Sweden is often portrayed as a success story in relation to drugs policy, not least by its own diplomats on the international stage and by the UN. But the evidence warns of urgent public health problems that Swedish politicians are currently failing to address. On the UN international day against drugs (Thursday, 26th June), some reality checking is needed.
The EU elections last month were an opportunity to review the manifestos of each of the main political parties in Sweden. Despite fundamental differences in ideologies the main parties are all pretty much all in agreement when it comes to drugs. Across the board they call for more of the same approaches that have barely changed for decades, based on the vision of a 'drug free society'.
These strikingly similar manifestos make for unsettling reading when compared to the data released in earlier this month by the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA). The EMCDDA is the focal evidence-gathering hub on drugs issues for the European Union. It relies on data from national focal points and compiles the European Drugs Report every year comparing figures from across the region.
Sweden has had some successes over time: lower than average cannabis and ecstasy use rates compared to the EU, for example, and generally lower rates of drug use among school age students, which is good to see. The extent to which these are a result of drug policy per se questionable, of course, but in any case these are by no means the only take-away messages. There are also serious problems.
Sweden has one of the highest hepatitis C rates among people who inject drugs in the whole of the EU. The Stockholm needle exchange has recorded prevalence at between 83% and 85%. Hepatitis C is a blood borne virus that, left untreated, can lead to cirrhosis of the liver and death.
There are, in addition, only five needle and syringe progammes in operation in the entire country; none in the second largest city, where I live, Göteborg. Reducing hepatitis C transmission requires a lot of effort including the distribution of a range of sterile commodities such as cookers and swabs alongside needles and syringes; and of course widespread voluntary testing and treatment.
That leads to the next problem. Sweden has no population size estimate for people who inject drugs. While we know that at least four fifths of people who inject drugs have hepatitis C we have no idea how many people need treatment for it, nor how many people need to be reached with needle and syringe programmes. Sweden is not doing nearly enough on a clear epidemic in the country.
Sweden also has the fourth highest per capita drug related death rate in Europe; almost quadruple the EU average. That should speak for itself in terms of being a health and human rights priority. But bear in mind, too, that opiate users are at very high risk of overdose death. Unfortunately there is no population size estimate for this group either, even though a fifth of all people entering treatment report opiate use.
Despite having lower rates of use for some drugs, Sweden has the third highest rate for lifetime use of amphetamines in the region (i.e. those aged 15-64 who have ever used amphetamines). It has the fourth highest rate for amphetamine use among young adults aged 15-34 in the last twelve months. What's more, three quarters of amphetamine users report injecting.
With all of this in mind it is important to look at where Sweden places its resources. It is very difficult to quantify expenditure in drug policy but the last data made available to EMCDDA were for 2002. At that time three quarters of the total drugs budget went to supply reduction: Police, prisons, courts, probation etc. Only between 0.1% and 0.2% went to harm reduction (required to deal with the mortality and morbidity noted above) and just over 22% to 28% to treatment.
The overwhelming focus of supply reduction attention, moreover, is on cannabis - over 1,700 kilos of cannabis seized in 2012 compared to 361 kilos of amphetamines and 7 kilos of heroin - and on individuals, not traffickers. The 7 kilos of heroin required 363 seizures. You can do the calculations on how little was taken each time. The 361 kilos of amphetamine was precisely the same requiring over 3600 seizures. These individuals are precisely those in need of protection; they are the people behind the statistics above.
There are multiple imbalances of focus here. Funding of health versus enforcement. Policing individuals versus traffickers. The policy space taken up by cannabis versus important health harms associated with other substances.
Addressing these problems is of course complicated, but not impossible if the political rhetoric gives way to reality. But that is precisely why the party manifestos are so unsettling. In the face of urgent concerns about communicable diseases and drug-related deaths, none of the main Swedish political parties have called for a proper assessment of where drug policies are working and where they need to change.
That is precisely the pledge that we need to hear from a responsible future government if the very real public health problems Sweden is facing are to be confronted. It is exactly what should be reflected upon on an international day about drugs.
Harm Reduction International is a partner in the Support. Don't Punish Campaign. A day of action will involve demonstrations in 100 cities worldwide on June 26th calling for new approaches to drug policy based on public health and human rights. http://supportdontpunish.org/
Follow Damon Barrett on Twitter: www.twitter.com/DamonHRDP