Country overview: Sweden
- Drug use among the general population and young people
- Problem drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-related deaths
- Treatment responses
- Harm reduction responses
- Drug markets and drug-related offences
- National drug laws
- National drug strategy
- Coordination mechanism in the field of drugs
- Public expenditure
- Drug-related research
|Year||EU (27 countries)||Source|
|Population||2011||9 415 570||502 476 606 p||Eurostat|
|Population by age classes||15–24||2011||13.3||:||Eurostat|
|GDP per capita in PPS (Purchasing Power Standards) 1||2010||123||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2009||32.1 p||29.5 % p||Eurostat|
|Unemployment rate 3||2011||7.5||9.7 %||Eurostat|
|Unemployment rate of population aged under 25 years||2011||22.9||21.4 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2010||74.1||:||Council of Europe, SPACE I-2010|
|At risk of poverty rate 5||2010||12.9||16.4 %||SILC
p Eurostat provisional value.
b Break in series.
1 Gross domestic product (GDP) is a measure of economic activity. It is defined as the value of all goods and services produced less the value of any goods or services used in their creation. The volume index of GDP per capita in Purchasing Power Standards (PPS) is expressed in relation to the European Union (EU-27) average set to equal 100. If the index of a country is higher than 100, this country's level of GDP per head is higher than the EU average and vice versa.
2 Expenditure on social protection contains: benefits, which consist of transfers, in cash or in kind to households and individuals to relieve them of the burden of a defined set of risks or needs.
3 Unemployment rates represent unemployed persons as a percentage of the labour force. Unemployed persons comprise persons aged 15 to 74 who were: (a) without work during the reference week; (b) currently available for work; (c) actively seeking work.
4 Situation of penal institutions on 1 September, 2010.
5 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold, which is set at 60 % of the national median equivalised disposable income (after social transfers).
Since 2004, an annual public health survey is carried out in Sweden and refers to a question on cannabis use. The results from the last health survey in 2010 showed that the lifetime of cannabis use prevalence in the ages 16–64 decreased somewhat during the period 2007–08, but increased between 2008–09 for men, and 2009–10 for women. Similarly, although not significant, a pattern is also observed for last-year and last-month cannabis use. Although for the younger ages, the lifetime, last-year and last-month prevalence reported were significantly higher than those for all adult populations.
A large-scale postal survey of the use of illicit drugs was conducted among 58 000 in 2008. Although this survey contained questions about other substances (alcohol, tobacco, steroids), the main focus of the questions was the use of illicit drugs, in terms of type (category options were cannabinoids, amphetamines, cocaine, opiates, ecstasy, hallucinogens and ‘other’, requiring specification), quantity, frequency and latest period of use (lifetime, last 12 months, last 30 days). Data from the large-scale drugs survey showed that the most common drug used was cannabis, the second one being amphetamine. Cocaine was also common, especially among those who had used in the previous 30 days. It is clear that drug use is higher in males, although use varies by age category in both males and females. For both sexes, the use of drugs was most common in the age group of 25–34 years where a little less than one third of the men and one fifth of the women had used a narcotic substance at some point during their lives.
School surveys on drug use have been carried out in Sweden annually since 1971 by the Swedish Council for Information on Alcohol and other Drugs (CAN). Reported lifetime prevalence for illegal drugs among students between the ages of 15–16 was highest in the 1970s (15 %) and subsequently dropped to its lowest level in 1989 (3 % for boys and girls). Since then, the rate rose again in 2001, before dropping in 2006. In 2010, national school surveys regarding drug use were carried out among students turning 16 and those turning 18. Cannabis was by far the most common substance in the surveys among 16-year olds (7 %), followed by inhalant and volatile substance abuse (5 %). The lifetime prevalence (2010) of cannabis use among the 17–18-year-old students was 17 %, which is more when compared to 2009 and 2008 figures (16 % and 15 % respectively).
The latest ESPAD survey in 2011 showed that, as in most European countries, cannabis was the illegal drug that students had most frequently experimented with in their lifetime, with results indicating 9 % for students aged 15–16 years, with respectively 11 % among males and 5 % among females. Lifetime prevalence in 2011 of solvents and inhalants was 11 %, and 2 % for ecstasy, while for other substances it was at 1 %. In addition, results indicated that 6 % of the sample used cannabis during the last year (compared to 5 % in 2003 and 2007), 3 % during the last month (2 % in 2007 and 1 % in 2003), rates being also higher among males then females.
