The increased use and availability of illicit drugs, and their social and health-related harms, constitute a global public health concern. Various stakeholders across society, including individual actors and organizations, actively work to address these issues through policymaking, yet they often possess competing interests, divergent values, and conflicting moralities. This dissertation explores contemporary drug policy and policymaking in Sweden, with a particular focus on stakeholders. It aims to advance our understanding of the context and policy processes shaping drug policy by analyzing stakeholders’ values, interests, and forms of involvement. The data consists of key informant interviews with national-level stakeholders, media texts, and policy documents. Utilizing the health policy triangle framework in combination with an assortment of theories and concepts to guide the analyses, the dissertation underscores the interrelationships between stakeholders, processes, context, and policy content within the domain of drug policy as public health policymaking. It comprises four related papers: 

Study 1 examined stakeholders’ visibility and the moral justifications of their argumentation in the Swedish drug policy media debate. Study 2 analyzed stakeholders’ strategies to influence drug policy and perceptions of their and others’ opportunities to influence drug policy in Sweden. Study 3 explored stakeholders’ moral positions regarding the current (“a drug-free society”) and recently proposed revision (to “a society with reduced harm from drugs”) of the Swedish drug policy aim. Stakeholders’ perceptions of the role of commissions of inquiry in drug policymaking were also analyzed. Study 4 aimed to further our understanding of why harm reduction measures have become more accepted in Sweden, while punishments have become more severe, and the role of stakeholders in shaping policy processes in this case. 

The findings highlight the different ways stakeholders are involved in and attempt to influence drug policy. In exploring the successes and challenges faced by stakeholders in their influence attempts, several stakeholder characteristics and contextual factors were identified. The identified stakeholder characteristics included the number of resources, highlighting how an unequal distribution of resources affects opportunities to influence drug policy, while contextual factors included the predominance of support for the restrictive drug policy. The findings also highlighted a longstanding divide between two moral positions of stakeholders within the Swedish drug policy field, as supporters or opponents of the restrictive drug policy based on the aim of a drug-free society. Yet, the studies also suggest that there are signs of fracturing stances through increasingly complex values and moralities, including a growing acceptance of harm reduction measures and a widespread will to reduce stigma, while maintaining the aim of a drug-free society with stricter penalties for drug offences. Finally, the studies suggest how to increase participation and opportunities to influence in drug policymaking among people who use drugs and their significant others, while critically discussing the potential to strengthen the role of commissions of inquiry for effective drug policy implementation. Altogether, the dissertation provides a nuanced understanding of how public health is conceptualized, contested, and implemented within the context of 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.

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.

This brief report presents results on how gamblers have experienced risks and change during the exceptional situation caused by the COVID-19 pandemic. The study is based on online questionnaires collected by the University of Helsinki and the Finnish Association for Substance Use Prevention (N = 586). Results show that the reduced availability of gambling in the Finnish context has limited its total consumption. The risk of gambling-related harms has therefore become less pressing during the pandemic. Although gambling is a public health risk in addition to being a harmful activity for the individual, the policy measures during the pandemic have revealed that, at a societal level, the risk of infection with COVID-19 was perceived as being a more serious problem than was the risk of gambling harms. 

This study analyses everyday value constructs pertaining to the Finnish gambling profit-based state grant system – an institution that channels proceeds from the state gambling monopoly to the third sector. Recently, various experts have questioned the system because of its connections to gambling. Using the concept of mundane reasoning, the article maps out everyday understandings of the system. The study analyses three datasets that represent different mundane arenas: focus group interviews with Finnish citizens, interviews with welfare-promoting third-sector organizations, and articles from the Finnish daily newspaper Helsingin Sanomat. The results show that mundane ideas strengthen the role of the public sector as a primary service provider and the third sector in adding value to it. The article concludes that the gambling profit-based grant system represents both universalism and particularism in mundane reasoning. The arguments provided are important in view of the current discussions about the roles of the third and public sectors in the Nordic welfare state.

The composition, use, policies, and the societal position of cannabis are changing and diversifying internationally. Cannabis has emerged as an object of much controversy and is subject to varying forms of regulation. Its role and regulation are also debated in the Nordic countries. To shed light on such developments, this special issue sets out to explore how the phenomenon of cannabis, and related policies and subjectivities, are currently made, unmade, and transformed in multiple ways through discourses, practices, and materiality, and with different consequences.

Gambling during the COVID-19 pandemic: experiences of risks and changes

This study uses theories of risk society to examine how gamblers have experienced the exceptional situation caused by the COVID-19 pandemic, and what are the risks they have associated with the situation. The qualitative data was gathered by the University of Helsinki and EHYT ry. Results show that the reduced availability of gambling has limited total consumption, and the risk of gambling-related harms has therefore become less pressing during the pandemic. While gambling is also a public health risk in addition to being a harmful activity, the policy measures during the COVID-19 pandemic have revealed that, at a societal level, the risk of infection was perceived as a more serious problem than the risk of gambling harms.