Deep moral divides

At the heart of Sweden’s drug policy debate lies a longstanding ideological divide. Lerkkanen identifies two dominant camps: supporters and critics of the country’s restrictive approach, historically centered on the goal of a “drug-free society.” These positions are not merely technical disagreements. They are rooted in fundamentally different moral frameworks about drug use, reflecting different understandings of public health priorities.

“Importantly, disagreement was not just between stakeholder groups – but also within them. This ´ingroup dissonance´, where stakeholders hold conflicting views internally, may help explain why Swedish drug policy has remained at a standstill,” Lerkkanen says.

Sweden’s long-standing drug policy goal – “a drug-free society” – has recently been challenged by proposals to shift toward harm reduction – “a society with reduced harm from drugs”. In the analysis of this proposal and stakeholders’ reactions, Lerkkanen’s thesis identifies three stakeholder camps: progressive actors pushing for reform based on equity and social justice; conservative actors defending the current goal on utilitarian public health grounds; and a middle group proposing alternative revisions. Yet the research also points to a gradual shift.

Stakeholders across the spectrum increasingly express support for certain harm reduction measures – such as needle exchange programs – while simultaneously endorsing strict penalties for drug-related offenses.

This creates what Lerkkanen describes as a “fracturing” of traditional positions: a more complex policy environment where seemingly contradictory views coexist.

A mix of direct and indirect strategies

Lerkkanen´s findings show that nearly all stakeholders employ a mix of strategies to exert influence. These range from formal participation in consultations and government inquiries to informal approaches such as networking, media engagement, and public opinion shaping. However, access to these channels varies widely.

Results also show that although government commissions are widely respected, stakeholders expressed frustration that their recommendations are often not implemented. This gap between inquiry and action points to structural limits in how policy evolves.

Lerkkanen´s research highlights a key imbalance: resources often determine influence. Actors and organizations with financial means, institutional backing, and access to decision-makers are better positioned to shape outcomes, regardless of how strongly other groups are affected by the policies.

While many believe they have opportunities to influence drug policymaking, there is broad agreement that especially people who use drugs and their families, cannot get their voices heard. Lerkkanen highlights the need to strengthen their inclusion in policymaking processes, arguing that broader participation could lead to more equitable outcomes, supporting the wellbeing of these groups.

“Some of the most recent government inquiries have included representatives of these groups in expert panels, and several stakeholders I interviewed viewed this as a positive development,” Lerkkanen says.

Harm reduction gains ground – alongside tougher penalties

One of the dissertation’s key contributions concerns exploring how Sweden can simultaneously move toward greater acceptance of harm reduction while maintaining, and in some cases intensifying, punitive measures.

The analysis shows that two major issues – drug-related deaths and organized crime – have driven recent drug policy discussions. Despite broad support, efforts to evaluate effects of criminalization of drug use are being held back, while growing concerns about criminal networks have translated into stricter penalties.

Lerkkanen attributes this dual development to the interaction between stakeholders’ evolving values and the broader political and cultural context, where strong support for restrictive policy still dominates.

“Rather than a simple policy shift, the findings suggest a layering effect: new public health approaches are added onto an existing punitive framework, rather than replacing it,” Lerkkanen says. “Harm reduction is acknowledged but remains secondary to control-oriented approaches, which makes it impossible to further develop harm reduction in Sweden, for example, when it comes to experimenting with safe consumption sites.”

Rethinking drug policy as public health policy

By applying the “health policy triangle” framework, Lerkkanen’s work connects actors, processes, and outcomes, offering a more integrated understanding of drug policy as a form of public health governance. The thesis sheds light on different ways of understanding public health.

“This work raises questions like ‘What does a public health approach mean in practice for Swedish drug policy?’, and ‘Is it possible to simultaneously prioritize general prevention and harm reduction among people who already use drugs?’ This thesis suggests how to strengthen a public health approach over a control policy approach“, Lerkkanen says.

As debates over drug use, harm reduction, and criminalization of personal drug use continue in Sweden and beyond, the dissertation provides timely insights into how policy evolves – and why change can be both slow and contradictory.

As countries worldwide grapple with drug-related harms, the Swedish case offers a revealing example. Even in evidence-driven policy environments, who is in control of policymaking – and which values prevail – can ultimately determine the direction of reform.

Håkan Soold