Country overview: Sweden
- Situation summary
- Drug use among the general population and young people
- High-risk drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-induced 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 (28 countries)||Source|
|Population||2013||9 555 893||505 665 739||Eurostat|
|Population by age classes||15–24||2013||12.9 %||11.5 % ||Eurostat|
|25–49||32.8 %||35.0 % |
|50–64||18.3 %||19.7 % |
|GDP per capita in PPS (Purchasing Power Standards) 1||2012||126||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2011||29.6 % p||29.0 % p||Eurostat|
|Unemployment rate 3||2013||8.0 %||10.8 %||Eurostat|
|Unemployment rate of population aged under 25 years||2013||23.4 %||23.4 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2012||67.8||:||Council of Europe, SPACE I-2012|
|At risk of poverty rate 5||2012||14.1 %||17.0 % e||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, 2012.
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 among 20 000 randomly selected adults aged 16–84 (with a response rate of around 50 -%). 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. An analysis of the entire time series shows that the trend is stable at the same level for both sexes, in terms of both experimental use and more regular use among a subsample of 16 to 64-year-olds. Lifetime prevalence for males was higher at the start of the time series (17.6 % in 2004) and at the end (18.5 % in 2009; 18 % in 2010; 17.2 % in 2011; 17.5 % in 2012). Among females, lifetime prevalence was higher at the end of the time series (10.4 % in 2010; 11 % in 2011; 12.2 % in 2012). Last year and last month prevalence of cannabis use was considerably lower than lifetime prevalence for both genders, but indicated a fairly stable trend, with males reporting higher cannabis use prevalence rates than females. Lifetime, last year and last month prevalence were significantly higher for younger ages than for the whole adult population. Lifetime prevalence was the highest among 16- to 34-year-old males, reaching 23.6 % in 2012. An increase in lifetime prevalence was noted among 16- to 34-year-old females between 2008 and 2012 (13.5 % in 2008 and 20.7 % in 2012). Among males aged 16–34 there was an increase in the last year prevalence of cannabis use between 2008 and 2009 from 5.8 % to 9.8 %, while for females an increase was noted between 2009 and 2012 (3.8 % in 2009; 5.7 % in 2012). Last month prevalence of cannabis use was highest among males aged 16–24 (4.5 % in 2012).
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 an illicit psychoactive 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 inhalants (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 inhalant use 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.
Drug prevention activities in Sweden are a key element of A Cohesive Strategy for Alcohol, Narcotic Drugs, Doping, and Tobacco Policy 2011–15. 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, as well as being directly responsible for implementation of some activities under the Policy, also 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 2012 about 70 % had substance use prevention strategies in place and half had respective action plans. Municipalities also bear the main responsibility for the implementation of prevention measures. Approximately 75 % of the municipalities have now appointed a full-time or part-time drug coordinator for alcohol and drug prevention work at the community level, and a key component in preventive work is the support of municipality management.
School-based prevention interventions, mostly non-manualised, 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, and many schools also have in place interventions that involve parents.
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, police 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 detection 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 drug-intoxicated clients’ access to the setting. About 15 % Swedish municipalities had programmes in recreational settings in 2012.
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.
A new commission was set-up by the Government in 2012 to compile research on, and evaluate, drug prevention activities, with a specific focus on cannabis.
View ‘Prevention profile’ for additional information.
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. However, in 2012 a new definition of ‘high-risk drug use’ was adopted. The new definition includes ‘problem drug use’, but is broader (mainly in its inclusion of high-risk use of more substances). Details are available here.
The most recent estimate (for 2007) of the number of problem drug users (PDUs (1)) in Sweden was 29 513 (4.9 problem drug users per 1 000 inhabitants aged 15–64). According to the available estimates, the number of PDUs has been more or less constant since 1998. Problem drug use in Sweden is dominated by amphetamines and heroin.
(1)It should be noted that the definition of ‘problem drug use’ in Sweden is broader than the EMCDDA definition in that it includes more drugs.
Data is collected for the treatment demand indicator (TDI) by pooling data from various separate information sources, all of which function on a voluntary basis. The following data sources exists: (i) clients in substance misuse treatment (KIM), which covers about 25 % of the known 600 units in social services, and follows TDI guidelines; (ii) a system for quality development (DOK), which covers about 130 units, is integrated with KIM and contains all TDI variables; (iii) the Swedish dependency register (SBR) which covers inpatient and outpatient treatment units in healthcare, and is integrated with KIM/TDI; (iv) addiction severity index interviews, mainly used in prisons and not fully integrated with KIM/TDI.
In 2010 data on treatment demand were reported from 290 treatment units (134 outpatient and 156 inpatient units). A total of 6 424 clients entered treatment during the reporting year, of which 1 597 were new clients entering treatment for the first time. Among all clients treatment demands were linked mainly to amphetamine, cannabis and opioids. Among new clients the majority of treatment demands were linked to cannabis, followed by amphetamines and opioids. About 37 % of all clients entering treatment reported injecting drug use, with amphetamine being the main drug used by injection.
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.
Fewer cases of human immunodeficiency virus (HIV) were reported among people who inject drugs (PWID) in 2010–11 compared to 200–09, with 16 new HIV cases notified in 2012. In May 2012 an outbreak of five cases was detected among PWID in the city of Kalmar.
