8. 2 Drug-free society

In the election campaign of 1982, the Social Democratic Party had
promised to "clean the People's Home from drugs". Immediately after
the election, when the Social Democratic Party had come into office
again, Deputy Prime Minister Ingvar Carlsson appointed a Narcotics
Commission to analyse the drug situation and propose actions. In the
directive to the commission Carlsson stated:

The fact that drug abuse obtained a foothold in our country at the end of the 1960s
must be regarded as a great failure for the welfare state. Generally speaking, the
forces that came into motion when abuse started to spread and establish itself were
underestimated. Direct action by society hitherto has not been able to press back the
dissemination of abuse. Neither has it proved possible by means of care to
rehabilitate abusers to the extent that would have been desirable (Dir. 1982: 100).

Members of the commission were the chief of police in Stockholm
County, the chairman of the Social Democratic youth league and a
member of the Supreme Court. The committee produced eleven reports
concerning all fields of the drug problem except assistance, which was
assigned to a working group within the Ministry of Social Affairs.85 The
commission was supposed to work fast and to recommend actions in the
process of its investigation. One of its first actions came in October that
year. With reference to the incident with the house dealer in cannabis in
the Dutch town of Enschede in autumn 1982, the commission
recommended the government to make a statement as soon as possible
that emphasised the dangers of cannabis.86


United front

In February 1984 the commission presented its final report, "Co-
ordinated Drug Policy" (SOU 1984: 13). Some of its conclusions are
summarised below.
The drug problem was defined as part of a larger social problem and
for most abusers part of their social exclusion. Drug abuse was a
complex problem without a single cause. The availability of drugs,
personality disturbances, and social conditions together caused drug
abuse in a complicated interplay (Ibid. 66).
In chapter 4, "United Front against Drugs", the situation was
reviewed. Sweden had a widespread cannabis problem. Cannabis could
be purchased periodically in most parts of the country but nobody knew
for sure how big the problem was. However, the prevalence of
experimental abuse (primarily cannabis) among youth (age 15/16) was
at a record low in 1983, i.e. 5% (Ibid. 67).
The situation concerning severe abuse was described as stable. Abuse
of amphetamines seemed to have increased slightly while heroin abuse
had decreased somewhat. Intravenous abuse was dominated by
amphetamines and little more than 1000 persons were heroin abusers.
Fresh recruitment into intravenous abuse seemed to be small, with few
people younger than 20. Instead, intensive cannabis smoking seemed to
have increased among youngsters with severe abuse. Taken together,
available data gave grounds for a certain but controlled optimism (Ibid.
67). Yet, the situation was still threatening. From an international
perspective there had never before been produced such enormous
quantities of cannabis, heroin, and cocaine. These quantities meant that
Sweden could await a price war on drugs (Ibid. 68).

Co-ordinated and intensified drug policy

In October 1984, the government presented the drug policy bill: "Co-
ordinated and Intensified Drug Policy" (Prop.1984/85: 19). The
government had already implemented a number of proposals from the
Narcotics Commission. Police, prosecution offices, and customs had
been reinforced. Funds for preventive activities had been raised and
care and assistance extended. Control of inmates was increased and
drug-free wings had been created especially for young first-time
convicts.
The goal of the drug policy would be to create "a drug-free society".
The government adopted the cautious positive description of the
situation by the Narcotics Commission, but also added that Sweden, as
a rich country, was an attractive market for illegal drugs. The main
problem was that as long as there was a demand for drugs, the country
would be subjected to pressure from producers and dealers of drugs.
Consequently, the risk that heroin and cannabis would continue to pour
into the Swedish market would be there all the time. The struggle
against drugs was to be continued and given top priority: "trying to
prohibit an intoxicant that has already become accepted in a country's
cultural pattern is far from possible" (Ibid. 4). Another reason for
stepping up actions was that the problems that emerge due to drug
abuse were much more serious than abuse of other substances; they
carried a higher immediate death risk and cause greater social harm.
One part of that struggle had been a successive tightening of
legislation. Other important instruments were parents, relatives, friends,
schools, and organisations. In addition, a general policy for social
welfare and against exclusion would be an indispensable link. The drug
policy stressed that society should react unambiguously and act
consistently. Most of all, society's actions had to be reinforced and be
so all-embracing that no one would be excluded (Ibid. 4).
Co-ordination of actions was the key to achieve this goal. The
government pointed out two fields in which co-ordination was
particularly important. On the local level, co-ordination between social
services, police, school, organisations and parents had to be improved
under the auspices of the social services. On the central level, co-
ordination had to be changed drastically. The intensification of the
struggle against drugs required effective and offensive co-ordination
and a new co-ordination body (SAMNARK) was to be established
within the Cabinet Office. Lifting the organisation of the struggle
against drugs into the governmental sphere would also emphasise the
importance of the problem.

