Let’s Try Portugal’s Solution to the Heroin Epidemic

Maureen MurdockAddiction, Criminal Justice System3 Comments

Last year approximately 64,000 Americans died of overdoses, as many as were killed in the Vietnam, Afghanistan and Iraq Wars combined.

More than fifteen years ago both Portugal and the U.S. were struggling with illicit drug use. The U.S. cracked down, spending billions of dollars incarcerating drug users. Portugal, on the other hand, decriminalized the use of all drugs in 2001. At the same time, it unleashed a major public health campaign to tackle addiction, treating it as a medical issue rather than as a criminal justice issue.

Guess whose approach is more successful?

Portugal’s drug mortality rate is the lowest in Western Europe––1/10th the rate of Britain or Denmark and 1/50th the number for the U.S. The Portuguese Health Ministry estimates that only about 25,000 Portuguese use heroin down from 100,000 when the policy began.

Mobile vans cruise Lisbon’s streets everyday and supply users with methadone, an opioid substitute, to stabilize their lives and enable them to work. Methadone treatment programs exist in the U.S. but are often expensive or difficult to access. Only 10% of Americans struggling with addiction get treatment; in Portugal, treatment is standard for all.

Decriminalization in Portugal has made it easier to fight infectious diseases and treat overdoses. In 1999, Portugal had the highest rate of drug-related AIDS in the European Union; since then H.I.V. diagnoses due to I.V. drug use have fallen by 95%. Medical workers go into the most drug-infested neighborhoods to pass out clean needles and urge users to try methadone. One crucial mistake that Portuguese doctors did not make was to follow the U.S. in adopting prescription opioid painkillers for routine use. Portuguese doctors resisted overprescribing and regulators also stood in the way.

Portugal switched to its health focus under the leadership of a socialist prime minister named Antonio Guterres, who is now the United Nations secretary general.

“We were facing a devastating situation so we had nothing to lose,” said Joao Castel-Branco, a public health expert and architect of the policy. Under the decriminalization law, dealers still go to prison and drugs are still illegal, but the purchase or possession of small quantities (up to a 10-day supply) of any drug, including heroin, is considered an administrative offense, like a traffic ticket. Instead of going to jail, the person gets mandatory medical treatment. Offenders are summoned to a “Dissuasion Commission” hearing where they meet with social workers who try to prevent a casual user from becoming addicted.

According to a NY Times article by Nicholas Kristof, the Portuguese approach is so attractive because it’s much cheaper to treat people than to jail them. The Portuguese Health Ministry spends less than $10 per citizen per year compared to the U.S. which spends approximately more than $1 trillion over decades of a failed drug policy that results in more than 1,000 deaths each week. The public health approach arises from an increasing common worldwide view that addiction is a chronic disease, comparable to diabetes, and requires medical care, not incarceration.

The lesson Portugal is teaching the world is that while we can’t eradicate heroin, we can begin to save the lives of drug users by treating them as human beings who are suffering rather than punishing them by locking them up without treatment.

 

For more info go to: https://www.nytimes.com/2017/09/22/opinion/sunday/portugal-drug-decriminalization.html?emc=eta1&_r=0

http://www.npr.org/sections/parallels/2017/04/18/524380027/in-portugal-drug-use-is-treated-as-a-medical-issue-not-a-crime

3 Comments on “Let’s Try Portugal’s Solution to the Heroin Epidemic”

  1. Seems ironic, but perhaps a blessing, that the epidemic is hitting many Republican conservative states very hard, and has the attention of Republican governors Christie of New Jersey and Katich of Ohio, and Republican Senator Portman of Ohio, who are advocating for a more sensible approach to this tragedy. Unfortunately Atty. Gen. Sessions stands in the way. Thanks for showing how a sensible system (Portugal’s) works. We have to keep trying.

  2. Wow! No fake news here. The statistics and stories show tremendous evidence that this approach makes a whole lot more sense. I have a brother visiting San Francisco who was shocked by the amount of homeless people and people openly using drugs on the street, including heroin, and the utter mess that their lives are, not to mention the mess they make on the street. It would be so much more compassionate, not to mention economical, as you indicate, Maureen, to learn from Portugal’s method of coping with this health crisis in our nation.

  3. As always — Thank You Dr. Murdock for continuing to inform us about drug addiction, it source causes and it’s punitive responses from the US.

    The humanistic and informed approach by the government of Portugal proved effective. With the pharmaceutical Industry’s gripping influence over the US legislators, the US thus far takes a punitive, crippling, de-humanizing, and criminalizing approach with very limited and disasterous results . Perhaps statistics will force US legislators to shift its tactics toward human life rather than pocketed $$$$ profits. — JMorgan Elliott

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