Sweden's Battle Against Drugs and Prejudice

The Swedish government has launched an investigation on how to prevent drug-related deaths. Last month, Health Minister Gabriel Wikström announced that he wants needle exchange programmes to be managed by county councils instead of councils. County councils cover larger areas in the country. The report will be delivered in April next year.

"Needle exchange programmes are an important measure towards disease control, which we know from Swedish, as well as international, experiences. The aim of these propositions is to make needle exchange programmes available all over the country. This will give us new opportunities to meet groups that have previously been difficult to get hold of," Wikström said in a press release.

For decades, a majority of Swedish political parties have claimed that harm reduction programmes such as needle exchange programmes and drug consumption rooms "encourage" drug use rather than do good. But according to the 2016 annual report by the European Monitoring Center for Drugs and Drug Addiction, Sweden has the second highest death rate from drug use in Europe. Only Estonia has higher drug-related deaths per capita. According to Sweden's National Board of Health and Welfare, 48 percent of drug-related deaths in 2014 were caused by an overdose.

In November last year, UN's Deputy High Commissioner for Human Rights, Flavia Pansieri, criticised Sweden's views on drugs. She told public broadcaster SVT that she was "surprised to see that [Sweden] lags behind a number of other countries in terms of its policies on drugs."

Stockholm's needle exchange programme has been available since 2012. The programmes have since become available at several places including Malmö, Jönköping, and Kalmar. And according to the Public Health Agency of Sweden, they're actually working. "For the individual, these efforts can improve the chances to a life without serious or deadly infectious disease. For society as a whole it all comes down to improving the possibilities of equal health," Johan Carlson, director general of the Public Health Agency said in a statement.

"Max" is a 24-year-old from Stockholm who recently got clean from a four-year-long drug addiction. He injected heroin during the last eight months of his drug abuse. "The argument that needle exchange programmes encourage people to use drugs is wrong. It's not encouraging because if you're injecting drugs, you're injecting drugs regardless of what programmes are available. If the people injecting aren't going to places where you can get needles for free, they'll order them online. They will use the same needles over a longer period of time. That would break their veins a lot quicker, and they would have to inject in other places on their bodies sooner. I've met plenty of people with broken veins in their arms who are injecting in their necks. It's insane," Max told me.

However, despite the government's call on expanding needle exchange programmes, a majority of county councils are still in favour of Sweden's zero tolerance policy – ignoring scientific evidence that supports harm reduction instead of criminalising drug use.

I called up Mikael Andersson Elfgren, a Moderaterna politician who represents the opposition in Västmanland county council. He supports Sweden's zero tolerance policy. He thinks that there are other ways to get in touch with people abusing drugs than via needle exchange programmes. "Naturally, there are flaws within current policies. But I stand behind the main policy. I think it should be illegal to use drugs in Sweden," he told me.

This spring, Gothenburg council, who have been strong opponents of needle exchange programmes suddenly agreed with the government. Andersson Elfgren does not want his county council to follow Gothenburg's example. "I'm against needle exchange programmes because of two reasons. Firstly, I don't think politicians and politics in general should supply people with instruments that are used to break the law. Secondly, looking at Västmanland specifically, we have very few cases of disease associated with using needles," he said.

Fredrik von Kieseritzky is an experienced medicinal chemist who holds a Ph.D. in organic chemistry. He has been appointed expert witness in several drug-related criminal and civil trials. His daily work includes collaborations with medical doctors involved with pain management and needle exchange programmes. He's also a scientific adviser to the Swedish Drug Users Union. "My main critique towards the Swedish model is that current policies are based on outdated beliefs and a zero tolerance policy that is not evidence-based. This becomes evident if we look at the international peer-reviewed science produced over the past ten years. For example, there is very little scientific support for the belief that repressive drug policies have had the desired effect on supply and demand. The current policies don't appear to achieve their intended goals. Do they cause more harm than good?"

Sweden's zero tolerance policy on drugs stretches back to the 1970s. According to Magnus Linton, author of Knark – En svensk historia [Drugs – A Swedish history], it all began when professor Nils Bejerot published a series of papers in which he claimed that unless drugs were eliminated, "a social process of decay will inevitably wear away welfare society."

