Select Committee on Home Affairs Minutes of Evidence

Examination of Witness (Questions 1560 - 1579)



  1560. What about hepatitis C? As a key health issue, the figures we have, from an article you were provided with, state that 90 per cent of injecting drug users in Sweden have hepatitis C, which is by far the highest in Europe. Again, is this because you have not had harm reduction as a big enough part of your strategy or is it something else?
  (Mr Löfstedt) I do not know. The problem is that in our needle exchange programme in the southern part of Sweden there is the same rate of hepatitis C in that area as elsewhere in the country. On the other hand, it does not seem as though the needle exchange programme should have any impact on hepatis C and B. I cannot give a reason. One theory is that we have succeeded in reducing new incidents of HIV, not because we are giving drug addicts clean needles but more because we have tested people. That was very controversial in the beginning, in the mid-Eighties. It means that drug addicts are taking care and responsibility for themselves and for others. They still share needles, and we can see that by looking, for instance, at the hepatitis rates, but they are not sharing needles with HIV sufferers or else the HIV-positive person uses the needle last in the chain. I cannot see any other explanation for this.

  1561. Do you have a target for reducing the number of drug-related deaths in your national plan?
  (Mr Löfstedt) We do not have the figures. The target, of course, is to reduce drug-related deaths. In the action plan there are no figures on reducing the number of drug addicts by 5, 10 or 20 per cent.

  1562. Does it worry you that in 1998 there were 85 acute drug-related deaths in Sweden?
  (Mr Löfstedt) Yes, it worries us.

  1563. That is a big figure, is it not? Do you feel that the strategy has held you back from dealing enough with that issue of harm, death, HIV and hepatitis C or not?
  (Mr Löfstedt) I do not think so. When you are creating a drug policy for society, you must see the whole thing in context. Whatever you do, you make sure that more harm will not be done than is solved. Of course we are concerned about the high figures. We are concerned about the health of drug addicts. We are concerned about social life and we put a lot effort in to helping but we think that the best way of helping drug addicts is to provide treatment and make sure that they can live a drug-free life, instead of focussing on technical solutions that may help them to continue their addiction or drug use but with a little less risk.

  Mr Cameron: I was coming to that. When it comes to treatment, we have had witnesses from Switzerland and Holland who have talked about heroin prescribing for addicts who have a very strong addiction to heroin, who are not yet ready to kick the habit. They said that the most important thing is to get these people a stable, clean supply of heroin so that they stop stealing, they do not overdose, do not inject themselves with impure drugs and they do not die. The evidence would seem to be that they have reduced the number of drug-related deaths through doing that. What do you think about prescribing heroin in extreme circumstances?


  1564. But strictly controlled circumstances, so there is no leakage.
  (Mr Löfstedt) I have thought about that a great deal but, to be brief, it was not long ago that we saw methadone as the final solution to the drug problem. After a while, we found it was not the answer. Now it is heroin prescription that is the final solution to the drug problem. We will probably find in a couple of years that that is not the answer either. What is the difference between methadone and heroin? You get a kick from heroin but you do not have that from methadone. The problem I see is that you lose the borders. The Swiss are talking about a project with 1,000 of their hardest heroin addicts but what would we do with the rest? How does a project like that affect society if, instead of 1,000 we have 30,000? The Swiss are saying that is the number of heroin addicts in Switzerland. What shall we do with those who take amphetamines, cocaine or morphine? We keep widening the borders. If we do that, I think we should be clear about what we are doing. We are now talking about pilot projects, as is happening in Switzerland, the Netherlands and elsewhere. I do not think we should discuss this in terms of pilot projects. If you start a project like that, it is impossible to stop and go backwards. What will you do with the persons to whom you give heroin for a year or a number of years? You cannot kick them back on to the streets again. Before we stop, I think we should be very careful to analyse the effects, not only on the individuals but also on the families and society as a whole. One problem, as I see it, is that we only look at these projects from the perspective of the individual. We say, "We have this individual; he has been on heroin for ten years. It is unlikely that he will succeed in treatment". That is the first problem, saying that people are hopeless. I am an old social worker, and I know that no one is hopeless but treatment takes time. You have to work for many years perhaps to succeed. I have seen people who after three, four or five treatments finally return to a drug-free life. What will the effect on society be if we take more and more people directly from drug addiction into another type of drug addiction, but one sponsored by society?

