Urban drug scenes as risk environments - how do the police and social welfare institutions intervene and how are problem drug users affected?
Persons who frequently use or inject illegal drugs constitute a vulnerable group in society. They experience significant problems related to physical and psychological health and to their social and financial situations. Moreover, the group has a high mortality rate. In most large cities in Europe there are public spaces where drugs are sold and used openly. Such open drug scenes are associated with criminality and violence and are often seen as nuisances by the public. However, open drug scenes can also be viewed as potential arenas for prevention efforts and harm reduction measures from social welfare institutions, since they constitute social spaces for people who use drugs.
This project is collaborative and builds upon ethnographic research conducted in Denmark and Norway about local responses to open drug scenes in relation to the need to balance public health and public order. Equivalent research in Sweden is lacking. We will use ethnographic methods to study everyday lives, social marginalization, vulnerability and health-related risks of problem drug users who frequent urban drug scenes in Malmö. We will also consider how local police and social welfare services intervene in drug scenes. The project will use the three cases of Malmö, Copenhagen and Bergen to develop a theoretical framework for understanding how drug scenes are targeted within social welfare settings and the consequences diverging policy approaches have for problem drug users.
Final report
Final report of the project Urban drug scenes as risk environments
The project’s purpose and development:
The main purpose of the project has been to study everyday life, social exclusion, vulnerability, and health risks for people with problematic drug use who visit drug scenes in Malmö. We have also studied the local interventions from the police, social services, and healthcare in these arenas. A further aim has been to use Malmö and Copenhagen as two cases, with the aim of developing knowledge about how drug scenes are handled within social welfare states and comparing the consequences of local drug policies for people who use drugs.
The Covid-19 situation initially meant that we had to wait with the planned ethnographic fieldwork and conduct interviews via telephone or zoom instead of face-to-face. Due to the pandemic we chose to carry out a study with social workers about their views on drug users risks and access to interventions and how Covid-19 affected social work with people who use drugs. With some extension of the project due to Covid-19, we have been able to implement all planned parts of the project. The project has led to several scientific articles and popular science texts. The very extensive empirical data (see below) means that we still have ongoing articles within some sub-studies.
Brief about the implementation:
We have collected a broad and very rich data material that sheds light on various aspects of the drug situation and drug scenes in Malmö, as well as on various interventions around drug problems. In total, we have conducted more than 70 qualitative interviews with professionals and a web survey with over 200 social workers. We have conducted over 280 interviews (both qualitative interviews and structured interviews) with people with drug problems and have also conducted a small ethnographic fieldwork study in Malmö.
The project has been carried out in the form of several sub-studies:
The police’s work against narcotics has been studied through interviews with 19 police officers in Malmö. The sub-study has resulted in one published article and one article manuscript.
The role of unaccompanied minors in Malmö’s drug scene has been studied through interviews with 11 unaccompanied minors in Malmö as well as interviews with 12 professionals/volunteers who meet this group. The sub-study has resulted in one submitted scientific article. A further article is planned.
Social work with addiction has been studied through a survey study with social workers in Malmö (81), Gothenburg (82) and Gävleborg (47), qualitative interviews with 14 deacons in Scania, 3 focus groups with social workers and qualitative interviews with 22 social workers in Malmö. The sub-study has resulted in two published articles on social work with addiction during Covid-19, one published article on diaconal work with addiction, one submitted article on social workers’ attitudes to harm reduction interventions for people with drug problems, and one submitted article that introduces the concept of Harm Reduction Social Work with people who use drugs.
LARO (substitution treatment for opioid addiction) as a risk and enabling environment has been studied through interviews with 32 patients and 15 staff. The sub-study has resulted in one article manuscript.
Everyday life and risks for drug users in Malmö and Copenhagen have been studied through structured interviews with 231 drug users in Malmö and 243 drug users in Copenhagen (conducted by Danish researchers) as well as through ethnographic fieldwork and interviews with 27 drug users in Malmö. The sub-study has resulted in two article manuscripts.
