Studien undersöker förekomsten av brukarinflytande vid implementeringen av det första sprututbytet i Stockholms län. I studien ges en bakgrund till Sveriges narkotikapolitik och hur dess utvecklingen har sett ut från 70- talet fram till idag. I bakgrunden till studien presenteras ett governace-perspektiv på brukarinflytande och de deliberativa processer där brukarinflytande är en naturlig del av policyprocessen. Syftet med studien är undersöka förekomsten av brukarinflytande i implementeringsdelen av den besluts- policyprocess som ledde fram till sprututbytets öppnande i april 2013. Studiens teoretisk ramverk består av teorier som ifrågasätter givenheten i governance-synsättet på brukarinflytande genom hänvisning till svårigheter med aktörskap och risken med konstruerat brukarinflytande. Forskningsstrategin som studien utgår ifrån är intervjuer med utvalda respondenter som har varit delaktiga vid implementeringen av sprututbytet samt brukarorganisationer som representerar och företräder sprututbytets målgrupp. Resultatet av studien visar på en svag förekomst av brukarinflytande vid implementeringen av sprututbytet. Det brukarinflytande som kan anses har förekommit har varit på en individuell nivå och icke-formaliserat. I analysen presenteras tre möjlig förklaringar till den svaga förekomsten av brukarinflytande vid implementeringen av sprututbytet samt en analys om svårigheter med aktörskap vid implementeringen kopplat till studiens teoretiska ramverk. / This study examines the occurrence of user influence during the implementation of the first Needle and Syringe exchange Programme (NSP) in Stockholm County. The survey in his study consists of interviews conducted with persons that have been involved during the process and debate around the NSP in Stockholm County. The interviews have been conducted with two different groups of actors: User organizations and public actors. The first group called user organizations consists of actors from three different user organizations representing and organizing the target group for the NSP. The second group called public actors consists of public actors which have been involved under and/or before the implementation of the NSP in Stockholm County. The study contains a description of the background of NSPs in Sweden. The study describes the development of the Swedish drug policy from 1970 until today. Further it covers the development of the NSPs in other parts of Sweden as well as the development of harm reduction as a general strategy for drug addiction management. Several definitions to the terms user and user influence are presented. Four are conventional definitions of the term user, together with a fifth one which is then used within in the context of the study. The study presents definitions of the term user influence by a model dividing user influence in three categories: individual level, operational level and system level. Another division of the term user influence presented is formalized and non-formalized user influence. These different classifications are used in the analysis of the results. The study also presents a background to the governance view on user influence as a natural and unproblematic part in the policy process. The theoretical framework in the study consists of two parts: The first part questions governance and the given of user influence within a policy process. The study highlights the problems with a governance view on actorhood and user influence. The second part of the theory chapter presents a model for the policy process. The policy process is described in five stages: Initiation, processing, decision making, implementation and evaluation. The results of the survey show little occurrence of user influence during the implementation of the NSP. By using the classification with the three different levels of user influence the result is that the occurrence of user influence found in the investigation has the characteristics of individual level user influence. The study also shows that the user influence found can be classified as non-formalised influence. The analysis first discusses the factors of why there has been little occurrence of user influence during the implementation of the NSP and proposes three different plausible explanations: Politically sensitive question, structural difficulties and users view was already known. The analysis also discuss the problem with a governance view on actorhood and user influence in relation to the study. The study concludes that there has been little occurrence of user influence during the implementation of the NSP in Stockholm County and that the occurrence of user influence found can be classified as individual level user influence, with one plausible exception.

Bakgrund: Personer som injicerar droger har i tidigare studier visat sig ha en lägre livskvalitet än andra populationer och många lider av psykisk ohälsa. Spridning av blodsmittor som hiv och hepatiter och andra blodburna infektioner kan vara en risk vid injicering. Tillgång till sterila sprutor och kanyler genom sprututbyte är en åtgärd för att minska spridning av infektionssjukdomar. Centralt för psykiatrisk omvårdnad, i likhet med harm reduction, är att värna mänskliga rättigheter, att erbjuda vård på lika villkor och stärka förmågan till egenvård. Syfte: Syftet med denna studie var att undersöka om livskvalitet hos personer som injicerar droger förbättras över tid efter inskrivning på Stockholms sprututbyte samt om det fanns någon skillnad mellan könen. Metod: Denna studie genomfördes som en prospektiv icke-experimentell longitudinell kvantitativ studie. Urvalet bestod av besökare på Stockholms sprututbyte som valde att delta. Studiedeltagarna svarade på livskvalitetsenkäten EQ-5D vid tre mättillfällen. EQ-5D mäter graden av tillfredsställelse i fem dimensioner (indexpoäng) samt innehåller en global skattning av nuvarande hälsotillstånd (EQ VAS). Förändring över tid analyserades med hjälp av ANOVA för upprepade mätningar. Resultat: Resultatet visade på en signifikant förbättring av livskvalitet över tid avseende EQ VAS för hela gruppen. Resultatet visade vidare att kvinnor skattade sitt nuvarande hälsotillstånd EQ VAS signifikant lägre än män. Slutsats: Deltagande i sprututbyte verkar ha betydelse och inverka positivt på hälsorelaterad livskvalitet hos personer som injicerar droger men mer behöver studeras för att få en bredare kunskap om vad det är som gör att det förhåller sig så. / Background: People who inject drugs have shown in previous studies to have a lower quality of life than other populations and many suffer from mental illness. The spread of blood infections such as hiv and hepatitis and other blood borne infections can be a risk when injecting. Access to sterile syringes and needles through syringe exchange is a measure to reduce the spread of infectious diseases. Central to psychiatric care, like harm reduction, is to protect human rights, to offer care on equal terms and to strengthen the capacity for self-care. Aim: The purpose of this study was to investigate whether the quality of life of people who inject drugs improves over time after enrollment in Stockholm needle and syringe exchange program and if there were any gender differences. Method: This study was conducted as a prospective non-experimental longitudinal quantitative study. The selection consisted of visitors at the Stockholm exchange who chose to participate. The study participants answered the quality of life questionnaire EQ-5D on three occasions. EQ-5D measures the degree of satisfaction in five dimensions (index points) and contains a global estimate of the current state of health (EQ VAS). Change over time was analyzed using ANOVA for repeated measurements. Results: The results showed a significant improvement in quality of life over time with regard to EQ VAS for the entire group. The results further showed that women estimated their current state of health EQ VAS significantly lower than men. Conclusions: Participation in needle and syringe exchange programs appears to have significance and a positive impact on health-related quality of life but further studies needs to gain a broader knowledge of what it is that makes it so.