6. 2 Sweden's first drug policy bill

Six months after the committee's report on the control system,
Sweden's first drug policy bill was presented (Prop. 1968 no. 7). It was
divided into a part about assistance to drug abusers and one about the
control system.38 In this section, the bill is discussed together with the
recommendations from the committee.
Minister Aspling of Social Affairs summarised the committee's
conclusions on the drug situation as follows:

· Due to interventions by the National Board of Health, prescriptions
of central stimulants were greatly diminished. At the same time
trafficking in these substances had increased in steadily growing
quantities. Hallucinogenic substances like LSD and similar
substances had recently been added. Abuse of cannabis had spread
more and more, particularly among youth.
· Drug abuse was a typical big city phenomenon but the situation was
most serious in Stockholm. The local child welfare board had
reported a steady rise of clients with drug abuse, from 40 in 1964 to
299 in 1967.
· In reports from state correctional schools, young drug abusers were
increasingly noticed as well as an increase in drug abuse in the
institutions.
· From several hospitals, a large number of drug abusers were
reported, mostly of hypnotics and tranquillisers but also of central
stimulants.
· Data from police and correctional treatment corroborated the fact
that the most serious drug abuse occurred among certain asocial and
criminal groups.
· An increase of hepatitis B was noticed (Ibid. 61­63).

Further, the drug problem was very much an international problem. Its
occurrence reflected the internalisation of the world and the reduction
of distances. Poisons that had for ages been used in limited areas were
spread around the whole world (Ibid. 102). International drug
syndicates that illicitly imported drugs into Sweden were singled out as
the main problem.


Assistance

Abuse of medicines constituted, in the perception of the committee, a
complex of problems with medical, social, psychological, and juridical
aspects. Treatment of people addicted to medicines was according to
the committee primarily a medical (social psychiatric) matter. Medical
treatment should consider the role of physical, psychiatric, and social
factors in the genesis, development, and treatment of the disease.
Especially with respect to rehabilitation, "social care" should be
emphasised (SOU 1967: 25: 111).
Assistance to drug addicts was in its infancy and the committee
urged a rapid expansion of resources for care of drug abusers. The
target group for care would primarily be youngsters, whose abuse was
destructive and often brought about lasting negative or life-threatening
conditions. Settings in which abuse took place constituted a risk of
contagion, a threat to the future welfare of others, and abuse contributed
to criminality and poor social conditions (Ibid. 112).
The traditional temperance institutions and temperance councils were
in the eyes of the committee no appropriate agencies for treatment of
drug abusers. Detoxification from drugs was of a different nature than
detoxification from alcohol and a task for psychiatry. Recommendation
on the role of temperance care in outreach and aftercare activities would
be outlined in a coming report (Ibid. 162). According to the new Act on
Coercive Psychiatric Care (SFS 1966: 293), abuse of narcotics was
equal to the diagnosis "narcomania", i.e. a mental disease and an
indication for compulsory psychiatric care. However, motivation for
treatment would, according to the committee, be stronger if care was
based on the patient's own consent. Compulsory care would therefore
be applied restrictively, but in many cases be necessary. The legal
framework for such care was judged sufficient and did not need to be
extended (Ibid. 161).


Abstinence

What would be the goal for assistance according to the committee? The
general goal had to be ending addiction and preventing relapse.
However, some drug abusers needed first to adjust socially and be
motivated to refrain from abuse later. For patients who could not be
induced to live a drug-free or socially adjusted life, a legitimate goal
would be: to reduce their suffering, to prevent dissemination of abuse
and to obstruct criminality and other behavioural disorders (Ibid. 112).
However, the presence of different goals for treatment could entail
confusion. The motivation of some patients to live a drug-free life could
be reduced by the knowledge of other patients being treated according
to an alternative goal. The general goal should therefore only be
abandoned occasionally and on precise indications (undoubtedly the
committee had maintenance treatment with substitute drugs in mind)
(Ibid. 112). The committee also recommended the closing down of the
experimental ambulatory project in Stockholm where abusers received
prescriptions for drugs to be taken intravenously (Ibid. 129).
In the bill, the minister adopted the committee's goal of abstinence:

Together with preventive measures to obstruct the emergence and dissemination of
drug abuse, society must ensure that those who are affected by the illness that abuse
constitutes, receive the care and treatment that can free them from the dependence
on the substance (Prop. 1968 no. 7: 63).

