'It has gotten a lot better, but it is still bad': Experiences with the police among marginalized PWUDs in a context of depenalization.

Based on a survey (n = 249) and qualitative interviews (n = 38) with marginalized people who use drugs (PWUDs) in Copenhagen, Denmark, we investigate the experiences of this group with the police in a context where drug possession had been depenalized in and around drug consumption rooms (DCRs). Our findings point to positive experiences with the police, especially with the local community police in the depenalization zone, who refrained from drug law enforcement and practiced 'harm reduction policing.' However, marginalized PWUDs also reported that they were still targeted for drug possession by other sections of the police despite the depenalization policy. Specifically, the drug squad of the police would continue to confiscate illicit drugs for investigatory purposes to counter organized drug crime, as well as continue to target user-dealers who were not formally included in the depenalization policy. The findings illustrate how marginalized PWUDs still found themselves in a precarious legal situation without any legal rights to possess the drugs that they were dependent on, even though possession of drugs had been depenalized in and around DCRs.

The impact of the COVID-19 lockdown on services for substance use in Denmark: Implications for meeting users' needs and recommendations for the future.

Background: The aim of this study was to document employees' experiences of changes in service provision for substance use disorders (SUDs) during the first COVID-19 lockdown in Denmark (spring 2020), as well as to examine their relation to challenges in meeting the service users' needs. Methods: Employees (N = 373) working in SUD treatment and harm reduction services completed an online survey soon after the first national lockdown. The survey included questions about changes in service provision during the lockdown, perceived concerns of the service users, and challenges in meeting the users' emerging needs. Results: Employees reported some positive changes in service provisions, such as increased flexibility in appointments, administering medication-assisted treatment (MAT), and use of telehealth. Negative changes were related to reduced contact with practitioners and harm reduction facilities. Approximately one third of employees reported significant challenges in meeting the users' emerging needs. This was particularly so when users' concerns were about physical and mental well-being, and substance use. In regression models, negative changes in the access to practitioners and MAT administration (but not other changes) predicted difficulties meeting the users' needs. Conclusion: Employees in SUD treatment and harm reduction services in Denmark experienced both positive and negative changes as a result of the first lockdown. However, not all the provision changes were linked to challenges in meeting the users' needs. We discuss practical and research implications of our findings with a focus on the users' physical and mental health, use of telehealth, MAT, and overall service reorganisation.

Drug Consumption Rooms: Welfare State and Diversity in Social Acceptance in Denmark and in France.

Drug consumption rooms (DCRs) have the potential to have a positive impact on the opioid overdose crisis. DCRs could also potentially change the political environment for public health because they can affect the distribution of responsibility for harm reduction between the individual and society by collectivizing responsibility for harm reduction through welfare regimes. The methodology is based on 2 case studies-1 in Copenhagen, Denmark, and 1 in Paris, France-about residents, people who inject drugs (PWID), and politicians' experiences of DCRs involving semidirective interviews. Denmark has a long history of harm-reduction policy, and the implementation of DCRs in Copenhagen has happened through close collaboration between local authorities and the local community. France is far more centralized and paternalistic in terms of the distribution of authority and decision-making in welfare and drug policy. Difficulties in cohabitation between local residents and PWID happened in both countries and can sometimes make public authorities hesitate to implement DCRs because of the NIMBY ("not in my backyard") phenomenon. However, the Danish and French case studies show that DCRs have the potential to become an instrument for civic cohabitation as well as to contribute to the destigmatization and health of PWID. (Am J Public Health. 2022;112(S2):S159-S165. https://doi.org/10.2105/AJPH.2022.306808).

Substance Use and Violent Victimization: Evidence from a Cohort of >82,000 Patients Treated for Alcohol and Drug Use Disorder in Denmark.

Although the association between substance use and violence has been well established, knowledge on predictors for violent victimization of individuals treated for alcohol use disorder (AUD) or drug use disorder (DUD) is lacking. Using Goldstein's tripartite conceptual framework, this study examines the relationship between substance use and violent victimization. Data were derived from national registers on persons aged between 15 and 75 years, living in Denmark, and admitted for AUD or DUD treatment during 2006-2016 (n = 82,767). Rates of new incidence of violent victimization were estimated per 10,000 person years for the patient cohort, and for an age- and gender-matched control group of 492,397 people with no history of treatment for drug and alcohol problems. The incidence of victimization for the AUD/DUD sample was 145.6 per 10,000 person years and 5.4 per 10,000 person years for the comparison cohort. Results of multivariate Cox regression on specific types of substance use supported Goldstein's psychopharmacological and economic compulsive models of victimization, but not the systemic model. Gender-stratified results showed that the use of cannabis and methadone was associated with victimization in women treated for AUD and DUD. Patients with a non-Western background were more likely to experience victimization than Danish patients. The study highlights the strong association between substance use disorder and victimization, and the important role that service providers play in addressing the high levels of victimization experienced by patients with AUD or DUD.

Making up a new drug user from depenalization to repenalisation of drug users in Denmark.

