Drug user organizations in the Nordic countries--local, national, and international dimensions

Drug use and the constitution of homo politicus in Swedish politics 1966-1979

BACKGROUND

The emergence of the drug user as a political problem in Sweden during the 1960s presented politicians with the problem of how to fit this new character into the existing democratic order. The aim of this article is to examine how Swedish politics sought to regulate democratic participation by establishing norms that conditioned who is recognized as a political subject as well as what counts as political speech and action.

METHODS

The analysis is based on a close reading of parliamentary debates, political motions, and public reports and covers the period 1966-1979.

RESULTS

During the examined period, Swedish politics constituted the ideal subject of democratic politics, homo politicus, as a subject embedded in a community of active and politically conscious citizens endowed with the capacity to cooperate and engage in the collective formulation of the common good. Drug use therefore posed a threat to the democratic order due to its passivizing effects that inhibited the cooperation needed to uphold the democratic polity.

CONCLUSION

The perceived individualism, passivity, and inability of the drug user to engage in cooperation within a politically conscious community of citizens positioned the drug user as a threat to the democratic order. The drug user thereby became a useful figure in the political regulation of the democratic sphere and the constitution of homo politicus, the ideal subject of democratic politics.

Creativity, care and 'messy' drug use: A collective history of the early days of peer-led needle exchange in Dunedin, New Zealand

Established in 1988, the New Zealand Needle Exchange Program (NZNEP) was the first needle exchange programme in the world to operate nation-wide under legal sanction. As in other countries, the ground for legislative reform was laid by activist action among the affected communities and their allies. In context of growing HIV/AIDS notifications, the provision of injecting equipment was positioned as a necessary, albeit politically contentious, public health priority. The NZNEP operated under a unique organisational model, with a national network of peer organisations formalised and supported to provide 'user pays' needle exchange. Unlike many other programmes of community empowerment instigated in response to HIV/AIDS, the NZNEP has over the past thirty years retained a significant degree of community control. Not without tensions, this history requires commemoration. The body of this essay was originally written as a chapter, focusing on the history of DIVO (Dunedin Intravenous Organisation), for a book to commemorate thirty years of the NZNEP. Under the auspices of a 'secret Facebook group' seven peers who worked at DIVO in the late 1980s and early 90s contributed the memories that make up this piece. As one of these peers, the author collated, coded and thematised these remembrances to create the story of DIVOS early days. From strategic positioning as a drug user organisation 'under wraps' DIVO garnered enough community support and institutional confidence to be 'out and proud' in advocating for the human rights of PWID. Ingenuity and action necessitated 'bending the rules' to protect against hepatitis C, and a community of care was recreated in the warmth of reconnection among the Facebook peer group. Tensions are inevitable in a peer-based organisation innovating in a context of precarious legitimacy, and they weave throughout this essay. This collective history is, however, primarily celebratory - of the achievements and legacy of a network of peers who were instrumental in providing care for their communities and advocating publicly for the rights of PWID in New Zealand.

Making legitimacy: Drug user representation in United Nations drug policy settings

BACKGROUND

The importance of engaging people who use drugs in drug policy development is increasingly acknowledged including in recent UN documents. Little scholarly attention has been paid to 'drug user representation' in the global drug policy setting of the UN such as the Commission on Narcotic Drugs (CND). This paper examines 'drug user representation' in key UN drug policy processes over three decades.

METHOD

A mapping process was undertaken using a corpus of publicly available documents from the UNGASS on Drugs and associated CND processes to identify relevant policy processes from 1987 to 2019 (n = 15) which were then assess for presence/absence of 'drug user representation'. Those processes with positive evidence of 'drug user representation' (n = 9) were critically interrogated across three co-constitutive domains of the subjects, objects and forms of 'drug user representation'.

RESULTS

Our analysis shows that despite calls for greater involvement, dominant UN drug policy discourses and other practices delimit both the political subjectivities available to people who use/have used drugs and their capacity to bring their voices to bear in this context. The analysis also highlights that human rights-based discourses, employed by 'drug user representatives', have emerged as an important practice of resistance against the problematic and delimiting power effects of existing UN discourses, governing practices and modes of engagement.

CONCLUSIONS

In addition to the practices of resistance being undertaken by 'drug user representatives', we suggest there is a need to improve how 'drug user representation' is being made possible and done in the sites of UN drug policy deliberation and, that these sites should be opened for questioning. This we argue will not only have a positive impact on political legitimacy for 'drug user representation', but on the health and human rights of people who use/have used drugs.

