The Complexity of Drug Consumption Room Policy and Progress in Finland

Ali Unlu,Tuukka Tammi,Fatih Demiroz,Pekka Hakkarainen

doi:10.1177/00914509211002542

Abstract

Drug consumption rooms (DCRs) have been established to reach high-risk people who use drugs (PWUDs) and reduce drug-associated harm. Despite effectiveness, their establishment requires strong advocacy and efforts since moral perspectives tend to prevail over health outcomes in many countries. DCRs have generally emerged as a local response to inadequate central government policy. Likewise, the initiative of the Municipality of Helsinki in 2018 opened up a discussion between central government, society, and local actors in Finland. This would be the first DCR in Finland, which makes the policy process and the progress of the initiative interesting for analysis. In this article, the identification of agents, structures of interactions, environmental challenges, and policy opportunities are analyzed within the framework of complexity theory. Our results show that the initiative faces policy barriers that have mainly arisen from the conceptualization of DCRs in moral frameworks that result in the prolongation of political and professional actors to take a position on DCRs.

Highlights

Drug-induced deaths have become a significant issue in Europe over the last few decades (Alho et al, 2020)
By employing the complexity lens, the article focuses on agents who are actively participating in the governance of the Drug consumption rooms (DCRs) issue, their networks and interactions, the rule structure that governs these interactions, and the internal and external environment
To identify the fundamental elements and characteristics of the governance system for DCR adoption and implementation in Finland, the researchers reviewed the content of city council decisions, committee reports, documents created by government agencies, drug expert feedback, an ongoing study on drug consumption room policy, and newspaper articles as a source of data

Summary

Introduction

Drug-induced deaths have become a significant issue in Europe over the last few decades (Alho et al, 2020). Finland has higher rates of drug-induced deaths compared to the European average. The average drug-induced mortality rate among adults (aged 15–64 years) was 22 deaths per million in Europe in 2017, whereas in Finland it was 53 deaths per million (European Monitoring Centre for Drugs and Drug Addiction, 2019). Drug-related deaths increased by more than one fifth the year before and reached 261 deaths in 2018, which was the highest level in Finland’s history.

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