The Danish Local Drug Policy Project

Introduction

Drug policy may be defined as the regulation of certain psychoactive drugs, their use and the harms associated with their use. As such it constitutes a vast field of a multiplicity of different regulations and interventions, which reaches from the sphere of international politics to the level of local communities and spans over all sectors of society where it involves many different institutions and organisations. In fact recent years has seen a veritable proliferation of drug policies as different actors and institutions have become concerned with drug use and drug harm. Drug policy is an umbrella concept, which contains many different kinds of policies, which have as their common denominator that they in one way or another address the regulation of drugs, their use and the problems associated with them. Usually a distinction is made between drug control, drug treatment, drug prevention and harm reduction (Narkotikarådet 1999; Ritter and McDonald 2005; Reuter 2006). Drug control involves the rules, legislation and programs which regulate the access to use drugs, or as it may be the case, the prohibition of any use of a drug. Treatment involves measures to remove or alleviate drug related problems like drug addiction. Prevention involves measures to prevent people from using drugs or progress from experimental to regular use or heavy use. Harm reduction finally seek to reduce the adverse consequences of ongoing drug use. In Denmark the organisation and implementation of the ‘social’ elements of Danish drug policy – treatment, prevention and harm reduction – have been decentralised to the local level, just like most other social policies. After the structural reform of the social sector most of this responsibility has been left with the 98 municipalities. Enforcement of drug legislation is the responsibility of the police districts, which may enforce the legislation in different ways, even within the same police district. While some local research has been done within each of the four policy areas mentioned above, none of this research has been able to provide us with comparative knowledge about how these policies are organised and implemented across all or just a significant number of municipalities and police districts. A similar lack of knowledge exists with regard to the balance between the different policies which constitute drug policy at the local level and how they may differ from locality to locality. It is the aim of the Danish local drug policy project to produce such comparable knowledge about local drug policies in Denmark.

Aims of study

The aim of the Danish local drug policy project is to create knowledge about how drug policy is organized and implemented at the local level in Denmark and about how public resources are spent on drug policy interventions. The local drug policy project will therefore develop a model, which makes it possible to analyse and compare the organisation and implementation of local drug policies in all 98 municipalities in Denmark across all four main drug policy areas: Law-enforcement, treatment, prevention and harm reduction. There are four overall aims with this project.

  1. To produce the first comprehensive account of Danish drug policy from a bottom-up perspective based on the way drug policies are organised and carriedout at the local level.
  1. For the first time to be able to compare how local drug policies are organised and carried out.
  1. To analyse drug policy as a whole and by doing this being able to account for: a) different drug policies as specific combinations of control, treatment, prevention and harm reduction, b) the different ways in which such organisations of drug policy come about, whether it is through cooperation between different institutions and agencies, or something, which happens by default.
  1. To develop the basis for making a ‘drug budget’ of public spending on drug policy in Denmark which will also make it possible to compare spending in across municipalities.

Background

Denmark has no central agency to coordinate drug policy. Furthermore, white papers and action plans from the government, which encompasses all four policy areas are only made approximately every ten years. This means that very few political efforts and decisions concern drug policy as a whole and that Danish drug policy most of the time develops in a rather fragmented and ad hoc manner. The incoherence of Danish drug policy is not surprising, if we take in to consideration how complex and diverse the character of drug related issues and the heterogeneity of different actors who deal with these issues.

This lack of coherence is also reflected in our knowledge about public spending on drug policy in Denmark. Unlike most other policy areas very little is known about how many public resources we spend in the drug policy field in Denmark. An important reason for this is the heterogeneous nature of drug policy interventions and the diversity of actors and institutions, which make these interventions. It is therefore a complicated task to construct a ‘drug budget’ in order to know how many resources we spend on drug policy and how we prioritize these resources between law-enforcement, treatment, prevention and harm reduction. The local drug policy project will also fill this gap in our knowledge about Danish drug policy. By doing this the project will place itself within an emerging field of drug policy research and it will continue and develop further ongoing research in this field on the Nordic level (Econark ref, Reuter XX).

