5. 1 Control of drugs


Sweden

The first sign of drug abuse as a social problem came in 1954 when the
liberal MP Rimmerfors in the Riksdag discussed an increasing tendency
among youth to smoke marijuana for pleasure and escape. However,
marijuana soon disappeared as a problem (Lindgren 1993: 155). About
ten years later cannabis was depicted as sporadically used during the
1950s by visiting jazz musicians and other artists, and presumably
under their influence by their Swedish colleagues (SOU 1969: 52: 127.
Instead of cannabis, use of amphetamines among youth was singled out
as the most serious drug problem. Furthermore, a certain type of drug
abuse, drug abusers, and their personal characteristics was singled out
as more threatening than others (Lindgren 1993: 156). Intravenous use
of amphetamines came into focus in the drug problem and would be
there for a long period and a reason to describe amphetamine use more
in detail. Quite soon after the introduction of amphetamines as a
medicine in 1938 they were used for a wide range of diseases.27 It was a
great success (400,000 tablets had been purchased in the first year) but
after reports on abuse the National Board of Health (NBH) promulgated
a regulation in 1939 making amphetamine obtainable only by a doctor's
prescription. This led to a decrease of consumption, but only
temporarily. In 1942, six million tablets were sold and the number of
users was estimated at 200,000, i.e. 3% of the adult population (Olsson
1994: 68). The number of excessive users was estimated at 200. The
next year, a guideline from the NBH for restrictive prescription practice
resulted in a halving of consumption. In 1944, the same regulations on
prescription as for narcotics (opiates) were applied to amphetamines.
According to Olsson, this was the first occasion on which drug
legislation in Sweden was motivated by domestic developments (Ibid.
166).
During the 1950s, amphetamines became increasingly popular and
reason for the NBH to classify amphetamine as a narcotic in 1958,
followed by the newly introduced central stimulants Preludin
(phenmetrazine) in 1959 and Ritalin (methylphenidate) in 1960. In
1960, the NBH recommended restrictive practice on prescriptions by
telephone. The governmental measures to curb the legal use of
amphetamine and its derivatives had been quite successful. The number
of doses of amphetamine had decreased from 33.2 million in 1959 to 5
million in 1965. The medical profession accepted these restrictions
because the pharmaceutical industry succeeded in producing new kinds
of stimulants (Olsson 1994: 168).
However, during the second half of the fifties the situation changed.
Concurrently with measures to bring down legal consumption, abusers
were forced to look for other sources of supply. Forging prescriptions
and burgling pharmacies became a common strategy to obtain the hard
accessible drugs and an illegal market in amphetamines arose (Lindgren
1993: 156).
Furthermore, while legal use of amphetamines among socially
adjusted groups was under (medical) control, illegal abuse, and
especially intravenous abuse of amphetamines was beginning to spread
among socially marginalised youth, criminals, and prostitutes.
According to Olsson, the social locus had moved from the conception
of drug abuse as an illness and individual drug abusers as patients, to
other categories (subcultures) that were already social deviants.
Consequently, other professions than the medical profession, which had
held a monopoly position in the field of information on drugs, became
involved in the process of defining the problem (Olsson 1994: 166­
167). Both the judicial system and the municipal authorities, especially
the child welfare board, were confronted with the drug problem that
also came to the attention of the media and the parliament. In this
process, the medical profession had to share its influential position with
police and justice authorities.


