The Decriminalization Experiment

Portugal decriminalized the possession and consumption of drugs in 2001 and since then has seen a dramatic reduction in overdoses, HIV and drug-related crime. Several other countries including The Netherlands and Switzerland have also tinkered with non-prosecution of possession solely for personal use. What is it about their policies, and cultural shift in general, that has proven so effective even as the United States faces some of the highest addiction rates in our nation’s history?

Back in the 1980s, Portugal was in even worse shape than the US with approximately 10 percent of their population hooked on heroin. It impacted the entire spectrum of society from bankers to miners and from socialites to university students. Practically every single Portuguese family was affected. The country’s initial knee-jerk reaction was to attack and they began a campaign of an all-out-war on drugs. They also implemented strict addiction treatment policies requiring complete abstinence combined with psychotherapy. Neither of these approaches had much of an impact. At the same time, some enterprising charitable organizations began experimenting with needle exchanges programs and the use of methadone to taper addicts into recovery. Both initiatives began to show promise. Yet, it still took another 15 years, or so, of progress to take those programs nationwide. It’s only when Portugal hit its own rock bottom with an estimated half of its prisoners incarcerated for drug related crimes and an HIV rate of 104.2 cases per million people, that they were willing to try something different.
Portugal’s program is built around a three-pronged philosophy:

(1) There’s no such thing as hard or soft drugs, only healthy and unhealthy relationships with drugs, (2) An individual’s unhealthy relationship with drugs often conceals a frayed relationship with themselves, loved ones and the world around them, and (3) Eradication of all drugs is an impossible goal.

Now, to be clear, decriminalization is not legalization. Portugal still has laws on the books and effects active enforcement against people manufacturing, distributing and selling drugs. However, when it comes to the individual, those people caught with a personal supply are given a warning, small fine or told to appear before a local commission. These local commissions are typically comprised of a doctor, lawyer and social worker, who collectively promote treatment, harm reduction and educating users on the support services available to them. The official policy of decriminalization has shifted funding from enforcement to treatment and support, making it easier for those struggling with addiction to access a broad range of services (health, psychiatry, employment, etc.) and has enabled those agencies to more effectively pool and provide those services.

However, it’s more than that. It’s all about changing the national mindset including the dialogue. The language is now more sympathetic too, changing from drogados (junkies) to people who use drugs or those with addiction disorders. As one government official noted, “it’s not about administering methadone, you have to maintain a relationship.”However, their is a huge difference between decriminalizing addiction and making problematic substances (such as marijuana) freely available for indiscriminate use and abuse.I firmly believe that legalization is not part of the solution, it’s part of the problem.

As a result of Portugal’s experiment in compassion, HIV cases have since plummeted to 4.2 per million, fatal drug overdoses are now the lowest in the European Union and drug related crimes have dramatically decreased. Yet, despite Portugal’s apparent progress, few other countries are willing to consider such a “radical” approach. Norway, Brazil and two of the three major parties in Canada are outliers, pushing similar policies, and have support from such organizations as The Global Commission on Drug Policy and the World Health Organization. I find it particularly interesting that conservative, isolationist and heavily religious Portugal was the first country to take such revolutionary measures. I suppose it takes a certain type of desperation to take such a dramatic step.

Despite some of the positive developments, decriminalization is not a panacea. As we all know, you can provide all the help and services in the world but you can’t force a person to want help and stop using. That segment of Portugal’s population therefore struggles with health complications related to long term drug use and diseases such as Hepatitis C, cirrhosis and liver cancer. There is also a growing shortage of health professionals, particularly those who specialize in addiction treatment.

One last point I’d like to make comes down to the distinction between decriminalization and legalization. Many people seek to lump in the wave of marijuana legalization in the US and abroad as another positive example. I humbly submit that marijuana advocates are missing the point when they claim that what they are doing is part of the fight addiction. Portugal doesn’t blindly allow mass distribution of heroin, they’ve only stopped jailing people for solely using that substance.

It seems hard to fathom that the United States would go as far as Portugal to decriminalize all drugs considering one person is arrested an average of every 25 seconds for possession of drugs solely for personal use (according to Human Rights Watch). In fact, under the current administration, our federal government has been stepping up enforcement, doubling down on the War on Drugs. Attorney General Jess Sessions has declared open season on drug gangs and even against growers of marijuana in states where the its sale has been legalized but still runs afoul of federal law. President Trump has even taken the extreme position of advocating the death penalty for drug dealers. However, some relatively recent developments provide sparks of hope. The federal government has implemented federal drug courts to offer up sentencing alternatives such as treatment, and plans on expanding their use. They offer the carrot of treatment as an inducement with the threat of incarceration to help motivate someone to realize he or she might truly need help. More federal dollars than ever are also being directed toward treatment programs and funding expanded availability of naloxone, which immediately saves the lives of people mid-overdose. The President’s Commission on Opioids has also called on more states to enact “Good Samaritan” laws which protect people who call emergency services to report an overdose.

We still have a long way to go in the battle against addiction in America. It can often feel as if we’re merely stacking sandbags against a rising tide. That is why it’s so important to occasionally step back to question and re-examine what we’ve been doing and take a look around to see what might be working elsewhere. No one person or country has a monopoly on good ideas. We need to consistently keep our eyes on the objective of reducing the impact of addiction and the number of people affected, and be open minded to what methods might be best to get us there.