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SWEDEN’S SUCCESSFUL DRUG POLICY:
A REVIEW OF THE EVIDENCE
FEBRUARY 2007
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TABLE OF CONTENTS
PREFACE........................................................................................................................................4
PREFACE........................................................................................................................................5
INTRODUCTION...........................................................................................................................7
PART 1: THE SWEDISH DRUG CONTROL POLICY ............................................................9
THE EMERGENCE OF DRUG ABUSE IN SWEDEN .....................................................................9
TOWARDS A NATIONAL DRUG CONTROL POLICY .................................................................9
The Narcotics Drug Committee................................................................................................9
The 1969 ten-point anti-drugs programme.............................................................................10
Drugs on prescription-the Stockholm experiment ..................................................................11
The role of Nils Bejerot in shaping Swedish drug control policy ...........................................12
The introduction of methadone maintenance therapy ............................................................13
Sweden’s role in the negotiations of the 1961 and 1971 United Nations drug control
conventions .............................................................................................................................13
SETTING THE VISION OF A DRUG-FREE SOCIETY.................................................................14
A progressively restrictive policy ...........................................................................................14
Changes in the treatment system ............................................................................................15
The introduction of needle exchange programmes.................................................................16
Drug use becomes a punishable offence.................................................................................16
REAFFIRMING THE VISION OF A DRUG-FREE SOCIETY ......................................................17
The 1998 Drugs Commission..................................................................................................17
The National Action Plan on Drugs .......................................................................................18
SWEDISH DRUG POLICY IN PERSPECTIVE ..............................................................................20
PART 2: THE DRUG SITUATION IN SWEDEN ....................................................................23
AMPHETAMINE - THE MAIN PROBLEM DRUG........................................................................23
Development of amphetamine use from 1940 to date.............................................................24
DRUG USE IN SWEDEN SINCE 1970............................................................................................26
The expansion of drug abuse in the 1990s..............................................................................27
Downward trend in drug abuse from 2001/02 to 2005/06 .....................................................31
THE DRUG SITUATION IN SWEDEN - AN INTERNATIONAL COMPARISON .....................36
Life-time prevalence of drug use among students...................................................................36
Regular drug use ....................................................................................................................38
Perceived drug availability.....................................................................................................44
Perceived risk of drug use ......................................................................................................46
Experiences with visible drug scenes......................................................................................48
Problem drug use estimates....................................................................................................49
Intravenous drug use and HIV/AIDS......................................................................................50
CONCLUSION .............................................................................................................................51
STATISTICAL ANNEX...............................................................................................................53
LONG-TERM DRUG USE TRENDS IN SWEDEN ........................................................................53
INTERNATIONAL COMPARISONS..............................................................................................56
YOUTH SURVEYS..................................................................................................................56
Surveys among 15-16 year old students .................................................................................56
Surveys among 15-24 year olds..............................................................................................62
GENERAL POPULATION SURVEYS............................................................................................69
PERCEIVED RISK OF DRUG USE.................................................................................................78
OTHER DRUG ABUSE RELATED DATA.....................................................................................82
INTRAVENOUS DRUG ABUSE AND HIV/AIDS.........................................................................84
4
PREFACE
The supply and abuse of drugs effects every country all over the world in one way or another. The
Swedish vision is that drug abuse shall remain as a marginal phenomenon in the society. Solidarity
with disadvantaged and vulnerable members of society, not least, demand as such. People are
entitled to a life of dignity and a society which safeguards health, prosperity, security and safety of
the individual. The vision is that of a society free from narcotic drugs.
The overriding task of our drug policy is to prevent abuse. Preventive measures shall strengthen
the determination and ability of the individual to refrain from drugs.
Young peoples’ attitude towards drugs demands special attention. At the same time we must
emphasize the importance of an interaction between control measures, other preventive efforts and
treatment. This interaction is essential if the fight against narcotics is to be successful.
United Nations Office on Drugs and Crime has decided to present a report on the Swedish drug
policy and its implementation. I am of course proud that the overall judgement is positive, even if
there also are critical remarks. We have far from solved the drug problem, perhaps we never will,
but the political commitment will remain very strong from both the Parliament and the
Government. I am convinced that the path we have chosen and the steps we have taken are in the
right direction even if there is much more to do.
As the report points out it is difficult to establish a direct and causal relationship between policy
measures and results. Our experience is that in times where we have thought that the problems
where more or less under control and the drug problem was given less priority, we could see an
increase in drug consumption among young persons. We learned that we have to convince every
generation.
I am convinced that it is possible to tackle the drug problem, but we need strong commitment from
society and support from the general public. We have today a political consensus and support from
the public for a comprehensive and restrictive drug policy, based on the UN conventions, which
include both supply- and demand reduction.
Maria Larsson
Minister for Elderly Care and Public Health
5
PREFACE
Drug use in Europe has been expanding over the past three decades. More people experiment with
drugs and more people become regular users, with all the problems this entails for already strained
national health systems. There are thus suggestions, at the European level, that drug policies have
failed to contain a widespread problem.
Sweden is a notable exception. Drug use levels among students are lower than in the early 1970s.
Life-time prevalence and regular drug use among students and among the general population are
considerably lower than in the rest of Europe. In addition, bucking the general trend in Europe,
drug abuse has actually declined in Sweden over the last five years. This is an achievement that
deserves recognition.
I am personally convinced that the key to the Swedish success is that the Government has taken
the drug problem seriously and has pursued policies adequate to address it. Both demand reduction
and supply reduction policies play an important role in Sweden. In addition, the Government
monitors the drug situation, examines the policy from time to time and makes adjustments where
they are needed.
Sweden, of course, has had some advantages in addressing the drug problem. Sweden is not
located along major drug trafficking routes. Income inequalities, which often go hand in hand with
criminal activities including drug trafficking, are low. Unemployment, including youth
unemployment, is below the European average. This reduces the risks of substance abuse.
International surveys show that the Swedish population is particularly health-conscious, so less
prone to large-scale drug use. There is a broad consensus that production, trafficking and abuse of
drugs must not be tolerated. Thus a clear and unequivocal message is given to the general public,
notably to the country’s youth. Last but not least, with its strong economy, Sweden has the
wherewithal to devote adequate resources to dealing with the drug problem. Increases in the drug
control budgets in recent years went hand in hand with lower levels of drug use.
It is my firm belief that the generally positive situation of Sweden is a result of the policy that has
been applied to address the problem. The achievements of Sweden are further proof that,
ultimately, each Government is responsible for the size of the drug problem in its country.
Societies often have the drug problem they deserve.
Antonio Maria Costa
Executive Director
United Nations Office on Drugs and Crime
7
INTRODUCTION
The present report reviews the evolution of the drug control policy in Sweden, one of the most
widely examined and debated drug control policies in the world.
The Swedish drug control policy is guided by the vision and the ultimate goal of achieving a drug-
free society and the unequivocal rejection of drugs, their trafficking and abuse is considered
somewhat unique. This is particularly so when the drug policy in Sweden is compared to drug
control policies in other countries of the European Union. Over the years, the drug control policy
in Sweden has been subject to scrutiny numerous times, either at the national level, mostly by
expert Commissions established specifically for that purpose, or by scientific researchers both in
Sweden and internationally.
As part of its ongoing series on drug control policies at local and national level, UNODC has
decided to review the Swedish drug control policy that has evolved over the past forty years. It is a
rapid assessment, based on open-source documents, supplemented by Government documents and
information obtained from Government officials. While the report does not aim to be
comprehensive or exhaustive, an attempt has been made to thoroughly review the available
evidence, including data on drug abuse, dating back to the 1940s.
The document examines important junctures in Swedish drug control policy, including the often-
discussed Stockholm experiment of drug prescription, the introduction of methadone maintenance
programmes and, of course, the vision of a drug-free society. An analysis of the drug control
situation in Sweden over the years accompanies the document and shows how the drug control
situation has evolved over time.
It is difficult to establish a direct and causal relationship between specific policy measures and the
resulting drug situation. Nevertheless, in the case of Sweden, the clear association between a
restrictive drug policy and low levels of drug use is striking. Few people in Sweden are likely to
take drugs in their lifetime, and even less likely to use drugs regularly. Attitudes towards drugs
and their abuse is clearly negative. Preliminary calculations for the UNODC Illicit Drug Index, a
single measure of a country’s overall drug problem, show a very low value for Sweden which
indicates that its drug problem is small, compared to that of other States. However, the relatively
high proportion of heavy drug use among drug abusers remains a concern that has been difficult to
address. This document cannot provide definite answers to questions about how the levels of drug
abuse are influenced by policy measures. It can only present the facts and leave the readers to
draw their own conclusions.
Part 1: The Swedish Drug Control Policy
9
PART 1: THE SWEDISH DRUG CONTROL POLICY
The emergence of drug abuse in Sweden
Drug abuse was virtually unknown in Sweden until the 1930s. Excessive use of drugs was first
reported in 1933 but was a very limited phenomenon. An enquiry in 1940 to all state- and
municipally-engaged physicians gave a total of 70 known cases of drug abuse, mainly of opiates.
1
The introduction of amphetamines in about 1938, however, resulted in drug abuse becoming more
widespread. Soon, large sections of the Swedish population, were occasional or even regular users
of amphetamines. Countermeasures did not lead to a sustained reduction in use. The introduction
of prescription requirements for amphetamines, in 1939, for example, only brought about a short-
lived stabilization of sales. Soon after, sales skyrocketed as people found ways to circumvent
existing restrictions. In 1943, almost 10 million tablets of amphetamines were consumed annually
and the number of estimated users was 200,000 (4.6 per cent of the population age 15-64).
In 1943, the National Medical Board of Health of Sweden issued a warning on the risk and abuse
of stimulants. This measure resulted in a sharp drop in the sales of the substances. However, the
market recovered and abuse continued to spread. The introduction of new central-nervous system
stimulants of the amphetamine-type enlarged the market considerably.
Dexamphetamine and phenmetrazine were used as weight-reducing agent, while methylphenidate
was marketed as a lower-risk version of amphetamine. The increasing diversity in the number of
psychoactive substances on the market made the drug abuse problem more difficult to control.
In the first years of the emerging drug problem, authorities in Sweden usually took measures that
restricted the availability of a specific drug in question. This could be done by introducing
prescribing requirements for the drugs or, by further restricting prescribing practices. In addition,
the National Medical Board issued circulars which alerted the medical profession that these drugs
were particularly liable to abuse.
These policy measures usually had the desired effect. Immediately after their introduction, the
level of sales would decline. This was the case for amphetamines in 1943. Similarly, in 1962,
subsequent to a warning from the National Board on the dangers of certain groups of drugs and
restrictions for doctors to prescribe amphetamines, the number of prescriptions for these
substances declined significantly.
2
Towards a national drug control policy
The Narcotics Drug Committee
So far, the two main drug policy measures in Sweden were the introduction of prescription
requirements and the issuance of warnings on health-related consequences of the drugs in
question. As drug use further expanded in the 1960s, it became clear that these actions, limited to
a small number of specific drugs, were no longer sufficient to address the growing drug problem.
In response to a parliamentary question, the Minister of Social Affairs of Sweden announced in
May 1965, that an Expert Group on Narcotics Drug Abuse to review the problem would be set up
within the National Medical Board.
Two months later, on 1 July 1965, the group started its work. In January 1966, the group was
reorganized and enlarged to form a Narcotics Drug Committee, comprising five subcommittees,
on legislative aspects, on therapeutic approaches, on technical-diagnostic problems, on social
medical aspects and on methods of prevention.
The mandate of the Narcotics Drug Committee was wide-ranging and the Committee was
requested to study problems involved in the abuse of narcotic drugs from medical, legal and social
aspects, focusing on the following issues:
Sweden’s successful drug policy: A review of the evidence
10
(i) a fact-finding survey to give a picture of the strata of the population involved, the
number, age and characteristics of drug abusers, and their background, to define the
character of the abuse;
(ii) a study on treatment, survey existing methods of diagnosis and possible effects of the
individual and on society of the abuse on narcotic drugs;
(iii) to investigate the legislative angles;
(iv) to review methods of prevention from medical, legal and social points of view and to
elucidate possible causal relationships and their importance for the origin of drug
abuse and its spread in society.
The results of the Committee were published in 1967 and represent the first comprehensive study
on the drug problem in that country. The first report (SOU 1967:25), on drug abuse, showed the
results of surveys on the extent and patterns of drug abuse in various segments of the population,
discussed the forms of treatment of drug abuse and made recommendations, inter alia, to maintain
a central registry of drug abusers.
3
The second report (SOU 1967: 41) focused on the legal aspects of drug control. It also called for
systematic monitoring of prescriptions for some drugs, including central-nervous system
stimulants, narcotic drugs and depressants in order to follow the development of a problem and to
be able to detect sudden changes at an early stage.
4
The body of evidence obtained by the Committee was the basis for the adoption of legislation
dedicated to address the drug problem. The Narcotic Drugs Act (
Narkotikastrafflag (1968:64)) was
adopted in April 1968. The Act made the transfer, unlawful manufacture, acquisition and
possession of drugs a punishable offence and lays down penalties for drug-related crime.
The 1969 ten-point anti-drugs programme
In December 1968, a meeting of all the regional chiefs of police in Sweden was convened in
Stockholm and presided over by the National Police Commissioner. At the close of the meeting, it
was decided that the efforts of the Swedish police against illicit traffic in drugs
should be given
the highest priority
. The Swedish Government was notified of the decision and given information
regarding developments in illicit drug traffic.
5
Subsequently, in 1969, the Government of Sweden approved a ten-point programme for
increasing public efforts against the drug problem. It aimed at the following:
1. Strengthening the resources of the police and customs to cope with the drug problem;
2. Closer co-operation between the police and customs, both nationally and internationally;
3. The right of the police, subsequent to a court decree, to use wire-tapping to uncover those
who profit from the misuse of drugs by financing, smuggling and "pushing" or peddling,
on a grand scale;
4. Stiffening the maximum punishment from four to six years for serious narcotics
violations;
5. Improvement and co-ordination of social detection activities, emergency treatment and
after-care;
6. Rendering legislation regarding treatment more effective;
7. Summoning a conference of youth organizations in order to disseminate information
among young people concerning the dangers involved in using drugs;
8. Information to the public in general concerning the dangers of drug abuse;
9. Increased Swedish activity at the international level - above all, in the United Nations
Commission on Narcotic Drugs - in order to secure international legislation in the matter
of psychotropic substances, primarily amphetamine, phenmetrazine etc.,
Part 1: The Swedish Drug Control Policy
11
10. Creation of a joint committee with, among others, the heads of the National Police Board,
the Office of the Chief Public Prosecutor and Prosecutor of the Supreme Court, the
National Social Welfare Board, the National Board of Customs and the National Board of
Education.
6
In line with the prevailing view of the drug problem at the time, the ten-point programme is heavy
on law enforcement measures. Nevertheless, it also covers demand reduction issues, particularly
the provision of treatment services to drug abusers and the prevention of drug abuse.
Drug abuse prevention was one of the main tasks of the joint committee which was formed in
January 1969, pursuant to point 10 of the 10-point programme. One of the results was the
establishment of a demand reduction programme operated by youth organizations. In 1969, a
collection of facts about drugs ("Fakta om narkotika") was disseminated. At the same time, an
advertising campaign was conducted in the newspapers concerning the risks in the misuse of
drugs.
These demand reduction activities were accompanied by a further stiffening of penalties. As
foreseen in the programme, the maximum penalty for serious narcotics offences under the
Narcotic Drugs Act was increased from four to six years, and at the same time, the police were
allowed to wire-tap - subsequent to a court decision in each individual instance - in order to
uncover perpetrators of serious narcotics offences.
Sweden also stepped up its activities at the international level to bring about effective international
control of psychoactive substance. In January 1970, Sweden participated in the first special
session of the United Nations Commission on Narcotic Drugs in Geneva, and gave its firm support
to the Draft Protocol on Psychotropic Substances.
Drugs on prescription-the Stockholm experiment
In 1965, an experimental project was launched for the legal prescription of drugs, the idea being to
limit the harmful effects of drug use, both on society and individual abusers.”
7
The project was
launched by the National Medical Board and run by a small number of doctors. Both opiates and
amphetamines were prescribed for oral as well as intravenous use.
8
The project was not a scientific experiment, as it had no control group or a planned design. It was
based on a “liberal and non-authoritarian view” on drug prescription, which meant, that, although
patients were under medical supervision, they were in practice free to decide on their own
dosages. If they had finished with their prescriptions, they could easily request more drugs.
The number of patients participating in the scheme increased from about 10 in 1965 to more than
150 in 1967.
9
On average, 82 patients were being treated at any point in time. Altogether, some
3,300,000 dosages of amphetamines (about 15 kilograms) and 600,000 dosages of opiates (about
3.3 kilograms) were prescribed in the two-year period from April 1965 to May 1967.
10
It was
widely known that many patients supplied friends and acquaintances with considerable quantities
of narcotic drugs obtained on prescription.
11
Problems became apparent soon after the experiment had started. As the legally prescribed drugs
were increasingly diverted to the illicit market, the project drew criticism from the police and the
drug prosecutor.
12
In one case, preliminary investigations against three individuals suspected of
drug offences revealed information that one drug addict had used part of his prescription to inject
other drug abusers.
13
The proportion of arrested people showing signs of intravenous drug use
rose in Stockholm from 20 per cent in 1965 to 33 per cent in 1967.
14
By 1967 almost all doctors in the project had stopped prescribing drugs, with the exception of Dr.
Åhstrom, the doctor in charge of it. In February 1967, a report from the pharmaceutical bureau of
the National Board containing an account of the prescriptions in the project was sent to the
Disciplinary Committee of the National Medical Board. After investigation, the Disciplinary
Committee concluded that there was well-founded reason to assume that Dr. Åhstrom “had
misused his right to prescribe narcotic drugs. This is reason for withdrawing his right to prescribe
such drugs. However, because of the difficulty to provide adequate care for his patients, this shall
not take force immediately.”
15
For a transition period, a specially designated pharmacy had the
Sweden’s successful drug policy: A review of the evidence
12
right to dispense prescriptions for patients on a list provided by the National Medical Board. Dr.
Åhstrom was advised to refer his patients to psychiatric care at a hospital. It was estimated that the
ambulant prescription activities should be closed by 30 April 1967. Dr. Åhstrom appealed the
decision but the Government did not alter its decision.
The matter came to a head with, in April 1967, the overdose death of a 17-year old woman on
morphine and amphetamine which was shown to have been procured through the project received
wide media coverage. It is often assumed that the public outcry accompanying this tragic event led
to the closing down of the project. This is, however, not the case. The decision to stop the project
had been taken much earlier. The project finally closed down on 1 June 1967, obviously not
having achieved its intended goal.
As the curtailment of the project did coincide with the issuance of the reports of the Committee, a
link has sometimes been made between the curtailment of the project and the subsequent and
progressive restrictiveness of the Swedish drug control policy. However, a review of the
documents at the time does not support a clear association.
What is true, however, is that wide reporting on the experiment, particularly long after the
experiment had been terminated, continued. Over the years, it has come to symbolize a bygone era
of drug policy, embodying a more permissive attitude towards drug abuse. It has also been used
both as an illustration of how well-intended harm reduction measures can spin out of control and,
occasionally, even to show that the well-being of some participants in the project improved. As a
non-scientific experiment, it cannot serve as evidence for either argument.
A personal perspective of the “drugs on prescription” experiment
I was then working at the Solna Police Authority, which is now a part of the Stockholm County Police Authority.
We had three (!) known abusers in our area who lived in one-room apartments. They knew us, we knew them and
we used to visit them in their homes.
The situation changed dramatically soon after the trials started. There were sometimes 10-20 people, all under the
influence of drugs, and plenty of illegally prescribed drugs in these apartments, and there was nothing we could do
about it. A few months later there were hundreds of abusers in the area and the police had totally lost control of
them and the extent of drug abuse in the district. After a couple of deaths involving legally prescribed drugs, the
trials were suspended.
During the trial period, the number of drug offences dropped to almost zero, simply because personal use and
possession for personal use were not reported. However, there was a rise in nearly all other types of crime. The
police were basically unable to take action against street-level drug offences.
Source: Remarks by Detective Superintendent Eva Brännmark of the National Police Board of Sweden
at the International Policing Conference on Drug Issues in Ottawa, August 2003
The role of Nils Bejerot in shaping Swedish drug control policy
The theoretical foundation of Sweden’s restrictive drug policy of the 1970s and 1980s appears to
be largely based on the work of Nils Bejerot, who is sometimes referred to as the founding father
of Swedish drug control policy. A deputy social medical officer at the Child and Youth Welfare
Board of the City of Stockholm, Bejerot diagnosed first cases of juvenile intravenous drug use in
Stockholm in 1954, much earlier than in most other towns in Europe.
