Country overview: Sweden
- Situation summary
- Data sheet
- Barometer
Contents
- Drug use among the general population and young people
- Prevention
- 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
- Drug-related research
| Year | Sweden | EU (27 countries) | Source | ||
|---|---|---|---|---|---|
| Population | 2008 | 9 182 927 | 497 455 033 | Eurostat | |
| Population by age classes | 15–24 | 2008 | 13 % | 12.6 % 1 | Eurostat |
| 25–49 | 32.7 % | 36.3 % 1 | |||
| 50–64 | 21.5 % | 18.4 % 1 | |||
| GDP per capita in PPS (Purchasing Power Standards) 2 | 2007 | 122.2 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 3 | 2006 | 30.7 % p | 26.9 % p | Eurostat | |
| Unemployment rate 4 | 2008 | 6.2 % | 7 % | Eurostat | |
| Unemployment rate of population agends under 25 years | 2008 | 20 % | 15.5 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 5 | 2006 | 79 | Council of Europe, SPACE 2006.1 | ||
| At risk of poverty rate 6 | 2006 | 12 % | 16 % 7 | SILC, 2007 | |
p Eurostat provisional value.
1 2007 figures.
2 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.
3 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.
4 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.
5 Situation of penal institutions on 1 September, 2006.
6 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold in the current year and in at least two of the preceding three years.
7 EU-25 countries.
Drug use among the general population and young people
In 2007, the most recent general population survey among the 16–64-year olds showed a lifetime prevalence for cannabis use of 12.8 % compared to 12 % in 2006 ( 9.8 % in 1996). Among younger adults (18–34 years old), the lifetime prevalence of cannabis was reported by 18.1 % of the respondents (19.1 % in 2006). Among the same group, the last year prevalence of cannabis use was reported by 4.8 % ( 5 % in 2006), the last month prevalence of cannabis by 1.3 % compared to 1.5 % in 2006.
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 4 % in 1985 and 5 % in 1986, reaching its lowest level in 1989 (4 %). Since then, the rate rose again to 9 % in 2001, before dropping to 6 % in 2006. The latest ESPAD survey, in 2007, showed that as in most European countries, cannabis was the illegal drug students had most frequently experimented with in their lifetime, with results indicating 7 % for students aged 15–16 years, with respectively 9 % among males and 6 % among females. Lifetime prevalence in 2007 of solvents and inhalants was 9 %, and 2 % for ecstasy, amphetamines, LSD and cocaine. Heroin has the lowest prevalence with 1 % of the sample who declared to have used it at least once in their lifetime. In addition, results indicated that 5 % of the sample used cannabis during the last year (compared to 5 % in 2003), 2 % during the last month (1 % in 2003), rates being also higher among males then females.
Prevention
Sweden has importantly reshaped prevention strategies. 80 % 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. Also, the number of programmes for parents on alcohol and drugs has increased and among them a new and well-researched indicated prevention programme for children with externalising behaviour problems.
School-based prevention programmes have had an important role in municipalities and schools and the effectiveness of methods became a concern. Training in motivational interviewing for the pupil healthcare’s staff had been carried out in a third of the municipalities and many interventions aim to improve the psychosocial climate in schools’ social and emotional training, aiming to develop children’s social and emotional capacity is widespread in Sweden.
Selective prevention in recreational settings is carried out by municipalities and the entertainment industry, with a focus on norm-setting and controlling approaches. 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.
Problem drug use
The most recent estimate (2003) on the number of problem drug users was close to 26 000 (25 745 or 4.5 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 drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.
Treatment demand
A regular system for the collection of treatment demand data is managed by the National Board of Health and Welfare. In 2007, data on treatment demand was reported by a total of 238 treatment centres comprising 96 outpatient treatment centres, 108 inpatient treatment centres and 34 treatment centres within the prison setting. In 2007, a total of 6 480 clients entered treatment, of whom 1 346 were new treatment clients.
The 2007 treatment demand data suggests that 34.3 % of all clients entering treatment reported amphetamines as the primary drug, followed by 25.7 % for opioids and 16.1 % for cannabis. Among new treatment clients, 28.1 % reported that cannabis was the primary drug, followed by amphetamines at 27.7 % and opioids at 21.6 %.
In 2007, 39 % of all clients entering treatment were aged more than 35 years. A lower age distribution was reported among new treatment clients, with 39 % under the age of 25 years. As regards gender distribution among all clients entering treatment, 74 % were male whereas 26 % were female. A slightly different gender distribution was reported among new clients entering treatment, with 67 % for males and 33 % for females.
Drug-related infectious diseases
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 Infectious Disease Control.
In 2007, the number of notified cases with acute hepatitis B infections through intravenous drug use was 62, or 69 % of all notified cases with a known transmission route (n=201). Over time, a shift in age dispersion can be noticed, with more cases in the younger age groups.
During 2007, 1 854 new cases of hepatitis C virus (HCV) infections with a known transmission route were notified, of which 992 were infected through intravenous drug use. 52 IDUs were reported to have contracted HIV during 2007.
