Why Ban Drugs? Part VII: Sweden and the Issue of National Sovereignty
I could not do justice to the story of the Swedish drug policy in the way that Tim Boekhout-van Solinge has[1]; his is a highly professional, book-length academic work with a great deal of nuanced cultural perspective. But my aim is less to produce a comprehensive picture than to illustrate certain lessons which can be extracted. What values in Swedish culture, what institutional arrangements, what political preferences created the ground for the policies which developed? Why did they work, and how did they fail where they did?
Until the 1990s, Sweden was seeing a consistent decline in the main indicators of drug abuse. But after this tipping point, the strict drug policy ceased to function, and drug consumption and the problems of addiction have been rising ever since. That said, Sweden still performs much better than European averages[2] for consumption of all substances, and was the model for the conservative UNODC program[3] before the left-liberal Global Commission on Drug Policy gained agenda-setting hegemony in 2011[4]. The story of how their system came to be, and how it was crippled is sad but educational. The following article will outline the development of the policy and its effects over time. It is educational for a couple key reasons, neither of which ought to be particularly surprising: drug control is expensive, border control is essential, and idle hands are the devil’s playthings.
The Temperate Society
Sweden shared a lot in common with the northern, protestant-dominated regions of the United States where the Temperance Movement campaigned against alcohol and drugs at the turn of the 20th century. As this movement swept the North Atlantic, several countries, including Norway and Russia prohibited alcohol. Sweden itself saw several large-scale protests by trade unions, as well as pressure from churches and industry, demanding the abolition of alcohol. By 1911, 93% of their elected representatives were teetotallers[5]. Even as late as the 1950s, Sweden had 350 000 members of the temperance movement, accounting for almost 10% of the adult population[1]. However, Sweden did not enact prohibition like other nations (e.g., Russia and the United States) who saw this grassroots movement take hold.
Their 20th century alcohol and drug control policies were, uniquely, both designed by individual physicians, Ivan Bratt and Nils Bejerot respectively, leading to a country with stiff alcohol controls, and strict drug prohibition. The young and nationally renowned Ivan Bratt, known for his articles in Dagens Nyheter, his dynamic public speaking and his progressive opinions, began writing a series of influential articles offering an alternative to complete prohibition. These articles got him enough attention to be admitted to the government’s commission for alcohol policy, and he shaped what would become Sweden’s alcohol policy for the next half-century – strict, state-controlled local monopolies, and the elimination of private interests in sales, with individual users registered and their consumption was monitored; a program reminiscent of the Japanese colonial approach to opium. By opposing prohibition in the referendum of 1922, Bratt tipped the scale in favour of the policy of legal restriction[5].
Ivan Bratt (left) and Nils Bejerot (right). Bejerot is also credited with having discovered and named the famous "Stockholm Syndrome", after studying the effects of the Norrmalmstorg robbery on the hostages taken by the robbers.
The rationing system was detailed and intrusive. The national company could deny access to alcohol for any number of reasons, from medical history, to reports of bad social behaviour. Only one ration book was allowed per household, and the amount of alcohol consumed was restricted to 2-3 litres per month. Bratt believed (as is now generally understood), that alcohol in moderation prolonged life, even if abuse shortened it, as he gathered from examination of British actuarial tables. He was of the opinion that abuse was a matter of motivation and habit, not some sort of illness – his patients showed him they were perfectly capable of abstinence or moderation if they were told not to indulge for medical reasons. The close social scrutiny the rationing system imposed granted this sort of local community oversight.
The local temperance committees had the power to monitor regular behaviour, and could confiscate ration books, hand out warnings, probation orders, or even take people into compulsory care[1].
