Drug Decriminalization In Portugal
Drug Decriminalizationin PortugalLearning from a Health andHuman-Centered ApproachPrepared By:Drug Policy Alliance131 West 33rd Street15th FloorNew York, NY 10001drugpolicy.org
Drug Decriminalization in Portugal:Learning from a Health and HumanCentered ApproachPortugal has received global attention for itsgroundbreaking and comprehensive drugdecriminalization program launched in 2001 inresponse to a public health crisis. In 1999, Portugalhad the highest rate of drug-related AIDS in theEuropean Union, the second highest prevalence ofHIV among people who inject drugs, and drugoverdose deaths were rapidly increasing.Since Portugal ceased criminalizing drug use, theresults have been dramatic.1 The number of peoplevoluntarily entering treatment has increasedsignificantly, while overdose deaths, HIVinfections, problematic drug use, and incarcerationfor drug-related offenses have plummeted.Drug decriminalization is defined as theelimination of criminal penalties for drug useand possession of drugs for personal use, aswell as the elimination of criminal penalties forthe possession of equipment used for thepurpose of introducing drugs into the humanbody, such as syringes.While several other countries have had successfulexperiences with decriminalization – including theCzech Republic, Spain and the Netherlands –Portugal provides the most comprehensive andwell-documented example. The success ofPortugal’s policy has opened the door for othercountries to rethink the practice of criminalizingpeople who use drugs. Canada, France, Georgia,Ghana, Ireland and Norway are all currentlydiscussing ways to end criminalization of personaldrug use.In March 2018, the Drug Policy Alliance (DPA) leda delegation of 70 U.S. advocates to Portugal tolearn from its health and human centered approachto drug use. This diverse group included manyindividuals and groups representing those hithardest by the drug war – from those who havebeen incarcerated for drug offenses to those whohave lost loved ones to an overdose. They live incommunities across the U.S., including NewOrleans; Mississippi; Durham, North Carolina; SanDrug Decriminalization in Portugal:Learning from a Health andHuman-Centered ApproachJuan, Puerto Rico; Chicago; Los Angeles; NewYork and San Francisco, and represent more than35 advocacy and community organizations workingon racial justice, criminal justice reform and harmreduction.In the United States, the dominant approach todrug use is criminalization and harsh enforcement,with 1.4 million arrests per year for drug possessionfor personal use. Disproportionately, those arrestedare people of color: black people are three times aslikely as white people to be arrested for drugpossession for personal use.2 The impact of thesearrests and convictions goes well beyond possibleincarceration, to include a range of barriers toaccess to housing, education and employment.The ripple effect throughout families andcommunities is devastating. Given how intenselycriminalization targets black and brown people inthe U.S., it amounts to a form of systemicoppression.Meanwhile, criminalization means that fewresources have been devoted to providingtreatment, access to health services, and support tothose who need it. For low-income people of color,such services and support are often non-existent.By visiting Portugal and learning from a differentapproach, DPA’s delegation sought to explore waysthe U.S. could also move toward dismantling thedrug war and replacing it with a drug policy thatfocuses on health and puts human beings at itscenter.Over three days, the delegation met with JoãoGoulão, the Portuguese General Director forIntervention on Addictive Behaviors andDependencies and chief architect of the Portuguesemodel. They also met with experts from theMinistry of Public Health, NGO leaders, peoplewho use drugs, and people who had beenincarcerated for their drug use. The group visitedthe largest drug treatment center in Lisbon andtoured methadone maintenance vans locatedthroughout the city. They also shadowed harmreduction street teams that do direct interventionwith people who inject drugs, includingimmigrants, chronically homeless people and sexworkers.2www.drugpolicy.org
Advocates also observed a “DissuasionCommission” session, where people who are foundpossessing small amounts of drugs are referred.The DPA delegation set out to learn how Portugalachieved a dramatic drop in HIV infections relatedto syringe-sharing and overdose fatalities, as well asthe impact of decriminalization on the criminaljustice system. With the U.S. in the midst of anoverdose crisis that is killing tens of thousands ofpeople a year, increasingly in communities of colorsuch as the South Bronx3 – and with policymakersramping up draconian policies such as druginduced homicide prosecutions4 – learning fromPortugal’s accomplishments is especially urgent.The trip to Portugal provided an opportunity fordrug policy reform advocates from the U.S. toappreciate how effective a dramatically differentapproach to drugs can be.“What I've seen here is that Portugal'sdrug policy encourages humanism andpragmatism with a focus on theindividual.”