NADRA 2022: Q&A with keynote speaker Riikka Perälä

Riikka Perälä, the theme of your keynote speech is new and old marginalization. When it comes to drug users, what is new and what is old in the way they are marginalized?

Traditionally illicit drug use has not been common in Finland. We had the so-called first drug wave at the turn of the 1960s and 1970s when especially the use of cannabis began to increase among youth. At the same time, we had veterans of the Second World War, who had become addicted to heroin during the war and formed marginalized user communities. The first drug wave subsided after drug use was criminalized in 1972.

Around the shift of the millennium, there was a big surge in illicit drug use again. This time it was particularly hard drugs like heroin and amphetamine. The change was quite dramatic and visible. Especially young problem drug users started to show up in the service system, but also on the streets. Since then, drug use has continued to increase, but at a slower pace. At the same time, drug use has become a more familiar phenomenon, and authorities deal with the issue of problem drug use daily.

The use of cannabis has also increased and become more and more normalized. This correlates with a more lenient attitude towards cannabis, especially among young people. The consumption of party drugs like cocaine and ecstasy has also increased, and here Finland follows European consumption patterns. The use of cannabis also has a political element, as many think it shouldn’t be something for the state to regulate.

Lastly, if we look at all drugs, both legal and illegal, it is good to remember that alcohol has always been and still is, the most common “drug” in Finland. Most drug-related health and social problems also stem from alcohol use. So, this is something that is “old”.

In my keynote speech, I will also talk about the profile of drug users. Traditionally the typical user with serious drug-related problems is male, younger, and living alone. This still holds, but the percentage of women in these circumstances has increased steadily in recent years.

Let us talk about the Finnish policy in dealing with drug users. Is there a distinction between new and old in the way authorities behave as well?

Yes. Traditionally the approach to dealing with drug users and people suffering from substance use problems, in general, has been quite control-oriented, and the police have played a major role. To put it a bit bluntly, the typical way for the authorities to deal with intoxicated people has been to seize them and place them in a cell to sober up. And this still takes place. The amount of people dying in cells is high compared to for example Sweden where it is more common to bring the same group of people to health care facilities instead.

There is and has been a controlling aspect in the way users are treated within the healthcare system. The emphasis has traditionally been on monitoring the client through different tests, such as urine tests, which will lead to consequences when failed. The control is also shown in the attitudes of the social and health care personnel.

Luckily, the situation is changing. More and more treatment facilities nowadays give their clients a bigger say in how their treatment is conducted, and clients are generally treated more humanely. This has been suggested by NGOs for many decades already, but now the ideas have started to be implemented in the entire social and healthcare system. This approach is also highlighted in the new Finnish addiction strategy which was published last year.

What does the future look like when it comes to drug use and drug treatment in Finland?

As a researcher, I have recently compared the treatment systems and legislation of Sweden, Denmark, Norway, England, and the Netherlands. In these countries, the trend is to treat the users more humanely and focus on each client’s individual needs. I hope this trend will continue and will be a central part of Finnish development as well.

Concerning drug use, in Finland, there is an ongoing discussion on the decriminalization of cannabis. I think decriminalization will happen at some point in the future, but not necessarily soon. This will lead to more cannabis-specific problems, which will need to be reflected in the treatment system.

In the future, I think the traditional alcohol treatment will be replaced by more specialized treatment centers focusing on different kinds of drugs and addictions.

Text: Sebastian Dahlström