My name is Berne Stålenkrantz. I am the founder and chairman of The Swedish Drug Users Association. I will firstly thank you for the opportunity to express our concerns regarding the issue of health relating to drug use in Sweden.
We (SDUU) are currently the only organisation in Sweden that work with issues of drug use, and primarily opiate users, from a client perspective. We have been working since 2002 with issues of health, treatment and human rights for drug users in Sweden. We founded the organisation as a reaction to a lack of understanding and knowledge within the prior existing organisations that talked on clients behalf without experience, and authorities that failed to understand the complex problems related to drug use.
We work with individuals who need help and support in their contacts with authorities, care givers, and social services on a variety of issues regarding health, social problems, and sometimes legal issues. Our main ambition is focused on a client-caregiver model. This in order to create a working model for effective methods of work, and best attained by a dialogue between drug users and care givers. That means that we also work with authorities and care givers. We provide experienced insights, information and function as an instance for developing good practicies regarding health and treatment. One important work we do is to recognise failures of treatment, and case profile these failures. The main goal is to eradicate the harmful zero-tolerance policy on narcotics in Sweden and replace it with realistic, humanistic and scientifically based methods, and also a client perspective as a fundamental way of obtaining good practicies. All drug users that are in need of Methadone treatment—or clean needles—should have the opportunity to get access and also have the freedom of choice between care givers.
The policy on narcotics in Sweden is in our perspective highly problematic as it stands in opposition for the possibilites to work with methods of harm reduction. Treatment of drug users show substantial failures due to to the formulation of laws that are based on a zero-tolerance approach. This has been the case for many years.
One mayor point is that it is forbidden to use drugs in Sweden, which makes programmes for syringe exchange impossible to implement on a national scale. The other related problem is that the programmes for Methadone, which are very restricted and burdened with rules of conduct that in some cases leads to problematic users being kicked out of programmes. For people that get treatment within the Methadone programme other social problems some times get highlighted as social services are involved, and failure of conduct. The treatment is available but it is dubious how easily it is attained, and the difficulties involves both the possibilities to get into programmes–the rule of abstinence hinders that—and to stay in the programme—if someone have a relapse the risk is extremly high to get barred from further treatment.
The case of Anna illustrates the difficulties drug users often face in Sweden.
– Anna, 24 years old, is a heroin user. The use of heroin has here been transmitted trough generations in her family. Her grandfather was a heroin user (he passed away 15 years ago). Her mother and father, also heroin users. Her sister 27 years, also a heroin user, died of an overdose 4 years ago. Anna lives in the south of Sweden. She applied for treatment with Subutex. The doctor in charge of the substitution treatment and her social worker refuse to help her because she has already have had Subutex treatment twice and failed to obey the rules for treatment! To fail is to relapse, and that is concidered a breach of the rules for conduct, and accordingly she gets thrown out. She gets back to a daily heroin use. Society puts her in danger of her life. SDUU files a complaint to the ”Swedish board of welfare and social affairs” which is the body that inspect the health care, the answer: nothing!
In the prisonsystem as a further example, where drug use is profound, and the use of injection is widely spread there are no programmes for syringe exchange, and Methadone treatment is in a deadlock. The criterias for obtaining treatment whilst in prison is to have a guaranteed follow up upon release, and furthermore treatment can not start earlier than two months before release. This has resulted in zero drug users undergoing Methadone treatment in prison.
The two syringe exchange programmes that has succesfully run for the last twenty years in the south of Sweden is still concidered a political problem and very few politicians speak up in defence for making such programmes in other regions and cities of Sweden. Even if the two programmes can establish that they do reduce harm, critics willingly point to the fact that they do not reach such a high number. But that fact is due to how the programmes are made available for drug users to the clinics, the opening hours are restricted to two hours a day and at weekends they are closed. One other problem with the existing programme is the age restriction – young persons under the age of twenty are not allowed participation and are excluded from the programme. That means that young persons are especially put at risk as they have no legal access at all to clean needles even in regions where it is at some point available.
In our opinion there are about 5 000 problematic drug users (of 26 000 to 30 000) that are in need of access to programmes of Methadone, but only about 1 500 that are in treatment. This is mainly due to the restrictive structure of the programmes resulting in that many drug users doesn’t obtain treatment they seek and ask for. Another obstacle is that the law forbidding drug use also dampens the motivation to seek help in the first place, or even to have contact with either care givers or social services which are institutions that could be suitable instances for help seekers. This is were SBF is useful, but to reach such high numbers is not within our reach. This must be dealt with within the legal system and be solved politically. The problem in Sweden is that it is almost impossible on a political level to speak about harm reduction methods, such methods are almost always regarded by a majority of politicians as dubious and the tendency is therefore to refer to such issues as arguments for a legalization of all drugs – and other politicians in favour of harm reduction methods are effectively opposed. This is also reflected in the work we try to accomplish; as a drug user association we are often mariginalized and excluded from political processes that afflicts us and our members. Some improvements has been gained, but a lot remains still to be achieved.
We have during our work collected many cases where authorities and care givers fail to recognise drug users right to health. I point here to another case that highlight the consequences of Swedish repressive policy on narcotics:
– Max, is 26 yrs of age. He started to smoke heroin in October 2006. At the beginning of December 2006 he starts to inject heroin. Johan Stenbäck, the chairman of the Stockholm user group takes a private initiative to a small syringe programme some time in November 2006. Max meets Johan at the same time and he is not infected by either HIV or Hepatit-C. Max comes to the union every day, 7 days a week. The city of Stockholm finds out that Stockholm drug user group hands out clean needles, clean syringes, and alco a swab, filter and a cup. The union then receives a signed letter stating that Johan must stop handing out the equipment that are used as tools to commit a drug offence! If the city didn’t receive a counter signed letter from the unions board within 3 days, the funding then would be stopped immediately! The letter was signed by an executive civil servant who also is in charge of the funding! In July Max again comes to see Johan with the bad news: he now was infected by HIV and Hepatit-C!
Thank you for letting me speak in front of the commité