The committee's ideas about reducing drug-related harm, depending on
the patient's needs, however, were left out without comment.


Chain of care

The committee outlined a structure for assistance to adult abusers that
was called a "chain of care" and in which psychiatry was the axis. This
chain of care comprised: ­ outreach activities ­ ambulatory care ­
intramural care ­ aftercare. The chain had to be organised in such a way
that the highest possible integration between its components would be
guaranteed. Such integration was necessary to enable a fast and
effective transition from one link of the chain to the next. Integration
would also create continuity in treatment and "the revolving door" due
to uncoordinated measures would be avoided (Ibid. 113). The
committee separated the target group for care into two age categories:
abusers older and younger than 21 years. For each category, a separate
treatment organisation should be established.


Outreach activities

The first link of the chain would trace drug users (both young and
older), make them aware of their illness, and try to induce them to enter
treatment voluntarily. Outreach work was needed because a number of
abusers did not seek care, for example, when abuse had become a
desired and inevitable lifestyle and he was out of reach of pressure from
the outside world to seek treatment. Systematic outreach activities of
this kind did not exist, and the committee recommended that municipal
social workers and non-governmental organisations like the RFHL
should perform outreach activities. Outreach work should have contact
with outpatient clinics for drug abusers and special wards in psychiatric
hospitals (which were under construction) to enable prompt admission
in emergency cases. Abusers under 21 should be referred to municipal
child welfare councils or juvenile psychiatry (Ibid. 113).
As regards the responsibilities for assistance, the minister concluded
that uncertainty had occurred on the question of whether municipalities
were obliged by the Social Services Act to establish outreach activities.

The minister announced a clarification of the law in this respect (Prop.
1968 no. 7: 64).39


Ambulatory care

The next link was ambulatory treatment. If there were few patients,
ordinary ambulatory receptions and outpatient clinics could provide
ambulatory care of drug abusers. Larger groups conflicted with other
patients, and in Stockholm and Gothenburg provisional facilities for
ambulatory care of drug abusers had been established in spring 1966.
The committee recommended that such ambulatory facilities should be
located at psychiatric hospitals, led by physicians, and be open around
the clock. Other professional categories would be psychologist,
almoner, nurse, and secretary. Regular contact would be necessary with
rehabilitation treatment as well as a municipal official from the Social
Board (SOU 1967: 25: 120).


Intramural care

For intramural treatment of drug abusers, the committee recommended
the establishment of special psychiatric wards with limited capacity,
10­12 patients. The group affinity that characterises certain drug
abusers can be employed in a positive psychotherapeutic way. The
committee rejected the establishment of a separate hospital for drug
abusers for several reasons. One argument was that experiences from
separate care of alcoholics, tuberculosis sanatoria, etc., had shown that
after an initial period, they received smaller funds than ordinary health
care. Another argument concerned difficulties in attracting qualified
personnel (Ibid. 134).


Aftercare

After the initial therapy the patient could continue treatment at a
department of the psychiatric ward (called "discharge house") outside
the hospital but located near big cities to facilitate aftercare. To prevent
relapse in the phase of re-entering society, a therapeutic contact with a
physician, psychologist, or almoner should be established (Ibid. 135).
The "Chain of Care" model as outlined by the committee was
adopted in the bill with one exception. The proposal to establish
"discharge houses" as part of psychiatric hospitals where therapy
should continue and rehabilitation to society could begin was rejected
by the minister. To shorten the time in expensive hospital wards, special
units for drug abusers, "treatment homes", had to be established where
therapy could be combined with labour or education.40 Another
argument mentioned by the minister was that the patient should not
have to stay in a hospital milieu too long. Establishing and running
these treatment homes would be the responsibility of municipalities, not
psychiatry (Prop. 1968 no.7: 69).
Concerning the proposal to establish small units within psychiatry to
take care of the most severe cases, the minister noted that already a total
of 70 beds were available and others were planned to open in the near
future (Ibid. 68).