A Short-Lived Experiment
Much like the rest of the industrialised world, Sweden saw a precipitous influx of drug abuse following the Second World War. While there was some use of other drugs like LSD, cannabis and heroin, the major drug of choice, like in Japan and South Korea, was injected amphetamines. And much like the rest of the Western World, they had no idea what to do about it. Amphetamines had been legally available as pep-pills or as weight-loss supplements since 1938, but beginning in the late 1950s, youth experimentation with drugs become commonplace, and in addition to the growth in use of cannabis, which by then had affected around a third of the teenage population, amphetamines were being increasingly used recreationally. The government response was to reclassify them as restricted substances in 1959, making them only available through prescription. This dramatically reduced casual and sporadic use, but did little to affect severe abuse
At almost exactly the same time as Britain and the Netherlands, Sweden set up a special study to determine whether alternative models could be used to ameliorate the drug problems without the use of extensive repressive policies. Particularly influential was the so-called “English model”, which meant addiction maintenance therapy (state-sponsored supply of the user’s drug of choice). In 1965, the government, following trends in all the neighbouring north Atlantic countries, embarked on an inquiry into the best method to deal with the new forms of drug abuse, and decided to try out this radical program, which continued through 1967.
In the beginning about ten physicians were involved in the project, but by the end of 1965, only one physician remained, the same person who had initiated the project, police doctor Sven-Erik Åhström. [...] Åhström was known to be very outspoken, [... h]e was of the opinion that the patients themselves were responsible for the dosages they were taking, he delegated part of his work and responsibilities to a few patients that were permitted to prescribe and distribute as well, and he allowed patients to take drugs home for several days and, if this quantity ran out earlier than expected, they could come back and ask for more. Because of its liberal practices, the experiment became more and more controversial. Halfway through the experiment, when all the physicians except Åhström had abandoned the project, it was no longer supported by the client organisation RFHL. The police regularly found people with legally prescribed drugs that were not participating in the project, which meant that a lot of the prescribed substances were leaking out. Other criticisms concerned the high mortality among the participating patients and the fact that the crime figures did not decrease, as had been expected. When in April 1967 a 17-year-old girl not taking part in the project died from an overdose of amphetamine and morphine that had been administered by one of the patients, the experiment finally came to an end. - Boekhout van Solinge, 43
Nils Bejerot saw this as a unique opportunity for an epidemiological study, and monitored the spread of injection drug use among hospital admissions, homeless shelters and prisons, leading to a thoroughly grounded, and to the public quite shocking, revelation that addiction maintenance, far from minimising harm, actually spread and deepened addiction[6]. The Committee on the Treatment of Drug Abuse which had overseen this period from 1965 until 1969 took note of the increase in drug dependency, with 17% of the Stockholm youth having been found to have used drugs. The debates came to the conclusion that illegal drugs were more dangerous than prescription drugs or alcohol, since both existed in a framework of regulated social norms around consumption, whereas illicit drugs occupied an antisocial niche in society.
Nils Bejerot believed that drug abuse had an epidemic character - as a social practice it was memetically contagious, and therefore required control measures, not just to deter, but to prevent. After his public pleas, the policy experiment was put to a complete stop, and upon Dr. Bejerot’s instructions, the state adopted a total, hard-line ban on all narcotics, and took to establishing a strong moral education program and system of social deterrence. Unlike other countries, the Swedes do not distinguish between hard and soft drugs. They recognised that all drugs carry their own distinct dangers[7].
The Restrictive Line
In 1968, the public debate came to a head.The policy which followed from this became one of the most intrusive drug enforcement programmes in the world, and also one of the most successful. As a result of the lessons of the former experiment, and the socially embedded attitudes to intoxication in general, the Swedes held an extremely hard line on drug policy for the next two and a half decades.The Committee proposed two measures - first, the reduction of addiction, and second, the prevention of people coming into contact with drugs in the first place.
This formed the basis of the 1968 Narcotic Drugs Act, which strictly forbade, and imposed sanctions on the use of all drugs, without scheduling distinctions. If you used an illicit drug, it mattered not whether it was cannabis or heroin. Like all other crimes in Sweden, fines imposed on criminals are income-based, and increase with the power of the transgressor to pay for them. The fines imposed for minor breaches of the drug laws are therefore not a simple slap on the wrist for wealthier abusers, but a punishment to be taken seriously.
Nevertheless, there were limits and prosecution guidelines which were against the prosecution of minor possession cases, such as 3g of cannabis or 100 amphetamine tablets. But from his modest beginning, the codes became ever stricter and more punitive. In 1969 already, the penalty for major transgressions was boosted from four to six years in prison, and to ten years in 1972. Compulsory medical care was increased, and other prescription drugs and new substances were added to the schedule. Interestingly, the policymakers followed an unusually logical policy augmentation reasoning - the policy was working, and saw numbers decrease; therefore, more of the same could only improve matters. This established the approach for the 1970s.
