Aims:

To end the hepatitis and AIDS epidemics in the world by 2030, countries are encouraged to scale-up harm reduction services and target people who inject drugs (PWID). Blood-borne viruses (BBV) among PWID spread via unsterile injection equipment sharing and to combat this, many countries have introduced needle and syringe exchange programmes (NEP), though not without controversy. Sweden’s long, complicated harm reduction policy transition has been deviant compared to the Nordic countries. After launch in 1986, no NEP were started in Sweden for 23 years, the reasons for which are analysed in this study.

Methods:

Policy documents, grey literature and research mainly published in 2000–2017 were collected and analysed using a hierarchical framework, to understand how continuous build-up of evidence, decisions and key events, over time influenced NEP development.

Results:

Sweden’s first NEP opened in a repressive-control drug policy era with a drug-free society goal. Despite high prevalence of BBV among PWID with recurring outbreaks, growing research and key-actor support including a NEP law, no NEP were launched. Political disagreements, fluctuating actor-coalitions, questioning of research, and a municipality veto against NEP, played critical roles. With an individual-centred perspective being brought into the drug policy domain, the manifestation of a dual drug and health policy track, a revised NEP law in 2017 and removal of the veto, Sweden would see fast expansion of new NEP.

Conclusions:

Lessons from the Swedish case could provide valuable insight for countries about to scale-up harm reduction services including how to circumvent costly time- and resource-intensive obstacles and processes involving ideological and individual moral dimensions.

中文翻译：

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瑞典 30 年关于针具交换计划的政治争议是否有助于扩大世界范围内的减害服务？

目标：

为到 2030 年结束全球肝炎和艾滋病流行，鼓励各国扩大减低危害服务并针对注射吸毒者（PWID）。PWID 中的血源性病毒 (BBV) 通过未经消毒的注射设备共享传播，为了对抗这种情况，许多国家推出了针头和注射器交换计划 (NEP)，尽管并非没有争议。与北欧国家相比，瑞典漫长而复杂的减害政策过渡已经偏离了方向。自 1986 年推出后，瑞典连续 23 年没有启动 NEP，本研究分析了其原因。

方法：

使用分层框架收集和分析主要在 2000-2017 年发表的政策文件、灰色文献和研究，以了解证据、决策和关键事件的持续积累如何随着时间的推移影响 NEP 的发展。

结果：

瑞典的第一个 NEP 在以无毒品社会为目标的压制性毒品政策时代开启。尽管 PWID 中 BBV 的流行率很高，并且反复爆发、不断增长的研究和包括 NEP 法在内的主要参与者支持，但没有推出 NEP。政治分歧、行动者联盟的波动、对研究的质疑以及市政当局对 NEP 的否决权，都发挥了关键作用。随着以个人为中心的视角被带入毒品政策领域，双重毒品和健康政策轨道的表现，2017 年修订的 NEP 法律以及否决权的取消，瑞典将看到新的 NEP 快速扩张。

结论：

瑞典案例的教训可以为即将扩大减害服务的国家提供宝贵的见解，包括如何规避代价高昂的时间和资源密集型障碍以及涉及意识形态和个人道德层面的过程。