Learning From Portugal

Over the past few years, American politicians have been (grudgingly) coming to terms with the fact that the nation’s much-touted “War on Drugs”–a war almost as massively expensive as those fought by the Pentagon–has consistently proven to be a failure.

Years of research that documented that failure have pointed to the fundamental flaw in American drug policy: a failure to properly categorize.

That failure wasn’t just the lumping of relatively harmless recreational marijuana in the ranks of  truly dangerous substances, although that was bad enough. (As pro-pot activists liked to point out, alcohol and cigarettes, both legal, account for far worse health problems– there have been zero deaths attributed to pot.)

By far the worst “category” problem was the decision to attack drug abuse as a criminal justice issue rather than a health issue.

Portugal doesn’t make that mistake, and as years of research have demonstrated, properly characterizing drug abuse as a medical problem has allowed that country to achieve far more success in managing it.

Decades ago, the United States and Portugal both struggled with illicit drugs and took decisive action — in diametrically opposite directions. The U.S. cracked down vigorously, spending billions of dollars incarcerating drug users. In contrast, Portugal undertook a monumental experiment: It decriminalized the use of all drugs in 2001, even heroin and cocaine, and unleashed a major public health campaign to tackle addiction. Ever since in Portugal, drug addiction has been treated more as a medical challenge than as a criminal justice issue.

After more than 15 years, it’s clear which approach worked better. The United States drug policy failed spectacularly, with about as many Americans dying last year of overdoses — around 64,000 — as were killed in the Vietnam, Afghanistan and Iraq Wars combined

In contrast, Portugal may be winning the war on drugs — by ending it. Today, the Health Ministry estimates that only about 25,000 Portuguese use heroin, down from 100,000 when the policy began.

The number of Portuguese dying from overdoses plunged more than 85 percent before rising a bit in the aftermath of the European economic crisis of recent years. Even so, Portugal’s drug mortality rate is the lowest in Western Europe — one-tenth the rate of Britain or Denmark — and about one-fiftieth the latest number for the U.S.

As the linked article notes, if the U.S. could meet Portugal’s death rate from drugs, that would equate to saving one life every 10 minutes. That’s almost as many lives as those that we lose now to guns and car accidents combined.

Many people are also coming to Portugal to explore what a smarter, health-driven approach might look like. Delegations from around the world are flying to Lisbon to study what is now referred to as the “Portuguese model.”

“This is the best thing to happen to this country,” Mario Oliveira, 53, a former typesetter who became hooked on heroin 30 years ago, told me as he sipped from a paper cup of methadone supplied by a mobile van. The vans, a crucial link in Portugal’s public health efforts, cruise Lisbon’s streets every day of the year and supply users with free methadone, an opioid substitute, to stabilize their lives and enable them to hold jobs.

Methadone and other drug treatment programs also exist in the U.S., but are often expensive or difficult to access. The result is that only 10 percent of Americans struggling with addiction get treatment; in Portugal, treatment is standard.

In the U.S., we don’t treat. We punish. And we aren’t deterred by the fact that punishment doesn’t work.

Many years ago, when I was Executive Director of Indiana’s ACLU, I made a speech to a large audience–I no longer recall what the event was–and included a critique of American drug policy. When an audience member suggested that we just weren’t being tough enough, I asked what seemed to me to be a very reasonable question: If there was a doctor who had performed 100 operations and every single one of his patients had died, would you agree that he just needed to do the same operation again? Would you go to that doctor?

What I call Americans’ “category problem” is influenced by our national inability to separate concepts of sin and crime. We saw that same confusion with prohibition–drunkenness is sinful, so we outlawed booze, making no distinction between social drinking and alcoholism. Drug addiction is sinful, so let’s not bother to distinguish between use and abuse, and let’s not look at evidence about cost-effective ways to address abuse…

The public health approach arises from an increasingly common view worldwide that addiction is a chronic disease, perhaps comparable to diabetes, and thus requires medical care rather than punishment. After all, we don’t just tell diabetics, Get over it

Portugal’s approach isn’t perfect. But it’s rational.

