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 | 2010 | 9 340 682 | 501 105 661 p | Eurostat | |
| Population by age classes | 15–24 | 2010 | 13.3 % | 12.1 % p | Eurostat |
| 25–49 | 32.9 % | 35.8 % p | |||
| 50–64 | 19.1 % | 19.1 % p | |||
| GDP per capita in PPS (Purchasing Power Standards) 1 | 2009 | 119 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 2 | 2008 | 29.4 % | 26.4 % p | Eurostat | |
| Unemployment rate 3 | 2010 | 8.4 % | 9.6 % | Eurostat | |
| Unemployment rate of population aged under 25 years | 2010 | 25.2 % | 20.9 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 4 | 2009 | 77.2 | Council of Europe, SPACE I-2009 | ||
| At risk of poverty rate 5 | 2009 | 13.3 % | 16.3 % | SILC | |
p Eurostat provisional value.
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, 2009.
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).
Drug use among the general population and young people
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 did sharply increased between 2008–09. Similar pattern is observed also for last year and last month cannabis use, and for the ages 16–34. 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 hade 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 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. Also in 2009, 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 (6 %). The lifetime prevalence (2009) of cannabis use among the 17-18-year-old students was 16 %, which is slightly more when compared to 2008 figures (15 %).
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. 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. 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 played an important role in municipalities and schools. 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 (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 drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.
Treatment demand
The National Board of Health and Welfare collects the data from various separate information sources, which all function on a voluntary basis. In 2009, data on treatment demand was reported by a total of 328 treatment centres. In 2009, a total of 6 216 clients entered treatment, of whom 1 694 were new treatment clients.
The 2009 treatment demand data suggests that 27.7 % of all clients entering treatment reported amphetamines as the primary drug, followed by 26.5 % for opioids and 21.0 % for cannabis. Among new treatment clients, 37.9 % reported that cannabis was the primary drug, followed by opioids at 20.1 % and amphetamines at 18.1 %.
In 2009, 36 % of all clients entering treatment were aged more than 35 years. A lower age distribution was reported among new treatment clients, with 42 % under the age of 25 years. With regards to gender distribution among all clients entering treatment, 69 % were male, whereas 31 % were female. The same gender distribution was reported among new clients entering treatment, with 70 % for males and 30 % 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 2009, 24 new HIV cases among injecting drug users were registered in Sweden, which is at same level as in 2008 (22 cases), and indicates decline after a sharp increase in 2006–07 when 33 and 61 new HIV cases was recorded respectively. The increase was attributed a 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 know 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 metropolitan cities of Stockholm and Gothenburg in 2009.
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 241 drug-related deaths 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 at the mean age of 41 years old; and more than 85 % 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.
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. 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 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 the beginning of 2010, 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 2009, 85 000 syringes were given out at the two programmes, which also 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.
Drug markets and drug-related offences
Illegal drugs consumed in Sweden are mainly smuggled into the country. However, 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 60 % of all drug seizures in 2009. Cannabis seized in Sweden originates from Morocco. 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 2006 these accounted for 33 % and 36 % respectively of all illegal substances mentioned in criminal convictions.
In 2009, the quantity of cannabis resin seized increased (from 1 012 kg in 2008 to1 424 kg in 2009), as well as the quantity of LSD (from 1 323 units in 2008 to 5 426 units in 2009) and methamphetamine (from 75 kg in 2008 to 164 kg in 2009) when compared to 2008 figures. However, the amounts of herbal cannabis, heroin, ecstasy and amphetamine declined. The quantity of cocaine seized, although the figure is much less than in 2006 (1 358 kg), increased when compared to the last two years (39 kg in 2007, 49 kg in 2008 and 75 kg in 2009). Regarding heroin, the quantity seized declined from 55 kg in 2008 to 31 kg in 2009 and amphetamine from 361 kg in 2008 to 351 kg in 2009.
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 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.
A new bill was introduced in 2010 to enable confiscation and destruction of so-called ‘new psychoactive substances’ and also to regulate GBL and 1,4–BD as narcotics. In addition, turnover of a number of new psychoactive substances was put under control of the Swedish drug laws (classified us narcotic drugs and/or goods dangerous for health) in 2009–10.
National drug strategy
Two separate action plans in relation to drugs, one for alcohol and the other for drugs, namely ‘National alcohol and drug action plans 2006–10’ came to an end in 2010. The drug action plan was comprehensive, focused on illegal drugs and covered prevention, treatment and rehabilitation, and supply reduction. Its purpose was to establish a direction for drug preventive work and to guide and improve social efforts to tackle drugs. Implementation was the responsibility of local, regional and national actors. Each year, the Government developed an action programme to support the implementation of the action plans. In 2010, an evaluation of the action plan was carried out. Although achievements were noted in the development of a solid knowledge base for prevention of drug use at all levels, the evaluation drew attention to the increase in observed harmful consequences of the drug use phenomenon, such as drug-related morbidity, mortality and crime in Sweden.
The new strategy covering 2011–15 is being finalised and, pending adoption, it will be similar to the previous one, and will continue to endorse the overall goal for the Swedish drug policy — a drug-free society. The strategy will cover drugs, alcohol, doping and tobacco. The following long-term political objectives are foreseen in the new strategy: (1) to reduce supply of drugs, (2) to protect children from the harmful effects of drugs, (3) to reduce the recruitment of new drug abusers, (4) to reduce the development of high-risk drug use behaviours, (5) to increase access to high quality healthcare and social support services, (6) to reduce direct and indirect harmful health consequences of drug use, (7) to promote the Swedish drug policy internationally.
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 ANDT (alcohol, drugs, doping, tobacco) Secretariat and the ANDT Council. 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 ‘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 2010 Swedish National report mainly focused on aspects related to responses to the drug situation.
