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by Charles Fain Lehman
Thursday, 13
July 2023
Analysis
07:00

Blue states are learning the wrong lessons from Portugal

Drug policy involves more than just decriminalisation
by Charles Fain Lehman
Police officers inspect a popular underpass for drug-takers. Credit: Getty

When Americans talk about drug policy, someone invariably brings up Portugal. In 2001, the tiny European nation decriminalised possession of all controlled substances, replacing jail time with referral to health-oriented “dissuasion commissions.” Progressives routinely invoke Portugal as a more “humane” alternative to the American approach. Oregon’s pioneering drug decriminalisation initiative, Measure 110, was even ostensibly based on Portugal’s model.

But has Portugal’s drug experiment run aground? Reporting from the city of Porto, the Washington Post recently detailed that city’s struggles with addiction: “people with gaunt, clumsy hands lift crack pipes to lips, syringes to veins. Authorities are sealing off warren-like alleyways with iron bars and fencing in parks to halt the spread of encampments.”


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Speaking at Georgetown University’s law school on Tuesday, Portugal drug coordinator Dr. João Goulão conceded that “we are having some difficulties nowadays” with getting people off of treatment wait lists, and with public drug use. But Goulão, widely credited with overseeing Portugal’s transition to a “public health” approach, attributed these problems not to his regime, but to a slackening of public funding and increased demand precipitated by the pandemic.

Goulão may have a point. Drug overdose deaths in Portugal, though rising, have remained low relative to other European countries — a 20-year record of success that has only been marred by recent trouble. And increasing problems are reasonably attributable to, as the Post noted, a decline in both funding for and the number of people referred to drug treatment.

That said, this backsliding suggests that getting a “public health” approach to drugs right is about far more than “decriminalisation.” Just as importantly, there needs to be pressure on problem users to get clean — something progressives don’t seem to grasp. As Stanford addiction specialist Keith Humphreys told the Oregon state legislature last year: “The open use and flagrant drug dealing in West Coast cities are virtually absent in Portugal, which shuts them down and uses court pressure to get people into treatment”.

Drug use in Portugal does not lead to jail time. But possession and use aren’t legal, and individuals identified as engaging in these activities are summoned before “dissuasion commissions,” which ask them about their drug use and its effects. This summons system relies on the police to manage drug use.

All this makes the Portuguese model a far cry from the approach implemented in Oregon. There, since voters passed Measure 110 in 2020, small possession of controlled substances is a ticketable offence, with the ticket waivable if offenders call a hotline to be told about treatment. There are no dissuasion commissions and little follow-up — only about 2% of Portland offenders have paid their fines, and a similar share actually bothers to call.

Measure 110 was also meant to expand funding for treatment, siphoning off money from the state’s marijuana sales tax revenue. But most of the cash has thus far flowed to “harm reduction” and “peer support” services. In the first year of Measure 110, less than 1% of those helped with new funding entered treatment. Is it any surprise that overdose deaths continue to surge?

Porto’s recent challenges suggest that a “public health first” model like Portugal’s can only work with aggressive funding and utilisation of treatment, as well as mechanisms for holding people accountable for the harms of their drug use. And while, It’s reasonable to treat drug addiction like a disease, in need of treatment rather than prison time, doing so doesn’t mean leaving people free to suffer the consequences of their addictions. 

Progressives who invoke Portugal are too quick to assume our problem is just with the “criminalisation” of drug users. The problem that places like Oregon have failed to address, though, is the drugs themselves.

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Kirk Susong
Kirk Susong
2 months ago

I am one of the old school types that is motivated less by compassion for the drug user, and more by compassion for the drug user’s neighbors.
That doesn’t mean criminal law is the right way to address drug use. But rather than tell me how various public policy initiatives are affecting drug users, tell me how they are affecting their neighborhoods.
In that respect, it seems like whether you favor a criminal law approach or a public health approach, a necessary component of any response to drug use is to segregate the drug users from the other members of the community (in camps, prisons, institutions, clinics, call them what you will).
In any case, the stupidity and lies of the Blue State activists who think simple deregulation is the solution is utterly baffling. Imagine activists protesting that people are required to drive on one side of the road or the other. “Why should the State or Society tell me which side of the road to drive on? I’ve always felt like that other side of the ride is the right one for me! And the rest of you should simply accommodate me a little; it’s not that much trouble.”
The idea that to have a functioning society requires people to follow some basic laws of public order – like not getting stoned – is somehow a stretch today.

