In Portugal, drug addiction is treated as a disease – not a crime. Could that make all the difference?
On a broken-down set of steps, a 37-year-old fisherman named Mario mixes heroin and cocaine and carefully prepared a hypodermic needle. “It’s hard to find a vein,” he says, but he finally found one in his forearm and injected himself with the brown liquid. Blood trickled from his arm and pooled on the step, but he was oblivious.
“Are you OK?” Rita Lopes, a psychologist working for an outreach program called Crescer, asks him. “You’re not taking too much?” Lopes monitors Portuguese heroin users like Mario, gently encourages them to try to quit and gives them clean hypodermics to prevent the spread of Aids.
Decades ago, the United States and Portugal both struggled with illicit drugs and took decisive action – in diametrically opposite directions. The US cracked down vigorously, spending billions of dollars incarcerating drug users. In contrast, Portugal undertook a monumental experiment: it decriminalised 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 US drug policy has 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 enpding 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 per cent, 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 of the latest number in the US.
I came to Portugal to talk with drug dealers, users and public health experts, because this nation has become a model for a drug policy that is not only compassionate but also effective.
It’s not a miracle or perfect solution. But if the US could achieve Portugal’s death rate from drugs, they would save one life every 10 minutes. They would save almost as many lives as are now lost to guns and car accidents combined.
This issue is personal to me, because my hometown in rural Oregon has been devastated by methamphetamines and, more recently, by opioids. Classmates have died or had their lives destroyed; my seventh-grade crush is now homeless because of her addictions.
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, a 53-year-old former typesetter who became hooked on heroin 30 years ago, tells me as he sips 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 stabilise their lives and enable them to hold jobs.
Methadone and other drug treatment programs also exist in the US, but are often expensive or difficult to access. The result is that only 10 per cent of Americans struggling with addiction get treatment; in Portugal, treatment is standard.
“If I couldn’t come here, I don’t know if I’d still be alive,” Oliveira told me. He said that he used to steal to support his habit, but is now getting his life under control. Two weeks ago, he began reducing his dose of methadone, and he hopes to wean himself off opioids completely.
Yet Portugal’s approach is no magic wand.
“I’m homeless and jobless and addicted again,” Miguel Fonseca, a 39-year-old electrical mechanic, says as he holds a lighter under a sheet of tin foil, to turn a pinch of heroin powder into fumes that he smokes to get high. He spends about $100 (£76) a day on his habit, and in the past has sometimes turned to theft to support it.