Sweden has importantly reshaped its prevention strategies. Organisation and implementation of prevention activities is mainly responsibility of municipalities, however the Swedish National Institute of Public Health provides overall coordination and monitoring of prevention activities. Approximately 75 % of the municipalities have now appointed a full- or part-time drug coordinator for the alcohol and drug preventive work at community level and the support of the municipality management is a key component in preventive work.
School-based prevention programmes play an important role in municipalities and schools. Several interventions focus on development of children’s social and emotional capacity. In 2010, the social and emotional training was implemented in about half the Swedish municipalities, while ‘School Comet’ was applied in one fifth of municipalities.
Also, the number of programmes for parents on alcohol and drugs has increased. For example, ‘Community Parent Education’, a prevention programme for parents with children aged 2 to 13 years, is implemented in about a third of communities. The programme aims to improve parenting skills to handle their children’s behaviour and create supportive family networks.
Selective prevention activities mainly include early intervention programmes for individuals suspected of drug abuse and programmes for children from families where parents are addicted to alcohol or drugs. ‘Comet for parents’, a well-researched prevention programme for parents with 3- to 18-year old children with externalising behaviour problems, has showed a positive effect on the children’s behaviour and parenting skills.
In recent years, an increasing number of recreational settings, such as clubs and restaurants, had adopted environmental prevention measures, such as norm-setting among staff and use of controlling approaches limiting access of drug-intoxicated clients to these settings.
Special characteristics of the prevention culture in Sweden within the European context are — besides the importance given to controlling individuals for signs of drug use — a strong local community-based delivery of prevention which comprehensively tackles alcohol alongside illicit drugs, and provides much research into new prevention approaches.
View ‘Prevention profile’ for additional information.
The most recent estimate (2007) on the number of problem drug users was 29 513 (4.9 problem drug users per 1 000 inhabitants). According to the available estimates, the number of PDUs has been more or less constant over the years since 1998, with a peak in 2001 of close to 28 000 problem drug users. Problem drug use in Sweden is dominated by amphetamines and heroin.
The EMCDDA defines problem drug use as intravenous drug use (IDU) or long duration/regular use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.
The National Board of Health and Welfare collects the data from various separate information sources, which all function on a voluntary basis. In 2010, data on treatment demand was reported by a total of 290 treatment centres. In 2010, a total of 6 424 clients entered treatment, of whom 1 597 were new treatment clients.
The 2010 treatment demand data suggests that 27.8 % of all clients entering treatment reported amphetamines as the primary drug, followed by likewise proportions for cannabis and opioids (24.9 % and 24.8 % respectively). Among new treatment clients, 45.1 % reported that cannabis was the primary drug, followed by amphetamines at 19.4 % and opioids at 16.5 %.
In 2010, 33 % of all clients entering treatment were aged more than 35 years. A lower age distribution was reported among new treatment clients, with 53 % under the age of 25 years. With regards to gender distribution among all clients entering treatment, 72.3 % were male, whereas 27.7 % were female. The same gender distribution was reported among new clients entering treatment, with 73.1 % for males and 26.9 % for females.
Statutory surveillance of communicable diseases is regulated in the Communicable Disease Act in Sweden, and notifications are submitted to the County Medical Officer (one in each of the 21 counties in Sweden) and the Swedish Institute for Communicable Disease Control.
In 2010, 25 new HIV cases among injecting drug users were registered in Sweden, which is at same level as in 2008–09 (22 and 24 cases respectively), and indicates decline after a sharp increase in 2006–07 when 33 and 61 new HIV cases was recorded respectively. The increase was attributed an HIV outbreak in the domestic IDU population in Stockholm.
In 2008, the number of notified cases with acute hepatitis B infections through intravenous drug use was 61, or 41.5 % of all notified cases with a known risk factor (n=147).
During 2008, 1 615 new cases of hepatitis C virus (HCV) infections with a known transmission route were notified, of which 1 083 were infected through injecting drug use. A diagnostic testing indicates 59.7 % of hepatitis C infection rates in samples of injecting drug users from the metropolitan cities of Stockholm and Gothenburg in 2009.
