International - Sweden

Basic Data

(Lifetime Prevalence of Use) "The population study indicated that approximately 23 per cent of the men and 12 per cent of the women in the population had used illicit drugs at some time in their lives. This means that approximately 600,000 men and 300,000 women 15-64 years of age have used illicit drugs at some time. In addition, 4 per cent of the men and 8 per cent of the women had used narcotics-classed or addictive medicines without or in excess of a physician’s prescription. This corresponds to 116,000 men and 200,000 women. These figures must be viewed as minimum numbers. The report discusses the value of asking about lifetime drug use. Among other aspects, it appears as if people forget or deny earlier use with increasing age."

(Estimated Number of Current Drug Users) "Two per cent of the men and 0.9 per cent of the women reported some type of illicit drug use in the past 30 days, corresponding to approximately 53,000 men and 24,000 women or a total of 77,000 people. Adding to this the 50,000 people who in the past 30 days had used prescription medicine without a doctor’s prescription, the total figure increases to 127,000 people. The population study indicates that the highest proportion of regular drug use is found among young men between the ages of 15 to 24, while the highest proportion among women is observed in the ages of 25 to 34. Regular drug use then decreases with increasing age for both genders. The results from the student survey do not indicate that students use illicit drugs more than others of the same age in the population. For prescription medicines, patterns opposite to illicit drugs are seen in terms of age and gender. Approximately twice as many women as men have used narcotics-classed or addictive medicines without or in excess of a doctor’s prescription."

(Lifetime Prevalence of Use Among Youth) "The lifetime prevalence of any drug for 15-16 year-old boys and girls were 9 and 7 per cent respectively, which are the same percentages as the year before. The past-30-day prevalence was 3 per cent for boys and 2 per cent for girls. Cannabis was by far the most common drug in the surveys among 15-16 year-olds, irrespective of sex.
"Lifetime prevalence (2010) of ever having used an illicit drug among the 17-18 year-old students was 21 per cent for boys and 14 per cent for girls, which for boys was 3 percentage points higher than in 2009. The past-30-day prevalence was 5 per cent and 2 per cent, respectively. Among those who had used an illicit drug, the most common drug of choice was cannabis, but benzodiazepine and amphetamine were also reported."

(Age of First Use) "According to CANs school population survey 2010, very few students have used drugs before the age of 14; 2 per cent of the boys and 1 per cent of the girls. The percentage of students who reported drug use before the age of 14 has been stable over the last 20 years.
"The percentage of students (15-16 years) who have had opportunity to try drugs (for the first time) increased by the end of the 1990s and the increase continued until 2000 when 27 per cent reported in the survey that they had had the opportunity to try drugs. From then on, the percentage decreased again and in 2010 it was 19 per cent. The percentage of older students (17-18 years) who have had opportunity to try drugs is somewhat larger, approximately 35 per cent."

(Women with Substance Abuse Problems) "A larger share of socially excluded persons use drugs in Sweden, but most drug users are not socially excluded (Statens folkhälsoinstitut, 2010c). Female regular drug users have less social support and a worse mental health compare [sic] to male regular drug users.
"Women and substance abuse
"Approximately 23 per cent of the adults with substance abuse problems who were receiving housing assistance on 1 November 2010 were women. The proportion of women among those receiving individually means-tested out-patient care was approximately 30 per cent, and among those receiving round-the-clock care it was about 25 per cent. The proportion of women among those receiving compulsory care on 1 November 2010 was 36 per cent (Socialstyrelsen, 2011a)."

(Number of Drug Offenses and Convictions, 2010) "According to the 2010 official criminal statistics of Sweden, about 87,900 offences against the Act on Penal Law on Narcotics were reported in 2010. An increase by almost 10 per cent compared to 2009. The number of convictions with drug violations as the main crime increased by 8 per cent (about 1,500 convictions) compared with 2009. Of the 20,021 convictions with a drug offence as the main crime during 2010, 15 per cent involved women and 26 per cent involved adolescents between the ages of 15 and 20. The offences were considered minor in 83 per cent of the cases (16,952), not minor in 14 per cent (2,701) and serious in 2 per cent (368) as reported in the 2010 Swedish Official Criminal Statistics from the NCCP."