– Denise Cullen, Executive Director,Broken No MoreThe Move to DecriminalizeIn the 1990s, Portugal faced one of the highestprevalence rates for overdose deaths andproblematic drug use in Europe, with people whoinject heroin comprising 60 percent of the HIVpositive population in the country.5 The Portuguesepublic ranked drug-related issues as the main socialproblem in 1997,6 prompted by fears of rising druguse and the prevalence of open and visible use inpublic spaces.Additionally, they recommended having an honestdiscussion on prevention and education; providingaccess to evidence-based, voluntary treatmentprograms; adopting harm reduction practices; andinvesting in the social reintegration of people withdrug dependence.The recommendations were accompanied by a newphilosophy concerning drugs and drug use basedon the following assumptions:7 drugs and drug use are not inherently evil;a drug-free society is unattainable;people use drugs for a number of reasons;andpunitive policies are unethical andineffectual.“What struck me the most is theirapproach to solving a problem instead ofcompounding it the humane, logicalapproach to helping its citizens. Beingthere, seeing it and understanding it, andthen looking at what we do in the U.S.,made me think of our approach andpolicies as almost barbaric.I said that at a meeting once here andeveryone’s heads turned like it was a cussword The response to drug use here ismore harmful than the drug use itself.Come on U.S., we can do better!”– Susan Burton, Executive Director,A New Way of LifeIn response, the government appointed acommittee of experts – including doctors, lawyers,psychologists and social activists – to study theproblem and make recommendations for a nationalresponse. The committee recommended ending thecriminalization of people who use drugs, regardlessof what drug they are using.Drug Decriminalization in Portugal:Learning from a Health andHuman-Centered Approach3www.drugpolicy.org
The Portuguese Decriminalization ModelThe Portuguese national government adopted themajority of the committee’s recommendations,passed an accompanying law (Law no. 30/2000) in2000, and began to set up Commissions for theDissuasion of Drug Abuse, under the Ministry ofHealth.Under the policy, when police come across peoplewho are using or possessing drugs, they confiscatetheir substances and refer them to a DissuasionCommission. This Commission is comprised ofone official from the legal arena and two from thehealth or social service arenas who determinewhether and to what extent the persondemonstrates dependency on drugs.These Commissions – which operate independentlyfrom the criminal justice system – make decisionson a case-by-case basis. If the committee believesthe person’s use of drugs is not a problem, they cansimply dismiss the case and the application ofsanctions altogether. Alternatively, they can imposeadministrative sanctions that range from fines tosocial work or group therapy.The majority of people who appear before theCommissions are deemed to be using drugs nonproblematically and receive no sanction orintervention, but rather a provisional suspension ofthe proceedings. If they are not found in thepossession of drugs again within six months, thematter is completely dropped.For people who appear to use drugs frequently andproblematically, the Commissions will makereferrals to treatment, which is always voluntaryand never mandated. If people with substance usedisorder opt not to enter treatment, administrativesanctions – such as the revocation of a drivinglicense or community service – can be applied, butrarely are.ended criminal penalties for drug use andpossession, they made a commitment not toincarcerate someone for failing to enter treatment,failing a drug test or continuing to use drugs.Law no. 30/2000 stipulates the threshold quantitiesof illegal substances defined as possession forpersonal use. These amounts are generally derivedfrom estimations of the average quantity requiredfor an individual for 10 days.However, these thresholds mostly serve as abaseline from which the police and prosecutorsexercise their discretion to decide whether theperson’s possession of the drug is for personalconsumption or if the person is involved intrafficking.In cases of possession of amounts beyond thethresholds, the court decides whether to send theperson to a Dissuasion Commission, apply thesame type of sanctions meted out in theCommissions, or charge the person withtrafficking. Activists in Portugal raised concernsabout how discretion can lead to disparatetreatment of comparably placed people based onrace, ethnicity, immigration status orsocioeconomic factors.In Portugal, drug trafficking can incur a sentence ofone to 12 years in prison, depending on the type ofsubstance, the quantity, cooperation withauthorities, and whether the person is selling drugsto finance their addiction (this incurs a morelenient maximum sentence of three years). In“aggravating circumstances,” which includetrafficking as part of a criminal organization and ifthe offense causes death or serious bodily harm,drug trafficking sentences can increase to 25 years.8The Dissuasion Commissions aim to provideaccurate information about drugs, the potentialrisks of drug use, and harm reduction strategies, ina non-judgmental way. The goal is for people whouse drugs to become better informed and develophealthier relationships with drugs. Thus, peoplewho use drugs can do so without riskingpunishment or incarceration. When the PortugueseDrug Decriminalization in Portugal:Learning from a Health andHuman-Centered Approach4www.drugpolicy.org
