Response to interpellation 2023/24:263 on Sweden's narcotics policy
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns Sweden's drug policy. KD argues that the policy should be compatible with evidence-based care and harm reduction 1. KD emphasizes that the right to health applies to everyone and that stigmatization must be countered 1. KD believes that Sweden has made progress in reducing HIV transmission and that criminalization has a deterrent effect 2. KD wants to improve healthcare interventions and lower the thresholds for help 2. KD denies that the government wants to decriminalize drugs for personal use 3. C wants an unbiased and evidence-based investigation to determine the consequences of current legislation 4.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Socialministern Jakob Forssmed (KD)
Madam Speaker! Niels Paarup-Petersen has asked me if I intend to act to introduce a scientifically based drug policy against the background of, among other things, that Sweden uses enormous police resources to maintain a policy that lacks evidence, which does not achieve the goal of reducing drug use in society and which at the same time likely contributes to increased morbidity and more deaths.
The mandate of the Narcotics Inquiry (S 2022:01) has not been criminal law-related; rather, the purpose has been to ensure that narcotics policy is compatible with the requirements for evidence-based care, proven experience, and harm minimization, as well as that it is developed and adapted to the challenges of the present and the future.
The right to health applies to all people, and that naturally includes persons with harmful use and addiction to drugs. Both adults and children and young people with harmful use or addiction shall have the same conditions for good health and be offered care and support on the same terms as others in need of care.
The narcotics investigation has submitted several proposals aimed at increasing accessibility to care and support, so that persons with harmful use and addiction receive the interventions they need. Stigmatization needs to be countered. Interventions are also needed so that no one dies as a result of drug or narcotic poisoning. Every death caused by drugs is a tragedy for the individual and their relatives and is unacceptable for a modern society.
The Criminal Justice Reform Commission (Ju 2023:14) shall conduct a review of the sentencing scales and reform the sentencing system. The purpose of the assignment is that the sentencing scales shall, in a better way than today, reflect the severity of the crimes and that the sentences imposed shall appear reasonable. It appears from the directive that in the future sentencing system, it may more often than today be possible to use a sentence with a care orientation when someone is sentenced for a minor drug offense where the act is rooted in addiction (dir. 2023:115).
We need to work broadly and long-term to reduce the number of drug-related illnesses and deaths. To achieve the goals, actions are required within several different policy areas. This could, for example, involve actions to create safe and good growing conditions, for education, and to counter homelessness and social exclusion, as well as actions to combat drug-related crime. This requires many different actors to work to reduce the number of drug-related illnesses and deaths, both in their respective roles and jointly.
The more knowledge we have, the better decisions we can make.
Niels Paarup-Petersen (C)
Madam Speaker! Thank you, Minister, for an excellent answer!
I can start by saying that there is much in the latest investigation that is good, for example, increased information efforts and increased support. We also see clearer rules regarding LARO, which can be of great use if it turns out well. Something else positive has also occurred – or is at least on its way to happening – namely the improvement of access to naloxone. This is very positive, and I am grateful that Läkemedelsverket has taken new steps forward there. I can now tick off a motion in the Riksdag; it is not always possible to do that!
So there is a huge amount of positive. The debate here today, however, is specifically about the criminalization of drug use for personal consumption - naturally not about sale etcetera. The latest investigation was not tasked with looking at this, but the investigator has nevertheless stated that the government should review the criminal penalties. On December 7, the Minister for Justice was in the chamber and received the question of whether one should not review decriminalization and how to best do so for an improved knowledge situation. The Minister for Justice said no thanks to this. I think it can be worth to clearly ask the Minister, who is responsible for healthcare issues etcetera, how he views it.
What does it actually look like? The investigator behind We can do better! says that one should review how the penalties look. One perhaps should not have them at all. The Public Health Agency has for a long time requested a review and said that one should investigate the criminalization and see if it has actually had the effects we desired. The UN High Commissioner says in general that one should, for various reasons, review the criminalization.
The Expert Group for Studies in Public Economics presented a report on the effects of criminalization on November 28. According to the report, the criminalization has been expensive, harmful, and ineffective. These are not things that we, overall, think describe legislation that we want to keep.
The Prosecutor General and Brå already stated when the criminalization was introduced that it did not quite live up to the way we usually view people according to Swedish criminal law principles.
The Lancet, which is one of the world's most prestigious scientific journals, or publications, most recently described that criminalization has proven to be harmful and ineffective when this has been examined on an international level regarding use for own consumption.
