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.
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.
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