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.

Background: Experiences of intoxication elude scientific research because of their immediate and ‘inner’ nature for the intoxicated individual. In this chapter, we show how ‘trip reports’ – reports of psychedelic intoxication – from online drug information forums and libraries allow for further understanding the experience of psychedelic intoxication from LSD, DMT and psilocybin by examining psychonauts’ (i.e., recreational psychedelic users) own understandings. Methods: The chapter draws on textual ethnography to analyze the trip rapports, approaching the reports as ‘native’ texts that allow for understanding constructions, conventions and practices of intoxication among participants in online psychonaut culture. We reviewed approximately 100 reports from three online drug information forums and libraries: Bluelight, Erowid and Shroomery. By focusing on nine of these reports, we demonstrate how they can be used to analyze psychedelic intoxication. Results: Our analysis shows how psychonauts construct their experiences by combining the context of psychedelic intoxication with inner aspects. The context refers to psychosocial factors of the psychonaut, such as expectations, and their material and social surroundings, such as interior design and other people present during intoxication. The inner experience refers to the arguably psychologically internal reactions and experiences of intoxicating effects, and how the psychonauts narrate them. Conclusions: Our findings show that intoxication follows observable patterns which may best be unraveled by approaching it as structured experience. Yet, the structure of these experiences is not necessarily framed in mystic or religious ways, suggesting that trip reports may complement current research on psychedelic intoxication that approaches it as religious or mystic experiences. Moreover, we suggest that further research should examine the systematics of context and inner experience of psychedelic intoxication which might aide the development of better methods for harm reduction and the study of the therapeutic potential of psychedelics.

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.

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.

Background: Khat is a psychoactive plant with stimulant qualities that is a legal commodity in several nations on the Arabian Peninsula and in East Africa. However, khat is also used in diaspora settings in Europe and North America, where it is a criminalized substance and surrounded with controversy. This chapter focuses on khat use and its association with the Somali community in Sweden to analyze a case of ethnified intoxication.

Methods: I carried out 16 qualitative semi-structured interviews with representatives from Somali civil society organizations in Malmö, Sweden and analyzed the material with an abductive approach.

Results: The interviewees resisted a common stereotyping of the Somali minority as a homogenous problematic ethnic collective burdened by khat use. They discussed both problematic and positive aspects of khat use and differentiated between khat use and khat abuse. Overall, the interviewees constructed the solutions to problematic khat use less in relation to the drug itself or to ethnicity and culture, and more to the socioeconomic situations of the users in a diaspora setting.

Conclusion: The association between khat use and Somali ethnicity and culture was resisted by the interviewees, but it also meant that they engaged in ethnic boundary-making since khat use has been thoroughly ethnified in Sweden. I suggest that reflection by scholars and practitioners is needed to avoid overly simplified explanations of khat use, and that historical cases of drug scares about the intoxicant use of ethnic and other minorities should inform current practices and policies.

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.

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.

Objective: Family members of a person with drug addiction often experience negative impacts on their lives and face barriers to seeking professional support. More knowledge is needed about such barriers so they can be reduced. This article examines the help-seeking experiences of parents of adult children with drug addiction, a group that has received little attention in research. Method: We conducted in-depth interviews with 32 parents of adult children with drug addiction in Sweden. Results: Parents described problems in encounters with social services and barriers to adequate support for their children. On a psychological level, they described feelings of shame and guilt, negative views of social services, and fear of stigma and loss of control that were barriers to seeking professional support. On an interpersonal level, barriers to help were connected to problems in the interaction among parents, children, and social services. On a structural level, barriers pertain to deficiencies in the availability and quality of support measures, inadequate cooperation between authorities, and a shift in responsibility from the state to the individual and the family. Conclusions: Parents of children with drug addiction are a vulnerable group that often experience problems in their contacts with authorities. A more collaborative approach by social services may abate parents’ self-blame and concern and may strengthen their role in their children’s treatment process.

Aims: To examine parents’ experiences of abuse directed at them by their adult children with drug problems. Material and Method: The material consists of 32 qualitative interviews on child-to-parent abuse with 24 mothers and eight fathers. The interviewees had experienced verbal abuse (insults), emotional abuse (threats), financial abuse (damage to property and possessions) and physical abuse (physical violence). Findings: In the parents’ narratives, the parent-child interaction is dominated by the child’s destructive drug use, which the parents are trying to stop. This gives rise to conflicts and ambivalence. The parents’ accounts seem to function as explaining and justifying their children’s disruptive behavior in view of the drug use. The fact that an external factor - drugs - is blamed seems to make it easier to repair the parent-child bonds. The parents differentiate between the child who is sober and the child who is under the influence of drugs, that is, between the genuine child and the fake, unreal child. The sober child is a person that the parent likes and makes an effort for. The child who is on drugs is erratic, at times aggressive and self-destructive. Conclusions: The interviewed parents’ well-being is perceived as directly related to how their children’s lives turn out. The single most important factor in improving the parents’ situation is to find a way for their adult child to live their lives without drug problems.

BACKGROUND: Several studies have examined the effect of community interventions on youth alcohol consumption, and the results have often been mixed. The aim of this study is to evaluate the effectiveness of a community intervention known as the Öckerö Method on adolescent alcohol consumption and perceived parental attitudes towards adolescent drinking.

METHOD: The study is based on a quasi-experimental design, using matched controls. Self-report studies were conducted among adolescents in grades 7-9 of compulsory education in four control and four intervention communities in the south of Sweden in 2016-2018. Baseline measures were collected in autumn 2016 before the intervention was implemented in the intervention communities. Outcomes were the adolescents' alcohol consumption, past-year drunkenness, past-month drunkenness and perceived parental attitudes towards alcohol.

RESULTS: Estimating Difference-in-Difference models using Linear Probability Models, we found no empirical evidence that the intervention has any effect on adolescents' drinking habits, or on their perceptions of their parents' attitudes towards adolescent drinking.

CONCLUSION: This is the first evaluation of this method, and we found no evidence that the intervention had any effect on the level of either young people's alcohol consumption or their past-year or past-month drunkenness, nor on their parents' perceived attitudes toward adolescent drinking. A further improvement would be to employ a follow-up period that is longer than the three-year period employed in this study.

TRIAL REGISTRATION: ISRCTN registry: Study ID: 51635778 , 31th March 2021 (Retrospectively registered).