In 2016, two persons were sentenced to eight and four years in prison for the importation of 193g of cocaine, 10,000 MDMA doses, and 9kg of amphetamines through the international airport in Keflavík. This case was labeled as 'burðardýrsmálið' (drug mule case) and included smuggling from Holland (Supreme Court 2016). The person who received eight years in prison, a Dutch woman, attempted to help the police in catching the principal offender but to no avail. The stiff sentence she was awarded for simply being a drug courier was reportedly due to the amount of hard drugs being smuggled. How many of the inmate population in Iceland have served time in prison for drug-related offenses?

In the 21st century, about one third of the entire inmate population has routinely been serving time in prison for drug-related offenses. In 2018 and 2019, the ratio of drug offenders reached a historic high of 40% of the total inmate population (Prison and Probation Administration 2020). In 2016, a total of 100 inmates served time in prison for drug importation, production, or sale. In the 1980s, and well into the 1990s, the rate of drug offenders in prison was considerably lower, less than 10% of the prison population (Gunnlaugsson & Galliher 2000).

## **Drug Crimes Known to the Police**

Figure 9 indicates the number of drug violations recorded by the Icelandic police each year since 2010, followed by Table 11, which shows the type and amounts of drugs being seized by the police. Both show an increase in the new millennium.

As can be seen in Figure 9, the total number of drug offenses increased markedly during 2010–2014, from about 1500 offenses in 2010 to about 2400 offenses in 2014, a peak year. Since 2015,

**Figure 9.** Total number of drug offenses in Iceland, 2010–2019, including only possession of drugs, and the number of offenses per 100,000 inhabitants.

Source: National Commissioner of the Icelandic Police, annual reports, 2020.

**Table 11.** Types and amounts of substances seized by police, 2011–2019.

Source: National Commissioner of the Icelandic Police, annual reports, 2020.

the total number each year has become more stable, with about 2000 offenses registered annually in Icelandic police records, including cases under police investigation for suspicion of drug violations (National Commissioner of the Icelandic Police 2020).

These offenses, as before, consist predominantly of possession of drugs and, in smaller portions, of importation, production, and distribution of drugs. About 70% of these offenses involved the possession of drugs for personal use. As can also be seen in Figure 9, the number of drug offenses known to the police has been hovering around 600 offenses per 100,000 inhabitants during most recent years.

As can be seen in Table 11, a variety of drugs have been seized by police in the past few years. The total amount of drugs apparently increased during the time period 2011–2019. The most notable increases included cannabis, cocaine, and amphetamines, with a peak year in 2019. Most of the drugs seized by the police in 2019 comprised of amphetamines (55kg), cocaine (40kg), cannabis (hashish/marijuana) (35kg), and about 2500 ecstasy doses. Heroin was hardly ever seized by police during this time period.

The minimum fine stipulated for possession of drugs is approximately €350 for cannabis and more for ecstasy and cocaine. If the amount of cannabis seized is 10g, the fine is approximately €650 (Ministry of Justice 2018). Many of the drug offenses for possession of drugs occur during routine police checks on the road or while investigating criminal cases where drugs are found on crime suspects etc. With the legal change in 2018, drug fines of less than 100,000 Icelandic kronas (approximately €700) are no longer registered on the criminal record. The Justice Minister reported in Alþingi to a query by a *Pirate Party* member of parliament, that if the legal change had been made 6 months earlier, more than 100 persons only registered on criminal record for a minimum drug fine would have escaped this notification (Ministry of Justice 2018).

The ratio of those driving while on drugs has increased significantly in recent years (National Commissioner of the Icelandic Police 2020). In 2014, the total number of cases of driving while intoxicated (and not inebriated) was slightly short of 1500. In 2018, the number had reached almost 2500. In 2018, the number of cases of driving while intoxicated on alcohol was about 1700 – or a significantly lower number than the cases involving drugs. The overall rate of driving while intoxicated from alcohol or other drugs had previously been found to be comparatively high in Iceland (Gunnlaugsson & Galliher 2000).

## **Nature and Extent of Drug Use in Iceland**

International surveys indicate that drug use among 10th graders is generally lower in Iceland than in most other European countries (ESPAD 2020). The average in Iceland for lifetime prevalent use of cannabis, by far the most frequently used illegal drug, was, for example, 6% in 2019, while the European average (16%) was significantly higher. Iceland had the lowest levels of cannabis use among Nordic nations, with Sweden (8%), Faroe Islands (9%), and Norway (9%) coming close to Iceland. Finland (11%) and Denmark (17%), however, reported higher levels. As mentioned above, the *Youth in Iceland* project has been cited as being decisive in the positive development of drug use among youth in Iceland, with lower rates in 2019 than in previous ESPAD surveys.

Surveys of cannabis use among Icelandic adults (citizens over 18 years old) have not been measured as regularly as among adolescents. Population surveys conducted by the Social Sciences Research Institute, affiliated with the University of Iceland, during 1997–2019 suggest an increase in the lifetime prevalence of cannabis use (Figure 10) in this time period. Approximately 33% admitted to using cannabis at least once in 2019, with close to 5% admitting to its use in the last 6 months (Gunnlaugsson & Jónasson 2019). As Figure 10 shows, this suggests an increase from 2013, when the lifetime figure was 23%, and 2002, when the figure was 19%.

Therefore, use of cannabis among youth appears to be going down over time but, at the same time, increasing in the adult population. According to the 2019 survey of cannabis use among adults in the last 6 months (5%), as shown in Figure 10, it can be roughly estimated that up to 15,000 might be active cannabis users in Iceland, out of a total population of around 370,000 citizens. In comparison, active users of alcohol have been estimated to be at least half of the adult population (Directorate of

**Figure 10.** Percentage among adults (18 yrs and older) admitting cannabis use in their lifetime in 1997, 2002, 2013, and 2019. Source: Gunnlaugsson 2018; Gunnlaugsson & Jónasson 2019.

Health 2017), or much higher than levels of cannabis use. The apparent pattern of cannabis use among adults is described in the section below.

As Figure 11 suggests, most lifetime use seems to take place among younger age groups. Use appears to be experimental, temporary, perhaps most out of curiosity, many discontinuing its use altogether when they grow older as work and family obligations gain precedence (Gunnlaugsson 2018). Prevalence of this type of use over time probably linked to fashion waves, music taste, and other cultural fads – mostly international in nature – among younger age groups. Occasionally, experimental and social use appear to be trendy in popular culture and accompanied by increased access to drugs and more use, sometimes being less trendy with less use. The next sections further analyze drug abuse in this group.

Only a minority of these temporary users seem to require help from the social and health care services because of their use, i.e. the vast majority of this group are not drug abusers. These users are, for the most part, ordinary citizens who are not involved in any other forms of criminality, apart from using illicit drugs. However, all of them are at risk of being pursued by the police and criminal courts. Understandably, none of them want police involvement or criminal indictment for their use of drugs.

**Figure 11.** Percentage of adults older than 18 yrs who, in 2019, admitted cannabis use in their lifetime, by age. Source: Gunnlaugsson & Jónasson (2019).

Therefore, a pressing question emerges: Where is the drug abuse problem most pronounced? Interestingly, the most pressing and recent drug problem in Iceland has not only involved illegal drugs but also drugs originating mostly from the pharmaceutical industry and the medical profession.

## **Icelandic Opioid Crisis**

With respect to legally prescribed drugs originating from the pharmaceutical industry, the picture for Iceland becomes more complicated than that suggested from the above picture of experimental and temporary drug use in Iceland (Gunnlaugsson 2019). The use of prescription drugs, or other synthetic drugs, seems to be widespread across different social groups, rather than being found only among socially distinct groups.

Apparently, a lot of prescription drugs are in circulation in Iceland. According to *Nomesco* (2017), more opioids are prescribed in Iceland than in any other Nordic country. Iceland also appears to be the leading Nordic country with respect to prescribing medical treatment for ADHD and in terms of antidepressant consumption. In the last decade, the use of antidepressants reportedly increased by about half in Iceland, and the use of ADHD prescription drugs exhibited a whopping 165% increase (Arnórsson 2018). Even though prescriptions for insomnia and of sedatives have decreased somewhat in the country in the last decade, Iceland still leads Nordic nations for consumption of these drugs, also ranking among the highest in the world. Moreover, close to 20% of all women and about 10% of all men in Iceland received a prescription for an antidepressant in 2017. Most of the increase for these prescriptions in recent years has been among those who are 40 years old or younger (Jónsson 2018a).

Some of the opioid prescriptions end up on the black market. In addition to other sources, the smuggling of medical drugs from other countries is also prevalent. According to the head physician at a local rehab center, access to different types of drugs – both legal and illegal – is easy in Iceland and their prices have remained stable or reduced (Ólafsdóttir 2019). A new comparative Nordic study on drug dealing over social media platforms observed a high degree of drug dealing activity in Iceland. All kinds of drugs are available in closed groups, including prescription drugs in addition to illegal drugs (Demant et al. 2019). A total of 30 private Facebook groups with several thousand members were found online in Iceland. One seller in these groups stated in an interview, 'my customers are just ordinary citizens.' Recently, news reports have shown large seizures of cocaine by police (see Table 11), with cocaine reportedly flooding the market like never before (Brynjólfsson 2019; Helgason 2019).

## **High Number of Drug-Related Deaths**

The medical drug situation in Iceland described above may come as a surprise since Iceland is a country of low drug use according to the ESPAD study of young students mentioned above. Furthermore, this claim might be unexpected since Icelanders consume less alcohol than most western nations, even though the gap between Iceland and other countries has been shrinking (OECD Health Statistics 2020). The opioid situation in Iceland has created significant national concern because opiates are highly addictive and can easily result in different types of health risks, in addition to other problems, such as accidents on the roads. Moreover, opiates are often used with other substances, such as alcohol and other drugs, thereby creating toxic cocktails.

Resultantly, numerous drug-related deaths have been reported in Iceland. From 2015 to 2017, a total of 85 drug-related deaths from different drug-related intoxications were reported (see Figure 12), including a total of 42 citizens dying due to opiate abuse. Opiate abuse was the most frequent cause of deaths due to intoxications for this time period, exceeding deaths due to illegal drugs by a large margin. The opiates mostly consisted of morphine, codeine, demerol, tramadol, and fentanyl (Jónsson 2018b). In 2018, as can be seen in Figure 12, a total of 39 related deaths in Iceland were reportedly related to drug overdoses, and more than half of them were opioid-related (Magnúsdóttir 2019; Yaghi 2019). According to the *New York Times*, deaths due to opioid drug overdoses are comparatively high in Iceland, and about half of the rate in the US (Katz 2017). This rate translated to 6.6 deaths per 100,000 Icelandic citizens in 2018. The total rate of drug-related deaths during 2010–2019 was however higher, as can be seen in Figure 12. The total rate of drug-related deaths during 2010–2019 was from 7.1–11.1 deaths per 100,000 inhabitants, as can be seen in Figure 12. Moreover, as shown in Figure 13, males had a higher drug-related death rate than females for most of this time period.

**Figure 12.** Total number of drug-related deaths and drug-related death rate, 2010–2019. Source: Directorate of Health 2021.

**Figure 13.** Drug-related death rate per 100,000 inhabitants in Iceland by gender, 2010–2019.

Source: Directorate of Health 2021.

Why does the situation of prescription drugs and drug-related deaths appear so grim in Iceland? Perhaps prescription drugs are more accessible in Iceland than, for example, in the other Nordic nations. The Directorate of Health in Iceland, therefore, established an online prescription database for physicians in 2016 to prevent people from receiving multiple prescriptions for medications from different doctors. In July of 2018, regulations concerning prescription drugs were tightened further, making it more challenging than before to legally obtain drugs of this type. The impact of tighter regulations has indeed resulted in fewer opiate prescriptions in most recent years, yet Iceland is still leading Nordic nations in the number of prescriptions (Directorate of Health 2021). However, if drugs are smuggled in large quantities from abroad, such measures might not show much impact on local black-market availability.

The supply and availability of drugs do not account for the high demand for these types of drugs in Iceland. Prescription drugs probably carry less stigma than illegal drugs and, therefore, may appear more attractive to larger groups of ordinary citizens than illicit drugs. As for legally prescribed drugs, alternatives to drug use, such as consulting and therapy – increased access to social and psychological services – are options that perhaps have not been utilized to the same degree as in other Nordic nations.

