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.

In this article, we analyze the care work employed by people who inject drugs to counter risks in their life situations and make their drug use safer. Injecting drugs is associated with numerous health and social risks, such as overdose, the use of used and shared equipment, and getting caught by the police. We approach descriptions of injection events as narratives of care. Participants (N=32) were recruited for semi-structured interviews primarily from the Stockholm Needle and Syringe Exchange Program between August 2022 and March 2023. The sample is heterogeneous in terms of age, gender, drug use, and social situation. The interviews were analyzed using actor-network theory, asking what kind of care work and ‘action programs’ strengthen or weaken participants' capacities for safer injection events and what kinds allow risks – or antiprograms – to enter the event. We identified four different action programs based on home or public settings. They all aimed to increase capacities for safe drug use, but two of them were more vulnerable to risks. Their success depended on the type of actors they could recruit for care work, the risks they were targeting, and how well they coordinated actors to work together to minimize risks. The analysis highlights the scope, strengths, and limitations of care work in relation to material, social, political, and institutional actors, as well as the importance of access to proper resources such as a home, stable income, and a healthy body.

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. 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.

Background: Drug policy is a polarized and value-laden policy area with divergent interests of stakeholders. Through a Swedish case study, this article examines stakeholders’ strategies to influence drug policy, and perceptions of their own and others’ opportunities to influence drug policy—a topic that has not been systematically analyzed previously.

Methods: The analysis of 38 semi-structured key informant interviews with stakeholders within the national-level drug policy field drew on concepts from research on political access and influence strategies.

Results: Most stakeholders used both ‘direct’ and ‘indirect’ strategies when trying to influence drug policy. The majority perceived having opportunities to influence but they agreed that the voices of people who use drugs (PWUD) and significant others remained unheard. Stakeholders’ power and interest varied within the drug policy field, as did their resources, often serving as a doorway to political arenas and greater influence.

Conclusion: This study highlights the variety of strategies stakeholders use in drug policymaking, and how stakeholders’ resources are connected to their power and opportunities to influence drug policy. Consequently, power outweighs interest, leaving PWUD and significant others in a weak position. A political will is necessary to ensure more equitable stakeholder involvement in drug policymaking.

Background: Reducing risks and harms among people who inject drugs by, for example, Needle and Syringe exchange Programs (NSP) may be impeded in practice by, for example, policy restrictions, particularly in settings like Sweden where a zero-tolerance drug strategy prevails. In practice, risks and harms are produced through an interplay of multiple mutually reinforcing factors. Moreover, risk management strategies may constitute risks per se and generate new risks, potentially intensifying overall harm. This study aimed to increase our understanding of how such risks are generated in the lives of people who inject drugs. Methods: In 2022–2023, we interviewed 32 purposively selected research participants, primarily recruited through the Stockholm NSP. Drawing on actor-network theory, we analyzed the interviews to identify factors—constituent human and non-human actors—that constitute and generate risk and harm. These dynamics were conceptualized as risk-amplifying loops, in which harms are contingently enacted, may multiply, and the effects of policy and practice may become unintentional and unpredictable. Results: Four risk-amplifying loops were inductively elucidated: the Service deficit, Perpetrator-victim, Deprivation, and Solitude loops. In each, two actors—the drug and the person who injects drugs—were constituted differently. Furthermore, the loops were interlinked and more fully understood in relation to one another, forming a network that reflected the broader environment of injection drug use (IDU) in Sweden. Each loop was shaped and co-constituted by the prohibitionist framing of Swedish drug policy influencing access to services, the drug market, and the position of people who use drugs. Conclusions: Understanding drug-related harms as risk-amplifying loops highlights the emergent effects of the multiple and unfolding risks in the lives of people who inject drugs. This perspective facilitates discussion of impediments to effective harm reduction practices and points to potential sites for countermeasures and policy reform.

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.

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.