Control

As regards control, the commission had concluded that in order to solve
the drug problem better results could be achieved by combating demand
than by combating supply. However, control measures against supply
could also have preventive effects:

To obstruct drug dealers from gaining a foothold they should be continuously
disturbed and pushed around. The curious and the novice ­ although not the
experienced abusers ­ will have difficulties getting drugs. This strategy however,
requires police work that goes on day after day, the whole year round, year after
year in every police district in the country (SOU 1984: 13: 85).

Such strategy required large resources and consequently the
commission proposed more police officers but also that police priorities
should be set by the government and the Riksdag to ensure that the
continuous struggle against drug dealing could proceed (Ibid. 85).
Another control measure was to keep drugs out of Sweden, which
was a task for customs. The border-guarding activities executed by
customs were, according to the commission, of such importance that
customs should concentrate wholly on this task (Ibid. 81).
The commission also proposed replacing the term "misdemeanour" in
the Drug Act by "minor drug offence". The reason for changing the
nomenclature was, according to the commission, that public opinion
had criticised the term misdemeanour because it conveyed an indulgent
attitude to the seriousness of the matter (Narcotics Commission PM no.
8: 13). This proposal was adopted in the bill. According to the minister,
this change was of little practical significance but valuable as a message
to the population. Further, the maximum penalty for minor offences
would be raised to six months' imprisonment. This would enable the
courts to sentence offenders to probation and the police to carry out
house searches. The minister emphasised that imprisonment for minor
offences should be applied extraordinarily restrictively.
Another change was the cancelling of fines for simple drug offences.
The Narcotics Commission's proposal to raise the maximum fine but to
keep it as a sanction was rejected by the government: "one should avoid
giving the impression that society does not have a firm and consistent
view of penal action on illegal handling of drugs" (Prop. 1984/85: 19).
Again, the importance of giving a clear signal to the people was a
decisive argument.
Furthermore, the commission had recommended that dismissal of
prosecution should not be used for adults at all. Possession of cannabis
even in small quantities should be punished. Socially established
cannabis abusers could usually not be subjected to social measures and
a fine could be used to mark society's repudiation of drug abuse (SOU
1984: 13: 26). However, the minister held the view that the current
restrictive practice was sufficient.
The commission discussed extensively a criminalisation of use that
had been demanded by public opinion and MPs since 1981. According
to those who advocated criminalisation, this would emphasise society's
repudiation of all illicit handling of drugs. Another argument for
criminalisation was that, if consumption was not penalised, the idea of
abuse being not that serious could easily disseminate. Consequently, it
would have an important preventive effect, especially among youth and
others in a risk zone. The Narcotics Commission rejected these
demands. One argument against criminalisation was that drug-related
harm hit only the user. A basic principle in modern penal law was that
actions solely directed against the offender himself or his own interest
normally are not penalised, for example, suicide. Secondly, especially
in the case of addiction, it would be meaningless to regulate severe
abuse by a threat of penal action. Thirdly, penalising use could make
people refrain from seeking treatment. A fourth argument was that
socially established persons would seldom be in settings where it would
be justified to make them subject to urine tests. This circumstance
would make criminalisation an instrument of class justice (PM no. 8:
11). The Prosecutor-General also rejected the criminalisation of use. At
a meeting with the commission he stated: "That much should be left of
the liberal drug policy" (Narcotics Commission, meeting 19 November
1982).
Demands to criminalise consumption of drugs had preceded the bill.
In autumn 1984, a petition to the government organised by the FMN
and RNS had collected 434,309 signatures in favour of criminalisation
(Rd 1984 no. 56: 95). A poll showing that 95% of the Swedish people
supported the criminalisation of use and furthermore that 71% thought
that this already was the case.87 The government rejected the demands
for the criminalisation of use with the same arguments as the Narcotics
Commission. This issue was the main topic in Riksdag's debates on the
bill and overshadowed all other issues.

