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.