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  • 1.
    Andersson, Lisa
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Håkansson, Anders
    Lund University.
    Berge, Jonas
    Lund University.
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Changes in opioid-related deaths following increased access to opioid substitution treatment2021In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 16, no 1, article id 15Article in journal (Refereed)
    Abstract [en]

    Background Opioid-related mortality is high and increasing in the Western world, and interventions aimed at reducing opioid-related deaths represent an important area of study. In Skane County, Sweden, a patient choice reform resulted in increased access to opioid substitution treatment (OST). In addition, a gradual shift towards less restrictive terms for exclusion from OST has been implemented. The aim of this study was to assess the impact of these policy changes on opioid-related deaths. Methods Detailed data on opioid-related deaths in Skane during the 2 years prior to and following the policy change were obtained from forensic records and from health care services. Data on overdose deaths for Skane and the rest of Sweden were obtained using publicly available national register data. Time periods were used as the predictor for opioid-related deaths in the forensic data. The national level data were used in a natural experiment design in which rates of overdose deaths were compared between Skane and the rest of Sweden before and after the intervention. Results There was no significant difference in the number of deaths in Skane between the data collection periods (RR: 1.18 95% CI:0.89-1.57, p= 0.251). The proportion of deaths among patients enrolled in OST increased between the two periods (2.61, 1.12-6.10, p= 0.026). There was no change in deaths related to methadone or buprenorphine in relation to deaths due to the other opioids included in the study (0.92, 0.51-1.63, p= 0.764). An analysis of national mortality data showed an annual relative decrease in unintentional drug deaths in Skane compared to the rest of Sweden following the onset of the reform (0.90, 0.84-0,97, p= 0.004). Conclusions Opioid-related deaths, as assessed using forensic data, has not changed significantly in Skane following a change to lower-threshold OST. By contrast, national level data indicate that the policy change has been associated with decreased overdose deaths. The discrepancy between these results highlights the need for more research to elucidate this issue. The result that more patients die during ongoing OST following an increase in access to treatment underlines the need for further preventive interventions within the OST treatment setting.

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  • 2.
    Andersson, Lisa
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Håkansson, Anders
    Krantz, Peter
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Investigating opioid-related fatalities in southern Sweden: contact with care-providing authorities and comparison of substances2020In: Harm Reduction Journal, E-ISSN 1477-7517, Vol. 17, no 1, article id 5Article in journal (Refereed)
    Abstract [en]

    Background Opioid-related deaths have increased in Western countries over recent decades. Despite numerous studies investigating opioid-related mortality, only a few have focused on the lives of the deceased individuals prior to their deaths, specifically regarding contact with care-providing authorities such as health, social and correctional services. Furthermore, a change has been noted in the last two decades as to which opioids cause most deaths, from heroin to prescription opioids. However, studies comparing fatalities caused by different substances are rare. The aim of this study was to investigate contact with care-providing authorities during the year prior to death among individuals who died as a result of opioid intoxication and to analyse differences relating to which opioids caused their deaths. Methods The study is based on retrospective register data and includes 180 individuals with a history of illicit drug use, who died from opioid intoxication in Skane, Sweden, between 1 January 2012 to 31 December 2013 and 1 July 2014 to 30 June 2016. Intoxications caused by heroin, methadone, buprenorphine and fentanyl were included. Data were collected from the National Board of Forensic Medicine, regional health care services, municipal social services and the Prison and Probation Service. Statistical testing was performed using Pearson's chi-square test, Fisher's exact test and the Mann-Whitney U test to analyse group differences. Results A total of 89% of the deceased individuals had been in contact with one or more of the care-providing authorities during the year prior to death; 75% had been in contact with health care, 69% with the social services, 28% with the Prison and Probation Service, and 23% had been enrolled in opioid substitution treatment at some point during their final year of life. Few differences appeared between the substance groups with regard to which opioid contributed to the death. In addition to opioids, sedatives were present in more than 80% of the cases. Individuals whose deaths were buprenorphine-related had been in contact with the social services to a significantly lesser extent during the year prior to death. Conclusions The studied population is characterised by extensive contact with care-providing authorities, thus providing numerous opportunities for authorities to reach this group with preventive and other interventions. Few differences emerged between groups with regard to which opioid had contributed to the death.

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  • 3.
    Andersson, Lisa
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Dödlig överdos skedde ofta utan person nära som kunde ingripa: Kunskap om närvaron av vittnen är betydelsefull för hur naloxonprogram bör utformas2022In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 119, no 4-5, article id 21121Article in journal (Refereed)
    Abstract [en]

    Fatal opioid overdoses usually occur without anyone being present and able to intervene. Knowledge of the presence of witnesses is important for how naloxone programs should be designedDrug mortality has increased in Sweden during the 2000s. The vast majority of deaths are opioid overdoses. The National Board of Health and Welfare recommends that the antidote naloxone and a brief overdose education should be offered to people who are at risk of opioid overdose. A retrospective registry study of 193 forensically examined fatal opioid overdoses in Skåne showed that over 80 percent occurred in private residences, most often the deceased’s own home. Other people were present in just over 40 percent of the 193 deaths, but usually in another room or asleep. In most cases, the witnesses were friends, partners, parents, or other people close to the deceased. Naloxone programs should be expanded to include family members and other persons who are close to opioid users, and who therefore may witness or be present early in case of an overdose.

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  • 4.
    Andersson, Lisa
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Patient choice as a means of empowerment in opioid substitution treatment: a case from Sweden2020In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370, Vol. 27, no 2, p. 105-117Article in journal (Refereed)
    Abstract [en]

    Patient choice of treatment provider was introduced within opioid substitution treatment in the southern Swedish county of Skåne in 2014. Substitution treatment has often been criticised for being strict, rule-based, and driven by an ethos of discipline. This study explores the patients’ views and experiences of patient choice, particularly as a potential means of empowerment. The study is based on semi-structured interviews with 33 patients at six substitution treatment clinics in two cities. Patient choice within substitution treatment has empowered the patients in that many are able to choose their treatment provider and transfer to another provider. The interviewees appreciated the possibility to choose and transfer, and felt that they had gained more influence on their treatment. Experiences of poor staff conduct and the new clinic’s policies and practice on prescribing benzodiazepines were important reasons for choosing and transferring between clinics. In particular, the patients stressed the importance of the possibility to leave a clinic they felt offered substandard treatment, and the psychologically important feeling of knowing that they could transfer to another facility. However, patient choice in addiction treatment is very rare in Sweden, and the demographic structure limits the development of patient choice within substitution treatment.