Drug-related deaths
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 157 drug-related deaths in 2006 (135 in 2004). Since 1990, the data show an increase in drug-related deaths, which peaked in 2000 and appears to have been declining since then. It must be noted, however, that changes in the registrations system should be taken into consideration when interpreting the data. The change in the ICD system was introduced in 1997: There have been no relevant changes in the registration system since 1997, and this also needs to be taken into account when looking at the trendline for drug-related deaths.
Apart from the Cause of Death Register, a special local register on drug-related mortality operated between 1985 and 1996. It consisted of information from all deaths investigated by the Department of Forensic Medicine in the Stockholm reception area (covering counties of Stockholm, Södermanland and Götaland). The data between 1985 and 1996 also suggest an increase in the number of drug related deaths. Furthermore, the 1994–2007 data from the forensic toxicity register also suggest an increase in the number of drug related deaths in the last 10 years.
Treatment responses
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. Most treatment is drug-free and the vast majority is delivered in outpatient settings. 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.
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 60 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.
In 2007, a total of 3 115 clients were in substitution treatment, 1 496 of whom were on methadone and 1 619 on buprenorphine.
Harm reduction responses
The ‘National action plan on drugs (2006–10)’ does not use the phrase harm reduction measures and overall the plan follows a restrictive policy. Even though the Drugs Commission in Sweden has commented that drug users can be offered help without the requirement of an immediate and/or long-lasting drug-free life, the Commission advises against legal prescription of heroin, safe injection rooms and other low-threshold programmes. 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 a 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 summer 2008, no needle exchange programmes have been established in addition to the two programmes already in place in southern Sweden (Lund since 1986 and Malmö since 1987). In 2007, 116 648 syringes were given out at the two programmes, which also assist drug users with other medical/social support 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.
Drug markets and drug-related offences
According to police reports, the illegal drug most frequently seized in Sweden is cannabis, accounting for 50.6 % of all drug seizures in 2006. Cannabis seized in Sweden originates from Morocco and it is smuggled through Spain and more recently, through Portugal. Cannabis is also trafficked by tourists travelling between Sweden and Denmark, as the prices for cannabis are cheaper in Denmark. Amphetamine mostly originates from the Netherlands, Belgium, Estonia, Poland and Lithuania, with brown heroin originating from Afghanistan.
In 2007, a total of 26 038 drug related offences were reported with 36.1 % for cannabis-related offences, followed by 32.7 % for amphetamines and 4.8 % for cocaine. With regards to quantities in 2007, the Swedish customs seized the largest amounts ever with a total of 1 358 kg of cocaine. However, in 2007 the quantity of seized cocaine was less, with a total of 39 kg of seized cocaine. Another significant quantitative seizure in 2006 was ecstasy, with a total quantity of 291 385 tablets. However, in 2007 the quantity of ecstasy was less with a total quantity of 103 130 of seized ecstasy tablets. The quantity of seized amphetamine in 2006 was 422 kg, an amount lower than for 2007 with a total seized quantity of 293 kg.
Data regarding prices of drugs at street level are reported by the Swedish Council for Information on Alcohol and Other Drugs (CAN). In 2007, CAN reported that there was a decrease in the average price of hashish and amphetamines in the last decade. In 1996, the average price for cannabis resin was EUR 10/gram whereas in 2007, the average price was EUR 9/gram. On the other hand, in 1996, the average price for amphetamines was EUR 33/gram, whereas in 2007, the average price was EUR 22/gram.
National drug laws
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 rapidly 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 are punished in the same way as for drugs offences, whereas their possession and transfer will be punished by up to one year imprisonment.
National drug strategy
Sweden has two separate plans in relation to drugs, one for alcohol and the other for drugs, which were adopted together: the ‘National alcohol and drug action plans 2006–10’. The drug action plan is comprehensive, focuses on illegal drugs and covers prevention, treatment and rehabilitation, and supply reduction. Its purpose is to establish a direction for drug preventive work and to guide and improve social efforts to tackle drugs. Implementation is the responsibility of local, regional and national actors. The overall goal for the drug policy is a drug-free society, divided into three main working areas: reducing the recruitment of new drug abusers; inducing more drug abusers to kick the habit; and reducing the supply of drugs. This drug policy is combined with other social policies preventing unemployment, social exclusion and so on.
Coordination mechanism in the field of drugs
The Ministry of Health and Social Affairs is responsible for drug coordination, via the ANT-secretariat and there is an Inter-ministerial Committee with representatives from the Ministries of Health and Social Affairs, Justice, Finance and Foreign Affairs (SAMANT). The National Drugs Policy Coordinator (NDPCo) ceased to exist in 2007. The Swedish National Institute of Public Health (SNIPH) is now coordinating the work of the counties and their implementation of the 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.
Drug-related research
The current ‘National action plan on drugs’ significantly increased drug-related research and available funding. Priority is given to research involving identification of, and prevention within, high-risk social and demographic groups. The national drug policy also emphasizes 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 2008 Swedish National report mainly focused on aspects related to responses to the drug situation.