Review’s Radio: Portugal’s Drug Decriminalization Policy, 18 Years Later: An Interview with Dr. João Goulão

[0:00] Alec Regino: From the McGill International Review, I’m Alec Regino. 

18 year ago, following years of waging war on drug abuse, the Portuguese government took an unorthodox approach to addressing its drug-related issues: it decriminalized ALL of them.

[0:28] João Goulão: We were living in the 90s, we were living the true epidemic mostly caused by heroin use and we had the huge impact of it with overdose deaths with HIV infections, with criminality, petty crimes. Huge impact in everyday life.

[0:45] AR: Dr. João Goulão is a physician and the Director General of the Service for Intervention on Addictive Behaviours and Dependencies in Portugal. He authored the drug policy that decriminalized drugs in 2001. I spoke with him in April during the Institute of Health and Social Policy’s conference on Marijuana Legalization in Canada.

[1:02] Tell me a little bit more about why the government turned to a health-based response to drug abuse.

[1:09] JG: Drugs and drug addiction were very present as the priority for the population. The government started to develop a network of centers for the treatment of drug addicts; lump sum responses— preventive work, treatment facilities, Some re-integration of work. But things didn’t seem to respond. So we’ve felt the lack of a clear guidance to address those problems. In fact we needed a strategy, a comprehensive strategy to address it.

[1:42] AR: Information on the history of drug consumption in Portugal before the 90s generally relies on societal impressions and anecdotal evidence, but the statistics we do have are pretty damning.

In 1999, a staggering 1 percent— a hundred thousand people, were addicted to heroin, and Portugal had the highest rate of drug-related AIDS cases in the EU.

At the onset, Portugal responded to its rising drug problems like most other nations: they increased the length of sentences for offenders and emphasized funding on investigating and prosecuting drug users. Despite government efforts, the fear of being labelled as a criminal dissuaded many from seeking help. The usage of drugs was regarded to be on the same level as dealing them, and syringe and needle exchange programs were illegal.

The rising social pressures, the spread of drug-related diseases, and the large number of users led the government to change strategy.

[2:29] JG: The government invited a group of people, a group of experts to build that strategy and the proposal was some new policies in terms of all mission areas— preventive work, treatment, harm reduction, re-integration but everything based in the idea that we were dealing mostly with a health issue rather than a criminal one. And accordingly we proposed the decriminalization of the use of every drug. So the strategy was approved in 99. The issue of decriminalization had to be discussed at the parliament which happened one year later. And since then all the set of policies was put together.

Well what we can see is that since then, the evolution of all the available indicators has been quite positive. We halved the number of problematic users. We have a drop in HIV infections, in hepatitis, in overdose deaths which is very striking. From one overdose a day, 360 more or less, in the mid 90s… we have in 2016 we have 27 overdoses all over the country during one year. So well it’s not a solved problem in our society I believe, but we are quite happy with the evolution of all the data. The model seems to be effective. I think nowadays, 18 years later, we can say it is effective.

[4:09] AR: So what exactly changed in the general public consensus regarding the way people approached drug abuse?

[4:13] JG: It’s all the mindset you know? Decriminalization contributed to drug stigma and allowed people to discuss drug-related issues in every setting— in families, in schools, in workplaces. If you have problems and you are working in a company, if you admit you have problems, [that] you need to stop and go for treatment. You’d hold your place, you don’t lose your job. And this facilitates everything. So I think the main impact of decriminalization along with the practical issues of being a new gateway to the treatment process is the change in mindset. People tend to admit that drug addiction is a disease with the same dignity as other diseases and patients who suffer from it have the same dignity as patients who suffer from other diseases such as diabetes, or hypertension, or whatever. And this makes all the difference.

[5:23] AR: The results of the change in policy have been striking. In 2000, 1,482 intravenous drug users test positive for HIV. In 2014, that number dropped to 40. As mentioned by Dr. Goulão, the number of overdoses in 2016 was 27. In 1999, it was 369.

Treating drug addiction as a health challenge rather than a crime, made it easier for Portugal to face it head on. Instead of focusing on the difference between hard and soft drugs or attempting to eradicate it all together, the government emphasized the individual and their unhealthy relationship with consumption. For the most part, it seems to have worked.

[5:55] So what are the current challenges in Portugal regarding drug abuse?

[5:58] JG: You know we lived for recently a very strong economic and social crisis during which we had a lot of relapses of ancient heroin users which are much older now. 20 years later they are much older and this poses new kind of challenges. If 20 years ago we developed our reforms in order to bring them back to society completely functional, nowadays with some of them being 60, 70 years old, this poses other kinds of challenges. We feel that our responsibility nowadays is to be with [them] while they get old, with dignity, with access to health care and to the satisfaction of basic needs, but in fact, this is a new challenge so the ageing of population is a new and big challenge.

Another one— the new psychoactive substances we are not very much [affected] by it yet but when we look around and we see other countries that have serious problems, we are preparing to deal with them. The same with some synthetic opioids such as fentanyl that we see happening here in Canada, in other places, in some places of Europe. We do not yet have big problems with it but we are preparing to deal with [it.] And cannabis which is always present. But still more important than cannabis and all those illicit substances, the big challenges come from alcohol abuse which is the traditional drug in our country.”

[7:38] AR: And just talking about the opioid crisis for a second: do you think the legalization of marijuana in Canada will have any striking effect on it?

[7:45] JG: I don’t know. I hope it can have a beneficial influence, I’m not sure, I think genetically we can anticipate that— Yes, but we need to see it. We are following with lots of interest what is going to happen in Canada in the next few months and few years, because we think it’s important to learn with others experiences and such as same way that Portugal became a social laboratory we are now watching very carefully other experiences that are taking place in other parts of the world.

[8:22] AR: That brings up the next thing I actually wanted to ask: Portugal’s drug policies are seen by many as this model for other countries to follow. Do you think other states would be able to enact the exact same structure and policies that Portugal put into practice in their own states?

[8:36] JG: I don’t know if it’s even convenient that other countries just copy-paste. I think the two countries have different cultures, different histories and they must adapt to different experiences to their own reality. Anyway I believe that for instance in Norway it’s coming, the adoption of a model very similar to the Portuguese one. The same happened in the Czech Republic. We are happy to share our experience and to share our results to the different countries to adopt. But there’s a clear and important trend that we believe that we very much influenced.  This is the trend of changing the focus of the drug policy from prosecution, from justice, home affairs, into the health system. And this is a big victory I believe.”

[9:25] AR: So what are the basic reforms in justice or health care that you would recommend for a country like Canada for example, which is currently in the process of legalizing marijuana? What are the key lessons from Portugal that we can take away?

[9:34] JG: Once again we have different societies and different organizations. But I believe that it is crucial to have health responses available for those in need of it. Because problems will arise whatever is the framework of the substances so we will also always have people who suffer from addiction. It does not depend on the legal status of the substance. So having health responses available, easily accessible, for free if possible, is crucial in my view to prepare the ground for any change.

[10:12] AR: Dr. Goulão, thank you very much for talking with me.

That’s it from the McGill International Review. I’m Alec Regino. Thank you for listening.