US considers Portugal's new drug policy
The country changed drugs from criminal issue to a public health one in hopes of keeping them off the black market
By Barry Hatton and Martha Mendoza
LISBON, Portugal — These days, Casal Ventoso is an ordinary blue-collar community — mothers push baby strollers, men smoke outside cafes, buses chug up and down the cobbled main street.
Ten years ago, the Lisbon neighborhood was a hellhole, a "drug supermarket" where some 5,000 users lined up every day to buy heroin and sneak into a hillside honeycomb of derelict housing to shoot up. In dark, stinking corners, addicts — some with maggots squirming under track marks — staggered between the occasional corpse, scavenging used, bloody needles.
At that time, Portugal, like the junkies of Casal Ventoso, had hit rock bottom: An estimated 100,000 people — an astonishing 1 percent of its population — were addicted to illegal drugs. So, like anyone with little to lose, the Portuguese took a risky leap: They decriminalized the use of all drugs in a groundbreaking law in 2000.
Now, the United States, which has waged a 40-year, $1 trillion war on drugs, is looking for answers in tiny Portugal, which is reaping the benefits of what once looked like a dangerous gamble. White House drug czar Gil Kerlikowske visited Portugal in September to learn about its drug reforms, and other countries — including Norway, Denmark, Australia and Peru — have taken interest, too.
"The disasters that were predicted by critics didn't happen," said University of Kent professor Alex Stevens, who has studied Portugal's program. "The answer was simple: Provide treatment."
Drugs in Portugal are still illegal. But here's what Portugal did: It changed the law so that users are sent to counseling and sometimes treatment instead of criminal courts and prison. The switch from drugs as a criminal issue to a public health one was aimed at preventing users from going underground.
Other European countries treat drugs as a public health problem, too, but Portugal stands out as the only one that has written that approach into law. The result: More people tried drugs, but fewer ended up addicted.
Here's what happened between 2000 and 2008:
— There were small increases in illicit drug use among adults, but decreases for adolescents and problem users such as drug addicts and prisoners.
— Drug-related court cases dropped 66 percent.
— Drug-related HIV cases dropped 75 percent. In 2002, 49 percent of people with AIDS were addicts; by 2008 that number fell to 28 percent.
— The number of regular users held steady at less than 3 percent of the population for marijuana and less than 0.3 percent for heroin and cocaine — figures that show decriminalization brought no surge in drug use.
— The number of people treated for drug addiction rose 20 percent from 2001 to 2008.
Portuguese Prime Minister Jose Socrates, one of the chief architects of the new drug strategy, says he was inspired partly by his own experience of helping his brother beat an addiction.
"It was a very hard change to make at the time because the drug issue involves lots of prejudices," he said. "You just need to rid yourselves of prejudice and take an intelligent approach."
Officials have not yet worked out the cost of the program, but they expect no increase in spending, since most of the money was diverted from the justice system to the public health service.
In Portugal today, outreach health workers provide addicts with fresh needles, swabs, little dishes to cook up the injectable mixture, disinfectant and condoms. But anyone caught with even a small amount of drugs is automatically sent to what is known as a Dissuasion Committee for counseling. The committees include legal experts, psychologists and social workers.
Failure to turn up can result in fines, mandatory treatment or other sanctions. In serious cases, the panel recommends the user be sent to a treatment center.
Health workers also shepherd some addicts off the streets directly into treatment. That's what happened to 33-year-old Tiago, who is struggling to kick heroin at a Lisbon rehab facility.
Tiago, who requested that his first name only be used to protect his privacy, started taking heroin when he was 20. He shot up four or five times a day, sleeping for years in an abandoned car where, with his addicted girlfriend, he fathered a child he has never seen.
At the airy Lisbon treatment center where he now lives, Tiago plays table tennis, surfs the Internet and watches TV. He helps with cleaning and other odd jobs. And he's back to his normal weight after dropping to 50 kilograms (110 pounds) during his addiction.
After almost six months on methadone, each day trimming his intake, he brims with hope about his upcoming move to a home run by the Catholic church where recovered addicts are offered a fresh start.
"I just ask God that it'll be the first and last time — the first time I go to a home and the last time I go through detox," he said.
Portugal's program is widely seen as effective, but some say it has shortcomings.
Antonio Lourenco Martins is a former Portuguese Supreme Court judge who sat on a 1998 commission that drafted the new drug strategy and was one of two on the nine-member panel who voted against decriminalization. He admits the law has done some good, but complains that its approach is too soft.
Francisco Chaves, who runs a Lisbon treatment center, also recognizes that addicts might exploit goodwill.
"We know that (when there is) a lack of pressure, none of us change or are willing to change," Chaves said.
