Why Portugal is proud of its liberal drug laws

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Health workers in Lisbon supply clean syringes to addicts. James Glossop for The Times.
Health workers in Lisbon supply clean syringes to addicts. James Glossop for The Times.

Chris Smyth Health Correspondent in Lisbon
April 22 2011 12:01AM

On one side of the road, addicts openly inject heroin in the wasteland between bricked-up houses. On the other, elderly women go about their grocery shopping while a young girl plays in the street. A police car cruises by without stopping.

Here, in the Casal Ventoso area of Lisbon, the visitor treads gingerly across a carpet formed by the detritus of drugs: vials, wrappers and packets — but no syringes.

Portugal has decriminalised all drugs, in a bold experiment that is attracting attention around the world. But that does not mean that addicts are ignored. Teams of health workers exchange new needles for old, chatting and advising users as they do so. The Times listens in on a lengthy discussion of the merits of a new design of crack pipe being piloted by the Ministry of Health.

“Our intervention is based on the relationship we create. We exchange syringes, we talk about their lives and the risks they take. We talk about treatment and what they want from life,” explained Elisabete Moutinho of the Crescer Na Maior street team. “We have taken people to hospital when they could have died on the street. There are almost no needles on the ground. That didn’t happen years ago. It’s working.”

The statistics seem to agree. In July it will be ten years since Portugal adopted the developed world’s most liberal drug laws. Fewer young people are trying drugs. New HIV cases among drug users are down from 907 in 2000 to 267 in 2008. Overdoses and drug deaths are down, and Portugal has one of the lowest usage rates in Europe.

A study published in British Journal of Criminology last year, concluded that Portugal was “a model for other nations that wish to provide less punitive, more integrated and effective responses to drug use”.

Officials from Britain and numerous other countries have beaten a path to Lisbon to see how decriminalisation — which opponents predicted would lead to plane-loads of drug tourists descending on the country — has become a quiet success.

João Goulão, who was part of the group that developed the reforms and now runs Portugal’s drug agency, said that the law was the least important part of the country’s approach to drugs. “If you had decriminalisation without doing anything else, it probably would have been a disaster,” he said.

He argues that the essence of their approach is to see drug use neither as a crime, nor as a harmless diversion, but as a medical problem.

“The way we think about this has changed completely. We look at this problem as we look at diabetes for instance. It’s a chronic relapsing illness and you try to keep people in balance,” he said.

“Thinking about drugs is still too much linked to moral approaches. It’s seen as a self-inflicted disease. But obesity and diabetes are also linked to behaviour and you don’t have the same moral charge when looking at those health problems. We proposed decriminalisation because it made sense for [addicts] to be in healthcare rather than the criminal system.”

Experts still debate how much impact the law actually has had — evidence from around Europe shows little correlation between laws and drug use. But almost all agree that Portugal disproves the argument that liberal drug laws must lead to more drug use.

In Casal Ventoso, young addicts are strikingly rare. All those approached by The Times had begun using in the 1990s, before the law was changed, and all had been offered treatment.

Maria Manuela Pereira, 37, who has been using heroin for more than 20 years, said: “I used to see young people and teenagers. Now I don’t. It’s older people.” Police are a much less visible presence, she says.

Like many others, Ms Pereira had stopped using drugs for years before personal problems brought her back to the streets. “I’m taking methadone as well, and it helps,” she said. “We get treatment if we need it. But if I don’t want to stop, there’s no treatment.”

For those who do want to get better, detox, rehabilitation and therapy are widely available.

Miguel Vasconcelos, a psychiatrist at the Júlio de Matos Hospital in Lisbon, argues that the Portuguese approach is effective because it integrates prevention, treatment, harm reduction and rehabilitation, without the criminal law getting in the way. If doctors and addicts seem happy with the system, so too do the public.

“In polls, drugs was the first concern in the late 1990s. Now it is thirteenth,” Dr Goulão said. “We feel very comfortable with what has evolved.” The opposition parties, who decried decriminalisation in 2001, made no move to reverse it during a spell in power in the mid-2000s.

José Sócrates, the outgoing Prime Minister, even made a speech during the 2009 election campaign boasting of his role in introducing the reforms.

The police, initially sceptical, now back decriminalisation. “We feared an explosion in consumption and the rise of drug tourism. It didn’t happen,” said Chief Inspector José Figueira of the anti-trafficking unit in Lisbon. He says that leaving users alone frees up more resources to chase smugglers and dealing, which remain illegal. Petty crime is down, and the pressure has also eased on Portugal’s prisons.

Exact figures are unavailable, but some argue that the reduced burden on the criminal justice system compensates for the annual €75 million (£66 million) cost of the health programmes.

Unlike in the Netherlands, where the sale of cannabis in “coffee shops” is tolerated, drug dealing remains a crime punishable by long jail sentences. In theory, police too are not meant to ignore users but refer them to “dissuasion boards” run by the Ministry of Health, which educate users about the risks of drugs, refer addicts to treatment, and can fine or impose ASBO-style orders on persistent recreational users.

Nuno Portugal Capaz, the vice-president of the Lisbon commission, argues: “It’s better than the criminal system. The judicial system works on the basis that if you are given a penalty you won’t do it again. Drug addicts aren’t like that.”

He believes that for many addicts the commissions can be a springboard for treatment. “It’s quite rewarding when people say that we were the push that they were waiting for.”

(originally from here ... Copyright - The Times)

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