Drug-related deaths data originate from the Cause of Death Register at the National Board of Health and Welfare (the ICD system), which has national coverage and is more than 95 % complete. According to the EMCDDA standard definition (which includes acute deaths directly related to drug consumption or overdoses), there were 267 drug-related deaths in 2009 (241 in 2008, 232 in 2007; 172 in 2006, 186 in 2005). Between 2006 and 2007, the data showed a decline in drug-related deaths; however, since 2007, a raise in drug-related death cases is noticed. In 2009, a majority of cases were registered among men, the mean age at death was 40 years; and more than 87.3 % of all death cases were linked to opiates. Methadone-induced deaths had almost tripled between 2006 and 2008, and were most likely linked to the leakages of a substance used in the methadone treatment programmes.
In Sweden, social legislation determines that social services in the local community are responsible for the implementation of treatment of problem drug use. Treatment is mainly delivered by public institutions, followed by private and non-governmental organisations. Funding of substance treatment, including treatment delivered by NGOs, is provided by the public budget of the municipalities, which are also subsidised by state funds. In the case of NGOs, public funding is handled by the National Board of Health and Welfare and is based on applications from the NGOs.
Social services in the municipalities are responsible for the treatment of problem drug use, even if the cases require medical treatment. Thus, most treatment for problem drug use is organised outside hospitals by social services. There are treatment facilities specifically for problem drug users, but as a rule of thumb, treatment of problem drug use takes place alongside treatment of alcohol and/or other addictions. As regards social reintegration, there are reports of social reintegration interventions, although they seem to be modest in availability and coverage. This was confirmed by the National Board of Institutional Treatment that expressed the belief that there were shortcomings in aftercare, especially in housing.
The Medical Products Agency’s Code Statutes LVFS 2004:15 stipulate that only treatment centres can initiate, and should be predominantly involved in, substitution treatment. Methadone introduced in 1967 and buprenorphine introduced in 1999 are the only officially recognised pharmaceutical substances for substitution treatment. In Sweden, there are about 64 treatment units at hospitals used in substitution treatment. Substitution treatment with methadone has always been subject to strict regulations. Since the new guidelines for substitution treatment came into force in January 2005, provision of medically-assisted treatment has increased. At the same time some centres have introduced ‘zero tolerance’ against lateral drug use which leads to low retention in the treatment. The number of clinical trials is conducted in Sweden to increase the retention rates in medically-assisted treatment through administration of structured psychosocial interventions.
In 2007, a total of 3 115 clients were in substitution treatment, 1 496 of whom were on methadone and 1 619 on buprenorphine.
View ‘Treatment profile’ for additional information.
The new ‘National action plan on drugs (2011–15)’ likewise its predecessor further endorses the visionary goal of a society free from narcotics while one of its long-term objectives is to decrease harm due to use of alcohol, narcotics, doping and tobacco. The evaluation of the 2006–10 National Action Plan on Drugs further suggested the County Councils to diversify evidence-based interventions targeting drug users, including needle exchange, and several new law and bill proposals are proposed for adoption in early 2013.
As of 2006, the Swedish government introduced a law which in effect allows each of the 21 regions in Sweden to introduce needle exchange programmes.
The National Board of Health and Welfare presented the new regulations concerning needle exchange in February 2007. They address the procedures for county councils to follow in order to establish an NSP, including a justification of need (e.g. estimation of number of potential service users); an assessment of available resources; and a provision plan for complementary and additional care services (e.g. detox, drug treatment and aftercare). They stipulate the obligation for NSPs to inform clients about injecting risks, to offer additional services including infectious diseases testing and vaccinations, and define further quality management rules for the implementation of such services. Until the end of 2011, three syringe exchange programmes were in place in southern Sweden. In 2009, 85 000 syringes were given out at the two programmes in Lund and Malmo. The Syringe Exchange Programmes assist drug users with other medical/social support, offer free HIV, HBV and HCV testing and refer them to drug-free treatment within the social services. Pharmacies are not entitled to sell needles/syringes without a prescription for medical use, such as diabetes care, etc.
