Portugal’s drug policy gets a lot of attention as a model policy, but details get considerably less attention. I watched this Brookings seminar a few weeks ago. It was a great opportunity to hear about it straight from the source.
I decided to pull together some highlights for all of you.
The role of harm reduction
Dr. João Castel-Branco Goulão is the Portuguese Drugs and Alcohol National Coordinator and Director General of the Intervention on Addictive Behaviours and Dependencies General Directorate (SICAD). He discusses the role and definition of harm reduction. [Very lightly edited for readability. Emphasis mine.]
“This sign from the Biden administration is very, very positive — admitting harm reduction policies. We defined it (HR) in our strategy back in 1999 as a set of policies that recognizes that even if someone is not able to stop using drugs, then he or she deserves the investment of the state in order to have a better life, and a longer life. Harm reduction is a set of strategies that allow health professionals to approach these less oriented, or less organized people, and contribute to improving their health and, whenever possible, to contribute to addressing these people for treatment and to stop using, and to have a real change in their lives. So we believe this is a very important step to recognize harm reduction as one of the components of their policies”
Portugal’s drug policy
Dr. Goulão describes the Portuguese model and it’s implementation. [Very lightly edited for readability. Emphasis mine.]
…people tend to think that we just legalized all drugs that using drugs in Portugal is completely free. That’s not the case. We propose the decriminalization of drugs but not depenalization. In fact, in 2000, we only changed one article of our previous drug law. That is the article that deals with personal drug use and possession for personal use. All the rest remains the same as it was since 1993. What changed here is that using drugs is no longer a crime, but it is prohibited under the administrative law. In practice we can compare the law enforcement of using drugs to the use (or not use) of the safety belt when you drive. If you do not wear your safety belt (which is something that is intended to protect your integrity [safety?]) the police officer officer still stops you, and may apply a fine. In theory, they may impose that you attend a training course for for drivers, but you do not get a criminal record that stands for life and stigmatizes you for the rest of your life, and you never end up in prison, and that makes really the difference. We have different conditions from yours. We have a universal health system — free, easily accessible for everybody without the the difficult issues of insurances and coverage. We have the [service] capacity because we were developing a network of services to to address drugs problems far before the approval of the strategy. We had the system in place when we decriminalized, so it was much easier to to address people with drug-related problems for treatment when needed, and to offer all the services, and all the support that they may need.
Let me briefly explain how the system works, in practice. If someone is intercepted by a police authority using drugs, or in possession of small amounts of drugs… we have a table with the with the threshold limit for the the amount of drugs that someone can have on him or her. If he has more than that he undergoes criminal procedures, as before. In a trial, we must define if there was traffic activity or not. But, if we have less than that amount we are just addressed to a commission, which we call the Commission for the Dissuasion of Drug Addiction. We have one on each district. We have 18 districts in in mainland Portugal, plus one in Madeira and others in Azores. You must attend that commission within 72 hours, where you have an interview with a panel of of health personnel and you must discuss your drug use.
Where it is possible to identify the needs of that person, [for example,] is he or she someone addicted and dependent on drugs and in need of treatment? If so, they are invited–not compulsory–but are invited to assessment treatment needs, but he’s free to refuse–“Okay, I don’t need. I don’t want.” [We say,] “It’s up to you, but please don’t come back here in the next few months, otherwise I will have to apply a penalty.” There’s a long list of penalties from fines to other administrative sanctions.
But, if you are not an addicted person, that’s where the the efforts of the commission are most important, is in trying to identify other factors in your life that, along with drug use, may lead you to a more problematic use later on. [The user may say,] “Okay, I have no problems with drugs. I smoke a joint with my friends on weekends–no problems, no addiction. But, my parents are divorcing, or my father just lost his job, or I have some psychological problems I’m having difficulties dealing with.” Then, the commission can direct the person to other responses in society that may help this person to deal with those difficulties and solve them, if possible. With this, we can prevent the drug use from turning much more problematic later on.
This is how we deal with it. Those commissions are an instance of an indicated prevention tool where we can make contact with people that otherwise are not touched by the health system. Then we can direct the person to the adequate responses.