## **Risk Factors and Drug Abuse**

Studies show that alcohol and drug dependence can affect anyone; for instance, alcoholics seem to belong to all walks of life. Nevertheless, research indicates that a significant section of those who hit rock bottom due to heavy drug abuse, especially those who inject drugs, face various personal and social problems (see, for example, Curry 1994 and Zilney 2011). Low formal education, limited work experience, health care problems, and crime-prone lifestyles are all factors associated with drug abuse (Goode 2015), and to a much larger degree than found in the general population. Research findings of this type on drug abuse in Iceland, fueled by the local opioid crisis, have raised questions about the most effective way to respond to the problem of drugs.

A recent study conducted in Iceland seems to support the above social portrayal of heavy drug abuse. Based on data from a national rehab clinic in Iceland, where information about close to 200 patients suffering from hard drug abuse (use of needles) was utilized during a two-year period, Aradóttir located (as cited in Gunnlaugsson 2015) a distinct social pattern. About half of the sample admitted upon entrance to the clinic that they had earlier been diagnosed with a disability of some sort and had limited work experience. The majority had only completed compulsory education. About 60% of the hard drug users in this study had previously been arrested or charged for drug violations, while only 25% of other patients at the clinic had the same experience. About one third admitted to having prior police history of thefts, frauds, or violence. Thus, it is evident that most hard drug users are crime-prone with prior police history. The vast majority suffered from mental health problems, depression, anxieties, and tension. More than 70% of these drug users had considered suicide and about half had attempted suicide. More than half had been diagnosed with liver problem C and a few with HIV. Of the females, the vast majority had experienced violence and about 75% of them reported having been sexually victimized.

Admissions to the national rehab center are in the thousands each year, as previously mentioned. Increasingly, more patients in this group are admitted due to drug dependence, and the rate of alcohol abuse alone has diminished in recent years (SÁÁ 2021). In 2017, close to 40% of those admitted did not have any permanent housing, thereby suggesting poor social conditions, and about one quarter resided with their parents.

A survey conducted in Icelandic prisons in 2015 indicated similar results of poor standing among prisoners. The vast majority of inmates suffered from serious alcohol and drug problems and had been diagnosed with a variety of personal and social problems, including ADHD and reading and writing difficulties (Hlöðversdóttir 2015; Gunnlaugsson 2018).

Therefore, there seems to be a high polarization of drug users in society. A large part of the population, particularly young people, appear to be willing to experiment and use drugs recreationally without apparently harming themselves. A large minority, however, end up becoming serious drug abusers with multi-faceted personal and social problems, posing a risk to themselves and others. Research, both in Iceland and elsewhere, roughly seems to draw up this polarized picture of the drug problem.

Is the criminal justice response the appropriate measure to deal with the kind of behavior described above? Is an unregulated black market of drugs, including opioids, where consumer protection obviously is limited and appropriate education on how dangerous these drugs can really be not available, acceptable in modern-day welfare societies? In the wake of a public debate where questions of this type have appeared, harm reduction principles have slowly emerged in Iceland in recent years to tackle this profound problem with a new approach. The long history of treatment availability in Iceland, and wide recognition of its success in dealing with substance use, has undoubtedly helped in paving the way for an alternative approach.

Consequently, local harm reduction programs have been established in Iceland. As early as 2009, the Red Cross in Iceland launched a project on wheels, *Frú Ragnheiður* (Mrs. Ragnheiður), driving around the streets of the capital for six evenings a week (Frú Ragnheiður 2020). The vehicle is a specially equipped medical reception for the homeless and people with drug addictions, offering medical care and general health advice to individuals, as well as a service that exchanges old needles for new. In 2018, approximately 450 individuals sought assistance from this program.

### **New Drug Alternatives in Iceland?**

A widespread consensus to continue with the firm stand against drugs has existed for a long time among Icelandic authorities. The public, at large, seems to support this national effort and moral sentiment. As population surveys have repeatedly indicated, there exists widespread opposition in Icelandic society toward drug use. In 2014, the vast majority of Icelanders were in favor of offering more rights to the police to investigate drug crimes. Most respondents believe drug use to be the most serious crime in Iceland and substance use to be a decisive factor in the genesis of local crime (Gunnlaugsson 2018). In May of 2019, about 26% of all respondents favored the legalization of cannabis and 35% were in favor of the decriminalization of the possession of drugs for personal use (Gunnlaugsson & Jónasson 2019), so the significant majority of Icelanders were against both the legalization of cannabis and the decriminalization of drug use.

However, support for alternative drug policies has increased somewhat in recent years, suggesting a retreat from the punitive stand. As a case in point, about 80% of all respondents opposed the legalization of cannabis in 2012, with fewer, or less than 70%, opposing legalization in 2019 (*Mbl.is* 2019). Local efforts such as *Frú Ragnheiður* and evidence on the nature of drug abuse, as for example reflected in the opioid crisis, have paved the way for new approaches to the drug problem. Resultantly, the notion that drug abuse should be defined and treated as a public health problem instead of a criminal justice issue has become more prominent (for example, Holm 2015). In the last few years, alternatives to current drug legislations have consequently appeared in Iceland. Proposals have been introduced in Alþingi, with the intent to revise the local narcotics legislation. The primary focus has been on softening the ban on drugs to some extent, i.e., decriminalizing personal possession and use of drugs, particularly cannabis (see, for example, Alþingi 2012–2013). These proposals have typically generated widespread public debate in society. Even though not put into immediate effect, they still served to open up the drug debate in society, providing a platform for alternative actions adopted by the government later.

More active public debate on drugs can indeed be detected in Iceland. Different opinions have been raised on tackling the local drug issue, with seminars and conferences critically dealing with the drug problem (see, for example, *Heilsutorg* 2014). Local grassroots groups (for example, *Snarrótin* 2020) offering alternative perspectives on the drug problem have also emerged. Individual political parties, such as the *Pirate Party* and young members of the *Independence Party*, have increasingly voiced alternative approaches in their party agenda.

In 2014, the Minister of Health from the *Independence Party* publicly announced at a meeting with young members of his party that decriminalization of personal possession of drugs should be seriously considered by the local legal body. Subsequently, an expert committee was established to revise and introduce new drug legislation on the issue (Bjarnar 2014). This move by the Minister of Health was unusual because drug controls and drug legislations, as previously mentioned, are formally located within the Ministry of Justice, and so this possibly reflects new voices in society that believe drug abuse to be a public health problem rather than a crime problem.

A report from the committee was eventually submitted to Alþingi in the name of the Minister of Health (2016). The most noteworthy recommendation in the report was the discontinuation of registering minor possession of drugs on the criminal register and stopping the use of urine tests to determine whether individuals are driving while intoxicated. In 2018, as previously mentioned, provisions concerning the criminal register notification were revised by the state prosecutor. Moreover, a proposal establishing a safe place for needle change and drug use was also included in the report. Such a safe site for those most affected by serious drug abuse would enable health workers to step in and assist them.

In May of 2020, Alþingi passed a new legal provision permitting local governments to open safe places for drug addicts (Alþingi 2020). However, as of early 2021, this place had not yet been opened, apart from the Red Cross program *Frú Ragnheiður* mentioned above. A critique raised belonged to the capital area police chief. Drugs used by addicts are controlled substances, and the local police are obligated to confiscate them. The police cannot look the other way and do nothing while illegal possession and the use of drugs are occurring in front of their eyes (Pétursson 2019). Despite opposition from the Icelandic police, a legal change allowing safe places for drug addicts was still approved by the local legal body.

As for driving while intoxicated, since 2018, drug residuals found in urine samples cannot serve as a basis for conviction; only blood samples can be used (Icelandic Transport Authority 2018). In the past, many drivers who had drug residuals in their urine sample, such as THC from cannabis, which may have been consumed up to a month earlier, were at risk of being convicted for driving while intoxicated. Currently, only those who exhibit signs of drug intoxication at the time of driving, as shown in blood samples, can be convicted for driving while intoxicated (DWI).

These legal actions can be considered a sort of policy shift from the punitive stand against drugs and a minor step toward the decriminalization of the personal use of drugs, in addition to only punishing those who are shown to be intoxicated while driving a vehicle. This suggests a retreat in the battle against drugs, moving away from restrictive policies to a somewhat softer approach. However, possession of drugs for personal use is still punishable by Icelandic law, resulting in a fine.

In the fall of 2019, a new drug bill was introduced in Alþingi (Alþingi 2019a). Nine MPs out of a total of 63 members, representing five of the eight political parties in Alþingi, introduced a proposal calling for the decriminalization of possession of all drugs for personal use. The type and quantity of drugs were not specified in the preamble of the bill. Under this bill, receiving and buying drugs above an unspecified limit for personal use will continue to be illegal. Possession of drugs for personal use will only be regarded as a public health issue and not a penal one. The importation, production, and distribution of drugs continues to be prohibited. If this bill is passed, according to the preamble, supervised drug sites for serious drug abusers will become possible for the first time. An important reason for not establishing such sites earlier was that the possession of drugs for personal use is prohibited and punishable by at least a fine. This makes it challenging, if not impossible, for health care workers to provide the necessary health services to hard drug abusers. The positive outcome of the Portugal experience of decriminalization was cited as a source to justify the objectives of the proposal. However, as previously noted, safe places for drug addicts have now been allowed by the legal body.

This new proposal was finally defeated in an Alþingi vote by a large margin in late June of 2020 after a heated debate (Hrönn 2020). Realistically, it did not seem likely to be passed. Two of the political parties in the present coalition government in Iceland did not have representation among the sponsors of the bill. A proposal originating from the opposition is not likely to be passed. However, a proposal departing from the punitive stand on drugs had reached the legislative agenda in Alþingi and so symbolizes new voices and directions in dealing with the country's drug problem. An editorial in the most-read local newspaper openly supported the proposal, stating that the war on drugs had been lost (Sigurþórsdóttir 2019).

Interestingly, in January of 2021 the Minister of Health announced plans to introduce a new bill in Alþingi calling for decriminalization of small amounts of drugs for personal use (Pearson 2021), based on the assumption that drug addiction is more of a public health issue than a crime problem, similar to the earlier bill defeated in June of 2020. As a possible obstacle, the Directorate of Health repeatedly opposed a legal change of this type (see, for example, Alþingi 2019b). Yet in January of 2021, a new direction could be detected. In a formal statement about the new bill, the Directorate of Health revealed a favorable stand on decriminalizing small amounts of drugs for drug addicts (Þórisdóttir 2021), although added a reservation that this was only to be approved if the legal reform was to be properly placed within a broader social policy on drugs. Therefore, it can be argued that a possible paradigm shift in dealing with drug abuse might be in the making in Iceland. However, the bill did not make it to a vote before the Alþingi recession in June of 2021, and therefore did not pass.

## **Concluding Remarks**

The free market is a fundamental doctrine of the European Union, the World Trade Organization, and other powerful institutions (Sulkunen 2009). However, the free-market ideology has not yet penetrated to any significant degree into the market for illegal drugs that are mostly used for recreational purposes in the western world. Punitive measures in the area of drug use are vigorously and morally defended by western authorities, including Nordic nations, as shown in this book, using the state apparatus to seek out and prosecute both drug producers and sellers – and in many countries, also drug users.

These efforts by the state are, in one way or another, justified by the principles of protecting the public – a similar battle to the one western authorities lost a long time ago in the struggle against alcohol (Gunnlaugsson 2012). Even though actions adopted by governments to curb drug use contain the potential for subverting legal traditions of individual freedom, they are still believed to be necessary for ensuring public good.

Why has the state been able to both introduce and maintain this punitive grip over drugs in modern society? The relatively short history of the influx of drugs to the western world in the 1960´s and 1970´s most probably has something to do with the intensity of punitive state reactions today. As a case in point, tobacco and alcohol have a much longer history in western societies, with both being legal despite posing immense health risks. For Iceland, a small island nation far away from neighboring countries, drugs have been seen even more as an outside imposition threatening the nation, especially the young, possibly undermining the future of the nation. Drug use is risky and regular media reporting on devastating stories of drug abuse understandably alarms the general public.

A recent United Nations *World Drug Report* was blunt in its conclusion, claiming that criminal sanctions for drug use are not beneficial (*World Drug Report* 2014). It is certainly worthwhile and interesting to speculate on what future drug legislation developments will occur, or will look like, in Iceland or other Nordic countries. Is it probable that many recreational drugs, such as cannabis, will be defined and regulated by law in the same manner as we define alcohol today, or even tobacco, as has been the case in, for example, many US states and Canada? General alcohol and tobacco prohibition seem somewhat out of place in modern-day society and are incongruent with our ideas of freedom and human rights, despite alcohol problems and the harms of tobacco both being well-known and serious (Gunnlaugsson 2012). Will, similarly, the current prohibitive drug legislations be perceived in the future as both archaic and unjust, and perhaps even futile? In this respect, it is noteworthy that the use of tobacco has significantly decreased in recent years in many western societies without punitive measures. Perhaps the same can happen with recreational drugs, with its use being regulated through social and cultural norms instead of resorting to action by the criminal justice system.