Recasting Participation in Drug Policy

Calls for “evidence-based policy” and greater community “participation” are often heard in the drug policy field. Both movements are in different ways concerned with the same questions about how “drug problems” ought to be governed and the place of “expertise” and “engagement” in democratic societies. However, these calls rely on the assumption that knowledges, publics, expertise, and issues of concern are fixed and stable, waiting to be addressed or called to action, thus obscuring ontological questions about what “participation” (be that lay or expert) may do or produce. There has been limited research in the drugs field that has taken “participation” as an object of study in itself and through critical examination attempted to open up new possibilities for its remaking. In this article, we draw on science and technology studies scholarship that has sought to illuminate the relations between public deliberation and government decision-making in public affairs involving technical claims and the generative capacity of such engagement (including for democracy itself). We describe various rationales for participation and examples of experiments that have sought to remake participatory processes in other policy domains. This literature provides fruitful ground for a reengagement with (and possibly a reconfiguration of) “evidence-based policy” or community “participation” in drug policy. Through this exploration, we hope to recast and more sensitively articulate the concept of “participation” in deliberations about public affairs involving technical claims in drug policy, thus opening up possibilities for experiments and practices that redistribute expertise, “slow down” reasoning, attend to emergent publics, and disrupt consensual claims as to “what counts” and what does not.

The perspectives of structurally vulnerable people who use drugs on volunteer stipends and work experiences provided through a drug user organization: Opportunities and limitations

BACKGROUND

While drug user organizations (DUO) have received public health attention as a means to potentially reduce the harms associated with drug use, there is a lack of research on the compensation and structural forces that promote or inhibit participation in DUO. Against the backdrop of structural vulnerability experienced by people who use drugs (PWUD), we examined the impact of monetary 'volunteer stipends' provided through a DUO and explore their role in providing low-threshold employment opportunities and shaping participation in DUO.

METHODS

Participants were purposively sampled to reflect a range of perspectives and experiences volunteering at Vancouver Area Network of Drug Users (VANDU) and receiving stipends. Semi-structured qualitative interviews were conducted with 23 members of VANDU. Interview transcripts were coded in Atlas.ti 7 for key a priori themes and emergent categories from the data and analyzed thematically.

RESULTS

Stipends provided participants with symbolic and material recognition of the time, effort, and expertise they contribute to the organization, and functioned to facilitate ongoing participation. Payments that rewarded, skills, labour and drug-related knowledge reduced participant's perception of stigma against PWUD. Paid work in VANDU further provided participants with non-material benefits commonly attributed to regular employment, including social connections and a sense of purpose. Participants also identified the low level of pay as a limitation of VANDU's paid participation program. The daily demands of survival (accessing shelter, food, and drugs) posed more complex structural vulnerabilities to participate in VANDU, as small stipends were not sufficient to address these needs.

CONCLUSION

Low threshold employment opportunities within DUO may provide significant individual and public health benefits. However, these benefits are constrained by the small size of stipends. Therefore, to ensure better inclusion of PWUD, our findings recommend the development and expansion of equitable, accessible, well-paying employment programs for PWUD.

Smørrebrød or Smörgåsbord: the Danish and Swedish drug users unions: contexts, aims, activities, achievements

Purpose

– The purpose of this paper is to first, inform readers of the roles, activities and contexts of drug users unions in Denmark and Sweden. Second, to show the achievements and impacts of the two. Third, to illustrate the differing social and political situations in the two countries and how they determine the priorities and activity of the unions.

Design/methodology/approach

– The paper is written by a UK commentator who bases the text on meetings, interviews and conversations with members and representatives of the two unions. Spokespersons for both unions have contributed to, commented on and clarified draft texts and provided contextual papers and information.

Findings

– The two unions have differing roles and levels of acceptance and influence according to the political and legal situations in the two countries. There are differing situations and needs in Denmark and Sweden, reflected in the levels of drug-related deaths. There is no “Scandinavian” model. In Denmark the users union is involved in high-level discussions on policy making and practice. In Sweden the new unions are starting to be involved in local discussions about provision and practice.

Research limitations/implications

– Danish experience shows how political acceptance of the existence of a drug using population is leading to improved health and well-being amongst that population, and to social policy responses which are inclusive of this and other marginalised groups, and to a reduction of stigma and demonisation. Swedish experience differs and can be seen as essentially prohibitionist and punitive. Many Swedish drug users are moving to Denmark because of the levels of service and social attitudes. It may be of interest to UK policy to adopt a similar approach to drug users organisations – as distinct from service users’ voices.

Practical implications

– Strengthening the role of drug users unions in all countries and including them in national policy making discussion and debate.

Social implications

– Accepting the existence and needs of drug using groups in society and developing responses informed by their views and experience. Adopting inclusive social policies and recognising the variety of need and choices in treatment. Combatting stigma and demonisation.

Originality/value

– The paper is based on extensive interviews and conversations whose results and content are recorded, not interpreted. The Danish work was conducted in Danish, adding to the number of voices and conversations it was possible to include. A distinction between policy and practice in Denmark and Sweden is established which may run counter to UK impressions of “Scandinavian” rather than national realities.