In 1965, Bejerot initiated a study at the Stockholm Remand Prison to monitor the spread of
intravenous drug abuse in Stockholm, which confirmed his scepticism of the consequences of
legally prescribing amphetamine to amphetamine users.
In 1969, Bejerot founded the ‘Association for a Drug-Free Society’ (RNS), which played an
important role in shaping Swedish drug policies.
16
He warned of the consequences of an
‘epidemic addiction’, prompted by young, psychologically and socially unstable persons who,
usually after direct personal initiation from another drug abuser, begin to use socially non-
accepted, intoxicating drugs to gain euphoria. He was particularly concerned with the highly
psycho-social contagiousness of drug use and considered contagion to be a function of
susceptibility of the individual and exposure to drugs.
Part 1: The Swedish Drug Control Policy
13
One key precondition for the spread was availability. While susceptibility of the individual was
difficult to influence, exposure could be limited through drug policy. Therefore, Bejerot concluded
that society had to have a restrictive drug policy to limit general exposure to illicit drugs. He also
argued that drug policy had to target the drug user, since the drug user was the irreplaceable
element in the drug chain while drug dealers could be easily replaced in the event of being
arrested. In addition, he saw the need for a broad popular support to be achieved through a broad
political agreement and massive information campaigns, leading to something like a popular
uprising against drug epidemics. The practical implications – which over the years were put into
practice – were: (i) to increase prevention and treatment activities as well as to criminalize not
only drug trafficking but also drug use, (ii) to target cannabis use as the first drug in the chain
towards drug abuse (based on the ‘gateway’/‘stepping stone’ hypotheses) and (iii) to create a
national consensus on drug policies across party lines, supported by civil society pressure groups.
The introduction of methadone maintenance therapy
As the prescription of amphetamines and opiates was failing in Stockholm, scientists in the nearby
town of Uppsala investigated new methods of treating heroin addicts. Reports on the clinical trial
with methadone maintenance, published in the Journal of the American Medical Association in
1965, created considerable interest in Sweden and the following year, in 1966, a Swedish National
Methadone maintenance programme was opened at the Psychiatric Research Center in Uppsala.
Sweden thus became the first country in Europe to carry out methadone maintenance treatment,
long before it became an established and accepted form of drug abuse treatment and despite the
fact, that the most “problematic” drugs in terms of treatment demand were amphetamines and not
opiates. The National Methadone Maintenance Programme operated in Sweden under the same
conditions for 23 years and was the longest-running in Europe. The programme was rather
extensive, in relation to the small population of heroin addicts, even in comparison to such
programmes in other countries known to be favourable towards harm reduction policies.
17
The
programme has generally been judged as being very successful. Among the positive results are: an
average yearly retention rate of 90 percent; a significant decrease in drug abuse, criminality and
prostitution compared with the situation before treatment and a dramatic reduction in mortality of
those staying in treatment.
18
Sweden’s role in the negotiations of the 1961 and 1971 United Nations drug
control conventions
At the international level, Sweden has always been an active participant in bringing about
international drug control. Already in the early 60s, it was party to most international drug control
treaties in force at the time, with the exception of the 1936 Convention for the Suppression of
Illicit Traffic in Drugs. Sweden had even become party to the controversial 1953 Opium Protocol,
which restricted opium production to only seven States in the world.
In 1961, Sweden was one of 73 States represented at the Plenipotentiary Conference for the
Adoption of the United Nations Single Convention on Narcotic Drugs and became a signatory to
the Convention. Sweden ratified the 1961 Convention in 1964.
Concerted international action against stimulants was a major concern for the Swedish
Government. Stimulants were not restricted in many countries in Europe where these substances
were manufactured, making all national efforts to curb their abuse difficult. Specialized traders
developed a brisk business supplying non-medical demand in countries with more restrictive
regulations, mostly in Scandinavia. Taking the lead in Scandinavia, Sweden urged manufacturing
States to cooperate.
19
In 1965, Sweden called on the World Health Organization’s drug
committees “to impose controls on stimulants and depressants.”
20
In 1970, Sweden participated in the first special session of the United Nations Commission on
Narcotic Drugs and assumed an active role in promoting the control of psychoactive substances.
During the negotiations for the Convention on Psychotropic Substances, Sweden, together with
other Scandinavian Governments and Soviet bloc countries, formed what drug policy researcher
McAllister called a “strict control” coalition that argued for stringent limitation of all classes of
Sweden’s successful drug policy: A review of the evidence
14
psychotropic substances.”
21
The provisions of the Convention that was eventually adopted in
1971, were in some respects weaker than what Sweden had hoped for, mainly due to the efforts of
the pharmaceutical industry which enlisted the help of former United Nations officials to ensure
that their products escaped control. The Convention did, however, succeed in placing stringent
controls over amphetamines, which continued to be Sweden’s prime concern in terms of abuse.
Sweden was not only advocating additional control measures at the international level. On the
contrary, in the run-up to the adoption of the 1972 Protocol amending the 1961 Convention, it was
Sweden that proposed a weakening of the penal provisions of the 1961 Convention, suggesting
that measures of treatment, rehabilitation and social integration should be offered to drug abusers
as an alternative to conviction or punishment or in addition to punishment.”
22
Sweden also proposed that the amended Convention should have a separate article requiring
parties to take all practicable measures for the prevention
of abuse of drugs and for the early
identification, treatment, education, after-care, rehabilitation and social reintegration of the
persons involved.
In introducing the amendments, the representative of Sweden stated that
“meaningful action against drug abuse must be directed both against supply and demand. There
must, in other words, be a proper balance between control measures, law enforcement etc. on the
one hand, and therapeutic and rehabilitative activity on the other. ”
23
Both amendments were
accepted and became articles of the 1961 Convention, as amended by the 1972 Protocol.
Setting the vision of a drug-free society
A progressively restrictive policy
At the national level, the 70s saw an increase in heroin abuse, resulting, as in other European
countries, in a higher mortality among drug abusers.
24
The Narcotics Drugs Act was amended
again, in 1972, with the maximum penalties for serious offences raised to 10 years. At the same
time, however, drug abusers were protected from prosecution. From 1972 onwards, prosecutors
could waive charges for possession of amounts equalling up to one week’s use.
Nevertheless, drug abuse continued unabatedly which, possibly, led to changed attitudes within
society. Very soon, some thought society had a duty to intervene against individual abusers whose
lives were in acute danger and to take more vigorous action against all forms of drug trafficking.
25
A parliamentary bill was therefore introduced in 1978 (Prop. 1977/78:105) which proposed to
raise the standards for drug control policy efforts. The standard should be to eliminate drug abuse
not simply lower it. The bill stated that: “The struggle against drug abuse may not be limited only
to reducing its existence but must aim at eliminating drug abuse. Drug abuse can never be
accepted as a part of our culture.”
26
The bill was approved by Parliament and endorsed the guiding
principles of the drug policy: “The basis for the struggle must be that society cannot accept any
other use of narcotic drugs than what is medically motivated. All other use is abuse and must
forcefully be opposed.”
27
Thereafter, policy was further tightened. In 1980, new directives to prosecutors ruled out any
waiver of charges unless the amount possessed for personal use was so small that it could not be
subdivided, that is, at most one dose of cannabis or one dose of central nervous system stimulants.
Moreover, charges for possession of heroin, morphine, opium or cocaine, should, in principle,
never be waived at all. One year later, the penalties for drug offences were raised again; the
maximum prison terms for non-serious offences were raised from 2 to 3 years; in addition
minimum sentences for serious offences were raised from one to 2 years. In 1982, the Social
Services Act was amended and permitted the State to coerce adult drug abusers into treatment.
October 1984 saw the adoption of another Government bill (Prop. 1984/85:19) on a “coordinated
and intensified drug policy”, which spelled out the aim of Swedish drug policy as a drug-free
society: “The goal of society’s efforts is to create a drug-free society. This goal has been
established by Parliament and has strong support among citizens’ organizations, political parties,
youth organizations and other popular movements.”
28
The bill encouraged people to play an
Part 1: The Swedish Drug Control Policy
15
active role, stating that “everybody who comes in contact with the problem must be engaged, the
authorities can never relieve [individuals] from personal responsibility and participation. Efforts
by parents, family, friends are especially important. Also schools and non-governmental
organizations are important instruments in the struggle against drugs.”
29
This vision of a drug-free society still remains the overriding vision. The ultimate aim is a society
in which drug abuse remains socially unacceptable and drug abuse remains a marginal
phenomenon. In this visionary aim, drug-free treatment is the preferred measure in case of
addiction and prosecution and criminal sanctions are the usual outcome for drug-related crime.
30
Changes in the treatment system
Following the proclamation of a drug-free society, the focus was increasingly on the abuser. Drug
abusers could be coerced into treatment. The Social Services Act (1980:620) made it possible to
commit adult abusers of alcohol or drugs within the social services to coercive care.
A compulsory care order in Sweden can only be issued if certain legal conditions are met. The two
conditions are: (a) that the person is in need of care/treatment as a result of ongoing abuse of
alcohol, narcotics and volatile solvents and that (b) the necessary care cannot be provided under
the Social Services Act. The first option for the substance abuser is always voluntary treatment
under the Social Services Act. The social welfare committee, which works on the prevention and
countermeasures of abuse of alcohol and other addictive substances, acts in consensus with the
individual, according to Section 11 of the Act. The modalities of coercive care were laid down in
the Care of Abusers (Special Provisions) Act (1981:243), which entered into force in 1982, at the
same time as the Social Services Act. The introduction of compulsory treatment brought about an
increase in the number of patients treated.
Figure 1: Number of patients discharged after compulsory treatment in Sweden, 1982-1988
0
50
100
150
200
250
1982 1983 1984 1985 1986 1987 1988
Number of patients
Source: Adapted from Mats Ramstedt, The drug problem in Sweden in 1979-1997 according to official statistics, in Håkan
Leifman and Nina Edgren Henrichson (eds), Statistics on alcohol, drugs and crime in the Baltic Sea region, Nordic Council for
Alcohol and Drug Research, Publication Nr. 37, Helsinki, 2000
Conditions for coercive care were modified in 1988. The maximum coercive care period was
extended from two to six months and the target group was extended to include abusers of solvents.
The Care of Alcoholics, Drug Abusers and Volatile (Special Provisions) Act (1988:870) aims to
motivate drug abusers so as to induce them to “collaborate in continued treatment and accept
support to discontinue” abuse.
31
The conditions that have to be met include not only “running an
obvious risk of destroying his life”
32
but also when “it can be feared that he will inflict serious
damage on himself or on someone with whom he has a close relationship.”
33
The concept of compulsory care may be seen as a logical consequence of the pursuit of the
objective of a drug free society. But it is not unique to Sweden. It has also been applied in a
number of other countries, including in countries such as the Netherlands
34
which have a different
vision.
Sweden’s successful drug policy: A review of the evidence
16
In the 1990s, the number of patients admitted to residential care, both voluntary and coercive,
decreased, mainly due to budgetary constraints in the early years of the decade. Subsequently,
priority was given to persons who were willing to undergo treatment. Thus, as of 1 November
2005, only 6 per cent of all substance abusers in residential treatment within the social services
system were in coercive care.
Other factors may have also played a role. With the advent of HIV in Sweden, the concept of
“Offensive Drug Abuser Care” was developed which emphasizes outreach activities and aims at
motivating drug abusers for treatment. As of 1986, so-called drug abuser care bases were
established in the main municipalities and in the social welfare districts of the larger cities. A
number of new residential treatment centres were opened and numerous joint projects were started
by social services and prison and probation authorities. Budgetary constraints in the early 1990s
led, however, to a reduction in some of these activities. As the budget situation improved in recent
years, the main trend has been to develop open care options
.
The introduction of needle exchange programmes
In 1985, the number of newly registered HIV positive persons among injecting drug users was 142
(45 per cent of all reported cases) and in the following year, when 204 additional cases of HIV
infection were recorded, a debate flared up. Should drug-free treatment continue to be the main
policy of treating drug abusers or should the policy instead be aimed at limiting the social and
medical damages? It was decided that both were possible. The strict line was maintained while
harm reduction measures were implemented in areas where they were needed.
Needle exchange programmes started, on a project basis, in Malmö and Lund in 1987 and 1986
respectively. In Malmö, some 1000 people are involved in the programme annually.
35
Along with
the Netherlands, Sweden was one of the first countries in Europe to introduce these programmes.
In April 2006 the Swedish Parliament endorsed a Government Bill proposing a new law (Lag
(2006:323) allowing needle exchange programmes across the country on certain conditions. The
National Board of Health and Welfare may issue a permit to a regional health authority to run
needle exchange programmes provided that the application has been endorsed by the local
community. The programmes should be organised to motivate drug abusers to seek treatment and
the applicant health authority must describe how it is going to meet the needs for detoxification
and treatment. The new law took effect on 1 July 2006.
Drug use becomes a punishable offence
Drug abuse became a punishable offence in 1988. At the time, it was argued that this was
necessary “in order to signal a powerful repudiation by the community of all dealings with
drugs.”
36
In addition, it was felt that criminalizing personal consumption would have a preventive
effect, particularly among youths. Further emphasis was placed on the importance of adopting a
uniform approach within the Nordic countries- drug use was already an offence in Norwegian and
Finnish legislation. The most severe punishment was a fine.
In 1993, the law was further tightened by introducing imprisonment into the scale of punishments
(1992/93:142). Police were now empowered to undertake a bodily examination in the form of
urine or blood specimen test where there are reasonable grounds to suspect drug use. The purpose
of the more severe provision was to “provide opportunities to intervene at an early stage so as to
vigorously prevent young persons from becoming fixed in drug misuse and improve the treatment
of those misusers who were serving a sentence.”
37
However, in an evaluation of the criminal
justice system measures, the National Council for Crime Prevention of Sweden concluded that
“based on available information on trends in drug misuse there are no clear indications that
criminalization and an increased severity of punishment has had a deterrent effect on the drug
habits of young people or that new recruitment to drug misuse has been halted.”
38
On the contrary,
the Council found that drug experimentation among young people, increased throughout the
1990s, a trend, which was similar in Sweden to that in other countries.
Swedish drug control policy also changed by introducing stricter legislation for drug-related
offences:
Part 1: The Swedish Drug Control Policy
17
Progressive tightening of Swedish drug laws (1968-1993)
1968 Narcotics Drugs Act (Narkotikastrafflag (1968:64) adopted
1969 Maximum sentence for serious offences raised to 4 years imprisonment
1969 Maximum sentence for serious offences raised to 6 years imprisonment
1972 Maximum sentence for serious offences raised to 10 years imprisonment
1980 Circular of Prosecutor-General on certain questions regarding the handling of narcotics
cases: dropping of prosecutions for drug offences should be limited to cases involving
only possession of indivisible amounts of drugs
1981 Maximum sentence for non-serious offences raised to 3 years imprisonment
1981 Minimum sentence for serious offences raised from 1 to 2 years imprisonment
1981 Introduction of coercive care for drug abusers
1985 Prison term for minor drug offences raised to maximum of 6 months
1988 Drug use becomes punishable offence, punishable with fine
1988 Act on Treatment of Alcoholics and Drugs Misusers (1988:870)
1993 Drug use becomes imprisonment offence (1992/93:142)
Reaffirming the vision of a drug-free society
The 1998 Drugs Commission
During the economic crisis of the 90s, major cuts were made at the local level. Municipalities
were not allowed to raise taxes and this meant that resources were directed towards care of the
elderly and the disabled. Resources for social services were kept at more or less constant level but
were directed to areas other than the care and treatment of drug abusers. According to the National
Board of Health and Welfare, the costs of addiction care expressed as a proportion of social
services cost decreased gradually from 1995. Heavy drug abusers suffered most from the funding
cuts. Outreach work for drug abusers became a rarity. The funding cuts coincided with an
increase of drug abuse and drug-related problems.
The renewed drug problems resulted in the appointment of a Special Commission - the Drugs
Commission - in 1998. The six-expert Commission had the mandate to revise, discuss and propose
all possible options to improve governmental action toward the goal of a society free of drugs.
The report of the Commission was issued in 2001, ominously entitled “Crossroads - the drug
policy challenge.”
The Commission identified major deficiencies in the field of drug control and found that “the
present state of drug policy is above all due to a demotion of the drug issue as a political
priority.”
39
The absence of political concern, the Commission continued, is reflected in “reduced
funding of the public authorities and other sectors of the community which have to deal with
narcotic drugs and their consequences. During recent years, all sectors of society in this field have
experienced heavy cutbacks, simultaneously with the problem itself becoming severer and more
widespread.”
40
However, the overall goal of aiming for a society free from drug abuse was not put in question. On
the contrary, pronouncing itself on the general direction of the policy, the Drugs Commission
stated that “Sweden’s restrictive policy on drugs must be sustained and reinforced. The
Commission finds no arguments or facts to suggest that a policy of lowering society’s guard
against drug abuse and drug trafficking would do anything to improve matters for individual
abusers or for society as a whole.”
41
Sweden’s successful drug policy: A review of the evidence
18
This is not to say that the Commission did not find fault with the national drug policy at all. The
Commission was most critical of activities, or the lack of sustained activities, taken to reduce the
demand for illicit drugs. In its report, the Drug Commission put forward suggestions aimed at
creating coherence and balance and at strengthening, renewing and developing the restrictive
policy on drugs. Some of the main findings of the Commission concerned:
• Stronger political leadership:
The Commission noted a need for stronger prioritization,
clearer control and better follow-up of drug policy and recommended the appointment
of a minister specifically charged with the direction of drug control activities. The
Government responded by creating the post of a National Coordinator on Drugs who
took office in January 2002.
• Measures to combat demand
: The Commission noted that much of the preventive work
that was done was characterized by temporary measures and projects which are often
incapable of impacting on regular activities. The Commission also found grave
deficiencies in the design of drug abuser care, added to which, the volume of such care
is not commensurate with actual needs. Focusing on prevention, the Commission noted,
that for preventive measures to succeed, they must be “included in a system of measures
restricting availability, and there must be clear rules which include society’s norms and
values, as well as effective care and treatment.
• Measures to combat supply
: The Commission did not find any real deficiencies in the
legislation or the working methods used by the authorities in the control sector.
Cooperation between the authorities worked. Nevertheless, it called for further resources
with a view to reducing the supply of drugs.
• “Criminal welfare”:
The Commission saw an urgent need for resources to be allocated
to the prison and probation system, particularly for the intensification of its measures to
combat drug abuse.
• Competence development and research:
The Commission called for improvement of
knowledge of the drug situation, of laws and control measures, of methods relating to
prevention and treatment and of the effects of preventive measures and measures of
treatment.
The National Action Plan on Drugs
The findings of the Drugs Commission were the basis for the formulation of the National Action
Plan on Drugs that the Government adopted in January 2002. The National Action Plan on Drugs
(2002-2005) set out three main objectives: (1) to reduce the number of persons who engage in
illicit drug use, (2) to encourage more drug abusers to give up the habit and (3) to reduce the
supply of drugs.
In order to implement the vision of a drug free society, it was deemed necessary that
• more people are to become involved in the work;
• more people are to say ‘no’ to drugs;
• more people are to know about the medical and consequences of drugs;
• fewer people should start using drugs (to be achieved by reducing the desire of young
people to experiment with drugs and by breaking up environments and cultures that
attract and stimulate trying drugs for the first time);
• more abusers are to obtain help to a life free of criminality;
• the availability of drugs is to be reduced.
Activity areas, foreseen in the Action Plan, include, inter alia, new school-based programs;
interventions aimed at vulnerable groups; appropriate assistance for drug addicts; 10 million Euros
for prison and probation service; and information campaigns.
Part 1: The Swedish Drug Control Policy
19
The Action Plan foresees, however, a stronger goal orientation, with better coordinated measures
at the local, regional and national level to limit both supply and demand. For this purpose, a
National Drug Policy Coordinator was appointed by the Government with the task to implement
and follow up the National Action Plan. The main duties have been
• to develop cooperation with authorities, municipal and county councils, NGOs, etc.;
• to shape public opinion;
• to undertake a supporting function for municipal and county councils in the
development of local strategies;
• to initiate the development of methods, development and research;
• to serve as the Government spokesperson on drugs issues;
• to evaluate the action plan; and
• to report regularly to the Government (at least once a year).
The plan also spelled out that intensified measures were needed to make drug issues a strong
political priority, to improve cooperation among authorities and between authorities and private
sector organizations, to improve prevention and treatment through method & competence
development and research, to develop the treatment perspective within the correctional system, to
render the measures in the control area more effective, to improve the methods to monitor the
development in the drugs area as well as society’s responses, and to increase international
cooperation.
