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-law 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||2012||9 482 855||503 663 601 b p||Eurostat|
|Population by age classes||15–24||2012||13.1 %||11.7 % b p||Eurostat|
|25–49||32.8 %||35.4 % b p|
|50–64||18.5 %||19.5 % b p|
|GDP per capita in PPS (Purchasing Power Standards) 1||2011||127||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2010||30.4 % p||29.4 % p||Eurostat|
|Unemployment rate 3||2012||8.0 %||10.5 %||Eurostat|
|Unemployment rate of population aged under 25 years||2012||23.7 %||22.8 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2011||71.6||:||Council of Europe, SPACE I-2011|
|At risk of poverty rate 5||2011||14.0 %||16.9 % e||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, 2011.
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).
An annual public health survey has been carried out in Sweden since 2004. It includes a question on cannabis use, which enables the trend in cannabis use in Sweden to be described, rather than year-to-year differences. The results from the latest health survey in 2011 showed a fairly stable trend in cannabis use prevalence in those aged 16–64, with some gender differences. While males reported higher cannabis use prevalence rates than women, a significant increase in lifetime prevalence among females was noted in 2010 compared to 2008. Among males, lifetime prevalence rates decreased slightly during 2004–08 (from 17.6 % to 14.6 %), but in 2009 increased to 18.5 %. Thereafter, the figures remained stable, although the 2011 prevalence was slightly lower (17.2 %) than in 2009. Among females, following a slight decline during 2004–08 (from 9.9 % to 8.4 %), prevalence increased to 11 % in 2011. The pattern for last year cannabis use was similar to lifetime cannabis use; among males prevalence rates showed an increasing tendency after 2008, while among females the prevalence rates were fairly stable over the period 2004–11. The pattern for last month prevalence is stable for males and females, but among males prevalence was temporarily higher in 2009, and has declined slightly since then. In 2011 about 1.2 % of males and 0.6 % of females reported using cannabis at least once in the past 30 days. For younger ages, the lifetime, last-year and last-month prevalence reported were significantly higher than those for the whole adult population.
A large-scale postal survey on the use of illicit drugs was conducted among 58 000 inhabitants 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’ with a requirement to specify), quantity, frequency and latest period of use (lifetime, last 12 months, last 30 days). The data showed that cannabis was the most commonly used drug, with amphetamines second. Cocaine was also common, especially among those who had used in the previous 30 days. Drug use was higher in males, although use varied by age category in both males and females. For both sexes, drug use was most common in the 25–34 age group, where a little less than one-third of males and one-fifth of females had used a narcotic substance at some point in 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 illicit drugs among students between the ages of 15–16 was highest in the 1970s (15 %) and subsequently fell to its lowest level in 1989 (3 %). The rate then rose again to 8 % in 2000, and has remained at between 5–7 % since then. In 2011 national school surveys on 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 15- to 16-year-olds (6 %), followed by inhalant and volatile substance abuse (4 %).
The latest European School Survey Project on Alcohol and Other Drugs (ESPAD) study in 2011 showed that, as in most European countries, cannabis was the illicit drug that students had most frequently experimented with in their lifetime. Lifetime prevalence was 9 % for students aged 15–16, with figures of 11 % for males and 5 % for females. Lifetime prevalence of solvents and inhalants in 2011 was 11 %, for ecstasy it was 2 %, and for other substances it was 1 %. Last year prevalence of cannabis use was 6 % (compared to 5 % in 2003 and 2007), and last month prevalence of cannabis use was 3 % (2 % in 2007; 1 % in 2003), with a higher rate among males than females.
The organisation and implementation of prevention activities for licit and illicit substances is mainly the responsibility of regional and local governments. However, the Swedish National Institute of Public Health provides overall coordination and monitoring of prevention activities. All 21 counties have a county coordinator to synchronise and promote evidence-based prevention measures at the regional and local level, and in 2011 about half had substance use prevention strategies in place and seven had respective action plans. Municipalities also bear the main responsibility for implementation of prevention measures. Approximately 75 % of the municipalities have now appointed a full-time or part-time drug coordinator for the alcohol and drug prevention work at community level, and a key component in preventive work is the support of municipality management.
School-based prevention programmes play an important role in municipalities and schools, and they are mainly implemented in the context of promoting a healthy school environment. They cover both licit and illicit substances. Several interventions focus on the development of children’s social and emotional capacity. In 2010 social and emotional training was implemented in about half of Swedish municipalities, while School Comet was applied in one-third of municipalities.