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  • 5.
    Andersson, Lisa
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Valfrihet och egenmakt: en utvärdering av Region Skånes vårdval för LARO2018Report (Other academic)
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  • 6.
    Andersson, Lisa
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Vårdval LARO: En målorienterad intressentutvärdering2017Report (Other academic)
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  • 7. Englund, Amir
    et al.
    von Kieseritzky, Fredrik
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Eriksson, Anders
    Forskningsetiskt haveri om dödsfall orsakade av cannabis2016In: Dagens Medicin, ISSN 1402-1943, Vol. 16, no 7Article in journal (Other (popular science, discussion, etc.))
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  • 8. Halling, Christina
    et al.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Mediebilden av Försäkringskassan 2003-20122014Book (Other academic)
    Abstract [sv]

    Hur påverkas förtroendet för Försäkringskassan och socialförsäkringarna av massmediernas rapportering? Forskarna Christina Halling och Björn Johnson vid Malmö Högskola har studerat mediebilden av Försäkringskassan under perioden 2003–2012. Studien visar att medierapporteringen om Försäkringskassan är omfattande och att den ökar i samband med viktiga förändringar på socialförsäkringsområdet. Rapporteringen var som störst under åren 2005 och 2007, då många förändringar genomfördes både i socialförsäkringarna och i Försäkringskassans organisation. Mest medieintresse ägnas åt sjukpenningen, som står i fokus i drygt hälften av rapporteringen. Övriga ersättningsslag fokuseras i mer begränsad omfattning. Rapporteringens vanligaste ämnen är tillämpningen av regelverket och graden av försäkringsutnyttjande, men även regelverket utformning, Försäkringskassans förmåga att fullgöra sitt uppdrag samt Försäkringskassans relation till andra offentliga aktörer tas ofta upp i rapporteringen. Grundtonen är rapporteringen är genomgående negativ. Medierna fokuserar nästan uteslutande på de delar av Försäkringskassans verksamhet som anses fungera dåligt. Den vanligaste kritiken handlar om tillämpningen av regelverket och om Försäkringskassans kompetensnivå, effektivitet och tillförlitlighet. Christina Halling och Björn Johnson menar att den mediebild som utkristalliseras är både negativ och otydlig. Det är ofta svårt som mediakonsument att avgöra i vilken utsträckning bilden stämmer överens med verkligheten och var ansvaret ligger.

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  • 9.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS).
    After the Storm. Developments in Maintenance Treatment Policy and Practice in Sweden 1987–20062007In: On the Margins. Nordic alcohol and drug treatment 1885–2007 / [ed] Johan Edman, Kerstin Stenius, Nordic Centre for Alcohol and Drug Research , 2007, p. 259-287Chapter in book (Other academic)
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  • 10.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS).
    Beroendesjukvård och socialtjänst i samverkan2011Report (Other academic)
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  • 11.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Dansk narkotikapolitik i svensk press2014In: Svensk och dansk narkotikapolitik / [ed] Fredrik Nilsson, Bengt Svensson, Centrum för Öresundsstudier, Lunds universitet , 2014, p. 14-26Chapter in book (Other academic)
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  • 12.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Farliga förbud2013In: Axess, ISSN 1651-0941, no 1Article in journal (Other (popular science, discussion, etc.))
  • 13.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Fast i det förflutna: Recension av ”Idéerna som tände debatten” av Jan Malmstedt2015In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 32, no 4, p. 443-444Article, book review (Other academic)
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  • 14.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Från arbetsmiljö till överutnyttjande: sjukfrånvaroproblemets transformering2013In: Vägar till välfärd: idéer, inspiratörer, kontroverser, perspektiv / [ed] Hans Swärd, Per-Gunnar Edebalk, Eskil Wadensjö, Liber, 2013, p. 265-284Chapter in book (Other academic)
  • 15.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS).
    Graviditet och läkemedelsassisterad behandling vid opiatberoende2009In: Jordemodern, ISSN 0021-7468, no 7-8Article in journal (Other academic)
  • 16.
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Icke-förskrivet bruk av metadon och buprenorfin samt vidareförmedling av dessa substanser från patienter i substitutionsbehandling: en kunskapsöversikt2019Report (Other academic)
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  • 17.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS).
    Kampen om sjukfrånvaron2010Book (Other academic)
    Abstract [sv]

    Efter att kostnaderna för den svenska sjukförsäkringen skjutit i höjden vann bilden av de sjukskrivna som fuskare och inbillningssjuka mark i början av 2000-talet. Vad som inte kom fram i debatten var att antalet nya sjukskrivna faktiskt inte hade ökat särskilt mycket. Istället var det rehabiliteringsarbetet ute på arbetsplatserna som hade havererat, med allt längre långtidssjukskrivningar som resultat. Björn Johnson, statsvetare och forskare vid Malmö högskola, tecknar i Kampen om sjukfrånvaron ett stycke socialpolitisk nutidshistoria. Han visar hur debatten definierade om sjukfrånvaron från ett arbetsmiljöproblem till att handla om överutnyttjande och fusk. Johnson visar hur ett allt mer polariserat och onyanserat debattklimat ledde politikerna att fatta beslut på bristfälliga och i vissa fall direkt felaktiga grunder. Kampen om sjukfrånvaron riktar sig till alla oss sjukförsäkrade, till politiker, fackligt engagerade, arbetsgivare, sjukskrivna, forskare, studenter, journalister och alla andra som är intresserade av frågor som rör socialförsäkringarna och den svenska välfärdsstatens framtid.

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  • 18.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS).
    Mediebilden av sjukfrånvaron som samhällsproblem. Dagens nyheters bevakning av sjukfrånvarofrågan 1995-20042007Book (Other academic)
  • 19.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS).
    Metadon och buprenorfin: attraktiva på gatan och utanför vården2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 45, p. 2309-2311Article, review/survey (Other academic)
    Abstract [en]

    Over the last ten years, maintenance treatment with methadone or buprenorphine has become an increasingly common form of treatment for Swedish opiate addicts. These medical drugs are effective in treatment, but they are also in demand on the illegal market. Research from countries with well-developed maintenance treatment show that a high proportion of opiate addicts use methadone or buprenorphine outside of treatment programmes. However, according to self-reporting studies of patients in methadone maintenance programmes, less than 10 percent admit to regularly selling or giving away their medication. This paradox may be due to methodological problems. In a new research project, researchers will therefore interview both patients and active drug users about whether or not they have used or sold these medical drugs illegally. A group of patients will be trained to conduct some of the interviews, to see if they receive other answer than the researchers.