Mr Cameron

  1565. We are doing that, are we not, with methadone and the Swedish are doing it with methadone as well. We have had people coming to us saying, "You need different forms of treatment for various sorts of people". We had some witnesses last week whose children had died from drug abuse. The child of one of them could not take methadone because it gave him nightmares but there was no clean supply of heroin available. Do you have a specific objection? If you are going to start giving methadone to drug addicts, do you have a specific objection to stabilising some addicts in some cases with diamorphine and heroin? Is it because of the society point or is there something else?
  (Mr Löfstedt) It is mainly the society point. Also, there is no discussion about heroin prescriptions in Sweden. That should not be possible from a political point of view. Personally, I do not think that is successful.

  1566. What do the majority of your addicts do? I think you said earlier you have 17,000 heroin addicts and somewhere we saw that you have 600 to 800 methadone treatment places.
  (Mr Löfstedt) Yes.

  1567. What do the rest do? Where do they go? Where does an addict go when he comes in for treatment?
  (Mr Löfstedt) Basically the main drugs in Sweden are amphetamines. We cannot solve that problem with methadone. We have strict rules concerning methadone. For the same reason, we see methadone as part of a comprehensive treatment programme; it is not the methadone itself but the methadone could be used in a treatment programme. Then again, how do we do that for the people in most need without that affecting the drug-free treatment? We see in other countries that if you start with more or less free methadone, that will affect the whole treatment system. In some countries you cannot find any drug-free treatment facility today. In Sweden the main focus is on drug-free treatment.

  1568. Are those residential programmes?
  (Mr Löfstedt) They are both residential and open care. The rule concerning methadone is just to find people in need and no one else; the methadone should be a part of the treatment programme, which includes social and psychiatric care and whatever the person needs. We do not want to see a development whereby a drug addict just goes to his general practitioner and receives methadone and then goes back on the street again. That is not our view. The next problem, as you indicate, is: what do we do with people who do not fit within the programme? We have rules. That is a problem. We have to take care of that in a different way. To be on a methadone programme, you have to follow the rules and, if you do not, you will be thrown out. You are welcome to come back but for a while you will leave the programme. It is up to the social authorities to help that person in another way and try to take care of him one way or another. In some countries we see developing, low threshold methadone programmes. What effect does that have on the rest of the addict group? Some might say, "Why should I go through a strictly controlled methadone programme if I could go on to a low threshold methadone programme and still use my heroin?"

  1569. Do you think you get addicts off heroin by pushing them into a form of treatment that they may not respond to?
  (Mr Löfstedt) It depends what you mean by "push". The basic idea is that society has the responsibility to push or motivate people from drug addiction into treatment. We are not just sitting waiting for drug addicts to say, "Hey, I want to go into treatment and now I am ready". We think it is important to influence drug addicts as early as possible and also to motivate them to enter treatment. Our problem is not people who want to enter treatment. Our problem is people who do not want to go into treatment and our efforts to put them into treatment.

Mr Russell

  1570. If the United Kingdom liberalised its current drug policy, would that have any impact at all on Sweden?
  (Mr Löfstedt) Probably. Drug policy is very natural and we need to co-operate on an international level. Last week I attended a meeting of the UN Drugs Control Committee. There was a huge debate on cannabis. I do not know if you know about IZB, the European Board for Narcotic Drugs. Every year they present a report. The theme of this year's report was cannabis. The conclusion is that there is a number of problems with cannabis. For instance, is cannabis harmless or not? The IZB said that there are routines and rules to show a substance to be harmless. People who have that kind of evidence should put it to the World Health Organisation, which will scrutinise it and arrive at a decision. It is impossible to withdraw drugs if they are shown to be harmless from the UN lists. Another problem was also discussed in an international perspective. For a number of years we have been telling the developing countries that they should put a lot of effort into reducing these crops. Now the rich countries are saying that they cannot afford to fight the demand, so they do not care; they do not think there is a problem with cannabis and they tolerate cannabis. That means that we are saying to developing countries that they can go on producing cannabis because of the liberalisation and that it is tolerated in Europe. That also means that supplies will increase.

