PUBLIC HEALTH by Ross ColquhounNews Weekly
Sweden shows the way on early intervention
, July 18, 2015
Treatment and rehabilitation are important components of an effective drug policy. However, it is more often applicable to those who have developed a severe dependence on drugs. It does not take into account the more important strategy of prevention of drug use through supply-and-demand interventions, except to send a message that continued drug use is not going to be tolerated.
Primary (supply reduction) and secondary prevention (demand reduction) strategies are more effective and undoubtedly more cost effective than is chasing the bolted horse. In the context of primary prevention, the fundamental principle that public-health theory applies in dealing with epidemics, including drug epidemics, is that if the number of first-time contacts (users) is not reduced, the strategy employed will not succeed.
An emphasis on treatment tends to draw attention away from primary and secondary strategies and may send the message that as treatment is ineffective continued drug use is inevitable; or that when treatment is needed society will pay for it, thereby dissuading people from taking personal responsibility not to use drugs.
While treatment is a component of drug-use reduction strategies, it is less effective than a) discouraging people from initiating drug use; and b) stopping it as early as possible before long-term treatment is necessary. This approach would promote enforcement of the law, demonstrate a commitment to being a drug-free society and, as the major thrust of policy, shift the focus to those that have not yet used drugs.
Critical to the success of the policy as implemented in Sweden is a cultural consensus that drug use is dangerous and we are best able to deal with it by reducing overall levels of drug use in society.
On the other hand, in Australia, harm-reduction policy has largely been confined to outcomes for people whose drug use has become entrenched and who are dependent and are resistant to changing behaviour. The evidence, which needs to be emphasised, is that reduced drug use in society is the most potent factor in reducing harm. Once a person begins drug use and becomes dependent on drugs, the chances of reducing harm are vastly reduced.
To achieve reduced drug use, a shift is needed from harm-reduction policies – for example, needle exchange and drug substitutes such as methadone – to a “drug-free” approach. At the same time, policy needs to be refocused away from the protection of those who have chosen to use drugs, to the protection of those who have not as yet started to use drugs or are in the early stages of drug use.
The Swedish model emphasises compulsory drug testing and early intervention, including mandatory treatment. These are not used as an alternative to prison, which implies long-term problematic drug use, but as enforcement of laws relating to drug use (not just the crime that is related to it). Such a policy demonstrates the society’s commitment to protecting its youth from long-term damage, including criminal convictions and physical, social and psychological harm.
Sweden consciously moved back to a more restrictive anti-drug policy with the aim of a drug-free society and zero tolerance. Authorities adopted drug policies that encompassed a broad range of harm-minimisation strategies, and modified the balance of elements to respond to changed circumstances, including the introduction of a compulsory drug-testing scheme implemented by the Swedish police.
This random drug testing was found to be effective in identifying drug abusers and referring them to receive treatment at an earlier stage.
Swedish police do not require physical signs and presence of drugs to trigger drug testing. The offence of drug consumption in Sweden is comparatively lenient. Imprisonment is technically possible, but the maximum penalty in practice is a fine, and the criminal record can be completely erased after three or five years.
Australia has blindly adhered to a policy that uses harm reduction as the foremost strategic component and has not responded to the evidence that drug use and harm have increased here more than they have in nations such as Sweden.
The evidence from Sweden is that early intervention, even if involuntary, can be effective once more accurate information as to the harm resulting from drug use has been received. However, early intervention implies detection before real harm has resulted. Compulsory and random drug testing at places such as rave dances not only provides this opportunity to intervene, but acts as a deterrent, thus reducing demand, and emphasises the concerns within society about the harm associated with drug use.
The secretary general of the Swedish National Association for a Drug Free Society, Per Johansson, said at the time the new policy was introduced: “One of the common stereotypes in global drug-policy debates is that successful welfare states adopt permissive drug policies as part of their commitment to compassion and tolerance of diversity. Sweden, a country noted for its liberal views, stands out as an exception to this stereotype and offers a model for a more restrictive drug policy, not because it is repressive politically but because it promotes public health and lowers both drug use and the harms caused by drug use.”
Dr Ross Colquhoun is an executive member of Drug Free Australia and research fellow, and a member of the Drug Advisory Council of Australia.