Tag Archives: Opiods

Lessons From Portugal

Note to those who previously ordered Living Together: I apologize for the formatting. (Never self-published before–publishers always fixed spacing, etc.). I’ve deleted and republished, and hopefully those who order from now on will receive a nicer-looking text. (Contents haven’t changed.)

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Remember when it was possible to believe that the United States was a leader among nations?

I have no intention of enumerating all the lessons we Americans have stubbornly refused to learn because, after all, what could those foreigners have to teach superior-by-definition us? (Think education, gun control, transportation, urban planning…)

But given our struggles with Opiod addiction, and our counterproductive approach to marijuana, it might be timely to take a look at  how things are going in Portugal. Portugal decriminalized drugs in 2001, taking what it called a “Health and Human-Centered Approach.”

So how’s that working out?

Since Portugal enacted drug decriminalization in 2001, the number of people voluntarily entering treatment has increased significantly, overdose deaths and HIV infections among people who use drugs have plummeted, incarceration for drug-related offenses has decreased, and rates of problematic and adolescent drug use have fallen.

Meanwhile, the U.S. is facing an overdose crisis and resistance to common-sense reforms.

In March 2018, some 17 years into Portugal’s experiment, America’s Drug Policy Alliance took 70 U.S. reformers to Portugal. The trip was billed as an opportunity for drug policy reform advocates to determine whether a dramatically different approach to drugs might be more effective than criminalization. (Spoiler alert: it is.)

Some definitions and conclusions from the group’s subsequent report:

Drug decriminalization is defined as the elimination of criminal penalties for drug use and possessionof drugs for personal use, as well as the elimination of criminal penalties for the possession of equipment used for the purpose of introducing drugs into the human body, such as syringes. ….

While several other countries have had successful experiences with decriminalization–including the Czech Republic, Spain and the Netherlands –Portugal provides the most comprehensive and well-documented example. The success of Portugal’s policy has opened the door for other countries to rethink the practice of criminalizing people who use drugs. Canada, France, Georgia, Ghana, Ireland and Norway are all currently discussing ways to end criminalization of personal drug use….

Under the policy, when police come across people who are using or possessing drugs, they confiscate their substances and refer them to a Dissuasion Commission. This Commission is comprised of one official from the legal arena and two from the health or social service arenas who determine whether and to what extent the person demonstrates dependency on drugs.

These Commissions –which operate independently from the criminal justice system –make decisions on a case-by-case basis. If the committee believes the person’s use of drugs is not a problem, they can simply dismiss the case and the application of sanctions altogether. Alternatively, they can impose administrative sanctions that range from fines to social work or group therapy. The majority of people who appear before the Commissions are deemed to be using drugs non-problematically and receive no sanction or intervention, but rather a provisional suspension of the proceedings.

If they are not found in the possession of drugs again within six months, the matter is completely dropped. For people who appear to use drugs frequently and problematically, the Commissions will make referrals to treatment, which is always voluntary and never mandated. If people with substance use disorder opt not to enter treatment, administrative sanctions –such as the revocation of a driving license or community service –can be applied, but rarely are.

Meanwhile, back in the good old U.S. of A…

In the United States, the dominant approach to drug use is criminalization and harsh enforcement, with1.4 million arrests per year for drug possession for personal use. Disproportionately, those arrested are people of color: black people are three times as likely as white people to be arrested for drug possession for personal use.

The impact of these arrests and convictions goes well beyond possible incarceration, to include a range of barriers to access to housing, education and employment. The ripple effect throughout families and communities is devastating.

Given how intensely criminalization targets black and brown people in the U.S., it amounts to a form of systemic oppression. Meanwhile, criminalization means that few resources have been devoted to providing treatment, access to health services, and support to those who need it. For low-income people of color, such services and support are often non-existent.

Portugal’s approach is based upon the understanding that drugs are a public health issue, not a criminal justice issue–and Portugal has demonstrated that its approach works.

Ours doesn’t. But Americans make policy on the basis of religion and ideology, not evidence.