(Drug Offenders in Prison) "On any given day, there are approximately 3,200 people in prisons (excluding remand prisons) who are addicted to alcohol and/or drugs. This is about 60 per cent of the prison population on any given day. Including remand prisons and those with probation sanctions, there are between 9,000 and 10,000 people who are addicted to alcohol and/or drugs or have a substance use disorder in Swedish prisons."

(Estimated Number of Problem Drug Users) "In total, the number of problematic drug users in Sweden was estimated at a rounded of figure of 29,500. This number is not directly comparable to the figures previously derived in Sweden due to differences in both the data sources and the methods used. The national estimate relating to population was 3.2 [Problem Drug Users per 1,000 population] with the “all ages” denominator and 4.9 with the 15-64 years of age denominator (see ST7 and ST8 for details)."

(Estimated Number of Problem Drug Users) "Based on register data from the patient register and from the Prison and Probation Services, it was estimated that there were 29,500 problematic drug users. This corresponds to 38 per cent of the 77,000 people who confirm regular use of illicit drugs in the population survey, or 23 per cent of the 127,000 people who regularly use some type of illicit drug or presomption medicine without a doctors prescriptive [sic]. This means that there is a large group of people whose regular drug use does not lead them in to the health or corrections systems."

(Previous Estimates of Problem Drug Use) "The population of problematic drug users in Sweden was estimated at approximately 15,000 in 1979, approximately 19,000 in 1992 and around 26,000 in 1998. This means an increase in nominal figures. However, a per capita figure would be more accurate since the general population increased during the same time period. In 1979, there were 1.8 PDUs per 1,000 inhabitants according to the above estimates. In 1998, this figure increased to 2.9 per 1000. Please note that the above figures refer to all ages.
"It should be noted, however, that there were some differences with regard to data collection methods (e.g. inclusion criteria, sample size), as well as a changing attitude in society with regard to drug users and to the central gathering of data. It cannot be ruled out that these factors have influenced the figures."

(Characteristics of Syringe Exchange Program [SEP] Participants) "Last year syringe sharing has occurred in a total of 37 per cent of SEP-users and during the last month in 19 per cent. IDUs [Injection Drug Users] integrated into mainstream society, but not in the subculture, have significantly lower numbers than the rest, 29 per cent and 8 per cent respectively. Most IDUs had previously received some form of drug treatment, a total of 75 per cent.
"The average visitor participates in the programme for four years, does 50 visits and collects 200 syringes and 400 needles. The variations are however large. About half of the visitors have visited the clinic at any time without changing needles and syringes or using any other regular service. These visits seem to be of an informal social nature.
"Syringe and needle coverage was based on interview data on injection patterns during the last year. From the register the number of distributed needles and syringes was then obtained. Ratios of total syringes coverage was estimated at 15 per cent and 30 per cent for needles. Frequent users (> 100 visits) has a ratio for syringes of 21 per cent and for needles 44 per cent. Those who in the last year had not shared injecting equipment with others had a ratio of syringes of 17 per cent and for needles 34 per cent. The corresponding figures for those who had shared equipment with other were 11 per cent and 22 per cent.
"Nearly 60 per cent of SEP-users had some form of treatment experience before they joined the exchange programme. More than 40 per cent had received some form of treatment while in the programme, but of those, only 8 per cent had no previous treatment experience. Just over a third had never received treatment for their drug
use (Stenström, 2008)."

(HIV and Injection Drug Use) "Compared with many other European countries Sweden has a relatively small proportion of IDUs infected with HIV. During the last 5-10 years the proportion of IDUs among the reported HIV cases in Sweden has been between 15 and 25 per cent. Local studies have shown a prevalence of HIV among IDUs of between 0 and 8.4 per cent (EMCDDA, 2009a)."