In addition to the various sub-studies, we have organized a research circle with professionals that has run throughout the project, organized a study trip to Vancouver with visits to various services and knowledge exchange with a number of researchers. As a conclusion to the project, we organized a conference in Malmö where we invited researchers, drug users and professionals. The conference was attended by over 200 participants. We have also participated in several national and international conferences (see publication list for international conferences).
The project’s three most important results, as well as a reasoning about the project’s conclusions:
A first central result from the project deals with the vulnerability of drug users in urban drug scenes and how this is related to the drug policy and interventions in the area. This became particularly clear in a sub-study that compared drug users’ everyday life, vulnerability and access to care and treatment in Malmö and Copenhagen. The drug users in Malmö experienced a greater fear of and vulnerability related to the police, described poorer access to certain harm reduction efforts and used drugs in more hazardous places compared to drug users in Copenhagen. These differences were clearly linked to the countries’ different drug policies and police efforts. Certain groups of drug users proved to be particularly vulnerable on Malmö’s drug scenes. This applied, for example, to women - who were largely concerned about stigmatization and sexual violence - as well as unaccompanied minors - who experienced poor mental health, great social vulnerability, and little opportunity for help. Interventions such as syringe exchange programs and substitution treatment were important for many drug users in Malmö. At the same time, substitution treatment was described as both a protective environment (access to a safe medication, reduced crime and stress) and as a risk environment (“locked in effects”, dependency on the medication, difficulties in completely leaving the drug scene).
A second central result concerns the importance of social work with addiction. The majority of drug users in our studies had contacts with social services. Based on one of our sub-studies, there seem to be large variations in social workers’ attitudes towards harm reduction in different regions of Sweden. This can affect access to interventions for people with drug addiction and mean unequal access to care and treatment.
In another study, we introduce the concept of Harm Reduction Social Work, to show how social work with addiction can have a primary focus on lowering thresholds for care, reducing risks and harm, while at the same time embracing a holistic perspective also focusing on motivational work and rehabilitation.
In two additional studies, we could see that social workers, not least in low-threshold services, can be decisive in crises such as the Covid-19 pandemic. Some social workers and services became the "last outpost" for marginalized drug users when other services closed down or completely switched to digital meetings. In other cases, social workers acted as "digital bridges" to other welfare workers, especially for older drug users and other people with limited digital capital.
In a further study, we show how deacons performed important social work for people with drug problems. Their freer role compared to the more bureaucratic and structured roles of social workers within authorities, meant that they became an important complement to publicly funded social work.
A third key result concerns the police’s work against drugs on open drug scenes. An interview study with police officers in Malmö showed that they generally had a positive view of harm reduction efforts such as substitution treatment, syringe exchange and naloxone programs. They refrained from prosecuting drug users in connection with important harm reduction efforts and generally saw no point in arresting marginalized drug users for minor drug offenses. The police focused on public order, drug sales and on prosecuting and referring young drug users to social services rather than arresting "already known or heavy addicts". This result differs from previous descriptions of the police’s work against drugs in Sweden, and points to a possible shift in the police’s approach to drug problems.
Possibly new research questions:
• Older drug users were singled out by many professionals as a growing group in great need of help. This led us to initiate a new research project on elderly people with addiction funded by Forte.
• The project has demonstrated the importance and potential of comparative studies, both national and international. More comparative studies can provide important knowledge about the strengths and weaknesses of different drug policy models and their applications.
• The sub-study on Covid-19 has pointed to the importance of further research on vulnerable groups in crises and on the effects of digitization in social work and healthcare.
How the project group has disseminated the research and results, and if and how collaboration took place:
The project has built on collaboration with Aarhus University, mainly with associate professor Esben Houborg, and involved close collaboration with German researcher Anke Stallwitz, who was employed in the project. These contacts continue after the project and include collaborations around research and teaching. A collaboration with Juliana Holeksa (doctoral student in social work at Malmö University), who previously worked with research and outreach work for drug users in Canada, made it possible to organize a study trip to Vancouver. This visit involved networking and knowledge exchange with several Canadian researchers as well as drug users.