A total of SEK 325 million (about US$ 44 million) was allocated over a period of four years to
implement the plan. In actual fact, some SEK 405 million were invested in the implementation of
the plan (more than US$50 million or more than €40 million at 2006 exchange rates). A large
portion was spent on supporting research in order to improve the efficiency and effectiveness of
measures taken. The budget signaled additional resources, since the Drug Policy Coordinator did
not take over the responsibilities of other national authorities or authorities at the regional or local
level.
The Government provided additional resources for the development of local prevention policies
by providing earmarked grants that could be used for the development of prevention activities at
the local level, including the hiring of local coordinators of substance abuse prevention on a 50:50
per cent funding basis. As a consequence, a majority of all municipalities in Sweden has such
coordinators now. Coordinators work on substance abuse issues (alcohol and drugs), based on
Sweden’s public health model of integrated community based prevention activities.
The National Drug Policy Coordinator’s Office has been operating as a catalyst and agent for
mobilizing society at all levels towards a common goal: reducing drug use to come closer to the
ultimate vision of a drug-free society. By doing this, the National Drug Coordinator serves another
purpose: giving a human face to some abstract policies. This had been missing in Sweden’s drug
policy up to that time: a national anti-drug advocate and coordinator, who was responsible for the
implementation of the drug policies.
The implementation of most policies is aided if championed by an individual who exercises
leadership in his or her area of competence. While in the 1970s and 1980s this role was taken by
people such as the late Nils Bejerot who succeeded in mobilizing broad sections of the population,
a vacuum had been created in the 1990s. It has now been filled in a – seen from an institutional
perspective – far more rational manner than before.
The Office of the Drug Policy Coordinator has been successful in raising awareness of the drug
issue and a greater interest across society. It has also served as a signal to the local levels to take
the drug issue seriously.
The current policy model was successful and has therefore been maintained. The new Swedish
Anti-Drug Strategy (2004-2007) is in line with the restrictive drug policy. This involves no
Sweden’s successful drug policy: A review of the evidence
20
tolerance to drug abuse. Drug-related crime should always lead to prosecution and criminal
sanctions, and drug-free treatment is seen as a priority measure in response to addiction.
A new National Action Plan on Drugs was unanimously endorsed by Parliament in April 2006.
All parties agreed that the overall goal of the Swedish drug policy remains to strive for a drug-free
society. Parliament also underlined the importance of a holistic view. Drug policy initiatives
should target both supply and demand. There is a wide consensus about the overall goal of the
drug policy, namely the drug-free society and its objectives: to reduce the recruitment of young
people to drug abuse; to enable drug abusers to stop their drug abuse, and to reduce the availability
of illicit drugs. There is also consensus that a balanced approach is required.
42
The goal is outlined as follows: The drug policy is based on the right to a life with dignity in a
society that guards the needs of the individual to feel safe and secure. Narcotic drugs should never
be allowed to threaten the health, the quality of life and the security of the individual nor the
general welfare or the development of democracy. The goal is a society free of drugs.”
43
Swedish drug policy in perspective
The Swedish policy is fully in line with the three United Nations Conventions on drugs: the 1961
Single Convention on Narcotic Drugs, the 1971 Convention on Psychotropic Substances and the
1988 United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic
Substances. The International Narcotics Control Board, the independent, quasi-judicial expert
body responsible for monitoring the implementation of treaties by Governments, carried out a
mission to Sweden in 2004 and commended the Government for its commitment and efforts in the
fight against drug abuse and illicit trafficking, in line with the international drug control treaties.
44
Drug control legislation in Sweden, is in many respects stricter than what is required by the
treaties which do not, for example, require that drug use (as opposed to possession) be punished.
At the same time, such provisions are permissible and many Governments provide for stricter
sanctions in their national legislation than those required in the Conventions.
The vision of a drug-free society is not unique to Sweden but used to be shared by many of its
Nordic neighbours. The Action Plan to Combat Drug- and Alcohol-related Problems, adopted by
the Government of Norway in 2002, spells out that the “main vision forming the basis for the
Norwegian drug control policy is a society free from drugs and substance abuse.”
45
Finland, in
2002, was reported to have as its main goal of national drug control “to prevent drug use and the
proliferation of drugs so as to reduce the detrimental effects on individuals and the costs entailed
by drug abuse.”
46
Similarly, for several years, Iceland carried out a programme called “Drug-free
Iceland 2002”, under which several drug prevention activities were carried out and which is
considered a success in mobilizing the general public against drug abuse.
47
Only Denmark has always adopted a slightly different view. Already back in 1994, a joint policy
paper authored by the Ministries of Justice, Social Affairs and Health entitled “fight against drug
abuse-elements and problems”, states that “a drug-free society is seen as probably unrealistic”.
The same attitude is reflected in the 2003 Action Plan Against Drug Abuse, adopted by the Danish
Government in October of the same year which reads, in part, as follows: “It is evident that a
society without any drug abuse at all would be desirable, but from a realistic point of view this
must be considered as an unattainable goal. And no Government in any country has been able to
“solve” the problem of drugs.”
48
Nevertheless, the plan continues, one would be “totally mistaken
to assert that society’s efforts against drug abuse over several decades have failed, also because
unlimited resources have at no time been available for these efforts.”
49
Over the last few years, some Nordic countries seem to have adopted a similar approach,
especially those which are European Union members or associated members. Finland, for
example, now takes the view that “a drug free society is not a realistic objective for anti-drug
campaigns.”
50
The current main policy document makes no reference to the ideal of a drug-free
society and its objective is now to “bring about a permanent change for the better in the drug
situation in Finland.
51
Norway also appears to be moving away from the goal of a drug-free
society, especially with the introduction of drug injection rooms. According to the Government,
Part 1: The Swedish Drug Control Policy
21
drug injection rooms were in fact, also established to “facilitate an evaluation of the effect of
exemption from punishment for possessing and using drugs in a specifically delimitated area.”
52
At the level of the European Union, drug control strategies are very general in nature, leaving
much room for Member States to carry out their national policies. Neither the current EU Action
Plan on Drugs (2005-2008) nor the EU Strategy (2005-2012) make reference to a society free
from drug abuse, let alone, describe it as a guiding vision or principle.
The debate about the Swedish drug policy intensified after Sweden (as well as Austria and
Finland) joined the European Union in 1995. Of all three new European Union members, Sweden
was arguably pursing the most restrictive drug policy. Given its low rate of drug abuse compared
to other European Union Member States, the policy of Sweden was seen as successful and there
were repeated references to the Swedish model in drug policy discussions.
53
However, this
development was not welcomed by all. While the statement of one researcher that Sweden’s entry
into the European Union “paralyzed the general trend towards liberalism that had been
developing,”
54
is probably an overstatement, it is true that a harmonized European Union drug
policy remains an elusive goal. Nonetheless, States members of the European Union are parties to
the United Nations treaties and thus bound by their provisions.
As regards investment into drug control policies, a study by the European Monitoring Centre on
Drugs and Drug Addiction showed that, after the Netherlands, Sweden has the highest drug-
related expenditure per capita in EUR and as percentage of GDP.
Table 1: Drug- related expenditure per capita in EUR and as percentage of GDP
Per capita % of GDP
Netherlands 139 0.66
Sweden 107 0.47
UK 68 0.35
Luxembourg 54 0.15
Ireland 49 0.27
Finland 31 0.15
Belgium 18 0.09
Austria 18 0.08
France 16 0.08
Denmark 14 0.05
Italy 11 0.06
Portugal 9 0.10
Spain 9 0.07
Germany 9 0.04
Greece 2 0.02
N/A = not available
Austria: 8,114,000 population and GDP of €181,937 million; Belgium: 10,214,000 population and GDP of €214,961
million; Denmark: 5,319,000 population and GDP of €148,975 million; Finland: 5,171,000 population and GDP of
€107,900 million; France: 59,099,000 population and GDP of €1,244,312 million; Germany: 82,087,000 population
and GDP of €1,870,714 million; Greece: 10,553,000 population and GDP of €106,742 million; Ireland: 3,745,000
population and GDP of €67,861 million; Italy: 56,952,000 population and GDP of €1,011,082 million; Luxembourg:
431,000 population and GDP of €15,410 million; Netherlands: 15,754,000 population and GDP of €332,513 million;
Portugal: 9,983,000 population and GDP of €92,031 million; Spain: 39,418,000 population and GDP of €492,989
million; Sweden: 8,868,000 population and GDP of €201,024 million; UK: 59,333,000 population and GDP of
€1,165,057 million
Source: adapted from Public expenditure on drugs in the European Union 2000-2004, EMCDDA, 2004
Part 2: The Drug Situation In Sweden
23
PART 2: THE DRUG SITUATION IN SWEDEN
The development of the drug problem at the national level will be reviewed in more detail to see
to what extent changes in drug policy have had an impact of drug use levels in Sweden.
Amphetamine - the main problem drug
Unlike most European countries, the main problem drug in Sweden is not heroin but intravenously
administered amphetamine. As outlined above, Sweden was among the first countries in Europe to
experience a major amphetamine epidemic, dating back to the 1930s. Despite progress made in
curbing amphetamine use, amphetamine is still the main problem drug in the country.
Heroin, the main problem drug in Europe, was not known in Sweden until the late 1960s. While
its abuse has expanded over the years, heroin ranks second as a problem drug in Sweden. Cocaine
and ecstasy are of limited importance. As in most countries around the world, cannabis is the most
widely used drug among youth and the general population.
Data for treatment demand clearly show the predominant role of amphetamine abuse in Sweden.
Amphetamine (35.1 per cent) outranks opiates (31.5 per cent), with cannabis in third place (19.5
per cent). The proportion of amphetamine in treatment is in Sweden four times larger than in
Europe as a whole.
Figure 2: Drug-related treatment demand in Sweden, 2003
Amphetamines
35.1%
Ecstasy
0.5%
Cannabis
19.5%
Other
2.4%
Sedatives
9.0%
Cocaine
2.0%
Opiates
31.5%
Source: UNODC, Annual Reports Questionnaire Data.
Sweden’s successful drug policy: A review of the evidence
24
Figure 3: Drug related treatment demand in Europe, 2000-04
Opiates
58.5%
Cannabis
15.9%
Ecstasy
1.1%
Other
7.0%
Sedatives
2.5%
Cocaine
6.5%
Amphetamines
8.5%
Source: UNODC, 2006 World Drug Report
Development of amphetamine use from 1940 to date
The introduction of amphetamines, primarily benzedrine and methamphetamine (marketed as
pervitin), in about 1938 marked the beginning of a drug abuse problem in Sweden. Drugs were
heavily advertised (one popular slogan was “Two pills are better than a month’s vacation”), sold
freely and subsequently used by large sections of the population. Representative enquiries into
student behaviour in Sweden found a few years after their introduction into the Swedish market
that 70-80 per cent of students were occasional users of ‘pep pills’.
55
Although figures are not
directly comparable, in 2003, life-time prevalence of amphetamines among 15-16 year olds ini
Sweden was estimated at 1 per cent (2003 ESPAD study).
56
The introduction of a prescription requirement for amphetamine in 1939 did not lead to a sustained
reduction in use. Sales were halted only for about a year before skyrocketing again as people
collected prescriptions through third parties. The use of amphetamine began to rise continuously
and in 1943, almost 10 million tablets were consumed annually. At that time, the number of
amphetamine users was estimated at 200,000 users, equivalent to 4.6 per cent of the population
age 15-64.
The sales of amphetamine plunged, however, when the National Medical Board of Health issued a
warning on the risk and abuse of stimulants in April 1943. The decline, which has been estimated
at between 40 to 60 per cent, was caused, inter alia, by restrictive prescription practices.
Soon after 1943, the market for amphetamines recovered and abuse continued to spread. By the
late 50s, abuse of methylphenidate, a central-nervous system stimulant, was a great concern.
Dexamphetamine and phenmetrazine were also widely used as weight-reducing agents.
In 1959, the total number of amphetamine users peaked at 313,000 people or 6.4 per cent of the
population age 15-64, which is extremely large, even by today’s global standards. (The highest
level of amphetamines use worldwide is currently reported from the Philippines with an annual
prevalence rate of 6 per cent, followed by Australia with 3.8 per cent).
57
However, by 2000/2003, the total number of amphetamines users in Sweden was only a fraction of
what it had been in 1959, some 25,000 persons (UNODC estimate
58
) or 0.4 per cent of the
population age 15-64. The Swedish drug policy seems to have contributed to this decline.
Part 1: The Swedish Drug Control Policy
25
Figure 4: Amphetamine use in Sweden among the general population (age 15-64), 1943-
2003
4.6%
6.4%
1.7%
0.4%
3.2%
4.3%
1.2%
0.2%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
1943 1959 1965 2000/03
all amphetamine use (incl. problem drug use)
occasional & regular use / annual prevalence
Sources: Börje Olsson, Narkotikaproblemets bakgrund – Användning av och uppfattningar om narkotika inom svensk medecin
1839-1965 (The Background of the Drug Problem – Use of and Conceptions about Narcotic Drugs in Swedish Medicine, 1939-
1965), Stockholm 1994; and UNODC, Annual Reports Questionnaire Data.
The massive decline in overall amphetamine use since the late 1950s, however, does not appear to
have been sufficient to reduce problematic use of amphetamines. An ever larger proportion of
amphetamine users eventually became dependent on the substance, partly linked to a trend
towards injecting amphetamine.
Estimates of the number of heavy amphetamine abusers were still rather low in 1959, at some
3,300 persons or 0.07 per cent of the population age 15-64). By 1965, this number had increased
to some 4,000 persons, despite stricter prescription requirements. Offering drugs, notably
amphetamines, to drug abusers, as was done in the Stockholm experiment, could not reverse this
trend. By 1969, the number of problem drug users had increased to 10,000. Given the fact that the
overwhelming majority used amphetamines, the number of amphetamine abuser is estimated at
8,000 persons.
The gradual restriction of the Swedish drug control policy after 1968 is associated with a fall in
both overall amphetamine use and problematic amphetamine use. In 1979, the number of problem
drug users was estimated at between 10,000-14,000 persons, of which an estimated 5,600 were
amphetamine abusers, equivalent to 0.11 per cent of the population age 15-64 - much lower than
in 1969.
No estimates on problem drug use are available for the 1980s, but it is generally assumed that
there was not much of an increase as rising drug budgets meant that ever more drug addicts
benefited from treatment.
This changed in the 1990s. By 1992, the overall number of problem drug users was estimated to
have increased to 17,000 (14,000-20,000), rising further to 26,000 by 1998 and 28,000 by 2001.
The proportion of amphetamine as the prime drug among problem drug users, however, continued
to decline, from 47 per cent in 1979 to 32 per cent in 1998.
59
Applying the ratio of 32 per cent to
the number of problem drug users in 2001, calculations suggest that there were some 9,000
amphetamine related problem drug users in Sweden, or 0.16 per cent of the population age 15-64.
Less than 26,000 persons were estimated to be problem drug users in 2003, which, assuming a
constant proportion of amphetamine in overall problem drug use, gives an estimate of 8,200
persons or 0.14 per cent of the population age 15-64 in 2003. This would be still more than
amphetamine-related problem drug use in 1959, 1965 or 1979 though at similar levels as estimates
for 1969.
Sweden’s successful drug policy: A review of the evidence
26
Drug use in Sweden since 1970
As shown above, Sweden experienced significant increases in amphetamine use in the 1940s and
1950s. This period was followed by major successes in curbing amphetamine use, notably over the
1959-65 period (more than 70 per cent), mainly by addressing the prescription practices of
medical doctors. Thus, within a five to six year period, Sweden’s extensive amphetamine use
levels have been on the way towards a gradual elimination. However, a number of new drugs
emerged and existing ones, notably cannabis and LSD, became widespread within short periods of
time.
Epidemiological data in Sweden has been collected systematically since the 1970s. The best
available data to monitor the impact of the drug policy are the regularly undertaken national
school surveys and the surveys on military recruits in Sweden.
Life-time prevalence of drug use among 15-16 year old students declined from 15 per cent in 1971
to 3 per cent in 1989. Past month prevalence rates showed an even steeper decline, falling by 90
per cent over the same period, from 5 per cent to 0.5 per cent.
Figure 5: Life-time prevalence of drug use among 15-16 year old students in Sweden,
1971-2006
9.0
15.0
6.0
9.2
3.0
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
1971 1976 1981 1986 1991 1996 2001 2006
Source: CAN
Life-time prevalence of drug use among military recruits fell by more than half, from 15.7 per cent
in 1971 to 5.8 per cent in 1988. It may be noted though that the decline in drug use in the 1970s
was limited to pupils in the younger age group while the decline of life-time prevalence among
military recruits only took effect in the 1980s; in contrast, current use of drugs among military
recruits already started declining in the 1970s (by about 25 per cent between 1972 and 1980) .
Part 1: The Swedish Drug Control Policy
27
Figure 6: Life-time prevalence of drug use among military recruits in Sweden, 1971-2005
19.2
5.8
17.9
13.5
15.7
5.8
0.0
5.0
10.0
15.0
20.0
25.0
1970 1975 1980 1985 1990 1995 2000 2005
life-time prevalence
Source: CAN
Figure 7: Past month prevalence of drug use among military recruits in Sweden, 1971-2005
3.1
2.0
0.7
0.8
3.7
4.9
0.0
1.0
2.0
3.0
4.0
5.0
1970 1975 1980 1985 1990 1995 2000 2005
monthly prevalence (in %)
monthly prevalence used several times during last 30 days
Source: CAN
These patterns were reflected for most drug categories. Life-time prevalence among conscripts
showed steep declines for cannabis, cocaine, amphetamines and LSD between the early 1970s and
the late 1980s.
As can be seen from above, progressive restrictiveness of drug policies was associated with lower
levels of drug use. The proclaimed goal of a drug-free society no longer seemed to be an utopian
objective, but a goal that was within reach.
The expansion of drug abuse in the 1990s
Data for the 1990s, however, clearly pointed in the opposite direction. The trend showed upwards
in general population surveys where life-time prevalence of drug use among those aged 15-75 rose
from 7 per cent in 1990 to 12 per cent in 2000. Increases were observed for those 15-29 year olds,
30-49 year olds and 50-75 year olds. Massive increases were evident in youth surveys and
conscript surveys. In addition, the number of problem drug users rose by more than a third
Sweden’s successful drug policy: A review of the evidence
28
between 1992 and 1998. Drug-related treatment demand rose by more than half. The number of
drug related deaths doubled over the 1990-2000 period.
Figure 8: Life-time prevalence of drug use,
sliding three year averages, 1988-
2000, breakdown by age group
Figure 9: Number of problem drug users in
Sweden (and as a proportion of the
population age 15-64), 1979-1998
12
9
7
8
0
5
10
15
20
1988
1989
1990
1991
1992
1993
1994
1996
1998
2000
life-time prevalence in %
Total (15-75) 15-29
30-49 50-75
Source: CAN.
26,000
15,000
19,000
26,000
12,000
17,000
0.46%
0.34%
0.28%
-
5,000
10,000
15,000
20,000
25,000
30,000
1979 1992 1998
Number
Estimates for heavy drug use
Problem drug use (readjusted figures)
Sources: Tim Boekhout van Solinge, The Swedish Drug Control
Policy, 1979 and CAN 2006.
Figure 10: Treatment demand for drug abuse
in Sweden, 1990-2000
Figure 11: Drug-related deaths in Sweden,
1990-2000
14,826
9,710
8,889
5,534
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Number
In patient treatment episodes
No. of persons in treatment
Source: CAN
199
186
238
254
281
296
342
335
341
353
403
0
50
100
150
200
250
300
350
400
450
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Number
Source: CAN
Part 1: The Swedish Drug Control Policy
29
Drug prices also declined, despite rising seizures, a clear indication for increased drug supply.
From 1990 to 2000, prices for heroin, amphetamine, cocaine and cannabis resin declined
significantly.
While a general increase in drug abuse in Europe was observed at the time, the deterioration of
drug use indicators in Sweden was nevertheless startling. There was no ‘softening’ of Sweden’s
drug policies in the 1990s. Therefore, increases in drug abuse cannot be explained by any
permissive trends. A number of other factors played a role:
Slowdown in economic growth and resulting budget cuts
GDP growth, which had amounted to 2.5 per cent p.a. over the 1985-1990 period, declined by, on
average, 0.9 per cent over the 1991-93 period
60
. In parallel, the general government balance
moved from a surplus to a deficit of 11.3 per cent of GDP by 1993 and the debt/GDP ratio peaked
at 72.9 per cent in 1993.
