Addiction and Decriminalization: Portugal’s success in coping with an epidemic of opioid drug abuse

written for Inspire Malibu

It’s easy to forget that not every country in the world approaches issues of drug abuse and addiction as if it were a war. In fact, federal and state laws on illegal drug use in the United States seem uncompassionate at best and barbaric at worst, when compared to some other developed nations.

In the late 1980’s and early ’90’s, Portugal faced a crippling opioid epidemic where one out of every 10 people were addicted to heroin. By 2001, the government decriminalized the use of all drugs and transformed Portuguese society.

“The national policy is to treat each individual differently. The secret is for us to be present,” Portugal’s drug czar, João Goulão, told Susana Ferreira, a writer for The Guardian.

Portugal’s policy on illegal drug use is so simple, it’s somewhat poetic. Their strategy is based on the following three pillars:

  • There’s no such thing as “hard drugs” or “soft drugs,” only healthy or unhealthy relationships with a given substance
  • When a person has an unhealthy relationship with drugs, i.e. addiction problems, there are, likely, external factors at play – for example, struggles with family, mental health issues or career and financial difficulties
  • Getting rid of all illegal drugs is impossible and unpractical

While the sale of illegal drugs in Portugal is still, technically, illegal, drug abuse and addiction isn’t considered a crime. Instead, it’s treated as a health issue. Some experts, like the founder of the Center for Addiction and Substance Abuse at Columbia University, Joseph Califano, criticized the country’s new policies.

“What we don’t need is legalization or decriminalization, which will make illegal drugs cheaper, easier to obtain and more acceptable to use,” Califano wrote in a 2007 essay.

More than a decade later, critics of Portugal’s drug policies haven’t seen what they predicted. It’s been quite the opposite. A 2015 report by the European Monitoring Centre for Drugs and Drug Addiction found some of the following data on Portugal:

  • Has the second lowest fatal overdose rate in the European Union, at 3 drug deaths per 1 million people
  • Rates of HIV and hepatitis infection decreased dramatically
  • The number of drug related crimes and incarceration rates also saw significant decrease

Goulão is quick to point out, though, that the positive results aren’t totally the result of decriminalization. In the Guardian, Ferreira writes that the changes “could not have happened without an enormous cultural shift, and change in how the country viewed drugs [and] addiction,” and that decriminalization “was merely a reflection of transformations that were already happening in clinics, in pharmacies and around kitchen tables across the country.”

The more liberal drug policies made it possible for national, state and local organizations to offer treatment, psychiatry services, housing and employment programs that helped people struggling with addiction to get back on their feet.

Harm reduction advocates in Portugal still have their complaints with the government. They feel legislators have been slow to establish supervised injection sites, enact needle-exchange programs and failed to make Naloxone, an anti-overdose medication, more widely available.

Portugal is just one of a number of countries that ended their “war on drugs.” In the U.S., a new, more conservative government appears to be doubling down on strict polices and mandatory sentences for drug use crimes, despite evidence that this harsh approach is actually counterproductive. Still, with nations like Portugal and others having success with decriminalization and harm reduction policies, there are positive examples that struggling nations can learn from.

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