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  • 20.
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Nils Bejerot och den svenska narkotikapolitiken2021 (ed. 1)Book (Other academic)
  • 21.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Olofsdotter Stensöta, Helena, 2009. Sjukskrivningarna och välfärdens infriare: En studie av svensk sjukvårdsbyråkrati2013In: Statsvetenskaplig Tidskrift, ISSN 0039-0747, Vol. 115, no 1, p. 98-102Article, book review (Other academic)
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  • 22.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Paternalism råder ännu2013In: Alkohol & Narkotika, ISSN 0345-0732, no 1Article in journal (Other (popular science, discussion, etc.))
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  • 23.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS).
    Risker och sidoeffekter i läkemedelsassisterad rehabilitering av opioidberoende: en forskningsöversikt2010In: Socialvetenskaplig tidskrift, ISSN 1104-1420, E-ISSN 2003-5624, Vol. 17, no 1, p. 46-66Article, review/survey (Other academic)
    Abstract [sv]

    Läkemedelsassisterad rehabilitering (LAR) med metadon eller buprenorfin är idag den vanligaste behandlingsmetoden vid opioidberoende. LAR har starkt forskningsstöd, men är trots detta kontroversiell. Detta hänger bland annat samman med att det finns en rad avigsidor och risker knutna till metoden. I artikeln diskuteras de vanligaste invändningarna mot och riskerna med metoden. De områden som berörs är (1) om LAR kan sägas vara ”ett byte av en drog mot en annan”, (2) risken att LAR kan etablera eller hålla kvar patienterna i ett beroende, (3) om LAR riskerar att konkurrera ut andra (läkemedelsfria) behandlingsmetoder, (4) risken för läckage till den illegala drogmarknaden, (5) risken för grannskapsstörningar i anslutning till behandlingsenheterna samt (6) dödsfall av överdoser i och utanför behandling. En forskningsgenomgång görs med utgångspunkt i medicinsk, beteendevetenskaplig och samhällsvetenskaplig forskning. Sammantaget tyder denna genomgång på att flera av invändningarna är överdrivna. Några risker bör dock tas på stort allvar. Detta gäller framför allt risken för läckage till den illegala drogmarknaden och den därtill kopplade risken för metadon- eller buprenorfinrelaterade dödsfall utanför behandlingsprogrammen. Ett problem i sammanhanget har varit att många av de åtgärder som internationellt har vidtagits för att minska riskerna för läckage och dödsfall varit kontraproduktiva. LAR har blivit föremål för komplicerad och mycket detaljerad reglering när det gäller bland annat intagnings- och uteslutningskriterier, krav på patientnärvaro, dosnivåer, hämtningsrutiner, urinprovtagning, journalföring och behandlingstider. Resultatet har blivit en ”demedikalisering” av behandlingsmetoden som måste bedömas ha orsakat betydande terapeutiska försämringar för patienterna, utan att för den skull lösa de problem de varit avsedda för.

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  • 24.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS).
    Skadereducering på narkotikaområdet2009In: Straffa syndare eller hjälpa människor: skadereducering, det okända alternativet / [ed] Waldemar Ingdahl, Louise Persson, Eudoxa förlag , 2009Chapter in book (Other academic)
  • 25.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS).
    Stoltenbergutvalgets rapport: reflektioner ur ett svenskt perspektiv2011In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 28, no 1, p. 77-78Article in journal (Other academic)
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  • 26.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS).
    Två risker i läkemedelsassisterad behandling: läckage och förgiftningsdödsfall2009In: Narkotikamissbruk: debatt, behandling och begrepp, Studentlitteratur AB, 2009Chapter in book (Other academic)
  • 27.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    User movies as a means of incorporating the knowledge and experience of users in web-based professional education2013In: Social Work Education, ISSN 0261-5479, E-ISSN 1470-1227, Vol. 32, no 4, p. 468-483Article in journal (Refereed)
    Abstract [en]

    Combining video clips with forum discussions is a useful strategy in web-based distance learning. This article documents experiences from a project where specially recorded ‘user movies’ were used as a means of incorporating a user perspective in a web-based course on maintenance treatment of opiate addiction. User movies can help solve two common pedagogical challenges in distance learning. Firstly, the high dropout rate, which to some extent is connected with the fact that distance-learning students tend to feel lonely and isolated. The second challenge concerns the task of combining theory and practice in distance-based professional education. A description of the process of making the user movies, which were produced in cooperation with individual users, is followed by a discussion of some examples of how they were used on the course. The user movie concept was sparked by practices in the field of problem-based learning and other case-based methods. The article concludes with a discussion of the results of the course evaluations. The experiences from the project show that movies and discussions can serve as an effective means of supporting learning processes. The model with user movies has great potential for other types of distance-learning-based professional education.

  • 28.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Vetenskap och beprövad erfarenhet eller ett blött finger i luften?2013In: Med narkotikan som följeslagare: femton texter till Bengt Svensson / [ed] Björn Johnson, Philip Lalander, Malmö högskola, 2013, p. 108-118Chapter in book (Other academic)
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  • 29.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Christiansson, Lena
    Dahlqvist, Tilde
    Kampen om sjukfrånvaron: Tre organisationers konstruktioner av sjukfrånvaron som samhällsproblem2009Report (Other academic)
    Abstract [sv]

    Under de första åren av 2000-talet betraktades ”den galopperande sjukfrånvaron” som en av de absolut viktigaste frågorna i den välfärdspolitiska debatten. En mängd aktörer förde fram olika (och ibland konkurrerande) uppfattningar om problemet, dess orsaker och tänkbara lösningar. Sådana skeenden brukar kallas problemdefinieringsprocesser och har stor betydelse, både för vilka frågor som hamnar på de massmediala och politiska dagordningarna och för utvecklingen av offentliga policies. I rapporten studeras hur tre centrala aktörer i debatten – LO, Svenskt Näringsliv och Sveriges Läkarförbund – definierade sjukfrånvaroproblemet. Resultaten visar att de tre aktörernas olika problemdefinitioner var nära knutna till de politiska och materiella intressen de företräder. Valet av problemdefinition kan till stor del betraktas som en makt- och intressekamp, där aktörerna kämpar om ”äganderätten” till problemet.