These conditions necessitated the implementation of severe economic austerity programmes which
involved a review of the country’s generous welfare system. Cuts to welfare spending included
reductions in child allowances, pensions, housing subsidies as well as the health sector. Expressed
as a percentage of GDP, health expenditure was slashed from levels exceeding 9 per cent of GDP
in the early 1980s (one of the highest such levels at the time among industrialized countries) to
levels around 8 per cent of GDP in the 1990s. It was Sweden’s drug control system, notably its
treatment system for drug addicts, that was heavily affected by these cuts.
Figure 12: Total health expenditure in Sweden, 1970-2000
Source: OECD, OECD Economic Surveys – Sweden, Volume 2005/9, August 2005
Therefore, while the basic orientation of Swedish drug policy had not changed, the overall priority
of drug control, as reflected in budget allocations, undeniably declined in the 1990s.
The increasing decentralization of Sweden’s health care system also played a role and de facto
reduced the priority given to the drug problem. Because of the economic crisis at the beginning of
the 1990’s large cuts were effected at the local level. The municipalities were not allowed to raise
taxes during a couple of years. Available resources were directed primarily towards care of the
elderly and the disabled while resources for social services - which have the overall responsibility
for prevention and treatment of substance abuse - were kept more or less constant. Within the
social services there was a reallocation of resources to economic support and to the care of
children. According to the National Board of Health and Welfare, the cost of addiction care
Sweden’s successful drug policy: A review of the evidence
30
decreased gradually as a share of social services costs in the 1990s (15 per cent between 1995
and 2000). In terms of money spent, there was a decrease of about a quarter from almost SEK five
billion in 1995 (almost €540 million or US$700 million in 1995) to SEK 3.7 billion in 2000 (€440
million or US$400 million). As a consequence, less treatment was available. The time a user could
spend in treatment was also reduced. Whereas in 1989 there were 19,000 people in treatment
centres (for both alcohol and drugs), this number dropped to 13,000 by 1994. Due to the budget
cuts, 90 treatment homes had to be closed between 1991 to 1993.
61
Cuts also affected outreach
work in many municipalities at the beginning of the 1990’s so that outreach work among drug
addicts became a rarity.
Reduction in employment in the public and private sector saw increases in Sweden’s
unemployment rate which rose from a mere 1.5 per cent in 1989 to 9.9 per cent in 1997
62
.
Figure 13: Unemployment rate in Sweden and in the EU-15, 1983-2005
6.3*
1.5
3.7
9.9
10.5
7.9
-
2.0
4.0
6.0
8.0
10.0
12.0
1980 1985 1990 1995 2000 2005
Unemployment rate in %
Sweden EU-15
Source: Eurostat database, Harmonized Unemployment rate.
The effect was even more pronounced for young people. Unemployment among young people
(age 15-24) rose from 3.7 per cent in 1990 to 16.7 per cent in 1994 and remained at the high levels
in subsequent years (15.4 per cent in 1997).
63
Drug use and unemployment have been shown to be
strongly correlated and the unemployed, notably young unemployed, are believed to be far more
susceptible to drug use than those employed.
Widening income inequalities
Widening income inequalities are frequently seen as contributing factors to criminal activities,
including drug trafficking. Participation in drug trafficking is, inter alia, a function of the
perceived risk/benefit equation; the risk function is, inter alia, influenced by the level of income
inequality in society.
64
Increases in drug trafficking lead to falling drug prices and thus increases
the likelihood of drug use. Though income inequality is still one of the lowest worldwide (2
nd
lowest among all OECD countries behind Denmark and ahead of the Netherlands and Austria in
2000), it clearly widened in Sweden in the 1990s
65
.
Increase in imports
Imports more than doubled between 1991 and 2000. Expressed as a proportion of gross domestic
product, goods imports rose from less than 20 per cent in 1991 to 30 per cent of GDP in 2000.
The mere fact that foreign trade played an ever bigger role for the Swedish economy also meant
that it became de facto easier for drug traffickers to hide drugs in licit goods deliveries.
Part 1: The Swedish Drug Control Policy
31
Figure 14: Import of goods, expressed as a percentage of GDP
19.5%
29.9%
30.9%
15.0%
17.0%
19.0%
21.0%
23.0%
25.0%
27.0%
29.0%
31.0%
33.0%
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
As a percentage of GDP
Source: Statistics Sweden – National Accounts .
The opening of Eastern Europe following the removal of the iron curtain in 1989 and thus the
emergence of ever stronger trade links with the Baltic countries and Poland as well as Sweden’s’
entry into the EU in 1995 and the related opening of the country towards the rest of western
Europe may have also played a role in raising the attractiveness of Sweden as a drug market.
Downward trend in drug abuse from 2001/02 to 2005/06
The upward trend in drug use was reversed again in the new millennium, particularly among
young people. Life-time prevalence among 9
th
graders declined by 35 per cent between 2001 and
2006 (from 9.2 per cent to 6.0 per cent). The decline was observed among both male and female
students.
Life-time prevalence of drug use among conscripts declined significantly between 2002 and 2005
by 25 per cent (from 17.9 per cent to 13.5 per cent) for all drug categories. The declines were most
pronounced for LSD (-62 per cent between 2002 and 2005), ecstasy (-56 per cent), heroin (-50 per
cent) and amphetamine (-42 per cent).
Figure 15: Life-time prevalence of drug use among 9
th
graders (15-16 year olds) in Sweden,
1998-2006
7.5
9.2
6.0
-
2.0
4.0
6.0
8.0
10.0
1998 1999 2000 2001 2002 2003 2004 2005 2006
Life-time prevalence in %
Source: CAN
Sweden’s successful drug policy: A review of the evidence
32
Figure 16: Life-time prevalence of drug use among conscripts in Sweden, 1998-2005
17.9
13.5
16.4
15.0
12.6
16.7
0.0
5.0
10.0
15.0
20.0
1998 1999 2000 2001 2002 2003 2004 2005
life-time prevalence in %
all drugs cannabis
Source: CAN
Figure 17: Life time prevalence of drug use other than cannabis among military conscripts,
1998-2005
1.6
3.6
3.6
1.9
1.5
0.9
1.1
2.4
0.5
0.80.8
0.2
0.0
1.0
2.0
3.0
4.0
1998 1999 2000 2001 2002 2003 2004 2005
Life-time prevalence in %
Amphetamine Ecstasy Cocaine LSD Heroin
Source: CAN
Part 1: The Swedish Drug Control Policy
33
Falling levels of drug use among 9
th
grade students (after 2001) and among conscripts (after 2002)
were also reflected in general population surveys on cannabis - a proxy for drug use in general - in
2005. Following years of increase, general population survey data showed a decline in 2005.
Figure 18: Life-time prevalence of cannabis use among the general population, age 18-64, in
Sweden, 1996-2005
10.5
12.5
14.0
12.0
0
5
10
15
1996 2000 2004 2005
Life-time prevalence in %
Source: Statens Folkhälsoninstitut, 2005 National Report to the EMCDDA – Sweden.
Declines were also evident in the number of problem drug users, which fell from 28,000 in 2001
to less than 26,000 in 2003 (-7 per cent). Similarly, drug-related treatment demand declined, from
15,500 episodes in 2001 to 14,400 in 2003 (-7 per cent). The number of drug-related deaths (with
drugs being an either an underlying or a contributing cause) also declined, from 403 cases in 2001
to 385 cases in 2003 (-7 per cent).
Figure 19: Number of problem drug users in Sweden, 1998-2003
Source: Statens Folkhälsoninstitut, 2005 National Report to the EMCDDA – Sweden.
Sweden’s successful drug policy: A review of the evidence
34
Figure 20: Treatment demand for drug abuse in Sweden, 1998-2003
15,473
14,438
14,289
8,614
8,516
9,111
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
1998 1999 2000 2001 2002 2003
Number
In patient treatment episodes No. of persons in treatment
Source: CAN
Figure 21: Drug-related deaths in Sweden, 1998-2003
341
353
403 403
391
385
0
50
100
150
200
250
300
350
400
450
1998 1999 2000 2001 2002 2003
Source: CAN
In examining the reasons for the general decline in drug use and drug-use related consequences in
Sweden and considering the contributing factor of the economic downturn earlier on, the role of
economic factors should be examined.
Part 1: The Swedish Drug Control Policy
35
Figure 22: Economic growth in Sweden, average annual changes of constant GDP, 1981-
2005
1.9
2.5
-0.9
3.4
2.2
-2.0
-1.0
0.0
1.0
2.0
3.0
4.0
1981-85 1981-90 1991-93 1994-2000 2001-05
Source: Eurostat – database
As can be seen from the above figure, economic growth cannot explain the decline in drug use
over the 2001-2005 period when the economy grew with 2.2 per cent at a lower rate than in the
previous period (1994-2000). Economic growth accelerated strongly over the 2004-2005 period
and boomed in 2006, with a rate of 4.8 per cent for the first two quarters. Drug use, however,
started declining prior to this economic boom.
Similarly, drug use indicators continued deteriorating at the end of the 1990s when the Swedish
economy had already recovered from the period of negative growth in the early 1990s. The
correlation between the deterioration of Sweden’s economy and increases in drug use thus only
applies to the early 1990s.
While a direct link between economic growth and drug use cannot be established, there are some
indirect mechanisms at work. Economic recovery had a delayed impact on the level of
unemployment. If one takes an average of 5-year intervals, drug use and unemployment do
correlate rather strongly. However, falling drug use rates in recent years, cannot be explained
exclusively by lower unemployment rates.
All of this points to another crucial element - Sweden’s drug policy. It seems to have played, once
again, a significant role in lowering drug use levels in this country in recent years.
As seen above, Swedish drug policy received an impetus after the work of the Drugs Commission
had been concluded in 2000. The adoption of a National Action Plan on Drugs as well as stronger
political leadership on the drug issue is associated with the subsequent improvement of the drug
control indicators. Moreover, investment in drug policies was seen as a measure to reduce health-
related costs in the future. A recently undertaken review of total public expenditure on Sweden’s
drug policy revealed that it totaled between €0.5 and €1.2 billion
66
in 2002, equivalent to between
0.2 per cent and 0.5 per cent of GDP or between 0.7 per cent and 1.7 per cent of total government
expenditure.
Sweden’s successful drug policy: A review of the evidence
36
The drug situation in Sweden - an international comparison
Over the past few years, the drug control indicators in Sweden have shown marked improvements.
But how ‘good’ are these results at the international level? The following chapter tries to provide
some answers to that question.
It is interesting to compare the Swedish results with those of other countries or areas participating
in the European School Survey Project on Alcohol and Drugs (ESPAD), conducted on behalf of
the Council of Europe and in close cooperation with the Swedish Council for Information on
Alcohol and Other Drugs (CAN) in 35 European countries and areas. Results are directly
comparable as ESPAD surveys take place at roughly the same time, target the same age group (15-
16 year old students) and use the same methodology across all participating countries. More than
100,000 European students participated in the latest survey, including 3,200 in Sweden. The
Eurobarometer survey on ‘Young People and Drugs’, conducted among 15-24 year olds across the
countries of the EU-15 in 2004 (sample size: 7,700 people, including some 500 people
interviewed in Sweden) also offers important insights.
Life-time prevalence of drug use among students
The latest ESPAD study shows that illegal drug use among 15-16 year old students amounted in
Sweden to 8 per cent, just a third of the European average (22 per cent).
Overall life-time prevalence of drug use among students declined slightly from 9 per cent in 1999
to 8 per cent in 2003 and was thus - among 35 countries and areas investigated - the fifth lowest in
Europe, after Romania, Cyprus, Turkey and Greece. Moreover, the moderate decline recorded in
Sweden contrasted the overall upward trend. Average life-time prevalence of drug use in Europe
rose over the same period from 18 per cent to 22 per cent.
Figure 23: Life-time prevalence of drug use among 15-16 year old students, 1995-2003
6
8
13
18
22
9
0
5
10
15
20
25
1995 1999 2003
Life-time prevalence in %
Sweden Europe
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs
Part 1: The Swedish Drug Control Policy
37
Figure 24: Changes in lifetime prevalence rates of illegal drug use among 15-16 year old
students in Europe over the 1999-2003 period*
* Countries above the line show increased life-time prevalence rates
while countries below the line show decreases in life time prevalence
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN)
, The ESPAD Report 2003, Nov. 2004
Like in the rest of Europe, drug use in Sweden is primarily linked to cannabis. Sweden has low
levels of cannabis use as well as low levels of overall drug use. Just 7 per cent of Swedish 15- to
16- year olds tried cannabis as compared to, on average, 21 per cent in Europe. In other words,
life-time prevalence of cannabis is just a third of the European average.
Figure 25: Life-time prevalence of cannabis use among 15-16 year old students, 1995-2003
6
8
7
12
17
21
0
5
10
15
20
25
1995 1999 2003
Life-time prevalence in %
Sweden Europe
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN), The ESPAD Report 2003,
Nov. 2004
Sweden’s successful drug policy: A review of the evidence
38
For the more problematic current use of cannabis, as reflected in the monthly prevalence rates, the
difference between Sweden and the European average is even more pronounced. While 1 per cent
of Swedish youth, aged 15-16, used cannabis in the month prior to the survey, the European
average amounted to 9 per cent. The monthly prevalence rate of cannabis use in Sweden is thus
only slightly more than a tenth of the European average. Monthly prevalence of cannabis was
lower only in Romania.
Life-time prevalence of drug use other than cannabis amounted to 3 per cent in 2003 in Sweden,
half the European average (6 per cent) among 15-16 year old students. Lower rates were only
reported from the Faroer Islands, Ukraine and Romania. Drug use levels among students in
Sweden are also below the European average for ecstasy, cocaine, amphetamine and heroin.
Figure 26: Lifetime prevalence of drug use among 15-16 year old students, 2003
22
21
6
3
2.4
2
1.1
8
7
3
2
111
0
5
10
15
20
25
All drugs cannabis other drugs ecstasy amphetamine cocaine heroin
Life-time prevalence
Europe Sweden
Correlation coefficient among 35 countries:
‘Cannabis use’ and ‘other drug use’: R = 0.74
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN), The ESPAD Report 2003,
Nov. 2004
Regular drug use
Annual and monthly prevalence of drug use among young people
Low life-time use levels in Sweden are also reflected in below average annual prevalence and
monthly prevalence rates. The 2003 ESPAD study found that annual prevalence of cannabis use in
Sweden affects 5 per cent of those 15-16 year old students, less than a third of students, on
average, in Europe (16 per cent). For other drugs, annual prevalence amounts to 2 per cent, i.e.
half the European average (4 per cent). In terms of monthly prevalence, the differences are even
more pronounced.
Part 1: The Swedish Drug Control Policy
39
Figure 27: Annual prevalence of drug use among 15-16 year old students, 2003
16
4
5
2
0
5
10
15
20
cannabis other drugs
Annual prevalence
Europe Sweden
Source: Council of Europe, The ESPAD Report 2003, Nov. 2004
Figure 28: Monthly prevalence of drug use among 15-16 year old students, 2003
9
2
11
0
2
4
6
8
10
cannabis other drugs
Monthly prevalence
Europe Sweden
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN), The ESPAD Report 2003,
Nov. 2004
The Eurobarometer study revealed that just 3 per cent of Swedish young people (age 15-24) had
used cannabis in the last month, about a quarter of the EU-15 average (11 per cent). Regular use of
drugs other than cannabis was also below average.
Sweden’s successful drug policy: A review of the evidence
40
Figure 29: Monthly prevalence of cannabis use among 15-24 year olds in EU-15, 2002-2004
1%
4%
6%
8%
5%
8%
5%
5%
12%
10%
12%
20%
9%
13%
15%
11%
1%
3%
5%
6%
7%
8%
9%
9%
10%
11%
12%
14%
14%
17%
20%
11%
0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20%
Greece
Sweden
Finland
Denmark
Portugal
Italy
Luxembourg
Austria
Denmark
Belgium
Netherlands
France
Ireland
UK
Spain
EU-15
2002 2004
Source: European Commission, Eurobarometer, Young people and drugs, June 2004.
Part 1: The Swedish Drug Control Policy
41
Figure 30: Monthly prevalence of drugs other than cannabis among young people (15-24),
2002-2004
0%
2%
2%
1%
1%
2%
2%
3%
3%
2%
3%
3%
4%
5%
4%
3%
0%
1%
1%
1%
1%
1%
1%
2%
2%
3%
4%
4%
5%
8%
8%
3%
0% 1% 2% 3% 4% 5% 6% 7% 8%
Greece
Sweden
Portugal
Austria
Italy
Denmark
Luxembourg
France
Finland
Belgium
Denmark
Netherlands
Spain
Ireland
UK
EU-15
2002 2004
Source: European Commission, Eurobarometer, Young people and drugs, June 2004.
Regular drug use among the general population
Data in the present section are primarily based on data collected by UNODC from Member States,
published in the World Drug Report. Comparisons must, however, be treated with caution as
underlying data differ with regard to the period when surveys were undertaken or the specific age
groups investigated, which may affect results. In some cases, data are UNODC estimates,
extrapolated from other available information, such as life-time prevalence rates among the
general population, local studies, or student survey results in order to provide reasonable orders of
magnitude of the likely extent of drug use.
Taking all of these caveats into consideration, data are, nonetheless, robust enough to state that
illegal drug use in Sweden is clearly below the West & Central European average (EU-25 and
EFTA countries) and – except for once substance (ecstasy) – below the overall European average.
Sweden’s successful drug policy: A review of the evidence
42
Figure 31: Annual prevalence of drug use in Sweden as compared to Europe among the
population age 15-64, 2004 or latest year available
2.2%
0.2%
0.1%
5.6%
0.7% 0.7%
7.4%
1.1%
(0.4%)
0.2%
0.4%
0.5%
0.2%
0.7%
0.9%
0.5%
0.0%
2.0%
4.0%
6.0%
8.0%
Cannabis Amphetamines Ecstasy Cocaine Opiates
annual prevalence in %
Sweden Europe West & Central Europe
Source: UNODC, 2006 World Drug Report
Cannabis
Cannabis is the most widely used drug in Sweden, like in the vast majority of all countries in the
world.
A national postal survey, undertaken in Sweden in 2004 found for cannabis a life-time prevalence
of 13.8 per cent and an annual prevalence of 2.2 per cent. A subsequent national postal survey,
undertaken in 2005, revealed a decline in the life-time prevalence to 11.9 per cent and in the
annual prevalence to 2.0 per cent of the population aged 16-64. This is lower than the European
average of cannabis use of 5.6 per cent or for the average for West & Central Europe of 7.4 per
cent (EU-25 and EFTA countries) in 2004. The annual prevalence rate of cannabis use in Sweden
in 2004 was equivalent to about 40 per cent of the European average or 30 per cent of the West &
Central European average. Sweden had the 6
th
lowest cannabis prevalence rate out of 40 European
countries examined in 2004.
Amphetamines
For amphetamine, the most recent information from Sweden dates back to 2000 when a national
general population survey showed life-time prevalence rates of 1.9 per cent and an annual
prevalence rate of 0.2 per cent among population age 16-64. This is less than half the European
average (0.5 per cent) and less than a third of the West & Central European average (0.7 per cent).
In the United Kingdom, Estonia or Denmark prevalence rates of amphetamine use are some 7
times larger than in Sweden. Out of 38 countries, for which prevalence estimates are available,
Sweden was among the 6 countries with the lowest levels of amphetamine use.
It should be noted, however, that Sweden has a significant proportion of amphetamine users
among its problem drug use population - which is not the case in most other European countries.
The extent of amphetamine problem drug use is not necessarily reflected in the household survey
data. A UNODC estimate suggests that the total number of amphetamine users could be close to
0.4 per cent (range: 0.3 per cent-0.5 per cent) of the population age 15-64. However, even at such
a levels, Sweden would be still well below the West & Central European average (0.7 per cent).
Part 1: The Swedish Drug Control Policy
43
Ecstasy
The latest official estimates for ecstasy use also date back to 2000 when 0.2 per cent of the
population age 16-64 was reported having used ecstasy, both in terms of life-time prevalence and
annual prevalence.
However, given strong increases in the use of ecstasy among youth in the late 1990s until 2002, it
is doubtful whether a general population estimate for the year 2000 is still valid for the situation
today. In neighbouring Finland, ecstasy prevalence rates among the general population reportedly
increased from 0.3 per cent in 2000 to 0.5 per cent in 2002. At the same time, life-time prevalence
among 15-16 year old students amounted to just 1 per cent among the 15-16 year olds in 2003 and
was thus lower than in Sweden (2 per cent). Against this background, the use of the 200
prevalence rate as a proxy for the current situation would probably be misleading.
Extrapolating annual prevalence estimates from the 2003 ESPAD study of 15-16 year old students
– and assuming that the ratio of youth surveys to general population surveys found in other West
European countries would apply to Sweden as well – UNODC estimated ecstasy use among the
general population in Sweden to affect some 0.4 per cent of the population, age 15-64.