Treatment and Harm ReductionWhat architects of the Portuguese modelemphasize is that ending criminalization alone didnot cause the impressive improvements in the livesof people who use drugs. One of the most strikingelements of the Portuguese approach is the focuson the individual person using drugs and their wellbeing. Drug treatment in Portugal is based on aholistic understanding and assessment of a person’ssocioeconomic situation.The DPA delegation’s first site visit was to Centrodas Taipas, Lisbon’s largest treatment center.There, the director of the center described howduring the intake process, the social worker firstassesses the person’s housing and family situation,economic security, access to education, and othersocial supports. Only after they have assessed thesecritical issues do they turn their focus to theperson’s use of drugs and the problems it hascaused. This underscores the dramatic change fromstigmatizing and criminalizing people who usedrugs to promoting their well-being and treatingthem with dignity.Harm reduction is a set of ideas andinterventions that seek to reduce the harmsassociated with both drug use and ineffectivedrug policies. It is based on acknowledging thedignity and humanity of people who use drugsand bringing them into a community of care inorder to minimize negative consequences andpromote optimal health and social inclusion.This can include ending the discriminationagainst drug users, reducing drug overdoses,providing supervised consumption services forpeople who use drugs, and immunity fromarrest for witnesses to an overdose.in addition to prison-based opioid substitutiontherapy.However, in some ways, Portugal’s harm reductionpractices lag behind those of other Europeancountries, indicating a potential stagnancy ininnovation since it adopted its decriminalizationmodel. Portugal does not have take-home naloxoneprograms, supervised consumption services,heroin-assisted treatment, or prison-based syringeexchanges. Medical or adult-use marijuana is alsonot available in Portugal.Portugal has made major efforts to scale up theavailability, accessibility and quality of treatment,and the training of medical staff. All doctors,psychologists and nurses in Portugal receiveeducation about drugs and addiction as part oftheir formal medical training. Treatment optionsavailable to people who use drugs includedetoxification, psychotherapy and methadone.Methadone is given free of charge, available sevendays a week, and is often distributed via mobile vanunits.The number of people entering treatment hasincreased significantly since decriminalization.9Treatment centers also coordinate with socialreintegration teams, which offer advice and supporton finding a job or returning to higher education,though Portugal has significantly scaled back thiswork since the economic recession of 2009. Thereis also limited housing available to peopleundergoing or leaving treatment, usually offered ona short-term basis, from six months to a year.Harm reduction strategies have also been critical toPortugal’s success. In addition to its treatmentcenters, the government funds social work agenciesthat engage with people who use drugs in the streetby distributing sterile syringes, hygiene materials,and condoms, while offering information abouttreatment and harm reduction services. Portugaloffers syringe access programs, as well asmethadone and doctor-prescribed buprenorphine,Drug Decriminalization in Portugal:Learning from a Health andHuman-Centered Approach5www.drugpolicy.org
Effects of Decriminalization on HealthOutcomesPortugal went from having one of the highest ratesof problematic drug use in Europe beforedecriminalization, to having a rate of overall drugconsumption that is low in comparison with that ofother European countries. Aside from marijuanaand new psychoactive substances, drug use for allother drugs has fallen below 2001 levels.Overdose deaths and new cases of HIV and AIDSamong people who use drugs have bothplummeted since 2001 – a remarkable benefit ofPortugal’s decriminalization model. In 2000, peoplewho used drugs accounted for 52 percent of newHIV/AIDS diagnoses (1,430 out of 2,758 cases).10In 2015, it decreased to a low of 6 percent (77 outof 1,228).11 Since 2001, HIV-related deaths amongpeople who use drugs have consistently fallen.Overdose deaths decreased by over 80 percentafter decriminalization.12 In 1999, 369 drugoverdose deaths were recorded in Portugal (36.2per million)13; by 2015 that number had fallen to 54(5.2 per million).14 Portugal’s drug-inducedmortality rate was 5.8 deaths per million in 2015,which is far lower than the European average of20.3 deaths per million.15 Portugal’sdecriminalization model has not led to increases inoverall drug use, while it has decisively loweredproblematic drug use and improved healthoutcomes.In 2017, there were more than 72,000 overdosedeaths in the U.S. If the U.S. overdose death ratewere on par with Portugal’s, there would have beenfewer than 800 overdose deaths that year.16What Happened in Portugal AfterDecriminalizationOverdose deaths decreased by over 80%Prevalence rate of people who use drugs thataccount for new HIV/AIDS diagnoses fell from52% to 6%Incarceration for drug offenses decreased by over40%Drug Decriminalization in Portugal:Learning from a Health andHuman-Centered Approach“The trip confirmed there is nothing inour history or culture that inevitablydooms the U.S. to repeat the mistakes ofour own drug policies.That was the most significant lesson that Ibrought home from Portugal: Fear-basedrhetoric and appeals to discriminatorybias lose their power when a solutionoriented response is available to apressing society-wide problem.”