A number of community-based programmes at the municipal level focus on the provision of alternative leisure activities, primarily in cooperation with sports organisations, the temperance movement and other community-based organisations. The number of programmes for parents on alcohol and drugs has also 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 their parenting skills, assist them to manage their children’s behaviour and help them to create supportive family networks.
Selective prevention activities mainly include early intervention programmes for individuals suspected of drug abuse (young people, drivers and people suspected of minor offences) 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 shown a positive effect on the children’s behaviour and the parents’ parenting skills.
In recent years an increasing number of recreational settings, such as clubs and restaurants, have adopted environmental prevention measures, such as norm-setting among staff and the use of controlling approaches that limit access to drug-intoxicated clients. About one in 10 Swedish municipalities had programmes in recreational settings in 2011.
A special characteristic of the prevention culture in Sweden within the European context — alongside the importance given to checking individuals for signs of drug use — is the strong local community-based delivery of prevention, which tackles alcohol alongside illicit drugs and carries out a considerable amount of research into new prevention approaches.
View ‘Prevention profile’ for additional information.
The most recent estimate (2007) on the number of problem drug users (PDUs) in Sweden 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 since 1998, with a peak in 2001 of close to 28 000. Problem drug use in Sweden is dominated by amphetamines and heroin.
Up to 2012 the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) defined problem drug use as injecting drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis were not included in this category. Details are available here.
The National Board of Health and Welfare collects the data from various separate information sources, which all function on a voluntary basis. In 2011 data on treatment demand was reported only by prisons, with a total of 1 076 clients reported. Therefore an estimated number of 6 231 treatment clients in Sweden was calculated based on the prison data and treatment demand data reported in 2010. The 2010 treatment demand data suggests that 27.8 % of all clients entering treatment reported amphetamines as the primary drug, followed by similar proportions for cannabis and opioids (24.9 % and 24.8 % respectively).
About 36 % of all clients entering treatment in prisons were over the age of 35. In terms of gender distribution, among all clients entering treatment 86.2 % were male and 13.8 % were female.
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 2011 there were 12 new HIV cases among IDUs registered in Sweden, which is less than in 2008–10 (22 in 2008; 24 in 2009; 25 in 2010), and indicates a decline after a sharp increase in 2006 (33 cases) and 2007 (61 cases). However, the 2012 Annual report mentioned an outbreak of five cases in early 2012 in the city of Kalmar.
In 2011 the number of notified cases with acute hepatitis B virus (HBV) infection through intravenous drug use was 18, or 23.1 % of all notified cases with a known risk factor (n=78). Similar to HIV, the number of acute HBV cases among injecting drug users has also decreased since 2007, when 67 cases were recorded.
During 2011 some 1 268 new cases of hepatitis C virus (HCV) infections with a known transmission route were notified, of which 967 were infected through injecting drug use, and all cases are assumed to be of domestic origin. A diagnostic testing indicated a HCV infection rate of 55.7 % in samples of injecting drug users in drug treatment from the metropolitan cities of Stockholm and Gothenburg in 2010.
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 239 drug-related deaths in 2011 (267 in 2009; 241 in 2008; 232 in 2007; 172 in 2006; 186 in 2005). In 2011 some 69.0 % of cases were males, and the mean age at death was 41.8 years. Toxicology reports were available for 95.8 % of deaths, and the data indicate the presence of opiates in 90.4 % of these cases.
In Sweden, social legislation determines that social services in the local community are responsible for the implementation of problem drug use treatment. Treatment is mainly delivered by public institutions, followed by private and non-governmental organisations (NGOs). Funding for substance treatment, including treatment delivered by NGOs, is provided by the public budget of the municipalities, which are 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 submitted by the NGOs.
Social services in the municipalities are responsible for problem drug use treatment, even if the cases require medical treatment. Most problem drug use treatment is organised outside hospitals by social services. There are treatment facilities specifically for problem drug users, but as a rule of thumb problem drug use treatment takes place alongside treatment of alcohol and/or other addictions. There are reports of social reintegration interventions, although they seem to be limited in availability and coverage. This has been confirmed by the National Board of Institutional Treatment, which has expressed the belief that there are 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 substitution treatment units in hospitals. Substitution treatment with methadone has always been subject to strict regulation. 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 rates in the treatment. A number of clinical trials have been 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), like its predecessor, endorses the visionary goal of a society free from narcotics, while one of its long-term objectives is to decrease harm caused by use of alcohol, narcotics, doping and tobacco. The evaluation of the 2006–10 National Action Plan on Drugs further suggested that the county councils should broaden the range of evidence-based interventions targeting drug users, including needle exchange, and several new law and bill proposals are planned for adoption in early 2013.