Other countries have chosen a different path. Many countries are currently looking at whether war against drugs and criminalization is the best way to ensure a small use and small harmful effects of narcotics. The Swedish government - both the previous and the current - is very skeptical about conducting an investigation of the criminalization, even though it has never during its nearly 40 years been investigated whether it has actually achieved the effects that was desired for it to achieve.
The conclusion of the Minister's response was very good, Madam Speaker. The more knowledge we have, the better decisions we can make. But apparently, that does not apply in this matter. That is why I wonder if we could not get an investigation into whether the criminalization of drugs has actually had the effects for society that we want.
Socialministern Jakob Forssmed (KD)
Madam Speaker! I thank Niels Paarup-Petersen for the interpellation.
I want to start by saying that I have the same view as Gunnar Strömmer. We belong to the same government and have the same view, to state the obvious.
There are a number of things in the interpellation that I think there are reasons to look a bit closer at. It is claimed, for example, that an effect in Portugal would be that the spread of HIV decreased significantly when they decriminalized. This is entirely possible. It is also said that Sweden has had an increase in the spread of HIV, but this is not correct. In 2022, Sweden did not have a single case of HIV transmission due to contaminated injection materials. All twelve cases we had were abroad. Between 2013 and 2022, we have gone from 100 to 50 cases, so here we have made very large progress. We also have one of the smallest HIV transmissions via contaminated injection tools in all of Europe.
This has obviously been fully possible in Sweden. Here it is described as that our effects would be the opposite effects in Portugal, but we have thus come very far precisely when it comes to this aspect of the whole.
Another matter concerns the deaths. Here, it is very difficult to compare between countries. In the ESO report that the interpellator mentioned, one realizes this and also chooses not to compare with any countries other than countries in the Nordic region. Furthermore, it is the case that the statistics capture both illegal drugs and pharmaceuticals, which are legally available on the market. Eight of the ten leading causes of death are pharmaceuticals. Heroin is an important part, but the vast majority are pharmaceuticals which, in any case, are partially available legally.
All this makes these complex issues truly deserve a complex discussion. I think that many who advocate for decriminalization make it easy for themselves and do not see the conflict of objectives between getting people to refrain from starting and ensuring that people are given the right opportunities to come into contact with care and support.
I think it deserves to be noted that Sweden has a lower use of drugs than many other countries. In the ESO report, it is referred to, without questioning CAN's perception, that it is a very limited part of Sweden's population that uses drugs and that a large part of the drugs are also consumed by heavy users or consumers with problematic behavior, which in many ways makes this different from legal drugs.
It is completely obvious that this is complex and that there are conflicting goals here. Perhaps it is the case that the very restrictive Swedish policy has caused the introduction of some harm-minimizing measures to be somewhat delayed - one can imagine that is an effect of this.
This is a complex area. I am in contact with many other countries. I speak with and have met people from other countries who have chosen different paths in drug policy to gain better knowledge of how things are developing in those countries. It is by no means unambiguous things one sees there; rather, there are quite a few problems that remain even in those countries that have chosen a different path. They also have a different situation in the country than what Sweden has.
Niels Paarup-Petersen (C)
Madam Speaker! I note again that the Minister is correct in a good deal of what he says. It is an incredibly complex issue, and I do not intend to make it easy for myself. There is no doubt that all changes can have effects in several different directions. It may very well be so that the use of narcotics would increase in the event of a decriminalization. But it could also lead to less abuse, better care, fewer deaths, and other positive effects.
Since it is so complex, it is probably sensible to let an inquiry look into it. Inquiries are intended to handle complex issues and find the best solution. An inquiry can take into account the entire complexity, has time, and can write about it over 700-1,000 pages. After that, one can arrive at what is best for Sweden.
I therefore do not understand why the starting point for the government and the Minister is to say no to looking at this. Sweden has had the same policy for many years, and perhaps it has led to certain damage-mitigating measures being delayed and complicated with suffering as a result, which the Minister himself mentioned. If the Minister sees this consequence of current legislation, it is well reasonable that one, just as the Social Affairs Committee requested, reviews the legislation completely without preconditions. This is what I and C want. It should not be like with some of the government's inquiries where one arrives at an answer in advance, but one should look without preconditions at whether this is the best policy for as little suffering as possible and the best healthcare interventions. Based on what the Minister himself says, I do not understand why he does not want to do this. It sounds very strange.
I would very much like to know why the government and the cabinet do not want to know more.
Socialministern Jakob Forssmed (KD)
Madam Speaker! I want to know more about very many different things, but I do not use the state investigation system for all the questions that exist. In Sweden, we have curiosity-driven research and all the possibilities to conduct different types of investigations, but we have a very limited investigation system. The Government has no ambition to decriminalize drugs for personal use, and therefore we have also not commissioned such an investigation.