Illegal drugs consumed in Sweden are mainly smuggled into the country via the bridge connection with Denmark, ports and international airports. However professional full-scale illegal indoor cultivation of marijuana is spreading through out the country. In 2008, 20 well-organised and sophisticated indoor marijuana cultivations were dismantled. In addition, some small-scale outdoor cannabis cultivation, some manufacturing of GHB and diversion of narcotic pharmaceuticals is observed but is judged to be of limited importance for the availability and supply.
According to police reports, the illegal drug most frequently seized in Sweden is cannabis, accounting for two thirds of all drug seizures in 2010. Cannabis resin seized in Sweden originates from Morocco, while domestic cultivation is a main source for herbal cannabis. Amphetamine mostly originates from the Netherlands, Belgium, Estonia, Poland and Lithuania, with brown heroin originating from Afghanistan.
According to the official criminal statistics of Sweden, a steady increase in drug-related offences is registered. Although drug-use related offences predominate, the steepest raise in the past decade is noted for the production-related offences. The number of persons that were convicted with drug offence as the main crime also shows a steady increase during past 10 years. Amphetamines and cannabis remain the two most common illegal substances in the convictions statistics. In 2009, these accounted for 27 % and 42 % respectively of all illegal substances mentioned in criminal convictions.
In 2010, the quantity of herbal cannabis increased (from 263 kg to 375 kg), as well as the quantity of heroin (from 31 kg to 58 kg) when compared to 2009 figures. Although the amount of seized ecstasy tablets increased from 2 400 tablets to 7 100 tablets between 2009–10, there has been dramatic decline in the ecstasy seizures since mid-2000 assumed mainly due to a decrease in production, introduction of other ‘party drugs’ and decline in availability of MDMA. In 2010, the amounts of cannabis resin, cocaine, LSD, methamphetamine and amphetamine declined. Declining trend in a number of amphetamine seizures and the amounts of the substance seized since 2006 is explained by an increase in availability of other similar drugs.
The use and possession of illegal drugs are criminal offences under the Narcotic Drugs Punishment Act. Use and possession are punished according to three degrees of severity for drug offences: minor, ordinary and serious. The degree of offence takes into consideration the nature and quantity of drugs and other circumstances. Penalties for minor drug offences consist of fines or up to six months’ imprisonment, for ordinary drug offences up to three years, and for serious drug offences, two to 10 years’ imprisonment, with penalties of up to 18 years possible for recidivists. The penalties for drug trafficking offences regulated in the Law on Penalties for Smuggling are identical with the penalties provided in the Narcotic Drugs Punishment Act.
Sweden also operates a system of classifying substances as ‘Goods dangerous to health’, which may be used to control goods that, by reason of their innate characteristics, entail a danger to human life or health and are being used, or can be assumed to be used, for the purpose of intoxication or other influence. The import of such goods is punished in the same way as for drugs offences, whereas their possession and transfer will be punished by up to one year imprisonment.
The Bill on the Control of Narcotic Drugs enables handling of narcotics for industrial purposes while in 2011 it also allowed to regulate GBL and 1,4–BD as narcotics. A new bill came into effect in 2011 to enable confiscation and destruction of so-called ‘new psychoactive substances’. In addition, turnover of a number of new psychoactive substances was put under control of the Swedish drug laws (classified as narcotic drugs and/or goods dangerous for health) in 2009–10.
View ‘Legal profile’ for additional information.
The current Swedish drug strategy, A Cohesive Strategy for Alcohol, Narcotic drugs, Doping and Tobacco (ANDT) Policy, was adopted on 18 April 2011. Covering the period between 2011 and 2015, the strategy has the same overall objective as its predecessors, that is, to have a society free from narcotics. In addition to the strategy’s overall objective, a society free from narcotics and doping and decreased medical and social harm from alcohol and a decrease in use of tobacco, there are seven, equally prioritised, long-term objectives:
- Curtailing the supply of illegal drugs, doping substances, alcohol and tobacco;
- Protecting children against the harmful effects of alcohol, narcotic drugs, doping and tobacco;
- Gradually reducing the number of children and young people who initiate the use of tobacco, illicit drugs or doping substances or begin drinking alcohol early;
- Gradually reducing the number of people who become involved in harmful use, abuse or dependence on alcohol, illicit drugs, doping substances or tobacco;
- Improving access to good-quality care and support for people with substance abuse or addiction;
- Reducing the number of people who die or suffer injuries or damage to their health as a result of their own or others' use of alcohol, illicit drugs, doping substances or tobacco;
- Promoting a public-health based, restrictive approach to ANDT in the EU and internationally.
