Portuguese drug reform 10 years later: no “illusion” that society will be drug free

July marks the 10-year anniversary of a radical experiment in drug policy in Portugal:  complete decriminalization of all drugs. Earlier this month, I had an opportunity to visit Portugal and interview government officials, public health workers, addicts and non-profit volunteers about the impact of drug decriminalization and a host of related public health reforms.

A psychologist with Associasão Ares do Pinhal, a government-contracted non-profit based in Lisbon, holds syringes and other public health supplies distributed to heroin addicts. Robust harm reduction programs are key elements of Portugal's drug strategy.

To the Portuguese, drug abuse is a health issue, first and foremost. That’s how they got to this point: In the 1990s, about one percent of the Portuguese population was addicted to heroin. While the country’s overall drug rates were about on par with other European nations, the rate of problematic drug use was alarmingly high. HIV and Hepatitis C were spreading rapidly among intravenous drug users. Public consumption of drugs and drug trafficking had become the number one public concern. Instead of digging in its heels in the war on drugs, the government convened a panel of experts and actually listened to them, bringing the war to its end.

Luis Mendão, a Portuguese AIDS activist and drug policy reformer, recalls the rationale: “Some of us were convinced – are convinced – that drugs and psychostimulant drugs have always been used in society. Alcohol. Poppy seeds. Coca leaves. The solution that was found in going deeper and deeper in the war on drugs not only did not achieve the goal of zero consumption in the country, but it also did more harm than good. To transform someone who has a problem into a criminal is the wrong approach.”

In 2001, the Portuguese parliament declared that personal possession of drugs – generally regarded as up to 5 grams of hashish, 25 grams of marijuana, one gram of heroin or 10 pills of ecstasy or other drugs – was no longer a crime. Today, if you are caught using drugs in public you are referred to a local “dissuasion board” which determines if you are an addict or a recreational user. Addicts are referred to free government treatment (though not compelled to participate). Recreational users are told that drugs are dangerous and still illegal and often (but not always) given a fine that is the equivalent of a speeding ticket. (Note that I specifically referred to doing drugs in public, like on the street or in a public park. Police will not investigate cases of drug use inside your home, unless you are suspected of drug trafficking – which is still a crime.) The dissuasion commissions are part of the Ministry of Health – not part of the criminal justice system. To the Portuguese, addiction is a disease; recreational use is, well… who cares?

“A drug free society is not doable, so we are not aiming for that,” explains Nuno Portugal Capaz, a sociologist and vice president of the Lisbon dissuasion board. “We are trying to change their drug using from addiction. We don’t try to push people from doing drugs. We try to prevent people from misusing or abusing it.”

From most indications, it is working: problematic drug use and use among youth is down and the rate of new HIV infections among drug users has plummeted, officials say. While there was an uptick in overall rates of adults who have tried drugs at some point in their lives (which has been latched onto by anti-drug forces), officials explain this is because the population who never tried drugs (prior to the nation’s 1974 revolution that opened up trade and travel to and from the country) are dying off.  The country has also not become a mecca of drug tourism, as some feared — primarily because it is just as difficult to get drugs in Portugal as it is anywhere else. There is no legal equivalent to Amsterdam’s coffee houses or anything. The only advantage a tourist would have is knowledge that they won’t go to jail if they are caught. (I’ll let the experts weigh in on the outcome: Here’s the much publicized 2009 report from the Cato Institute and the more recent and well-rounded analysis that appeared in The British Journal of Criminology late last year.)

Dr. João Goulão, president of Portugal’s Institute of Drugs and Drug Addiction (IDT), a branch of the health ministry which oversees the nation’s drug strategy, stresses that it is the public health component – not the change to criminal law – that has made the real impact in the country. The reality is that Portugal never locked away all that many drug users anyway. Still, drug decriminalization freed up activists to give out clean syringes and drug addicts felt more comfortable seeking help. Today, IDT operates a number of treatment clinics that are mostly free, offering a range of treatment services including methadone treatment, detoxification and a day center where addicts learn socialization skills. The agency and local governments also contract with non-governmental organizations to provide harm reduction services to more marginalized populations. (See pictures.)

Goulão says he believes societies need to learn to “live with” drug use, just like we live with disease. “I don’t think this solves the problem in our society, but I feel we are dealing with it in an appropriate way. We don’t have the illusion that we can eradicate drug use,” he says.

Heroin addicts get methadone from a mobile van operated by the non-profit Associasão Ares do Pinhal under a bridge in Lisbon. The group is funded by national and local government contracts.

An addict takes the methadone, distributed in the van by a nurse. Addicts also get regular screenings for AIDS, tuberculosis and other diseases.

READ MORE: A more detailed essay on Portugal’s drug policy will appear soon in a U.S. political magazine. This post will be updated with the details.

-AJC

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