(Hepatitis C and Injection Drug Use) "In Sweden the prevalence of hepatitis C among injecting drug users is very high. In various studies conducted during the last 15 years, the prevalence has been reported to be between 60 and 92 per cent (EMCDDA, 2009b).
"In 2010, a total of 1,944 cases of hepatitis C were reported to the Swedish Institute for Infectious Disease control, which represented a 12 per cent decrease in cases reported compared to 2009. Intravenous drug use is the dominant transmission route and most cases are domestic. Seen in a longer perspective the total number of reported cases is decreasing. However, when looking by age group, no decreasing trend in cases infected via intravenous drug use is apparent in the younger age groups (15-19, 20-24, 25-29). This indicates that there is on-going transmission of the disease among young intravenous drug users in Sweden. The trend analysis is aggravated by the fact that it is not possible to differentiate between acute cases and chronic cases of hepatitis C in the surveillance data."

(Hepatitis B and Injection Drug Use) "In the beginning of the 21st century there was an outbreak of hepatitis B among intravenous drug users in Sweden. Following the outbreak vaccination activities were intensified at prisons and the 2005 vaccination recommendations for risk groups regarding hepatitis B were developed. Despite an increase in vaccination activities local minor outbreaks of hepatitis B among intravenous drug users are still being reported. This indicates that not all IDUs are being vaccinated and that the transmission of hepatitis B is still a problem in this group despite it being a vaccine preventable disease. About 150-200 cases of acute hepatitis B are reported annually in Sweden. In 2010, 125 cases of acute hepatitis B were reported out of which 51 reported had been infected via injecting drug use in Sweden."

(Methadone Treatment and Mortality) "The number of deaths with presence of methadone in the blood has tripled in Sweden during the period 2006-2008. In the same period, there has been a rapid expansion of methadone treatment. In 2005, the regulations on medically assisted substitution treatment were changed in Sweden. The previous restrictions on the number of people who were allowed to participate in treatment at the same time were removed. The number of new treatment units increased tenfold when a number of new programmes started throughout the country (Fugelstad et al., 2010). In autumn 2010 there were 64 units that provided pharmaceutically assisted maintenance treatment in Sweden (Swedish National Institute of Public Health, 2010).
"A forensic medical examination of the methadone related deaths shows that the majority involved mixed intoxication where the methadone played an important role. As the Swedish prescription register shows that 80 per cent of the deceased persons had not obtained their methadone from any legal sources, methadone programmes or pain relief treatment, leakage from methadone treatment appears to be a possible but minor source (Fugelstad et al., 2010)."

(Number of Clients in Treatment) "For 2010, data is available from a higher number of reporting treatment centres than in previous years. In 2009 the reporting system covered 51 per cent of all inpatient and 31 per cent of all outpatient treatment centres. In 2010 the distribution should be similar even if the exact figures are not known.
"One third (1,597 patients) out of the total of 5,155 clients who were reported came into treatment for the first time. The main drugs of choice by new clients are cannabis and amphetamine, closely followed by the summary category “other opiates”. Most IDUs in the population of new clients use amphetamine. For all clients undergoing treatment, the use of amphetamine is most prevalent, followed by heroin. The prevalence of amphetamine IDUs are higher than the prevalence of heroin IDUs."

(Treatment Clients by Substance Used) "The distribution of drugs changed somewhat in 2008: cannabis being more frequent than heroin. This trend has continued in data for the clients that were reported from treatment units in 2009: cannabis is now much more frequent than heroin.
"Amphetamine is still the most commonly used drug (29 per cent) among the reported drug clients in treatment outside prisons, followed by cannabis (23 per cent), heroin (17 per cent), other opiates – analgesics and buprenorphine (11 per cent) and benzodiazepines (11 per cent).
"Cocaine use is still rare as a drug being the reason for seeking treatment (1 per cent), and crack cocaine is nearly non-existing in this population, as is also methadone, ecstasy and hallucinogens."

(Availability of Opiate Substitution Treatment) "Although access to medically drug-assisted therapy has increased significantly in Sweden, long queues still exist in many places. A survey from 2007 showed that only half of the Swedish county councils were able to offer drug-assisted therapy within the timeframes set by the health care guarantee (Sjölander and Johnsson, 2007). Swedish studies indicate that one of the main reasons for illegal use of buprenorphine¹⁵ is that existing programmes do not have capacity for all who require treatment (Antoniusson, 2007, Håkansson et al., 2007)."