  • 30.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Hermansson, Annika
    Överutnyttjandediskursen. En innehålls- och konsekvensanalys av diskursen kring överutnyttjande av sjukförsäkringen2007In: Arbetsliv i omvandling, ISSN 1404-8426, no 9Article in journal (Refereed)
    Abstract [sv]

    Debatten om den höga svenska sjukfrånvaron har under senare år alltmer kommit att kretsa kring överutnyttjande och fusk. Det har etablerats en överutnyttjandediskurs, som bygger på föreställningen om en sjukfrånvaroepidemi i den arbetande befolkningen. I denna skrift görs en närgången och detaljerad analys av överutnyttjandediskursens innehåll och verklighetsbeskrivningar. Mer specifikt intresserar vi oss för hur diskursen byggs upp och legitimeras av två statliga aktörer, Socialförsäkringsutredningen och Försäkringskassan. Skriften ingår som en delstudie i Arbetslivsinstitutets projekt Den svenska sjukfrånvaron – problemdefiniering och policyförändring. Vår analys tar sin utgångspunkt i ett problemdefinieringsperspektiv. I fokus för detta perspektiv står frågan om hur olika samhällsproblem framträder, etableras och institutionaliseras. Själva begreppet problemdefiniering hänsyftar på en social och politisk process där olika individer, grupper eller organisationer framför anspråk med avseende på ett visst samhällsproblem. När den svenska sjukfrånvaron började öka under slutet av 1990-talet uppfattades den till en början främst som ett ohälso- och arbetsmiljöproblem, men inom några år kom denna problemdefinition att utmanas av överutnyttjandedefinitionen. I samband med att sjukfrånvaron under 2000-talet började betraktas som ett av landets allvarligaste samhällsproblem blev överutnyttjandedefinitionen mer och mer förhärskande – diskursen växte fram. I vår analys av överutnyttjandediskursen har vi använt oss av kritisk diskursanalys, en diskursanalytisk tradition som också är en väl utvecklad metod för empiriska studier. Kritisk diskursanalys omfattar de tre analysdimensionerna text (lingvistisk analys av olika egenskaper hos en text), diskursiv praktik (analys av sambandet mellan texten och andra texter och diskurser) samt social praktik analys av de sociala sammanhang som texten och den diskursiva praktiken ingår i). Materialet till analysen hämtas dels från den statliga Socialförsäkringsutredningen – en utredning som hade till uppgift att analysera och bilda opinion kring det svenska sjukförsäkringssystemet – och dels från den informationskampanj som Försäkringskassan lanserade år 2004 i syfte att upplysa medborgarna om vad som gäller vid sjukskrivning. Resultaten av analysen visar att förekomsten av ett omfattande överutnyttjande av sjukförsäkringen är något som tas för givet i de studerade texterna. Sjukskrivning framstår i dessa som något som medvetet väljs av många sjukskrivna. Betydelsen av sjukdom tonas ner och den diskursiva praktiken får karaktären av en diskursiv kamp, som handlar om att söka kringgärda och begränsa sjukdomsbegreppet. Genom att sjukskrivning framställs som ett val skuldbeläggs sådana grupper som är överrepresenterade i sjukfrånvarostatistiken – framför allt arbetslösa, kvinnor och norrlänningar – och därigenom läggs också ansvaret för sjukfrånvaroproblemet på dessa grupper. Faktorer som lyfts fram som förklaringar till den uppkomna situationen handlar bland annat om att läkarna förlorat kontrollen över sjukskrivningarna och om attityd- och värderingsförändringar inom befolkningen. Sjukförsäkringens alltför liberala utformning antas dessutom ha bidragit till att förvärra situationen. Diskurser får ofta påtagliga konsekvenser, såväl för enskilda människor som för samhället i stort. Vår analys avslutas med en diskussion om diskursens observerbara och potentiella konsekvenser för olika sociala praktiker – både på individplanet och inom ramen för sjukförsäkringssystemet. Konsekvenserna rör bland annat möjliga effekter på individers sjukskrivningsbeteende och policyförändringar i form av ett ökat fokus på kontrollåtgärder, men också oönskade och oavsedda effekter, såsom stämpling av sjukskrivna och andra grupper. Överutnyttjandediskursen kan också i förlängningen medföra en avlegitimering och underminering av hela eller delar av socialförsäkringssystemet.

  • 31.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Lalander, PhilipMalmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Med narkotikan som följeslagare: femton texter till Bengt Svensson2013Collection (editor) (Other academic)
    Abstract [sv]

    Sedan tidigt nittiotal har Bengt Svensson varit en högaktiv forskare i socialt arbete. Hans avhandling Pundare, jonkare och andra: Med narkotikan som följeslagare är en modern klassiker inom den etnografiska missbruksforskningen. Respektfullt och med stor noggrannhet förmedlar han en förståelse för en grupp människor som av många bara ses som ”knarkare” eller samhällsproblem. Bengt Svenssons forskning handlar om människor som lever sina liv dag för dag. Myndigheterna möter de som klienter eller patienter, då de behöver hjälp eller blir föremål för tvångsingripanden. Av majoritetssamhället betraktas de ofta som avvikare, irrationella eller kriminella. Men Bengt Svensson ger dem röst, och det de berättar är väl värt att lyssna på. Här finns kärnan i Bengt Svenssons budskap: Lyssna mer på dem det gäller! I denna festskrift till Bengt Svenssons ära medverkar sjutton författare med sammanlagt femton kapitel. Texterna skiljer sig åt vad gäller ämne och anslag, men de är alla skrivna i Bengts anda.

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  • 32.
    Johnson, Björn
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Liahaugen Flensburg, Olivia
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Capusan, Andrea Johansson
    Department of Psychiatry in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Patient perspectives on depot buprenorphine treatment for opioid addiction: a qualitative interview study2022In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 17, no 1, article id 40Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Recently developed buprenorphine depot injections have the potential to reduce risk for diversion and misuse, and to increase adherence with fewer visits for supervised intake. However, it is unclear how patients perceive this new form of medication. The purpose of this study was to explore patients' experiences of depot injections and their reasons for continuing, discontinuing, or declining depot injection treatment.

    METHODS: We conducted semi-structured qualitative interviews with 32 people, 14 of whom had ongoing depot injection treatment, 11 who had discontinued depot-injections and switched to other medication and seven who had declined treatment with depot formulations. Interviews were transcribed, coded, and analysed using NVivo, based on this overall stratification into three participant groups.

    RESULTS: The main categories relate to the effects and side effects of the depot formulation, social and practical factors, psychological benefits and disadvantages, and interactions with treatment staff. Social and practical factors were of importance for choosing depot formulations, such as increased freedom and their making it easier to combine treatment with work and family life, as well as psychological advantages including "feeling normal". Initial withdrawal symptoms that resolved themselves after a number of injections were reported by most participants. Reliable information and patient-staff relationships characterized by trust helped patients to cope with these initial problems. Those who discontinued treatment often did so near the beginning of the treatment, reporting withdrawal symptoms and insufficient effects as the main reasons. Coercion and insufficient information contributed to a negative pharmaceutical atmosphere at one of the clinics, which may have adversely influenced perceptions of depot formulations and decreased willingness to accept and continue treatment.

