Tag Archives: medical versus criminal

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.