6. 4 Summary


The policy domain

The medical profession dominated in the Swedish committee. Use and
abuse of opiates and amphetamines was traditionally a matter for the
medical profession. Therefore, it was logical that the medical
professions were called in first to study the modern drug problem.
However, even when the drug problem was considered too complicated
and expertise from other disciplines was needed, the dominance of the
medical professions was maintained. This does not mean that a uniform
view prevailed on the problem within the medical profession.
Especially the way to approach drug addicts (compulsory care) was a
cause for controversies.
The one-sided composition, and strong connection to one single
central authority, the National Board of Health and Welfare, limited its
range of influence. The Swedish committee's recommendations were
not anchored in the policy domain but just one negotiable proposal
among others. This may explain the government's decision not to wait
for the committee's final report. The Swedish committee was just one
actor among others.
The implementation and co-ordination of the drug policy became a task
for central authorities working together in the SBN. The most important
central authorities were the National Board of Health and Welfare, the
National Police Board, the Office of the Prosecutor-General and the
Board of Customs.


Issue pressure groups

Quite soon after the drug problem had become a public issue in
Sweden, national associations were established. The RFHL was
founded in 1965 and was followed by the Parents Against Drugs (FMN)
in 1968, and the National Association for a Drug-free Society (RNS), in
1969. Bejerot established the RNS as a resistance movement with the
goal of forcing the government to pursue a sensible drug policy.
Another organisation, Hassela, specialising in treatment of young drug
abusers, also entered the drug policy arena. A common feature of the
Swedish movements was their repudiation of drug use as such. Even if
the organisations disagreed on the causes of drug abuse, its
dissemination, and the nature of countermeasures, they agreed that
abstinence was the only conceivable goal for a drug policy. A dividing
line that would put its mark on discussions about the drug policy for
many years to come, was the issue of compulsory care. The RNS and
the FMN held the opinion that addicts were the slaves of drugs. They
had lost their own free will and compulsory care was needed to free
them from the yoke of addiction. The RFHL, on the contrary, perceived
voluntary care as a precondition for successful treatment. Another
dispute was on the role of the legal control system. According to the
RFHL, police actions against drug abusers would only deteriorate their
condition. The RNS and FMN allotted the police and judicial system a
main role in confining the main source of contamination of the drug
epidemic, namely, the drugs and drug users. A salient feature of the
issue groups is that they operated at the national level and aimed at
influencing drug policy matters by using the media and lobbying among
MPs.


The problem definition

The Swedish committee compared the dissemination of drugs in its first
report as analogous to an epidemic disease. This implies that the drug is
the contaminating factor and its dissemination takes place through
contagious milieux. However, it did not make statements on the cause
of the problem (which would be done in its third report). Abuse was
defined as all non-medical use of narcotics and consequently the
committee spoke of abuse and abusers.
The perception of causality of the modern drug problem in the first
Swedish definition as adopted by the Riksdag was dual. On the one
hand, we find a biological explanation of an epidemic disease in which
the substance itself holds a central position. The proponents of the
epidemic theory perceived drugs as a threat to the whole population,
just like the plague or tuberculosis, and the incidence (new drug users)
would increase exponentially with a doubling of the number of drug
abusers every thirteenth month if no countermeasures were enforced. In
this perception, the drug problem gets very close to people's homes and
schoolyards. On the other hand, we find causal explanations in terms of
underlying disadvantageous social/psychological conditions that make
people vulnerable to the pharmacological properties of drugs.
In the Riksdag, the situation was defined as one of crisis that, if not
halted, would end in a disaster. Furthermore, the government and
authorities used the rhetoric of calamity as well. The nation was in
danger and the battle against drugs could only be won if all good forces
united. This means that they shared one basic belief, which, according
to Bergmark and Oscarsson (1988), is a precondition for the possibility
of different images existing together in the drug DOXA.
The most serious drug problem in Sweden was intravenous abuse of
amphetamines, which was closely connected to other socially deviant
behaviour like criminality, prostitution, etc. Use of cannabis had been
noted but was surpassed by amphetamines as the most serious problem.
The availability of drugs was blamed on foreign drug dealers that had
chosen Sweden as a profitable market. As regards the problem
population, a difference was made between experimental abusers and
severe drug abusers. The definition of drug abuse, i.e. all use for non-
medical or non-scientific reasons, excluded a distinction between users
and abusers and different types of drugs.