    CONCLUSIONS: Buprenorphine depot injections may have social, practical, and psychological benefits compared to other formulations. However, depot injections are not perceived as an attractive option by all patients. Trust, consistent and adequate information, and awareness of the implications of the pharmaceutical atmosphere should be considered when introducing new medications.

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  • 33.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    A comparison of privileged access interviewing and traditional interviewing methods when studying drug users in treatment2016In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 24, no 5, p. 406-415Article in journal (Refereed)
    Abstract [en]

    Aims: Privileged access interviewing (PAI) has traditionally been used to reach illicit drug users and other ‘hidden’ populations. How PAI data compare to other self-reported data have seldom been discussed. We compare data from patients in opioid substitution treatment (OST), gathered through PAI and researcher interviews, respectively, to investigate whether PAIs and researchers are reaching comparable populations, and whether differences in answers are due to the sensitive nature of the questions. Methods: Structured interviews were conducted with 368 patients from nine OST clinics in three Swedish cities. 237 interviews were carried out by researchers, and 131 by nine PAIs (OST patients). Data were analyzed with χ2 test, Fisher’s exact test, t-test and logistic regression analysis. Results: PAIs and researchers recruited comparable populations, with few differences in terms of individual, treatment and social factors. However, self-reported behaviors revealed several significant differences. Alcohol consumption and drinking to intoxication was more commonly reported among patients interviewed through PAI (p < 0.001 and p = 0.001, respectively). Furthermore, the PAI group reported selling medication (p < 0.001 last month, p < 0.001 during treatment episode) and snorting buprenorphine (p = 0.010 last month, p = 0.001 during treatment episode) more frequently. Conclusions: PAI is a useful method in studies of illicit drug use and a valuable complement to more traditional interviewing methods. Specifically as regards revelations of a sensitive or controversial nature, PAI seems to produce different results than researcher interviews, and possibly also more truthful responses. PAI may have considerable potential as a data-gathering method also when studying other, more easily accessible populations.

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  • 34.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Diversion of methadone and buprenorphine by patients in opioidsubstitution treatment in Sweden: prevalence estimates and risk factors2014In: International journal of drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 26, no 2, p. 183-190Article in journal (Refereed)
    Abstract [en]

    Background: Diversion—patients who sell or share their medication—is a hotly debated but rela-tively unresearched phenomenon. We have investigated the prevalence of self-reported diversion ofmethadone and buprenorphine at OST programs in Sweden. We have also examined if demographic,treatment, and social factors can be associated with an increased risk of diversion. Methods: Structured interviews were conducted with 411 patients from eleven OST programs. A standard-ized questionnaire with 106 close- and five open-ended questions were used. 280 interviews were doneon site, by the researchers, while 131 interviews were conducted by specially trained patients throughprivileged access interviewing. The data were analyzed through frequency- and averages-calculations,cross-tabulations, and logistic regression analysis. Results: In total, 24.1% (n = 99) of the patients reported diversion in the past month. 67.6% (n = 277) statedthat they had diverted at some point. The peer interviews showed significantly higher levels of diver-sion (37.4% past month) compared with the researcher interviews (17.2%). Neither demographic factors,dosages, nor collection routines were associated with diversion. The likelihood of diversion was higherfor patients on mono-buprenorphine (OR = 5.64) and buprenorphine–naloxone (OR = 2.10), than amongmethadone patients. Other factors which increased the likelihood of diversion were current illicit druguse (OR = 5.60), having had patients as a primary source of illicit methadone or buprenorphine prior totreatment (OR = 3.39), and mainly socializing with active drug users (OR = 2.12). Conclusion: Self-reported diversion was considerably higher than in previous studies. This is most likelydue to the new methodological strategy we used, but may also partly be explained by low availability ofOST in Sweden, leading to a high demand for the substances by heroin users outside treatment. Effortsto decrease diversion should primarily focus on psychosocial and lifestyle-changing interventions, andexpanded access to treatment, rather than on control measures.

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  • 35.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Diversion of methadone and buprenorphine from opioid substitution treatment: a staff perspective2014In: Journal of Psychoactive Drugs, ISSN 0279-1072, E-ISSN 2159-9777, Vol. 46, no 5, p. 427-435Article in journal (Refereed)
    Abstract [en]

    Opioid substitution treatment (OST) is still controversial, despite positive results. The issue of diversion to the illicit drug market is a cornerstone in the criticism typically voiced against the treatment. Little research is available concerning how professionals who work in OST view the issue of diversion. In this article, we discuss existing ideas and attitudes toward diversion of methadone and buprenorphine among OST staff in Sweden. The article is based on semi-structured interviews with 25 professionals working in eight OST-programs in southern Sweden. Diversion was seen as a deleterious phenomenon by the interviewees. Three problematic aspects were highlighted: Medical risks in the form of overdose fatalities and the recruitment of new opiate/opioid users; negative consequences for the legitimacy of OST; and moral objections, since diversion means that the patients remain in a criminal environment. However, positive aspects were also highlighted. Illicit methadone or buprenorphine is perceived as safer than heroin. In this way, diversion can fulfill a positive function; for instance, if there is a shortage of access to regular treatment. Patients who share their medication with opioid-dependent friends are seen as less culpable than those who sell to anyone for money.

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  • 36.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Diversion of Methadone and Buprenorphine from Opioid Substitution Treatment: Patients who Regularly Sell or Share their Medication2015In: Journal of Addictive Diseases, ISSN 1055-0887, E-ISSN 1545-0848, Vol. 34, no 1, p. 1-17Article in journal (Refereed)
    Abstract [en]

    Diversion-patients who sell or share their medication-is a much debated problem of opioid substitution treatment. We study regular diversion by patients at 11 OST programs in the South of Sweden. Using quantitative and qualitative data, we investigate whether those patients differ from other patients, their motives for and means of diversion, and who the recipients are. Regular diverters are a small, yet heterogeneous group. Continued illicit drug use, however, stand out as a common risk factor. Pecuniary need and a desire to help friends are other important motives. The client base mainly consists of people from the regular diverters' own drug milieus.