(Characteristics of Effective Treatment Programs) "In recent years, some Swedish drug-assisted programmes introduced a "zero tolerance" against lateral abuse, which means that a patient can be discharged from treatment after a single positive urine test (Heilig and Gunne, 2008), leading to low retention. Recent Swedish research has shown good results in clinical trials with highly structured treatment based on positive reinforcement of desired behaviours (Kakko, 2011). In an evaluation of a drug-assisted programme for female prostitutes in Malmö, two success factors are mentioned: effective liaison with social services and other mental health care and a reasonable programme size. Small scale programmes create an organizational vulnerability while large scale programmes increases the risk of neighbourhood problems and therapeutically unfavourable patient compositions (Laanemets, 2007)."

(Unemployment, Social Exclusion, and Drug Use) "The Swedish unemployment rates were rather low during the 1970s and the 1980s. During the first half of the 1990s unemployment rates reached relatively high levels, especially among youths (16- 24 years). In the late half of the 1990s the figures have decreased, but the unemployment rates 1998 was still four-folded compared to 1989. One possible reason for increases in drug use among younger people, apart from an increased supply, is problems connected to social exclusion and high levels of youth unemployment. Negative future prospects, at least for certain groups of youths, might be a reason for not giving up experimentation with drugs, which in turn might lead to long lasting severe drug use.
"During the 1990s there has been financial cut downs within the general welfare systems as well as in special forms of treatment (walk in clinics, therapeutic communities, etc). This might have had impact both on recruitment of new drug users who fall through the welfare net but also on the possibilities to offer drug users appropriate treatment. Statements from social workers, policemen, hospital staff and others sometimes indicates that the group of severe drug users are worse off nowadays, regarding economic and health aspects."

(Availability and Prices of Drugs) "The availability of cannabis resin is assessed to have increased for the past 20 years. Both the economic availability and the physical supply have increased. This assessment is made in light of the fact that seizures and court cases involving cannabis have increased sharply, at the same time that prices have fallen. However, data for 2010 indicates that this trend may have been broken in that the prices for cannabis resin rose and seizures decreased somewhat.
"This does not mean that availability of cannabis has decreased in general since demand of marijuana has increased. Seizures of marijuana have also increased and virtually all regions in Sweden currently report marijuana prices, which was unusual in 1990s. However, marijuana prices have risen under the past five years, maybe because demand is keeping prices up, despite a larger supply. This could also be due to an effect on prices by increases in quality. Although marijuana has become relatively more common, cannabis resin is still the dominant form of cannabis on the Swedish market.
"Central stimulants, such as amphetamines and cocaine, are assessed to be more available now compared with the end of the 1980s; the prices have fallen sharply at the same time that seizures have increased. Like marijuana, relatively few cocaine prices were reported at the beginning of the period, but in recent years, most of the regions in Sweden report cocaine prices. However, amphetamines are still the most common central stimulants in Sweden, although cocaine has become relatively more common compared with 20 years ago. Amphetamine prices have decreased more than other drug prices and today the price is a third of the price of 1988."

(Decrease in Drug Control Funding and Increase in Lifetime Prevalence) "During the 1990s there has been reduced funding in this field [drugs] and at the same time there has been an increase in the availability of drugs with a corresponding increase in lifetime prevalence of drug use among young people. However, the annual school survey in grade 9 made during the spring showed a decrease in use of alcohol, drugs and tobacco. This decrease was the first in more than a decade.
"There are indications that the number of problematic abusers has increased in this period and also that the social services are less informed about their whereabouts and conditions than they used to be. There are also fewer specialised agencies involved."

(Increasing Drug Seizures During the 1990s) "Throughout the 1990s the seizures of several drugs have increased. Particularly seizures of amphetamines and heroin have gone up significantly during the period, in numbers but also in kilos. Increase in seizures holds true also for LSD, ecstasy and cocaine, but at much lower and more fluctuating levels.
"Heroin and amphetamine prices have decreased significantly during the decade. Ecstasy and LSD prices fluctuate and the price intervals reported are considerable, probably due to limited availability. Cocaine and cannabis prices remain relatively unchanged and also the cannabis seizures have more or less hovered during the 1990s, both in numbers and size (apart from the very high figures of 1999).
"To sum up: availability of particularly heroin and amphetamines seem to have increased during the 1990s and there are no signs of this these trends to taper off."