By adopting a long-term and cohesive strategy, the Government aims to facilitate better coordination and cooperation between the different agencies and actors involved, as well as emphasising the responsibility of those involved. The strategy addresses its objectives through five pillars: prevention; treatment and rehabilitation; protection of children and adolescents; supply reduction; and cooperation.
Annual action plans are adopted to support the implementation of the strategy, which cover all aspects of ANDT and describe the priorities for the year ahead in greater detail than the overall five-year strategy. The first annual action plan was adopted on 28 April 2011.
View ‘National drug strategies’ for additional information.
The Ministry of Health and Social Affairs is responsible for drug coordination, via the ANDT (alcohol, narcotic drugs, doping, tobacco), Secretariat and the ANDT Council. Part of the Ministry’s Public Health Division, the Secretariat is responsible for coordinating ANDT policy, drawing up annual action plans for the implementation of the ANDT strategy and undertaking an evaluation of the work done to achieve the objectives set. Chaired by the State Secretary at the Ministry of Health and Social Affairs, the ANDT Council is comprised of representatives from central authorities and organisations and researchers. It is tasked with advising the Government on policy issues, new research and other information relevant to the development of ANDT policy.
The Swedish National Institute of Public Health (SNIPH) is coordinating the work of the counties and their implementation of the action plans. The National Board of Health and Welfare (NBHW) also work with supporting the implementation of the action plans. The formal responsibility for demand reduction and law enforcement are still with the relevant authority.
The County Administrative Boards are given a central position and are responsible for the supervision and the distribution of financial support for drug policy interventions in the municipalities. Regional drug coordinators are located at the regional level, most often at the County Administrations or at the County Councils. The regional drug coordinators’ tasks are to coordinate the regional activities in the drug area and to support the local activities in the municipalities.
The Swedish government defines a budget every year for some drug-related activities, respecting the principles of the action plan. Prevention and treatment are not budgeted for because they are financed by regional or local authorities. Six estimates of drug-related public expenditures have been made in Sweden, but only the study for 2002 (1) provides information about the methodology used.
In 2002, total drug-related expenditure (2) were estimated to represent between 0.2 % and 0.4 % of GDP, with 70–76% for law enforcement, 22–28% for treatment, 1.7–0.7 % for prevention and 0.2–0.1 % for harm reduction.
As the methods used to estimate drug-related expenditures have changed over time, it is not possible to report on trends in drug-related public expenditure in Sweden.
(1) Ramstedt, M. (2006), ‘What drug policies cost. Estimating drug policy expenditures in Sweden, 2002: work in progress’, Addiction 101, pp. 330–338.
(2) Some of the funds allocated by governments for expenditure on tasks related to drugs are identified as such in the budget (‘labelled’). Often, however, the bulk of drug-related expenditure is not identified (‘unlabelled’) and must be estimated by modelling approaches. The total budget is the sum of labelled and unlabelled drug-related expenditures.
The ‘National action plan on drugs’ that ended in 2010, significantly increased drug-related research and available funding. Priority was given to research involving identification of, and prevention within, high-risk social and demographic groups. The national drug policy also emphasises knowledge and competence in the area of research as a basis for prevention, and places particular importance on findings from research and methodological development studies that can be immediately applied in the field.
Funding for research comes mainly from governmental sources. The Swedish National Institute for Public Health (SNIPH) and other agencies have the task of handling project funding related to drug prevention and treatment. The main organisations involved in conducting drug-related research are university departments, although non-governmental and governmental organisations are also relevant partners. Several channels for disseminating drug-related research findings are available in Sweden, ranging from scientific journals, to dedicated websites, reports, manuals and conferences. Recent drug-related studies mentioned in the 2011 Swedish National report mainly focused on aspects related to responses to the drug situation, but research on prevalence of drug use, consequences of drug use and supply and market issues are also mentioned.
View ‘Drug-related research’ for additional information.