Pubdate: Fri, 12 Mar 1999 Source: Canberra Times (Australia) Contact: http://www.canberratimes.com.au/ Author: Brian McConnell Note: Brian McConnell is president of Families and Friends for Drug Law Reform (ACT) Inc. SIMPLE SLOGANS NO ANSWER TO DRUGS Their tough laws have not solved the Swedes' drug problem, but we can learn from their mistakes, says BRIAN McCONNELL. SWEDEN'S "zero-tolerance" style drug policy with its goal of a "drug-free society" is coming under closer scrutiny as a country which may hold the solution to Australia's drug problems. What makes Sweden's drug policy different and are there lessons for Australia when it is trying to grapple with the growing number of overdose deaths? The 1960s marked the beginning of changes in Sweden's drug policies when a group of doctors, over a two-year period from 1965 to 1967 and involving 120 patients, undertook a project of prescribing some illicit drugs. This project has been used as an example to oppose the ACT heroin trial and to "prove" that prescription heroin is a catastrophe giving rise to an epidemic of illicit drug use. A report on the project by police doctor Nils Bejerot is the basis for every claim that Sweden's prescribing project led to a "massive rise of the number of addicts" in the 1960s. The facts are somewhat different to the claims. The project was never meant as a scientific experiment, but merely a project that grew out of some doctors' practical work. The substances prescribed were primarily amphetamines for oral and injecting use, methadone and morphine. Heroin was never prescribed in this project. The initial involvement of 10 doctors dropped away by the end of 1965 to only one. The project was mismanaged with poor medical practices. The remaining doctor delegated part of his work to some patients who were permitted to prescribe and distribute. Drug doses were not consistent; there was over-prescribing; drugs leaked on to the black market; and patient records were not kept. The project came to an end when a 17-year-old girl, who was not a participant in the project, died from amphetamine and morphine administered by one of the patients. Bejerot claimed to find data to support his hypothesis that the project's permissiveness led to an increase in intravenous drug use in what he said was an epidemic-like spread. He claimed the experiment had a triggering effect for this "epidemic". His underlying assumptions have been questioned by the scientific community who do not share his views, in Sweden and abroad, but his views have been widely accepted by government officials. His influence marked the beginning of Sweden's gradual drug-policy shift to increased criminalisation of drug use. There is no distinction between "soft" and "hard" drugs. Where once the possession of small quantities of cannabis was met with a fine it is now dealt with as a criminal offence. The aim of a "drug-free society" was introduced in 1977 by a new coalition government, the first non-Social Democratic government since 1932. From that time drugs took on greater prominence in political debates. Disagreement with the policy is generally not tolerated. Special laws introduced in the 1980s allowed forced treatment for adult drug abusers but without any positive effect on drug abuse. Imprisonment for drug-related offences have tripled since the late 1970s and long prison sentences, together with application of harder drug laws, have contributed to the worsened situation in prisons. In 1993, police were given authority to perform blood and urine tests on suspected drug users. Up to the end of 1997, 39,000 blood and urine tests had been taken at a cost of $A1.2 million per year. Despite some police not being convinced of the effectiveness of the law, the police are now waiting for a new law that will allow them to test any person without reason. Since joining the European Union, and through fear that it may be swept up by the EU's moves towards decriminalisation and legalisation of drugs, the Swedish Government has been aggressively marketing its drug policy at drug forums throughout Europe and to visiting officials at home. A controversial part of the Swedish drug policy is police action against drug trafficking on the streets. While authorities admit that traffickers will simply move to another street, they believe the police action will make it harder for the traffickers to make contact with casual abusers and young people. The authorities also believe that such police action shows the public that drugs are not tolerated. Police activity is focused on the goal of a "drug-free society". The downside of this focus is that the police are being swamped by other rising crime. The amount of solved crime is falling and the backlog of crime still awaiting investigation is rising. Another goal of Swedish drug policy has been to offer help and rehabilitation, described as a "caring chain" of outreach services, detoxification, out-patient care and institutional care comprising abstinence-based treatment and methadone maintenance. Syringe exchange programs are also available. Compulsory drug treatment is controversial. Nationally there are 1,360 people in compulsory treatment homes. But the compulsory treatment of drug users is said to be uncommon and relatively rarely applied. However, for drug-using teenagers it is often used as a "threat" to force someone into "voluntary" treatment. Has Sweden achieved a "drug-free society" and will it ever achieve that goal? The answers are "no" and "probably not". The question of whether or not Sweden's policy is effective is problematic. In the case of treatment the meaning of statistics collected is unclear and not usually measured in terms that, addiction, a long-term chronic relapsing condition would normally be measured. Measuring in terms of drugs seized by police has the effect of measuring police activity and not success of policies. Measuring in terms of drug users provides some answers but positive questionnaire responses are usually under-reported because of prevailing attitudes toward drugs and drug use. Some answers come from a 1992 study of 102 people who underwent compulsory treatment: after six months 9 per cent were abstinent, 18 per cent had reduced abuse, 28 per cent had gone on voluntary treatment and 13 per cent underwent compulsory treatment again. In that same period 7 per cent of the clients had died. The mortality of the compulsory group was higher than those in voluntary treatment. This provides a note of caution and a useful yardstick for NSW's trial of drug courts. In Sweden there has been an increasing trend in deaths from illegal drugs since 1989, not downward as one would expect if the policy was successful. When compared with other European countries with similar drug-using populations, Sweden's death rate of 28.4 per million in 1997 means that its policies are no more effective than the rest in reducing drug deaths. In summary, Sweden has not solved its drug problem and is in fact lagging behind many other European countries in terms of the harm caused by illegal drug use. Despite the Swedish Government's aggressive assertions, the claim that a permissive drug policy increases the number of drug consumers is not proved by the evidence. There are nevertheless lessons to be learned, if only to identify and eliminate those policies that do not work and that are not based on the evidence. For a solution to the drug problem, Australia must look beyond simplistic slogans such as a "drug-free society". - --- MAP posted-by: Rich O'Grady