In 1976, a new coalition government, composed of more liberal and conservative parties (as opposed to the Social Democrats, who had been in power since 1932) took power, and immediately set about attempting to create a "drug free society". Prosecution guidelines introduced in 1980 were restricted so that only possession of an indivisible amount (eg, one joint, one pill) could avoid criminal prosecution. In comparison with the new pattern this era of policymaking introduced, the 1970s became regarded as "liberal" in character which, compared with the English or the Dutch, they most certainly were not. When the Social Democrats campaigned to take back control, they ran on a strong anti-drug platform. But rather than the usual blame being placed on material factors, the social contagion model of Bejerot was adopted in sloganeering - "it could happen to any family". The Minister for Health and Social Affairs, Gertrud Sigurdsen, took to placing social conservatives on all the drug policy advisory boards.
The range of acts covered by law were extended to the facilitation of dealing. By 1985, all drug offenses became prison offenses. While previous prohibitions were against possession, Sweden soon entered that rare territory only otherwise occupied by South Korea, the prohibition of consumption. In 1988, noticing their low margin of victory and the importance of drugs as a key issue in recent elections, the SD imposed fines on the use of drugs themselves. This was yet again augmented in 1991 by the Conservative coalition, which changed the punishment to imprisonment, ostensibly to allow testing suspects while in custody.
During this time, the state was, much like under the development of the alcohol control policies, under heavy pressure from civil society. The various family advocacy groups, church alliances and labour unions (as well as more unusual social movements like Hassela, which set up educational communities in the countryside for troubled youth) which made up this ecosystem, placed a great deal of pressure on policymakers and public commentators alike. The importance of civil society can therefore not be underestimated.
Between 1979 and 1993, the proportion of hard-core misusers who were under 25 (as reported by a national survey) fell from 37% to 10%[8]. But while this system had a lot of success, these positive figures were about to be undercut by broader developments.
The New, Open Sweden
Border control is one of the biggest reasons for the effectiveness of the North East Asian drug control strategy, (e.g., Korea, Taiwan and Japan). In the 1970s, Korea managed to entirely eliminate the domestic manufacturing and processing base for drugs, allowing them to turn focus to border control. As a corollary example, the Dutch create an inverse problem, since despite sharing Western Europe's propensity for narcotic indulgence, they are not net consumers, but net exporters. The effect that this has had on neighbouring countries is particularly pernicious, contributing to massive trafficking networks through Belgium and Germany into the rest of the continent, supplying over 90% of the continent's synthetic drugs, an industry that causes significant environmental damage[9]. This struggle to reconcile different national drug policies has resulted in a lot of chin-wagging from EU bureaucrats, but since the remarks made in this 2003 paper[10], the situation remains largely the same.
The Swedish, who had a notoriously strict and effective drug policy, saw their incredible downward trend in drug consumption completely reversed as they opened up border controls and relaxed trade restrictions from 1990, following the announcement that they intended to join the EEC[11]. The financial crash that followed was a game-changer. Throughout the 70s and 80s, Sweden had pursued a highly protectionist, Keynesian economic program. They chased down unemployment figures to as little as 2%, and maintained lavish and enviable welfare program, fed by an export-oriented market. This provided not only occupation but security. As these fell apart, despair and idleness grew, and drug use was introduced to a new generation of Swedes.
The collapse of the economy also meant significant cutbacks of police resources, which loosened the state’s grip on the chemical proclivities of its subjects. This happened just as the Soviet empire fell apart, producing an enormous criminal enterprise boom across the continent. By signing onto the Maastricht treaty, the Swedish irrevocably destroyed their independent border enforcement capacity. The trend reversal in indicators of drug use is a testament to the dramatic nature these changes had on Swedish society. Unemployment shot up to 8% and has been between 6% and 8% ever since.
Drug use and alcohol intoxication among Swedish conscripts, 1971-1999 (%)[12]
1988 Cost-price-index-adjusted street value in 2017 money value for hashish, marijuana, amphetamine, cocaine and brown heroin. 1988-2017[13].