Of course, only future surveys can tell, whether this estimate reflects reality. But, even with this
upward adjustment of the ecstasy prevalence rate, ecstasy use in Sweden is less than half the West
& Central European average (0.9 per cent), though higher than the overall European average (0.2
per cent). Several countries have ecstasy prevalence rates that are 4 to 6 times higher than the rate
in Sweden.
Cocaine
The latest official survey result for cocaine also dates back to the year 2000, and showed a life-
time prevalence rate of cocaine use of 0.9 per cent among the general population and an annual
prevalence rate of 0.0 per cent, that is, a prevalence rate of less than 0.049 per cent.
Given strong increases in cocaine use among youths until 2000 - and with these youth cohorts
entering the general population cohort age 15-65 in subsequent years – the annual prevalence
estimate for 2000 is likely to under-represent the situation of cocaine use among the general
population as of 2003/04. An extrapolation from the 2003 ESPAD study, suggested that around
0.2 per cent of the Swedish population, aged 15-64, used cocaine in 2003. Even based on this
upward adjusted estimate, cocaine use in Sweden is still extremely limited as compared to Europe
as a whole (0.7 per cent) or the average for West & Central Europe (1.1 per cent).
Heroin/opiates
The calculation of heroin/opiate prevalence rates is somehow different from the calculation of the
prevalence rates of other drugs.
It is generally accepted that household survey data are not a very appropriate tool to derive at
estimates of the number of heroin/opiate abusers as in many countries heroin addicts do not
necessarily live any longer in a private household. Thus heroin prevalence data based on
household surveys tend to underestimate the true extent of the problem by a significant margin.
Thus, heroin/opiate prevalence data are usually obtained through other methods, notably through
indirect indicators such various multiplier methods, the capture-recapture method or through case
finding studies. The resulting estimates provide more reasonable orders of magnitude of the
number of problem drug users. For most countries in Europe (with the exception of some of the
Nordic countries), this number used to be identical with the number of problem drug users. For
the Nordic countries, where a significant proportion of problem drug users is not consuming
opiates but other drugs (notably amphetamine), a further adjustment was made. The number of
problem drug users, as a next step, was then multiplied with the proportion of people in treatment
for opiates.
Based on case study findings from the 1990s and estimates derived from problem drug use
estimates for the year 2001, UNODC estimated opiate abuse to affect some 0.1 per cent of the
population age 15-64 in Sweden in 2001. Given a rise in the proportion of heroin users among all
problem drug users, Sweden’s opiates use prevalence rate is likely to have increased to around
Sweden’s successful drug policy: A review of the evidence
44
0.14 per cent by 2003/04. But even at that level, opiate abuse in Sweden is still clearly below the
West & Central European average (0.5 per cent) or the overall European average (0.7 per cent).
Summary
The figures above show that drug use is not only low among young people but also among the
general population. Drug use levels are not only low for cannabis but for other drugs as well.
While all the comparisons of general population survey results presented above – for
methodological reasons - must be treated with caution, available data and estimates are
sufficiently robust to conclude that drug use is in Sweden, in general, well below the West &
Central European average, and for most drugs below the overall European average. This applies to
cannabis, cocaine, opiates and, to a slightly lesser extent, to amphetamines. The low rate of
amphetamines use is particularly noteworthy as Sweden suffered in the 1950s from the largest
spread of amphetamine use in Europe, at levels which even by today’s standards would be
staggering.
Perceived drug availability
Drug use is said to be influenced by drug availability. Data from the 2003 ESPAD study show a
positive correlation between the high availability of drugs (students reporting that drugs are ‘very
easy’ or ‘fairly easy’ to get) and drug use. This means that the more students report to have ‘very
easy’ or ‘fairly easy’ access to drugs, the more they are also likely to have used these substances.
For cannabis, the correlation coefficient between life-time prevalence of cannabis use among 15-
16 year old students and high availability (‘very easy’ or ‘fairly easy’ to obtain) amounts to 0.65.
Reported availability of cannabis declined over the 1999-2003 period in Sweden (from 26 per cent
of students reporting ‘very easy’ or ‘fairly easy’ availability in 1999 to 23 per cent reporting the
same in 2003), as opposed to the European level where reported cannabis availability rose from 29
per cent to 35 per cent. This decline in cannabis availability in Sweden went hand in hand with a
decline in cannabis use over the 1999-2003 period.
Cannabis availability reported by Swedish students is low by European standards. Sweden holds
the 12
th
lowest rank in terms of cannabis availability in Europe (out of 35 countries investigated).
Slightly lower levels of cannabis availability among the old EU countries were only reported from
neighbouring Finland and from Greece.
Actual access to drugs, particularly cannabis, is also lower in Sweden than in Europe across all
locations where cannabis is typically bought. Access to cannabis in discotheques and bars is less
than a third of what it is, on average, in Europe (8 per cent versus 27 per cent); in schools it is less
than half the European average (7 per cent versus 16 per cent). On the streets, cannabis seems to
be more than 40 per cent less easily available than in Europe as a whole.
Reported availability of drugs other than cannabis is close to the European average in Sweden, but
still lower than the EU-15 average. Availability of ecstasy, amphetamine and cocaine is below the
EU-15 average but comparable to the overall European average.
Part 1: The Swedish Drug Control Policy
45
Figure 32: Locations where cannabis can be easily bought by 15-16 year old students
(2003)
27%
23%
21%
16%
8%
13%
11%
7%
0%
10%
20%
30%
Disco/bar Street/park House of a
dealer
School
Europe Sweden
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN), The ESPAD Report 2003,
Nov. 2004
The above suggests that successes in limiting drug availability may explain some of the success of
Swedish drug policy with regard to cannabis. Drug availability, however, seems to have less
explanatory power for the question as to why the use of other drugs is also lower than the
European average.
Table 2: Perceived drug availability – reported ‘very easy’ or ‘fairly easy’ to get in % of all
students, age 15-16, in 2003
Cannabis Ecstasy Amphetamine Cocaine Heroin
Sweden
23% 17% 13% 13% 13%
Europe (average)
35% 17% 13% 12% 11%
EU-15
42% 22% 16% 16% 13%
Correlation coefficient
(availability and life-time use)
0.65 0.62 0.67 0.63 0.32
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN), The ESPAD Report 2003,
Nov. 2004
The 2004 Eurobarometer study on ‘Young People and Drugs’ confirms the ESPAD findings that
overall drug availability in Sweden is significantly lower than the EU average. While 63 per cent
of the young people (age 15-24) of the EU-15 countries reported that it was ‘easy to get drugs near
to where they lived’, the corresponding ratio for Sweden was just 43 per cent and thus the third
lowest among the EU-15 countries. In contrast to the overall trend at the EU level, reported drug
availability declined in Sweden between 2002 and 2004 (from 48 per cent to 43 per cent).
Perceived easy access to drugs in nearly all locations declined in Sweden while corresponding
ratios increased at the EU level. The exception is perceived drug availability at ‘parties’ which
increased slightly but is still considerably below the EU-15 average.
Sweden’s successful drug policy: A review of the evidence
46
Figure 33: Drug availability (reported by 15-24 year olds) – ‘it is easy to get drugs …’
62%
63%
55%
57%
72%
76% 76%
79%
56%
53%
39%
49%
43%
48%
60%
59%
0%
20%
40%
60%
80%
2002 2004 2002 2004 2002 2004 2002 2004
near to where I live in or near
school/college
in pubs/clubs at parties
EU-15 Sweden
Source: European Commission, Eurobarometer, Young people and drugs, June 2004.
Perceived risk of drug use
Another factor which may influence drug use is the perceived risk. Risk perceptions, notably
among young people, can be formed, inter alia, through prevention work and awareness raising.
The correlation between perceived risk resulting from experimenting with cannabis (using it once
or twice) and life-time prevalence of cannabis use across the 35 ESPAD countries was –0.75 in
2003. This suggests that in countries where the perceived risks from drug abuse are larger, drug
use also tends to be lower. Data from the United States also show that - over time - there is a
fairly strong correlation between changes in perceived risk and changes in drug use levels among
high-school students.
According to the ESPAD survey results, ‘great risks’ arising from experimenting with drugs
(using them once or twice) in Sweden are considered by 15-16 year old students to arise primarily
due to injecting drugs (45 per cent), followed by using cocaine (36 per cent), ecstasy or
amphetamine (35 per cent) and cannabis (30 per cent).
The proportion of 15-16 year old students in Sweden, considering taking drugs once or twice to be
a ‘great risk’ is above the EU-15 average, though still slightly below the overall European average.
Except for the comparatively low risk awareness of the consequences from injecting drugs, risk
ratios that are slightly below the overall European average are, however, no reason for concern.
They may well be the result of a more thorough examination and debate in school on the drug
problem, resulting in some more realistic risk perceptions than may be the case in some other
countries.
Part 1: The Swedish Drug Control Policy
47
Figure 34: Risk perception among 15-16 year olds (2003)
How much do people risk harming themselves by using the following drugs once
or twice? Response: ‘ great risk’
23
41
60
30
45
33 33
36
35
35
0
20
40
60
80
Cannabis Amphetamine Ecstasy Cocaine Injecting drugs
'great risk' in %
EU-15 Sweden
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN), The ESPAD Report 2003,
Nov. 2004
Experimenting with cannabis once or twice is seen by 30 per cent of the 15-16 year olds in
Sweden to entail ‘great risks’. This is a significantly higher proportion than the EU-15 average (23
per cent) and notably higher than risks perceived in countries such as Denmark (15 per cent),
Czech Republic (13 per cent) or the United Kingdom (13 per cent). Perceived risk of cannabis use
was higher only in Finland and Portugal.
In addition to cannabis, the risks arising from occasional use of amphetamine and cocaine are also
perceived higher in Sweden than, on average, in the EU-15, though lower than in Europe as a
whole. However, for ecstasy and for injecting drug use, the perceived risks in Sweden are lower
than the EU-15 average and lower than the average for Europe as a whole.
Figure 35: Risk perception of drug use among 15-16 year olds (2003):
How much do people risk harming themselves by taking the following drugs
regularly? Response: ‘ great risk’
70
81
76
67
73
83
81 81
79 79
0
20
40
60
80
100
Cannabis Injecting drugs Cocaine Amphetamine Ecstasy
'great risk' in %
Europe Sweden
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN), The ESPAD Report 2003,
November 2004
Sweden’s successful drug policy: A review of the evidence
48
The Eurobarometer data showed that Swedish youth (age 15-24) has among the EU-15 the highest
risk awareness for cannabis, the second highest for amphetamine and cocaine and the third highest
for heroin. Risk awareness is less pronounced for ecstasy, where Sweden ranks fifth among the
EU-15 countries.
Experiences with visible drug scenes
Following strong increases in the 1990s in Sweden, data show a clear decline in the visibility of
drug scenes in subsequent years. Confrontations of the general population with drug problems
declined between 2000 and 2005 in Sweden from 18 per cent to 8 per cent while the EU-15
average continued to show an upward, from 17 per cent to 21 per cent. This reflected increases in
the visible drug scenes between 2000 and 2005 in Greece, Portugal, Luxembourg, Spain, Italy,
Netherlands, France and Belgium while declines, next to Sweden, were only reported from
Finland, Denmark, Austria and Ireland.
Figure 36: Contacts with drug problems* (‘often’ & ‘from time to time’) in the area of
residence in the EU-15 and in Sweden, 1996-2005
14
7
17
18
19
15
21
8
0
5
10
15
20
25
EU-15 Sweden
in percent of population age 15 and above
1996 Eurobarometer 2000 Eurobarometer
2002 Eurobarometer 2005 EU-ICS
*‘Over the last 12 months, how often were you personally in contact with drug related problems in the area where you live? For
example seeing people dealing in drugs, taking or using drugs in public places, or by finding syringes left by drug addicts?’
Sources: EU Commission, Eurobarometer, Public Safety Exposure to Drug Related Problems and Crime, Brussels 2003 and
Robert Manchin / Gergely Hideg, Drug related Problems in Europe’s Neighbourhoods, unpublished working paper
1
, August
2006, European Crime and Safety Survey, 2005.
1
The data used in this working paper is the copyright of the EU ICS Consortium, led by Gallup Europe. The EU ICS was co-
funded by the European Commission, FP6. The consortium website is http://www.gallup-europe.be/euics
. The working paper is
the copyright of its author(s).
Part 1: The Swedish Drug Control Policy
49
Problem drug use estimates
Critics of Swedish drug policy have usually focused on the allegedly high number of problem drug
users in that country that overshadow the successes achieved in keeping overall drug use levels
low. As shown earlier, the number of problem drug users increased indeed significantly in the
1990s (from 19,000 in 1992 to 26,000 in 1998 and 28,000 in 2001) before declining to less than
26,000 in 2003.
Despite the increase in problem drug use in the 1990s, Sweden’s prevalence rate of 0.44 per cent
of the population age 15-64 is still below the EU-25 average of 0.52 per cent. Sweden has the 7
th
lowest prevalence rate for problem drug use among the EU-25 countries. Sweden has similar
levels of problem drug use as neighbouring Norway (range: 0.37 per cent to 0.51 per cent in 2002)
and lower levels than both Finland (0.53 per cent) and Denmark (0.71 per cent). Sweden’s level
of problem drug use is still only half as high as problem drug use in the United Kingdom (0.98 per
cent) and significantly lower than in Italy (0.79 per cent) or Spain (0.6 per cent).
However, the proportion of heavy drug users among all drug users is very high in Sweden.
Between 1 out of 5 and 1 out to 6 drug users in Sweden (annual prevalence) is a problem drug user
while in the UK, for instance, the proportion is between 1 out of 12 and 1 out of 13. This reflects
the fact that general drug use levels are very low in Sweden. However, these figures may also
explain why drug use in Sweden is generally taken more seriously than in many other European
countries.
Figure 37: Problem drug use among West & Central European countries (2005 or 2004
or latest year available)
0.72
0.52
0.79
0.62
0.61
0.60
0.58
0.56
0.53
0.53
0.44
0.44
0.44
0.41
0.35
0.30
0.26
0.22
0.20
0.71
0.84
0.91
0.98
1.52
-
0.2
0.4
0.6
0.8
1.0
1.2
1.4
Poland
Germany
Greece
Netherlands
Hungary_Budapest
Czech-Republic
Sweden
Norway
France
EU-25 average
Slovenia
Finland
Ireland
Austria
Spain
Slovakia
Switzerland
Portugal
Denmark
Italy
Luxembourg
Latvia-Riga
United Kingdom
Estonia
03 04 04 01 03 04 03 02 99 04 01 02 01 02 02 02 02 00 01 05 00 03 04 04
Prevalence among population age 15-64 in %
Sources: EMCDDA, Statistical Bulletin 2005, UNODC, Annual Reports Questionnaire Data, United Nations Population
Division, World Population Prospects.
Sweden’s successful drug policy: A review of the evidence
50
Intravenous drug use and HIV/AIDS
Generally, Sweden’s rate of HIV infections (0.2 per cent as of 2005) was clearly below the global
average (1.1 per cent), clearly below the European average (0.5 per cent) and slightly below the
West & Central European average (0.3 per cent).
Data on the main modes of transmission of HIV show that injecting drugs is of only minor
importance in Sweden. Over the 1985-2005 period, three quarters of HIV infections were sexually
transmitted. Transmissions by drug users via infected needles amounted to some 7,000 cases or 14
per cent of all transmissions in Sweden. This is a far lower proportion than the rate of transmission
of HIV in Europe as a whole where injecting drug use over the last two decades accounted for the
main mode of transmission (38 per cent), according to the European Centre for the
Epidemiological Monitoring of AIDS (EuroHIV).
In addition, IDU-related HIV cases clearly declined over last two decades in Sweden, both in
terms of a absolute numbers (from a peak level of 204 new cases reported in 1986 to 25 cases in
2005 (-88 per cent), and as a proportion of all reported HIV cases (from 45 per cent in 1985 to 6
per cent in 2005). Between 2001 and 2005 the proportion of IDU related HIV infections in all
new HIV infection declined from 14 per cent to 6 per cent.
Figure 37: New injecting drug use related HIV cases in Sweden, 1985-2005
142
204
98
45 45
44
30
27
26
29
22
27
38
32
27 27
19
1616
17
25
13%
14%
6%
45%
0
50
100
150
200
250
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
IDU related HIV cases
0%
10%
20%
30%
40%
50%
IDU in % of all HIV cases
IDU related HIV cases % of all HIV infections
Source: CAN
New IDU-related HIV infections among all new HIV infections in 2004 were lower in Sweden (6
per cent) than among the EU-25 countries (9 per cent for countries reporting in 2004 or 11 per
cent if data for countries reporting in previous years are included) and significantly lower than in
Europe as a whole (27 per cent).
Fears that a rising number of problem drug users (from 19,000 in 1992 to 26,000 in 2003) would
result in a larger number IDU related HIV infections in Sweden did not materialize. The number
of new IDU related infections remained constant between 1992 and 2003 at 27 cases. This meant
that the risk of infection for problem drug users actually declined between 1992 and 2003, from
0.14 per cent to 0.10 per cent.
Conclusion
51
CONCLUSION
Following a short period of liberalization in the second half of the 1960s, Sweden has pursued
restrictive drug control strategies that address both drug supply and drug demand. In parallel,
Sweden has invested heavily in addressing the drug problem. Drug-related expenditures were
equivalent to 0.5 per cent of GDP, the second highest proportion among all EU countries. This
investment has paid off. The number of drug users in Sweden today seems to be smaller than it
was before the advent of a concerted drug policy, starting in 1969 when the Government
introduced a ten point programme against drugs. In 2006 6 per cent of the students age 15-16 had
used drugs, down from 15 per cent in 1971.
In comparison with other European countries, Sweden also fares well. Life-time prevalence and
regular use of drugs is considerably lower in Sweden than in the rest of Europe. This applies to the
general population as well as to young people, a group that is considered to be most vulnerable to
drug abuse. While average levels of life-time prevalence of drug use among 15-16 years in Europe
amounted to 22 per cent on average, the corresponding rate in Sweden was 8 per cent in 2003,
before falling to 6 per cent in 2006. Moreover, bucking the trends at the European level, drug use
in Sweden has declined in recent years. Sweden is also among the European countries with low
levels of injecting drug-use-related HIV/AIDS infections. On the supply side, drug prices in
Sweden are among the highest in Europe and therefore, drug tourism targeting Sweden is
largely unknown
.
Levels of problem drug use in Sweden (0.44 per cent of the population age 15-64) are slightly
below the EU average (0.52 per cent). The fact that Sweden’s heavy drug use levels come close to
EU average - though the country has below average drug use levels - could be seen as one of the
few weaknesses. Swedish drug policy is highly effective in preventing drug use, but seems to be
less effective in preventing drug users from becoming drug addicts. Nonetheless, it should not be
forgotten that heavy drug use levels in Sweden are still below the EU average.
Changes in the number of heavy drug abusers over the past decades coincide with budget changes.
Heavy drug abuse increased significantly from 1992 (19,000) until 2001 (28,000) at a time when
funding cuts hampered access of drug abusers to treatment facilities. Higher budgets have been
accompanied by a decrease of the number of problem drug users to 26,000.
Naturally, it cannot be stated with certainty that the generally positive drug abuse situation in the
country is the result of – by international standards - generous anti-drug budgets and strict policies
that have been applied over the last three decades. However, a review of fluctuations in abuse
rates shows that periods of low drug abuse in the country are associated with times when the drug
problem was regarded as a priority.
In addition to a clearly stated policy, a number of other factors also seem to have played a role for
Sweden to achieve positive results. Sweden is, for example, not located along any of the major
drug trafficking routes. Income inequality, which has an impact of the readiness of young people
to engage in criminal activity such as drug trafficking, is low. Sweden’s population at large is also
very health conscious which would not be in line with large-scale drug use. And Sweden, in
contrast to many other countries, has enjoyed a broad political consensus over the direction of
drug policy, thus avoiding the sending of mixed messages to potentially vulnerable groups of
society.
The Swedish drug policy has been one of the most widely debated and examined policy in Europe
and this process intensified following Sweden’s entry into the European Union. There has been
criticism and the vision of a drug-free society, that is guiding policy measures has, on occasion,
been derided as “unrealistic”, “not pragmatic” and “unresponsive” to the needs of drug abusers.