  • 37.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Diversion of methadone and buprenorphine from opioid substitution treatment: the importance of patients’ attitudes and norms2015In: Journal of Substance Abuse Treatment, ISSN 0740-5472, E-ISSN 1873-6483, Vol. 54, p. 50-55Article in journal (Refereed)
    Abstract [en]

    Aims Methadone and buprenorphine diversion by patients in opioid substitution treatment (OST) is a poorly understood phenomenon. We study the norms and attitudes on diversion among OST patients, including the role these norms and attitudes play as diversion risk factors. We also study whether perceived quality of care, social bonds to treatment staff, and deterrence can be associated with diversion. Methods Structured interviews were conducted with 411 patients from eleven OST programs. In total, 280 interviews were done on site by the researchers, while 131 interviews were conducted through peer interviewing by specially trained patients. The data was analyzed through frequency- and averages-calculations, cross-tabulations, and logistic regression analysis. Results Most patients consider diversion as mostly positive (83.7%), morally right (76.8%), and without any significant risk of detection (66.9%). Individual differences in norms and risk perceptions may play a role in explaining variations in diversion; patients who consider it right to share medication with friends report higher treatment-episode diversion than other patients (OR 1.455, p = 0.016). Patients who perceive control measures as effective report lower diversion than other patients (OR = 0.655, p = 0.013). Furthermore, data indicate that patients who are satisfied with the care and service are less prone to engage in diversion. Social bonds with treatment staff seem to be less importance. Conclusions The norm system described by patients resemble Bourgois’ ‘moral economy of sharing’ concept—not sharing drugs with friends in withdrawal is considered unethical. Efforts to decrease diversion may focus on lifestyle-changing interventions, and reducing black market demand for illicit medications by expanding access to treatment.

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  • 38.
    Johnson, Björn
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Non-prescribed use of methadone and buprenorphine prior to opioid substitution treatment: lifetime prevalence, motives, and drug sources among people with opioid dependence in five Swedish cities2019In: Harm Reduction Journal, E-ISSN 1477-7517, Vol. 16, no 31, article id UNSP 31Article in journal (Refereed)
    Abstract [en]

    Background: Opioid substitution treatment (OST) with methadone or buprenorphine is the most effective means of treating opioid dependence. If these substances are used by people who are not undergoing OST, they can however carry serious risks. This article examines the lifetime prevalence, motives, and drug sources for such use, as well as geographical differences in these variables. Methods: Structured interviews were conducted with 411 patients from 11 OST clinics in five Swedish cities. The researchers carried out 280 interviews on-site, while 131 interviews were conducted by specially trained patients through privileged access interviewing. Data were analyzed by frequency and average calculations, cross-tabulations, and χ2 tests. Results: The lifetime prevalence of non-prescribed use was 87.8% for methadone, 80.5% for buprenorphine, and 50.6% for buprenorphine/naloxone. Pseudo-therapeutic motives—avoiding withdrawal symptoms, staying clean from heroin, detoxification, or taking care of one’s own OST—were commonly cited as driving the use, while using the drugs for euphoric purposes was a less common motive. Most respondents had bought or received the substances from patients in OST, but dealers were also a significant source of non-prescribed methadone and buprenorphine. Geographical differences of use, motives, and sources suggest that prescription practices in OST have a great impact on which substances are used outside of the treatment. Conclusions: Experiences of non-prescribed use of methadone and buprenorphine are extremely common among those in OST in southern Sweden. As the use is typically driven by pseudo-therapeutic motives, increased access to OST might decrease the illicit demand for these substances. Buprenorphine/naloxone has a lower abuse potential than buprenorphine and should therefore be prioritized as the prescribed drug. Supervised dosage and other control measures are important provisions in the prevention of drug diversion and non-prescribed use among people not undergoing OST.

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  • 39.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Svensson, Bengt
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Alkohol- och narkotikaproblem2017Book (Other academic)
    Abstract [sv]

    Över en miljon människor i Sverige har ett riskbruk, missbruk eller beroende av alkohol eller narkotika. Alkohol- och narkotikaproblem berör ofta även anhöriga, vänner och arbetskamrater. För att kunna förstå, förebygga och behandla sådana problem krävs kunskap. I denna grundläggande lärobok presenteras aktuell, forsknings-baserad kunskap på ett pedagogiskt och lättillgängligt sätt. Boken är unik i den bemärkelsen att den tar ett helhetsgrepp på alkohol- och narkotikaområdet. Författarna belyser och problema-tiserar drogernas effekter och skadeverkningar, tar upp hur drog-problem kan förklaras med hjälp av teorier och begrepp från olika vetenskapsområden samt beskriver de sociala och hälso mässiga konsekvenser som problematisk droganvändning kan innebära för den enskilde. Boken innehåller även en gedigen redogörelse för samhällets olika insatser på området – alkohol- och narkotikakontroll, prevention, utredning, vård- och behandling samt skadebegränsning. Ett viktigt inslag i boken är intervjuer med yrkesutövare och en brukarföreträdare, som berättar om sina egna erfarenheter av att arbeta med frågor som rör bruk, missbruk och beroende. Alkohol- och narkotikaproblem vänder sig till personer som studerar till socionom, psykolog, sjuksköterska, läkare, polis eller behandlings-assistent samt till dem som redan arbetar inom något av dessa yrken. Personer som själva har eller har haft drogproblem är också en viktig målgrupp, liksom deras anhöriga. Men boken kan även läsas av personer med ett mer allmänt intresse av alkohol- och narkotikafrågor.

  • 40.
    Johnson, Björn
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Svensson, Bengt
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Parents as victims of property crime committed by their adult children with drug problems: Results from a self-report study2018In: International Review of Victimology, ISSN 0269-7580, E-ISSN 2047-9433, Vol. 24, no 3, p. 329-346Article in journal (Refereed)
    Abstract [en]

    Parents who are subjected to crime by adult children with drug problems have been neglected in victimological research. We have examined how common it is for parents to fall victim to theft and burglary committed by their children and how the risk varies depending on the parents’ and children’s circumstances. A self-report questionnaire on victimisation was distributed to parents of adult children with drug problems (n=687). The data were collected by means of a postal survey sent to members of the Swedish organisation Parents Against Drugs (Föräldraföreningen mot narkotika) (n=411) and through an online questionnaire that was disseminated on social media and among treatment facilities and other support associations for family members (n=276). Half (50.7%) of the parents declared that they had at one point or another been victims of theft or burglary committed by their children. The level was higher among older parents, among those whose children had more severe drug problems and among parents of children with attention deficit hyperactivity disorder. Of the respondents, 9.9% had been exposed to property crime during the past year. The level was higher among parents of children who were currently taking drugs, among parents of younger children and among parents whose children were living at home. Parents of adult children with drug problems run a high risk of being subjected to property crime by their children. The risk appears to be mostly related to the children’s drug problems and certain other circumstances pertaining to the children. Further research is needed on the extent and nature of this type of crime and about risk prevention for the parents.