In 2012 the number of notified cases of hepatitis B virus (HBV) infection through injecting drug use was 33, or 9.3 % of all notified cases with a known risk factor (n=355). In 2012 some 1 231 new cases of hepatitis C virus (HCV) infection with a known transmission route were notified, of which 941 were through injecting drug use, and all cases are assumed to be of domestic origin. A diagnostic testing indicated high HCV infection rate in samples of PWID. Thus, 55.7 % of PWID in drug treatment from the metropolitan cities of Stockholm and Gothenburg in 2010 and 95.4 % of those in Stockholm in 2012 were HCV infected.
Drug-induced deaths data originate from the Cause of Death Register at the National Board of Health and Welfare (the ICD system), which includes almost 99 % of all deaths occurring in Sweden. Data extraction and reporting is in line with the EMCDDA definitions and recommendations.
In 2012 there were 412 drug-induced deaths reported in Sweden, and the data indicate an increasing trend with the number of cases doubling compared to 2004, when 188 drug-induced deaths were reported. Of the 412 cases reported in 2012 some 308 were male. The mean age of victims was 41years. For almost all cases (401) toxicology reports were available, and the data indicate the presence of opioids (mainly buprenorphine and fentanyl) in the majority (344) of these cases.
The drug-induced mortality rate among adults (aged 15–64) was 62.6 deaths per million in 2012, more than three times the European average of 17.1 deaths per million.
In Sweden, drug treatment is organised by the social services in the local communities (specialised outpatient clinics), hospitals (providing detoxification) or therapeutic communities. Compulsory treatment is provided by the National Board of Institutional Care in special cases. Treatment is mainly delivered by public institutions, followed by private and non-governmental organisations (NGOs). Drug treatment is also offered for those in prisons and on probation.
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 overall long-term rehabilitation. There are treatment facilities specifically for drug users, but as a rule of thumb drug use treatment takes place alongside treatment for alcohol and/or other addictions. There are reports of social reintegration interventions, although they seem to be limited in availability and coverage.
The Medical Products Agency’s Code Statutes LVFS 2004:15 stipulate that only treatment centres can initiate, and should be predominantly involved in, opioid substitution treatment (OST). Methadone (introduced in 1967) and buprenorphine (introduced in 1999) are the only officially recognised pharmaceutical substances for OST. In Sweden there are about 64 OST units in hospitals. OST with methadone has always been subject to strict regulation. Since the new guidelines for OST 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 the administration of structured psychosocial interventions.
The latest available data indicate that in 2011 a total of 5 200 clients were in opioid substitution treatment in Sweden.
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 reduce the 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 and syringe 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 and syringe exchange programmes under authorisation from the National Board of Health and Welfare; 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 and syringe 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. an estimate 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 2013 five NSP were in place in Sweden. In 2012 about 73 000 syringes were given out via NSPs, and served about 1 037 clients. The NSPs 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.
Illicit 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. Twenty well-organised and sophisticated indoor marijuana cultivation sites were dismantled in 2008. Small-scale outdoor cannabis cultivation, GHB manufacturing and diversion of narcotic pharmaceuticals also occur, 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 more than half of all drug seizures in 2012. Cannabis resin seized in Sweden originates from Morocco, while domestic cultivation is the main source of herbal cannabis. Amphetamine mostly originates in the Netherlands, Belgium, Estonia, Poland and Lithuania, and brown heroin comes from Afghanistan.
In 2012 the quantity of seized cannabis resin and herb increased when compared to 2011. The quantity of cannabis resin increased from 950 kg in 2011 to 1 091 kg in 2012, and of herbal cannabis from 264 kg to 641 kg respectively. Overall, there is a slight decrease in amphetamine seizures since 2006, although the 314 kg amphetamine seized in 2012 is double that for 2011 (168 kg). Methamphetamine seizures, after reaching a maximum in 2009, have stabilised, but the quantity of methamphetamine seized is decreasing (164 kg in 2009; 47 kg in 2012). In the last three years ecstasy seizures have increased dramatically and the quantity of ecstasy tablets seized increased from 2 400 to 38 630 tablets between 2009–12. In 2012 the amounts of heroin and cocaine seized were smaller than in 2011.
According to the official criminal statistics for Sweden, there has been a steady increase in the number of drug-law offences registered, with 97 379 drug-related offences reported in 2012. 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 Act on the Control of Narcotic Drugs regulates trade in narcotics for medicinal or industrial purposes. The use and possession of illicit drugs are criminal offences under the Narcotic Drugs Punishment Act. Possession is 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. 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. Importing such goods is punished in the same way as for drugs offences, whereas possession and transfer are punished by up to one year of imprisonment. More recently, a new Act came into effect in 2011 to enable the confiscation and destruction of new psychoactive substances before their official classification as narcotics, but with no other penalty for the owner.
View ‘ELDD’ for additional information.
View ‘top of page
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 the evaluation 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.
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 Public Health Agency plays a central role in the implementation of the national drugs strategy and action plans. It works with and supports the ANDT coordinators at the county administrative boards and is responsible for monitoring the implementation of the national drugs strategy’s goals. The National Board of Health and Welfare functions as the administrative authority for the provision of healthcare and medical services generally, as well as in the area of drug use. It seeks to promote good health and social welfare, while supporting an equal level of care and quality for the whole Swedish population. The County Administrative Boards are given a central position and are responsible for the supervision and 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 the study for 2002 (1) is the only one to provide 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, 0.7–1.7 % for prevention and 0.1–0.2 % 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.
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 2013 Swedish National report mainly focused on aspects related to responses to the drug situation and consequences of drug use, but the prevalence, incidence and patterns of drug use, methodology issues, supply and markets and mechanisms of drug use and effects were also mentioned.
View ‘Drug-related research’ for additional information.