Assistance

In the section about assistance, primarily ambulatory care and aftercare
were discussed. Much discussed and criticised was the practice by some
social workers of making social assistance to drug abusers conditional
on taking part in treatment and/or being controlled by urine tests. The
Minister of Social Affairs, Sigurdsen, defended this method and stated:

Social services and the specialised care of drug abusers have previously taken a far
too passive attitude in relation to abusers that do not apply for care or fail to
maintain a treatment contact. Social services should avoid any kind of aid that
facilitates or cements ongoing abuse. Therefore, it is inconsistent for social services
to pay social security to a client who is drifting further into abuse (Ibid. 13).

As regards therapy in treatment homes, positive experiences were
reported. Many homes were doing a good job. However, there was
broad agreement in the Riksdag that drug abuse could not be cured out
of existence. Aftercare was still a problem: "It is not easy to return to
reality", the Minister of Social Affairs stated, and authorities and
organisations had to be more active: "People need help to get hold of
housing, a job and new friends" (Ibid. 77).


Prevention

According to the commission, a new governmental body would provide
important basic facts and voluntary organisations would play a
dominating role in disseminating this information. The state or
municipality should not determine the mode of mediating information
but the basic requirement from society would be that the information
aimed for freedom from drugs (Ibid. 76). According to the committee,
national unity around the stand for a drug-free society and knowledge
of the danger of drug abuse in all its forms was a precondition for
preventing drug abuse. Opinion formation should aim at influencing
people's attitudes, norms and behaviour, and by words and actions
repudiate all non-medical use of drugs (Ibid. 75). However, some
disturbances in society hampered this unity among people. Sections of
youth culture did have strong undertones of drug glorification.
However, the risk should not be exaggerated. These undertones could
normally be counteracted by steady backfire (Ibid. 75). Probably the
most effective countermeasure society could offer was Gemeinschaft.88
Popular movements and voluntary organisations were the logical
platforms for this Gemeinschaft (Ibid. 78-79).
The commission emphasised that the struggle against drugs was a
matter for the whole population:

One cornerstone is the understanding of the fact that the main front against drugs
goes in the immediate environment of the people. If the homes, schools,
workplaces, and neighbourhoods function, we can prevent the emergence of abuse
and quickly suppress it when it occurs. This work must be founded on good
knowledge of local circumstances and skills to discover abuse early in order to act
early. The message must be consistent and the voluntary forces and those who are
in the risk zone must be mobilised to participate in the job. The basis for this job
must be solidarity with the individual person and drug user. It is possible to stem
abuse and to rehabilitate even the most addicted abuser. It is also possible to put a
stop to the advance of drugs. Nothing is hopeless and not a single person is a
hopeless case (Ibid. 73).

In the bill, the government emphasised the importance of tracing young
drug abusers as early as possible. In the new Social Welfare Act of
1981, local social services had become responsible for prevention of
drug abuse in the municipality (11§). Consequently, municipalities had
to develop new methods to encounter individuals and groups in
destructive milieux. Furthermore, creating Gemeinschaft would be an
important preventive measure. State-provided information should be
co-ordinated by the National Board of Health and Welfare that also
would decide on applications for funds from NGOs for information
activities. Many MPs emphasised that prevention activities to youth
should be prioritised. "It was the first line of defence" as Eliasson stated
(Rd 1984, no. 56: 55).


The international context

Sweden was to work for a sharpening of the UN conventions and the
INCB should more openly and clearly take a stand on issues of
applying the conventions: "Sweden should in an appropriate manner put
forward criticism against countries that act insufficiently against the
production, trade, and abuse of drugs" (SOU 1984: 13: 97). An
important goal for Swedish drug policy would be to influence other
countries' attitudes in drug issues. One proposal from the commission
was that Sweden in the international context should demand that
possession of drugs for personal use and transferring of drugs even in
small quantities should be a punishable act and would be applied in
practice (Ibid. 26). The commission did not single out any countries but
a qualified guess is that the commission had in mind the Netherlands
and Denmark, which had a more lenient attitude towards use of
cannabis.

