sou · GOB3126d1 · 2001-01-01 00:00:00 — At the same time there must be pre- paredness for coping with the situation in the event of develop- ments resulting in drugs becoming a more accepted element of everyday living. Without any reduction of efforts to reduce new recruitment, work must therefore be made to focus more than hitherto on measures to reach those who have already begun ex- perimenting with drugs. Schools and leisure amenities have the great responsibility of discovering young persons on the brink of abuse. The signals coming from such young persons must be quickly observed and responded to, and prompt action taken when abuse is revealed. Teachers with a knowledge of early signs and an ambition to sup- port pupils who are not getting on well, like efficient school health care with a knowledge of young persons and substance abuse, are among the most important prerequisites for identifying and helping children in need of special support. Children and young persons with risk behaviour or otherwise in a risk zone must con- stitute a priority target group for preventive work in schools. In order to reach young persons who have started experimenting with drugs, there must be an effective social safety net in school and in the local community, as well as structured co-operation between social services, the , school, leisure-time activities and NGOs. The Drugs Commission has found, however, that social services in many quarters lack structured methods for working with these youngsters, and also that overarching co- operation between social services and the is often lacking. Curtailing young persons experimentation with drugs is a multi-stage process. Firstly, competence is needed to detect signals of drug use. Secondly, adequately dimensioned counselling activities are needed, and thirdly, there is a need for different treatment options. Parents whose children have become trapped in substance abuse, or are in the progress of becoming abusers, also need extensive support. The Commission therefore proposes that all young persons and parents have access to local counselling on alcohol, drugs and abuse-related issues. These activities shall be purely advisory and shall be based on trust and voluntary participation. persons who are experimenting with drugs or whose peers are doing so can also find themselves in situations where they are in more urgent need of counselling or assistance. The same also applies, of course, to parents and others closely connected with the youngsters themselves. It is important to be able to intercept young persons at this, a stage of things where they are motivated for changing their life-style and discontinuing their substance abuse. The Commission recommends that a national helpline be set up to which questions concerning drugs and their abuse can be ad- dressed free of charge and anonymously. should be commissioned to investigate how activities of this kind can be organised. Younger people should not need to define themselves as sub- stance abusers in order to get help and treatment. The Commission recommends that young people who need help in discontinuing their substance abuse should be enabled to receive it at a reception adapted for young persons. A reception of this kind can be operated as a separate activity under the aegis of social services or be incorporated in the activities of youth receptions, which would then be reinforced by staff with special competence relating to young persons and drugs. The Drugs Commission perceives a vital need, within the social services, for a reinforcement of specialist competence regarding young persons and substance abuse. Staff with specialist qualifica- tions of this kind should take charge of investigative measures re- lating to young persons with possible substance abuse problems. The Commission therefore proposes that municipal social services, acting in close co-operation with local health care and ser- vices, develop and maintain special knowledge and competence re- lating to young persons and substance abuse. should support development of this kind within the framework of its development funding. There are two basic principles applying to work with young per- sons who have started to abuse drugs, namely early discovery and clear reaction. Partly in order to facilitate early discovery, personal use of narcotic drugs was made a criminal offence in 1988, and in 1993 imprisonment for up to six months was added to the scale of penalties for the offence. In this way the were enabled to take blood or urine samples in order to verify and secure evidence of a suspected drug offence. The Drugs Commission has commis- sioned a survey of measures taken by social services for young per- sons between the ages of 15 and 17 in connection with minor drug offences (personal use). The survey, including 288 individuals, showed that half of them were unknown to the social services or that their drug abuse was not known. Judging by the results of the survey, the decisions made by social services are appropriate and pragmatic. One proposal often occurring in the course of debate is wider scope for compulsory drug testing. In the Commissions opinion, drug tests can play an important part in the discovery of young persons who are heading for drug abuse, but it does not recom- mend any widening of the scope for compulsory drug testing of children under 15, i.e. children below the age for criminal liability. has the Commission found it appropriate for such compulsory measures to be entrusted to school staff or to any other profes- sional categories but the . Finally, the Commission does not favour legislation on the use of drug tests at work. In the Com- missions opinion, the feasibility of drug tests at work varies to such a great extent from one workplace and one sector of employ- ment to another, that these activities should continue to be gov- erned by collective agreements, not by law. The Drugs