  1571. That is to Sweden as well.
  (Mr Löfstedt) To Sweden as well, and to all countries.

  1572. If you have the harshest drug regime in Europe, which I believe is the case, why is it then that you should be concerned that liberalising it in this country would have a negative effect on Sweden? People are more likely to come to the United Kingdom rather than to go to Sweden.
  (Mr Löfstedt) No, it is not so directly towards Sweden but of course it is a problem for Sweden that other countries in Europe are saying cannabis is not problematic. If we are saying you should not use cannabis and others are saying it is all right, that sends a double message, which will weaken our message. That is the problem.

  1573. If taking the drug in Sweden is going to be a criminal offence and if taking it in other European countries is not, why would foreign nationals wish to go to Sweden to take drugs? Equally, is there not a temptation for Sweden to export its drug addicts to other countries?
  (Mr Löfstedt) I do not think I see that as a major problem. Of course, young people today are travelling around. If we say they should not use cannabis because it is harmful to them, and they go to another country and are told it is all right, it is free and society will provide them with cannabis, then of course we will have a problem when they come back to explain why it is dangerous in Sweden and not in the Netherlands. This is a problem. Also, the message is conveyed in films, music and other media.


  1574. Is cannabis allowed for medicinal use in Sweden?
  (Mr Löfstedt) No.

  1575. Not at all?
  (Mr Löfstedt) No.

  1576. It is not allowed for pain relief in terminally ill people?
  (Mr Löfstedt) No. If there is scientific evidence that cannabis has any medicinal use, I do not see that as a policy problem, as long as we use the same rules for cannabis as for any other agents, those authorised by competent bodies, scientific evidence and so on.

  1577. Just going back to the experiments in the Netherlands and Switzerland with heroin users, you were saying that this may not work and it is a very expensive way of maintaining a heroin addict for life in some cases. I think that is what you are saying, is it not? There is one respect of course in which it might make a difference and that is that it will stop them committing crimes in order to fund their habit. Since in this country 40 per cent of acquisitive crime is drug-related, that would have an impact, would it not?
  (Mr Löfstedt) Certainly, and our experience in the Seventies with an amphetamine prescribing project showed that. I do not want to compare that with the Swiss experiment, which is different. I think that the Swiss experiment is better controlled than the Swedish one and it was for an elderly group; in Sweden a young group was used. It showed that criminality increased during the period; that is, not drug crimes but other types of crime increased. I am not sure, but one solution might be that normally you are both a criminal and a drug addict; you have both identities. It is not so easy to say you are just a criminal because you need money for drugs. If you receive the drugs free, it is not certain that you will stop your criminal behaviour. If you do not have to look for drugs, you have more time for crime. That is one idea behind the result in Stockholm. I think it is bit different with the Swiss experiment because that was with an older group. We also know that people reduce their criminal activities after their thirties. If we have heroin addicts of around 40, they will probably reduce their criminal activities.

  1578. I do not think anybody is suggesting that it should be just for people over 40. The point that is being made is at the moment in this country (and it must be true in most others) if you are a heroin addict, unless you happen to be wealthy, almost the only way you can fund your habit is by crime, there is no other way forward.
  (Mr Löfstedt) But how do you do that without affecting the prevalence of new drug addicts? That is the main problem. If we make drugs more easily available I think that will affect the number of drug addicts.

  1579. You would obviously have to lay down some criteria, ie, it would only apply to chronic heroin addicts who had been taking heroin for two years, something like that. If you said only those over 40 you would be rather undermining the original object?
  (Mr Löfstedt) That is my point. It is very difficult to find criteria which do not interfere in a negative way in the policy. If you say, "You have to have been using drugs for at least two years", you would certainly have a number of people using drugs for two years just to be able to go into the programme. So in one way or another you will affect the whole system and my advice is to be very careful when thinking and analysing and taking decisions because any decision will affect the system. One problem that we could see in Europe is we only think from the individual perspective, we very seldom think from the perspective of society. I think that the heroin project is one example of that. You look at individuals and you see that an individual has changed his health and his social life or whatever, but the evaluation does not look at what happened to the families, what happened to their working life, what happened to society as a whole, and the next step, what will happen if we increased the number of heroin addicts.

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