BACKGROUND: In 2004 the Danish parliament repenalised possession of illicit drugs for personal use after it had been depenalised for 35 years. This article analyses the introduction of a more repressive drug policy in Denmark by studying how drug use and drug users were problematized in two key government whitepapers and how this problematization articulated a more general problematisation of 'a culture of intoxication' among young Danes. The analysis also shows how the policy change involved a change of governmentality away from a welfarist and towards a neo-liberal governmentality. The analysis particularly focuses on the implications of these problematisations for the constitution of young drug users a 'governable subjects'. METHODS: The article takes its inspiration from research that has applied governmentality theory to analyse drug policy and particularly how the governmentalities that drug policies articulate involve different subjectifications of drug users. Within this overall framework the article also takes inspiration from Carol Bacchi's post-structural approach to policy analysis to show the assumptions about young people, drugs and how to govern them before and after the policy change. RESULTS: The new drug policy articulated new ways of problematising drug use and the young drug user. Drug use was no longer defined as more or less socially conditioned but as an individual choice made by a rational actor. Punishment for violating the drug legislation should make the drug user responsible for his or her transgressions and deter others from making similar transgressions. CONCLUSION: Research has shown that neo-liberal discourses can lead to more empowering and harm reduction oriented drug policies. This is not the case in Denmark. Here neo-liberal discourses led to a more repressive drug policy. Briefly accounting for some of the lived effects of the new drug policy, the article shows how socially disadvantaged parts of the Danish population bears the burden on the more punitive drug policy. This more repressive drug policy goes against the trend in several other European countries that have become less repressive. However, even if Danish drug policy has become more repressive, the legal measures taken against drug users in Denmark are still fairly 'mild' compared with the legal measures taken against drug users in other countries.

Drug policing assemblages: Repressive drug policies and the zonal banning of drug users in Denmark's club land.

BACKGROUND: Zonal banning of disorderly and intoxicated young people has moved to centre stage in debates about nightlife governance. Whereas existing research has primarily focused on the use of zonal banning orders to address problems of alcohol-related harm and disorder, this article highlights how zonal banning is also used to target drug-using clubbers in Denmark. METHODS: Based on ethnographic observations and interviews with nightlife control agents in two Danish cities, the article aims to provide new insights into how the enforcement of national drug policies on drug-using clubbers, is shaped by plural nightlife policing complexes. RESULTS: The paper demonstrates how the policing of drug-using clubbers is a growing priority for both police and private security agents. The article also demonstrates how the enforcement of zonal bans on drug-using clubbers involves complex collaborative relations between police, venue owners and private security agents. CONCLUSION: The paper argues that a third-party policing perspective combined with assemblage theory is useful for highlighting how the enforcement of national drug policies and nightlife banning systems is shaped by their embeddedness in local 'drug policing assemblages' characterized by inter-agency relation-building, the creative combination of public and private (legal) resources and internal power struggles. It also provides evidence of how drug policing assemblages give rise to many different, and often surprising, forms of jurisdiction involving divergent performances of spaces-, objects- and authorities of governance.

Drug consumption rooms and the role of politics and governance in policy processes.

BACKGROUND: In 2012 after more than 20 years of discussion Denmark introduced drug consumption facilities as part of its drug policy. This article investigates the processes that led to this new policy and its implementation in Copenhagen. The aim of the article is to analyze if the new policy and its implementation can be understood in terms of a shift from 'government' to 'governance' in drug policy. On this basis the aim is also to discuss the possibilities and limitations of 'governance' as an analytical perspective for understanding policy change in the field of drug policy. METHODS: Through the use of Kingdon's theory about policy change as following alignments of problem streams, policy streams and politics streams and deployment of Callon's concepts of 'framing' and 'overflowing' the article presents an analysis of recorded communication from the public debate and national and local policy processes. RESULTS: Politics and the authority of government played a key role in the policy change that led to the introduction of drug consumption facilities in Denmark. It was only after a change of government and a change of legislation that a new policy came about. Drug consumption facilities did exist on a small scale before this through acts of civil disobedience committed by civil society stakeholders. CONCLUSION: The space for governance seems to be limited in a drug policy that is prohibitive, at least when it touches upon issues that concern law enforcement and the sovereign power of the state.

Methadone, a contested substance: Danish methadone policy in the 1970s.

BACKGROUND: During the 1970s in Denmark, there was a great deal of controversy about the role of methadone in Danish drug policy. At stake were not just epistemological issues about how to explain drug problems or indeed technical issues about the best possible treatment for such problems, but also social issues about how drug problems and drug treatment affected and were affected by social change. The paper uses an analytical framework in which drugs are co-constructed with their social worlds. It uses this framework to investigate how conflicts emerged about the different ways of conceiving of the relationship between methadone and Danish society. METHODS: Documentary data from the archives of a pressure group of parents of children with drug problems, the archives of an addiction doctor, newspaper articles, and policy documents from that time were coded in order to identify and analyze central controversies. RESULTS: The methadone controversy of the 1970s was not just about the best treatment methods, but also a matter of the future of the Danish welfare state. The nation debated whether it should medicalise a social problem or solve it through social reform. CONCLUSION: Drug treatment is not just a technical issue, but also a political issue and this needs to be accounted for when making drug policy.

Shifts in opioid substitution treatment policy in Denmark from 2000-2011.

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.