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

Maureen MurdockAddiction, Criminal Justice System5 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

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

  1. Examining our current Opioid Epidemic led me to incorporate your (Maureen Murdock’s) work into my Master’s Thesis. I deeply believe that Heroin is calling to the Heroine within each of us to heal the deep wounds we carry… Thanks SO much for your work! We simply MUST look for fresh new approaches… Abstract from my thesis:

    “Attempting to numb our pain is yielding tragic results in society today- Pain continues, Addiction rages, and People are dying! My hypothesis is that the current pain scale is fueling the opioid crisis. Pain is viewed as the enemy, with the single goal of silencing it, at any cost. By flipping the pain scale, I am offering a new Vision- “Comfort Quest” where valuable energy is focused on real solutions- uncovering root causes, understanding pain’s messages, and empowering the body to heal.

    In this work, I explore current allopathic approaches to pain management in Section One- Analysis to Paralysis which has focused for decades on reactive Pathogenesis (silencing pain). Realizing that “Problems cannot be solved with the same mindset that created them”, I offer Salutogenesis as a proactive theory in which physical, mental, and social well-being are cultivated. Neuroscience, quantum physics, energy medicine and positive psychology all support this transformative, new vision.

    In Section Two, Our Heroine’s Journey, I embrace my intuition and offer feminine wisdom as a healing potion for pain and addiction today. An adventure of nine chapters unfolds in which the rejected feminine (feeling) endures various trials, the illusion of success, dark descent, and eventual reintegration with the masculine (with heart). It is through the union of the complementary nature of the healthy masculine and feminine that the goals of authentic wholeness and well-being are achieved.”

    The “Comfort Quest” vision (flipped pain scale) can be viewed at http://www.nursesempoweringhealth.com along with a link to recently published article.

  2. 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.

  3. 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.

  4. 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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