 

 

28 thoughts on “Learning From Portugal

  1. Another piece of this puzzle is that the R’s learned that they can make lots of money with a private Prison complex. Use the government to feed an unending supply of offenders to their for profit prisons. GENIUS. They can make money off of nearly anything. Illness and death: LETS MAKE SOME MONEY. (Don’t help – Just make money)
    Another way is outlined by Gabor Mate in “The Wisdom of Trauma”
    Gabor Mate worked with drug abuse victims for decades. His documentary is informative.
    Trailer at
    https://www.youtube.com/watch?v=70HNmSsJvVU

  2. In the same vein as patmcc, it isn’t about helping, or saving lives…it’s the associated crime (money) that politicians want to fight. I have never heard a pol say that prison for drugs will save lives. They don’t think those lives have value. (They probably don’t vote, and certainly don’t contribute)

  3. Beportugal site states this “ A group of pioneer doctors across the country, who were tackling the problems in their respective areas, were revolutionising treatments. They soon helped pave the way for the Portugal Drug Policy to be introduced.

    This caused a momentous shift in the nation’s attitude towards drugs.”

    People like Dr Oz who lead thexway in public discussion are the ones who need to research and find out how they are doing it.

    The 1994 crime Bill written by President Biden put a lot of people in jail followed by the privitization of jails that the Clintons are well known to have invested in shows the hypocrisy of our politicians in saying they care but historically have done exactly the opposite.

    Portugal is treating people with drug issues, getting rid of the source is a major issue. Fentynol is being produced by Chinese chemical corporations and is supplying to Mexican cartels, we have to educate our kids to stay away from these drugs that fentynol is being substituted for.
    100,000 have died from these drugs.

    In Portugal these policies were carried out while conservative leaders were in office which shows that both conservatives and liberals are making progress elsewhere.

  4. Two things:

    One, the “war on drugs” is also extremely racist. There’s an obvious reason the sentences for possession of crack cocaine are much worse than those for powdered cocaine. I’m cynical, perhaps, but I wonder if this wasn’t a driving force behind it. After all, Reagan was an extremely racist guy, and the “war” really ramped up during his terms.

    Two, these sentiments around punishment are often grounded in religious beliefs. There are many among the evangelical christians who equate personal problems (as they determine them; like being poor, or prone to addiction, etc.) with a failure of morals or character. It’s as though they have no empathy at all. I guess if you’re not part of their “tribe”, then they really don’t have any empathy for you. Case in point: MTG suggesting the catholic church being in favour of helping refugees means they weren’t following Jesus’ teachings, and were, in fact, being led by Satan.

  5. In 1976 I had equal time on a Terre Haute TV station to respond to that station’s news anchor who had said possession of marijuana should be decriminalized. I said we need to legalize all drugs. I still believe that we should legalize all drugs. Then again, I’m the only pro-choice, pro-environment, pro-voting rights, anti-trump GOP candidate for anything in the United States.

  6. And the most pregnant of questions remains: Why are humans so enthralled with substances that THEY KNOW ARE HARMFUL OR DEADLY? Getting high goes back as far as recorded knowledge – and probably further – with the Egyptians inventing beer. SNARK AALERT: Justice Kavanaugh would have enjoyed those times of beer and absolute dictatorship.

    Are our brains so in need of consciousness-altering substances that we are compelled to use them until death? Then, our fascination with life-ending devices like nuclear weapons doesn’t seem enough of a deterrent from having/using them on each other. Humans are the ONLY species that wantonly commits genocide for the sake of committing genocide. So maybe mind-altering drugs are just devices to aid in our fascination with the unknown: DEATH.

    No laws or actions by any government is going to alter that fascination or use of those chemicals. We are who and what we are. Our CHOICES are our choices. So-called criminals, aka business men and women, will continue to get rich on those choices no matter what.

    Gosh! Portugal reduced its drug deaths from 100,000 per year to 25,000. Boy, that’s real progress.

  7. Pat blamed Republicans for making money off of private prisons. Does that mean Democrats don’t take money from the Prison Industry?

    Also, this statement above, “we have to educate our kids to stay away from these drugs.”

    The reason fentanyl has become more prevalent is the supply of heroin from Afghanistan has stopped. Fentanyl was being cut into heroin, but now it’s all fentanyl. The Taliban stopped opium production after the US Military left their country. So, who was profiting off the sale of heroin during our 20-year occupation? 😉

    Police unions fight the legalization of drugs…why?

    Mainly because it will eliminate their jobs and side hustles; who do you think oversees the drug trade in the communities?

    If drug addiction is treated as a preventable disease, then wellness (prevention) must focus in our healthcare system. Unfortunately, since our entire healthcare system is built off the profit-making model, it’s not set up for that. Profit maximization wins out over prevention.

    Converting our healthcare system to a prevention-oriented model would completely alter many other industries, not just drug, and alcohol addiction. Legalizing drugs would eliminate entire industries and replace them with new industries.

    Our food industry would change overnight, as would our energy policies. For example, the consumption of meat would go way down as people shift to alternative sources of nutrition.