  • 41.
    Johnson, Björn
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Svensson, Bengt
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Physical Violence and Property Damage towards Parents, Committed by Adult Children with Drug Problems2022In: Journal of family Violence, ISSN 0885-7482, E-ISSN 1573-2851, Vol. 37, p. 165-180Article in journal (Refereed)
    Abstract [en]

    Drug use has previously been identified as a risk factor for child-to-parent abuse. We examine how common it is for parents to be exposed to physical violence and property damage by adult children with drug problems, and whether such victimization varies based on factors related to the parents and the adult children, respectively. A self-report questionnaire on victimization was completed by 687 parents of adult children with drug problems. The data were collected via a postal questionnaire to members of the Parents Against Drugs association and a web-based questionnaire to persons recruited via social media, treatment centers and other associations for families of drug users. The proportion of parents who reported having been exposed to physical violence was 19% ever, 6% during the past year. The proportion who had been exposed to property damage was 40% ever, 10% during the past year. Exposure during the past year was higher among parents whose children were currently experiencing drug problems. Mental health problems in the children were associated with higher levels of parental victimization, particularly in the form of physical violence. Parental victimization was also associated with the children being younger and still living at home. Exposure to property damage was higher among parents of male children. Adult children's drug problems are of significance for parental victimization; they do not however appear to constitute a major risk factor but rather one risk factor among several others. Exposure to physical violence is clearly related to the presence of mental health problems in the children.

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  • 42.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Svensson, Bengt
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Åkesson, Anders
    Reglerna för underhållsbehandling av opiatberoende är godtyckliga och saknar stöd i forskningen2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 8, p. 420-421Article in journal (Other (popular science, discussion, etc.))
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  • 43.
    Johnson, Björn
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Svensson, Robert
    Malmö University, Faculty of Health and Society (HS), Department of Criminology (KR).
    Alcohol drinking among adolescents with native-Swedish and non-European immigrant background: the importance of parental attitudes and peer attitudes for acculturation2021In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370, Vol. 28, no 3, p. 255-266Article in journal (Refereed)
    Abstract [en]

    In this study, we examine differences in alcohol drinking between first- and second-generation non-European immigrant and native-Swedish adolescents. We also examine whether parental and peer attitudes toward alcohol are associated with the acculturation of drinking habits among adolescents with an immigrant background. The study is cross-sectional and based on a school survey conducted in 2016–2019 in eight municipalities in southern Sweden. The sample consists of 3743 adolescents in year 9 of compulsory education, aged 14–15 years, of which 538 (14.4%) had a non-European immigrant background. Non-European immigrant adolescents reported significantly lower levels of drinking than native-Swedish adolescents. Second-generation immigrants reported a higher level of consumption than first-generation immigrants, and among first-generation adolescents, drinking was more prevalent the longer the adolescents had resided in Sweden, which suggests acculturation of drinking habits. This acculturation is mainly related to changes in peer attitudes toward alcohol. Immigrant adolescents with a longer stay in Sweden reported having friends with more positive attitudes toward alcohol. Among first-generation immigrants, drinking was more common among boys than girls. These differences were primarily found among immigrant adolescents with a relatively short period of residence in Sweden, which suggests that acculturation occurs more quickly among boys than among girls.

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  • 44.
    Kapetanovic, Sabina
    et al.
    Department of Social and Behavioural Studies, University West, Trollhättan, Sweden; Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Lisa
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Svensson, Robert
    Malmö University, Faculty of Health and Society (HS), Department of Criminology (KR).
    Johnson, Björn
    School of Social Work, Lund University, Lund, Sweden.
    Validation of the Super-Brief Pathological Narcissism Inventory (SB-PNI) among Swedish adolescents2024In: Current Psychology, ISSN 1046-1310, E-ISSN 1936-4733Article in journal (Refereed)
    Abstract [en]

    This study examines the psychometric structure and properties of the Swedish version of the Super-Brief Pathological Narcissism Inventory (SB-PNI) among adolescents. In order to ensure the validity and feasibility of the measure, we examined the factor structure, measurement invariance across gender, age and ethnicity, and construct validity in relation to a number of correlates of narcissism in adolescence. Data were drawn from a large cross-sectional survey conducted in 35 schools in southern Sweden. The sample consisted of N = 5313 adolescents (Mage = 16.10 SD = 1.55) with 52.2% girls, 45.9% boys and 1.8% adolescents with unspecified gender, from compulsory and upper secondary schools in southern Sweden. The results showed that the measure holds a two-factor structure, suggesting the use of the subscales grandiosity and vulnerability separately, rather than as a unidimensional measure. The correlated factors grandiosity and vulnerability yielded full configural and metric invariance across gender, age, and ethnicity. Both grandiosity and vulnerability were correlated with externalizing and internalizing symptoms, as well as with low self-esteem. The study provides evidence for the utility of the SB-PNI among Swedish adolescents and indicates that the measure can be used across male and female adolescents of different ages and ethnic groups. 

  • 45.
    Liahaugen Flensburg, Olivia
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Nordgren, Johan
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Svensson, Bengt
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    "Something wasn't right"-parents of children with drug problems looking back at how the troubles first began2022In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370, Vol. 29, no 3, p. 255-264Article in journal (Refereed)
    Abstract [en]

    In this study we analyze how parents of adult children with drug use problems view the initial stages of identifying their children's troubles as a severe drug problem. We focus on the parents' accounts of the discovery process by identifying significant events in the parents' narratives through 'the micro-politics of trouble'. The study is based on an analysis of 32 semi-structured interviews with parents of adult children (aged 18+) with drug problems. Four themes emerged from the parents' narratives: (1) the first signs of a problem, (2) drug problem or teenage defiance? (3) the awakening, (4) a passing phase. The different themes show how the parents' interpretations of the situation influence their definitions and thus their actions. Early signs and indicators of something being wrong do not initially result in parents framing the situation as problematic as they are perceived as everyday concerns and dealt with as such. Our focus on the initial phase of the problem definition process and how this affects the parents may provide a better understanding of the parents' situation and needs for support. This may be of use to professionals in the fields of social work and drug treatment who meet these parents and may have a role to play in the development of support measures that can improve their situation.

