Swedish drug policy is often presented as a matter of evidence and science. However, Tuulia Lerkkanen’s new dissertation shows that in practice it is also about power, morality, and access to the arenas where public opinion and political decisions are shaped. In material covering the years 2015–2025, a clear pattern emerges: politicians, government agencies, and other established actors dominate the debate, while people who use drugs and their families remain among the least visible voices. The dissertation also highlights how resources, institutional norms, and strong support for restrictive policies shape who is able to influence policy outcomes.
This does not mean that evidence is irrelevant. On the contrary, the dissertation shows that many actors claim to support evidence-based policy. But evidence is almost always intertwined with values. In the media debate, three broad positions emerge: supporters of restrictive policy, critics advocating alternatives such as decriminalization or legalization, and a more neutral group emphasizing knowledge-based policymaking.
Resources Determine Who Gets Influence
The research makes clear that facts alone are not enough to gain political influence. Arguments are also rooted in morality, ideas about children and public safety, social justice, and beliefs about whether people should receive punishment or care.
This helps explain why reform advocates so often struggle to gain traction. The dissertation shows that actors supporting restrictive policy — especially those with substantial organizational resources — are far more likely to influence public debate and policymaking. Reform-oriented actors, meanwhile, often lack the same institutional access and financial resources. The study describes this as a form of “privileged pluralism”: many voices formally exist, but the same well-connected groups dominate the most influential arenas.
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Reform May Be Discussed — But Rarely Implemented
Perhaps the clearest example of this political deadlock is the national drug policy review process. When the Swedish Parliament voted in 2020 to evaluate national drug policy, many saw it as a historic opportunity. Yet the government quickly excluded the criminalization of drug use from the inquiry’s mandate.
At the same time, political focus increasingly shifted toward organized crime and gang violence. This produced a separate policy process centered on harsher penalties for low-level drug sales and tougher law enforcement measures.
According to the dissertation, the political system proved much more open to expanding punitive measures than to seriously considering decriminalization or broader reforms.
Harm Reduction Is Accepted — As Long As the System Remains Intact
The picture is not entirely static. Lerkkanen’s work shows that harm reduction measures such as naloxone distribution and needle exchange programs have become more accepted in Sweden over the past decade.
But this acceptance often comes with limits. Harm reduction is tolerated as long as it does not fundamentally challenge the core principles of prohibition and the vision of a “drug-free society.”
The dissertation concludes that the restrictive framework still defines the boundaries of what is politically possible. New health-oriented interventions may be introduced, but the larger questions — criminalization, punishment, and prohibition itself — remain politically protected. Reform advocates may be invited into the conversation, but they are rarely allowed to shape its direction.
Those Most Affected Are Heard the Least
One of the dissertation’s most important contributions is not simply identifying who holds influence, but showing what happens when influence is distributed unequally. The groups most directly affected by Swedish drug policy are often the least represented in the policymaking process.
If Swedish drug policy is truly meant to become evidence-based, it will require more than references to research and public health. It will also require opening political space for the people and perspectives that are currently marginalized, excluded, or systematically weakened in the debate.
Only then can Sweden move beyond ideological deadlock and toward an honest discussion about what policies actually reduce harm and improve people’s lives.
Links
Stakeholders in Swedish drug policy: Values, interests and involvement
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