This does not seem to be the case. Several new approaches on tackling drug abuse were pioneered
in Sweden. The first methadone maintenance programme in Europe was established in Sweden, in
1966, at a time when even the concept of maintenance treatment was hardly accepted. Drug
abusers in Sweden continue to have access to methadone as well as other substitution substances,
Sweden’s successful drug policy: A review of the evidence
52
such as buprenorphine. Similarly, along with the Netherlands, Sweden was one of the first
countries to introduce needle exchange programmes as one measure to stem the onslaught of
HIV/AIDS. However, these measures, aiming at limiting the adverse consequences of drug abuse,
were never pronounced to be the sole, overriding goal of the drug control policy of Sweden.
The ambitious goal of the drug-free society has been questioned not only outside the country but
in Sweden itself, as a number of research papers on the subject attest. Nevertheless, despite several
reviews of expert commissions, the vision has not been found to be obsolete or misdirected. As
shown in this report, the prevalence and incidence rates of drug abuse have fallen in Sweden while
they have increased in most other European countries. It is perhaps that ambitious vision that has
enabled Sweden to achieve this remarkable result.
Statistical Annex
53
STATISTICAL ANNEX
LONG-TERM DRUG USE TRENDS IN Sweden
Cannabis use among military recruits, 1976-2005
10.8
5.3
15.2
12.6
16.7
18.3
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
1975 1980 1985 1990 1995 2000 2005
life-time prevalence in %
Hashish Marijuana All cannabis
Source: CAN
Amphetamine use among military recruits, 1976-2005
0.6
2.3
0.8
1.6
3.5
3.6
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
1975 1980 1985 1990 1995 2000 2005
life-time prevalence in %
Source: CAN
Sweden’s successful drug policy: A review of the evidence
54
Heroin use among military recruits, 1976-2005
0.2
0.8
0.1
0.7
0.6
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1975 1980 1985 1990 1995 2000 2005
life-time prevalence in %
Source: CAN
LSD use among military recruits, 1976-2005
0.5
2.0
0.1
0.9
1.3
2.4
0.0
0.5
1.0
1.5
2.0
2.5
3.0
1975 1980 1985 1990 1995 2000 2005
life-time prevalence in %
Source: CAN
Annexes
55
Cocaine use among military recruits, 1984-2005
0.1
0.9
1.5
0.5
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1975 1980 1985 1990 1995 2000 2005
life-time prevalence in %
Source: CAN
Ecstasy use among military recruits, 1984-2005
1.6
0.8
3.6
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
1975 1980 1985 1990 1995 2000 2005
life-time prevalence in %
Source: CAN
Sweden’s successful drug policy: A review of the evidence
56
INTERNATIONAL COMPARISONS
YOUTH SURVEYS
Surveys among 15-16 year old students
Lifetime prevalence of illicit drug use among 15-16 year old students in Europe, 2003
(1999)
1%
0.6%
0.6%
(1999)
0.6%
(2001)
0.6%
(2001)
0.4%
(1999)
0.4%
(1999)
0.3%*
(2000)
0.3%*
(2000)
0.2%
(1997)
0.2%
(1997)
(2000)
< 10%
16 - 25%
10 - 15%
26 - 35%
> 35%
Data not available
European average: 22%
Data not directly comparable
44
41
38
29
28
11 (Malta)
9
8
6
5
6 cities
5
6 cities
27
24
23
23
22
10
(1998)
5
22 (Moscow)
21
19
18
17
16
16
13
11
23
29
36
(2002)
36
(2002)
33
30
6 provinces
38
40
40
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN),
The ESPAD Report 2003, November 2004
Annexes
57
Lifetime use of cannabis use among 15-16 year old students in Europe, 2003
(1999)
1%
0.6%
0.6%
(1999)
0.6%
(2001)
0.6%
(2001)
0.4%
(1999)
0.4%
(1999)
0.3%*
(2000)
0.3%*
(2000)
0.2%
(1997)
0.2%
(1997)
(2000)
< 8%
16 - 25%
8 - 15%
26 - 35%
> 35%
Data not available
European average: 21%
Data not directly comparable
44
40
38
28
27
9
7
6
4
6 cities
4
6 cities
27
23
21
23
21
8
(1998)
3
22 (Moscow)
21
18
15
16
16
10 (Malta)
13
13
11
22
28
36
(2002)
36
(2002)
32
27
6 provinces
38
39
39
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN),
The ESPAD Report 2003, November 2004
Lifetime use of drugs other than cannabis among 15-16 year old students in Europe, 2003
(1999)
1%
0.
6
6%
0.6%
(1999)
0.6%
(2001)
0.6%
(2001)
0.4%
(1999)
0.4%
(1999)
0.3%*
(2000)
0.3%*
(2000)
0.2%
(1997)
0.2%
(1997)
(2000)
6 - 8%
4 - 5%
2%
3%
9%
Data not available
Data not directly comparable
2
2
4 (Moscow)
3
3
3
4
3
(1999)
5
5
5
6
6
6
6
6
6
7
7
7
7
8
8
8
9
(2002)
9
(2002)
9
9
10
1
0
11
2
10
(6 provinces)
10
(6 provinces)
3
(6 cities)
European average: 6%
>
_
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN),
The ESPAD Report 2003, November 2004
Sweden’s successful drug policy: A review of the evidence
58
Lifetime use of amphetamines among 15-16 year old students in Europe, 2003
< 1%
2 - 3%
1%
4 - 5%
> 6%
Data not available
European average: 2.4%
Data not directly comparable
13
(1999)
1%
0.6%
0.6%
(1999)
0.6%
(2001)
0.6%
(2001)
0.4%
(1999)
0.4%
(1999)
0.3%*
(2000)
0.3%*
(2000)
0.2%
(1997)
0.2%
(1997)
(2000)
1 (Malta)
1
2
2
2
3
3
3
3
3
3
3
< 1
< 1
< 1
(1999)
< 1
(1999)
5
(6 provinces)
5
1
5
5
2
2
(6 cities)
2
2
4
7
1
1
1
1
1 (Moscow)
1
4
4
(2002)
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN)
The ESPAD Report 2003, November 2004
Lifetime use of ecstasy among 15-16 year old students in Europe, 2003
1%
3 - 4%
2%
5 - 6%
> 7%
Data not available
European average: 3%
Data not directly comparable
13
5
(1999)
1%
0.6%
0.6%
(1999)
0.6%
(2001)
0.6%
(2001)
0.4%
(1999)
0.4%
(1999)
0.3%*
(2000)
0.3%*
(2000)
0.2%
(1997)
0.2%
(1997)
(2000)
8
2
2
3
1 (Malta)
3
3
2
2
2
6 cities
3
5
3
2
3
1
1
(1999)
1
(1999)
3 (Moscow)
1
3
4
5
7
3
3
2
3
1
5
5
5
(2002)
5
(2002)
5
4
3
6 provinces
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN),
The ESPAD Report 2003, November 2004
Annexes
59
Lifetime use of cocaine among 15-16 year old students in Europe, 2003
(1999)
1%
0.6%
0.6%
(1999)
0.6%
(2001)
0.6%
(2001)
0.4%
(1999)
0.4%
(1999)
0.3%*
(2000)
0.3%*
(2000)
0.2%
(1997)
0.2%
(1997)
(2000)
< 1%
2 %
1%
3 - 4%
> 5%
Data not available
European average: 2%
Data not directly comparable
13
5
1 (Malta)
1
1
(1999)
< 1
ppggy
2
2
(6 cities)
3
3
3
4
2
2
(6 provinces)
2
3
1
1
1
1
1
1
1
2
3
1
1
1
1
1
4
6
(2002)
6
(2002)
1 (Moscow)
1
3
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN),
The ESPAD Report 2003, November 2004
Lifetime use of heroin among 15-16 year old students in Europe, 2003
European average: 1%
(1999)
1%
0.6%
0.6%
(1999)
0.6%
(2001)
0.6%
(2001)
0.4%
(1999)
0.4%
(1999)
0.3%*
(2000)
0.3%*
(2000)
0.2%
(1997)
0.2%
(1997)
(2000)
2%
1%
< 1%
>3%
_
Data not available
Data not directly comparable
1
(6 provinces)
1
1
1
1
1
1
< 1
< 1
< 1
< 1
< 1 (Moscow)
1
1
1
1
1
(2002)
1
2
2
2
(6 cities)
1
1
1
1
1
1
1
1
1 (Malta)
1
1
2
4
2
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN),
The ESPAD Report 2003, November 2004
Sweden’s successful drug policy: A review of the evidence
60
Life-time prevalence of cannabis use among 15-16 year old students in Europe,
1999-2003
1
2
9
8
7
12
7
10
12
15
9
11
14
17
12
20
16
22
13
24
19
23
25
25
35
35
32
35
17
3
4
4
6
7
9
9
10
11
13
13
15
16
18
16
21
21
21
22
22
23
23
27
27
27
27
28
28
32
36
38
38
39
39
40
44
21
0 5 10 15 20 25 30 35 40 45 50
Romania
Cyprus
Turkey
Greece
Sweden
Faroe Isl.
Norway
Malta
Finland
Lithuania
Iceland
Portugal
Hungary
Poland
Latvia
Austria
Bulgaria
Ukraine
Croatia
Russia /Mosc.
Estonia
Denmark
Slovak Rep.
Germany
Greenland
Italy
Slovenia
Netherlands
Belgium
Spain
France
UK
Isle of Man
Ireland
Switzerland
Czech Rep.
Europe avg.
Life-time prevalence in %
1999 2003
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN),
The ESPAD Report 2003, Nov. 2004
Annexes
61
Life-time prevalence of illicit drug use other than cannabis among 15-16 year old
students in Europe, 1999-2003
3
4
9
3
4
2
2
6
3
4
5
9
5
7
5
5
6
7
5
6
9
11
8
9
12
9
9
2
2
2
3
3
3
3
3
3
4
4
4
4
5
5
5
6
6
6
6
6
6
7
7
7
7
8
8
8
9
9
9
10
10
10
11
11
6
6
0 2 4 6 8 10 12 14
Faroe Isl.
Ukraine
Romania
Sweden
Greece
Finland
Cyprus
Norway
Turkey
Malta
Greenland
Bulgaria
Russia/Moscow
Hungary
Slovenia
Latvia
Iceland
Slovakia
Croatia
Denmark
Switzerland
Netherlands
France
Portugal
Lithuania
Poland
Austria
Italy
Belgium
Ireland
UK
Spain
Germany
Estonia
Isle of Man
Czech Rep.
Europe
Life-time prevalence in %
1999 2003
Source: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN),
The ESPAD Report 2003, Nov. 2004
Sweden’s successful drug policy: A review of the evidence
62
Surveys among 15-24 year olds
Lifetime use of cannabis among 15-24 year olds in EU-15, 2004
< 15%
20 - 24%
15 - 19%
25 - 34%
> 35%
Data not available
EU-15 average: 33%
40%
37%
26%
14%
7%
31%
23%
18%
40%
45%
44%
31%
27%
38%
33%
Source: European Commission, Eurobarometer, Young People and Drugs, June 2004
Change in lifetime prevalence of cannabis among 15-24 year olds in EU-15, 2002-2004
+4%
(26 to 27)
-11%
(45 to 40)
+3%
(37 to 38)
-5%
(19 to 18)
-18%
(17 to 14)
-18%
(17 to 14)
+72%
(18 to 31)
+72%
(18 to 31)
+64%
(14 to 23)
+64%
(14 to 23)
+37%
(27 to 37)
+40%
(5 to 7)
+40%
(5 to 7)
-4%
(47 to 45)
+14%
(35 to 40)
52%
(29 to 44)
52%
(29 to 44)
+53%
(17 to 26)
+53%
(17 to 26)
+38%
(24 to 33)
+38%
(24 to 33)
+24%
(25 to 31)
+24%
(25 to 31)
< -15%
-5% to +5%
-15% to -6%
+6 to +15%
> +16%
Data not available
EU-15 average: +14%
(from 29% to 33%)
Change 2002 to 2004
Source: European Commission, Eurobarometer, Young People and Drugs, June 2004
Annexes
63
Lifetime use of drugs other than cannabis among 15-24 year olds in EU-15, 2004
< 3%
10 - 14%
4 - 9%
15 - 19%
> 20%
Data not available
EU-15 average: 10%
y
4%
9%
8%
9%
7%
7%
7%
6%
11%
16%
19%
8%
8%
18%
22%
Source: European Commission, Eurobarometer, Young People and Drugs, June 2004
Change in lifetime prevalence of drugs other than cannabis among 15-24 year olds in EU-15, 2004
< -15%
-5% to +5%
-15% to -6%
+6 to +15%
> +15%
Data not available
EU-15 average: +11%
(from 9% to 10%)
Change 2002 to 2004
-11%
(9 to 8)
-11%
(9 to 8)
-13%
(8 to 7)
-13%
(8 to 7)
+29%
(14 to 18)
+29%
(14 to 18)
-33%
(9 to 6)
-33%
(9 to 6)
-10%
(10 to 9)
-10%
(10 to 9)
+60%
(5 to 8)
+60%
(5 to 8)
+29%
(7 to 9)
+29%
(7 to 9)
0%
(7 to 7)
0%
(7 to 7)
0%
(1 to 1)
+45%
(11 to 16)
+45%
(11 to 16)
0%
(11 to 1)
+58%
(12 to 19)
+58%
(12 to 19)
33%
(3 to 4)
33%
(3 to 4)
+144%
(9 to 22)
+144%
(9 to 22)
+14%
(7 to 8)
Source: European Commission, Eurobarometer, Young People and Drugs, June 2004
Sweden’s successful drug policy: A review of the evidence
64
Past month use of cannabis among 15-24 year olds in EU-15, 2004
< 5%
10 - 12%
5 - 9%
13 - 15%
> 16%
Data not available
EU-15 average: 11%
8%
3%
6%
9%
9%
7%
14%
1%
5%
10%
12%
20%
11%
17%
14%
Source: European Commission, Eurobarometer, Young People and Drugs, June 2004
Change in past month use of cannabis among 15-24 year olds in EU-15, 2002-2004
< -20%
-5% to +5%
-20% to -6%
+6 to +15%
> +16%
Data not available
EU-15 average: 0%
(from 11% to 11%)
Change 2002 to 2004
gy
-25%
(8 to 6)
-25%
(8 to 6)
-30%
(20 to 14)
-30%
(20 to 14)
+31%
(13 to 17)
+31%
(13 to 17)
-17%
(6 to 5)
-25%
(4 to 3)
-25%
(4 to 3)
+80%
(5 to 9)
+80%
(5 to 9)
+40%
(5 to 7)
+40%
(5 to 7)
+80%
(5 to 9)
+80%
(5 to 9)
0%
(1 to 1)
-17%
(12 to 10)
0%
(12 to 12)
+33%
(15 to 20)
+33%
(15 to 20)
0%
(8 to 8)
+55%
(9 to 14)
+55%
(9 to 14)
+10%
(10 to 11)
Source: European Commission, Eurobarometer, Young People and Drugs, June 2004
Annexes
65
Past month use of drugs other than cannabis among 15-24 year olds in EU-15, 2004
< 1%
2 - 3%
1%
4 - 5%
> 5%
Data not available
EU-15 average: 3%
1
y
1%
1%
1%
1%
1%
1%
2%
< 1%
2%
4%
4%
5%
3%
8%
8%
Source: European Commission, Eurobarometer, Young People and Drugs, June 2004
Change in past month use of drugs other than cannabis among 15-24 year olds in EU-15, 2002-2004
< -15%
-5% to +5%
-15% to -6%
+6 to +15%
> +15%
Data not available
EU-15 average: 0%
(from 3% to 3%)
Change 2002 to 2004
-50%
(2 to 1)
-50%
(2 to 1)
-33%
(3 to 2)
-33%
(3 to 2)
+100%
(4 to 8)
+100%
(4 to 8)
-33%
(3 to 2)
-33%
(3 to 2)
-50%
(2 to 1)
-50%
(2 to 1)
0%
(1 to 1)
-50%
(2 to 1)
-50%
(2 to 1)
-50%
(2 to 1)
-50%
(2 to 1)
0%
(<1 to <1)
+33%
(3 to 4)
+33%
(3 to 4)
+33%
(3 to 4)
+33%
(3 to 4)
+25%
(4 to 5)
+25%
(4 to 5)
0%
(1 to 1)
+60%
(5 to 8)
+60%
(5 to 8)
+50%
(2 to 3)
+50%
(2 to 3)
Source: European Commission, Eurobarometer, Young People and Drugs, June 2004
Sweden’s successful drug policy: A review of the evidence
66
Lifetime prevalence of cannabis use among 15-24 year olds in EU-15, 2002-2004
5%
17%
19%
14%
17%
26%
25%
18%
24%
27%
37%
45%
35%
29%
47%
29%
7%
14%
18%
23%
26%
27%
31%
31%
33%
37%
38%
40%
40%
44%
45%
33%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Greece
Sweden
Finland
Portugal
Italy
Germany
Belgium
Austria
Ireland
Luxembourg
UK
France
Netherlands
Spain
Denmark
EU-15
2002 2004
Source: European Commission, Eurobarometer, Young people and drugs, June 2004.
Annexes
67
Monthly prevalence of cannabis use among 15-24 year olds in EU-15, 2002-2004
1%
4%
6%
8%
5%
8%
5%
5%
12%
10%
12%
20%
9%
13%
15%
11%
1%
3%
5%
6%
7%
8%
9%
9%
10%
11%
12%
14%
14%
17%
20%
11%
0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20%
Greece
Sweden
Finland
Germany
Portugal
Italy
Luxembourg
Austria
Denmark
Belgium
Netherlands
France
Ireland
UK
Spain
EU-15
2002 2004
Source: European Commission, Eurobarometer, Young people and drugs, June 2004.
Sweden’s successful drug policy: A review of the evidence
68
Monthly prevalence of the use of drug other than cannabis among 15-24 year olds
in EU-15, 2002-2004
0%
2%
2%
1%
1%
2%
2%
3%
3%
2%
3%
3%
4%
5%
4%
3%
0%
1%
1%
1%
1%
1%
1%
2%
2%
3%
4%
4%
5%
8%
8%
3%
0% 1% 2% 3% 4% 5% 6% 7% 8%
Greece
Sweden
Portugal
Austria
Italy
Germany
Luxembourg
France
Finland
Belgium
Denmark
Netherlands
Spain
Ireland
UK
EU-15
2002 2004
Source: European Commission, Eurobarometer, Young people and drugs, June 2004.