If some of the drugs currently banned will eventually be regulated, or even legalized, will this inevitably result in increased public use with more health-related risks than we experience today? By allowing free-market forces to realize their full impact, legalization of the most common drugs – for example, cannabis – will most probably result in more general use of the drug, just as was the case previously with alcohol use (Gunnlaugsson 2017). The temporary and experimental use of drugs, which primarily characterizes use today, as shown in this chapter, will most likely be replaced by more widespread and permanent use of drugs in older age groups. Preliminary results from the legalization of marijuana in the US have been followed by lower prices, a dual legal and illegal market, and – in some instances – more problematic use (Savona, Kleiman & Calderoni 2017). Yet, it is probably too early to be conclusive about the outcome of the recent legalization in the US and Canada. Nevertheless, we might still expect that these changes are not altogether unproblematic.

Contrarily, it is not self-evident that the legalization of drugs necessarily includes free marketization and increased drug use. The supply of drugs and market availability could instead be regulated through similar sources as common medicines and drugs. Even state monopoly on alcohol sale restrictions, as are currently present in several Nordic nations, are also possible options for distributing recreational drugs. Sale arrangements, however, rely on political decisions and, obviously, many different policy choices are open to policymakers if the ban on drugs is relaxed, or even lifted, in the future.

As for the decriminalization of the possession of drugs for personal use, it is evident that it does not include the free marketization of drugs. The production and sale of drugs continue to be banned and will, therefore, not be placed on the free market with decriminalization. As early signs suggest (Drug Policy Alliance 2019; Hughes & Stevens 2010; Quintas & Arana 2017), decriminalization policies do not necessarily result in increased drug use where these policies have been enacted.

As for Iceland, which only legalized beer in 1989, a major legal change might seem unlikely. More liberal alcohol policies, including the legalization of beer, have indisputably increased the total amount of alcohol consumed in Iceland in recent years (Gunnlaugsson 2017). Alcohol use among youth, however, has not increased as many beer opponents had feared. Some new, local signs pointing toward a retreat of the firm punitive stand against drugs have, nevertheless, appeared in Iceland, suggesting a possible paradigm shift in the future. This retreat has largely centered on reacting against drug abuse, fueled by the local opioid crises. As the review above indicates, the notion that drug abuse is a public health issue instead of a crime problem has increasingly gained a foothold in Icelandic society. This has been most clearly shown in the legal change allowing safe havens for drug addicts in 2020 and a new decriminalization proposal from the Minister of Health in 2021.

However, recreational drug use as a legally and socially accepted policy in Iceland might seem farther away, as public opinion surveys have repeatedly shown. Social and cultural aversion of drugs in Iceland, revealed in local surveys, do not suggest immediate public support for decriminalization proposals. Nevertheless, more active public debate on drug policy alternatives in most recent years might possibly change the public mind in the foreseen future. Legal reforms, including reduced punishment for the importation, production, and sale of drugs, not to mention legalization of all drugs, have moreover not yet appeared in the legislative body of Alþingi. The criminal courts routinely mete out relatively harsh punishments for these types of drug offenses without any notable opposition from the public or government officials alike. Recent prison figures of drug offenders show no retreat of punitive practices, reaching a historic high in 2018 and 2019 with about 40% of the total inmate population serving time for drug-related offences.

A thorough restructuring of the Icelandic drug laws toward a non-punitive drug policy, where the production, sale, and use of drugs are legally regulated, seems more likely to be adopted in Iceland as part of a broader multi-nation effort, rather than Iceland acting alone. Nordic nations, being internationally recognized welfare societies, could be ideal candidates to adopt alternative and more humane drug policies in the future. Nordic nations, however, currently offer different drug policies, as shown in this book, which might make a unified Nordic drug policy seem unlikely.

## **References**

Research Council for Criminology. Retrieved October 22, 2019: https://www.jus.uio.no/ikrs/english/research/publications/2015 /drugs-problem.html.

Retrieved October 22, 2019: https://www.ruv.is/frett/thrju -staerstu-kokainmal-islandssogunnar-a-arinu.

*in Nordic Countries*. NSfK Working Group Report, pp 47–61. Århus: Scandinavian Council for Criminological Research.

*substance use*]. Lögð fyrir Alþingi á 145. löggjafarþingi 2015– 2016. Submitted to Alþingi (Iceland Parliament).

Vog Rehab Center claims access to drugs is easy and price going down]. *Visir.is*. Retrieved February 1, 2021: https://www.visir .is/g/2019758169d.

## **5. From Medicine to Morals, and Back Again? The Changing Perceptions of 'the Drug Problem' in Norway since 1965**

*Paul Larsson*

This article will deal with how the public and political discourse has changed in Norway during the last five decades concerning the 'the drug problem'. The basic idea is that these changes are related to the ways the drug problem is perceived and presented in the public discourse and official publications. The reasons for these changes in perception are related to factors such as external pressure to implement penal regulations of the field but also changes in youth culture and how it is conceived by the public, media, and the political elite (NOU 2019: 26; Ot.prp nr. 5 1971– 72; Skretting 2013; St.meld. 66 1975–76).

Hauge (2009) and Lind (1974) stated that, until the mid 1960s, Norwegian state officials implemented the international laws concerning drugs, such as the single convention, without giving them too much attention. Drugs were not seen as a substantial problem in Norway, at least *not a crime problem*, so the effects or relevance of these laws did not cause much worry. The main strategy towards the drug problem from the 1930s until the early 1960s was health oriented (Lind 1974; Pedersen 2020). Drugs were not a hot topic in the press or in politics, they was mainly regarded as a medical problem for experts to deal with. The first two police officers working part-time with drugs were appointed in the Oslo PD in 1965. This relaxed approach was to change dramatically in the years to come. One of the most interesting features of this process of penalization was the creation of the drug user as deviant

#### **How to cite this book chapter:**

Larsson, Paul. From Medicine to Morals, and Back Again? The Changing Perceptions of 'the Drug Problem' in Norway since 1965. In: *Retreat or Entrenchment? Drug Policies in the Nordic Countries at a Crossroads*, edited by Henrik Tham, 103–127. Stockholm: Stockholm University Press, 2021. DOI: https://doi.org/10.16993/bbo.e. License: CC BY 4.0.

and criminal, and the development of new and expanding categories of crime. Drug users used to be conceived as a health problem, in need of care and assistance. The criminalization of drugs was a move from medicine to morals. The normal reaction towards drugs changed to one of police involvement, sentence – normally a fine – and an attached stigma. In line with classic stigma theory, deviance is not something that originates from the person itself or the act, but instead our way of reacting to certain acts under certain circumstances by certain people (Franko 2020). The criminal drug addict became associated with youth with certain traits – long hair and often with social, mental, and health problems. As Lind points out as early as 1974, the ones who came to be labelled as drug addicts and rounded up by the police were not the average youth experimenting with drugs, but a sad representation of marginalized segments of Norwegian society.

Table 12 shows the growth in cases investigated from 1968 to 1998. There are no other forms of reported crimes that are even close to this rate of expansion. The numbers continued to grow until 2013, when they peaked at an all-time high with more than 47,000 cases reported (Table 13).19 Since this time there has been a marked decline, as with other forms of registered crime. The numbers show the most dramatic increase in the 1990s.

**Table 12.** Investigated drug cases, 1968–1998.

Source: Haslund (1999).

<sup>19</sup> Table 12 represents investigated cases while 13 deals with reported cases. The numbers of reported cases will be higher than those investigated since cases will be dropped for different reasons.

Source: Reported Crimes.21

Not only did the number of cases and police resources increase, so too did the severity of punishments and sentences. Christie and Bruun (1985) document the developments in the scales of punishment, from a maximum of two years imprisonment in 1964 to 21 years in 1984. This raises two questions: what can explain these numbers? How can we make sense of them?

The common response to this growth in numbers is that they simply reflect the developments of the drug problem. 'Look at these numbers, something must be very wrong in society when we create harsher laws but numbers still keep rising.' The answer to this claim has often been that we need still tougher laws and more police resources to scare off traffickers, pushers and users.

Another response is that the numbers primarily mirror the control activity in the field. The more police and customs resources that are used, the higher the number of cases detected. In this perspective, drug-related crimes are a more or less inexhaustible resource where police 'round up the usual suspects'. This is pointed out by Lind (1974) when she documents that approximately 5% of the cannabis users in Oslo were apprehended by the police. In general, users reflected the general population, however the ones caught more often had personal, social, and medical problems. They confirmed the stereotypical image of the 'drug addicts'.

We know from data on self-reported use that there was a clear increase in drug use in the 1970s (Haslund 1999). This increase was not in any way close to the growth in the number of investigated cases. The alarming development in the 1990s, with an increase in reported cases of approximately 300%, cannot be

<sup>20</sup> In the period 1993 to 2013, the percentage of drug cases compared to all recorded crimes increased from 5.5% to 18%. There has been a drop since 2013, not only in drug reports but all reported crime (Larsson).

<sup>21</sup> Tabell 4 Lovbrudd anmeldt, etter type lovbrudd. 1991–2001 (ssb.no).

explained by the rise in use alone – the main explanation is related to policing. The period was characterized by stability and a sharp rise in the use of ecstasy and pills at the end of the century, often linked to the techno and rave culture, which later went down again (Stene 2003).

When it comes to sentencing, Hauge (2008 and 2015) documented that the peak came early, in the 1980s. Since that time there has been a move from imprisonment towards fines for users. Today, fines dominate (Larsson 2011; NOU 2019: 26). Sanctions against traffickers and dealers are still severe and disproportionate compared to the levels of punishment for other crimes in Norway (Träskman 2012).

## **Towards a Moral Panic?**

Christie's article, 'Long haired life-style' (1968), described the reactions of panic by parts of the establishment concerning the small groups of strange looking, highly visible youngsters in Oslo at the end of the 1960s. As researchers in the field have pointed out, drug use is nothing new, but the visible presence of long-haired, weirdly dressed youngsters smoking cannabis, combined with a growing interest in drugs among the public, media, and politicians, created an atmosphere verging on panic (Skretting 2013). As Lind (1974) pointed out, there was indeed a growth in the use of some substances from the mid 1960s, but the way the media presented this blew it way out of proportion. Drug use was depicted as epidemic and youngsters could get hooked after more or less one puff of the pipe. The result was not only wasted lives and early death but also a threat to our morals, society, and culture. 'The point is that the development only goes in one direction, towards moral and physical decay, loss of sense of reality, a dissolution of the self … Sadly there are thousands of examples that just one little try might lead to dependency and damage done …'22 (Lind 1974:39). The debate and the reactions seem to have all the basic ingredients of a moral panic, as Stanley Cohen described, with a clear enemy, a threat to society and norms, a black-and-white, exaggerated, and one-sided

<sup>22</sup> These arguments are from one of the first interpellations on drug problems in the Norwegian Parliament in 1967.

depiction of the problem in media and strong societal reactions (Cohen 1972/2009). Drugs shifted from medicine to morals. The level of punishment was raised. The main legal argument then, as now, was a general preventive one – that the threat of punishment would scare off users and the wider normative effects it would create (Christie & Bruun 1985). But we also see clear traces of another penal logic – punishment as social defence (Flaatten 2014). The drug situation at the time was described by many as an epidemic23 wildfire, with strong measures seen as appropriate to stop the destruction of the youth and save society.

Use and possession was criminalized in 1965. As mentioned, Legemiddelloven of 1964 came as a follow-up to the UN Single Convention and was adopted before the 'new' drug problem came to Norway. In accordance with the Convention, the law was aimed at the illegal possession and sale of drugs, and contained no explicit provision for use. Prohibition of use, however, was included in the 1965 regulation, and was used as a legal basis to impose penalties for use in the first drug cases that came to court this year (Skretting 2013). Lind (1974) points out that the legal status of punishment for use was disputed. The dispute ended with a Supreme Court decision in favour of using punishment in May 1967.

The end of the 1960s was a time of change and flowering of counterculture. The use of different substances was often associated with radical changes and seen as a general threat to established society by more conservative elements of society. It is pointed out that Nixon's war against drugs was more a war against blacks and radical groups (Hari 2015). By chasing drug use among certain visible groups the police activity had aspects of 'cleaning up' elements seen as threatening, unwanted, and deviant.