Commission considers the care and treatment of drug abusers to be a necessary component of drug policy measures. Appropriate measures of treatment help to reduce drug abuse and serve to improve the situation of drug abusers. There are serious deficiencies in the design of drug abuser care today, and the volume of such care falls short of actual needs. Long-term initiatives are called for, above all as regards interaction and the development of methods and competence, but drug abuser care also needs to be given more resources. Deficiencies are especially great where heavy abuse is concerned, and methods are also lacking for responding to cases of incipient drug abuse. The Drugs Commission notes, however, that there is also a great deal of encouraging experience, and it expresses a basically positive view of the possibilities of influencing drug abuse and the situation for drug abusers through treatment measures of various kinds. Furthermore, the Commission notes that statistics, follow-up and other documentation concerning drug abuser care is inade- quate and hard to interpret, and in certain cases does not meet the documentation requirements laid down in the Act. This affects the legal security of the individual person seeking help, added to which, it impedes the planning and follow-up of public initiatives. The Commission has also found there to be considerable differences between municipalities, and even between different parts of the same municipality, as regards offering and conducting meaningful and long-term treatment measures for sub- stance abusers. The financial difficulties of municipalities and county councils are part of the reason for the inadequacy of drug abuser care in many quarters, though here again, the picture emerging is anything but uniform. To a great extent what seems to be involved is a com- bination of resource constraints and poor utilisation of the re- sources available, due among other things to bottlenecks, e.g. a shortage of detoxification places. In many places an infelicitous combination of economisation targets and division into progres- sively smaller performance units has thwarted the necessary holistic view of the individual abuser and of treatment initiatives. Short-term, isolated decisions often take the place of interaction and examination of the abusers long-term needs. There are indications to suggest that the number of heavy abusers has increased, and also that social service and other com- munity agencies are less well informed about abusers than they used to be; at all events, there are fewer agencies involved per abuser. The documentation is also fairly unanimous in showing that the very heaviest category of abusers are faring badly and that, while admittedly receiving help in the form of emergency care, a certain amount of outpatient care, sheltered housing and to some extent periodic LVM1 care, they are more rarely the subject of long-term, co-ordinated initiatives. One basic prerequisite for the efficacy and development of both care and outreach work is the availability within the municipality of personnel with in-depth knowledge of abuse problems and of the possibilities of long-term care and treatment The Commission wishes to underscore the importance of professional networks being built up and of different parts of community caring agencies together devising systems whereby long-term support can be provided even to those who are most at risk and least motivated. Models have to be found and applied which will prevent different agencies from passing the buck, at the same time as responsibility for caring inputs and follow-up at every stage has to be clearly defined. The Drugs Commission believes that properly adapted treat- ment for drug abuse generally has positive effects on the clients drug habits and situation in life. But an individual initiative can never be expected to result in total rehabilitation. Generally a com- bination of several initiatives is needed. The abusers situation has to be viewed in a holistic perspective. If initiatives are carefully tailored to the needs and circumstances of the client, treatment outcomes can be considerably improved. Caring measures shall primarily emanate from and focus on the abusive behaviour, but at the same time, on a parallel basis, possibilities have to be created for processing the clients other problems and difficulties. This generally requires the of genuine co-operation be- tween different care providers and community agencies with reference to individual persons. The Drugs Commission wishes to underscore the importance of the support and initiatives devoted to the individual substance 1 LVM: the Care of Abusers (Special Provisions) Act (1988:870). abuser being adapted to his or her needs, circumstances and recep- tivity to care. Furthermore, true to the intentions of the Social Ser- vices Act, the measures taken must be planned and conducted in consensus with the individual and with respect for his or her per- sonal integrity. Even in cases where the law sanctions coercive in- tervention, the measures taken must be based on analysis of the need and to the greatest possible extent in consultation with the abuser and/or his or her family. On the basis of the national objectives, the Drugs Commission has formulated the following aims by which public measures of care and treatment for addition to and abuse of narcotic drugs should be guided. All drug abusers shall be reached by an offer of help and, if necessary, care for the abuse. Advice, support and assistance shall reach people at an early stage of abuse. Measures of care shall be aimed at achieving a life free from substance abuse and illegal drugs. Care and other measures on behalf of substance abusers shall be of good quality. Measures to combat substance abuse shall be sustainable and long-term. In with the overarching aim of a drug-free society, the aim of measures of care and treatment is for abusers