Correctional treatment

The committee also discussed the situation concerning drug abusers and
drug abuse among prisoners. A national survey conducted in prisons in
August 1966 showed that 10% of all detainees were drug abusers or had
used drugs on the premises. The possibilities of providing care in
prisons were limited to detoxification and in some case treatment by
forensic psychiatry. Abuse of drugs in prisons was described as a
serious problem. The committee observed a conflict between more rigid
control measures and principles for human correctional treatment. More
knowledge of the extent and the nature of drug abuse in prison and the
supply route of drugs into prison was needed (Ibid. 143).
The committee's proposal to concentrate addicted detainees in
certain prisons should, according to the bill, be further considered
(Prop. 1968 no. 7: 71)

Juvenile care

Young drug abusers were not very common within youth psychiatry.
The committee ascribes this to the fact that drug abuse and asociality or
maladjustment causes contact with the child welfare council rather than
with psychiatry. According to the Law on Child Welfare, municipal
child welfare boards are obliged to interfere and arrange care of
youngsters up to the age of 21. This law enables quick admission to
state correctional schools. At some of these schools special wards for
young drug abusers had been established or were planned for in the
near future. The committee also recommended the establishment of a
special youth diagnostic centre in Stockholm from which young abusers
could be referred to appropriate treatment (Ibid. 142). The centre
would, according the minister, be opened as soon as possible.
Furthermore, state correctional schools took care of large shares of
young drug abusers and their resources were continuously reinforced
(Prop. 1968 no. 7: 70).


Control by penal law

In the bill for a Drug Act (NSL), which was in line with
recommendations from the Narkomanvård Committee, drug crimes
were differentiated into three degrees:

· Misdemeanour: possession for personal use, penalised by a fine:
dismissal of prosecution possible.
· Simple drug offences: petty dealing penalised by a fine or maximum
two years' imprisonment.
· Serious drug offences: drug dealing on a large scale, minimum six
months' imprisonment and maximum four years (Prop. 1968 no. 7).

This differentiation was necessary, according to the minister,
considering the position of (in particular young) drug abusers who are
involved in drug criminality. These should be kept out of prison (Ibid.
111). Furthermore, the sharpening of the Drug Act by increased
penalties and an extension of criminal acts was directed at the trade in
drugs. As the committee had emphasised, extended control measures
should not jeopardise co-ordination with health and social services. The
control system should primarily be aimed at suppressing supply. Drug
addicts were victims and in need of care and treatment. According to
the committee, "Without a clarified goal the control bodies run the risk
of following their own track in the work with drug issues" (SOU 1967:
41: 13).
According to the committee, the issue of possession of drugs for
personal use had been the subject of lively public discussion and
debates in the Riksdag. The idea of relaxing regulations on possession
for personal use was rejected by the Narkomanvård Committee. First,
Sweden was a signatory of the Single Convention since 1965, and
according to the Convention, unauthorised possession of drugs should
be criminalised. The Narkomanvård Committee rejected a common
argument against criminalisation: namely, that this would influence the
motivation of drug users to seek care negatively. There was no evidence
for this hypothesis, and the drug abuser could rely on the physician's
professional secrecy (Ibid. 74). Police authorities put forward another
argument. According to them, decriminalisation of possession for
personal use would hamper the prosecution (collecting evidence and
conducting searches) of the main target for police actions, the wholesale
dealers (Ibid. 74).
Another objection against the decriminalisation of possession for
personal use was, according to the Narkomanvård Committee, the
difficulty of setting a limit for the quantity of drugs. For a number of
drug abusers a thousand tablets would probably be a minor amount
while for others ten tablets would do the job. There was also a risk of
dealers carrying just the permitted quantity of drugs and filling their
stash later from elsewhere (Ibid. 75).
The general wish not to apply penal regulations to trivial offences
could be met by the dismissal of charges by the prosecutor. Concerning
illegal possession of drugs for personal use, the committee referred to
the prosecution practice that had developed in Stockholm. Between
1964 and 1965 a total of 77 persons had escaped prosecution in drug
cases, among them 69 who were indicted for possession (alone or
together with other criminal acts). The number of persons convicted for
possession during the same period was 412 (Ibid. 71). In the bill, the
minister agreed with the committee and emphasised that a liberal
practice of prosecution was of utmost importance (FK 1968 no. 10:
131). A few weeks before the Drug Act came into force, the Prosecutor-
General proclaimed that even if no need for care exist, there could be
reason not to indict people for possession of a little quantity of drugs for
personal use: "the nature of the crime is not such that prosecution
generally can be regarded as required from a general point of view"
(RÅC 43).
The issue of cannabis was discussed in many sections of the bill. The
minister referred to public debates that advocated a more liberal
approach to cannabis in relation to other drugs. Such ideas were
rejected with the same arguments as the committee: the Single
Convention, the stepping stone theory, psychological dependence,
hallucinations, and psychotic episodes (Prop. 1968 no. 7: 106).
Furthermore, in cannabis-using milieux, other drugs were often not far
away, and cold-hearted dealers mixed cannabis with other substances
(Ibid. 106).
The international aspect of the drug problem was also an argument. It
was emphasised that countries where cannabis was a common drug held
the view that it should be combated fiercely. Another, more pragmatic
reason was that if Sweden urged support for its efforts to make Preludin
and equivalent substances subject to international control, solidarity
with countries that experienced problems with cannabis would be
necessary. Besides, knowledge about cannabis was far too little to
question the international control system (Ibid. 106).