Last edited 2 months ago by Kirk Susong
Andrew Fisher
Andrew Fisher
2 months ago
Reply to  Kirk Susong

Or getting uncontrollably drunk perhaps? But people on the Right tend to loathe measures to restrict the use of alcohol (they often like that particular drug!). Alcohol more than many other drugs leads to direct harms to others, not just the users. In any case there is a big inconsistency here.

Kirk Susong
Kirk Susong
1 month ago
Reply to  Andrew Fisher

I’m all for stricter enforcement of ‘drunk in public’ laws, but you and I both know there’s a reason alcohol and ‘hard drugs’ are treated differently – both their personal and social effects are radically different. Alcohol can easily be enjoyed in moderation – heroin not so much. It’s also easier to manufacture, has a longer cultural history, etc. The idea that we should equate getting drunk in a bar with using heroin is silly. That doesn’t mean we should ignore alcohol abuse, but they are very different problems with different solutions and responses.

Jeremy Bray
Jeremy Bray
2 months ago

The problem is that people think that there is a good solution. There is not. Whatever solution is adopted to drug addiction people will suffer. The choices are about who and how much.

Warren Trees
Warren Trees
2 months ago
Reply to  Jeremy Bray

Agreed. When I read lines like…“people with gaunt, clumsy hands lift crack pipes to lips, syringes to veins.” I can’t imagine how or why anyone would think decriminalizing this scourge is the correct approach. Add in the public encampments, replete with open defecation and intercourse, and you have the icing on the progressive dystopian cake.  

Caradog Wiliams
Caradog Wiliams
2 months ago

Population of Portugal – 10 million. Comparing Portugal to most big countries forgets that it is relatively easy to manage a smaller number of people. The same thing comes in when people talk about how happy Swedes and Finns are.
Northern Portugal is indeed a bad area, with very high unemployment. About 5 years ago I was working in a town very close to Porto. Youth unemployment was around 50%. I saw a march of civil servants through the streets, on strike demanding higher wages and pensions. Unemployed young men were stoning the marchers.

Steve Murray
Steve Murray
2 months ago

It wasn’t illegal for the marchers to get stoned.
(Apologies in advance!)

Ian Barton
Ian Barton
2 months ago
Reply to  Steve Murray

Maybe the marching scene could best be described as a meeting of the “high and mighty”.
.
(I’ll get my coat ..)

Last edited 2 months ago by Ian Barton
Billy Bob
Billy Bob
2 months ago

On average each state in America has less than 10 million people (I’m aware a few have substantially more) so why would population be a barrier for those states when it isn’t for Portugal?
From the outside looking in America seems to have lost any ability for pragmatism, on every subject it’s either horribly draconian or stupidly liberal with both ending up with predictable results.
I’m also not sure what point you’re trying to make in regards to the Scandinavians being regularly voted amongst the happiest people. I though it was more due to a largely homogeneous population and well funded public services that everybody benefits from rather than simply having a small population

Dominic A
Dominic A
2 months ago
Reply to  Billy Bob

“This feeling of embarrassment, this shyness, this bashfulness, if you take that out of the people, then these people will do whatever they want to do. And that is the very definition of America, a people who have no shame, and therefore they do, whatever, they want, to do.”
A sermon from an unknown preacher that about sums it up. America splits into extremes – they have the freedom, the entitlement, and the brazenness which fuels this. For example the US has some of the strongest unions, and weakest regulated job markets. Drug draconianism, and drug indulgence. Bleeding hearts and extreme authoritarians. Religious and irreligious; Stupidest and smartest (equally vocal). Rock and Rollers and Pearl Clutchers. Hyper capitalists and Back-to-the-landers. Super rich and desperately poor. ‘Go figure’

Charles Boespflug
Charles Boespflug
2 months ago

@Caradog Williams, exactly! Many western European or North American cities are bigger than the whole populations of Portugal or Norway, so the answers that these latter countries provide are often not exportable.

Matt M
Matt M
2 months ago

I have always wondered why habitual drug addicts can’t be sentenced to secure detox units, where they have to stay until they are clean and sober. Has it been tried somewhere? Does it work? I would have thought that once you have stopped using heroin for a year in a rehabilitation prison, you would be likely to stay clean when released. Is this naive?

Sophy T
Sophy T
2 months ago
Reply to  Matt M

Because unless they want to stop they will start taking drugs again as soon as they are released.

Matt M
Matt M
2 months ago
Reply to  Sophy T

I assume some, pretty large, proportion of drug users who end up getting caught would want to give up, if the help to do so was there. Of course another pretty large group wouldn’t.

