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Lessons from Portugal

In early October, the New York Times put out an article by Austin Frakt about Portugal’s drug policy. Portugal has long been cited by advocates as a country to possibly emulate in terms of their drug law and policy as they have taken a treatment based model toward illicit drug use. Below are some highlights from the article as well as some notes on limitations or factors that need to be explored further. The full article can be accessed here.

Portugal has taken a different stance toward illicit drugs when compared to many countries in the world. Portugal’s laws have decriminalized (not legalized) illicit drugs in small quantities for the past 19 years. This has given researchers time to study the impact of these policy changes. Advocates have long called for Portugal’s model to be emulated, especially in the United States. This includes their laws and policies but also their expansion of treatment. Austin Frakt’s New York Times article lays out some of the benefits seen in Portugal, seemingly associated with their model, below are the highlights:

-In 2001 Portugal decriminalized use of all illicit drugs in small amounts. Drug trafficking was not decriminalized.

-Incarceration for drug charges was removed but local penalties are still imposed by medical panels which could include treatment referrals and community service.

-The number of people receiving substance use disorder treatment rose after decriminalization. By 2008, 75% of those in treatment for opioid use disorders received medication assisted treatment.

-Portugal made investments in harm reduction and treatment. Studies show in the US, money spent on treatment saves money in crime reduction and money spent on syringe exchange programs saves 6x as much on HIV related costs.

-Overdose deaths and new cases of infectious disease such as Hepatitis C and HIV in Portugal dropped.

-Prison overcrowding decreased.

While treating addiction strictly as a disease and not a criminal behavior has led to some of the above benefits, it isn’t without other factors to consider. Studies have shown that after decriminalization experimentation rates with illicit substances rose and murder rates and drug trafficking increased for 5 years after.  Trends after decriminalization could also be continuation of trends before decriminalization as Portugal previously had a more treatment related stance against drugs.

Is this type of system able to be replicated in the United States? Some things to consider not fully explored in the article include the following. The United States population is significantly larger and contains different demographic make ups than Portugal. The United States is also geographically significantly larger and has more and different border contacts or ports of entry for substances. There are a number of other socio-political ills that may contribute to substance use disorder prevalence, development, progression, and treatment (or lack thereof). Attitudes toward the use and criminalization of substances are relaxing, but criminalization and substance use being related to poor personal choice are still prevalent viewpoints in the United States. The culture of United States in terms of its current laws and their enforcement has been punishment based and not treatment based.  Small steps will slowly change attitudes and policy, but the punitive and judgmental view currently taken by the United States against substance use is baked throughout the system and will take a significant overhaul to change via policy and action, never mind trying to change people’s personal viewpoints.

What do you think? What lessons from Portugal can be learned? Let us know.

Chris Dorian, Founder of Know Your Why Recovery

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