs doubled in Sweden.

Methods

The aim of this qualitative study is to trace historically the awareness and responses to DRDs in the parliamentary debate in Sweden in order to investigate to what extent knowledge and arguments about DRDs propelled the drug policy in a more harm reductionist direction. Beginning with the AIDS epidemic among people who inject drugs (PWID) in the 1980s and ending up with the alarming numbers of DRDs by the EMCDDA in 2017. Furthermore, inspired Rhodes (2002) risk environment framework we will primarily investigate if the proposed policy responses have been directed at individuals or the community, and if there are any discernable connections between the number of, and policy responses to, DRDs.

Results

When looking at the more recent parliamentary debates of the 2010s, MPs began to highlight and question the unequal access of PWID to welfare state services in general, and health care in particular. The treatment of intravenous drug users typically aiming at abstinence, both within social services and health care, was challenged and condemned. From a policy aspect, harm reduction measures became separated from the field of drug policy and relocated into the public health policy area. Further, the availability to Naloxone was fast tracked, the availability to needle exchange became mandatory “wherever there was a need”, and the previously decided maximal number of opioid substitution treatment patients increased. All of these policy measures were debated and initiated in the Swedish parliament, and arguably instigated by the high numbers of drug-related deaths. Nothing like this happened in the 1980s when the death rates were alarming, however not as high in international comparison.

Conclusions

There is reason to consider the Swedish – and other – restrictive drug policy nations as reactive rather than pro-active when it comes to battle DRDs. Also, the aim for a drug-free society is creating a strong path dependence along the repressive path, failing to instead take the risk reducing path. Finally, a long-term perspective (see e.g. Rhodes & Lancaster, 2023) on policy responses to DRDs reveals the importance of context – in this case the prohibitionist setting.