Astrid Skretting

Shifting Focus in Substitution Treatment in the Nordic Countries

The article compares the development of substitution treatment in Denmark, Finland, Norway and Sweden. The focus is on the official guidelines: under what conditions, for whom and by whom should substitution treatment be organised? For many years, substitution treatment was fiercely opposed in Finland, Norway and Sweden, all of which had a restrictive drug policy and relied on social work rather than medicine. The debate cut through the professions and was at times the main political issue. Methadone treatment started in Denmark and Sweden in the 1960s, and while Finland and Norway did not give the go-ahead until the latter part of the 1990s, they have today expanded their substitution treatment considerably. In all four countries, substitution treatment has become an accepted and established part of treatment responses to abuse problems. The guidelines have become less strict even if the regimes in practice include various kinds of control measures. The thresholds of substitution treatment have remained the lowest in Denmark where this treatment mode is more geared toward harm reduction than in the other countries.

Measuring the Harm of Illicit Drug Use on Friends and Family

AIMS This paper explores different approaches to quantify the human costs related to drug use. DATA AND METHODS The data come from a representative survey of 3092 respondents above the age of 18 in four Nordic capitals: Copenhagen, Helsinki, Oslo and Stockholm. Results The results show that in most Nordic capitals more than half of the respondents at some time have known and worried about the drug use of somebody they know personally. Moreover, while the average reported harm was about 2 on a scale from 0 to 10, a significant minority (10%) of those knowing drug users indicated that the harm was above 5. Conclusions Many persons have at some time personally known somebody who uses drugs. This causes significant human harm and should be included in the estimate of the social cost of illegal drugs. These results are relevant in the debate on the size of the drug problem as well as for targeting groups that experience the highest costs.

Governmental conceptions of the drug problem: A review of Norwegian governmental papers 1965–2012

Background It is almost 50 years since the “new” drug problem appeared in Norway. How have central authorities conceived of the drug problem during these 50 years? On what have relevant policymaking and action been based? How has the governments conceptions of the drug problem been expressed over the years? Data White papers, action plans, bills etc. Results A review of the main policy documents shows how Norway adopted strict penal measures from the outset, while recognizing at the same time the need to apply an interdisciplinary approach to drug abuse and initiate various support measures for drug users alongside the penal measures. In recent years, there has been an increasing emphasis on seeing drug abuse as a health-related problem rather than one of control. Substance abuse is today perceived more in terms of dependency or as a disease, and harm reduction is increasingly seen as a pivotal aspect of policy. People with drug problems were known until recently as substance abusers, though the preferred term today is “drug dependents”. Conclusions As such, one could say, Norway seems to have developed a “schizophrenic” view of the drug problem. On the one hand, the health aspects of drug abuse are increasingly central to thinking, while on the other penalties for drug offenses remain high. This health/penalty loop in turn seems to prevent the government from softening its stance on penalties - even if such a move were considered appropriate.

Heroin smoking and heroin using trends in Norway

A.L. Bretteville & A. Skretting: Heroin smoking and heroin using trends in Norway The aim is to ascertain whether new ways of administering heroin have gained ground in Norway by examining three series of cross-sectional surveys (D1–D3). D1–D2 are based on postal questionnaires for which D1 is a representative sample of 15–20 year olds in Oslo (1968–2006) and D2 is a corresponding sample of 21–30 year olds (1998, 2002, 2006). D3 is based on personal interviews and consists of users of a needle-exchange service in Oslo (1993–2008). Despite a substantial rise in illegal drug use over the study period, there is no indication of increased heroin use by young people. The prevalence rates are relatively low for all heroin use (1–2%). Routes of heroin administration seem to have changed, however, as more young people (21–30 years) now report having smoked heroin and fewer report having injected the drug. There also seem to be changes in drug use patterns among current injecting drug users (IDUs). Splitting the sample by year of injection debut, we find among those starting since year 2000; i) a rise in average injection debut age of 10 years (25.6 versus 15.5 years); ii) a higher proportion with heroin smoking experience (74% versus 53%); and iii) a higher proportion having smoked heroin before injecting the drug (73% versus 16%), compared to the IDUs debuting before 1980. Consequently, the data suggest changes in drug use patterns, particularly heroin use, among recreational users and heavy drug users. So, in addition to an increase in the number of IDUs, it seems likely that the number of heroin smokers has risen too.

Public injection rooms, a help to heroin addicts?

The situation regarding heroin addicts in Norway is a matter of big concern and thus harm reduction measures are seen as an important supplement to help and treatment services to drug addicts. Public injection rooms are proposed to be included in the harm reduction strategy. In the article arguments in the Norwegian debate why public injecting should be established are discussed. Will public injecting rooms reduce the relatively high number of drug related deaths? Are public injecting rooms a measure in improving the bad health condition seen among the group of drug addicts? Will public injecting rooms be a way of raising the dignity of the drug addicts? Could public injecting rooms be motivated as a way of getting in touch with drug addicts? Will public injection rooms facilitate the misuse of drugs? What about public injecting rooms in the light of the UN-conventions and the penal laws? The main focus of the article is if public injecting rooms would be of any real help to the many problems seen in the group of heroin addicts.