An interesting detail is that this more or less coincided with the removal of the vagrancy paragraphs that made consumption of alcohol in public illegal in Norway (the vagrancy law). This highly discriminating law, which more or less without exception punished poor drinkers, was abolished in 1970 (Mathiesen 1975). The public was waiting for the streets to overflow with drunkards.

<sup>23</sup> The Norwegian director of health, Karl Evang, and the Swede Nils Bejerot were among the proponents of the idea of an epidemic perspective.

Instead, what happened was that the police changed from pursuing old-sailors, helpless drunks, and vagrants and started to catch a new group of deviants, the long-haired youths associated with drug use.

## **1970s and Early 1980s – Hunting the Drug Shark!**

The repeated raising of the level of punishment during the 1970s and 1980s was not primarily aimed at the drug users.24 Instead, the cynical Mr. X or drug shark became the main enemy. This started in 1972 with the raising of the maximum punishment for drug related crimes to 10 years. We were told there was a drug industry – we are not talking of the legal, multibillion-dollar drug industry – controlled by cynical criminals with immense powers and riches. In Nordic language they were known as bakmenn, literary *men behind the scenes*. These facilitators speculated in turning people into drug slaves to reap even higher profits. The goal of the police was to 'take out' these sharks, and Denmark was the first Nordic country with its own police force dedicated to this goal.25 Arresting these villains would stop drugs from entering the streets and deter others joining the trade. They were nothing but plain killers peddling their poison on kids and turning them into slaves of 'lifelong torture'.26 Severe punishment would make it less 'attractive' for drug traffickers to search out the Norwegian market and would have a deterrent effect (Lind 1974; Skretting 2013). Therefore, heavy penalties and wide police powers were appropriate and needed.

The problem with this approach, based on commonly shared beliefs, was that it had some basic flaws. Drug markets are not controlled by a handful of people. Instead, they are flexible and

<sup>24</sup> The belief in the deterrent effects of punishment towards users may have been a constant, but the idea of how punishment was having such an effect has varied. There have been periods when a 'scared straight' idea has been dominant, with the threat of police action seen as keeping kids away. Today, however, there is a belief in the *normative effects* of punishment, usually described as 'sending the right signals' (often underlined by the police) and as a '*last threat*' in preventive policing (described below).

<sup>25</sup> Statsadvokaten for særlig økonomisk kriminalitet, known as bagmandspolitiet, was established in 1973.

<sup>26</sup> From Ot. tidende nr. 49, sak, nr. 4, 1967/68 (Lind 1974:50).

highly adjustable. The police and customs confiscate tons of cannabis, heroin, cocaine, and other drugs, but there are always plenty more and the market also adjusts with the production of new drugs, often more dangerous than the original ones (Bewley-Taylor 2012; Nutt 2012). The level of punishment seems to have a marginal effect on smuggling, production, and consumption (MacCoun & Reuter 2001; Paoli, Greenfield, & Reuter 2009).

Once in a while, a drug baron controlling at least parts of the drug trade in some countries pops up (Zaitch 2002). But research has documented, at least since the time of Bødal (1982), that the 'sharks' that end up in prison are users themselves, with few exceptions, often with dire problems. They look confusingly similar to the ordinary prisoner – people with multiple social, health, and medical problems.

Even more depressing was the fact that removing actors that seemed to be big time players of central importance made little difference at all (Woods 2017). Arresting a trafficker (Gjermund Cappelen, known as GT) who admitted to having smuggled 20 tons of hash to Norway in a 20-year period made no visible difference to the market. The number of big drug cases in Norway before 2000 was very few. Still today, 97–98% of the cases handled by the police are concerning use, possession, and small-time dealing (Larsson 2011).

## **Mid 1980s to 2000 – Cracking Down on the Users, 'Stress Policing'**

The 1990s saw an explosion in the number of reported drug cases that is hard to explain (Stene 2003). There might be different factors contributing, such as changes in registration practices and drug use, but most of the increase seems to be connected to police activity. So, what happened? At a time when reported crimes started to drop, the drug cases sky-rocketed while the level of consumption increased moderately.

The State Institute of alcohol and drug research have asked youth in the age 15–20 years if they ever have used cannabis. The proportion giving a yes answer increased from 5 to 18 percent in the period 1986–1998. In the same period the numbers of investigated drug crimes increased by seven times.

(Haslund 1999)

Some of it might have to do with new routines for reporting crimes and the implementation of a new digital system in the police (Ellingsen 2001). But there must be other factors. One such factor is priority and resources allocated to the police. Another might be that the police were better organized, the Norsk narkotikapolitiforening (NNPF), a mighty organization for the Norwegian drug police, was established in 1994. The police were impressed by the Danish 'uropolitiet' (stress police). Both the Danish and the Norwegian uropolitiet worked in the streets in plain clothes by infiltration, provocation and other 'creative' methods (Jensen 2015). Money was never a problem when it came to policing drugs in this period. No political party would cut the budget of the drug police. The work was seen as saving lives and of high importance.

Police got more professional and specialized in the drug field. There have since been courses and training programs in how to detect narcotics and substance use, with the number of drug sniffer dogs also having increased.

This coincided with the implementation of New Public Management ideals in the police force. With new management ideals there was a pressure to register more activity (Lomell 2018). Police officers are quick to point out that this created a pressure to register cases easily solved and with high clear-up rates. Therefore, there might be evidence that a substantial part of the increase seen was a result of the drive towards cooking the books for better scores (Reiner 2010). Drug numbers are well known fixers of police statistics, with an extraordinarily high clear-up rate and a short processing time. In many countries, drug statistics are not included in the general crime statistics for this reason,27 but not in Norway. There are plenty of examples of the unintended consequences of the stressing of certain management goals (Wathne 2015). One well-documented example was the manipulation

<sup>27</sup> Example is the Crime Statistics of England and Wales. https://www.ons .gov.uk/peoplepopulationandcommunity/crimeandjustice/bulletins /crimeinenglandandwales/yearendingmarch2019#overview-of-crime.

of drink driving tests by the Swedish police by blowing the tests themselves,28 or getting the correct numbers in other ways (Granér 2004). Doing the real test could be hazardous – if they actually caught a drunk driver there was lots of paperwork, so the best thing would be to do the test in low-risk areas and at times when there was less chance of drunk driving.

## **The Increased Focus on Organized Crime**

A major shift occurred in the mid 1990s when organized crime was introduced as a major threat (Larsson 2018). Serious drug crimes were re-labelled. For many police officers, organized crime was more or less synonymous with drug crimes. This is still reflected in priorities and resources used and in what the police register in their intelligence files (Eidet 2019). There was a move from policing the streets towards more analytical approaches based on intelligence work (intelligence-led policing) and the use of hidden and coercive methods, such as wiretapping, infiltration, and the use of informers (NOU 1997: 15; NOU 2009: 15). A new group of police specialists and experts evolved with more analytical skills. They worked in more pro-active ways to build cases (Fyfe, Gundhus, & Rønn 2018). In the words of Murji (1998), there was a move from low-level to high-level policing. Resources were diverted from street work to catch importers and traffickers of drugs. Working on the streets with 'stress policing' used to be of high status in the police, however, now there has been a move towards experts in analysis and intelligence-led policing (Larsson 2015, 2018).

Policing drugs has been the spearhead of substantial changes in policing for the last 50 years (Sheptycki 2000; Larsson 2014). Some of the most important changes are a growth in international policing, a wider use of coercive methods, more effective co-operation with other agencies of policing, the development of intelligence-led policing and analysis, new investigative methods, and a growth in the numbers of civilian experts in the police

<sup>28</sup> By blowing the tests themselves, they avoided catching any drunk drivers, and so also avoided all the extra paperwork and other nuisances that went with this.

(Larsson 2018). Policing drugs has been one of the most central contributors to changing the role of the police and introducing new methods that have implications for society far beyond the police force itself.

## **The Sick Drug Addict and the Problematic Youth**

Norway have been described as one of the hawks in the drug policy field. This has only been a partial truth (Bewley-Taylor 2012; Skretting 2013). There have always been groups of users treated in more health-oriented ways, but the health focus has become more visible since the turn of the century.

Norway have had treatment facilities established for drug users since the early 1960s, but they were for 'traditional users' – doctors, health personnel, and patients with dependency problems (Lind 1974, NOU 2019: 26). A wider move towards a health approach came as a result of the HIV/AIDS epidemic of the 1980s. Harm reduction now became a central term (Bewley-Taylor 2012). The spread of LAR29 to a substantial number of heroin users and the opening up of injection rooms in 2004 are examples of a turn towards *health* (Olsen 2020). For a short period in 2004, the Police Chief of Oslo and the minister of Justice at the time, Dørum, declared that it was not the task of the police to chase sick and tired drug users, resulting in falling numbers of reported crimes. However, subsequently, things more or less returned to normal.30

The tired heroin user on the street has gone from being a prime example of 'the usual suspect', dangerous criminal, and police property, to being seen as sick and in need of help and rehabilitation. This process has taken years and one should not under-

<sup>29</sup> LAR is short for Legemiddelassistert rehabilitering. It is the use of opioid treatment for drug users, usually heroin users with a long history. Also known as substitution treatment.

<sup>30</sup> https://www.aftenposten.no/osloby/i/5E671/doerum-og-lae-lover-aa -ikke-jage-de-narkomane. The message was repeated by the General attorney in 2014. Police shall not chase worn-down drug users, but prioritize serious crimes. https://www.dagsavisen.no/nyheter/innenriks/politiet-skal -ikke-lope-etter-slitne-narkomane-1.278016.

estimate the roles of Nini and Thorvald Stoltenberg31 in giving a face to the user and the relatives. Thorvald was one of the first top politicians openly supporting the decriminalization of drug use, and the leader of the Stoltenberg Commission32 and member of the Global Commission on drug policy. The high numbers of drug-related deaths have, for the last decades, been a fly in the ointment and embarrassment of the Norwegian welfare system. The highly visible, tired, and sick opioid addicts in the main streets and parks of Oslo and Bergen have been bad publicity for the world's best country,33 and a thorn in the side of local politicians and businesses.34

Considering the population of 5.4 million, the numbers given in Table 14 are high. The numbers were low until the end of the 1980s. There was then a sharp rise, peaking in 2001. Since 2003 the numbers have fluctuated round 275 a year. It is interesting to

Source: Amundsen (2015); Narkotikautløste dødsfall 2020 – FHI.

<sup>31</sup> Thorvald Stoltenberg was former minister of foreign affairs and father of Jens Stoltenberg, prime minister and now General secretary of NATO. Nini was the daughter of Thorvald. She had a career in media before she became addicted to heroin. She was open with her problems and told the tale of the hard life of being a stigmatized addict. Thorvald got engaged in the drug case and was a strong believer in change. Nini died in 2014 and Thorvald passed away in 2018.

<sup>32</sup> https://www.regjeringen.no/globalassets/upload/hod/rappomnarkotika \_nettversjon.pdf.

<sup>33</sup> I use this term with a slight potion of irony for 15 years Norway has been on the top of UNDPs list of the best nations to live in. Human

Development Reports (undp.org). 34 Drug-related deaths are divided into three main categories: poisoning accidents (72%), suicides (20%), and mental disorders and behavioural disorder in connection to drug use. 83% of the deaths are related to opioids, with 'other opioids' (morphine, kodein, and oxycodon) at 31%, heroin at 20%, synthetic opioids at 18%, and methadone at 14%. There are dark figures and the numbers of suicides are generally considered to be higher than what is reflected in the statistics (Narkotikautløste dødsfall 2019 – FHI).

note that these numbers seem like a mirror of the rise in reported drug cases (Table 13).

Skretting (2013) describes the Norwegian policy as basically schizophrenic – there are elements of a strong belief in punishment and severe penalties, but also in rehabilitation and health care.35 Norway has a maximum penalty for serious drug crimes of 21 years of imprisonment. What is conceived as a serious case in a Norwegian context, however, might be viewed as small fry in The Netherlands, Spain, or the UK.36 This might not be as schizophrenic as Skretting claims, but instead mirrors that some groups are labelled as 'deserving' drug addicts and patients, while others are seen as a threat and so are suitable candidates for deterrence and punishment. The schism also reflects the different professions operating in the field and their perspectives. Social workers, police, and health personnel will perceive the drug problem and its solutions in different ways. The drug question is like the well-known story of the blind man and the elephant – dependent on what part you see or feel, it will appear as a different animal. The so-called symptom theory, that drug use was basically seen as a symptom of problems related to the social, health, and economic sphere, was officially established in 1976.37 This perspective underlines the *social causes*, while over the last decade we have gone a long way towards defining drug use in medical and health terms. We have moved from symptoms to illness. In this way, we have also gone from social to more individual causes as the main explanations. This might also reflect that the ones 'defining the solutions'

<sup>35</sup> 'Abuse is increasingly interpreted in a disease perspective, harm reduction has become more important, while people with drug problems are referred to as addicts. In this way, one could say that Norway is in a situation where we have developed a "schizophrenic" view of the drug problem, by on the one hand stressing the health aspects of abuse, while on the other hand seeming to be trapped in legislation, with severe penalties for drug offenses, which prevents a softening up if this is seen as appropriate' (Skretting 2013, translation Paul Larsson).