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  • 46.
    Monwell, Bodil
    et al.
    Department of dependency, Psychiatric Clinic, County Hospital Ryhov, Jönköping, Sweden; Jönköping University, School of Health Sciences, Jönköping, Sweden.
    Bülow, Per
    Jönköping University, School of Health Sciences, Jönköping, Sweden; Psychiatric Clinic, County Hospital Ryhov, Jönköping, Sweden.
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    The pros and cons of supervised urine tests in opioid replacement therapy: A study of patients' experiences2018In: Heroin Addiction and Related Clinical Problems, ISSN 1592-1638, Vol. 20, no 6, p. 5-15Article in journal (Refereed)
    Abstract [en]

    Background: In opioid replacement therapy (ORT), drug testing is performed continuously to ensure that patients are taking their prescribed medication, and to detect whether they have taken other, non-prescribed, substances. Typically, supervised urine testing is conducted, and in Sweden such testing is often an ORT precondition. Aim: This study investigates ORT patients’ experiences of and views on supervised urine testing. Methods: Structured interviews were conducted with 90 Swedish ORT patients. During the interview, patients were asked to say what they thought about the supervised urine tests required. The answers were then analysed through content analysis. Results: Three main themes with sub-themes were found in the patients’ statements. 1) The consequences of the test results (sub-themes: external control can provide assurance; proven drug intake may have negative consequences for patients; proven drug abstinence can yield advantages for patients), 2) The testing procedures (sub-themes: supervised urine testing is humiliating and causes harm; how you are treated is important; clinical culture and attitudes differ; stress, pressure and anxiety – tests can be difficult to perform), and 3) The structure of the testing (sub-themes: structure is needed in life; inflexible testing schemes can interfere with treatment goals; gathering people with similar problems can be counterproductive). Conclusions: Most interviewees found the testing functional as support or as proxy control in case of personal loss of control. However, supervised urine testing also constitutes a severe invasion of privacy. Less demeaning testing methods need to be developed and implemented.

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  • 47. Monwell, Bodil
    et al.
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Opiatregeln i konflikt med vetenskap, yrkesetik och klinisk erfarenhet: Hur en föreskrift för LARO hanterades i praktiken2019In: En dyster parentes: opiatregeln i svensk LARO-behandling 2010–2016 / [ed] Bodil Monwell, School of Health and Welfare, Jönköping University , 2019Chapter in book (Other academic)
    Abstract [en]

    This study presents an example of when the government introduced a regulation that did not coincide research, professional ethics, responsibility or commitments, and led to a conflict between professionals and rulers. In the Swedish statutes regulating opioid maintenance treatment (OMT), a unique definition of the term opiate-dependency, the opiate rule, was introduced in 2010—restricting the target group for treatment. Persons dependent on other opioids than heroin, morphine or opium (HMO) from now on were to be denied OMT. The regulation was enforced without support from research and against protests from clinics and referral agencies, an approach that previously not been problematised in research. This study investigates, through interviews with 13 persons in key positions in OMT, how clinical praxis responded and what strategies were developed. Healthcare providers were found to increase their efforts to find references to HMO in the journal. If HMO were not found, opioid-dependent patients were to be denied treatment and “negative merit” was provoked. Clinics developed strategies to provide ”unofficial OMT” or intentionally violated the regulation by admitting those without HMO documentation in OMT. These strategies were used with reference to evidence in research, professional evaluation of the medical treatment needs, and ethical obligations.

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  • 48. Monwell, Bodil
    et al.
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Gerdner, Arne
    Opiater eller opioider? Dags att städa bland begreppen2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 43Article in journal (Other (popular science, discussion, etc.))
  • 49.
    Nordgren, Johan
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Culture and Society (KS), Department of Urban Studies (US). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Monwell, Bodil
    Department of Social Work, Jönköping University, Jönköping, Sweden.
    Johnson, Björn
    School of Social Work, Lund University, Lund, Sweden.
    Gunnarsson, Nina Veetnisha
    Department of Social Work, Jönköping University, Jönköping, Sweden.
    Johansson Capusan, Andrea
    Center for Social and Afective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Healthcare staff’s perspectives on long-acting injectable buprenorphine treatment: a qualitative interview study2024In: Addiction science & clinical practice, ISSN 1940-0632, E-ISSN 1940-0640, Vol. 19, no 1, article id 25Article in journal (Refereed)
    Abstract [en]

    Background: Long-acting injectable buprenorphine (LAIB) formulations are a novel treatment approach in opioid agonist treatment (OAT), which provide patients with a steady dose administered weekly or monthly and thus reduce the need for frequent clinic visits. Several studies have analyzed patient experiences of LAIB but the perspective of OAT staff is unknown. This study aimed to explore how healthcare staff working in OAT clinics in Sweden perceive and manage treatment with LAIB.

    Methods: Individual qualitative interviews were conducted with OAT physicians (n = 10) in tandem with nine focus group sessions with OAT nurses and other staff categories (n = 41). The data was analyzed with thematic text analysis.

    Results: Five central themes were identified in the data: (1) advantages and disadvantages of LAIB, (2) patient categories that may or may not need LAIB, (3) patients’ degrees of medication choice, (4) keeping tabs, control and treatment alliance, and (5) LAIB’s impact on risk and enabling environments in OAT. Overall staff found more advantages than disadvantages with LAIB and considered that patients with ongoing substance use and low adherence were most likely to benefit from LAIB. However, less frequent visits were viewed as problematic in terms of developing a treatment alliance and being able to keep tabs on patients’ clinical status. Clinics differed regarding patients' degrees of choice in medication, which varied from limited to extensive. LAIB affected both risk and enabling environments in OAT.

    Conclusions: LAIB may strengthen the enabling environment in OAT for some patients by reducing clinic visits, exposure to risk environments, and the pressure to divert medication. A continued discussion about the prerequisites and rationale for LAIB implementation is needed in policy and practice.

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  • 50.
    Nordgren, Johan
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Svensson, Bengt
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Say No and Close the Door?: Codependency Troubles among Parents of Adult Children with Drug Problems in Sweden2020In: Journal of Family Issues, ISSN 0192-513X, E-ISSN 1552-5481, Vol. 41, no 5, p. 567-588Article in journal (Refereed)
    Abstract [en]

    Codependency is a term used to describe a range of behaviors among persons who are affected by the problematic drug use of family members. This article analyzes how 32 Swedish parents of adult children with drug problems talked about and understood codependency. The sociology of trouble was used as a theoretical framework and three significant themes were identified in the interviews. The parents spoke about how they defined codependency troubles, how they discovered codependency, and how they set boundaries for their children. The parents talked about their situations as highly distressing, and third-party troubleshooters defined their troubles and problems as codependency. The parents generally rejected the advice to “close the door” on their children and engaged in a range of remedial actions. The analytical focus of this study on the identification, definition, and remedial actions of parents gives valuable insights into family disruptions related to drug problems.

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