Klaus Mäkelä (1939–2013)

Social scientist and alcohol researcher Klaus Mäkelä has died at the age of 74. He was recognised in Finland for many reasons. In the 1960s he was among the founders of the peace organisation Committee of 100 (Sadankomitea), of Group 9 for gender equality, and the November Movement, which aimed at reduced societal control of criminals, homeless alcoholics and other vulnerable groups. He served as an expert in a number of governmental committees and working groups on abortion, marriage, and constitutional and penal matters. He wrote and edited much-cited books (in Finnish) on the role and responsibility of social research and on qualitative methods. He was editor of several scientific journals, including Acta Sociologica. He inspired Finnish research on conversation analyses, which now has the status of a centre of excellence. He remained active also after his retirement, particularly in academia. In recent years, he defended the interests of social and behavioural sciences in the reform of ethical regulations of research and in the Finnish discussion of the EU Parliament’s proposed restrictions on register-based research. Mäkelä was one of the most influential alcohol researchers in the latter half of the twentieth century, not only in Finland but also internationally. In the following we will focus on his Nordic and international contributions. Mäkelä completed his master’s degree in sociology in 1963 and his doctoral thesis in 1971. Recruited by Kettil Bruun, he began his alcohol research in 1964 with a study comparing halfway houses with different treatment ideologies in Finland. He worked at the Social Research Institute of Alcohol Studies and soon became its director. In 1980, he was appointed secretary (director) of the Finnish Foundation for Alcohol Studies, a post he held until his retirement in 2000. Mäkelä was studying the effects of the 1969 beer reform, and laid the foundations for the Finnish drinking habits surveys. During this time Finnish social alcohol research gained international recognition. Along with his colleagues at the Finnish research institute Mäkelä soon became involved in WHO collaboration and was a co-author of the Purple Book (1975). This book, which argued for a public health perspective on alcohol, had considerable political impact. He also coauthored its sequel Alcohol Policy and the Public Good (1994). In the Nordic arena in the early 1980s, he was part of the Scandinavian Drinking Survey, led by Ragnar Hauge and Olav Irgens-Jensen from the Norwegian alcohol research institute. Theirs is still one of the few Nordic comparative studies of drinking habits. Mäkelä also initiated and co-ordinated an international study of alcohol control policy resulting in the two reports, Alcohol, Society and the State (1981). In the 1990s he was the leader of the big comparative project on the AA as a social movement in eight countries. Later he was co-author of the report on Alcohol in Developing Societies: A Public Health Approach (2002). With these international projects and as one of the founding fathers of the Kettil Bruun Society for Social and Epidemiological Research on Alcohol, and working closely together with Robin Room, Mäkelä established intellectual traditions and practices in collaborative and comparative alcohol research. Mäkelä’s studies highlighted alcohol consumption and alcohol problems as empirical patterns of behaviour. They were analyses of the state apparatus and its care and control institutions as determining alcohol’s social position through their responses to alcohol use. In an interview at his retirement (Nordisk alNAD

Ingen enkle løsninger: Tiltaksplanen for alternativer til “Plata” i Oslo

Aims In light of escalating problems among drug users and illegal drug dealing on the doorstep of Oslo central station—an area known colloquially as “Plata”—there was mounting concern among city and national authorities. In January 2003, A Plan of Action—Alternatives to the Drug Scene in the Centre of Oslo was put into operation. In creating alternatives to the city centre drug scene the action plan aimed to: • Dissuade drug users from congregating in the city centre. • Controll the comprehensive drug trade in the same place. • Prevent more people from joining the drug user group. The plan suggested several measures. Taken together they sought to improve help for drug users, and discourage them from congregating in the city centre. The police would be playing a pro-active role here, helping drug users to get the help they needed from the social services. There was an emphasis on collaboration between services in Oslo and other municipalities, and between the city and the Oslo Police District. SIRUS was asked to evaluate the plan. • To what extent have the many measures been implemented? • Did the Action Plan contribute to a better cooperation among relevant bodies? • To what extent did the Action Plan contribute to dissolving the drug scene? Methods and Data Quantitative data, obtained mainly from Oslo city authorities, and qualitative data, collected through observation and interviewing are used Results There is no denying the strong commitment of Oslo city through its Alcohol and Drug Addiction Service to organize the measures set out by the action plan. These measures have worked well in most cases for the people they were meant to help. It would be going too far, however, to suggest that the plan succeeded in significantly lowering the number of drug users congregating at “Plata”. The action plan should therefore be considered more of an “extra”, a supplement rather than an alternative to the place that attracts drug users to the city centre. In spring 2004, the situation at “Plata” went from bad to worse. The police therefore stopped turning a blind eye to drug use and drug dealing at “Plata”. Drug users disappeared from the “Plata” area, but quickly regrouped in Skippergata, a nearby street. The group here counted fewer members, however, and drugs are not injected in full view of the public. Collaboration between the city and the police on the one hand and various voluntary organizations on the other proved a positive experience in the main. Conclusion The primary objective of disbanding the drug scene in the centre of the city was not accomplished. Oslo city has nevertheless put a great deal of effort into extending existing services and setting up new options for the group of drug users in question. It is a pertinent question as to whether the action plan was realistic in the first place. Given the aim to dissolve the drug scene in the city centre, the setting up of premises that acted as a café, needle exchange centre, outreach health amenity, and supervised drug injection facility in Tollbugate 3–not far from “Pata”–seems slightly paradoxical.