Annexes
69
GENERAL POPULATION SURVEYS
Annual prevalence of drug use in Sweden as compared to Europe among the population
age 15-64, 2004 or latest year available
2.2%
0.2%
0.1%
5.6%
0.7% 0.7%
7.4%
1.1%
(0.4%)
0.2%
0.4%
0.5%
0.2%
0.7%
0.9%
0.5%
0.0%
2.0%
4.0%
6.0%
8.0%
Cannabis Amphetamines Ecstasy Cocaine Opiates
annual prevalence in %
Sweden Europe West & Central Europe
Source: UNODC, 2006 World Drug Report
Sweden’s successful drug policy: A review of the evidence
70
Annual prevalence of cannabis use among population 15-64, in 2004 or latest year available
(1999)
1%
0.6%
0.6%
(1999)
0.6%
(2001)
0.6%
(2001)
0.4%
(1999)
0.4%
(1999)
0.3%*
(2000)
0.3%*
(2000)
0.2%
(1997)
0.2%
(1997)
(2000)
Europe: 5.6%
West & Central Europe: 7.4%
> 9% of population
5 - 7% of population
3 - 5% of population
7 - 9% of population
Level of abuse (annual prevalence)
< 3% of population
Data not available
6.2%
(2000)
5%
(2004)
3.2%
(2002)
3.8%
(2003)
(age 15-68)
1.8%
(2004)
1.8%
(2004)
2.6%
2.8%
(2002)
2.8%
(2002)
2.2%
(2004)
(age 18-64)
2.2%
(2004)
(age 18-64)
4.6%
(2004)
6.1%
(2001)
6.9%
(2003)
6.2%
(2004)
7.6%
(2004)
5.4%
(2002/3)
3.3%
(2001)
1.7%
(2004)
1.7%
(2004)
4.1%
1.8%**
(1998)
1.8%**
(1998)
3.9%*
(2003)
4.6%*
(2003)
2.4%*
(2003)
2.4%*
(2003)
3.9%
(2003)
(age 18-54)
(age 16-64)
(age 16-64)
(age 18-64)
1.9%
(2003)
1.9%
(2003)
3.6%*
(2003)
0.9%
(2004)
0.9%
(2004)
(2004)
(2004)
(2004)
4.1%*
(2004)
4%
8%*
(2003)
10.9%
(2002)
9.8%
10.8%
9.5%
7.1%
7.5%
5.1%
11.3%
(2002)
(2003)
(age 15 - 54)
(2003)
(age 15 - 54)
(age 18 - 64)
(2004)
(2004)
(2003/4)
(age 16-59)
(2003/4)
(age 16-59)
(2002/3)
(2003)
1.7%
(1999)
1.7%
(1999)
7.9%
(2003/4)
7.9%
(2003/4)
(age 16-59)
Source: UNODC, 2006 World Drug Report
Annual prevalence of amphetamines use among population 15-64, in 2004 or latest year available
0.9%
(2003)
> 1% of population
0.3 - 0.5% of population
0.1 - 0.3% of population
0.5 - 1% of population
Level of abuse (annual prevalence)
< 0.1% of population
Data not available
0.8%
(2003)
(2000)
1.1%
1.3%
(2002)
(2004)
(2003)
1%
1.3%*
0.6%
0.9%
0.7%
1.1%
0.9%*
0.8%*
0.8%
0.8%
(2001)
0.8%*
(2001)
0.5%
(2002)
0.3%
(2004)
(2004)
(2004)
0.2%
(2000)
0.3%
(2001)
0.2%
0.4%
0.5%*
(2003)
0.2%*
(1999)
0.4%*
(2003)
0.1%*
(2003)
0.2%*
(2003)
0.2%
0.01%*
(1995)
0.01%*
(1995)
0.02%
(2004)
0.02%
(2004)
0.2%
(2004)
0.2%*
(2003)
0.2%
(2002)
0.1%
(2001)
0.2%
(2003)
(age 15 - 44)
0.1%
(1998)
(2003)
(2004)
(2003)
(2004)
(2003)
(2002)
(2003)
(2003)
g
1.5%
(2003)
0.8%
(2003)
1.5%
(2003)
0.8%
(2003)
0.4%
(2003)
1.4%
(2003)
Europe: 0.5%
West & Central Europe: 0.7%
Source: UNODC, 2006 World Drug Report
Annexes
71
Annual prevalence of ecstasy use among population 15-64, in 2004 or latest year available
g
0.2%
(2002)
0.2%
(2002)
0.4%*
(2003)
0.5%
(2002)
0.5%
(2000)
0.5%
(2004)
0.3%
(2002)
0.4%*
(2003)
0.4%
(2001)
0.4%
(2004)
0.3%*
(2003)
0.4%
(2003)
(age 15 - 54)
0.1%*
(2003)
0.1%*
(2003)
0.01%*
(1997)
0.01%*
(1997)
0.1%*
(2004)
0.1%*
(2004)
0.1%*
(1999)
0.1%*
(1999)
0.2%
(2004)
0.2%
(2004)
1.5%
(2001)
0.6%*
(2003)
(age 15-65)
1.1%*
(2003)
1.1%*
(2003)
0.1%*
(1999)
0.1%*
(1999)
0.3%*
(2003)
0.8%
1/7%
0.9%*
2.5%
0.8%
0.5%
1.1%
1.7%
1.6%
2%
1.4%
0.8%*
0.9%
1.4%
1.2%
(2003)
(2003)
(2004)
(2003)
(2002)
(2003)
(age 18-59)
(2003)
(age
18-59)
(1998)
(age 15-65)
(1998)
(age
15-65)
(2003)
(2003)
(age 16-59)
(2003)
(age
16-59)
(age 16-59)
(age 16-59)
(2003)
(2003)
(2003)
(2004)
(2003)
(2003)
> 1% of population
> 0.5 - 0.7% of population
> 0.3 - 0.4% of population
> 0.8 - 1% of population
Level of abuse (annual prevalence)
< 0.2% of population
Data not available
Europe: 0.6%
West & Central Europe: 0.9%
-
-
-
-
Source: UNODC, 2006 World Drug Report
Annual prevalence of cocaine use among population 15-64, in 2004 or latest year available
0.2%
(2000)
0.2%
(2000)
10.6%
(2003)
2.4%
(2003)
(age 16-59)
2.7%
1.1%
(2003)
(2002)
1.2%
(2003)
(age 15 - 54)
(age 18 - 54)
(age 16 - 64)
(age 16-59)
(age 15 - 69)
(age 18 - 59)
(age 16+)
0.3%
(2001)
0.3%
(2002)
0.3%*
(2003)
0.2%
(2003)
0.3%*
(2000)
0.1%
(2004)
0.1%
(2004)
0.02%*
(2000)
0.02%*
(2000)
0.1%
(2002)
0.1%
(2002)
0.1%*
(2003)
0.1%*
(2003)
0.2%*
(2003)
0.2%
(2003)
0.2%
(2003)
0.02%*
(2003)
0.02%*
(2003)
0.07%*
(2003)
0.07%*
(2003)
0.6%
(2003)
0.1%*
(2003)
0.1%*
(2003)
0.4%*
(2003)
0.4%
(2003)
0.1%
(2004)
0.1%
(2004)
0.04%*
(2003)
0.04%*
(2003)
0.07%*
(2004)
0.07%*
(2004)
1.1%*
(2003)
0.9%*
(2003
0.5%
(2004)
0.2%*
(2003)
0.2%*
(2003)
1.1%
(2001)
0.3%
(2002)
0.1%*
(2000)
0.9%*
(2003)
0.8%
(2000)
1.4%
(2003)
1%
(2003)
0.8%
(2004)
1.1%*
(2003)
0.9%
(2004)
> 2% of population
0.6 - 1% of population
0.3 - 0.5% of population
1.1 - 2% of population
Level of abuse (annual prevalence)
< 0.3% of population
Data not available
Europe: 0.7%
West & Central Europe: 1.1%
Source: UNODC, 2006 World Drug Report
Sweden’s successful drug policy: A review of the evidence
72
Annual prevalence of opiate use among population 15-64, in 2004 or latest year available
1.7%
(2001)
1.7%
(2001)
0.1%
(2001)
0.1%
(2002)
0.7%
(2000)
0.6%
(2000)
0.6%
(2001)
0.4%
(1997)
0.3%
(2003)
0.9%
(2000)
0.5%
(2001)
0.1%
(2001)
0.4%
(1999)
0.4%
(2003)
0.3%
(2001)
0.3%*
(1998)
0.4%
(1997)
0.6%
(2000)
0.3%
(2004)
0.5%
(2002)
0.5%
(2001)
0.3%*
(2003)
(18-54)
0.3%
(2002)
0.2%
(2002)
1.7%
(2001)
1.7%
(2001)
0.5%
(2001)
0.5%
(2001)
0.5%
(2000)
0.5%
(2000)
0.7%
(1999)
1.2%
(2001)
(2002)
(2004)
(2004)
(2004)
(2004)
0.05%
(2003)
0.05%
(2003)
0.3%*
(2002)
0.07%
(2000)
0.07%
(2000)
0.4%*
(2003)
0.8%*
0.8%
2%*
0.9%
0.6%
0.9%
(2001)
1.5%
(2003)
1.5%
(2003)
> 1% of population
0.3 - 0.5% of population
0.1 - 0.3% of population
0.5 - 1% of population
Level of abuse (annual prevalence)
< 0.1% of population
Data not available
Europe: 0.7%
West & Central Europe: 0.5%
Source: UNODC, 2006 World Drug Report
Annexes
73
Cannabis use among population 15-64, in 2004 or latest year available
0.8
0.9
1.7
1.8
1.9
2.2
2.2
2.6
2.8
3.2
3.3
3.6
3.7
3.8
3.9
3.9
4.0
4.1
4.1
4.6
4.6
5.0
5.1
5.4
6.0
6.1
6.2
6.2
6.9
7.1
7.5
7.6
7.6
7.9
8.0
9.6
9.8
10.8
10.9
7.4
5.6
11.3
0.0 2.0 4.0 6.0 8.0 10.0 12.0
Malta, (18-65), 2001
Romania, 2004
Greece, 2004
Albania, 2004
Turkey*, 2003
Sweden, (18-64), 2004
Lithuania, 2004
Belarus*, 2003
Poland, 2002
Finland, 2002
Portugal, 2001
Ukraine*, 2003
Cyprus*, 2003
Latvia, (15-68), 2003
Hungary, 2003
Russian Federation*, 2003
Croatia*, 2003
Slovakia, (18-64), 2004
Bulgaria*, 2003
Norway, 2004
Estonia, 2003
Iceland, (18-75), 2001
Ireland, 2002/03
Northern Ireland, 2002/03
Liechtenstein*, 1998
Netherlands, 2001
Slovenia*, 2003
Denmark, (16-64), 2000
Germany, (18-59), 2003
Italy, (15-54), 2003
Austria, 2004
Luxembourg*, 2003
Greenland*,2003
Scotland, (16-59), 2003
Belgium*, 2003
Switzerland*, 2003
France, 2002
England and Wales, (16-59), 2003/04
Czech Rep., (18-64), 2002
Spain, 2003
West & Central Europe
Europe
annual prevalence in %
Source: UNODC, 2006 World Drug Report.
Sweden’s successful drug policy: A review of the evidence
74
Amphetamines use among population 15-64, in 2004 or latest year available
0.01
0.02
0.1
0.1
0.1
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.3
0.3
0.3
0.4
0.4
0.4
0.5
0.5
0.6
0.7
0.8
0.8
0.8
0.8
0.8
0.8
0.9
0.9
1.1
1.1
1.1
1.3
1.3
1.4
1.5
0.7
0.5
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
FYR of Macedonia, 1995
Albania, 2004
Portugal, 2001
Greece, 1998
Romania*, 2004
Sweden, 2000
Cyprus, 2003
France, 2002
Italy, 2003
Slovenia*, 1999
Turkey*, 2003
Belarus*, 2004
Moldova, Rep., 1998
Russian Federation*, 2003
Ukraine*, 2003
Lituania, 2004
Malta, 2001
Slovakia, 2004
Ireland, 2003
Luxembourg*, 1999
Bulgaria*, 2003
Finland, 2002
Croatia*, 2003
Netherlands, 2001
Poland, 2002
Hungary, 2003
Austria, 2004
Belgium*, 2001
Northern Ireland, 2003
Spain, 2003
Switzerland*, 2003
Germany, (18-59), 2003
Iceland*, 2003
Czech Rep., 2002
Latvia, 2003
Norway, 2004
Denmark, (16-64), 2000
Estonia, 2003
Scotland, (16-59), 2003
England & Wales, (16-59), 2003/04
West & Central Europe
Europe
Annual prevalence in %
Source: UNODC, 2006 World Drug Report.
Annexes
75
Ecstasy use among population 15-64, in 2004 or latest year available
0.1
0.1
0.1
0.1
0.2
0.2
0.2
0.2
0.3
0.3
0.3
0.4
0.4
0.4
0.4
0.4
0.4
0.5
0.5
0.5
0.5
0.6
0.8
0.8
0.8
0.9
0.9
1.1
1.1
1.2
1.4
1.4
1.5
1.6
1.7
1.7
2.0
2.5
0.9
0.2
0.0 0.5 1.0 1.5 2.0 2.5 3.0
FYR of Macedonia*, 1999
Russian Federation*, 1999
Romania*, 2004
Ukraine*, 2003
Greece, 2004
Liechtenstein, 1998
Malta, (18-65), 2001
Poland, 2002
Turkey*, 2003
Croatia*, 2003
France, 2002
Cyprus*, 2003
Italy, (15-54), 2003
Sweden*, 2003
Bulgaria*, 2003
Lithuania, 2004
Portugal, 2001
Denmark, (16-64), 2000
Finland, 2002
Luxembourg*, (15-65), 1998
Norway, 2004
Iceland*, (15-65), 2003
Germany, (18-59), 2003
Latvia, 2003
Switzerland*, 2003
Austria, 2004
Slovenia*, 2003
Belgium*, 2003
Ireland, 2003
Slovakia, 2004
Hungary, (18-54), 2003
Spain, 2003
Netherlands, 2001
Northern Ireland, 2003
Estonia, 2004
Scotland, (16-59), 2003
England & Wales, (16-59), 2003/04
Czech Rep., 2002
West & Central Europe
Europe
Annual prevalence in %
Source: UNODC, 2006 World Drug Report.
Sweden’s successful drug policy: A review of the evidence
76
Cocaine use among population 15-64, in 2004 or latest year available
0.02
0.02
0.04
0.1
0.07
0.1
0.1
0.1
0.1
0.1
0.2
0.2
0.2
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.4
0.4
0.4
0.4
0.5
0.6
0.7
0.8
0.8
0.9
0.9
0.9
1.0
1.1
1.1
1.1
1.1
1.2
1.4
2.4
2.7
1.1
0.7
0.0 0.5 1.0 1.5 2.0 2.5 3.0
Belarus*, 2003
FYR of Macedonia**, 2000
Turkey*, 2003
Ukraine*, 2003
Albania*,2004
Russian Fed.*,2003
Greece, 2004
Poland, (16-99), 2002
Czech Rep.*, 2003
Romania, 2004
Latvia, 2003
Croatia,1999
Sweden*, 2003
Bulgaria*, 2003
Slovenia*, 2003
Portugal, 2001
Malta, (18-65),2001
France, 2002
Finland, (15-64), 2004
Lithuania, 2004
Liechtenstein, 1998
Northern Ireland, 2003
Hungary, (18-54), 2003
Greenland*,2003
Slovakia, 2004
Estonia, 2003
Cyprus, (15-65), 2003
Denmark, (16-64), 2000
Norway,2004
Belgium, 2004
Luxembourg*, 2003
Austria, 2004
Germany, (18-59), 2003
Switzerland*, 2003
Netherlands, 2001
Ireland, 2002
Iceland*, 2003
Italy, (15-54), 2003
Scotland (16-59), 2003
England & Wales, (16-59), 2003
Spain, 2003
West & Central Europe
Europe
Annual prevalence in %
Source: UNODC, 2006 World Drug Report.
Annexes
77
Opiates use among population 15-64, in 2004 or latest year available
0.05
0.07
0.1
0.1
0.2
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.4
0.4
0.4
0.4
0.4
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.6
0.6
0.6
0.6
0.7
0.7
0.8
0.8
0.9
0.9
0.9
1.2
2.0
0.5
0.7
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
Turkey, 2003
Moldova, Rep., 2000
Sweden, 2001
Finland, 2002
Poland,2002
Cyprus, 2004
Greece, 2004
Romania*, 2002
Iceland*,1998
Netherlands, 2001
Slovakia, 2002
Hungary, (18-54), 2003
Germany, 2003
Czech Rep.,2003
Belarus*, 2003
Norway,1997
Belgium,1997
France,1999
Austria, 2002
Malta, 2003
Bulgaria, 2001
Albania*, 2000
FYR of Macedonia, 2004
Slovenia,2001
Denmark, (16-64), 2000
Ireland,2001
Lithuania*, 2002/04
Switzerland,2000
Spain,2000
Croatia,1999
Portugal, 2000
Italy, 2004
Ukraine*, 2002
Latvia, 2001
Luxembourg, 2000
United Kingdom, 2001
Estonia, 2001
Russian Federation*,2004
West & Central Europe
Europe
Annual prevalence in %
Source: UNODC, 2006 World Drug Report.
Sweden’s successful drug policy: A review of the evidence
78
PERCEIVED RISK OF DRUG USE
Proportion of 15-24 year olds considering cannabis as ‘very dangerous’, 2004
24%
44%
40%
35%
31%
30%
28%
26%
22%
21% 21%
20% 20%
19%
8%
6%
0%
10%
20%
30%
40%
50%
EU 15
Sweden
Greece
Portugal
Ireland
Finland
Denmark
UK
Spain
Belgium
Austria
France
Italy
Luxembourg
Denmark
Netherlands
Source: European Commission, Eurobarometer, Young people and drugs, June 2004
Proportion of 15-24 year olds considering amphetamines as ‘very dangerous’; 2004
45%
73%
72%
49%
47%
45%
42%
40%40%
37%
35%
31%
24%24%
55%
55%
0%
20%
40%
60%
80%
EU-15
Finland
Sweden
Denmark
Italy
France
Spain
UK
Ireland
Denmark
Portugal
Greece
Belgium
Luxembourg
Austria
Netherlands
Source: European Commission, Eurobarometer, Young people and drugs, June 2004
Annexes
79
Proportion of 15-24 year olds considering ecstasy as ‘very dangerous’; 2004
66%
79%
72%
71%71%
69%
68%
67%
65%
64%
63%
61%
57%57%
48%
44%
0%
20%
40%
60%
80%
EU-15
Italy
UK
Denmark
Ireland
Sweden
France
Spain
Belgium
Greece
Luxembourg
Denmark
Austria
Portugal
Netherlands
Finland
Source: European Commission, Eurobarometer, Young people and drugs, June 2004
Proportion of 15-24 year olds considering cocaine as ‘very dangerous’; 2004
76%
84%84%
83%
82%
80%
79%79%
78%
76%
73%
72%
71%
67%
66%
65%
50%
60%
70%
80%
90%
100%
EU-15
Portugal
Sweden
Greece
Belgium
France
Austria
Finland
Italy
Denmark
UK
Ireland
Luxembourg
Netherlands
Spain
Denmark
Source: European Commission, Eurobarometer, Young people and drugs, June 2004
Sweden’s successful drug policy: A review of the evidence
80
Proportion of 15-24 year olds considering heroin as ‘very dangerous’; 2004
89%
96%
94%
93% 93%
92%
91% 91%
90% 90%
89%
87% 87%
85%
79%
77%
50%
60%
70%
80%
90%
100%
EU 15
Greece
Finland
Sweden
Austria
Italy
Denmark
UK
Belgium
Ireland
Portugal
France
Luxembourg
Spain
Denmark
Netherlands
Source: European Commission, Eurobarometer, Young people and drugs, June 2004
Annexes
81
Risk perception of regular cannabis use among 15-16 year olds (2003):
How much do people risk harm themselves by regularly taking cannabis?
Response: ‘ great risk’
44
46
47
47
54
54
54
58
59
61
61
64
65
68
68
70
71
71
72
72
74
75
76
77
77
77
80
81
81
81
83
83
87
87
88
70
0 102030405060708090100
Isle of Man
UK
Greenland
Netherlands
Belgium
Ireland
Turkey
Austria
Germany
Czech Republic
Switzerland
France
Slovenia
Italy
Ukraine
Slovakia.
Denmark
Portugal
Croatia
Romania
Bulgaria
Norway
Russia
Estonia
Hungary
Malta
Lithuania
Finland
Latvia
Poland
Iceland
Sweden
Faroe Isl.
Greece
Cyprus
Europe
S
ource: Council of Europe and Swedish Council for Information on Alcohol and Other Drugs (CAN),
The ESPAD Report 2003, Nov. 2004
Sweden’s successful drug policy: A review of the evidence
82
OTHER DRUG ABUSE RELATED DATA
Contacts with drug problems* (‘often’ & ‘from time to time’) in the area of residence
among EU-15 countries, 1996-2005
7
7
8
10
12
16
11
12
14
17
14
24
8
19
14
15
18
12
15
15
21
16
10
21
21
18
22
10
21
26
14
15
8
12
13
14
18
16
27
26
23
15
11
24
20
4
8
10
14
15
15
20
21
21
24
26
26
29
33
21
14
17
19
42
0 5 10 15 20 25 30 35
Finland
Sweden
Denmark
Austria
Germany
Ireland
Belgium
France
United Kingdom
Netherlands
Italy
Spain
Luxembourg
Portugal
Greece
EU-15
1996 Eurobarometer 2000 Eurobarometer 2002 Eurobarometer 2005 EU-ICS
*‘Over the last 12 months, how often were you personally in contact with drug related problems in the area where you live? For
example seeing people dealing in drugs, taking or using drugs in public places, or by finding syringes left by drug addicts?’
Sources: EU Commission, Eurobarometer, Public Safety Exposure to Drug Related Problems and Crime, Brussels 2003 and
Robert Manchin / Gergely Hideg, Drug related Problems in Europe’s Neighbourhoods, unpublished working paper
2
, August
2006, European Crime and Safety Survey, 2005.
2
The data used in this working paper is the copyright of the EU ICS Consortium, led by Gallup Europe. The EU ICS was co-
funded by the European Commission, FP6. The consortium website is http://www.gallup-europe.be/euics
. The working paper is
the copyright of its author(s).
Annexes
83
Acute drug-related deaths in 2003 (or latest year available), per million inhabitants
(national definition)
3
4
5
6
7
12
12
13
15
16
17
18
18
19
20
22
22
25
31
45
20
56
64
64
0 20406080
Hungary, 2003
France, 2000
Latvia, 2003
Netherlands, 2003
Italy, 2003
Lithuania,2003
Belgium,1997
Malta, 2003
Portugal, 2003
Slovenia, 2003
Sweden, 2003
Germany, 2003
Greece, 2003
Finland, 2003
Austria, 2003
Czech Rep., 2003
Ireland, 2001
Spain, 2001
Luxembourg, 2003
Denmark, 2003
United Kingdom, 2002
Norway, 2002
Estonia, 2002
West and Central Europe
Sources: EMCDDA, UNODC, ARQ, CAN
Sweden’s successful drug policy: A review of the evidence
84
INTRAVENOUS DRUG ABUSE AND HIV/AIDS
People living with HIV/AIDS in 2005 as a proportion of the population age 15-49
1.1%
0.5%
0.3%
0.2%
0.00%
0.50%
1.00%
1.50%
Sweden West & Central
Europe
Europe Global
In % of population age 15-49
Sources: UNAIDS, AIDS Epidemic Update, December 2005 and UNAIDS, A Global View of HIV Infections in UNAIDS 2006
Report on the Global AIDS Epidemic, May 2006.