The standing committee on Justice rejected many motions that urged
for a criminalisation of consumption of drugs, most of them from non-
socialist parties but also from social democratic MPs. However, the
committee added that it was desirable to follow developments in the
law practice concerning possession and consumption of drugs. If
necessary, a change of the Drug Act in this respect could be considered
(JuU 1984/85: 12). According to the committee, it was unfortunate that
such a great part of the debates had focused on an issue that possessed
such little significance (Ibid. 27).
In the Riksdag debates, the international commercialised drug culture
was pointed out as a threatening phenomenon. Furthermore, the drug
liberal attitude, flum, reigning between 1965 and 1975, in the country
itself was a cause for the drug situation Sweden now faced. A strategy
applied by proponents of criminalisation (the last gap in the Drug Act)
was to picture opponents of criminalisation as drug liberals. This issue
dominated the Riksdag's debates totally (Rd 1984 no. 56).


Methadone

The examination of policy documents and the subsequent Riksdag
debates may suggest that controversies were limited to proponents of
harsh actions and those who advocated even more severe actions.
However, there were other subjects on which opinions were divided
(and still are), namely, methadone maintenance treatment of heroin
abusers and compulsory care. While compulsory care was a hot potato
in the Riksdag, the absence of the methadone issue is remarkably absent
in Swedish policy documents. It was obviously not a governmental drug
policy matter during this period.89 Instead, the National Board of Health
and Welfare was responsible for regulating substitute drugs and played
an important role in decisions on the practice of the methadone
programme.
As described in chapter 6, the National Board of Health and Welfare
closed down the prescription project in Stockholm (1965­1967). The
main reason for this decision was the alleged leakage of substances
from the project to the illegal market. In January 1967, a methadone
maintenance treatment programme started at the Ulleråker psychiatric
hospital in Uppsala. The same year the Narkomanvård Committee had
noticed a tension between the goal for assistance to make addicts drug-
free and the existence of programmes that did not aim for abstinence.
This tension would be the core of the controversy on methadone, which
will be described briefly below.
In 1972, the National Board of Health and Welfare decided to
delegate all ambulatory prescription of methadone to addicts to the
programme in Uppsala (Socialstyrelsen 1972). According to the staff of
the programme, a capacity of 150­200 patients should be enough to
cover the need for methadone treatment in Sweden. Heroin was not
known to occur in Sweden at that time and the patients of the
programme had primarily become addicted due to medical treatment.
However, the National Board of Health and Welfare, was divided on
the subject of substitute drugs. The section for medicines within the
National Board of Health and Welfare had worked out the guidelines.
The social section of the National Board of Health and Welfare was
very explicit in its scepticism about the use of methadone. Negative
experiences from opiate (including methadone) prescription in the US
and UK was emphasised. However, the experiment with the methadone
programme at Ulleråker should continue but it was important that the
restrictive selection of patients should be maintained (Socialstyrelsen
1973).90 Furthermore, methadone treatment should be integrated in
other kinds of treatment and young persons should not be admitted at
all. For admission to the programme the patient should:

· be at least 20 years of age;
· have freedom of choice. Patients who are sentenced to imprisonment (including
§34 91) or intramural psychiatric care could not be admitted. The justification for
this criterion is the risk that patients who would abstain from methadone
maintenance, if free, would apply to the methadone programme only to avoid
compulsory care or other deprivation of freedom;
· have a documented compulsive intravenous abuse of opiates of at least four
years;
· have had at least three completed detoxifications at a hospital followed by a
quick relapse after discharge. To accomplish this criterion the patient had to be
reduced to zero every time and be drug-free for at least a week;
· show signs of actual ongoing abuse at the time of admission (abstinence
symptoms, positive urine test, fresh needle marks and so on); 92
· be without advanced multi-drug abuse (Socialstyrelsen 1981).

These criteria show that methadone obviously was meant as an ultimum
remedium.
In 1978, the issue of methadone was brought to a head. The
methadone programme was set up as an experiment and in 1978, the
financing of the ambulatory team of the programme was to end. The
National Board of Health and Welfare recommended a prolongation
until 1980 and a working group appointed by the Board would evaluate
the programme. The reason for recommending an evaluation was that
methadone treatment had become increasingly controversial. Many
social workers and NGOs (including the RFHL) opposed methadone
treatment. One argument was that the very existence of the programme
was a threat to drug- free treatment. Drug abusers would avoid entering
drug-free treatment because of the possibility of methadone. Another
argument was that drug abusers were not drug-free as long as they were
in the methadone programme. One addiction was simply replaced by
another. Others, for example Bejerot, held the view that methadone
could be useful in individual cases but was an obstacle to achieve the
overall goal of the drug policy: a drug-free society. This goal was
considered more important than the fate of the individual abuser
(Mattson, 1981).
According to the director of the programme, Dr Gunne, therapists in
most treatment homes shared a hostile attitude to psychiatric treatment
and other medical approaches. Other critics pointed out by Gunne were
the BRÅ Narcotics Group and the National Board of Health and
Welfare (Gunne 1990). The evaluation was a reason to Gunne to stop
new admissions because, according to him, it was unethical to start
treatment if it was uncertain whether the treatment could be carried
through.


