The infected question of sterile needles: A qualitative study of policy change regarding the needle exchange program of Gothenburg, Sweden

Abstract

The first needle exchange programs in Sweden started up in Lund in 1986 and Malmoe in 1987. It would take 27 years before Stockholm’s first official needle exchange opened in 2013 and another five years before Gothenburg followed their example in 2018. How can this delay of over three decades be understood and what were the events leading to this policy change?

I have been analyzing political documents concerning the question of needle exchange in Gothenburg as well as interviewing relevant decisionmakers, civil servants and health care staff about the process. I have made a thematic analysis of the data and interpreted the result through the framework of Walts and Gilson’s policy analysis triangle.

The findings suggest that the needle exchange of Gothenburg was delayed due to a strong opposition from a majority of the local decision makers, against harm reduction of all kinds. The opposition is based in the idea that harm reduction is incompatible with Swedish drug politics and the vision of a drug free society. The policy change was made possible because a change in the law on needle exchange that removed the municipal veto in the question and shifted the responsibility to the politicians in charge of health care issues. The changing of the law was proceeded by a number of changes in the Swedish government in combination with international critique concerning the lack of needle exchanges among other harm reducing efforts. With the example of the Gothenburg needle exchange, this thesis attempts to describe a potentially radical change in the Swedish approach to harm reduction.