<sup>36</sup> One example, 80kg of cannabis is the limit for what is seen as a serious crime concerning smuggling of cannabis. When it is defined as a serious drug crime the maximum sentence is 21 years. 80 kg of cannabis in the Netherlands, Spain or UK will not be treated as serious drug trafficking.

<sup>37</sup> St.meld. nr. 66 (1975–76).

have moved from social workers to the medical and health care professions.

The cornerstone of policing drugs in Norway for the last decade has been coined preventive work. The last action plan by the police concerning drugs underlined the need to reduce the availability of drugs on the street and the recruitment to drug use (Politidirektoratet 2010; Larsson 2015). This plan is characterized by low policing and street work, the remnants of stress policing. For some reason, the policing of import and trafficking is not mentioned in the action plan – it might be because this is seen as combating *organized crime*. Another plausible explanation of this omission might be that the plan is not written for experts but for the local patrolling officer.

The plan points to the importance of police combating availability of drugs on the streets, hoping to reduce demand, and use. The means of 'how to achieve this' are well known, it is a combination of cracking down on known users (on the street), by information to the public, and the use of surveillance. The plan is rather vague when it comes to describe the practical aspects of these approaches.

The last decade new preventive strategies aimed at young drug users have become fashionable. They are named the *dialog of concern*38 (bekymringssamtale) and *youth* and *drug contracts* (NOU 2019: 26). These are formally based on free will and consent39 of the youngsters, and are presented as help. These reactions can be supplemented with the use of mediation in a Conflict Resolution

<sup>38</sup> The dialog of concern has been developed by Norwegian police. It is a formalized dialog that the police will conduct with youth that have committed a crime or those who are in a situation that the police believe makes it likely they will commit a crime. It is for youth under 18 years and is also primarily based on free will. Often the police will contact the parents to inform them about the situation. The effects of this alternative have not been documented by research (Lie 2020). Politiets bekymringssamtale – NUBU.

<sup>39</sup> There is a discussion about whether or not these measures are actually perceived as being of free will, as the pressure to join and the control in these 'alternatives' are such that it is openly questioned if they are for the good of the youth. There has so far not been any study of the effects of these alternatives.

board. These 'preventive measures' are backed by the threat of punishment and a heavy use of urinal tests (Lien & Larsen nd \_PUB\_Flinkiser\_og\_dropouts\_\_orig.pdf (rus-ost.no)). They have a duration of eight months and the youngsters are obliged to attend talks with a nurse on a regular basis. Drug contracts are seen as suitable for youngsters and a low-threshold reaction. Even if the police label these measures as preventative, they view them as dependent on the threat of punishment. This, together with the normative argument (below), is among the main arguments against a decriminalization of drug use by the police and representatives of the political parties KrF (Christian Democrats), FrP (The Progressive Party, a populist party), and, to a certain extent, the AP (Social Democrats).

We are now in the rather strange situation where there is little resistance against a decriminalization and relabeling of heavy drug users from dope fiends to patients. At the same time, young experimental users will still be criminalized for the sake of the belief of punishment as prevention (Møller 2011). These preventive measures have not been evaluated for their effectiveness by any researchers. This is an echo of the Penal Code Commissions (Straffelovrådets) report from 1967: 'The fact that unjustified use is punishable must also be presumed to be *deterrent* to *some of those who might otherwise be willing to experiment with drugs*.' (Skretting 2013).

There is still the traditional belief in the symbolic normative value of punishment, which says it is wrong to decriminalize drug use because it sends the 'wrong signals' (Hauge 2008). Decriminalization is described as synonymous with the state approving drug use, however, strangely, the same argumentation is rarely used concerning alcohol or tobacco.

## **From Punishment to Health**

Christie and Bruun (1985) described drugs as a suitable enemy. Suitable enemies share some characteristics making them ideal targets for societal reactions. Drugs have, for the last five decades, been a focal point not only in criminal politics but also in politics in general. A minority have, until recently, been openly questioning the policy and the general rationality behind it, but the majority have supported the status quo.40 But things are changing.

Slowly, the climate of discussion and action seems to have changed. New voices can be heard, most notably, the voices of the users themselves. Debates are still heated and fronts can be hard, but there are now a wide variety of alternative views expressed. The field flourishes with all types of organizations and pressure groups, drug users fighting for their rights to use drugs legally; self-help groups; movements trying to establish drug use as a human right; some working for the safer use of drugs and others for treatment. There are a wide plethora of associations supporting criminalization and the use of penal sanctions. The most important event was probably when, in December 2017, the Norwegian parliament declared that there was a political majority for a change41 in the drug policy – from viewing drug use as a penal matter to defining it from a health perspective. Minister of health Bent Høie was crystal clear when he declared:

Drug addicts shall receive healthcare and respect – not punishment and condemnation. We are now starting on the task of changing the Norwegian drug policy and the attitudes towards fellow humans that struggle with drug dependency. (https://www.regjeringen.no /no/aktuelt/utvalg-skal-forberede-ny-rusreform/id2594838/)

There was advice from the politicians to the committee working on the whitepaper of the drug policy was clear, *look to Portugal*. In criminological and penal law terms the advice was to move the reactions on drug use from penalization towards prohibition with civil penalties, or decriminalization (Bewley-Taylor 2012). What this meant in practical terms was rather open. Should all types of

<sup>40</sup> There has been some voicing of other perspectives. One is the Penal law commission that proposed a decriminalization of the use and possession of drugs and a reduction in the levels of punishment (NOU 2002: 4). The reaction from the Minister of Justice was to put this proposal 'in the drawer', commenting that the time was not ripe for even discussing such changes in Norway.

<sup>41</sup> Three parties go against this: FrP (Populist party), SP (Centrum party) and KrF (Christian democrats). FrP is split – the youth organization have for years been pro-legalization.

use be decriminalized? There is a big difference between worndown heroin addicts, casual users of 'party dope' and youngsters experimenting or casual smokers of cannabis. Should it cover use of all kinds of drugs or just 'softer' drugs? What would help users and how should it work? Should there be civil sanctions, or even penalties for users who would refuse help and treatment? What is the role and tasks of the police in such a system? How would such a reform affect the working conditions and methods of the police? Parts of the police in particular aired scepticism on the whole idea of such a reform. Three days before the report the Police Director published a media article with the suggestive title, 'I am worried about the youth', showing her position against the reform.42 She was anxious that a reform would result in a growth in the number of young users and moral decay, and believed punishment was needed, claiming the current policy of punishing users a success. These arguments, similar to the ones used in the 1960s, came to be central in the weeks to come.43 But the stunt mainly backfired and was criticized as being built on a lack of knowledge and reflecting a moralistic stance.44

On the 19th of December, 2019, the report, *Drug-reform – from punishment to help*, was released (NOU 2019: 26). For those nervous about a toothless report, there was no need to worry.

The proposals were as follows: a decriminalization of the use of all types of drugs; using, buying, and possessing a certain amount of drugs for own use would be prohibited, but not a crime; and the sanction would be to meet for a board (rådgivningstjeneste) of municipal advisers. Users skipping such 'advise' should not be met with formal sanctions. The proposal when it came to the limits of drug possession was split. The basic argument was that the limit should be such that the users did not have to buy drugs every day, in this way reducing their contacts with the drug dealers

<sup>42</sup> https://www.nrk.no/ytring/jeg-er-bekymret-for-ungdommen-1.14821890.

<sup>43</sup> And also in the final rounds of the making of the new law in the spring of 2021.

<sup>44</sup> https://www.minervanett.no/benedicte-bjornland-rusreform/plag-oss -ikke-med-kunnskap/350229. Spring and summer of 2021 the Police Director was criticized for airing the views of the private organisation NNPF (Norwegian Drug Police Organisation) and mixing roles of the police and a pressure group strongly against reform.

on the street.  There are big differences in use, which reflect the users drug history. The majority proposed a limit of 5 grams of heroin, cocaine, and amphetamine, and 15 grams of cannabis. The minority had limits of 1 grams of heroin, cocaine, and amphetamine, and 5 grams of cannabis.45 The report also proposed limiting the use of intervening police practices towards users.46

The main message of the report was the move from punishment to help (Pedersen 2020). In some ways this was a return to the policy in place before 1965. The report was 412 pages long, and the scope was wide. The reactions on the report were primarily positive, but there was, as seen above, also critical voices. The most debated issue was 'the youth problem'. Fear of an increase in use and a moral decay among the youth is probably the aspect most hotly debated, even though the report analyzed these topics in detail and showed there was little reason for alarm. The lack of sanctions for the ones not meeting for the advisory board was another debated aspect.47 At this point, the report takes a different stance than that practiced in Portugal, where they have a wide spectre of sanctions, even if they are rarely used. Youngsters will not go to a consultation if there is no threat of a sanction or punishment, critics pointed out. The report argues, from a principal point, that when they do not propose sanctions, 'In the Committee's view, this would be unfortunate (the use of sanctions) in the light of the division of roles between the police and the health and welfare services and the trust between the individual and the public assistance services' (NOU 2019: 26).

The future of the drug reform is, at this time (March 2021), still uncertain. There have been major shifts in Norwegian politics

<sup>45</sup> This was changed and reduced during the process of making the law (Prop 92.L 2020–2021) to 2 gram of heroin and 10 gram of cannabis.

<sup>46</sup> This is a field with exceptionally wide police powers in Norway (Larsson 2014).

<sup>47</sup> This was changed in the process of making the law. It was proposed that a fine of 2400 nkr, that is approximately €230, could be given if the person did not attend the meeting.

since the release of the report that change the whole debate. The reform had a political majority because the ruling parties (Høyre, KrF, Venstre, and FrP) had decided at the Granavolden conference in 2019 to implement it. This decision was the result of tough political wrangling, as KrF and FrP were sceptical of the reform. The reform has been the baby of the liberal conservative party (Venstre) and Høyre (Conservatives). In January 2020, FrP (Liberal Populist Party) left the Government, the break officially a result of an Islamic State supporter being brought back to Norway from Syria with her two children for medical treatment. To get a majority in Parliament, the Government had to rely on FrP, who has now been openly critical. Today, the reform is dependent on the support of the Social Democrats, who are divided in their views. The Norwegian Labour Party (AP) are the ones that decide the destiny of the reform.48

## **Drug Reform as a Mixed Blessing**

The slow progress towards drug use being perceived mainly as a health problem should come as no surprise – it has been in the making for quite a while. But this is far from stating that policies are on the way towards legalization. It was not in the mandate of the drug reform committee to think 'outside the box' about what to do with the sale and handling of drugs. Alternatives such as medical marihuana and state-regulated sale of drugs in coffee shops are rarely openly debated in Norwegian politics. Punishment is seen as necessary to restrict the trafficking and use.49 Sentences in drug cases are still unproportionally severe. The idea that punishment works in restricting the volume of drugs in society, without taking into account the costs of this, are firmly held. Punishment is seen as necessary to deter new users, as expressed in 1967, while addicts are seen to need help instead of punishment. The problems

<sup>48</sup> The reform did not pass. In May 2021 AP decided not to support it. It was election year for Parliament and AP expressed the view that they would develop their own drug reform. 49 There have been some representatives of Venstre, and hard-core libera-

lists in FrP and among the youth parties, that have argued for legalization. https://www.aftenposten.no/norge/politikk/i/e8X0QR/unge-venstres -kampanje-for-legalisering-vi-deler-ikke-ut-rusmidler; https://www.vg.no /nyheter/innenriks/i/P.3ROd6/frp-forslag-om-statlig-salg-av-cannabis.

with this neat picture are that the majority use drugs in recreational ways and don't get sick or addicted (Hauge 2009; Møller 2011; Nutt 2012). Dependency, however, is a highly problematic concept in itself (Bramness 2018).

