Till följd av införandet av vårdval LARO väcktes behovet av en utvärdering av dess effekter. Denna uppsats kan ses som en mindre delstudie inom ramarna för denna utvärdering. Uppsatsen är specifikt inriktad på hur Region Skånes sprutbytesprogram, i egenskap av samverkanspartner till LARO-mottagningarna, upplevt förändringarna. Studiens fokus är hur sprutbytespersonalen upplevt vårdvalets effekter på samverkan med LARO-mottagningarna, patientsammansättningen samt på deras motivationsarbete. Totalt har åtta personer anställda inom sprutbytesverksamheterna i Helsingborg, Malmö och Lund intervjuats. Samverkan mellan sprutbytesprogrammen och LARO-mottagningarna sker på frivillig basis och större förändringar har inte uppmärksammats inom detta område. Det står dock klart att sprutbytets heroinberoende patientgrupp har gynnats av vårdvalets införande då kötider till inledande behandling idag helt försvunnit. Resultatet ger även en indikation om att sprutbytesprogrammens patientsammansättning har förändrats, då det finns en upplevelse av att heroinberoende patienter blivit färre. Anledningen till detta kan vara att fler har gått in i behandling och därmed försvunnit från sprutbytesverksamheterna. Personalens motivationsarbete påverkas av det behandlingsutbud som finns inom missbruks- och beroendevården. Vårdval LARO har medfört att antalet vårdgivare fördubblats och tillgängligheten till behandlingen har ökat, vilket haft en viss inverkan på sprutbytesprogrammens roll som konkret och praktisk länk till beroendevården. / With the introduction of healthcare choice OST came the need to evaluate its effects. This essay can be considered as a substudy within the frames of this evaluation. The essay is specifically oriented towards how Region Skånes needle exchange programs, as an interaction partner to the OST-receptions, have experienced the changes. The study emphasizes how the needle exchange personnel have experienced the effects of the healthcare choice related to the cooperation with the OST-receptions, patient composition and their motivational work. Eight of the needle exchange employees in Helsingborg, Malmö and Lund have been interviewed. The cooperation between the needle exchange programs and the OST-receptions is done on a voluntary basis and any bigger changes have not been noted within this area. It is however clear that the heroin-addicted patient group within the needle exchange programs have benefited from the healthcare choice, this due to that the former waiting time for treatment no longer exist. The result also gives an indication of changes in the needle exchange programs patient composition, as there is a feeling among the employees that the heroin-addicted patients have become fewer. The reason for this can be connected to the fact that these patients might have enrolled in treatment and therefore disappeared from the needle exchange. The personnel’s motivational work is affected by the amount of treatment alternatives with in the addiction care. Healthcare choice OST has resulted in twice as many healthcare providers and the treatment availability has increased. This has had some impact on the needle exchange programs roll as concrete and practical link to the addiction care.

About 35 years ago the WHO advocated that countries with injecting drug users should introduce the so-called needle exchange programs (NEP) to curb the spread of infection by blood-borne diseases. In Sweden the first NEP started 1985 in Lund, but the program was extremely controversial in a country with such a restrictive drug policy like Sweden. The study you are about to read shall process this controversy, when a NEP opened in Stockholm, by analyzing the articles published in the newspapers Dagens Nyheter and Svenska Dagbladet. By using discourse analysis as a processing tool we’ll try to see the difference between the two chosen newspapers. We will identify and analyze the different participant’s, such as doctors, politicians, user associations and media, arguments in the needle exchange issue.   Our results show that the liberal DN articles were supportive of the NEP and that they considered it to be an infectious disease control issue. The liberal conservative newspaper SvD had a different view of the issue and considered NEP to be a question about drug policy. Even after the decision was made the city had problems to find suitable premises for the NEP to operate from.