In April 2024, the Department of Public Health Sciences and its Center for So-cial Research on Alcohol and Drugs (SoRAD) at Stockholm University, hosted a Nordic conference for social science researchers in the field of ANDTS (Al-cohol, Drugs, Doping, Tobacco, Gambling). The conference was prompted by the decline in Nordic cooperation and comparative research in this area. It was funded by Forte (the Swedish Research Council for Health, Working Life and Welfare), and brought together about 70 researchers. The conference focused on comparative research on different addictive substances and behaviors, countries, research methods, and themes, e.g., policy, youth and migration. The conference opened with a theoretical presentation on Nordic cooperation, the relationship between Nordic cooperation and the Nordic welfare state, and the Nordic as a political concept. This was followed by an exposition of the visions and advantages as well as the challenges and reality of conducting Nordic regis-ter-based research. Next, the first day offered an overview of some recently finished Nordic comparisons. These looked at adolescents use of novel tobacco and nicotine products, labor market integration of adults with substance use problems, privatization and marketization of substance use treatment, emerging trends in harmful types of gambling according to helpline data, and older peo-ple’s drinking habits. These presentations covered Denmark, Finland, Green-land, Iceland, Norway and Sweden. The day was concluded with reflections on 35 years of experience in conducting Nordic comparative research. The second day was devoted to an in-depth look at topics of great interest and comparison in recent years: Drug policy, harm, reduction, and drug-related crimes; Regis-ter studies, mortality, and migration; and Adolescents/young adults’ substance use and well-being. On the last day, the conference looked ahead towards pos-sible comparisons by focussing on the importance of regulating harmful indus-tries, like alcohol and gambling. Two big research programs were presented: one on deaths of despair among young people, and one on the future of social work with substance use in a changing treatment system. Finally, new ideas on how to return to the study of organized activities of people who use drugs in the Nordic countries were outlined. The conference was well-received by the participants, who called for continued opportunities to gather and discuss re-search. Possibilities for continuing this work will be explored.

Intrigued by the overwhelmingly positive response to the needle and syringe exchange program (NSP) by people who inject drugs in Stockholm, this article sought to untangle harm reduction in a prohibitionist drug policy context. The article drew on assemblage thinking and used semistructured individual interviews with 32 people who inject drugs, and three focus groups with staff at the Stockholm NSP. The aim was to dissect harm reduction in the form of NSP and how it worked to move people who inject drugs towards or away from drug-related harm. The analysis identified how bodies such as the NSP regulations, the setting, and stigma gathered in ways that reduced the capacity to move forward and enroll, as the inclusion of the NSP in the assemblage would decrease the capacity to uphold other connections considered to be more important. Regular NSP visitors however described how free injecting equipment, staff care, continuity, and trust were important objects that gathered in ways opening up for movement towards less harm. Fiercely, these profoundly caring experiences at the NSP could also block new becomings and moves forward as people who inject drugs, discouraged from previous negative experiences of other service providers and structural stigma, refrained from other connections that could improve their wellbeing. They risked becoming locked in at the NSP and similar services. A significant consequence of the agential cuts of us researchers, the staff, and policymakers alike, targeting primarily those that do access and benefit from harm-reducing interventions, is that alternative solutions embracing also those locked out and locked in become unimaginable.

Objective: Alcohol and Other Drug (AOD) disorders cause substantial harm. Effective Substance Use Treatment (SUT) exists, but long-term outcomes remain inconclusive. This study used a 20-year prospective follow-up of 1248 service users entering SUT in Stockholm, Sweden, in 2000–2002 to elaborate on how different dimensions of long-term outcomes may be measured by register-based indicators. Baseline characteristics and attrition bias were explicated, and register-based outcomes were examined.Results: Register-based indicators are valuable, but they also have inherent limitations such as the lack of substance use data and inability to differentiate between un/met treatment needs and access. Significant variations in long-term outcomes were evident depending on which register-based indicator was used, and whether used in isolation or combinations. Six out of 10 service users were still alive after 20 years, but as many as 8 out of 10 of the survivors remained in treatment, and only two out of 10 had a stable economic situation. Hence, the register indicators identified only a few survivors, with stable economic and social situations, and without recent treatment contacts 20 years after treatment entry. The long-term outcomes were concerning and even more so when combining outcome dimensions.