to be able to lead a life free of abuse and illegal drugs. The aim measures leading to the abusers discontinuation of the abuse must not, however, preclude the deployment of emergency or humanitarian measures. The Drugs Commission is of the opinion that limited metha- done medication, in common with other maintenance and blocking medication, does not pose any threat to the credibility of drug policy. So long as these activities form part of a socio- psychological whole and are amply documented, such programmes can play an important part in the control of transmissible diseases and in rehabilitation, for example. The Commission also believes that other substitutes – bupre- norphine preparations, for instance – should come under much the same rules as methadone when used as a substitute. It is generally essential, however, that more medically oriented drug abuser care should always be integrated with and supplemented by social wel- fare measures and follow-up. Measures to combat supply The Drugs Commission has not found any real deficiencies in the legislation or the working methods used by the authorities in the control sector. Co-operation between the authorities runs smoothly, and so too does international co-operation. In its report, however, the Drugs Commission refers to the imperative need for the authorities in the control sector to be allotted further resources with a view to reducing the supply of narcotic drugs. The Commissions report does not contain any proposals con- cerning such fundamental issues as the purpose, means and ends of drug prevention in the control sector. The proposals contained in chapter 5, relating to the control of both legal and illegal trading, are more than minor adjustments to the system of rules and working methods which exists already and which the Commission has thus found appropriate. Firstly, the Drugs Commission has reviewed the provisions governing the control of legal drug trading. Its proposals in this respect are aimed at reducing leakage into the illegal market. First of all, the Commission recommends that the be instructed, acting in consultation with the authorities and organisations concerned, to construct a special reporting system for theft and other losses in transit to and from dispensaries and hospitals. No such coherent data are available at present. The Drugs Commission finds it essential that should be able to investigate, more rapidly and effectively than at present, whether a physician is supplying the illegal market with narcotic drugs. At present the Board is compelled, in its supervisory capacity, to search manually among processed prescriptions at certain selected dispensaries, in order to investigate the pattern of a physicians prescriptions. The Drugs Commission therefore proposes that be empowered, in the course of its supervisory activity, to obtain data from the Prescriptions Register concerning individual physicians prescription of narcotic medicinal prepara- tions. Data referable to individual patients shall not, however, be eligible for collection. The possibility of using the Prescriptions Registry for super- vision in the above mentioned cases would achieve a significant time-saving and reduction of workload both for dispensary staff and for the personnel of supervisory units within , added to which, the inclusion of all dispensations in the country would make the surveys more com- prehensive. To overcome the problem of drug abusers inducing several physicians, without one anothers knowledge, to each prescribe normal doses of narcotic medicinal preparations, the Commission proposes that dispensary staff be enabled to turn to prescribing physicians and inform them of this matter. A solution of this kind is at present precluded by the rules of secrecy, and the Commission therefore proposes that the matter be dealt with as part of the ongoing review of the Secrecy Act. Secondly, the Drugs Commission has reviewed the legislation and working methods relating to the task of combating illegal drug trading. The Drugs Commission has not gone into further detail con- cerning the best way for individual control authorities to organise their efforts to combat drugs. Where the are concerned, however, the Commission has come across certain questions of an organisational nature, which are not easily ignored. This being so, the Commission proposes that the Government instruct to undertake, as part of its inspection activi- ties, a special inspection of all authorities to examine the in- teraction of different levels. shortcomings, which may be felt to exist, should be analysed and followed up. As part of such an inspection, the Commission proposes that analyse more closely, for example, the way in which the abolition of specialised drug squads has impacted on the quality of investigations. One further circumstance, which the Com- mission feels should be studied more closely, is the compatibility of the age structure with the demands to be made on the organisa- tion. As regards the possibilities of preventing the spread of cannabis seeds, the Drugs Commission is of the opinion that the existing legislation can be said to afford scope for prosecuting anyone who sells, purchases or possesses such seeds for the purpose of using them for the production of narcotic drugs intended for abuse. In the Commissions opinion, such actions ought to be classifiable as conspiring to commit a drug offence. In this way the provisions on seizure should also be applicable. Accordingly, no statutory changes would appear necessary in order to prevent the sale of can- nabis seeds. In this connection the Commission underscores the importance of the Government working to maintain the Swedish ban on culti- vation of the species Cannabis sativa. Swallowers are a present-day problem. In street trading it hap- pens that of narcotic drugs keep their stock in their mouths and swallow it when approached by the . To enable the to