While Harm Reduction International and other harm reduction advocates were debating at Beyond 2008 in Vienna, I attended a seminar on harm reduction and human rights, organised by the Swedish Drug Users’ Union. The seminar, which attracted over 40 participants, including representatives from three of the main political parties, was held as a side event to Sweden’s annual ‘Almedalen’ political conference, held on the stunning island of Gotland.
Speakers included Janne Wallin and Berne Stalenkrantz from the SDUU, who described their experiences of drug use and accessing services in Sweden; Beppe Gudheimsson who spoke about his experiences as a drug counsellor and the need for greater involvement of people who use drugs in decisions that affect them; Jens Sjolander from the University of Malmo who presented on EU law; Torbjorn Bjorlund from the Left Party who discussed his party’s support for harm reduction; and Bjorn Fries, a member of the Social Democrat Party who was the drug policy spokesman for the government for many years.
Mr Fries spoke of the need to continue with Sweden’s successful drug prevention efforts, while at the same time ensuring that those people who are already using drugs, and who take up drug use despite prevention efforts, receive the healthcare they need. He noted that things are far better now in Sweden than a few years ago with more people accessing OST, for example, than ever before. But more needed to be done.
In my presentation I outlined the need for harm reduction in Sweden not only as a human rights imperative for Sweden’s drug users, but also to set an example in international policy where all too often the ideal of a drug free world has overshadowed human rights protections. I described some of the abuses from executions to forced crop eradication programmes and said that the ideal of a drug free Sweden, in my view, has also overshadowed the need to protect the vulnerable and marginalised in the country. I noted, for example, that women with drug problems can be refused access to domestic violence shelters. (This, in fact, had happened to a member of SDUU). The human rights violations in Sweden are different, but no less important to those epxeriencing them.
This, however, did not go down well with some participants who thought that I was exaggerating the issue in Sweden. I think, however, that the facts have a lot to say for themselves.
Sweden adopts a ‘restrictive’ drug policy which thus far has hampered the scaling up of harm reduction services for people who use drugs, violating their right to health. Though opioid substitution therapy and needle exchange are officially ‘legal’ the legislation and policies that surround them are extremely restrictive. There are only two needle exchanges in the country and there is a two year wait to access substitution therapy during which time most people will have contracted hepatitis C. Relapse results in exclusion from the OST programme for six months. (Janne Wallin from SDUU described how he is forced to obtain his methadone on the black market). Though Sweden has a low level of incarceration, diverting many from detention, over half of all people in prison are drug users. Harm reduction is unavailable in prisons. Similarly, though Sweden has lower than average drug use and injecting drug use, drug related deaths are higher than European average (over 300 in the last 12 months) and 90% of the country’s injecting drug users are estimated to be hepatitis C positive.
Sweden has been relatively successful in its drug prevention efforts, retaining low levels of use. But there is a gap in protection for people already using drugs and who are unable or unwilling to undergo abstinence based treatment. This is where significant disagreement arose. Some felt that there was no such gap and that becoming drug free was all about choice. Others thought that pursuing a drug free Sweden was the best way to address it. Others placed their hopes on abstinence based treatment. Some claimed that harm reduction was a slippery slope to further drug use (something Bjorn Fries quickly said there was absolutely no evidence for)
I asked participants at the seminar to accept harm reduction on its own terms. It will do what it claims to do and what it has proven capable of time and time again - reduce the transmission of blood borne viruses and other health related harms, reduce crime and increase the wellbeing of people who inject drugs, all in a cost effective manner. In this case it would help to fill the protection gap that exists in Sweden’s drug policy. The good news is that Sweden already has the infrastructure to introduce harm reduction successfully – excellent social safety nets, low levels of social inequality and high quality health and education systems.
If any country can adopt a human rights based approach to drugs , surely, it is Sweden. It has one of the highest standards of living in the world, and an excellent human rights record when compared with many, if not most other countries. But perhaps a change in ideology is required. I had finished my presentation by asking ‘How do you measure success in drug policy?’ If a drug free Sweden is the only measure of success then this has been a failure. If protecting those vulnerable from drug related harms is a measure of success, then this too has failed. In reply I was asked a very interesting question by a rather sceptical journalist. “What is wrong with the ideal of a drug free world?” he asked “You have to have a vision”. I don’t disagree. But I think the answer is this: Most of us have a vision of a world free from war. But nonetheless we would all do our best to protect those caught up in one. Our ‘vision’, whatever it is, no matter how good it sounds, must not be allowed to get in the way of that, because when your vision overshadows the requirements of the present, policy decisions become very flawed indeed.
Congratulations to the Swedish Drug Users Union on a truly important session at the country’s main week of political debate. I was really pleased to have been able to take part.
Human Rights Analyst