Knowledge, Values, and Needle Exchange Programs in Sweden

Abstract

Since the turn of the millennium, calls for evidence-based drug policy have become increasingly louder. In response, researchers have generated a large body of evidence in support of measures such as needle exchange programs (NEPs), while another strand of research testifies that policy makers often neglect to take the research evidence into account and hence fail to introduce these programs. This article studies the interplay between research-based knowledge, values, and policy making during 16 years of intense parliamentary debate in Sweden on the needle exchange issue. In 2000, the future of the two existing experimental NEPs was uncertain; in 2006, the regulations were reformed; and in 2015, they underwent a government inquiry. Both the reform and the inquiry aimed at regulating and expanding the programs. The analysis is guided by work done within the tradition of science-policy nexus, where the increased emphasis on evidence-based political measures is problematized. As drug policy arouses normative and ethical concerns, the analysis also explores values. The study illustrates the central role that values play in a policy field which is repeatedly declared to be science based. Within the overall framework of the Swedish drug policy ideology of a drug-free society, the advocates of NEPs framed drug misuse as a consequence of either an unjust society or a disease, arguing that because misuse is a condition beyond the control of the individual, the Swedish welfare state has an obligation to take care of those affected. For their part, the opponents framed drug misuse as a result of misguided attitudes, which would only be corrected by restrictions and prohibition. In their view, NEPs are a tool for drug policy liberalization. In the debate between the two positions, research evidence played only a minor role.

Great expectations

“…This is a position also taken by the National Board of Health and Welfare but rarely seen among politicians. Their point of view is influenced by that of the voters (Eriksson & Edman, 2017).…”

“…Perhaps the policy makers, the NBHW, and the authorities have underestimated the value of values (Eriksson & Edman, 2017)? This is an especially relevant question in a policy field positioned within a social framework and in a treatment field based on individual motivation.…”

“…Research has convincingly shown that ideology and values play a central role both in drug policy making and drug policy implementation (Edman, 2012;Eriksson & Edman, 2017;Monaghan, 2010Monaghan, , 2011Ritter, 2009;Stevens, 2007;Tieberghein & Decorte, 2013). This research highlights how drug policy choices lead to emotional and value-laden responses.…”

“…In aiming to understand the workings of the authorities in their intermediate role between policy goals and implemented practice, we need to define the parameters of this authority and the relation to residential rehabilitation. Research has convincingly shown that ideology and values play a central role both in drug policy making and drug policy implementation ( Edman, 2012 ; Eriksson & Edman, 2017 ; Monaghan, 2010 , 2011 ; Ritter, 2009 ; Stevens, 2007 ; Tieberghein & Decorte, 2013 ). This research highlights how drug policy choices lead to emotional and value-laden responses.…”

The Moral Foundations of Needle Exchange Attitudes

“…It was because it was a moral crusade that the movement to make AIDS a fundable disease on a par with cancer or heart disease was successful" (Moss, 2000). Similarly, in their discussion of 16 years of parliamentary debate over NEPs in Sweden, Eriksson and Edman (2017) concluded that moral arguments (rather than scientific evidence) dominated both sides of the debate. Understanding the nature of moral views on NEPs may bear insights for those interested in building acceptance of the programs.…”