Approved but restricted

The evaluation report on the methadone programme came in 1981. The
majority of care and treatment facilities in Sweden were described as
drug-free and aiming at abstinence. The methadone programme
occupied an exceptional position by using an opiate as an instrument to
carry through a plan of rehabilitation (Socialstyrelsen 1981: 121).
According to the National Board of Health and Welfare, it was likely
that the programme had certain undesirable side effects, even if these
could not be proven objectively:

· The existence of the methadone programme is said to reduce the motivation of
opiate abusers for drug-free treatment options.
· The existence of the methadone programme is said to make certain opiate
abusers strive to qualify for the programme by continuing their abuse or by
deliberate treatment failures (Ibid. 122).

However, the working group recommended that methadone treatment
should be accepted as an established method but under certain
restrictions. In order to obstruct the alleged adverse effects, the working
group recommended guaranteeing that methadone should only be used
when all other treatment options had been exhausted. A referral and
examination procedure with a qualified examination of psychological,
social, and other conditions of the individual patient should precede a
decision on admission to the programme. The criteria for admission
should not be publicly known to reduce the risk of opiate abusers trying
to qualify themselves for the programme (Ibid. 133). The maximum
number of patients in the programme should not exceed 150­200 to
enable satisfactory control. Furthermore, due to possible future changes
of the drug situation and the development of new treatment methods, a
new decision about the programme should be taken after five years.
In an attempt to compromise between different opinions, the
delegation decided on a three-year experimental period instead of the
five years proposed by the Board (Ibid. 30). In protest, Gunne
announced his resignation as director of the programme. According to
him, the programme had already been evaluated several times by the
research department at Ulleråker. The Director-General of the Board
and the Minister of Social Affairs persuaded him to remain in his post.
After a period of discussing the very existence of the methadone
programme in Uppsala, the National Board of Health and Welfare
proclaimed in January 1983 that the methadone programme was an
accepted method and useful in the rehabilitation of opiate abusers. With
some limitations and adjusted rules, the programme could continue. The
number of patients was limited to 150. The programme would be run
from Uppsala with the whole country as an intake area. One argument
in favour of the centralisation of the programme in Uppsala was a
uniform judgement of referrals. Centralisation also gave a sufficient
foundation for research and development of methods. A disadvantage
of centralisation was the fact that it could meet difficulties in the
follow-up of patients and their possibilities for local aftercare
(Socialstyrelsen 1987: 28).
The resistance to methadone should not only be seen as a conflict
between different sections of the assistance system to drug abusers but
also against the background of changes in the overall drug policy. In
March 1978, the government had re-formulated the goal for drug
policy: the elimination of drugs from Swedish society. The Social
Democratic Party promised "to clean the People's Home from drugs"
and to create a drug-free society. It is obvious that methadone in this
cleanup had very little support. Advocates of methadone maintenance
programmes had landed up in the category of the "bad forces".

85 The working group's final report, "Offensive Care of Drug Abusers II", came in
May 1984 (Ds S 1984: 11).
86 Narcotics Commission, meeting on 25 November 1982. The decision by the City
Council of Enschede to allow sale of cannabis in a youth centre was referred to. See
also chapter 9.
87 The poll was ordered by Lions Club International (Barometern 24 October 1984).
88 In Swedish gemenskap.
89 This would be different later in the eighties when HIV/AIDS among addicts became a
threat to the nation.
90 The number of patients in the methadone programme in Uppsala was 35 (BRÅ
Narcotics Group, meeting 3 May 1974).
91 §34 allowed a convict addicted to drugs to visit a place of treatment under the last
period of the sentence.
92 Of all patients it is required that intravenous opiate abuse can be verified by
hospital files.