Government Commissions of Inquiry and Moralities in Swedish Drug Policymaking

Aims Government commissions of inquiry (CI) have a long-standing role in policymaking in Sweden, alongside structured consultation processes with stakeholders. This study analyzes stakeholders’ perceptions of CI in Swedish drug policymaking and their moralities regarding a key proposal in the most recent CI: replacing the policy aim “drug-free society” with “a society with reduced harm from drugs”. Methods Semi-structured interviews with national-level stakeholders ( N = 38) and stakeholders’ written comments to the CI ( N = 76) were analyzed. The Policy Constellations (PC) approach was applied to identify moralities. Results Although stakeholders value CI, their role in drug policymaking appeared limited. A lack of implementation of recommendations was a shared concern across PCs. Analyzing the drug policy aim revealed three PCs: one favoring the current aim, grounded in conservatism and public health utilitarianism; one supporting revision, motivated by social justice and equity-based public health; and one drawing on both equity-based public health and public health utilitarianism, supporting modifying the aim in alternate ways. Conclusions Stakeholders’ perceptions underscore the need to scrutinize and strengthen CI's role in drug policymaking to support effective policy implementation and legitimacy. The significance of CI fractures in practice, as directives and implementation appear largely grounded in moralities, highlighting key moral tensions surrounding the Swedish drug policy aim. The predominance of utilitarian over equity-based public health approach may explain Sweden's cautious development toward harm reduction.