Portugal Treats Addicts as Patients, Not Criminals, and the Results Are Staggering

In 2001, in the midst of a heroin crisis, Portugal’s government took the radical step of decriminalizing the possession and consumption of all illegal drugs. At the time, around 1 in 100 Portuguese suffered with heroin addiction, overdose deaths were skyrocketing, the rates of addiction and related issues such as AIDS-deaths were the highest in Europe and the types of crime typically associated with addiction were on the rise.

Sixteen years on, Portugal’s decriminalization of drugs and shift toward a policy based around harm reduction has had a massively positive effect and is widely considered to be a system that other countries should emulate.

A Recipe for Disaster

Portuguese society’s experience with drugs has been vastly different to most other developed nations from the beginning. Under authoritarian rule for forty years since 1933, the Portuguese people had been victim to a series of policies designed to keep them docile, which left them under-educated and without strong institutions. They were disconnected from the outside world, with strict laws prohibiting even the most innocuous items, such as Coca-Cola.

In the 1960’s, at a time when most other western countries were going through some form of cultural awakening and the concept of personal experimentation with illicit substances was becoming more acceptable, the Portuguese were closed-off and still under the rule of a hardline-conservative government. Eventually, the people of Portugal revolted and overthrew the government, but when drugs like heroin began to enter into society, the understanding of drugs and addiction among those in government and medicine was extremely low, as was the average person’s understanding of the same concepts. This combination of factors proved to be a recipe for one of the largest heroin epidemics seen in Europe.

A Change of Tactics

Society struggled to cope with the escalating crisis for several years, until a radical policy direction was taken in 2001. Spurred on by work already proving successful by doctors all over the country on an ad-hoc basis, one of the country’s leading drug treatment specialists was asked to lead a rethink of government policy.

After a series of recommendations led to a new national plan of action on drug addiction, Portuguese ministers signed off on a policy which stopped treating drug addicts from a criminal point of view and instead looked at their problems from a medicinal standpoint. The main aim in doing this was to remove the stigma around addiction, and by also removing the fear of prosecution, those suffering with drug addiction became more likely to seek help.

In Portugal today, if you’re caught with an amount that could reasonably considered personal use of any illicit substance – including heroin – then you’ll receive a warning, a small fine or be told to appear before a local commission. Addicts are sent to these commissions – made up of a doctor, lawyer and a social worker – to discuss treatment, harm reduction and the help available to them. Portugal spends 90% of the money it allocates for drug-related issues on harm prevention and treatment, with the remaining 10% spent on enforcement. This ratio is almost reversed in the case of most developed countries, including the US, UK and Canada.

This policy is part of a broad shift in the way that Portuguese society thinks about drugs and drug users, of which decriminalization is only one, relatively small factor. Arguably what has been equally effective in fighting Portugal’s drug epidemic, is the focus on outreach, on building relationships with addicts and creating spaces where they can receive treatment, without judgement.

Addicts are given shots of methadone, a drug that takes away withdrawal symptoms.

An Example to Others

When Portugal adopted this bold new strategy, lawmakers from around the world criticized and gave grave predictions of spiraling drug use, more drug deaths and an emboldened epidemic. While most western countries have massively stepped up their “wars on drugs” in recent years,  and reacted to each new drug crisis in the same exact way, only to be surprised at getting the same result, Portugal has seen their problems largely dissipate.

The main aim of Portugal’s shift in policy was to help those suffering with addiction to heroin, who were dying at an unprecedented rate. In 2001, over 1,000 drug-users were diagnosed with HIV in Portugal, and a further 568 were diagnosed with AIDS. By 2012, those numbers had fallen dramatically, to 56 and 38, respectively. It now also boasts one of the lowest rates of overdose deaths in the world; 2.5x less than Spain, 10x less than the UK and 31x less than the US.

The Situation Elsewhere

Though for years Portugal’s policy was largely out on its own, there are now signs that others are starting to take notice. Though Portugal’s step of total decriminalization has yet to be copied elsewhere, varying levels of legalization, decriminalization and de-prioritizing of drug offenses have been enacted in various countries around the world. In recent years, even the US, home of the so-called “war on dugs” has begun to soften its approach with certain substances – cannabis is now allowed for medicinal use at least in 23 states. Elsewhere, many other countries makings efforts to tone down their prohibitionary policies to some extent; including Switzerland, Australia, Chile, Canada, France and Denmark.

At the latest UN General Assembly special session on drugs, despite some very positive rhetoric and the pleas for harm reduction and a more progressive approach to drug problems the world over, the UN assembly maintained the position of criminalizing non-medical or scientific drug use. The disparity between different countries’ methods – from the death penalty in Indonesia, to Norway’s calls for human rights-centred policy – emphasizes how far the world is from solid consensus on drug-related issues. So, for now at least, and at the expense of most of the world’s drug-addicts, Portugal’s policy serves only as a shining example to be admired from afar, and not a model to be adopted universally.

Cover image: Alta Mira Recovery

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