Research project Between Politics and Bureaucracy: Care and Treatment of drug misuse 2001-2015
The aim of the project has been to investigate the political discussions about, and the bureaucratic handling of, Swedish drug abuse treatment during the years 2001-2015.
The focus has been aimed at the drug issue’s and the drug treatment’s problem description, knowledge-base, and steering.
Three main policy areas connected to the care and treatment of people with a problematic use of drugs has provided the empirical foundation: 1. Parliamentary documents; how is the drug problem, its causes and solutions, described at the political level? 2. The bureaucratic handling of residential treatment; how is available knowledge implemented? 3. Needle exchange programs; which treatment solutions are promoted or discouraged?
Project description
In the case of the political discussions concerning the Swedish treatments for people with a problematic use of drugs, harm reduction measures in particular, the empirical material has been analysed based on the understanding that drug issues evokes normative as well as ethical values. The study shows that the political discussions that preceded the law making needle exchange available in all of Sweden (SFS 2017:7) was driven by a value-based understanding of misuse as a condition beyond the control of the individual. Therefore, it was argued, the society was responsible for the health and wellbeing of the users. With time, this position was embraced by a growing number of MPs. The opponents, on their part, argued that the society’s responsibility was instead to limit the possibilities to use drugs through restrictions and control. Another noteworthy result is that the Swedish goal to be a “drug-free society” is a hindrance for those promoting reform – all measures aiming for harm reduction is by the opponents interpreted as an ambition to liberalize the drug policy. Even though extensive research giving evidence for the benefits of NEPs was available, it was hardly mentioned.
This also turns out to be the case in the field of residential treatment, however for other reasons. The archives covering three different authorities show that the ambition to implement an evidence-based treatment still has not been fulfilled. Nor has the political ambition to achieve better steering and control. Despite large investments and high expectations placed on evidence based practice the study shows that research concerning which treatment method/-s is most effective still can’t deliver any unambiguous answers – if there is one it would be to emphasize flexibility and versatility. Our conclusion is that the EBP-policy should be interpreted as a result of ideological conviction rather than as a result of research-based knowledge.
On the local level, in Stockholm, the period surrounding the opening of the needle exchange clinic at St. Görans was marked by a heated debate in the City Council. We see here the same patterns, for the same reasons, as in the parliamentary debate though with a different emphasis. Those who were in favour of a clinic positioned needle exchange as a public health measure, in accordance with the position taken by several authorities ever since the AIDS-epidemic. There was also a greater readiness to refer to international bodies such as WHO, UNAIDS and EMC DDA. The opponents was also turning to public health by stating that needle exchange was harmful because it would send the wrong message and would result in the ground being littered with used needles. The international recommendations were dismissed at the same time as more research was demanded.
The project has been presented at several international conferences and has inspired us, together with Helena Bergman, to continue exploring this field of research through the project “Scientific state or state science” within the program Long Term Provision of Knowledge (financed by Forte, Formas, Vetenskapsrådet och Riksbankens Jubileumsfond).
Project members
Project managers
Johan Edman
Professor
Members
Lena Eriksson
Researcher