In 2006 the Swedish government introduced a law allowing each of the 21 regions to introduce needle exchange programmes; however, close cooperation with a treatment service is stipulated for the implementation of these programmes.
The National Board of Health and Welfare presented the new regulations concerning needle exchange in February 2007. The regulations address the procedures county councils must follow in order to establish a needle and syringe programme (NSP), including: a justification of need (e.g. estimation of the 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 and to offer additional services, including vaccinations and testing for infectious diseases, and they define further quality management rules for the implementation of such services. At the end of 2012 four syringe exchange programmes were in place in southern Sweden. In 2011 about 244 000 syringes were given out via NSPs. 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, international airports and recently via postal consignments. However, professional full-scale illegal indoor cultivation of marijuana is spreading within the country. In 2008 some 20 well-organised and sophisticated indoor marijuana cultivation sites were dismantled. There is also some small-scale outdoor cannabis cultivation, GHB manufacturing and diversion of narcotic pharmaceuticals, but these are judged to be of limited importance for availability and supply.
According to police reports, cannabis is the illegal drug most frequently seized in Sweden, accounting for two-thirds of all drug seizures in 2011. Cannabis resin seized in Sweden originates from Morocco, while domestic cultivation is the main source for herbal cannabis. Amphetamine mostly originates in the Netherlands, Belgium, Estonia, Poland and Lithuania, and brown heroin comes from Afghanistan.
In 2011 the quantity of cannabis resin seized increased from 702 kg in 2010 to 950 kg, as did the quantity of cocaine, from 35 kg in 2010 to 89 kg. The quantity of ecstasy tablets seized increased from 2 400 to 17 080 tablets between 2009–11; however, there has been a dramatic decline in the seizures of ecstasy since mid-2000, which is assumed mainly to be due to a decrease in production, introduction of other ‘party drugs’ and a decline in the availability of MDMA. In 2011 the amounts of herbal cannabis, heroin, methamphetamine and amphetamine seized were smaller than in 2010. The declining trend in the number of amphetamine seizures and the amounts seized since 2006 is explained by an increase in availability of other similar drugs.
According to the official criminal statistics of Sweden, there has been a steady increase in the number of drug-law offences registered. Although drug-use offences predominate, the steepest increase in the past decade has been in production-related offences. The number of people convicted with drug offence as the main crime has also increased steadily 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.
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 possible penalties of up to 18 years for recidivists. The penalties for drug trafficking offences regulated in the Law on Penalties for Smuggling are identical to 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 of imprisonment.
The Bill on the Control of Narcotic Drugs enables narcotics to be handled for industrial purposes, while in 2011 it also allowed GBL and 1,4–BD to be regulated as narcotics. A new bill came into effect in 2011 to enable the confiscation and destruction of so-called ‘new psychoactive substances’. In addition, turnover of a number of new psychoactive substances was put under the control of the Swedish drug laws (classified as narcotic drugs and/or goods dangerous for health) in 2009–11.
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 — which is a society free from narcotics and doping, decreased medical and social harm from alcohol and a decrease in use of tobacco — there are seven equally important 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; these 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.
The strategy will be evaluated externally and will focus on two specific concerns: (i) the degree to which the stated objectives have been met; and (ii) operational level and quality. The national evaluation will also include an international comparison to enable an assessment of the extent to which changes at national and regional level have been influenced by changes elsewhere in the world (Government Offices of Sweden, 2011).
View ‘National drug strategies’ for additional information.
The Ministry of Health and Social Affairs is responsible for drug coordination, via the ANDT 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. 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 supports the implementation of the action plans. The formal responsibility for demand reduction and law enforcement is 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 details an annual budget for some drug-related activities, in line with 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) was estimated to represent between 0.2 % and 0.4 % of gross domestic product, 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) M. Ramstedt (2006), ‘What drug policies cost: estimating drug policy expenditures in Sweden, 2002: work in progress’, Addiction 101, pp. 330–8.
(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.
View ‘Public expenditure profile’ for additional information.
The National Action Plan on Drugs, which ended in 2010, significantly increased drug-related research and available funding. Priority was given to research involving the 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 2012 Swedish National report mainly focused on aspects related to responses to the drug situation, but research on prevalence of drug use and consequences was also mentioned.
View ‘Drug-related research’ for additional information.