Co-ordination

The committee held the opinion that effective prevention of illegal
handling of drugs would be impossible to pursue without a uniform
international control system. Therefore, international control had to be
extended quickly to embrace central stimulants, sedatives, hypnotics,
and hallucinogens (SOU 1967: 41: 9). Until the day such a control
system was established, Sweden could gain support in efforts to
obstruct the illegal import of amphetamines only by means of bilateral
diplomacy. Diplomatic contacts had been taken by Swedish
ambassadors in Spain and Italy in order to restrain the export of
Preludin to the black market in Sweden. Pressure by negative publicity
was exerted, for example, on the manufacturer of Preludin, Boehringer,
to withdraw that product from the Swedish market (which happened in
1965) (Ibid. 23).
The committee also discussed the issue of the co-ordination of
actions in Sweden. Due to the nature of the problem, several authorities
and departments were involved. Therefore, according to the committee,
future inquiries into the drug problem would better not be conducted by
one single authority e.g. the National Board of Health. Instead, all
involved authorities would be included (Ibid. 14).
As pointed out by the Narkomanvård Committee, co-ordination
between authorities was crucial. To achieve this, the minister said, a
comprehensive basic outlook among authorities on matters of
prevention was necessary. Especially considering the ongoing debates
on the harmful effects of some substances (cannabis) and the lack of
knowledge about the drug problem, it was desirable to promote, as far
as possible, a basic stand on the part of the authorities (Prop. 1968 no.
7: 108).


Sites of dissemination

Another problem pointed out by the Minister were apartments where
drug users met. In Stockholm, the number of such sites was estimated at
between 500 and 600 (AK 1968 no. 10: 132).
Other sites where young drug abusers met were youth clubs. As
described in chapter 5, "Drug problems", several clashes between
police and young people that came from the suburbs to the centre of
Stockholm to enjoy themselves, had occurred in Stockholm during the
1960s. A category of youngsters did not feel comfortable at the
ordinary youth clubs that had been established throughout the town. To
keep these youngsters off the streets, special youth clubs (4an, JOVA)
opened in the very centre of Stockholm under aegis of the child welfare
board. In addition, youth over the age of 20 were allowed to become
members of the club. In 1968, about 150 youngsters visited JOVA
regularly. The board recognised roughly 100 of the regular visitors.
This group was characterised by criminality, alcohol and drug abuse,
etc. Minister Aspling depicted the clubs as a kind of outreach work
(Prop. no. 7 1968: 66). Liquor and wine were prohibited but to prevent
consumption on the streets visitors were allowed to consume beer they
had brought along (which was prohibited in ordinary youth centres).
Particularly interesting is the strategy of the staff concerning cannabis
smoking among visitors to the club. Smoking cannabis was not
accepted but tolerated for a practical reason: it was hard to find out who
smoked, and a pragmatic reason (to keep in contact with the
youngsters). Police visited the club two or three times a week but did
not act (SBN meeting, 16 September 1968).


