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.

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.

Aims: Swedish drug policy aim, “drug-free for society” was recently proposed to be updated to “a society with reduced harm from drugs” by a Commission of Inquiry (CI). This article explores stakeholders’ moral positions regarding the current and proposed drug policy aims and analyzes their perceptions of CIs in drug policymaking. 

Methods: The Policy Constellations (PC) Approach was applied to analyze key informant interviews (N=38) and stakeholders' referral responses to a recent drug policy CI (N=76). 

Results: Stakeholders formed three PC around the drug policy aim: The progressive PC criticized the current aim and supported revising it, motivated by social justice and equity-based public health. The conservative PC favored maintaining the current aim, grounded in principles of conservatism and public health utilitarianism. Drawing on both equity-based public health and public health utilitarianism, the micro-PC supported modifying the aim in alternate ways. Although stakeholders value CI, their role in drug policymaking appeared limited. A lack of implementations of inquiry recommendations was a shared concern across PCs. 

Conclusions: This study highlights the key moral conflicts surrounding Swedish drug policy aim, furthering our understanding of the underlying values and moralities that must be addressed when aiming to drive forward policy development. The predominance of public health based on a utilitarian versus equity-based approach may explain the cautious development of harm reduction measures in Sweden. Stakeholders’ perceptions also underscore the need for critical discussion on strengthening the role of CIs in drug policymaking to support effective policy implementation. 

Introduction: Harm reduction has gained international policy traction and increasing recognition as essential for health equity, while punitive drug control approaches have simultaneously re-emerged. This study examines Sweden, a country known for its restrictive drug policy, to explain why harm reduction measures have gained greater acceptance alongside increasingly severe penal responses to drug offences. Furthermore, it explores the role of stakeholders in shaping these policy processes.

Methods: We analyzed three data sets 2015–2025 (media texts, stakeholder interviews, referral responses to two commissions of inquiry) by using the Multiple Streams Framework. 

Results: Two main problem constructions were identified: drug-related mortality and organized criminality controlling illicit drug markets. Both were related to the opening of two policy windows; however, only one led to policy change (stricter penalties), while the other did not, despite broad stakeholder support (evaluating drug use criminalization). The results highlight the role of specific stakeholders as policy entrepreneurs, also indicating growing acceptance of harm reduction, although certain measures remain controversial. The results support previous findings of Sweden adopting a dual track policy structure. However, the control-oriented policy track continues to dominate drug policy formation.

Conclusion: This study suggests that control-oriented approaches are likely to prevail over harm reduction, when the tracks remain institutionally separate, and when control institutions, conventions, and key stakeholders hold greater authority than human rights frameworks. Furthermore, it indicates that focusing on control measures due to criminal networks and drug trafficking may hinder harm reduction development.