Sweden, a Nordic country covering 450,000 km2, has a population of roughly 9 million. The population is relatively homogenous, with almost 90% being Lutheran. Sweden has a social democratic tradition and is well known for its welfare system and conformist tradition. In Sweden, drug policy is viewed as part of its welfare and social policy. Drugs are seen as one of the most serious social problems and an external menace to the country. In comparison to other Western countries in Europe, Swedish drug policy is regarded as restrictive. One of the aims of the policy is to make it clear that drugs are not tolerated in society. Some examples of this restrictive attitude include:

• The overall goal is that of a drug-free society;
• Harm reduction programs are only available in a limited fashion;
• Treatment is abstinence-based and coerced;
• Consumption of narcotics is an offence, and urine and blood test are used to detect those suspected of drug use;
• Drug laws are strictly enforced;
• Discussions regarding the medical value of marijuana are almost non-existent;
• Swedish legislation strictly adheres, and even surpasses, the requirements set out in the three United Nations drug conventions.

Historically, Sweden has not had a problem with illegal drug use and such use was not regarded as a serious social problem. As in many other western countries, this changed in the 1960s. In Sweden in 1965, there were signs of increased drug use, including use of marijuana, amphetamines, LSD and opiates. Amphetamines were, and are, more of a problem than heroin. Amphetamines were introduced into Sweden in 1938, and were promoted for weight loss and as stimulants. They were used by large segments of the population. Over the years, as the controls on amphetamines increased occasional and experimental use declined, while regular use and abuse increased. In addition, the way the drug was taken (intravenously rather than orally) changed.

While Swedish drug policy is currently very restrictive, this was not always the case. In the 1960s, its policy was fairly liberal, basically reflecting a harm reduction approach. For example, from 1965 to 1967, it was possible for chronic drug users to obtain prescriptions for morphine and amphetamines. This non-scientific experiment (involving approximately 120 people) was used by Nils Bejerot, a police doctor and very influential figure in Swedish drug policy. Some of his findings included: that changes from restrictive to permissive policy and vice versa was reflected in the rates of intravenous drug use; that this experiment was the origin of the Swedish drug epidemic; and that the experiment did not have the desired effect of crime reduction. His findings are still widely accepted in Sweden even though they have been criticized.

Over time, Swedish policy became more repressive. The current Swedish policy, with its primary goal of a drug-free society, was instituted in the late 1970’s because of what was thought to be an increasing social problem. Some authors have drawn a link between Sweden’s restrictive drug policy and its restrictive alcohol policy. The temperance movement has a long history in Sweden and the country has developed a fairly restrictive alcohol policy, including a state monopoly on the sale of alcohol.

Sweden’ s vision, when it comes to drug policy, has not changed since the early 1980s: it is that of a drug-free society. However, one of the stated goals of Swedish drug policy is to rehabilitate the user rather than to punish them by way of the criminal justice system. Many of the institutions involved in treatment are non-governmental but are paid for their services by the government. This has created a very influential lobby group that obviously requests more resources for treatment initiatives as this is needed for their survival. While Sweden has spent large sums of money on treatment, few of its programs have been properly evaluated. Therefore, it is difficult to provide details of their effectiveness.

Methadone maintenance programs have been available in Sweden since the end of the 1960s. Currently, approximately 600 people are involved in methadone substitution programs in Stockholm, Uppsala, Malmo and Lund. The programs are strictly regulated and are officially viewed as being experimental. Some of the conditions for participation include that: the patient must be aged over 20 and demonstrate at least four years of intravenous opiate abuse; he or she must have tried several forms of drug-free treatment; the person in question must have entered the program on a voluntary basis (for example, the person must not be detained, under arrest, sentenced to a term of imprisonment or be an inmate of a correctional facility). For those participating in methadone substitution programs, other drugs are not permitted and the patient must visit the clinic on a daily basis.

With respect to harm reduction initiatives, there are few low threshold services in Sweden, most of which are staffed by voluntary organizations. Needle exchange programs are operated at clinics for infectious diseases in hospitals in Lund and Malmo. Harm reduction initiatives, such as needle exchange programs, are difficult to promote under a vision of a drug-free society where drug use is not accepted. A proposal in the late 1980’s to introduce needle exchange programs throughout Sweden was quashed by Parliament because it “was felt that a higher availability of needles would not stop the spread of HIV, on the contrary, it was thought to increase intravenous drug use.”

There is no real distinction between hard and soft drugs in Sweden. Marijuana is viewed as a dangerous drug that leads to harder drugs and lifelong addiction. Drug education programs start early and regularly appear throughout the school curriculum. The Swedish vision of a drug-free society is so widely accepted that it is not questioned in the political arena or the media. The Swedish drug policy has support from all political parties and, according to the opinion surveys, the restrictive approach receives broad support from the public. The Swedish population in general has a negative view of drug use and is convinced that drugs pose a major threat to society. These themes have been advanced by government, the media and other organizations in Sweden. Scientists are generally the only group that raises doubts with respect to the current policy.