SIMPLE SLOGANS NO ANSWER TO DRUGS

Their tough laws have not solved the Swedes' drug problem, but we can
learn from their mistakes, says BRIAN McCONNELL.

SWEDEN'S "zero-tolerance" style drug policy with its goal of a
"drug-free society" is coming under closer scrutiny as a country which
may hold the solution to Australia's drug problems. What makes
Sweden's drug policy different and are there lessons for Australia
when it is trying to grapple with the growing number of overdose deaths?

The 1960s marked the beginning of changes in Sweden's drug policies
when a group of doctors, over a two-year period from 1965 to 1967 and
involving 120 patients, undertook a project of prescribing some
illicit drugs.

This project has been used as an example to oppose the ACT heroin
trial and to "prove" that prescription heroin is a catastrophe giving
rise to an epidemic of illicit drug use. A report on the project by
police doctor Nils Bejerot is the basis for every claim that Sweden's
prescribing project led to a "massive rise of the number of addicts"
in the 1960s.

The facts are somewhat different to the claims. The project was never
meant as a scientific experiment, but merely a project that grew out
of some doctors' practical work. The substances prescribed were
primarily amphetamines for oral and injecting use, methadone and
morphine. Heroin was never prescribed in this project.

The initial involvement of 10 doctors dropped away by the end of 1965
to only one. The project was mismanaged with poor medical practices.
The remaining doctor delegated part of his work to some patients who
were permitted to prescribe and distribute.

Drug doses were not consistent; there was over-prescribing; drugs
leaked on to the black market; and patient records were not kept. The
project came to an end when a 17-year-old girl, who was not a
participant in the project, died from amphetamine and morphine
administered by one of the patients.

Bejerot claimed to find data to support his hypothesis that the
project's permissiveness led to an increase in intravenous drug use in
what he said was an epidemic-like spread.

He claimed the experiment had a triggering effect for this "epidemic".
His underlying assumptions have been questioned by the scientific
community who do not share his views, in Sweden and abroad, but his
views have been widely accepted by government officials.

His influence marked the beginning of Sweden's gradual drug-policy
shift to increased criminalisation of drug use. There is no
distinction between "soft" and "hard" drugs. Where once the possession
of small quantities of cannabis was met with a fine it is now dealt
with as a criminal offence.

The aim of a "drug-free society" was introduced in 1977 by a new
coalition government, the first non-Social Democratic government since
1932. From that time drugs took on greater prominence in political
debates. Disagreement with the policy is generally not tolerated.

Special laws introduced in the 1980s allowed forced treatment for
adult drug abusers but without any positive effect on drug abuse.

Imprisonment for drug-related offences have tripled since the late
1970s and long prison sentences, together with application of harder
drug laws, have contributed to the worsened situation in prisons.

In 1993, police were given authority to perform blood and urine tests

on suspected drug users. Up to the end of 1997, 39,000 blood and urine
tests had been taken at a cost of $A1.2 million per year.

Despite some police not being convinced of the effectiveness of the
law, the police are now waiting for a new law that will allow them to
test any person without reason.

Since joining the European Union, and through fear that it may be
swept up by the EU's moves towards decriminalisation and legalisation
of drugs, the Swedish Government has been aggressively marketing its
drug policy at drug forums throughout Europe and to visiting officials
at home.

A controversial part of the Swedish drug policy is police action
against drug trafficking on the streets.

While authorities admit that traffickers will simply move to another
street, they believe the police action will make it harder for the
traffickers to make contact with casual abusers and young people. The
authorities also believe that such police action shows the public that
drugs are not tolerated.

Police activity is focused on the goal of a "drug-free society". The
downside of this focus is that the police are being swamped by other
rising crime. The amount of solved crime is falling and the backlog of
crime still awaiting investigation is rising.

Another goal of Swedish drug policy has been to offer help and
rehabilitation, described as a "caring chain" of outreach services,
detoxification, out-patient care and institutional care comprising
abstinence-based treatment and methadone maintenance. Syringe exchange
programs are also available.

Compulsory drug treatment is controversial. Nationally there are 1,360
people in compulsory treatment homes. But the compulsory treatment of
drug users is said to be uncommon and relatively rarely applied.
However, for drug-using teenagers it is often used as a "threat" to
force someone into "voluntary" treatment.

Has Sweden achieved a "drug-free society" and will it ever achieve
that goal? The answers are "no" and "probably not".

The question of whether or not Sweden's policy is effective is
problematic. In the case of treatment the meaning of statistics
collected is unclear and not usually measured in terms that,
addiction, a long-term chronic relapsing condition would normally be
measured.

Measuring in terms of drugs seized by police has the effect of
measuring police activity and not success of policies. Measuring in
terms of drug users provides some answers but positive questionnaire
responses are usually under-reported because of prevailing attitudes
toward drugs and drug use.

Some answers come from a 1992 study of 102 people who underwent
compulsory treatment: after six months 9 per cent were abstinent, 18
per cent had reduced abuse, 28 per cent had gone on voluntary
treatment and 13 per cent underwent compulsory treatment again. In
that same period 7 per cent of the clients had died.

The mortality of the compulsory group was higher than those in
voluntary treatment. This provides a note of caution and a useful
yardstick for NSW's trial of drug courts. In Sweden there has been an
increasing trend in deaths from illegal drugs since 1989, not downward
as one would expect if the policy was successful.

When compared with other European countries with similar drug-using
populations, Sweden's death rate of 28.4 per million in 1997 means
that its policies are no more effective than the rest in reducing drug
deaths.

In summary, Sweden has not solved its drug problem and is in fact
lagging behind many other European countries in terms of the harm
caused by illegal drug use.

Despite the Swedish Government's aggressive assertions, the claim that
a permissive drug policy increases the number of drug consumers is not
proved by the evidence.

There are nevertheless lessons to be learned, if only to identify and
eliminate those policies that do not work and that are not based on
the evidence.

For a solution to the drug problem, Australia must look beyond
simplistic slogans such as a "drug-free society".