Background: Sweden faces high rates of overdose mortality, but supervised consumption sites (SCSs), where people can use drugs under healthcare supervision, have not been adopted. No studies have assessed the willingness of Swedish people who inject drugs to use a future SCS or their views on potential rules. Methods: This mixed-methods study applied a risk-environment approach and collected data from people who inject drugs in Stockholm using a 28-item survey and qualitative interviews. Results: Most of the 219 survey respondents reported significant risk factors, including unstable housing, previous opioid overdose, and public drug use. Among participants, 158 (72.1 %) were willing to use an SCS, while 61 (27.9 %) were unsure or unwilling. In multivariate analysis, opioid use (AOR 3.24; CI 1.31–8.02), public injection (AOR 5.22; CI 2.35–11.56), and overdose within the past year (AOR 6.89; CI 1.66–28.56) predicted willingness to use an SCS. The most common reason was “I want to avoid stress” (82.2 %). For the 61 participants unwilling or unsure, the main reason was “already having a safe place for drug use” (78.75 %). Certain rules, like bans on groin/neck injection and assisted injection, were less accepted among both survey and interview respondents. Qualitative data revealed reluctance to inject in front of SCS staff due to privacy concerns. Conclusion: Our results suggest high SCS acceptability among a marginalised cohort of people who inject drugs in Stockholm. Results confirm and extend prior research by illuminating their perceptions, including important preferences to consider when designing a future SCS in Sweden.

Background. Drug policy is prone to build on rationales based on different moralities rather than evidence. Less is known about how moralities influence drug policy implementation in practice. The aim was to analyze expressions of moralities among local policy-makers, professionals, and drug users in the context of the Stockholm needle and syringe exchange program (NSP).

Methods. Using political documentation from Stockholm (2003–2016), focus group (12 NSP staff), and 32 drug user interviews, moralities concerning drug policy and harm reduction were analyzed based on moral foundations theory and boundary work.

Results. Three main moral dilemmas were identified concerning the subjects, aims, and orientation of drug policy: whether drug users are worthy of inclusion to society; if the general public should be prioritized or the health of drug users, and the orientation of practices as based on control or autonomy. Policy debate was driven by virtues such as purity and authority, whereas staff and drug users valued care, fairness and liberty.Conclusions. The prohibitionist and abstinence-oriented Swedish drug policy has created social boundaries on the practice-level. Hence, users’ perspectives, and those who care about them, should be extensively involved in political discussions to foster a more moral and humane drug policy.

The Department of Public Health Sciences at Stockholm University and its Center for Social Research on Alcohol and Drugs (SoRAD) are announcing a conference on Nordic Comparative Research on Addictive Substances and Behaviors – Advancing by Comparing. It takes place in Stockholm, in April 2024. The three-day conference aims to revive the tradition of Nordic research collaboration by presenting the latest Nordic comparisons and sharing a platform for inspiring researchers to discuss possible comparisons in the future.