I am the first to admit that it is a complex area. I can identify situations that one might consider looking at. This concerns, for example, when one raises an alarm that someone has overdosed on drugs. Is it reasonable that one risks punishment in this situation? There is, of course, a possibility of exemption from punishment, but it is such a situation that one can identify.
I also think that one makes it easy for oneself when pointing to 1988 as a major paradigm shift in Swedish narcotics policy, because that is not quite the case. Possession was punishable even before 1988. It was the narcotics in the blood that became punishable in 1988, and it was not perceived then as a paradigm shift but rather as a logical consequence of the narcotics policy that was already being conducted.
I think that some of the evaluations that have been made by researchers and others should be debated in the research community. When one judges the entire Swedish drug policy and says that it has not reached its goals, one ignores that much else has happened in society. We have, for example, joined the EU, and a free movement for goods and services has been introduced throughout Europe. This is a component that could have an impact when it comes to drugs. This is not reflected at all in the ESO report.
Often, Portugal is discussed in this context. Now it is not going as well there as it did initially, and then it is said that it is because Portugal has cut back on healthcare resources. But what happened in Sweden in the early 1990s? Well, we had a crisis and made large cuts in various areas with the ambition to clean up the state finances. This is not discussed in the evaluations either. But when Portugal fails with its reform, people point to such external changes.
In Sweden, the Public Health Agency assesses that fewer people have a serious use of drugs now than a number of years ago. It is also more who receive care today than previously. Here we see, therefore, a positive change. Now changes are occurring for naloxone following the Medical Products Agency's renewed assessment, and furthermore, we continue to prepare the Narcotics Investigation's proposals, not least regarding better scientific support for when LARO treatment should be initiated. More occupational categories shall also be able to utilize naloxone in their operations to reach out with an opioid antagonist that can reverse overdoses. These are low-hanging fruits that I think we need to pick.
I have a question for Niels Paarup-Petersen: Is it his view that possession of narcotics should also be decriminalized? As I understand it, that is not the Center Party's view, but many who advocate for decriminalization want to see it.
Niels Paarup-Petersen (C)
Madam Speaker! Let me begin by answering the Minister's question. The Centre Party's policy is clear. We want an investigation into how to achieve the best policy linked to criminalization. That is the question. Therefore, we want a neutral investigation. There are many different views on criminalization, from far to one side to far to the other. What we want to see is a neutral, evidence-based investigation that establishes what the consequences are with current legislation and whether it would be better with different legislation. That is a reasonable starting point.
I appreciate the Minister's willingness to discuss this in the chamber, but if one excludes a broad investigation and says that it is something ongoing in the research community and should not be on the government's table, it implies certain limitations. As some know, I have a past in another country, and Frederick VII of Denmark said, in my free translation: Thus, no one else but we alone can have the ability to judge what is to the true benefit and best of the state and the people. That meant that no one else should contribute knowledge, and it was about the freedom of speech for the Danish king. But now it is about how we create the best policy linked to the criminalization of drugs or not, and despite a certain openness, the government sounds a bit like that old king: It is only the government's business; there should not be an investigation with answers. This is not quite confidence-inspiring. But I hope that the government can be a bit more open in the future.
Socialministern Jakob Forssmed (KD)
Madam Speaker! I thank the interpellor.
There is much to do within the framework of current legislation. As I referred to, we are conducting a review of criminal law, not just regarding drugs but in a broad sense, and it is noted there that one possibility is that more people should receive care instead of punishment as a penalty, and that it is something to be reviewed.
From Niels Paarup-Petersen, it sounds like the Center Party's perception will be entirely dependent on an investigation. But the Center Party has also stated that we should decriminalize drugs for personal use. That is the Center Party's perception, and it is one that is held even without an investigation.
In the same way, the government has the perception that we should not do this because many people, not least young people, describe that they use drugs to a lesser extent than they otherwise would or do not try it at all because it is criminalized. It has a significant deterrent effect on the use of drugs in Sweden.
However, I share Niels Paarup-Petersen's ambitions when it comes to improving healthcare efforts and ensuring that more people with harmful use and addiction receive help and support. The thresholds for obtaining that help and support must also be lowered.
We are preparing the Comorbidity Inquiry. We know that many of the people concerned have a comorbidity of psychiatric diagnoses and conditions. Care needs to be better interconnected here. Then, it is complicated to carry out such a reform, but nevertheless, it is a very important area if one is to seriously tackle the difficult situation that many who have a harmful use and addiction, and not infrequently also psychiatric concerns, find themselves in.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.