The development of the number of individual drug seizures (beslag), the number of people suspected of drug offenses (värdade personer), the number of persons diagnosed with drug-related diagnosis (misstänkta) and the number of drug-related deaths (dödsfall), per inhabitant. 1987-2017. Indexed to 1987 at 100.[14]
The large cliff you see in the first chart starting from 1980 marks the Swedish policy of criminalising consumption and cracking down on personal use. As the borders opened, the price of narcotics dropped, and with the free movement of people, drug supply was harder to interrupt. New users increased. Students went on holiday to consume drugs, taking advantage of the low cost of European travel and the legal diversity across the Union[15]. Along with this uptick in consumption, narcotics arrests predictably skyrocketed in the 90s. So have overdose deaths, addiction cases and seizures of drugs.
What Now?
Today, Sweden’s drug policy still manages to depress consumption to below half of the continental average. But this no longer seems special, and its shortcomings in care for drug abusers, as well as social stigma around seeking help, have achieved the second-highest overdose rate in Europe[16]. Other countries which, for cultural reasons (Greece, Turkey) have avoided developing high rates of drug abuse do not incur the same burden on their medical and justice system infrastructure as do the Swedes. Preventing drug abuse is expensive, contentious and difficult, and as we have seen, fragile. But it is not impossible. Like Sweden once was, North East Asia is today. With their tight controls on their borders, robust education and awareness policies which teach that drug taking is immoral, and a whole-state, centrally coordinated drug control systems, which strictly enforce laws against possession, manufacture and trafficking, these countries have achieved the lowest rates of narcotics consumption in the world.
And as Sweden demonstrates, these achievements are not culture-specific, but a result of concrete national political decisions. Decisions which can easily be undone when sovereignty is jeopardised.
[1] Boekhout van Solinge, Tim. The Swedish drug control policy. An in-depth review and analysis. Amsterdam, Uitgeverij Jan Mets/CEDRO (1997)
[2] EMCDDA, Country Drug Report, 2019
[3] United Nations Office on Drugs and Crime. Sweden's Successful Drug Policy: a Review of the Evidence. United Nations Office on Drugs and Crime, 2006
[4] Bewley-Taylor, David, and Martin Jelsma. "Regime change: re-visiting the 1961 Single Convention on Narcotic Drugs." International Journal of Drug Policy 23, no. 1, 2012
[1] Gould, Arthur. Developments in Swedish social policy: resisting Dionysus. Springer, 2001: 156
[5] Nycander, Svante. "Addiction History - Ivan Bratt: the man who saved Sweden from prohibition." Addiction 93, no. 1 (1998).
[1] Gould, 2001: 157
[6] Bejerot, Nils. "A theory of addiction as an artificially induced drive." American Journal of Psychiatry 128, no. 7. 1972.
[7] Westerberg, B. "Reply to Arthur Gould:“Pollution rituals in Sweden: the pursuit of a drug‐free society”." Scandinavian Journal of Social Welfare 3, no. 2. 1994
[8] Westerberg, 1994: 95
[9] Europol. "In Depth Analysis of the EU Drug Market", 2014: 124-125;
Schoenmakers, Y. M. M., and S. L. Mehlbaum. "Drugsafval in Brabant." Justitiële Verkenningen 43, no. 2 2017
[10] Chatwin, Caroline “Drug Policy Developments within the European Union: the destabilizing effects of Dutch and Swedish drug policies.” British Journal of Criminology, 43. 2003
[11] GATT. “Trade Policy Review Mechanism – Sweden” Report by the Government.1994
[12] Lenke, Leif, and Börje Olsson. "Swedish drug policy in the twenty-first century: A policy model going astray." The Annals of the American Academy of Political and Social Science 582, no. 1. 2002
[13] CAN (Centralförbundet för alkohol- och narkotikaupplysning) “Drogutvecklingen i Sverige 2019 – med fokus på narkotika” Rapport 180, Stockholm. 2019
[14] CAN, 2019
[15] Tatiana, Lantz, and Andreas Jana. “Ta mer, vi är inte i Sverige: En kvalitativ studie om svenska unga vuxnas risktagande av drogturism i Barcelona.". 2018
[16] EMCDDA, European Drug Report, Trends and Developments, 2019