A strait apart: Everyday life on the margins in Copenhagen and Malmö

Our survey of 474 people who use drugs in Copenhagen and Malmö shows how these political choices shape everyday life on the street. In Copenhagen, drugs can be used in safer and more controlled environments, while in Malmö, users are more often relegated to public spaces, stairwells, and backyards. They also rely more heavily on networks of other people who use drugs.

The results suggest that national drug policy still matters greatly. Yet they also point to a gradual shift: across the Nordic region, countries are beginning to move toward more pragmatic and convergent approaches to drug use and harm reduction.

One bridge, two worlds

Driving across the Øresund Bridge takes only twenty minutes. For people who use drugs, life on either side of the strait is shaped by starkly different policies and possibilities. Denmark and Sweden share many similarities – both are Nordic welfare states offering universal healthcare and strong social protection- but when it comes to drug policy, they have taken very different paths.

Denmark has prioritized harm reduction, offering low-threshold substitution treatment, drug consumption rooms, and heroin-assisted therapy. Sweden, by contrast, has maintained its commitment to a drug-free society, where both drug use and possession are criminalized. This approach has long hindered the introduction of harm reduction measures. Our study explores what these policy differences mean for the most marginalized people who use drugs in Copenhagen and Malmö: how do political frameworks and welfare systems shape their daily lives, their opportunities, and the risks they face?

Who did we talk to?

Our study draws on interviews with 474 socially marginalized people who use drugs – 243 in Copenhagen and 231 in Malmö. Participants were recruited through low-threshold and treatment services such as syringe exchange programs, drug consumption rooms, substitution treatment, and shelters. Most are in their forties, three-quarters are men, and nearly all receive public benefits. Many live in unstable housing situations, ranging from temporary stays with friends to periods of homelessness. Economically and socially, this is a structurally vulnerable group. The similarities across the strait make one thing clear: drug use in this population cannot be understood in isolation, but must be seen as a part of broader patterns of social and economic marginalization.

Two welfare states, two policy paths

Although both Denmark and Sweden share strong welfare traditions, systems offer very different conditions for people who use drugs. Since the 1980s, Denmark has gradually introduced harm reduction measures. Drug consumption rooms provide safer spaces for use, and cities like Copenhagen even offer heroin-assisted treatment. While the early 2000s brought a tougher stance on drug control, socially marginalized users are still met with care rather than punishment.

In Sweden, use and possession remain criminalized, and harm reduction services operate under tighter restrictions. Syringe exchange programs and naloxone distribution have only become more widespread in recent years, and there are no drug consumption rooms or heroin-assisted treatment.

In practice this means that a short trip across the bridge can result in vastly different conditions for people who use drugs.

Patterns of drug use across the strait

When it comes to the substances people use, Copenhagen and Malmö show both similarities and differences. In both cities, most participants are poly-drug users, combining multiple substances, often including alcohol. Cocaine is more common in Copenhagen, while amphetamine and methamphetamine dominate in Malmö. Heroin remains a central drug in both cities, with around 40 percent reporting use in the past year.

We also found that illicit methadone use was significantly higher in Copenhagen, whereas sedative use (benzodiazepines) was more prevalent in Malmö. These patterns reflect not only local drug markets and traditions but also differences in national prescribing practices and access to and conditions of opioid agonist therapy.

Where are drugs consumed?

Understanding drug use isn’t only about what substances are used, but also where they are consumed. The setting plays a crucial role for overdose and disease risk.

In Copenhagen, one in four participants had used a drug consumption room within the past week. Some had also used drugs in shelters or housing facilities, where staff often take a harm reduction approach. Roughly a quarter reported using drugs in public or semi-public spaces such as streets, parks, public toilets, stairwells, basements, and courtyards.

In Malmö, the picture looks very different. With no access to supervised consumption spaces, more than half of participants used drugs in public or semi-public areas. Shelters and housing facilities prohibit drug use, and as a result daily life for many unfolds in unsafe and unhygienic environments.

Resources and support

When we asked participants where they receive support, the answers revealed considerable similarities between the two cities. In both Copenhagen and Malmö, the public welfare system plays an important role in providing access to essential resources. Participants rely on a wide range of services, from doctors and social workers to low-threshold services that provide food, care, shelter and sometimes health services.

Yet drug policy still shapes access to harm reduction. In Copenhagen, people who use drugs can access facilities that simply do not exist in Malmö. In Malmö, informal peer networks take on a much larger role, providing access to drugs, money, housing, and protection.

Everyday concerns

When asked about their main worries, participants offered insight into how policy and practice are experienced on the street. In Copenhagen, the most common concern was being cheated in drug deals, while fears of overdose and police presence were less pronounced.

In Malmö, overdose, psychosis, and other drug-related harms were major sources of worry, and participants were also deeply concerned about arrest or having their drugs confiscated. Notably, the threat of losing drugs to the police was experienced as nearly as serious as the risk of overdose. This vividly illustrates how drug policy differences play out in daily life.

In both cities, loneliness and fear of hurting loved ones were among the most common worries – challenging the stereotype of ‘addicts’ as selfish or detached. These findings highlight the importance of strengthening social networks and relationships as part of interventions.

What do the results tell us?

Our study highlights that drug policy cannot be understood in isolation but must always be seen in relation to broader social and economic conditions. In Denmark, harm reduction and decriminalization create opportunities for safer use, and reduce fear of police interventions. In Sweden, stricter policies amplify the everyday risks of drug use, especially for those already socially marginalized. Even in strong welfare states, vulnerability persists for people lacking stable housing, employment, or social networks. By comparing Copenhagen and Malmö side by side, it becomes clear that political choices have real, tangible effects on daily life: they shape where and how people use drugs, the risks they face, and the resources they can draw upon.

Looking ahead: Toward a Nordic drug policy landscape

The differences between Denmark and Sweden remain, but they are gradually narrowing. Denmark has become more restrictive in some areas, while Sweden has cautiously expanded harm reduction measures. In Norway, debates on decriminalization and harm reduction have brought the country closer to a Danish-style approach.

Our results show that even small policy differences can have major consequences for people in marginalized positions. It is crucial to follow these developments closely and to include the lived experiences of users when shaping future policy. Crossing the Øresund Bridge may be quick, but for those navigating these policies on the street, the differences are still significant.

The article is written by

Esben Houborg, associate professor, Centre for Alcohol and Drug Research, Aarhus University, Denmark

Torkel Richert, associate professor, Malmö University, Department of Social Work, Malmö, Sweden

Johan Nordgren, associate professor, Malmö University, Department of Social Work, Malmö, Sweden

Kristian Relsted Fahnøe, senior lecturer, University College Copenhagen, Denmark

Mette Kronbæk, senior lecturer, University College Copenhagen, Denmark

Nanna Kappel, senior lecturer, University College Copenhagen, Denmark

Katrine Schepelern Johansen, senior researcher, Department for Clinical Research, Copenhagen University Hospital Hvidovre, Denmark

on the request of PopNAD