Finland is debating the opening of its first drug consumption room to respond to high overdose death rates. Tuukka Tammi, a top researcher in the drug field in Finland, says restrictive drug laws should be reformed as well.
Drugreporter: The Finnish education system is celebrated as one of the best in the world. Does it apply to drug education too? I mean, do you think drug prevention is as good in Finland as public education in general?
Tuukka Tammi: It is true that Finnish teenagers have had excellent results in PISA studies, but on the other hand we have had one of the widest learning gaps between boys and girls in the same studies. So not everyone gets good results, and here we can see an analogy with the fact that some people are marginalised despite being a generally ‘good’ society, welfare state, or education system.
Talking specifically about our drug education system, I think its basic principle is right: we recommend that drug education is linked to normal classroom teaching and integrated into compulsory health education. Our national prevention programme also emphasises an integrated approach: drugs should be dealt with alongside alcohol, tobacco, and gambling issues. I don’t think we need separate, manualised, school-based drug prevention programmes. However, the schools may decide for themselves and they are not systematically monitored, so I am afraid all kinds of oddities may occur in reality. So to answer your question: unfortunately we are not perfect in this respect either.
Scandinavian countries have deep roots of abstinence culture. Is this also true for Finland? Is there any difference between Sweden and Finland in this regard?
Unlike Sweden, Finland did have alcohol prohibition from 1919 to 1932. Both countries also have alcohol sales monopolies. So to some extent we share the same culture with regard to intoxication, but sisters are never alike. Finnish drug policy has been more pragmatic than in Sweden where drug policy has had a ‘drug-free society’ as its goal. This has made adoption of harm reduction programs very difficult in Sweden as harm reduction has been considered too liberal or simply being about drug legalisation in disguise.
Luckily Finland chose a different path at the end of the 1990s. In my dissertation (titled “Medicalising Prohibition”), I named our drug-policy model the “dual tracks approach”. By this I mean a policy paradigm where public health oriented harm reduction measures are adopted, but not at the expense of criminal control of drug users: harm reduction is accepted but also criminal control of drug users remains. Before the mid-90s, harm reduction was barely heard of in Finland; but then it quickly became a fully integrated part of our system. Especially our needle and syringe exchange network is quite comprehensive, with almost 6 million paraphernalia distributed annually to people who inject drugs.
What happens with a drug user if is he or she is caught by the police? What are the sanctions?
As I said, the integration of harm reduction measures to drug policy has not reduced coercive and punitive criminal justice policy in Finland. Police in Finland record around 15,000 drug use offences every year, and these figures are on the rise. While sanctions for minor drug offences are not very heavy (usually a fine or a warning), simply being caught using drugs can have profoundly negative effects on a person’s life – even if they are not criminally prosecuted. Someone found using drugs will have their name entered into a police database – where it can be stored for up to ten years, with the possibility of the offence being discovered by future employers in the case of a background check. There are many good reasons why we should decriminalise drug use.
According to the EMCDDA, Finland has more than 13,000 problem opioid users but only 3,329 are on opioid substitution treatment. This is not a very high rate, why is it so?
That is a good question. And I am not very sure if I can answer exhaustively even if we have written an entire article to answer your question.
Partly it is about being still too cautious and control-spirited. Even if it has become looser than before, the criteria for getting to OST is still quite strict. And as far as I’ve been told it is also too easy to get kicked out from the treatment if you do not follow the rules. So the combination of cautiousness and control is one answer. Another answer has to do with regional inequality: there are differences in different cities with regard to access to OST. This said, OST is an integrated part of Finnish drug policy and is provided in various drug treatment units as well as in municipal health centres. The amount of patients in OST has been rising all the time.
The number of overdose deaths is relatively high in Finland – twice the European average. Is Naloxone and overdose prevention training available for drug users? What more can you do to prevent deaths?
The number of overdose deaths is definitely high in Finland. We just recently proposed that we should start a national action plan to prevent ODs. This said, comparison between countries should be made with caution: reporting systems, case definitions, and registration processes are different, and there is under-reporting in some countries. I dare say that in Finland the detection system is one of the best in the world: if a person dies because of drugs, my colleagues at our forensic toxicology unit will know it!
Although overdose deaths are preventable deaths, in Finland the typical opioid use pattern makes it challenging to respond effectively. One reason is that our most commonly used opioid is buprenorphine, not heroin. Buprenorphine, usually in combination with alcohol or benzodiazepines, is involved in the majority of drug-induced deaths, and a typical overdose death happens while the person is sleeping. It is hard to prevent. Naloxone does not work very effectively in that kind of situation. But I think we should still try take-home-naloxone and see how it could best be used as not all deaths are linked to buprenorphine and poly-drug use. We also should start systematic OD prevention trainings for drug users as well as for their friends and families.
The Green Party supports a plan to open the first drug consumption room in Helsinki. How do you see the chances of this? Is this possible without a change in the legislation?
This much debated proposal was supported by the City Council’s majority. Currently our expert group is working on a more detailed proposal of how and where such a DCR could be established. The final decision will probably follow in the coming spring. Even if the police and prosecutors did not clearly oppose the initiative, they have stressed that a legislative change is necessary prior to a possible DCR opening. So I see chances but I also see a long road ahead.
You were the leading researcher of HAREACT, an EU project on harm reduction. Based on your experiences, how do you see trends, challenges, and opportunities?
HA-REACT focused on Eastern EU countries, and you Peter know so well how bad the combination of decreasing resources and political populism can be for harm reduction. Harm reduction is based on values that are antithetical to right-wing populism.
Although HA-REACT had many concrete products like manuals, training, educational materials, mobile units, and so on, I think the most valuable thing was the involvement of 18 governments to advocate harm reduction policies. This was a wonderful result. And I think we should continue that: to create alliances between governmental institutions and civil society organisations to make harm reduction more firmly established in countries where the political environment is challenging.
What would you recommend to harm reduction activists in other countries who would like to convince decision makers about the need for more harm reduction?
One thing we need is more good quality data on harm reduction. The decision makers like facts, numbers, and evidence. One source of new information will be the monitoring tool I am developing with Correlation Network at the moment. The EMCDDA and Harm Reduction International, who already do very good work on harm reduction monitoring, are cooperating with us. The idea is to gather more information and knowledge from the civil society organisations working in the harm reduction field, and to use the data to increase understanding and support for harm reduction. And show your decision makers this video explainer we made in HA-REACT (watch below!).
An interview by Peter Sarosi