With regard to drug policy research, the small amount of research, which has been carried out in Denmark in order to reach across all drug policy areas, has only been concerned with the national level with whitepapers, legislation, transcripts from parliamentary debates etc. as data (Kruse et. al. 1989; Storgaard 2000; Jepsen; Houborg; Asmussen…). But as mentioned above the organisation and implementation of drug policy is to a large measure delegated to the local level. There is therefore a need to direct research towards the local level. In fact, most drug research in Denmark is conducted at the local level, but it is mainly concerned with specific institutions and issues: Treatment (Pedersen and Asmussen 2002; Houborg 2006; Pedersen and Villumsen 2006; Bjerge 2007; Dahl, Frank et al. 2008; Houborg 2008; Pedersen and Heckscher 2008); control (Laursen 2000; Asmussen 2007; Asmussen and Jepsen 2007; Jepsen 2008; Møller 2008); harm reduction (Asmussen and Dahl 2002; Andersen and Järvinen 2007; Järvinen 2008); and prevention???. Such studies show significant local variation in the way e.g. drug treatment or law enforcement is organised and conducted. There are a few research projects, which have used a broad, national and comparable perspective, but this has only been done in regard to specific elements of drug policies e.g. treatment (Pedersen and Nielsen 2007)SFI???. Therefore, there is also a need to broaden some research at the local level to encompass all four drug policy areas and to make comparative research of different local drug policies. On this background the local drug policy project will develop a model, which will make it possible to conduct comparative research of the way drug policy is organised and implemented locally in Denmark.

To the general need for knowledge about local drug policy should be added that the newly implemented structural reform [strukturreformen] provides a unique possibility to investigate drug policy ‘in the making’. Since January 1st 2007 the 98 municipalities in Denmark have been given the sole responsibility for organising and carrying out the social and medical aspects of Danish drug policy. This responsibility was previously shared between the counties and the municipalities with thecounties carrying the majority of the responsibility. The reform has thus made the municipalities very important actors in Danish drug policy. This also means that many municipalities are now in the process of formulating local drug policies with new actors and institutions in the drug field.

Furthermore, in 2003 an important change happened in Danish drug legislation where possession of illicit drugs for personal consumption was re-penalised after 35 years of de-penalisation. This makes it relevant to investigate how this new legislation is enforced in different localities. Again we know from prior research that enforcement of drug legislation can differ considerably between different localities (Xxref). The change of legislation co-insides with a structural reform of the Danish police from 1st of January 2007, which has changed the police districts and to some extent the way policing is conducted, e.g. by putting less emphasis on community policing. Which effect may this have on drug control?

Inspirations and conceptual tools

In developing a model for analysing local Danish drug policies we define policy as “a set of interrelated decisions taken by a political actor or group of actors concerning the selection of goals and the means of achieving them” (Jenkins 1978: 15 in Colebatch 2002: 85). The basic approach of the research project is to identify, describe and analyse drug policy interventions (DPI), which we, with a refrasing of Ritter and MacDonald’s definition (Ritter & MacDonald 2005), define as any attempt to regulate drug use or drug harm, which has drug use and drug harm as its explicit concern. This means that policies and interventions, which may affect drug use and drug harm, but which do not have drug use or drug harm as their explicit concern, will not be included in this research project. In order to develop a model for the analysis and comparison of local drug policies a number of conceptual tools and methods will be deployed. We have chosen a number of tools from the international literature of drug policy research in order to make our research into local Danish drug policy comparable with international research. We have been particularly inspired by the Australian “Drug Policy Modeling Project”, which has done a big effort in reviewing the literature, developing tools and putting them to use.

The Four Pillar Approach

There exist different models and schemes for analysing the complex field of drug policy. In the search for a scheme for the local drug policy project, we have been looking for one, which is commonly used in drug policy analysis and has been tested as a reliable analytical tool. Based on this we have chosen the so-called ‘four pillar’ scheme, which characterises drug policies according to the four different modes of intervention already presented: control, treatment, prevention and harm reduction. This model may serve as a useful tool for making synchronic and diachronic comparisons of drug policies. By mapping the drug policy interventions in different contexts or in the same context over time and classifying them according to the four different policy categories – and allowing for hybrid forms – it should be possible to compare drug policies by analysing the content of each policy category and the balance between the different categories. In this way it becomes possible to characterise the ‘policy mix’ of different local drug policies. The scheme has been used in the Australian “Drug Policy Modelling Project”, where it was tested on 107 drug policy interventions and proved to be a useful tool for categorising such interventions (Ritter and McDonald 2005). The fact that the model is widely used and that it has been tested and used by the DPMP is an important qualification of the model for the local drug policy project, because it makes the task of making international comparisons possible.