(Failure of Enforcement During 1990s) "Indicators such as seizures (amounts as well as number of seizures), prices on the street and anecdotal data from users unanimous tell the same story: supply is more generous and prices lower than ever. The variety of drugs has also expanded during the 90s and now follows what happens in the rest of the EU."

Laws and Policies

(New Swedish National Drugs Strategy) "An evaluation of the last five-year Swedish action plan on drugs (2006-2010) indicates that the national efforts to reach the goals have stagnated in the area of narcotics (Statens folkhälsoinstitut, 2010b). A new national strategy for the period 2011-2015 has been launched and the visionary goal of a society free from narcotics remains. The strategy has seven long-term political objectives, including increased access to health care and support of good quality for individuals with abuse or dependence, as well as a decrease in the number of deaths or harm due to use of alcohol, narcotics, doping and tobacco (Regeringens proposition 2010/11:47). In January 2010, a preliminary commission report concluded that Swedish health care and social services is of insufficiently quality and not diversified enough in the area of drug use. In the commissions’ final report in June 2011 a number of proposals were submitted including increased financial resources, implementation of national guidelines, increased availability to drug treatment including a statutory enhanced health care guarantee, needle exchange and other evidence based interventions. The report also suggest new laws and a new organization where the County Council is given overall responsibility for treatment and municipalities overall responsibility for social support. The commission’s proposals are suggested for adoption in January 2013 (SOU 2011:35)."

(National Drug Control Strategy) "A five-year strategy covering the years 2011 to 2015 was adopted in March 2011 by the Riksdag (Swedish Parliament) (Regeringens proposition 2010/11:47).
"The strategy is similar to previous years, as the main objectives include a society free from narcotics and doping and decreased medical and social harm from alcohol as well as a decrease in the use of tobacco. The new five-year strategy also states that the overarching goals from previous national action plans remain.
"As described in the preface of the summarised version of Government Bill 2010/11:47 (Regeringens proposition 2010/11:47), the strategy aims to facilitate state management of public support in the ANDT sphere. The strategy establishes the goals, priorities and direction of public measures for the period 2011–2015. It covers a range of areas; local preventive actions, measures designed to limit supply, the fight against drugs, care and treatment, alcohol and tobacco supervision, and EU and international efforts. Further, the five-year cohesive strategy aims to facilitate a long-term perspective and better coordination and cooperation between agencies and other actors and to emphasise the responsibility of all actors involved. With the strategy, the Government stress that cooperation between the spheres of health promotion, disease prevention, crime fighting, treatment and rehabilitation should be intensified."

(Harm Reduction) "In 2006, the new Act on Exchange of Syringes and Needles entered into effect (SFS 2006:323). The purpose of this Act is to prevent the spread of HIV and other blood-borne infections through the exchange of syringes and needles, and this is to be carried out in connection with interventions aimed at motivating the individual to accept care and treatment. Exchanges may not be done without the permission of the National Board of Health and Welfare (NBHW)."

(Police Authority to Order Drug Tests) "Since drug use is prohibited with a maximum of six months imprisonment, the police are allowed to conduct drug tests (blood or urine) if there is reasonable cause to believe that a person is under the influence of drugs, however not on persons younger than 15 years old. The conservatives have however suggested a change in the legislation so that also these persons could be tested, in order to detect and stop drug use among young teenagers at an early stage. Not only the conservative former Minister of Justice and the present Social Welfare City Commissioner of Stockholm are advocating this for example, but also representatives from other parties as well. A response to criticism on the proposal is that the health of the children is more important than their integrity."

(History of Restrictive Policies) "Between 1917 and 1955 Sweden had an alcohol rationing system, and even today embraces a comparatively restrictive alcohol policy. This tradition makes a restrictive drug policy a logical option. The current alcohol policy is based on the “total consumption” model, which holds that the more people use alcohol, the more they will abuse it and the greater the total harm caused by alcohol will be. The implication for policy, then, is to limit alcohol use through the instruments of price and availability."