    These aren’t progressive ideas but almost Leftist dreams in today’s world. Imagine a society focused on the people and the plant versus profit-maximization.

  8. None of the responses have mentioned chronic pain sufferers that need something so that they can get on with life. The healthcare “industry” does not want to address this problem. Chronic pain sufferers are not able to get the drugs they need to function so they go to the black market.

    Legalizing drugs will save lives and research has proven it. Look no further than hospice. They have end of life processes that give the dying some dignity.

    Look no further than Purdue Pharma that was fined a billion dollars for the lives that were lost because of their negligence. Why are there so many drug addicts? Once we answer that question with science, hopefully the market for drugs will disappear.

    Let’s decriminalize mental illness first. It should not be a crime to have mental health problems. But getting help worldwide is always a problem because addicts look for help and get jailed instead.

    Portugal is proving that science works. Maybe I’ll retire there.

  9. In the 1970’s I worked as receptionist in the intake office of Community Addiction Services Agency (CASA) which received federal funds and addicts seeking help received treatment at no charge to them. We had excellent, qualified staff members throughout the system here. There were outlying neighborhood clinics once they were registered in the system via the intake unit; of course the funds were cut and there was no alternative treatment for addicts which ranged from business men and women, working people with families, criminals and street people. Our clinics worked on a detox system; gradually lowering methadone levels; the system was also linked to other clinics in other state and would temporarily treat their patients when visiting or just passing through. Many of the other clinics simply maintained the methadone levels the same as heroin levels when patients entered the system. This simply maintained drug addicts and we paid to maintain their drug addiction, simply changed drugs.

    I later worked as receptionist and “house mother” for a court-ordered, in-patient center for teenage addicts state-wide. The Administrator was a young former public health nurse with 2 pre-school age children who knew nothing about teenagers or drugs. I had to set up the entire in-patient format; furnishings, needed staff, office system, and carried out the job of typing the confidential counselor’s treatment records. The Administrator was amazed and congratulated me on using an alphabetical system for filing; when the kids ignored the rules, she changed the rules to cover their misbehavior and no one was punished. She refused to listen to the counselors who tried to tell her that the one boy who was gone for 2 days returned high on drugs…until he was found unconscious on the floor of his room. He was hospitalized for a few hours, returned to our care and again overdosed on drugs he had hidden; he was found the 2nd time on the floor not breathing, barely a pulse, had lost control of bladder and bowels. Fortunately one of the counselors knew CPR and kept him alive till the ambulance arrived. Administrator then decided only counselors with Masters Degrees could provide treatment, those with a BA degree could work the night schedule and occasional trips to entertain the kids, basically babysitting work. She also decided I was no longer qualified to read the confidential counseling reports and I returned my key to that file cabinet to her. Of course I was still to type those confidential counseling session reports; I could no longer unlock the cabinet to tile them. The kids were allowed to attend school and have part-time jobs; she approved the boy from southern Indiana who was a “huffer” to work as a house-painter assistant then kicked him out for “huffing” paint thinner. This facility was primarily funded with federal funds and didn’t last long before it was shut down due to problems caused by ineffectual leadership due to an appointment based on political connections. The Administrator was also pathologically terrified of rain and snow; the first sign of rain showers or snowflakes we watched the get her purse, her coat in winter, call her husband to come pick her up. She sat unresponsive in her chair till he arrived and helped her to his car.

    This country needs to learn from someone, somewhere how to deal with the availability of drugs on the streets. Does anyone else remember the Bernie Sanders’, Chris Hayes’ MSNBC special a few months after Trump’s inauguration from the poorest county in West Virginia who had supported Trump. The loss of jobs and health care was only part of problems reported in that program. The millions of opioids available due to doctors over prescribing and Big Pharma happily providing the drugs while both made money legally on the addictions of residents of that county and others who came due to the easy availability of drugs from doctors. That area of Manchin’s home state needs to be revisited to study the drug problems since that MSNBC program.

    I refuse to apologize for the length of these comments; I am the mother of children, grandchildren and now great-grandchildren who have drug problems. Some legally supplied, others from the streets; the problems caused by these drugs are many and run the gamut of day-to-day life for the addicts and effect other family members due to those addictions.

    “What I call Americans’ “category problem” is influenced by our national inability to separate concepts of sin and crime.”

    Americans also cannot separate, because they do not recognize or care, about the difference between the victims (that “sin and crime” faction) and the major suppliers of the drugs available.

  10. John S,

    Dr Oz? Really? A carnival Barker at the very best.