Bejerot's views had a huge effect on decision-makers at the time. After more than a decade's work with authorities, schools, and police, Bejerot managed to unite Sweden on the path towards the dream of a drug free society. In 1988, the same year as Bejerot passed away, it became a criminal act not only to possess drugs, but to get high, too.

"As I support doctors and their patients, it's quite obvious that Sweden's narcophobia prohibits medical practitioners from giving patients the best medical care possible. I only wish that our drug policies were well-grounded in modern science. Unfortunately, that isn't the case," von Kieseritzky told me.

I called up "Anna" – a 22-year-old recovering addict from Stockholm who used to inject drugs over a three-year-period. She thinks the needle exchange programmes are great. "They're a good thing because they prevent blood pockets and disease. It's never a good thing to use drugs with dirty gear," she told me.

According to the European Monitoring Center for Drugs and Drug Addiction, there are a number of other things Sweden can do to reduce and prevent drug-related deaths. One example is drug consumption rooms, which haven't been considered by any political party in the parliament. Youth organisation Grön Ungdom [Green Youth] is the only political organisation in favour of drug rooms. "By establishing user rooms in all counties, life saving arrangements can reach more people," Carolina Bruseman, Mårten Roslund and Aida Badeli wrote in a debate article published in ETC this summer. "This means a safe and arranged environment where social workers and nurses can give information on how to inject safely, administering antidote during overdoses, and eventually recommend ways of quitting."

Although the rooms are yet to be considered in Sweden, this August, Scandinavia's largest ever drug room, H17, opened its doors in Copenhagen. According to an article published in newspaper Sydsvenskan, the room, spanning over 1,000 square metres, receive between 200 and 300 visitors per day.

Surprisingly, both Anna and Max think that drug rooms are a strange idea. "To me it sounds like a place to go to in case you want to get really fucking high. Or if you're like, 'I've never been injecting this much, but I want to try it and see if I survive,'" Max said. "If we're talking about encouraging people to use drugs, it sounds to me that setting up drug rooms is along that line if anything. I don't think that's good at all," Anna said.

Andersson Elfgren insists on other ways to prevent drug-related deaths. "I think the main issue with abusing drugs is the fact that people are abusing drugs. That's where the biggest risks are. It's obviously important to offer healthcare and treatment. Here's where contact centres should be available," he told me.

Max says he hasn't been in touch with charities to get access to healthcare. "Needle exchange programmes offer healthcare. I've been tested for HIV and hepatitis, and they've been really careful about giving me information. The people who work there are good people," he said. Von Kieseritzky agrees. "There exists extraordinarily solid scientific evidence in support of a national needle exchange programme and an extension to substitution medication programmes," he told me.

WATCH: Combatting America's Opioid Crisis: Heroin's Antidote

Another way to prevent drug-related deaths is to make sure drug users get access to Naloxone, a nose spray that works as an antidote on heroin overdoses. But the political process of establishing a national Naloxone programme is slow. The Naloxone programme is on trial in Skåne county since last year. This summer, it was reported that the Naloxone programme in Stockholm will be delayed for at least a year due to legal and distribution matters. As a response, the Swedish Drug Users Union with support by billionaire George Soros handed out free Naloxone spray to users at Stockholm's central square Sergels torg. Chairman of the Swedish Drug Users Union, Berne Stålenkrantz, told newspaper Svenska Dagbladet that with the spray, "we have a chance to break drug-related deaths."

When I ask Max about what he thinks can minimise the amount of people dying from drugs, he thinks the zero tolerance policy is a bad idea. "I've only heard stories – because I didn't live at the time – when addicts came to schools and talked with kids and were like, 'if you smoke a joint, you'll end up like me.' Maybe something similar could be done, but kids should be told how things actually are. That people take drugs for various reasons. That it's stimulating, or because you're in pain, or because you're depressed – or any of those reasons – so that kids know what to avoid or what to be aware of. I think it all comes down to information that's correct. Not some fucking propaganda."

@caisasoze

Photo: Dimitris Kalogeropoylos, via

More from VICE:

Drug Deaths Are at an All-Time High in Scotland

What It's Like to Keep Falling in Love with Heroin Addicts

The Anatomy of a Heroin Relapse