People living with HIV/AIDS in 2005 as a proportion of the population age 15-49
5.0 - <15%
15.0 - 34%
0.1 - <0.5%
<0.1%
0.5 - <1.0%
1.0 - <5.0%
Aldult prevalence %
Sources: UNAIDS, AIDS Epidemic Update, December 2005 and UNAIDS, A Global View of HIV Infections in UNAIDS 2006
Report on the Global AIDS Epidemic, May 2006.
Annexes
85
UNAIDS estimates of HIV/infections in Europe in 2005 as a proportion of the
population age 15-49
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.2
0.3
0.3
0.3
0.4
0.4
0.4
0.5
0.6
0.8
1.1
1.1
1.3
1.4
0.3
0.5
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0
Romania
Bulgaria
Turkey
Croatia
Bosnia Herzegovina
Albania
Slovakia
Slovenia
FYR of Macedonia
Hungary
Germany
Malta
Norway
Poland
Czech Rep.
Finland
Sweden
Greece
Iceland
Ireland
Serbia & Montenegro
Denmark
Luxembourg
Netherlands
UK
Lithuania
Austria
Belgium
Belarus
France
Switzerland
Portugal
Italy
Spain
Latvia
Russia
Moldova
Estonia
Ukraine
West & Central Europe
European average
In % of population age 15-49
Sources: UNAIDS, AIDS Epidemic Update, December 2005 and UNAIDS, A Global View of HIV Infections in UNAIDS 2006
Report on the Global AIDS Epidemic, May 2006.
Sweden’s successful drug policy: A review of the evidence
86
Sweden: Reported HIV infections, by modes of transmission, 1985-June 2005 (N = 6,897)
IDU
14%
mother to child
1%
not known
7%
homosexual
37%
heterosexual
41%
Source: EuroHIV, HIV/AIDS Surveillance in Europe, Mid-year report 2005, Paris 2006.
EU-25: Reported HIV infections, by modes of transmission, 1985-June 2005
(N = 215,510)
IDU
14%
mother to child
1%
not known
22%
homosexual
32%
heterosexual
31%
Source: EuroHIV, HIV/AIDS Surveillance in Europe, Mid-year report 2005, Paris 2006.
Annexes
87
Europe (WHO region)*: Reported HIV infections by modes of transmission,
1985-June 2005, (N = 646,142)
IDU
38%
not known
33%
mother to child
0.02%
hetero-sexual
18%
homosexual
11%
* includes countries of the Caucasus region and Central Asia, but not Turkey.
Source: EuroHIV, HIV/AIDS Surveillance in Europe, Mid-year report 2005, Paris 2006.
New injecting drug use related HIV cases in Sweden, 1985-2005
142
204
98
45 45
44
30
27
26
29
22
27
38
32
27 27
19
1616
17
25
13%
14%
6%
45%
0
50
100
150
200
250
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
IDU related HIV cases
0%
10%
20%
30%
40%
50%
IDU in % of all HIV cases
IDU related HIV cases % of all HIV infections
Source: CAN
Sweden’s successful drug policy: A review of the evidence
88
Sweden: newly reported HIV infections, by modes of transmission,
in 2004 (N = 431)
IDU
6%
not known
12%
mother to child
3%
heterosexual
60%
homosexual
19%
Source: EuroHIV, HIV/AIDS Surveillance in Europe, Mid-year report 2005, Paris 2006
EU-25: newly reported HIV infections, by modes of transmission, in 2004(N = 24,184)
IDU
9%
mother to child
1%
not known
22%
homosexual
24%
heterosexual
44%
Source: EuroHIV, HIV/AIDS Surveillance in Europe, Mid-year report 2005, Paris 2006.
Europe (WHO region*): newly reported HIV infections, by modes of transmission, in
2004 (N = 74,760)
IDU
27%
mother to child
0%
not known
36%
homosexual
8%
heterosexual
29%
* includes countries of the Caucasus region and Central Asia, but not Turkey.Source: EuroHIV, HIV/AIDS Surveillance in
Europe, Mid-year report 2005, Paris 2006.
Annexes
89
Proportion of newly reported IDU related HIV infections among all newly reported
HIV infections in 2004
0%
0%
0%
0%
0%
0%
0%
0%
2%
2%
2%
3%
3%
3%
4%
4%
5%
6%
6%
7%
7%
7%
8%
8%
9%
11%
14%
19%
20%
20%
28%
30%
35%
45%
46%
51%
57%
75%
78%
27%
9% (11%*)
0 0.2 0.4 0.6 0.8
Malta
Albania
Bulgaria
Cyprus
FYR Macedonia
Romania
Slovakia
Slovenia
United Kingdom
Greece
Belgium
Hungary
Turkey
France
Netherlands
Denmark
Luxembourg
Germany
Sweden
Norway (2003)
Italy (2003)
Croatia
Austria**
Finland
Czech Rep
Switzerland
Serbia & Montenegro
Bosnia
Ireland
Iceland
Poland
Russia
Portugal
Latvia
Belarus
Moldova
Ukraine
Lithuania
Estonia (2002)
EU-25
Europe
* EU estimate: 9% for all EU countries reporting in 2004 (n=21 countries) or 11% including EU countries reporting in
previous years (Italy, Estonia) but not in 2004
Data for Austria are based on a UNODC estimate.
Source: EuroHIV, HIV/AIDS Surveillance in Europe, Mid-year report 2005, Paris 2006.
Sweden’s successful drug policy: A review of the evidence
90
Risk of new IDU related HIV infections among problem drug users in Sweden,
1992-2003
0.10%
0.14%
0.00%
0.05%
0.10%
0.15%
1992 2003
Source: CAN
Proportion of IDU among newly diagnosed AIDS cases in 2004
3%
39%
28%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
Sweden EU-25 Europe
Source: EuroHIV, HIV/AIDS Surveillance in Europe, End-year report 2005, Paris 2005.
Annexes
91
Newly reported IDU related HIV infections per million inhabitants in 2004
-
-
-
-
-
-
-
-
0.1
0.2
0.7
0.8
0.8
0.9
1.4
1.5
1.9
2.1
2.5
2.6
2.6
2.9
3.0
3.0
3.3
3.4
4
5
7
11
15
17
29
37
43
60
63
71
95
123
526
12
28
0 100 200 300
Albania
Bulgaria
Cyprus
FYR Macedonia
Malta
Romania
Slovakia
Slovenia
Turkey
Hungary
Czech Rep.
Bosnia Herzegovina
Greece
Croatia
Serbia & Montenegro
Germany
Finland
Belgium
United Kingdom
Denmark
Italy (2003)
Netherlands
Sweden
France
Norway (2003)
Iceland
Austria
Poland
Luxembourg
Switzerland
Andorra
Ireland
Lithuania
Belarus
Moldova
Spain
Latvia
Russia
Portugal
Ukraine
Estonia (2002)
EU-25
Europe
Source: EuroHIV, HIV/AIDS Surveillance in Europe, Mid-year report 2005, Paris 2006.
Sweden’s successful drug policy: A review of the evidence
92
Newly reported IDU related AIDS cases per million inhabitants in 2004
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.1
0.1
0.2
0.2
0.2
0.3
0.4
0.5
0.5
0.6
0.8
0.9
1.2
1.2
1.2
1.3
1.5
1.5
2.2
2.3
4.9
7.7
9.2
12.6
12.7
18.9
29.3
29.5
40.9
4.3
6.2
0 1020304050
Albania
Andorra
Bulgaria (2003)
FYR Macedonia
Iceland
Malta
Slovakia
Turkey
Hungary
Greece
Romania
Czech Rep.
United Kingdom
Croatia
Germany
Netherlands
Belgium
Slovenia
Denmark
Finland
Sweden
Austria
Ireland
Serbia & Montenegro
France
Lithuania
Norway (2003)
Luxembourg
Poland
Belarus
Switzerland
Italy (2003)
Moldova
Estonia (2002)
Spain
Latvia
Portugal
Ukraine
EU-25
European average
Source: EuroHIV, HIV/AIDS Surveillance in Europe, End-year report 2005, Paris 2005.
Annexes
93
Newly diagnosed injecting drug use related HIV infections per million inhabitants in 2004 (data for 1996 in brackets)
AUSTRIA
UNITED
KINGDOM
NETHERLANDS
DENMARK
NORWAY
SWEDEN
FINLAND
BELGIUM
GERMANY
POLAND
HUNGARY
UKRAINE
BELARUS
LATVIA
ESTONIA
LITHUANIA
BULGARIA
ROMANIA
GREECE
TURKEY
TURKMENISTAN
UZBEKISTAN
KAZAKHSTAN
TAJIKISTAN
KYRGYZSTAN
CZECH REP.
CROATIA
PORTUGAL
SWITZERLAND
AZERBAIJAN
GEORGIA
IRELAND
ICELAND
SLOVAKIA
FYR of
MACEDONIA
SERBIA &
MONTENEGRO
BOSNIA
HERZEGOVINA
ALBANIA
SLOVENIA
ITALY
MALTA
FRANCE
(1)
(5)
(3)
(5)
(2)
(2)
(1)
(9)
(7)
(0.1)
(0.1)
(0.9)
(9)
(91)
(2002)
(2003)
(2003)
(85)
(1)
(1)
(0)
(3)***
(2)
(0)
(0.2)
(0.3)
(0.04)
(0)
(0.2)
(2)
(2)
(16)
(5)
SPAIN
MOLDOVA
RUSSIAN
FEDERATION.
ARMENIA
3
3
2
7
2
17
3
3
60
95
3
0.8
0
0.8
1
11
3
3
3
2
0.7
5
0
0.2
4
0.9
0
0
0
0
0
123
43
37
71
526
63
29
0.1
23
7
11
31
24
16
29
EU-25 average: 12
Europe average: 28
IDU-related HIV in 2004
> 100 cases per million inhabitants
> 50 cases per million inhabitants
> 10 cases per million inhabitants
> 5 cases per million inhabitants
< 5 cases per million inhabitants
_
Estimates based on reported IDU
related AIDS cases
Main trafficking routes
yg j g g p ( )
94
NOTES
1
Leonard Goldberg, Drug abuse in Sweden, Bulletin on Narcotics, 1968, No. 1
2
Leonard Goldberg, Drug abuse in Sweden, Bulletin on Narcotics, 1968, No. 1
3
SOU 1967:25. Narkotikaproblemet, Del 1. Kartläggning och vård. Betänkande avgivet av narkomanvårdskommittén.
Stockholm, Allmänna, 1997
4
SOU 1967:41 Narkotikaproblemet. Del.2. Kontrollsystemet. Betänkende avigivet av narkomanvardskommittén, Stockholm,
1967
5
Esbjörn Esbjörnson, The drug problem in Sweden-from the police point of view, Bulletin on Narcotics, 1971, No. 1,
6
Esbjörn Esbjörnson, The drug problem in Sweden-from the police point of view, Bulletin on Narcotics, 1971, No. 1,
7
A restrictive policy. The Swedish experience, National Institute of Public Health, Sweden, 1993
8
Leif Lenke, Börje Olsson, Drugs on prescription- the Swedish experiment of 1965-1967 in retrospect, European Addiction
Research 1998, 4,
9
A restrictive policy. The Swedish experience, National Institute of Public Health, Sweden, 1993
10
Leif Lenke, Börje Olsson, Drugs on prescription- the Swedish experiment of 1965-1967 in retrospect, European Addiction
Research 1998, 4
11
A restrictive policy. The Swedish experience, National Institute of Public Health, Sweden, 1993
12
Leif Lenke, Börje Olsson, Drugs on prescription- the Swedish experiment of 1965-1967 in retrospect, European Addiction
Research 1998,4
13
Legal narkotikadöd (Legal Drug Death) by Carl-Axel Åkerman, Sobers Förlag AB 1978 (ISBN 91-7296-061-2).
14
Nils Bejerot, Drug Abuse and Drug Policy, Stockholm 1975.
15
Legal narkotikadöd (Legal Drug Death) by Carl-Axel Åkerman, Sobers Förlag AB 1978 (ISBN 91-7296-061-2).
16
http://www.nilsbejerot.se/om.htm and Tim Boekhout van Solinge, The Swedish Drug Control System, An in-depth Review and
Analysis, Amsterdam 1997
17
Leif Lenke, Börje Olsson, Drugs on prescription- the Swedish experiment of 1965-1967 in retrospect, European Addiction
Research 1998, 188
18
Leif Grönbladh, A National Swedish Methadone Program, 1966-1989, Acta Universitatis Upsaliensis, Comprehensive
Summaries of Uppsala Dissertations from the Faculty of Medicine 1325, Upssala, 2004, 22
19
William B. McAllister, Drug diplomacy in the twentieth century- An international history, Routledge, London, 2000, 228
20
William B. McAllister, Drug diplomacy in the twentieth century- An international history, Routledge, London, 2000, 228
21
William B. McAllister, Drug diplomacy in the twentieth century- An international history, Routledge, London, 2000, 229
22
United Nations Conference to consider amendments to the Single Convention on Narcotic Drugs, 1961, Geneva 6-24 March
1972 (E/CONF.63/10), Volume I, 5
23
United Nations Conference to consider amendments to the Single Convention on Narcotic Drugs, 1961, Geneva 6-24 March
1972 (E/CONF.63/10), Volume I, 5
24
Leif Grönbladh, A National Swedish Methadone Program, 1966-1989, Acta Universitatis Upsaliensis, Comprehensive
Summaries of Uppsala Dissertations from the Faculty of Medicine 1325, Uppsala, 2004, 1
25
A restrictive policy. The Swedish experience, National Institute of Public Health, Sweden, 1993
26
Government bill Prop 1977/78:105, unofficial translation from the Deputy National Drug Policy Coordinator, Sweden, 2
August 2006
27
Government bill Prop 1977/78:105, unofficial translation from the Deputy National Drug Policy Coordinator, Sweden, 2
August 2006
28
Government bill Prop 1977/78:105, unofficial translation from the Deputy National Drug Policy Coordinator, Sweden, 2
August 2006
29
Government bill Prop 1984/85:19, unofficial translation from the Deputy National Drug Policy Coordinator, Sweden, 2 August
2006
30
National strategies: EMCDDA Country Profile Sweden, December 2002, accessed at
http://www.emcdda.europa.eu/?fuseaction=public.AttachmentDownload&nNodeID=1793, August 2006
31
The Care of Alcoholics, Drug Abusers and Abusers of Volatile Solvents (Special Provisions) Act (1988:870), UNODC Legal
Library, E/NL.1996/56
95
32
Section 4 (2) of the Act
33
Section 4(3) of the Act
34
EMCDDA Report 1999
35
Mats Ramstedt, The drug problem in Sweden in 1979-1997 according to official statistics, in Håkan Leifman and Nina Edgren
Henrichson (eds), Statistics on alcohol, drugs and crime in the Baltic Sea region, Nordic Council for Alcohol and Drug Research,
Publication Nr. 37, Helsinki, 2000
36
National Council for Crime Prevention (BRÅ): The criminalisation of narcotic drug misuse- an evaluation of criminal justice
system measures, English summary, Stockholm, 2000, 42
37
National Council for Crime Prevention (BRÅ): The criminalisation of narcotic drug misuse- an evaluation of criminal justice
system measures, English summary, Stockholm, 2000, 42
38
National Council for Crime Prevention (BRÅ): The criminalisation of narcotic drug misuse- an evaluation of criminal justice
system measures, English summary, Stockholm, 2000, 42
39
Vägvalet-den narkotikapolitiska den narkotikapolitiska utmaningen, SOU 2000:126, p.33
40
Vägvalet-den narkotikapolitiska den narkotikapolitiska utmaningen, SOU 2000:126, p.33
41
Vägvalet-den narkotikapolitiska den narkotikapolitiska utmaningen, SOU 2000:126, p.33
42
Unofficial translation by the Deputy National Drug Policy Coordinator, Sweden, 13 July 2006
43
Unofficial translation by the Deputy National Drug Policy Coordinator, Sweden, 13 July 2006
44
Report of the International Narcotics Control Board for 2004, paragraph 540
45
Strategies and coordination in the field of drugs in the European Union- a descriptive review, EMCDDA, 2002, 21
46
Strategies and coordination in the field of drugs in the European Union- a descriptive review, EMCDDA, 2002, 21
47
A Drug Free Iceland - a Five-Year Project: Aims, Means and Achievements, An Address by Dögg Pálsdóttir to the Conference
of the European Cities Against Drugs, Reykjavik, Iceland, April 25, 2002
48
The Fight Against Drugs- Action Plan Against Drug Abuse, The Danish Government, October 2003, 5
49
The Fight Against Drugs- Action Plan Against Drug Abuse, The Danish Government, October 2003, 5
50
Ann Christin Rognmo Olsen, National Policies and Contexts, in Petra Kouvounen, Astrid Skretting and Pia Rosenqvist, (eds),
Drugs in the Nordic and Baltic countries: Common concerns, different realities, Nordic Council for Alcohol and Drug Research,
Publication Nr. 48, Helsinki, March 2006,
51
Government Resolution on a Drug Policy Action Programme in Finland 2004 – 2007. Helsinki 2004, 2
52
Paragraph 1 of the regulations relating to the trial scheme of premises for drug injection (the Injection Rooms Scheme)
contained in http://odin.dep.no/filarkiv/242619/Provisional_Act_No_64__Sproyteromsloven_.pdf, accessed August 2006
53
Boekhout van Solinge, Tim (1997), The Swedish drug control policy. An in-depth review and analysis. Amsterdam, Uitgeverij
Jan Mets/CEDRO, 10
54
Caroline Chatwin, Drug policy developments within the European Union-the destabilizing effects of Dutch and Swedish drug
policies, The British Journal of Criminology, Summer 2003, 571
55
Leonard Goldberg, ”Drug Abuse in Sweden”, in United Nations Bulletin on Narcotics, 1968, Vol. 1.
56
Council of Europe and the Swedish Council for Information on Alcohol and Other Drugs, The 2003 ESPAD Report,
Stockholm 2004.
57
UNODC, 2006 World Drug Report, Vol. II, pp. 388-389.
58
The number of amphetamine users was 0.2 per cent or 11,800 according to a national household survey; the number of
amphetamine users among problem drug users (N = 25,745 in 2003) amounts to 18,800 people (based on a 1998 study that 73
per cent of problem drug users use amphetamine (exclusively, or in combination), including 32 per cent using it as their primary
drug (Reitox Sweden, 2005). Adding this to the number of amphetamine users in the household survey, would give a figure of
30,600. This is the upper limit of the estimate as it would assume that no problem drug user was living in a private household in
Sweden. The lowest possible estimate – assuming that drug users would still be living in households, would be equivalent to the
number of amphetamine problem drug users of 18,800. This figure would mean 11,800 people were identified in the household
survey and another 7,000 in other locations/institutions (street, prison, hospitals etc.). However, this would also mean that not a
single occasional user was found in the household survey, which does not reflect reality. A tentative estimate of the total number
of amphetamine users must thus be within the range: 18,800 – 30,600; the mid-point estimate of this range amounts to 24,700
(or rounded 25,000) and is taken as UNODC’s best estimate of the total number of amphetamine user in Sweden.
59
Statent Folkhäloinstitut, 2005 National Report to the EMCDDA by the Reitox Focal Point, Stockholm 2005, 20.
60
Eurostat database – main aggregates – annual data - gross domestic product at constant prices
61
Gérald Lafrenière, ‘National Drug Policy: Sweden’, prepared for the Senate Special Committee on Illegal drugs, (Library of
Parliament), Ottawa (Canada), April 2002.
96
62
Eurostat database – harmonized unemployment rate.
63
OECD, Employment Outlook June 1998, Paris 1998, 196.
64
T. Pietschmann, “Price Setting Behaviour in the Heroin Market, in United Nations”, Bulletin on Narcotics, 105-139.
65
OECD, OECD Economic Surveys Sweden, Volume 2005/9, Paris 2005, 38.
66
Statent Folkhäloinstitut, 2005 National Report to the EMCDDA by the Reitox Focal Point, Stockholm 2005, 8.