The research results have been disseminated through scientific articles in international journals with peer review (4 published, 3 under review and a several in progress), popular science texts (5), presentations at conferences (7 national, 7 international), lectures for university students (4), lectures for social services (2), a final project conference for researchers and practitioners (over 200 participants), a research circle for practitioners (10 meetings), a study trip to Vancouver, and through participation in media (10).
The project’s purpose and development:
The main purpose of the project has been to study everyday life, social exclusion, vulnerability, and health risks for people with problematic drug use who visit drug scenes in Malmö. We have also studied the local interventions from the police, social services, and healthcare in these arenas. A further aim has been to use Malmö and Copenhagen as two cases, with the aim of developing knowledge about how drug scenes are handled within social welfare states and comparing the consequences of local drug policies for people who use drugs.
The Covid-19 situation initially meant that we had to wait with the planned ethnographic fieldwork and conduct interviews via telephone or zoom instead of face-to-face. Due to the pandemic we chose to carry out a study with social workers about their views on drug users risks and access to interventions and how Covid-19 affected social work with people who use drugs. With some extension of the project due to Covid-19, we have been able to implement all planned parts of the project. The project has led to several scientific articles and popular science texts. The very extensive empirical data (see below) means that we still have ongoing articles within some sub-studies.
Brief about the implementation:
We have collected a broad and very rich data material that sheds light on various aspects of the drug situation and drug scenes in Malmö, as well as on various interventions around drug problems. In total, we have conducted more than 70 qualitative interviews with professionals and a web survey with over 200 social workers. We have conducted over 280 interviews (both qualitative interviews and structured interviews) with people with drug problems and have also conducted a small ethnographic fieldwork study in Malmö.
The project has been carried out in the form of several sub-studies:
The police’s work against narcotics has been studied through interviews with 19 police officers in Malmö. The sub-study has resulted in one published article and one article manuscript.
The role of unaccompanied minors in Malmö’s drug scene has been studied through interviews with 11 unaccompanied minors in Malmö as well as interviews with 12 professionals/volunteers who meet this group. The sub-study has resulted in one submitted scientific article. A further article is planned.
Social work with addiction has been studied through a survey study with social workers in Malmö (81), Gothenburg (82) and Gävleborg (47), qualitative interviews with 14 deacons in Scania, 3 focus groups with social workers and qualitative interviews with 22 social workers in Malmö. The sub-study has resulted in two published articles on social work with addiction during Covid-19, one published article on diaconal work with addiction, one submitted article on social workers’ attitudes to harm reduction interventions for people with drug problems, and one submitted article that introduces the concept of Harm Reduction Social Work with people who use drugs.
LARO (substitution treatment for opioid addiction) as a risk and enabling environment has been studied through interviews with 32 patients and 15 staff. The sub-study has resulted in one article manuscript.
Everyday life and risks for drug users in Malmö and Copenhagen have been studied through structured interviews with 231 drug users in Malmö and 243 drug users in Copenhagen (conducted by Danish researchers) as well as through ethnographic fieldwork and interviews with 27 drug users in Malmö. The sub-study has resulted in two article manuscripts.
In addition to the various sub-studies, we have organized a research circle with professionals that has run throughout the project, organized a study trip to Vancouver with visits to various services and knowledge exchange with a number of researchers. As a conclusion to the project, we organized a conference in Malmö where we invited researchers, drug users and professionals. The conference was attended by over 200 participants. We have also participated in several national and international conferences (see publication list for international conferences).