    I have to agree with JoAnn,

    My mother also worked for CASA, she was a caseworker which would go to the hospitals and facilities mostly to deal with rape victims. Drug addiction always seemed to be orbiting even that sort of issue. She ended up leaving after about 5 years because it was just too depressing and there was never enough funding. This quantifies directly into the abortion issue, one that was brought up in this thread over the past couple of weeks.

    My wife has family members in federal law enforcement. And, her adopted sister and her sister’s husband also have family members in federal law enforcement one is an FBI section chief retired.

    They readily admit crossing paths with other government spooks, those who are involved in the drug trade for off the book reasons.

    The drug trade was actually started in this country by our government (Iran Contra for one). Used to fund those off the book wars, and also to bribe South American and Middle Eastern governments the (Soviet Afghanistan conflict) with access to the vast resource of American addiction.

    Only when the Opiate crisis exploded in the white communities, did the government start going after prescribers and producers of opioids.

    As long as it remained in the minority areas, it was fine! When that white billy goat was king of its mountain, it would knock off all of the other goats, and, it’s the same on every other mountain top across this planet. Prestige, authority, power, and wealth! Those are powerful drivers to keep yourself at the Pinnacle of society, even as it sinks like the Titanic.

    The American government is the poster child for obscurantism!

    When Heroin and later on Crack Cocaine, were prevalent in the so-called ghettos, that was because those folks were more animal than human! And, if you can kill off or have folks kill each other off, well, your job is a lot easier, and of course there’s always plausible deniability.

    And JoAnn,

    Never apologize for your compassion and empathy! More of that is needed, not less.

  11. I really appreciate you writing about Portugal’s Drug Policy Model, but it was first implemented in 2001 and deemed a great success by 2004. Twenty years later, we still can get nothing done in our Congress because of the Christian right’s criminalizing drug use. And nothing will happen until we get our election system out from under two-party domination and back to the people.

  12. We are a country based on opinions, some of them bought (renewable energy is silly, fossil fuels are still the best). Proven facts like Portugal? Medical treatment instead of jail? What will the observant Progressives come up with next?

  13. We the people are a big part of the problem. If you ask people if they would pay higher taxes to provide additional health care to just about anyone, most would give you a resounding NO. On the other hand, if you ask if they would pay higher taxes to get drug abusers off the streets and throw them in jail, most would give a resounding YES! It makes no dense, but when did we ever make sense?

    To John S, Dr. Oz? Really? Clowns like him don’t do medical research. I doubt any reputable agency would fund any proposal he sent in. Medical research is hard to do and even harder to get funded. I agree with the Neurology Association that requested that his license to practice medicine be revoked.

  14. Absolutely right that the US approach is all about siphoning money. Social damage means nothing. Profits are everything. That’s why even saving taxpayers money, let alone saving lives, is irrelevant. “Fiscal responsibility” is code for cut social spending.

  15. Hypothesis:

    The liberal to authoritarian spectrum organizes the means to manage society of any size. For instance, you can organize neighborhoods socially (community organizers like Obama) or with violence like gangs (extreme authoritarianism). You can organize globally with alliances (NATO), or militant colonialism (Putin). On this spectrum the military is slightly to the right of corporations which are quite to the right of volunteer organizations. Everything in the middle of the spectrum has a useful place in society and government. The nature of the organization tends to mirror the “personality” of the management style used to organize it.

    Laws (policies) are enforced by categorizing behavior as legal, infractions (misdemeanors) or crimes with the enforcement also graduated accordingly. (BTW, so do families.) (A great deal of current social trauma is because police treat some suspects as though they were potential serial killers before courts adjudicate the real nature of the crime.)

    What about the nature of problems that have as their root cause emotional trauma or mental deficiency? We still need laws to be enforced that protect the victims of behaviors of the inflicted. What works best, more liberal or more authoritarian means?

    For those suffering from drug induced misbehavior, where on the spectrum leads to the best results for both those under the influence and any victims of their deeds in support of satisfying their addiction? The US has much more authoritarian policies than does Portugal.

    There is much evidence in support of the wisdom of Portugal’s place on the spectrum from liberal to authoritarian. It works better for everyone from nearly every perspective.

  16. 1) $$$$$$$$$$$$$$$$$$$$$$$$$$

    2) Everything Smekens said.

    3) It’s about the cruelty. Authoritarianism makes good business sense. Trauma is profitable.