-Andy Ko, Executive Director, Partnershipfor Safety and JusticeCriminal Justice After DecriminalizationEven before decriminalization, Portugal neverexperienced the level of mass criminalization thatthe war on drugs has fueled in the United States.Though Portugal criminalized drug possession forpersonal use before 2001, it did not widely enforcecriminalization, and of the 3,863 peopleincarcerated for drug law offenses in 1999, onlyone percent was for drug use or possession forpersonal use.17In contrast, the criminalization of drug possessionis by far the largest driver of arrests in the UnitedStates. Each year, U.S. law enforcement makesapproximately 1.6 million drug arrests. Theoverwhelming majority – more than 85 percent –are for possession only. In 2017, of the 1.63 milliondrug arrests, nearly 40 percent (599,282) were formarijuana possession, and over 48 percent(795,232) were for possession of drugs other thanmarijuana.Racial bias compounds the harm and sufferingcaused by arresting and prosecuting people solelyfor drug possession. People of color bear the bruntof the costs of drug law enforcement, which causesirreparable harm to the individuals who arearrested, their families and their communities.Black people are three times as likely as whitepeople to be arrested for possession of drugs for6www.drugpolicy.org
personal use,18 even though black and white peopleuse drugs at similar rates.19 Meanwhile, police haveused the enforcement of criminal laws on drugpossession as an excuse for targeting communitiesof color, and over-policing them in ways that havetranslated into not only arrests but also increasedsurveillance, law enforcement interactions, andkillings.The racial disparities also exist in terms of access totreatment. If white people suffer from a substanceuse disorder, they are more likely to accesstreatment programs and then return to their liveswithout suffering the myriad, long lastingconsequences of criminalization. In the context ofthe existing overdose crisis in the U.S., whitemiddle-class communities such as Staten Islandhave enjoyed an increase in access to treatment andother health supports, whereas black communitiessuch as the South Bronx – which have experiencedan explosion of overdoses – have not receivedsimilar support.questions around biased enforcement. Accordingto statistics compiled by the Ministry of Justice,foreign nationals are incarcerated at higher ratesthan Portuguese people for drug trafficking, whilethe reverse is true for minor trafficking andtrafficking to support individual consumptioncharges.22“The US remains entrenched in aretributive stance on drug use, which is amajor obstacle, although we do see someprogress. With greater understanding ofthe need for harm reduction strategiesbecause of the opioid overdose crisis,there is a little more room for openingminds to ending the war on drugs andmajor drug policy reform.”After decriminalization in Portugal, incarcerationfor all drug offenses fell, including for traffickingand related crimes. The number of peopleincarcerated for drug offenses has fallen by 43percent since decriminalization, from 3,863 in 1999to 2,208 in 2016.20– Gretchen Burns Bergman, Co-Founderand Executive Director, A New PathPeople incarcerated in Portuguese prisons continueto have access to harm reduction services, albeitlimited. The national healthcare service coversmedication-assisted treatment (predominantlymethadone) in prisons. In 2007, a pilot syringeexc
Since Portugal ceased criminalizing drug use, the results have been dramatic.1 The number of people voluntarily entering treatment has increased significantly, while overdose deaths, HIV infections, problematic drug use, and incarceration for drug-related offenses have
Regarding the Portuguese case, Greenwald (2009) conducted an extensive report concluding that drug decriminalization has caused no harm and, if anything, it has improved the situation. Indeed, empirical data shows lower lifetime prevalence rates in the post-decriminalization period for almo
Policy Brief Decriminalization: Options and Evidence Rebecca Jesseman, M.A., and Doris Payer, Ph.D. Executive Summary A growing body of evidence suggests that decriminalization is an effective way to mitigate the harms of substance use and the policies and practices used to deal with it, especially those harms
the Portuguese case, which is indeed consistent with a body of literature that offers much support for legalization, but little theoretical basis for decriminalization. In the discussion section, this paper considers possible explanations for the
non-specialized police forces. On the supply side,F elix and Portugal(2017) show that the prices of opiates and cocaine did not decrease in the sequence of the drug decriminalization in Portugal, which contrasts with the argument that softer drug law enforcement necessarily leads to lower prices and, c
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Working Paper1 Timothy Young2 Department of Economics University of California, Irvine October 27th, 2016 Abstract This paper uses marijuana decriminalization laws, passed in 21 states over the last 40 years, to analyze the differences in earnings and employment that result from being arrested. A
2 New York State - County Opioid Quarterly Report (2017, July). Retrieved September 5, 2017, from . insurance, and healthcare reform in this country, cannot impede the significant progress that New York . 7 Drug Decriminalization in Portugal: A H
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