Shifts in Opioid Substitution Treatment Policy in Denmark from 2000–2011

Abstract

This article discusses how opioid substitution treatment policy has developed from 2000 to 2011 in Denmark. Empirically, it takes its point of departure in a stakeholder analysis including 17 qualitative interviews with stakeholders who have played important roles in this field. Analytically, it is inspired by Kingdon's concepts of agenda and policy window. Three major shifts are identified: a shift from psychosocial to medical thinking and practice, from an abstinence driven ideology to health care, and from perceptions of passive clients to user involvement. These shifts are discussed in relation to the legal context of substitute prescribing medicine.

Keywords :

• agendas
• policy window
• stakeholders
• evidence-based treatment
• problematic drug use

THE AUTHORS

Vibeke Asmussen Frank, PhD, Anthropologist, is the Director of Centre for Alcohol and Drug Research, School of Business and Social Sciences, Aarhus University, Denmark, and an Associate Professor in social science drug and alcohol research. Her research activities are mainly based on qualitative research. She is involved in the management and conduction of several research projects. Current projects focus on prison-based drug user treatment, domestic cannabis cultivation, and implementation of drug policies in welfare institutions, including both control and welfare policies. She has published various articles on substitution treatment in Denmark.

Bagga Bjerge, PhD, is an Assistant Professor at the Centre for Alcohol and Drug Research, School of Business and Social Sciences, Aarhus University, Denmark. She is trained within anthropology and sociology. Her research activities are mainly based on qualitative methods. She is in involved in studies of policy processes in the Danish drug and alcohol field. Furthermore, she is involved in EU-based projects focusing on anthropological perspectives on drugs as well as stakeholders in the drug and alcohol intervention field.

Esben Houborg, PhD, Sociologist, is an Associate Professor at the Centre for Alcohol and Drug Research, School of Business and Social Sciences, Aarhus University, Denmark. His main areas of research are drug policy in a historical and contemporary perspective, criminological research particularly concerning law enforcement, and the relationship between science and politics in policy making and policy implementation.

Ethical statement: The research has been carried out using the prescribed ethical guidelines at the Center for Alcohol and Drug Research (CRF), School of Business and Social Sciences, Aarhus University, Denmark.

Notes

1 Although Kingdon uses the term “closely,” we use the concept of agenda more broadly because some of our stakeholders cannot be characterized as closely related to governmental officials, but nevertheless, they are important for understanding shifts in Danish drug policy.

2 There are uncertainties connected with these numbers because they depend on the definitions of what a drug user is and what kind of methods and data are used as the basis for the estimation. However, the estimation is based on a capture–recapture model and is based on information from two registers, The National Hospital Discharge Register and the National Register on Drug Users in Treatment, respectively. Both registers are kept by the National Board of Health.

3 Because the way of monitoring and the data used differs before and after 2008, the numbers from 1985 and 2001 are not directly comparable with the numbers in 2011 (Sundhedsstyrelsen, 2011, p. 40). However, a considerable rise in numbers can be seen especially from 1985 to 2011.

4 Empowerment is a very broad concept, which covers numerous perspectives on and methods for social work (Adams, 1996; Sharma, 2008; Ward & Mullender, 1991). It can refer to social movements’ fight for influence and participant democracy (Cruikshank, 1999; Graham, 2004), patient's or client's organizations’ demands for influence on health and social services (Ward & Mullender, 1991), or a way to enable individual clients to gain more control over their life circumstances (Houborg & Bjerge, 2011; Valenta & Berg, 2010). On the Danish policy agenda, empowerment primarily refers to the latter definition.

5 Also, this tendency corresponds with national (as well as international) developments in welfare and health services. For further discussion see Bjerge (2009); du Gay (2001); Greve (2002); Hood (1991); Houborg & Bjerge (2011); Shore & Wright (2000).

6 Something that in itself often as a built-in medical perspective, as the conception of “evidence” in such discourses are often modeled over how clinical evidence is produced (Houborg, 2012; Valentine, 2009).