Papers

Legalizing drugs is not a new idea. It was legal drugs that prompted the more restrictive policies that are sometimes dismissed as “prohibition.” An historical, global perspective can inform the current debate on the legalization of drugs. In its modern form nonmedical drug use dates back to the 19th century in China when opium smoking was established as a major social problem. In response, the first international conference promoting drug control was held in Shanghai in 1909.

 

In more recent years history provides many examples of failures when societies have tried to curb drug abuse. But it also provides some notable successes.

 

The Chinese example from the 1950s stands out – 20 million opium smokers quit in a couple of years. The methods used were brutal and cannot be recommended today but the results were impressive.

 

The Japanese example from the mid 1950s is more relevant. Over half a million methamphetamine addicts quit as a result of short prison sentences for about ten percent of them.

 

The Harrison Act of 1914 in USA proved to be a relatively slow but effective drug control measure leading to several hundred thousand opiate addicts being freed from their addiction over a decade.

 

Today some people want to reverse history by repealing the modern restrictive drug laws to make heroin, cannabis and other drugs legal once again. These ideas are most abundant in countries with larger drug problems, such as in the United Kingdom.

 

The drug abuse experiences of Sweden are informative. Sweden is a modern industrialized nation with an economy that is dependent on foreign trade. Democratic traditions are strong, social welfare is ambitious and human rights are respected. For almost three decades Sweden has practiced a restrictive and balanced drug policy with the ultimate goal of a drug free society, meaning that no nonmedical use of narcotic drugs (listed in the UN conventions) is tolerated in Sweden. Is this policy success or failure?

 

While Sweden is not drug-free, compared to other nations in Europe Sweden is distinguished by its low rate of drug use. The Swedish approach to drugs grew out of painful experiences. In the early 1960s Sweden was one of the first countries in Western Europe to have widespread drug abuse among its youth. The initial Swedish approach to this epidemic of intravenous drug use was permissive, similar to what later became the official policy in The Netherlands. Between 1965 and 1967 addicts could get the drugs of their choice on prescription from doctors in Stockholm. The hope of this policy was that medicalizing drug abuse would protect drug users from the black market and help them wean off drugs. This approach to drugs ended abruptly when a 17-year old girl died from an overdose of morphine prescribed by a doctor to a drug addict. By that time it was clear that medically prescribed drugs of abuse prolonged and spread the addiction because a large percentage of the medically prescribed drugs was given away or sold to an ever expanding network of new drug users.

Even after this experience, during the 1970s, small scale trafficking of drugs was de facto legal in Sweden. In those years prosecutors did not charge anyone possessing small amounts of drugs. For example, up to 20 grams of hash was tolerated.

 

The point of no return on Sweden’s initial permissive drug policy came in early 1980 when the Prosecutor General banned all waivers of prosecution of drug possession. Since that time there has been no tolerated level of drug possession. In 1988 the Narcotics Punishment Act was expanded to include the act of consuming illegal drugs. From 1993 to the present the police have been able to demand a urine or blood test as proof from a person who is suspected of having consumed drugs nonmedically. Over 30,000 drug tests are taken yearly now by the police. To this is added over 10,000 drug tests of automobile drivers suspected of drugged driving.

 

Prevalence levels of drug use in Sweden are generally lower than the European average. The difference becomes stunning when compared with the UK, a country that has had drug problems for about as long as Sweden has, since the early 60s.

 

With its restrictive drug policy Sweden does not have a huge prison population. For example the rate of incarceration in Sweden is considerably lower than the rate of incarceration in the Netherlands. It is claimed that the drug related death rate is high in Sweden. This is a difficult figure to compare because different countries have different definitions of drug-related deaths When UNODC compared 23 European countries Sweden came out at an average level. Norway and Estonia had by far the highest drug-related death rates.

 

From the changing drug policies over the past four decades Sweden has learned that during periods of permissive policies the abuse of drugs has gone up. During restrictive periods it has gone down. The Swedish drug policy is not to use excessive force or long prison sentences. Rather it has been to use as little force as necessary to enforce its laws against nonmedical drug use. A young person taken into custody by the police on suspicion of drug use is asked to give a urine sample to be tested. Swedes who test positive for drugs do not go to jail. Instead they must pay a fine. For youth their parents and social services are notified. If help, including treatment, is needed and wanted it is provided.

 

The key to the Swedish experience is to have a clear standard, one that is widely respected by all political parties, that the nonmedical use of drugs, including cannabis, is not permitted. This standard is enforced vigorously but not harshly. The Swedish drug abuse prevention policy has not ended drug abuse in Sweden but it has kept drug abuse low. It has also kept the calls for drug legalization muted in Sweden.

 

Unlike legalization, which is a throwback to the earlier open market in drugs of abuse and unlike the draconian approaches in China in the 1950s, but similar in many ways to the Japanese model, Swedish drug policy is restrictive as well as balanced and restrained. The Swedish drug policy is compatible with modern cultural values that promote individual freedom in a compassionate welfare state. Swedish drug policy is based on the view across the political spectrum that drug abuse is chemical slavery and thus is anathema to the values of the nation.

 

Swedish drug policy is well established. It offers an alternative to either harsh punishment or legalization and holds real promise as a model for many other nations in the world as they cope with the menacing and divisive modern epidemic problem of nonmedical drug use. 

                     

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Per Johansson, Sweden, Secretary of the Board of World Federation Against Drugs

Robert L. DuPont, M.D., USA, President, Institute for Behavior and Health and First Director, National Institute on Drug Abuse