Assistance

The Swedish committee proposed a detailed plan for the structure of
assistance: "the chain of care". Concerning the goal of care and
treatment, the Swedish committee denominated abstinence. Only in
cases when this was impossible, reducing the harm caused by addiction
was justified but only on strictly specified indications. However, in the
drug policy bill the latter goal was abandoned.
Treatment of drug abusers was allocated to psychiatry with assistance
from social services. According to the committee, psychiatry would be
best suitable to treat drug users for therapeutic as well as
financial/organisational reasons. Activities by NGOs were
supplementary to public services and limited to outreach work and
aftercare. The proposals by the Swedish committee meant a break with
the traditional responsibility of local temperance councils for
ambulatory care and of NGOs for intramural treatment of alcoholics.
While the government adopted the proposals of the committee overall,
it was precisely on the subject of allocating responsibilities that the
committee proposals were altered. Instead, special treatment homes had
to be established by the counties, municipalities, and NGOs.
Responsibility for outreach activities was also allocated to municipal
social services. The role of psychiatry was reduced to detoxification and
short-term treatment of drug abusers. Drug addiction (and abuse) had
been equated with a mental disease and addicts could be admitted to
psychiatric compulsory care.
Concerning assistance to young abusers, the government had no
objections. That would be a matter for local child welfare boards and
state correctional schools.


Control

The Swedish government rejected any differentiation in the Drug Act
between cannabis and other drugs. Cannabis had no medical usage.
Together with the stepping stone theory and the fact that cannabis in the
Single Convention was placed in the same schedule as heroin was
reason enough not to treat cannabis differently. If necessary, the general
prosecutor or the courts could consider the dangerous properties of
drugs. The same goes for possession of drugs for personal use.
Resources for justice and police were increased and customs would
give absolute priority to the struggle against drugs. Furthermore, the
public was urged to assist the police and customs in their battle against
drugs by reporting suspicious activities to the authorities. The target for
penal actions would be the dealers, the "sharks". Abusers were patients
in need of treatment.
A strong conviction can be noticed in the possibility of shielding the
country from drugs by cutting the lines of supply. Furthermore, the
production and distribution of drugs that caused problems was to be
constrained by means of pressure on the pharmacological industry and
international control.

Prevention

One form of prevention is to change unfavourable social conditions that
are perceived as a causal factor of the drug problem. The Swedish
government stated that such prevention measures could only become
beneficial in the long term and could not improve the current situation.
A second kind of prevention is to obstruct the population from coming
into contact with such substances by judicial measures. The Swedish
government invested a great deal in the control system to prevent
supply of drugs. The third kind of prevention is to influence the
attitudes and behaviour of the population by information and education.
Information was regarded as a weak means to prevent addiction but
information, especially to youngsters, was important and became part of
the school curriculum. The Swedish government, authorities and MPs
were very concerned about the harm caused by contradictory opinions
on the harm of drugs and in particular cannabis, that had been expressed
in television programmes and other media. The responsible authorities
decided to produce a leaflet with the "basic facts" on drugs and drug
abuse that would be the base for all further information provided by
authorities and organisations that received governmental funds for
information activities.
The decrease of public attention to the drug issue in Sweden was
seen as a worrying trend and subsequently a massive national
information campaign, aimed at the public, was mounted during the
first half of 1969.


The international context

The Swedish government's definition of illegal drug use as evil and
dangerous to mankind was in line with the Single Convention and
regularly referred to provisions of the convention to underpin its
arguments. Abuse of amphetamine was perceived as a consequence of
insufficient control of legal substances abroad. Consequently,
international control was perceived as a prerequisite to combat domestic
drug problems. The Swedish efforts to establish international control of
amphetamines were rewarded by the Convention on Psychotropic
Substances in 1971. Furthermore, by means of bilateral diplomatic
action, foreign governments and authorities were approached to sharpen
domestic control of substances and obstruct illegal export to Sweden.
Pressure was also put on the pharmaceutical industry to withdraw
certain products from the Swedish market.