secure evidence of a criminal offence, an order can at present be made for the suspect to be placed in a customs toilet. In its report the Drugs Commission proposes the possibility of a person who is suspected on reasonable cause of having sold a nar- cotic drug and who can today be placed in a customs toilet instead being given an emetic or some other such medicament. An order to use a medicament shall be made by a prosecutor and only a physician shall be allowed to carry out the medication. Where more serious drug crime is concerned, crime prevention authorities sometimes employ, among other things, what have come to be known as special investigation methods. These in- clude a working method such as controlled deliveries. does not regulate special investigation methods. The Drugs Commission sees no cause at present for introducing any such statutory regulation, but it is of the opinion that the Government should at the earliest possible opportunity appoint a special investigator who, together with representatives of the authorities concerned, will carry out a survey of the special investigation methods – as well as other working methods used in investigation activities – and their current application. In addition, any points of uncertainty should be examined and clarified, and an inquiry should be made to ascertain whether there are additional working methods which can and should be developed with a view to further enhancing the efficacy of crime prevention. The Commission proposes that the Government, acting in the light of the findings thus obtained, instruct the relevant authorities to jointly draft guidelines on the subject. The prison and probation system, not least in view of its intensive and close contact with a large number of drug abusers, has a pivotal bearing on societys ability of combat, above all, the abuse of drugs. Both time spent in remand and in prison, and time on probation, must therefore be used to motivate abusers for treatment. The Commission finds, however, that the prison and probation system must take measures of this kind to a greater extent than at present. The Drugs Commission sees an urgent need for the prison and probation system to be given resources, not only for the mainte- nance and improvement but also for an intensification of its measures to combat drug abuse. Activities in the prison and probation sector must as far as possible afford scope for the needs and capabilities of each individual. Methods for the planning of enforcement and treatment should be developed. Programme ac- tivities, methods development and competence development should be given priority, and activities in motivation and treatment units should be developed so as to permit greater involvement of the outside community. The Drugs Commission has found that the economisation requirements of recent years have affected both the scale and the content of prison and probation activities. The effects of this in- clude the high occupancy level of prisons, which in the Commissions opinion stands in the way of an appropriate differentiation of prison inmates. The Drugs Commission has further established that the so- called normalisation or mainstreaming principle, i.e. the principle whereby the social needs of convicted persons are to be provided for within the framework of societys general welfare systems, just as for other citizens, cannot be said at present to have achieved sufficient impact. This is above all due to the municipalities having grown far more reluctant to finance care and treatment for drug abusers. In the Commissions opinion, however, this is no reason for departing from the normalisation principle as such, and further efforts must be made, above all within the social services, to provide drug abusers with the care and treatment, as well as other support and assistance, which they may be in need of. Under Section 34 of the Act on Correctional Treatment (1974:203), a prisoner can be given permission to leave the institution if he can then be made a subject of special measures which will presumably facilitate his adjustment in the community, e.g. care and treatment for drug abuse. The cost of placing a prisoner in care outside the institution shall be borne by the prison and probation system. On the day of the prisoners release from prison, this financial liability passes to the municipality, which then defrays the cost until the treatment is concluded. It is, however, difficult at present to obtain pledges from municipalities to cover expenditure of this kind. Despite these dif- ficulties the Drugs Commission recommends that the current principles should continue to apply, but it proposes that the prison and probation authorities – in cases where they favour a Section 34 placement but for some reason a financial commitment is not forthcoming from the municipality – be empowered for a two-year experimental period to order such placement even if it continues beyond the prisoners release date. Similar problems apply to contract treatment (a special form of probation). The Commission proposes that the National Prison and task the probation authorities with pursuing development in such a way that every region develops a number of alternative care models acceptable both to the prison and probation system and to the municipalities concerned, the aim being as far as possible to eliminate administrative and overarching questions in the individual treatment plans which have to be drawn up prior to placement in contract treatment. Inmates and staff alike of remand centres and prisons are entitled to a drug-free environment. This being so, the obvious benchmarks, as the Drugs Commission sees it, are the inmates without drug problems shall not need to come into contact with drugs, that abusers shall be cut off from the supply of drugs and that inmates shall be prevented from trading in drugs within re- mand centres and prisons and in the community at large.