Maybe we have finally come to a point where other problems seem to attract more attention than drugs. The police have a wide array of 'suitable enemies' today, so drugs may seem to fall out of the picture – the immigration crisis, trafficking, cybercrimes, the war on terror, and environmental problems are examples from a long list50 (Franko 2020).

The number of countries and states that have now decriminalized and even legalized the use of one or more drugs has increased. Many of these are states we often like to compare ourselves with. At the same time, there now exists research that shows that this does not end in chaos, an explosion in drug use, and a doomed youth (NOU 2019: 26). Norwegian politics have always been influenced by international trends – we have a tendency to follow, which is also seen in the area of drugs (Hauge 2015). As described in this chapter, the field has always been open to a wide array of approaches and perspectives. Maybe we are at a tipping point where it is time to shift from an approach that, to a large extent, relies on the belief in deterrence and punishment towards a more health-oriented approach.

But what does this mean? Such a development might be a mixed blessing. To depict the drug user as dependent and sick is not only to put him in a position where he might get help, it is also a way to disempower, to introduce new modes of control and discipline that might be more coercive and just as intrusive as what we have now. The wide array of so-called preventive measures, presented as soft alternatives, normally rely on the extensive use of control measures, such as urine control in youth contracts (NOU 2019: 26). Police and health personnel cooperate.51 Youths on such contracts often experience these measures as degrading and

<sup>50</sup> https://pst.no/alle-artikler/trusselvurderinger/nasjonal-trusselvur dering-2020/.

<sup>51</sup> Not always – in some places the health workers do not want to take part as controllers taking urine tests. In these instances, private firms have taken the role of the health workers.

demanding.52 These alternatives are presented as 'free to choose', but the stick is there if you do not cooperate. Encounters between youth and police when it comes to enforcement of the contracts can be highly unpleasant. The rights of users on such alternatives are in a totally different league than if they had been sentenced in court. These youth are not sick, what they have committed are more often minor acts, such as smoking cannabis. These dilemmas have been addressed in the drug reform report. The alternative presented in the report, the advisory board, might be a better solution. Anyway, its main function is to give advice and channel the problem users to the help system. There is political pressure to sneak in punishment in the reform by differentiating between the types of users and by using waiver of prosecution53 in cases with adult drug users. It is pointed out time and again that the reform is dependent on substantial economic support to build up a working system of help and support, as is the case in Portugal (Hughes & Stevens 2012). Anyway, we should be aware of the dangers of re-labelling drug use, this might be a mixed blessing.

## **References**

<sup>52</sup> https://www.moss-avis.no/nyheter/nyheter/mener-politiet-misbruker -narkotika-makt/s/2-2.2643-1.8415607.

<sup>53</sup> These proposals for 'modifications' stem from the Labour Party and SP, both of them in political opposition to the ruling party. It is an election year in 2021.

Haslund, U. (1999). *Kraftig økning i narkotikaforbrytelser*, i: Samfunnsspeilet nr. 1 2000, https://www.ssb.no/sosiale -forhold-og-kriminalitet/artikler-og-publikasjoner/kraftig-okning -i-narkoforbrytelser.

Woods, N. (2017). *Good cop, bad war*. UK: Ebury Press.

Zaitch, D. (2002). *Trafficking cocaine. Colombian drug entrepreneurs in the Netherlands*. Hague: Kluwer Law International.

## **6. On the Possible Deconstruction of the Swedish Drug Policy**

*Henrik Tham*

Since 2006 the Stockholm Prize in Criminology has been awarded 'for outstanding achievements in criminological research or for the application of research results by practitioners for the reduction of crime and the advancement of human rights'. The prize is presented each year at a ceremony in Stockholm City Hall, usually by the Queen but sometimes by other official representatives of the state or the city. At the same time, the Swedish National Council for Crime Prevention organizes a symposium that opens with a panel where the Minister of Justice participates with the winners of the prize and other experts in discussing their research and views. In 2019, a renowned researcher on drug policy and a former President of Switzerland who has been active in harm reduction policy were awarded the prize. The year 2019 the Swedish state withdrew from both the panel debate and the prize ceremony.

Sweden has long been known as a 'hawk' in the war on drugs in comparison with other democratic countries in Europe. This reputation has hardly been seen as detrimental by Swedish governments, since the country has also claimed a successful drug policy. Fewer people than in other countries have tried drugs and the attitudes to drugs have been more negative. 'Sweden drug-free society' is the proud message that has been communicated both nationally and internationally.

Today, however, the situation is changing. Sweden's allied in the war on drugs, Norway, seems to be deserting by in a governmental

#### **How to cite this book chapter:**

Tham, Henrik. On the Possible Deconstruction of the Swedish Drug Policy. In: *Retreat or Entrenchment? Drug Policies in the Nordic Countries at a Crossroads*, edited by Henrik Tham, 129–158. Stockholm: Stockholm University Press, 2021. DOI: https://doi.org/10.16993/bbo.f. License: CC BY 4.0.

investigation proposing a policy that excludes the police practice of chasing drug users in the streets. Sweden has been criticized by the UN for not upholding human rights in its drug policy. No plans have been put forward regarding what to do about the rise in problematic drug use and drug-related deaths. Several countries have started on the road to decriminalization. Nils Christie's question (see *Introduction*, this volume) can then be asked: Has Sweden started a retreat and if not, why?

In an attempt to answer this question, we will start with a short description of Swedish drug policy since the 1960s and its theoretical and political justifications. This will include the development of drug legislation, number of people sentenced for crimes related to drugs and drug consumption among school children – a central indicator in Swedish drug discourse. The results of the drug policy are then discussed in relation to indicators of the development of problematic drug use and drug-related deaths. This is then followed by a description of the costs of Swedish drug policy in terms of legislation, police interventions and imprisonment. Drawing the conclusion that the costs cannot justify the gains, an attempt is made to understand why the drug policy in Sweden is not changing in a direction that would be more effective and less costly.

## **The Construction of Swedish Drug Policy**

In order to analyze the possible *deconstruction* of Swedish drug policy, it is necessary first to understand its *construction*. Drugs were identified as a social and political problem in Sweden in the 1960s, thereby disengaging the issue from an earlier medical and individualized perspective (Edman & Olsson 2014). Changes in penal legislation at this time were aimed at the big producers, smugglers and dealers. The maximum penalty was, in a few years, raised to 10 years imprisonment, the then highest penalty in Sweden except the life sentence. Drug users were looked upon as victims and the debate about the users in the 1970s concerned the issue of whether treatment should be voluntary or compulsory.

In the late 1970s the policy changed. The Swedish parliament, in 1978, stated that society would not accept any use of narcotic drugs except for that which is medically motivated, and any other type of use would be strongly combated (Proposition 1977/78:105: 30). This stand was later formulated as 'Sweden drug free society' (Proposition 1983/84:100), which became the motto for the drug policy. As a result of the zero-tolerance position, the General Prosecutor abolished the earlier praxis of waiver of prosecution for possession of small amounts for personal use. In 1980, the Police launched a national campaign for arresting drug users in the streets (Brottsförebyggande rådet 1983). The number of drug offences in the police statistics trebled in two years, mainly due to the police increasingly arresting already known drug users more often (Rättsstatistisk årsbok 1993:147).

This development was followed by a political debate about criminalizing consumption as such. The center-right parties in Parliament pressed the Social Democratic government to criminalize use, which was done in 1988 but only with a fine given as the penalty. The political opposition claimed that this was a useless law. Without imprisonment in the penalty scale the police had difficulties proving use. With the center-right parties in government a few years later, a law went into action in 1993 giving the police the right to take samples of body fluids by force in order to establish the use of drugs. The number of urine and blood tests carried out since then have increased sharply (Rättsmedicinalverket 2020). The number of drug offences reported to the Police in 2020 was 124,000, an increase of more than four times since the law was passed in 1993.

The increasing focus on the drug user meant that Swedish drug policy moved from supply prevention to demand prevention (Johnson 2021, p. 119 ff.). This change was influenced by a perception of the drug problem as an epidemic. The drug user was pictured as contaminating two or more others who, in their turn, would infect two or more, and so on. The drug user was also described as the only irreplaceable link in a chain of dealers, smugglers, producers and corrupt regimes in other parts of the world. If only just the users could be locked away, the whole pyramid would fall and the drug epidemic would come to an end (Bejerot 1975; Johnson 2021).

It was therefore argued that a strict policy directed towards the user was necessary.  This was the message of a doctor of social medicine, Nils Bejerot (1975), who was also the father of the epidemic theory. He was the central figure in the creation of the new drug policy and had hundreds of thousands of followers, in terms of the number of his books sold, articles written in the press and total audiences at his lectures. In 1979 he was bestowed the title of full professor by the center-right government.

The picture of drugs as a national threat to Sweden was supplemented by one of a successful policy. The Department of Justice seemed to have discovered that the proportion of school children using drugs was decreasing. After having stated in the central budget bill that drugs had emerged as one of the very largest social problems in the country (Proposition 1983/84:100), two years later they stated that 'Sweden leads a conscious and resolute drug policy' (Proposition 1985/86:100). The indicator of this claimed successful policy became the proportion of young people using drugs (Figure 14). The change in evaluating the development of drug policy could also be interpreted as a solution to a possible political problem. When the Swedish policy increasingly focused on the drug user by using penal law and the police, some success of this policy had to be demonstrated.

The claimed success of Swedish drug policy was spread in a government leaflet, which was translated into four languages (Swedish National Institute of Public Health 1993). Even though the situation was serious, Sweden claimed a more successful drug policy than that of other countries (Swedish National Institute for Public Health 1998). The climax of the claims, internationally, could be said to have been reached at the 1998 UNGASS (United Nation General Assembly Special Session) in New York, where Sweden appeared with a large delegation, including the Queen, claiming a successful drug policy (Regeringskansliet 1998).

From the turn of the century, however, fewer voices were raised to praise the Swedish drug policy. A government committee presented its report, *At the Crossroads*, in 2000 (SOU 2000:126). Problems were admitted, such as the fact that an increasing

**Figure 14.** Proportion of pupils in 9th grade (15 years old) who have ever tried drugs and who have used drugs in the last month, 1973–2020, percent.

Source: CAN (2020).

number of pupils had tried drugs, that the attitudes had become more permissive and that the mortality rate was high in relation to other countries. However, backing away from the restrictive Swedish model would mean 'lowered ambitions and the acceptance of considerable drug abuse' (op. cit.:11).

The government bill that followed the report reiterated the success of the Swedish policy, including in relation to other countries (Proposition 2001/02:91: 15, 23). The general repudiation of drugs in the Swedish population was stressed and the number of new recruitments and mortalities among young people were said to be lower than in other comparative countries (op. cit.:10). The concrete outcome of the bill was the appointment of a national drug policy coordinator. The office of the coordinator, 'Mobilization against drugs', existed for seven years before being closed down. The drug issue became less visible in politics and debate. It also disappeared from the election campaigns (Olsson 2011; updated). It did, however, reappear in the 2018 parliament

#### **Table 15.** Drug legislation, 1967–2020.

election when gang-related shootings in deprived areas became linked to the sale of drugs.

Some changes of the drug policy, in the direction of harm reduction, have been undertaken since the turn of the century. Substitution programs have expanded markedly. Syringe exchange was accepted on a general basis by the Parliament in 2006 and lately, other harm reduction measures have also been introduced, such as the use of nasal spray against the risks of overdoses and medical marijuana, albeit slowly and both on a restrictive base.

The dominating picture of Swedish drug policy is, however, a development in an increasingly strict direction. Penal and other types of compulsory legislation have expanded markedly, and so have both the numbers of crimes reported to the Police and sentences meted out in the criminal justice system. This is shown in Table 15 and Figure 15.

## **Has Swedish Drug Policy Been Successful?**

The expansion of penal law, reported crimes, police resources and sentences could perhaps be justified if this had led to a decrease in the damage and suffering caused by drug use. This is the position taken by various governments claiming the relative success of Swedish drug policy. This possible success is, however, limited to the comparatively low proportions in the population that have ever tried drugs, use them recreationally or who are favorable to the use of drugs. These indicators refer to use and attitudes, not to problematic use in terms of social malfunctioning, sickness or death. Here the picture becomes different.

In Sweden, three case-finding studies of 'heavy' or problem drug use were carried out in 1979, 1992 and 1998. Estimates based on different indicators were then conducted up to 2007 (Olsson 2011:36–38). Estimates since then have not been presented, neither in Sweden nor by The European Monitoring Centre for Drugs and Drug Addictions, EMCDDA, for Sweden. The picture that emerges is a doubling of the absolute number with problematic drug use since the late 1970s. The Swedish estimates at the beginning of the century are slightly below the European average as measured by EMCDDA.