  17. Pete,

    Look no further than the Reagan administration, they were responsible for much of the drug trafficking they claimed to fight with their war on drugs. Iran Contra as one of the more egregious examples of that administration. But they also used the social security trust fund as a personal piggy bank and left it with IOU’s instead of the trillions that they pulled out! Another Reagan administration shenanigan was closing many of the mental health facilities in the United States to supposedly save money? That was the beginning of the jails and prison system in the United States becoming it’s largest mental health facilities! There are very few of these once numerous facilities left to house many of the mentally ill So they don’t have have to wander the streets or live under bridges trying to self-medicate because there’s nothing available to help them.

    Here you have an actor who became president! Not unlike our previous POTUS, Except this last one was even more of a nut job, because he doesn’t even believe what he says. He just wants power! And, if he ever acquired it, it would not be pretty. He undoubtedly would make Hitler look like a saint!

  18. Thank you, Mark Small, for the comment about the racial aspect of all this.
    The “War on Drugs,” like the “War on Crime,” has/have been little other than was on civil rights, especially the right to vote,
    among the non-white cohort of the country. We have the “honor?” of having more people incarcerated than the rest of the
    planet combined. And, what percentage of those folks are people are people of color? Who can not vote from prison, who
    may never be able to vote. This is not a coincidence! Ask Sen. Scott how many thousands of people he stripped of voting
    rights in Florida? Ask Gov. Kemp a similar question. Ask….
    The voting issue in these “Wars” can not, IMHO, be separated from the general GOP striving to strip leverage from non-whites.

  19. john sorg; last week I happened to catch 1 hour of 4 hours of a documentary about the Reagans. Nancy said First Lady Jackie Kennedy’s choice of presidential china was ugly so she replaced it. With 420 place settings which cost $1,000.00 each. I’m still shaking my head and rolling my eyes over that waste of tax dollars. I’m still looking at thrift stores and yard sales to add odds and ends of Currier and Ives dishes which were sold here only at the Standard Grocery chain. That grocery chain has been gone for decades…lol

  20. Glad to see so much attention on this important issue. Legalize all drugs. 50 years of the war on drugs and there are more drugs than ever and more abuse of people’s rights than ever. Lets stop the madness.

    Legalization would make it harder for a State of Georgia County Sheriff’ department to pull over the Delaware State University Lacrosse team and randomly search their personal things looking for stuff because the drug dog yelped! Geez….

  21. A very wise choice of topic, Sheila. I picked up one thing I’d like you to do:
    Comment on the ACLU’s embrace of Wokeism. I also served on the ACLU King County/Seattle Board around 1970.

  22. The parallels to the abortion controversy are obvious. If abortion is classified as a sin, it’s treated very differently than if it’s treated as a social/medical issue. More than one study has shown that if women have access to highly effective methods of birth control, both the rate of abortions and the absolute numbers go down. There is no reason to assume that other changes, such as paid parental leave and affordable daycare, would not also reduce the rate and absolute numbers of abortions, AND help prevent the deleterious effects of forced birth on women’s education, employment and poverty levels.

    Treating it as a sin, however, allows conservatives to punish women for having sex, reduce access to medical services for poor women, and gives them a talking point about the godless heathens who advocate SPENDING MONEY to help women who are pregnant and don’t want to be. Oh, and the draconian laws passed by Louisiana, Mississippi and (eventually) Indiana that criminalize abortion have the added benefit of keeping for-profit prisons busy. Win-win! /s

  23. JoAnn.

    I’ll keep my eyes peeled, lol! It will give me something to do in my travels 😁

  24. Terry’s your only tool is a hammer
    patmcc’s for profit prisons
    many comments on racism
    add a bit of CIA profit for operations (under D & R administrations)
    all parts of the puzzle

    Let me add another pet peeve – politics trumps science, because who needs facts or even raw data

    Marijuana is a Schedule 1 drug, meaning no medical use.
    I want to study medical uses for marijuana to prove it should not be a Schedule 1 drug.
    No, I cannot, because it couldn’t possible have medical use because it is a Schedule 1 drug.

    This logic applies to various other drugs that are Schedule 1 but probably have medical uses if the moralistic DEA bureaucracy didn’t rule the roost. Besides, legalizing drugs puts the enforcement bureaucracy out of business, something they have been wary of since the end of prohibition.

  25. The American war on drugs has destabilized Central and South America leading to the ascension of drug gangs that in turn has led to hundreds of thousands fleeing these countries trying to get into the U.S.A. Illegal immigration, separation of families, death of immigrants and private penitentiaries are all the result of the war on drugs, not to mention the death of so many Americans.

Leave a Reply

Your email address will not be published. Required fields are marked *