The article compares the development of substitution treatment in Denmark, Finland, Norway and Sweden. The focus is on the official guidelines: under what conditions, for whom and by whom should substitution treatment be organised? For many years, substitution treatment was fiercely opposed in Finland, Norway and Sweden, all of which had a restrictive drug policy and relied on social work rather than medicine. The debate cut through the professions and was at times the main political issue. Methadone treatment started in Denmark and Sweden in the 1960s, and while Finland and Norway did not give the go-ahead until the latter part of the 1990s, they have today expanded their substitution treatment considerably. In all four countries, substitution treatment has become an accepted and established part of treatment responses to abuse problems. The guidelines have become less strict even if the regimes in practice include various kinds of control measures. The thresholds of substitution treatment have remained the lowest in Denmark where this treatment mode is more geared toward harm reduction than in the other countries.
Background It is almost 50 years since the “new” drug problem appeared in Norway. How have central authorities conceived of the drug problem during these 50 years? On what have relevant policymaking and action been based? How has the government's conceptions of the drug problem been expressed over the years? Data White papers, action plans, bills etc. Results A review of the main policy documents shows how Norway adopted strict penal measures from the outset, while recognizing at the same time the need to apply an interdisciplinary approach to drug abuse and initiate various support measures for drug users alongside the penal measures. In recent years, there has been an increasing emphasis on seeing drug abuse as a health-related problem rather than one of control. Substance abuse is today perceived more in terms of dependency or as a disease, and harm reduction is increasingly seen as a pivotal aspect of policy. People with drug problems were known until recently as substance abusers, though the preferred term today is “drug dependents”. Conclusions As such, one could say, Norway seems to have developed a “schizophrenic” view of the drug problem. On the one hand, the health aspects of drug abuse are increasingly central to thinking, while on the other penalties for drug offenses remain high. This health/penalty loop in turn seems to prevent the government from softening its stance on penalties - even if such a move were considered appropriate.
AIMS This paper explores different approaches to quantify the human costs related to drug use. DATA AND METHODS The data come from a representative survey of 3092 respondents above the age of 18 in four Nordic capitals: Copenhagen, Helsinki, Oslo and Stockholm. Results The results show that in most Nordic capitals more than half of the respondents at some time have known and worried about the drug use of somebody they know personally. Moreover, while the average reported harm was about 2 on a scale from 0 to 10, a significant minority (10%) of those knowing drug users indicated that the harm was above 5. Conclusions Many persons have at some time personally known somebody who uses drugs. This causes significant human harm and should be included in the estimate of the social cost of illegal drugs. These results are relevant in the debate on the size of the drug problem as well as for targeting groups that experience the highest costs.
A national survey on people's conceptions of various intoxicants and their attitudes towards such substances shows a high degree of support in Norway for the current very restrictive drug policy. Only 6% were in favour of a more liberal practice with regard to use of cannabis. The attitudes had changed little from 1968, when a similar study was carried out. Even a majority of those who reported having used cannabis themselves said that all use should be prohibited. A comparison of the crime of possessing quite a small quantity of cannabis with other commonplace violations of the law showed that the drug offence was considered a serious crime. Although the penalties for drug offences have been raised dramatically several times since the end of the 1960s, a majority still said that the punishment prescribed by the Norwegian law for being involved with drugs is too mild.
By examining persons arrested in Oslo during a certain period, we will try to obtain a better picture of intravenous drug abuse in Oslo. A pilot project was organized for 3 months during the autumn of 1987. In addition to having their arms examined, the arrestees were asked some questions about their abuse and HIV-testing. The paper presents some data from the pilot period: 35% of the arrestees had marks from intravenous drug abuse (almost 2/3 of the females and slightly less than 1/3 of the males); 78% of them were men, 22% were women; the majority were in the age range 21-35 years; 53% stated that they injected opiates, 35% that they injected stimulants and 12% that they injected both types. Nearly 80% stated that they had been HIV-tested. A larger proportion of users of opiates (88%) stated that they had been tested than users of stimulants (66%). The prevalence of HIV-seropositive cases among the arrested intravenous abusers was 13.8%. In the paper we also discuss methodological aspects of the study.
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