Control and welfare

Danish drug policy has been characterized as “an ambivalent balance between repression and welfare” (Laursen and Jepsen 2002), even though this ambivalence is not unique to Danish drug policy, but is present in most, if not all drug policies. The reason for this may be found in the ambiguity about the nature of drug use, drug abuse and drug addiction. One ambiguity would thus concern the nature of illicit drug use and whether or not it should be considered to be a wilful transgression of moral order, and thus by definition be defined as ‘drug abuse’, or whether it should be considered normal moral behaviour. Another ambiguity concerns the nature of addiction and the relationship between drug abuse and addiction. Even if drug addiction may be considered to be a condition, which demands treatment, the condition may be considered to be developed by through wilful illegal acts, which are subject to sanctions (O’Malley 2004, 55). But it may also be considered to be an individual symptom of social deprivation for which the individual cannot be held responsible. [Brickman et. al. (Brickman, Rabinowitz et al. 1982) presented a model, which contains four different ways of handling social problems based on whether or not they attribute responsibility to the individual for the cause of the problem and for solving the problem. In this the “moral model’ attributes high responsibility to the individual for causing the problem and for solving the problem, while the “medical model” attributes low responsibility to the individual for either and the “compensatory model” attributes low responsibility to the individual for causing the problem, but high responsibility for solving it.]

Much of the scientific literature on drug policy is concerned with the relationship between social control and welfare strategies in the regulation of drugs in society. [Or, to stay with models of Brickman et. al. with the relationship between moral models on the one hand and compensatory and medical models on the other when defining and responding to drug use and drug harm.] On this background we find it important that our analysis and comparison of local drug policies pays explicit attention to the way they balance control and welfare strategies. For the purpose of this analysis we may draw on a scheme developed by Longshore et. al. (1998). According to this scheme drug control may analysed in terms of its restrictiveness with regard to who may used certain drugs as well as when, where, how and for which purposes they may used them, but also the severity of sanctions and the intensity with which rules and legislation is enforced. Welfare on the other hand may be conceptualised in terms of the access to and the variability of welfare and health services, including drug treatment and harm reduction measures like needle exchange programs. It will however also be necessary to analyse how local drug policies balance use reduction and harm reduction(MacCoun 1998) Use reduction can be defined as interventions, which have as their objective to minimize the use of drugs, be it through control, treatment or prevention. Harm reduction can be defined as interventions, which have as their objective to minimize the adverse consequences of drug use (Reuter 2006). This means that even if drug policy gives welfare a high priority it may still not include people who continue to use drugs.

The politics of risk

The prioritization and balance between use reduction and harm reduction shows that drug policies involve a politics of risk, because they involve the definition and recognition of drug related harms and risks and the distribution of such harms and risks in society. To this comes that that drug policies themselves may be a source of risk and harm. The definition and categorization of risks and harms associated with the use of illicit drugs and the evaluation of harm reduction interventions is therefore an important topic in drug policy research (henvisninger, incl DPMP mono 6). MacCoun et. al. (MacCoun, Reuter et al. 1996) categorize drug related harm and costs according to the types of harms and cost, the sources of the harms and costs and who bears the harms and costs. Types of harm may be health-related, related to social and economic functioning, individual safety and public order and to the criminalization of drug use. The sources of harm may be intrinsic to drug use or it may be caused by the conditions under which the drugs are used. Finally the costs and harms of illicit drug use in society may be carried by the drug users themselves, their friends and families, particular communities and neighborhoods or society at large.

Different drug policies distribute the risks and the harms of illicit drug use differently. A drug policy, which emphasizes use reduction may minimize prevalence and hence the number of people who are at risk from the harms of drug use. But for the ones who despite of this continue to use drugs, the risks of harm and the severity of harm may increase because of the circumstances for drug use under such a policy regime (O'Malley and Mugford 1991)(MacCoun, Reuter et al. 1996; MacCoun 1998; MacCoun and Reuter 2001).

As an example of the political discussion concerning these matters one could take the most recent whitepaper on Danish drug policy issued by the Danish government (Regeringen 2003). The whitepaper states that because Danish drug policy is based on the prohibition of all non-medical and non-scientific use of illicit drugs all harm reduction measures may be seen as paradoxical, because they may be perceived as making this prohibition less restrictive, among other things, because it by some could be read as a sign that the government condones illicit drug use. On this basis the whitepaper stated that safe injection rooms and heroin maintenance treatment would make the paradoxes of Danish drug policy too big to be acceptable for the government, which wanted to adhere to ‘the fundamental prohibition’. The government chose to in other words to distribute the risks and the costs of ‘the drug problem’ in a particular way by prioritizing what is saw as the social control effects of sending the right signals over measures, which may reduced the risks for people, who continue to use drugs.