The Netherlands

Before the Second World War, abuse of drugs was mainly confined to
opiates. During the Second World War, the supply of opium was
hampered and a number of addicts switched to amphetamines that were
injected subcutaneously and according to the government constituted a
bigger problem after the war than the use of opium. An increase of drug
use in the post-war period was blamed on difficult social and economic
times. This means that social conditions were seen as a cause of drug
use (de Kort 1996: 135).
Like their Swedish colleagues, Dutch physicians prescribed
amphetamines for a number of indications. However, amphetamines
could be purchased without prescription until 1968. In 1961, an
interdepartmental consultation group (ICG) concluded that the use of
amphetamines exceeded that of opiates. Counted in grams, the use per
1000 inhabitants was much larger than that of morphine.
Amphetamines were supplied by the pharmaceutical industry and the
absence of trafficking was the reason they were not subjected to
international control, which made it hard to include amphetamines in
the Opium Act (ICG meeting, 18 October 1961).28
Statistics about the magnitude of drug abuse are hard to obtain, partly
because of the professional secrecy and partly because the responsible
state health inspectorate strictly limited its attention to medically
registered cases of drug addiction. In 1949 about 300 persons were on a
list of "suspected patients", 25% of these were physicians and some
were nurses (de Kort 1995: 135). Illegal trade and illegal possession of
drugs was a matter for juridical authorities and fell outside the
jurisdiction of the health inspectorate. The police directed its actions
towards smuggling and fraud by manufacturers and distributors of
opiates and cocaine in the Netherlands. In conclusion, the non-medical
use of opiates and amphetamines was perceived as worrying, but
control measures were not aimed at users. Medical authorities and
police wanted to avoid a criminalisation of the user because that would
push users into the arms of criminal dealers and deteriorate their
situation (Ibid. 155).
In 1953, the possession and use of hemp products were also included
in the Act and the maximum penalty was raised from two to four years'
imprisonment.29 Once more, the reason was an adjustment of the
national law to a UN treaty (Anjewierden and van Atteveld 1989: 235).
At the end of the fifties the practice of not prosecuting users changed,
particularly in the case of marijuana smokers. Besides the
criminalisation of possession and use of cannabis in 1953, there were
other reasons for the changed approach. As Korf has pointed out, the
Netherlands became much more oriented towards the US and adopted
the American approach in drug matters that it previously had opposed
so many times (Korf 1995: 4). The dissemination of cannabis was
explained by several factors. American soldiers who were stationed in
Germany travelled to Amsterdam to purchase marijuana. Furthermore,
use of marijuana by musicians was also noticed to take place in jazz
clubs. Authorities and public opinion regarded cannabis as extremely
dangerous and users were sentenced to harsh penalties (Maalsté 1993).
Cannabis had become the drug in focus of attention for several reasons:
cannabis products lacked any medical usage and control was solely a
matter for justice; cannabis users did not fit in the category of patients
like opium addicts and were defined as deviant.
Intellectuals and experts in the field of drugs increasingly disputed
this strategy against marijuana smokers because it was not in proportion
to the risks of cannabis smoking (de Kort 1995: 169). The repressive
approach with severe penalties would prevail until the end of the sixties
but was subject to increasing criticism.


Comparison

The impetus leading to national drug acts was similar in both countries.
Until the Second World War, drug legislation was largely influenced by
international conventions, not by domestic developments. National
regulations were in practice statutes for medicine control rather than a
penal law. Police activities were directed at illegal trade and smuggling
activities, not at the individual users (patients).

When we look at domestic developments after the Second World
War, we can notice both similarities and differences. The drugs in
question (cannabis excluded) were perceived as medicines that could be
misused for non-medical purposes. The medical professions (physicians
and pharmacists) were the appropriate institutions to control drug use
and drug abuse.
During the 1950s, groups deviating from the traditional "patient"
category of drug addicts came into the spotlight of public interest. This
shift of categories from patients to socially deviating drug users also
had significant implications for both the problem definition and the
social institutions that faced the individual drug user. Illegal drug use
was becoming a social problem that could not be solved within the
domain of medical professions only.
Another difference concerns the type of substance that was
designated as problematic. In Sweden, the drug in focus was
amphetamines and in the Netherlands cannabis. In spite of the fact that
abuse of amphetamines in the Netherlands was described as far more
serious and widespread than opium, they could be purchased without a
prescription until 1968. This may indicate that in the Netherlands it was
harder to control physicians than in Sweden. Health care in Sweden was
in a phase of transition towards a public service controlled by the state,
and since the end of the 1950s the possibilities of physicians to steer
their own business has been circumscribed (Ahrne, Roman, and
Franzén 1996: 196). In the Netherlands, health care was primarily a
matter for NGOs that were organised in powerful interest organisations.
A final difference that should be noticed is that the practice of not
prosecuting users was abandoned and drug users were arrested and
sentenced to imprisonment or referred to health or social care agencies.

27 To name some: narcolepsy, hypertonia, psychosis, Parkinson's disease,
psychopathology with alcoholism, overweight, and to increase psychic and
physiological performance (Olsson 1994).
28 One interesting comment from one of the members: "the question is how far the
government should go against the use of poisons that individuals swallow
voluntarily". This question will occur many times in Dutch documents.
29 Possession of opium and cocaine was made a criminal offence by the Opium Act
in 1928. Use was criminalised in 1953 to facilitate police investigation, not to detect
users (Blom 1998: 56).