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Table 1 Overview of the development of OAT in Sweden

From: Desirable treatment or a problematic drug scene? – An interview study of patients’ and professionals’ views on the risks and benefits of liberalized opioid agonist treatment

1960s: Introduction of methadone treatment in 1966 as part of a pilot program, reflecting growing awareness of opioid addiction as a public health issue.

1970s: Emphasis on abstinence-based treatments with methadone only available under strict criteria. Regulations were tightened significantly following concerns about diversion and misuse. Patients had to demonstrate long-term and severe opioid dependence, often requiring multiple failed detoxification attempts before qualifying for methadone treatment. Treatment was centralized, with only a few approved clinics allowed to prescribe and administer methadone. This limited access significantly compared to decentralized models in other countries.

1980–1990s: Limited expansion of substitution treatment, with methadone programs focusing on stringent eligibility requirements. Buprenorphine was introduced in the late 1990s but access remained restrictive.

2000s: Regulatory shift allowed for greater availability of substitution treatment. This marked a move towards harm reduction, increasing the number of treatment slots and the inclusion of more opioid-dependent individuals in methadone or buprenorphine programs.

2010s: Expansion of treatment continued, particularly through the “Patient Choice” reform in Scania County, which increased access to treatment by offering patients more provider options. Criticism of strict “zero tolerance” policies (e.g., discharging patients for non-compliance) led to more flexible approaches in some settings.

2020s: Greater emphasis on balancing accessibility with safety. Discussions about low-threshold programs for harm reduction emerged, addressing the challenges of diversion while maintaining patient retention in treatment. Substitution treatment, including both methadone and buprenorphine, had become a cornerstone of Swedish drug policy for opioid dependence, with increased focus on reducing high rates of opioid-related mortality.

In 2024, Scania Regional Council decided to terminate the patient choice model.

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Harm Reduction Journal

ISSN: 1477-7517