The project’s three most important results, as well as a reasoning about the project’s conclusions:
A first central result from the project deals with the vulnerability of drug users in urban drug scenes and how this is related to the drug policy and interventions in the area. This became particularly clear in a sub-study that compared drug users’ everyday life, vulnerability and access to care and treatment in Malmö and Copenhagen. The drug users in Malmö experienced a greater fear of and vulnerability related to the police, described poorer access to certain harm reduction efforts and used drugs in more hazardous places compared to drug users in Copenhagen. These differences were clearly linked to the countries’ different drug policies and police efforts. Certain groups of drug users proved to be particularly vulnerable on Malmö’s drug scenes. This applied, for example, to women - who were largely concerned about stigmatization and sexual violence - as well as unaccompanied minors - who experienced poor mental health, great social vulnerability, and little opportunity for help. Interventions such as syringe exchange programs and substitution treatment were important for many drug users in Malmö. At the same time, substitution treatment was described as both a protective environment (access to a safe medication, reduced crime and stress) and as a risk environment (“locked in effects”, dependency on the medication, difficulties in completely leaving the drug scene).
A second central result concerns the importance of social work with addiction. The majority of drug users in our studies had contacts with social services. Based on one of our sub-studies, there seem to be large variations in social workers’ attitudes towards harm reduction in different regions of Sweden. This can affect access to interventions for people with drug addiction and mean unequal access to care and treatment.
In another study, we introduce the concept of Harm Reduction Social Work, to show how social work with addiction can have a primary focus on lowering thresholds for care, reducing risks and harm, while at the same time embracing a holistic perspective also focusing on motivational work and rehabilitation.
In two additional studies, we could see that social workers, not least in low-threshold services, can be decisive in crises such as the Covid-19 pandemic. Some social workers and services became the "last outpost" for marginalized drug users when other services closed down or completely switched to digital meetings. In other cases, social workers acted as "digital bridges" to other welfare workers, especially for older drug users and other people with limited digital capital.
In a further study, we show how deacons performed important social work for people with drug problems. Their freer role compared to the more bureaucratic and structured roles of social workers within authorities, meant that they became an important complement to publicly funded social work.
A third key result concerns the police’s work against drugs on open drug scenes. An interview study with police officers in Malmö showed that they generally had a positive view of harm reduction efforts such as substitution treatment, syringe exchange and naloxone programs. They refrained from prosecuting drug users in connection with important harm reduction efforts and generally saw no point in arresting marginalized drug users for minor drug offenses. The police focused on public order, drug sales and on prosecuting and referring young drug users to social services rather than arresting "already known or heavy addicts". This result differs from previous descriptions of the police’s work against drugs in Sweden, and points to a possible shift in the police’s approach to drug problems.
Possibly new research questions:
• Older drug users were singled out by many professionals as a growing group in great need of help. This led us to initiate a new research project on elderly people with addiction funded by Forte.
• The project has demonstrated the importance and potential of comparative studies, both national and international. More comparative studies can provide important knowledge about the strengths and weaknesses of different drug policy models and their applications.
• The sub-study on Covid-19 has pointed to the importance of further research on vulnerable groups in crises and on the effects of digitization in social work and healthcare.
How the project group has disseminated the research and results, and if and how collaboration took place:
The project has built on collaboration with Aarhus University, mainly with associate professor Esben Houborg, and involved close collaboration with German researcher Anke Stallwitz, who was employed in the project. These contacts continue after the project and include collaborations around research and teaching. A collaboration with Juliana Holeksa (doctoral student in social work at Malmö University), who previously worked with research and outreach work for drug users in Canada, made it possible to organize a study trip to Vancouver. This visit involved networking and knowledge exchange with several Canadian researchers as well as drug users.
The research results have been disseminated through scientific articles in international journals with peer review (4 published, 3 under review and a several in progress), popular science texts (5), presentations at conferences (7 national, 7 international), lectures for university students (4), lectures for social services (2), a final project conference for researchers and practitioners (over 200 participants), a research circle for practitioners (10 meetings), a study trip to Vancouver, and through participation in media (10).