Another measure of detrimental drug use is drug-related mortality. The Swedish figures can be compared both historically and with other countries. Figure 16 shows the development of drug-related mortality since 1969. The increase is considerable. The causes of the particularly sharp increase in the 1990s followed by a decrease in the early 2000s and then by a continued expansion is a matter of debate. First, a decline in resources for treatment after the economic crisis in the early 1990s and then an expansion of substitution programs has been mentioned.

**Figure 15.** Number of people sentenced for drug crimes as major crime, 1975–2019, per 100,000 inhabitants. Source: Kriminalstatistik.

These explanations are of less importance to the overall development of drug-related mortality. Even the secular trend, however, has been a matter of debate. Inclusions and exclusions of various drugs in the definition of drugs have affected the speed of increase. A study of the development of drug-related deaths concluded that the rise is considerable even though the sharp increase at the years before 2015 is exaggerated (Leifman 2016). That there is a marked rise is also compatible with the fact that there has been a rise in the number of people who are considered as having a 'heavy' or problematic pattern of drug use.

Drug-related mortality in Sweden is also one of the highest in Europe (EMCCDA 2019). Figures from Switzerland are included in Figure 16, showing that an increase is not an unavoidable development taking place everywhere in Europe – a fact that the Swedish Minister of Justice was not prepared to discuss in connection with The Stockholm Prize in Criminology 2019. Switzerland showed a marked increase in drug-related deaths up to the early 1990s, but the trend then took a downturn with a change in drug policy (De Preux, Dubois-Arber, & Zobel 2004). In relation to other European countries there are, of course, difficulties involved in doing comparisons. The Swedish government is quick to point this out when criticized for the high number of deaths (Swedish drug policy nd.:9). Sweden might also be making a rod for its own back by looking particularly carefully for indications of drugs in classifications of causes of death. Despite reservations of the possibility of making comparisons, a report to the Swedish government has admitted the high rate of drug-related deaths in relation to other countries in Europe (SOU 2000:126), which has been reiterated as late as 2021 (Proposition 2020/21:121).

## **The Costs of the Control of Drugs in Sweden**

In politics, possible gains must be balanced against possible costs. In making an evaluation of different measures of reducing drug abuse, the costs of these measures have to be included. Typical costs refer to the penal legislation and to the criminal justice system, like resources spent by the Police, the prosecutors and the courts, and the number of people in prison for drug crimes, both in terms of economic costs and suffering for those in prison. As costs related to the criminal justice system can also be counted, different types of discriminatory praxis and violations of integrity by the police should also be considered.

Penalization of an act is, in law, traditionally seen as a last resort, as a cost in itself, that should always be seriously considered before undertaking (Jareborg 1995). In the preparatory works from the Department of Justice that gave the Police the right to take blood and urine tests by force, it was pointed out that it was 'principally wrong to criminalize an act that was directed against the person him- or herself' (Ds 1992:19:28).

The fact that using drugs, in itself, is a criminal offence in Sweden is a violation of this principle. It also produces a large number of crimes and criminals. The National Council for Crime Prevention made a rough estimate of the number of crimes that occurred as a result of the consumption of drugs in 2015 and came up with a figure close to seven million crimes (Brottsförebyggande rådet 2016:10). The fact that the consumption of narcotic drugs is criminalized, an act without clear harm to others, has produced more than four times as many illegal acts as the total number of crimes reported to the Police. This can then possibly be regarded as a cost in terms of dark numbers or undetected crimes, the proportion of criminals in the population and recidivist rates.

Figure 17 shows the development of the number of years spent by the Police on drug cases in proportion to the total work force of police officers. The rise is particularly sharp from 1993, when the Police received the right to take samples of body fluids by force in order to establish the consumption of drugs. At most, the Police has spent almost one tenth of the total work force on drugs. The drop in the last few years can be attributed to a large police reform in 2015, however, whether it reflects a real drop in the use of police resources on combating drugs or just a change in registering activities is not clear. The drop in tests conducted by the National Board of Forensic Medicine is only seven percent and is back on the level it was at before the police reform in 2018. The figure for 2020 is 42,000 tests, which is an all-time high (Rättsmedicinalverket 2020). Disregarding the dip, which might not picture a real decrease in police resources, the development of police hours and sentences is fairly similar (Figure 15). Sentences

**Figure 17.** Number of years spent by the Police on drug cases in proportion to the total work force of police officers, 1970–2020, percent. Source: CAN (2019), updated.

seem then to be produced by the amount of police resources put in, as drug consumption is an almost inexhaustible source in terms of increasing the overall clearance rate.

The violation of integrity caused by this police practice might be experienced as particularly offensive if the suspected person has not consumed any drugs. The National Council for Crime Prevention (Brottsförebyggande rådet 2016) has studied the urine and blood samples collected by the Police from 1998–2015 that have been analyzed by The National Board of Forensic Medicine. It is shown that the number of false positives increased during the period from 10 to around 20 percent. The false positives were also, throughout the period, by far the highest in the youngest age group (17 years), where they were close to half (op. cit.:18). The National Council for Crime Prevention stresses the problem that such a negative test might be the first contact with the criminal justice system for a number of young persons (op. cit.:22).

Out of all prisoners who are serving time, more than one quarter has a drug crime, including smuggling, as the principal offence. The proportion was higher before a number of decisions in drug cases were made by the Supreme Court. Whether a sharpening of the law by the government in 2016 in order to reverse the decisions of the Supreme Court, and an announced sharpening by the government in 2019, will change this again remains to be seen. In addition, more than half of those in prison have been judged by the prison authorities to have a drug problem (Kriminalvården).

In a general expansion of the means of coercion available to the criminal justice system, the drug issue has played a central role. Secret wiretaps have been justified, particularly with reference to the suspicion of drug crimes. The wiretaps used quadrupled in Sweden from the 1970s to the 1980s – a development primarily explained by an increase in the police investigation of drug crimes (Svedberg & Svensson 1995). The majority of all wiretaps used concern drug crimes (Ds 2007:2). Since 2007, bugging has been legal in Sweden if there are suspicions of certain types of serious crimes. Central among these crimes are narcotic crimes.

The criminalization of drugs in itself produces criminality. The number of infractions caused by making the consumption of drugs illegal was mentioned above. The high economic costs of the consumption of narcotic drugs as compared to, for instance, the consumption of alcohol, can be expected to contribute to theft and other crimes against property. The high costs of drugs also lead to an illegal market where profits can be made. Such a market tends to be associated with high levels of violence. The case of Mexico is probably the most striking (Hari 2015).

A possible example from Sweden is the marked increase in shootings and homicides in socially deprived areas since 2013. The causes of the shootings were the object of a study carried out by The National Council for Crime Prevention (Brottsförebyggande rådet 2019), who interviewed young men who had been involved. The report discussing the causes of the conflicts states: 'The absolutely most common (cause) is that conflicts are tied to the drug market and particularly to the sale of cannabis …' (op. cit.:55). Several interviewees pointed out that they entered the criminal setting through the cannabis market – cannabis being so common in the socially deprived areas that no active introduction was necessary (op. cit.:116). The question could be raised as to whether the total ban on cannabis was a contributing cause of the fatal shootings.

Finally, there is the issue of discriminatory stop and search when it comes to drugs. The National Council for Crime Prevention conducted a study of young people in the Stockholm area comparing the distribution of suspects of drug use and drug use reported in anonymous surveys. The two indicators did not correlate as expected. Those from less wealthy areas, whose parents did not have higher education, who lived in rented flats and who were foreign born were more often suspected by the police for drug use. Drug use according to self-reported data, however, was more prevalent among those who lived in private houses in the richer areas, where at the same time fewer were suspected of drug use by the police (Brottsförebyggande rådet 2018; see also Holgersson 2007). In another study it was shown that the police discriminated against non-Europeans in stop and search on suspicion of drugs in Stockholm (Pettersson 2005).

Even though there can be other explanations to this outcome than direct discrimination from the side of the police, it could be interpreted as an example of procedural justice not being upheld. As such, an obvious cost of applied drug policy could be diminished respect for the criminal justice system and the negative consequences that have been reported to follow from this (Doobs & Gartner 2017: A14). Regardless of discrimination, stop and search has, in several studies, been shown to create frustration and tensions between the police and citizens (op. cit.). Stop and search for whatever reason is also often justified by reference to the suspicion of drugs (Murray 2014).

## **Some Harm Reduction But Mostly a Fast Stand**

Given the questionable success of Swedish drug policy, and the high costs of this same policy, a change in the direction of policy might be expected. As mentioned, there have been some examples of a harm reduction policy. These policy changes have, however, originally met with resistance. A substitution program where heroin users were given Methadone was already set up in 1966. In the early 1980s, however, no new admittances were accepted as a result of an unholy alliance between different interests. There were those who feared a medicalization of a social problem, those who opposed harm reduction as giving the wrong signals, and groups from the political left who regarded substitution programs as a pseudo solution in a capitalist society exploiting people (Johnson 2003:117– 128). The program, however, was later allowed to expand again.

Syringe exchange programs were also met with much resistance. Accepting syringe exchange was seen as a threat to the basic values of Swedish drug policy, and a program limited to two towns was the only one allowed as an experiment. The national drug coordinator worked hard to get the program accepted on a national level. The opposition was phrased in terms of risks of medicalization and that the goal of total rehabilitation would be abandoned. Syringe exchange was ultimately accepted by Parliament after guarantees of attaching social rehabilitation measures to the programs (Tham 2005:67 ff.). The programs were, however, still met by local resistance and further legislation was needed to get programs established (Proposition 2016/17:15).

In spite of the introduction of some harm reduction measures, the main impression given is that of strong resistance to liberalizing the drug policy in Sweden. In a survey before the general election 2018, the question was put to the political parties of whether they were willing to decriminalize the use of narcotic drugs. Only the Left party was in favor of changes in that direction. None of the parties wanted to legalize drugs. When it came to penalty scales, most parties wanted to stay with the present legislation, with the Moderates (liberal-conservative) and the Social Democrats wanting to increase the severity of prison sentences, and the Left party wanting to consider lower prison sentences (Andersson & Ekeroth 2018).

In the party programs there is strikingly little about drugs. Neither has there been much on drugs in earlier party programs, although a number of special reports and information folders were published earlier. The relative lack of action today could be interpreted as the parties being on the defensive with regards to the drug issue. They do not want to leave the motto 'Sweden drug free society' behind, but at the same time, do not really know how to develop an effective drug policy. When the word 'drugs' appears in the party programs it is mainly used as a way of underlining the general seriousness of the crime problem. The Social Democrats in particular use drugs as an intensifier in statements about the threat of crime against the country. In the criminal policy program of the party, drugs are mentioned nine times and in general alarmist contexts: 'Shootings and open drug trafficking have been a problem for a long time', 'Problems with gangs of thieves, an increase in reported sex crimes, and drug crimes are examples of problems that are found in all our country', 'Drug dealing, shootings, threats and violence have to get away from our streets' (Socialdemokraterna 2018).

The political parties watch each other for signs of liberalization of the drug policy, which are then used politically. Critique from non-political bodies could possibly, then, be used as an opportunity to look for new roads to take. In a number of rulings starting in 2011, the Supreme Court lowered the sentences for aggravated drug crimes. This was, however, not silently accepted by the government. First the center-right government and then the Social Democratic–Green government reacted against the new praxis of the courts and increased the penalty scale with a new category, 'extremely aggravated drug crime' (Proposition 2015/16:111).

The government, in a report to UNGASS 2016, explicitly defended why Sweden has criminalized drug consumption (Swedish drug policy nd.:7). In a government communication on the strategy for alcohol and drug policy 2016–2020 the goal of a drug free society was repeated (Regeringskansliet 2016). The Social Democratic–Green government has declared that it will raise the penalty for drug crimes. In 2019, the government commissioned the Police to intensify its work against drug dealing (Justitiedepartementet 2019). The Minister of Social Affairs has, in 2020, refused evaluations of the law criminalizing consumption after recommendation both from the Parliament and the Public Health Authority. Finally, in an introduction to a conference on drug treatment held by Swedish regions in 2020, the Minster of Justice declared that he would not accept a decriminalization of consumption, that drugs are the roots of organized crime, that a decriminalization would be an enormous gift to the criminals and that the critics should speak up about their real motives for liberalization (Johansson 2020).

## **Obstacles to Change**

The question to be raised then is why Sweden sticks to its old policy, a policy that also seems foreign to the general pragmatic politics of the country. A number of conditions and processes partly linked to each other can be distinguished.