Worldwide, a record 93 countries offered alternatives to jail time for drug abuse in 2010, according to the International Harm Reduction Association. They range from needle exchanges in Cambodia to methadone treatment in Poland.
Vancouver, Canada, has North America's first legal drug consumption room — dubbed as "a safe, health-focused place where people inject drugs and connect to health care services." Brazil and Uruguay have eliminated jail time for people carrying small amounts of drugs for personal use.
Whether the alternative approaches work seems to depend on how they are carried out. In the Netherlands, where police ignore the peaceful consumption of illegal drugs, drug use and dealing are rising, according to the European Monitoring Centre for Drugs and Drug Addiction. Five Dutch cities are implementing new restrictions on marijuana cafes after a wave of drug-related gang violence.
However, in Switzerland, where addicts are supervised as they inject heroin, addiction has steadily declined. No one has died from an overdose there since the program began in 1994, according to medical studies. The program is also credited with reducing crime and improving addicts' health.
The Obama administration firmly opposes the legalization of drugs, saying it would increase access and promote acceptance, according to drug czar Kerlikowske. The U.S. is spending $74 billion this year on criminal and court proceedings for drug offenders, compared with $3.6 billion for treatment.
But even the U.S. has taken small steps toward Portugal's approach of more intervention and treatment programs, and Kerlikowske has called for an end to the "War on Drugs" rhetoric.
"Calling it a war really limits your resources," he said. "Looking at this as both a public safety problem and a public health problem seems to make a lot more sense."
There is no guarantee that Portugal's approach would work in the U.S., which has a population 29 times larger than Portugal's 10.6 million.
Still, an increasing number of American cities are offering nonviolent drug offenders a chance to choose treatment over jail, and the approach appears to be working.
In San Francisco's gritty Tenderloin neighborhood, Tyrone Cooper, a 52-year-old lifelong drug addict, can't stop laughing at how a system that has put him in jail a dozen times now has him on the road to recovery.
"Instead of going to smoke crack, I went to a rehab meeting," he said. "Can you believe it? Me! A meeting! I mean, there were my boys, right there smoking crack, and Tyrone walked right past them. 'Sorry,' I told them, 'I gotta get to this meeting.'"
Cooper is one of hundreds of San Franciscans who landed in a court program this year where judges offered them a chance to go to rehab, get jobs, move into houses, find primary care physicians and even remove their tattoos. There is enough data now to show that these alternative courts reduce recidivism and save money.
Between 4 and 29 percent of drug court participants in the United States will get caught using drugs again, compared with 48 percent of those who go through traditional courts.
San Francisco's drug court saves the city $14,297 per offender, officials said. Expanding drug courts to all 1.5 million drug offenders in the U.S. would cost more than $13 billion annually, but would return more than $40 billion, according to a study by John Roman, a senior researcher at the Urban Institute's Justice Policy Center.
The first drug court opened in the U.S. 21 years ago. By 1999, there were 472; by 2005, 1,250.
This year, new drug courts opened every week around the U.S., as states faced budget crises exacerbated by the high rate of incarceration for drug offenses. There are now drug courts in every state, more than 2,400 serving 120,000 people.
Last year, New York lawmakers followed their counterparts across the U.S. who have tossed out tough, 40-year-old drug laws and mandatory sentences, giving judges unprecedented sentencing options. The U.S. Department of Health and Human Services is also training doctors to screen patients for potential addiction and reimbursing Medicare and Medicaid providers who do so.
Arizona recently became the 15th U.S. state to approve medical use of marijuana, following California's 2006 legislation.
In Portugal, the blight that once destroyed the Casal Ventoso neighborhood is a distant memory.
Americo Nave, a 39-year-old psychologist, remembers the chilling stories his colleagues brought back after the first team of health workers was sent into Casal Ventoso in the late 1990s. Some addicts had gangrene, and their arms had to be amputated.
Those days are past, though there are vestiges. About a dozen frail, mostly unkempt men recently gathered next to a bus stop to get new needles and swabs in small green plastic bags from health workers, as part of a twice-weekly program. Some ducked out of sight behind walls to shoot up, and one crouched behind trash cans, trying to shield his lighter flame from the wind.
A 37-year-old man who would only identify himself as Joao said he's been using heroin for 22 years. He has contracted Hepatitis C, and recalls picking up used, bloody needles from the sidewalk. Now he comes regularly to the needle exchange.
"These teams ... have helped a lot of people," he said, struggling to concentrate as he draws on a cigarette.
The decayed housing that once hid addicts has long since been bulldozed. And this year, Lisbon's city council planted 600 trees and 16,500 bushes on the hillside.
This spring they're expected to bloom.