Drug-related harms continue to increase globally and governments struggle in search of effective and legitimate countermeasures. The choice between policy options is intertwined with the arguments that dominate drug policy discussions, which in turn are closely related to who has access to the policy debate. In this study, we examine stakeholders’ visibility and moral justifications of argumentation in the Swedish drug policy debate in the media (2015–2021). Justification analysis (JA) is used as a methodological and theoretical tool to illustrate the moral principles behind the claims by the stakeholders. The results show that the most visible stakeholders were politicians, government agencies and molders of public opinion. Furthermore, the stakeholders with successful active attempts to participate in the debate were molders of public opinion, NGOs, and politicians. The silent stakeholders in the media were people who use drugs and significant others. Stakeholders generally revolve around a dividing line regarding the restrictive features of Swedish drug policy, and were divided into proponents, opponents and neutral ones. All stakeholder groups included all three sides, hence reflecting the ingroup dissonance that may explain the continuing deadlock in Swedish drug policy. Justifications that value evidence-based policymaking (industrial worth) was used in the argumentation by the majority of the stakeholder groups, often combined with other moral justifications. This notion challenges the dichotomy of evidence and values in drug policy debates. Proponents relied more on the justifications that value paternalism (domestic worth), while opponents leaned toward the justifications valuing civil rights and social justice (civic worth). The development of Swedish drug policy may depend on the relative strength of these two value positions (domestic versus civic worth) in society and among stakeholders in power. This study continues the discussion of making contesting values explicit in the drug policy, serving a riveting case for international comparison.

Sammanfattning av den vetenskapliga artikeln Debating the drug policy in Sweden: Stakeholders’ moral justifications in media 2015–2021 (https://doi.org/10.1177/00914509231159394) i ett mer lättilgängligt format på svenska online.

Background: Take-Home Naloxone (THN) programs were introduced in Sweden in 2018 —a country with one of the highest rates of overdose mortality in the EU and a severe stigmatisation of people who inject drugs. This qualitative study builds on the international research that has expanded a previously narrow and medical focus on overdose deaths. It uses Zinberg’s framework to look beyond the role of the “drug ”to include the attitudes and personality of the person ( “set ”) and contextual factors ( “setting ”). This study explores the impacts of THN from the perspective of overdose survivors. Methods: Between November 2021 and May 2022 semi-structured interviews were conducted with 22 opioid overdose survivors, recruited among clients of the Stockholm needle and syringe program. All the participants had been treated with naloxone in an overdose situation. The interviews were processed through thematic analysis using deductive and inductive coding in accordance with the theoretical framework. Results: Interviewees included men and women who used different types of drugs. THN has impacted on “drug ”in terms of naloxone-induced withdrawal symptoms and peers having to deal with survivors’ emotions. Exploring “set ”revealed feelings of shame following naloxone revival for the person who overdosed. Despite such reactions, participants retained an overwhelmingly positive attitude towards THN. Participants integrated THN into their risk management practices ( “setting ”) and some acknowledged that THN provided a new way to treat overdoses without necessarily needing to interact with authorities, especially the police. Conclusion: The THN program has influenced “drug, set and setting ”for participants, providing increased safety at drug-intake and transferring overdose management and the burden of care to the community. The lived experi- ence of participants also exposes the limitations of THN indicating that there are additional unmet needs beyond THN programs, particularly in terms of “setting ”.

New Public Management (NPM) has added new aspects to the conflict between political-bureaucratic steering and professional autonomy in the search for a substance use treatment system (SUT) that is economic and characterized by high quality, accessibility, and professional discretion. This article analyses if and how organizational aspects of NPM imply additional challenges for professionals and SUT. The experiences of 29 social workers, in different positions in the services and administration of SUT, in six municipalities with different degrees of NPM and post-NPM, form the empirical data. Many quality problems were common across municipalities: frequent unevaluated reforms, lack of resources for SUT, and cooperation issues. Several problems were especially pronounced in statutory social work. NPM added challenges. Competition with private providers was viewed as initially (in the 1990s) having improved treatment, but the present market was regarded as creating quality problems without savings. Cooperation between providers was a special quality challenge in NPM municipalities, and NPM added to treatment continuity challenges. While accessibility for resourceful clients was linked to NPM models, treatment for less resourced users was obstructed by NPM. Workplace climate and trust issues were more problematic in the most NPM-permeated municipalities. Professional discretion was difficult to link to local NPM degree. Increased standardization and documentation were often accepted as improving quality. While a system based on competition ideology appeared destructive for treatment quality, post-NPM reforms with cooperation between needs-assessment, treatment, and economic support, conformed better with professionals’ perceptions of good treatment.