Injecting drug use and the right to health in Sweden

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The International Harm Reduction Association's new HR2 Harm Reduction & Human Rights programme, in conjunction with the Swedish drug users union, has today published a report examining the issues around the state's response to the growing health problems (specifically blood borne diseases) relating to injecting drug use in Sweden, and the inadequate provision of harm reduction services for Sweden's growing population of drug injectors.

The report has been produced as a shadow submission to the Swedish Government's own report to the UN Committee on Economic Cultural and Social Rights. States that have ratified the Convention on Economic, Cultural and Social rights are required to periodically submit reports to the Committee, which acts as an independent body overseeing adherence to the convention (similar bodies exist for all UN treaties).

The IHRA report background intro notes that:

This report examines Sweden’s obligations under Article 12 of the International Covenant on Economic, Social and Cultural Rights. It reviews the failure of Sweden to provide comprehensive harm reduction programmes, such as needle exchange, for people who use injecting drugs. The failure to provide such essential preventative health interventions places people who inject drugs at unnecessary and avoidable risk of HIV and hepatitis C infection, and therefore reflects a failure of the State party to respect, protect and fulfil the right to the highest attainable standard of health for this most vulnerable and marginalised population.

Sweden has one of the best domestic human rights records in the world, and in the area of economic, social and cultural rights stands above most countries in terms of life expectancy, standard of living, education and healthcare. However, there are sections of Swedish society that do not enjoy this high level of human rights protection. Some communities, like the Saami and Roma, are increasingly recognised in Swedish human rights policy as suffering from marginalisation and discrimination. Others, such as people who use illegal drugs, also experience the effects stigma and discrimination, yet this goes largely unrecognised. One illustration of this is the fact that injecting drug use and related harms such as HIV and hepatitis C infection are entirely omitted from the State’s report to the Committee, as are any references to measures taken to address drug use and reduce drug-related harms.

In 2006, Professor Paul Hunt, UN Special Rapporteur on the Right to Health, undertook a mission to Sweden. While praising the overall state of human rights, the Special Rapporteur stated that there was no room for complacency and highlighted the specific situation of people who use drugs. Professor Hunt was critical of the poor provision of harm reduction services, especially needle exchange, despite international evidence of the effectiveness of these measures in preventing HIV and hepatitis C transmission among injecting drug users (IDUs). The Special Rapporteur visited a needle exchange programme in Malmö, one of only two in the country, and confirmed that harm reduction “enhances the realization of the right to health, including sexual and reproductive health, for intravenous drug users”. He recommended that Sweden adopt, as a matter of priority, comprehensive harm reduction services throughout the country.

Swedish drug policy is fascinating. Behind the veneer of a highly developed social welfare system and operating within wider policy paradigm of public health pragmatism is a somewhat incongruous dogmatic and moralistic view of drug use. It has resulted in a zero tolerance approach to drugs and drug users involving harshly enforced prohibition and a general disdain for harm reduction principles and practice (see this recent article in Druglink magazine for more discussion) .

The IHRA report notes that (page 6):

Sweden follows a strict law enforcement approach to drug use, rather than the health-based approach utilised in many other countries. Harsh sentences are imposed, including penalties for drug use itself. Indeed, Sweden is one of the few countries in the world to impose prison sentences for the use (rather than the possession) of drugs. Coercive testing and treatment are also utilised.

It has been found by Sweden’s own National Council for Crime Prevention that “based on available information on trends in drug misuse there are no clear indications that criminalisation and an increased severity of punishment has had a deterrent effect on the drug habits of young people or that new recruitment to drug misuse has been halted”. As noted above, the number of people injecting drugs in Sweden has continued to grow despite the country’s harsh law enforcement responses.

Evidence from other parts of the world has shown that harsh criminal sanctions are counter-productive to HIV prevention efforts among injecting drug users, as they are less likely to engage with the relevant health programmes for fear of identifying themselves.

read the full report here (pdf)
includes references left out of the above quotes