The Riksdag

Both the standing committees on Justice and on Social Affairs approved
the bills unanimously and they could have passed the Riksdag without a
debate (Su no. 37 1968; AL no. 1 1968). However, as Kaijser, a
conservative member of the Upper House, stated: "The issue is,
however, so important and serious and is a matter of such interest to all
of our people that in my opinion it would be a failing not to mention it
in a public debate in this chamber" (FK 1968 no. 10: 122).
The statements made in the Riksdag reflect how politicians perceived
the drug problem. As noted before, the Narkomanvård Committee
described the emergence and dissemination of the drug problem as
analogous to that of an epidemic disease.41 This metaphor would recur
in the Riksdag debates and was used by MPs from conservative parties
in particular, however not as a cause of the problem but as the
committee, to describe its dissemination. The drug user was seen as a
carrier of a disease and the sites where drug users meet as the source of
infection, which were described as the equivalent of Oriental opium
dens (AK 1968 no. 10: 133).
Kaijser referred to an article in Dagens Nyheter (Sweden's largest
newspaper) from spring 1968 in which drug epidemics were compared
to a threat of biological warfare in peacetime (FK 1968 no. 10: 123). A
liberal MP, Andersson, expected much from the new penal law: "New
legislation hopefully will be a better instrument to combat a plague that
disseminates fast and causes inhumane suffering" (Ibid. 129). However,
it should be noticed that while the Minister of Social Affairs refrained
from using the term "epidemic" he described drug abuse as a disease
and a symptom of (among others) psychological disturbance or social
maladjustment (Prop. no. 7 1968: 63). Furthermore, discussions in the
Riksdag focused on the dangerous properties of drugs and
countermeasures. A probable explanation may be that MPs preferred to
wait for an analysis of the causes of drug abuse in the Narkomanvård
committee's final report. Another reason may be a metaphor that
frequently was used: "No modern fire brigade starts its action when
arriving at the scene of the fire by investigating the cause of fire, but
instead tries to extinguish the fire and if that is impossible to keep the
fire within bounds" (FK 1968 no. 10: 121).
The situation was described in terms of a crisis of which the onus
was placed abroad. Some speakers also discussed the lack of a
consensus in statements from experts concerning the causes of drug
abuse and countermeasures. This made it hard for politicians to make
decisions. Anyhow, it was crucial to demonstrate that at least
concerning the seriousness of the drug problem there was no
disagreement among MPs. This was something the liberal MP Tistad
experienced when he proposed an amendment of the Single Convention
to allow a decriminalisation of possession of drugs for personal use.

The social democratic MP, Larsson, accused him of being the only
person who was breaking the unity in the Upper House (Ibid. 136). The
Minister of Social Affairs discussed also the matter of unity in the bill:

All ­ the state, health and social authorities, the pharmaceutical industry, voluntary
organisations and the individual citizen ­ should feel responsibility in the task of
obstructing drug abuse and increasing society's care resources (Prop. 1968: 7: 108).

In the Riksdag debates he stated: "In the struggle against drug abuse all
the good forces have to co-operate" (FK 1968 no. 10: 133).
These quotations from the Riksdag debates point out some central
themes in discussions about the drug problem in Sweden:

· Drug use spreads like an epidemic disease (a plague) and the drug
and drug users are sources of infection. There are good and dark
forces, and all good forces have to unite in the struggle against the
dark forces.
· Control of legal drugs in Sweden was considered sufficient and the
main problem was production of and illegal trade in amphetamines
from abroad. As long as other countries did not exert the same
control as in Sweden, the problem could not be solved.
· There was no time to lose by investigating the causes of the
problem. The fire had to be extinguished first.

The bill passed both the Upper House and the Lower House with
extensive declarations of the parties' standpoints on 6 March 1968.42



38 The Ministry of Health and Social Affairs drew up the Drug Act! The next
revised Drug Act of 1969 was also composed in the Ministry of Health and Social
Affairs. The Ministry of Justice has made later changes.
39 Later that year a provision in the Social Services Act was altered. Municipal
social boards were made responsible for informing themselves on the need for care
of individuals and working to provide for those needs (SOU 1969: 52: 303).
40 The Swedish term behandlingshem could be translated as "therapeutic
community". However, because of its connotation of a (new) home I have chosen
the translation "treatment home".
41 In its second report in 1967 and in its final report 1969, the committee had
abandoned the image of drug use as an epidemic disease.
42 In 1970, the Swedish parliament became a unicameral chamber.