#### A drug free society

The motto 'Sweden drug-free society' formulates possible positions in the drug policy debate as binary. It is either/or. You are against drugs or you are for drugs if you do not embrace the official motto. It makes it more difficult to try pragmatic, harm-reducing reforms. Such reforms, and particularly reforms in the direction of decriminalization, have been labelled 'a catastrophe' by the Ministeer of Social Affairs (Wallström 1998). Resistance against substitution programs and syringe exchange has been expressed in terms of not being compatible with the basic values on which the Swedish drug policy is founded. The 'Sweden drug-free society' perspective will not permit any distinctions between different types of narcotic drugs. The distinction between soft and hard drugs has officially been rejected by the government (Swedish National Institute of Public Health 1998:9). Those in the debate who have tried to articulate the difference have been accused of being 'soft on drugs'. The zero-tolerance foundation of Swedish drug policy has, in itself, become an obstacle to possible rational solutions to a social problem.

### The tradition from the Temperance movement

That the prohibitionist Swedish drug policy has its parallel in the Temperance movement has been pointed out in an analysis by Leif Lenke (1991). This movement had been quite strong in Sweden, however, after losing ground since the 1960s it gradually incorporated the drug issue. The zero-tolerance tradition of the Temperance movement, with total abstinence from alcohol, also became the approach to narcotic drugs. The Temperance movement was in conflict with the official Swedish alcohol policy of regulated drinking through price policy and a rationing system. The theoretical foundation of this stand was the stepping-stone or gateway theory. The use of alcohol in any form, even of low strength, meant a risk – a risk of continued consumption. Beer led to hard liquor and therefore was condemned. The equivalence when it came to narcotic drugs, then, was that cannabis smoking led to hard drugs and social exclusion, and therefore had to be fought particularly hard.

The gateway theory has not been empirically supported when it comes to the development of drug use in Sweden. Low prevalence or incidence of drug use has not been followed by a low number of people with problematic use or a low level of drug-related deaths. In comparison with other European countries, several have higher levels of recreational drug use without having as high levels of drug-related deaths as seen in Sweden (EMCDDA 2019). Still, the theory is used to justify a zero-tolerance drug policy. The indicators 'ever tried drugs' or 'have used drugs in the last month' continue to be referred to as proof of a successful drug policy.

#### The interventionist tradition

Identifying social problems and acting upon them with reforms is central to social engineering and the welfare state. Non-intervention is alien to this type of thinking. When the political parties before the election in 2018 were asked if they would consider decriminalization of the consumption of drugs, two of them, The Liberals and The Christian Democrats, said no to decriminalization but would consider changing the penalty to rehabilitation (Andersson & Ekeroth 2018). That people who use cannabis on a limited scale might not need drug treatment was not seen as an option.

The interventionist tradition could partly be understood against the background of the economic commitment of the welfare state to its citizens. The welfare state promises to take care of those who cannot take care of themselves. When unable to work because of sickness, disability, parental care or old age, for example, comprehensive social insurances will grant a reasonable standard of living. Such a system is costly and demands that as many people as possible work and contribute with taxes. The prospect that someone will never even enter the labor market because of heavy use of drugs and will need social allowances for his or her whole life might contribute to interventions, and sometimes even coercion.

This interventionist tradition is also related to a tendency to consider human rights in positive terms, stressing quality of life, rather than in negative terms, stressing the protection against the state. In the political debate in the 1980s about criminalizing consumption, the leader of The Liberals (then The People's Party) was pictured full size on advertising signs declaring that in the country of The Peoples Party using dope would be illegal. For the defenders of the forced tests by the Police, the question of whether the state has any business examining the urine of its citizens has not occurred.

Before UNGASS 2016 Sweden was, as mentioned, criticized by the UN for not upholding the human rights of drug users (The Local 2015). The answer from the Swedish government gives a picture of how it perceives human rights and the duty of political interventions.

The UN Convention on the Rights of the Child recognizes a child's right to grow up in a drug-free environment as a human right. The UN International Covenant on Social, Economic and Cultural Rights talks about the right to health. All societies attempt to protect their citizens from risks that they cannot foresee; these may be anything from additives in food to seat belts in cars. This is part of the duty of society and of governments to protect citizens from risks.

(Swedish drug policy nd.:9)

The Swedish government sets up two types of human rights against each other: the rights of the drug user as being protected against state force and the rights of children to grow up in a drug-free environment. Exactly how these two rights collide is not expounded. The document produced for the UNGASS also refers to the general duty of governments to protect its citizens from risks in connection with buying food and driving a car. In so far that such interventions justify penal law, it seems open to the possibility of fairly far-reaching restrictions on human rights as traditionally understood.

#### A general law and order climate

Sweden has moved in the direction of a criminal policy relying more heavily on punishment. Changes in the general criminal policy have been described in terms of an expansion of penal legislation, a shift towards an expressive approach to policy and symbolic legislation, an increasing stress on security, a pro-active Police and early interventions (Tham 2018).

These characteristics of the development are clearly shown in the drug policy. The expansion of penal law was shown in Table 15. The expressive character of penal legislation regarding drugs is quite visible in the preparatory works. Legislation should give the right signals and show that society does not accept drugs. The issue of drugs also lends itself to symbolic criminal policy. Drugs are said to be a threat to Sweden, to democracy and the whole of society (Tham 2005). Such statements also fit well with the increasing stress on security in Swedish politics (Hermansson 2019). The rule of law has had to yield for security concerns, and 'unconventional police methods' have expanded with reference to drugs. Early interventions and pro-active policing are consequences of the overall strategy for criminal policy: crime prevention. In the case of drugs, for example, a law now gives the possibility for mandatory drug tests of legal minors (Proposition 2009/10:105).

The parallel development of criminal policy, in general, and drug policy is clear. The general development in the direction of a policy relying increasingly on punishment could therefore be seen as an obstacle to a liberalization of the drug policy.

#### A punitive public?

In the document presented by Sweden to UNGASS 2016 it was pointed out that the drug policy has been formed from below: 'Sweden's drug policy has been firmly established for a long time, both across political boundaries and with support of the Riksdag (the Parliament), but also through strong support from the general public' (Swedish drug policy nd.:2).

In the process of criminalizing the pure consumption of drugs, popular support was claimed by referring to a survey sponsored by Lion's Club where 95 percent of the interviewed population agreed that all dealings with drugs ought to be prohibited (SIFO 1984). In the 1980s, the theme of the people vs the liberal elite was also clearly present in the drug discourse, and it was claimed that there was popular support for a tougher drug policy (Tham 1995:117 f.).

If this is the case, Swedish drug policy could be said to be an example of democracy at work (Beckett 1997). This view can, however, also be questioned and systematic empirical support of a pressure from below is lacking. Most people would have rather limited knowledge of drugs – as compared to alcohol – and would therefore have to rely on the analyses put forward in the public debate. The picture provided of the drug situation is, to a high extent, put forward from above: from politicians, the Police, experts, NGO's and the media. In the government bill launching a national drug coordinator in 2002, one of the tasks of the coordinator was to carry on public opinion work, engage authorities and youth organizations, and 'offensively' propagate the official policy of the government (Proposition 2001/02: 91, 90 f.). Alcohol, narcotics, doping and tobacco programs (ANDT) have also worked for several decades in schools.

A study of the Swedish drug policy carries the subtitle, *The opinion machine at work* (van Fessem 1996). The author writes:

Public opinion doesn't appear out of the blue. Opinions are shaped by history and previous experiences. And in the Swedish case, opinions are shaped through 'opinion formation' by the government institutions. The National Institute for Public Health (Folkhälsoinistitutet) has a central role to play in the process of opinion formation.

(op. cit.:71)

The report also lists a number of other authorities, private companies and NGOs that have been involved in forming the zero-tolerance stand against drugs in Sweden.

Even if the framing of the drug problem comes from above rather than from below, it could be effective and constitute an obstacle to a liberalization of Swedish drug policy. Such concerns have been voiced. After more than 40 years of 'Sweden drug-free society', an intense zero-tolerance policy and massive information from the government and pressure groups, the public might not be swayed that easily.

#### Drug control as a national project

In criminological analyses of criminal policy there is a long tradition of interpreting development of policy in terms of possible latent functions. Theses explanations usually take the form of a national discourse (Cohen 1972; Gusfield 1963; Hall et al. 1978). A sharp and uncompromising reaction to a form of deviant behavior, and out of proportion to the seriousness of the problem, is seen as a means of strengthening a threatened national identity.

Magnus Linton makes such an interpretation of the tremendous popularity and influence of the leading figure of drug policy in Sweden, Dr. Nils Bejerot. Drug use was, according to Bejerot, the most important sign of decadence following the lack of norms that was the result of 1968. The conscientiousness of the people of the working class who had built the Swedish welfare state was said to be challenged by dopes, sex liberalists, pop radicals and lovers of thievs – all alien to traditional Swedish culture. Bejerot then managed to focus the anxiety of large groups on the drug issue after the radical, and even revolutionary, 1968 and the stagnating economy after the oil shocks in the 1970s. The whole welfare state was said to be threatened but could still be saved if a strict policy of punishment and isolation was applied to people on drugs (Linton 2015: chap. 1).

The Swedish drug policy and discourse in the 1970s and early 1980s developed further but with a slightly different focus. The concept of 'The Swedish model', which earlier referred to an active labor market policy and generous social insurances, somewhat lost its ring in the 1980s when, along with the welfare state idea, it started to be questioned. The concept was then given a new meaning, referring to the Swedish drug policy. Swedes united behind a new model and explicitly tried to export it to other countries. The importance of making a stand against drugs became formulated in relation to 'the foreign': drugs are un-Swedish, drugs are not compatible with traditional Swedish morals, both drugs and ideas of liberalization come from abroad, and the solution to drug abuse would be farm work and mounting hiking in the north of Sweden. The control of drugs in Sweden could be seen as a national project when the welfare state project became less self-evident. A strict drug policy became a way of reinforcing Swedish-ness (Tham 1995).

## **Retreat?**

The official line of the government is still 'Sweden drug-free society', repeated by the government in the action plan for 2021– 2025 for alcohol, narcotic drugs, doping and tobacco (Proposition 2020/21:132). A governmental investigation in August 2021 presented a report proposing increased penalties for drug dealing after directives from the government (SOU 2021:68). Both the Minister of Justice and the Minister of Social Affairs have, as mentioned above, come out quite explicitly against any type of decriminalization. A number of obstacles to a more liberal drug policy were also pointed out above: the claimed success of the drug policy and its nationalistic undertones, the long-term and massive anti-drug information from the government and NGO's and its influence on the public, the tradition from the Temperance movement and the gateway theory, and the aversion in a welfare state to not intervene actively in anything that is regarded as a social problem. So, returning to the question asked by Nils Christie: 'How will the retreat be organized', it presently looks like Sweden will not retreat but will continue the war on drugs and will fight decriminalization and legalization.

However, there are also signs and circumstances pointing towards a liberalization of the drug policy in Sweden. Organizations have been formed combating the official zero-tolerance policy (Föreningen Tryggare Ruspolitik). Debates are taking place in the national press and on the internet (Månsson 2017). Programs are appearing in the national television on the issue of decriminalization. The youth organizations of the political parties are nearly all in favor of decriminalization, with two even in favor of the legalization of cannabis.

The claim that the people want a strict drug policy could be questioned. A study of the general sense of justice in relation to different crimes in all the Nordic countries (Balvig et al. 2015) did not indicate a punitive population in relation to drug crimes. In Sweden, the result of a national vignette survey was that the population, on average, propose sentences far below that of the courts. In a focus group study including a video of a mock trial, where the accused had smuggled 250 grams of heroin and the judges wanted to give a five-year prison sentence, half of the participants opted for an alternative punishment to imprisonment (Jerre & Tham 2010). The people, if properly informed, would perhaps not be an obstacle to decriminalization.

Even public organizations and authorities have begun to question the present drug policy. Sweden's municipalities and county councils (SKL, Sveriges kommuner och landsting 2018) has demanded an evaluation of the law criminalizing drug consumption and an international comparison. In 2020 the Public Health Authority, the governments expert authority on drug policies, published its report on the drug strategy for the next four years. It underlines the importance of syringe exchange as a probable means for reducing drug-related deaths and also suggests an investigation of the possibility of monitored drug consumption rooms as a further means for this purpose. The Authority also proposed an evaluation of the law criminalizing the consumption of drugs (Folkhälsomyndigheten 2020).