Dominic A
Dominic A
2 months ago
Reply to  Matt M

I’m afraid so, even though it seems like it should work. See link below. Enforced detox fails because it is usually not the drug that is the problem but the person(ality). People who’s lives and psyches are in a complete mess, whereby unaltered consciousness is intolerable. There was a very interesting bit of research where it was found that addiction rates (in rats) fell from around 80% to about 20% according to whether the rats were in a regular boring cage, or in a ‘rat hotel’ with rat runs, other rats, wheels, toys etc.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752879/

Matt M
Matt M
2 months ago
Reply to  Dominic A

Thanks for the link Dominic. Though interestingly it says that there are very few studies into the subject (only 9 met the inclusion criteria for the meta-analysis) and they are inconclusive.

Three studies (33%) reported no significant impacts of compulsory treatment compared with control interventions. Two studies (22%) found equivocal results but did not compare against a control condition. Two studies (22%) observed negative impacts of compulsory treatment on criminal recidivism. Two studies (22%) observed positive impacts of compulsory inpatient treatment on criminal recidivism and drug use.

Maybe it is an area worthy of more study as both criminalisation and de-criminalisation seem to be ineffective.

Dominic A
Dominic A
2 months ago
Reply to  Matt M

I agree – it may be a case of trying to sort out those who are ready for change, and not irrevocably damaged from those that are, sorry to say, hopeless. Then supplying the appropriate accommodations. Detox for the hopefuls – managed decline for the hopeless. There is, or was, a home for irredeemable alcoholics, I think in Wales, where the residents were allowed to safely drink at will – i.e. unto death.

jane baker
jane baker
2 months ago
Reply to  Matt M

Yes,because Care In The Community for mind sick people ,no drugs even,is freedom to sleep in a shop doorway and beg. A friend of mine had a mental breakdown. She is well now. I admire how she got herself better after discharged from the hospital,all credit to them. Her “care in the community” was a ten minute visit once a month from a social worker to ask “are you alright”. I don’t know what would have been the result had my friend said No. Probably a shoulder shrug
So where is the money or the will to pussyfoot around druggies,tuck them up in bed,spoon feed them and wipe their bums. We all need to free ourselves of 50 odd years of media mind training that “society” cares about us,because it doesn’t. WE are society and you dont care about me and I don’t care about you.

Sue Whorton
Sue Whorton
2 months ago
Reply to  Matt M

Unfortunately yes, however it gives people a chance to choose.

Brendan O'Leary
Brendan O'Leary
2 months ago

So much for the notion that legalisation will cause drug problems to magically disappear, and save the state money.

Dominic A
Dominic A
2 months ago

It was only tried because the notion that legislation will cause drug problems to magically disappear, and save the state money has not turned out so well. It has created huge organised criminal networks able to corrupt entire countries. Removes vast swathes of the economy from taxes and regulation; creates a huge ‘need’ for theft; chokes up policing, law courts and prisons, at huge cost and little effect; and creates a need for secrecy that greatly inhibits rehabilitation and produces adulterated drugs in unknown strengths, that is one of the main causes of death.

Stan Konwiser
Stan Konwiser
2 months ago

Drug addiction is a symptom rather than an illness. The disease is collapse of one’s mental health. The pressures, stress and insecurity applied in our society without family support and exacerbated by social media are primary causes of the emotional crises that is seemingly alleviated by drugs. The pharma industry is only too happy to provide with ‘a drug for that’ as a simple solution however at their price. The black market fills the gap and a drug use epidemic is the logical conclusion. Treating the sympton simply masks the disease.

Warren Trees
Warren Trees
2 months ago
Reply to  Stan Konwiser

There is no room here for logical and truthful replies, such as yours! If everyone operated with such clarity, and obvious truth, how in the world would we amuse ourselves?

jane baker
jane baker
2 months ago
Reply to  Stan Konwiser

Some of us are hungry souls. We want love,we want attention,we want validation. We want ,we want. But we lack any of the criteria for being loved,noticed or praised. That’s the “disease” – human nature.

Stan Konwiser
Stan Konwiser
2 months ago
Reply to  jane baker

Jane- Human nature designed the nuclear family as the developmental unit to bring children to adulthood. Humans, among all mammals, require the nurturing, education and aculturization of the family over at least 13 years to properly develop. Our ‘modern’ society is pretending that is not so. The same folks who proclaim nature is threatened by climate change and must be preserved, next declare that nature is null and void when deciding what sex to be or how children are capable of lifelong decisions at 6 years old. We allow these absurd notions at our own peril.

Sue Whorton
Sue Whorton
2 months ago
Reply to  Stan Konwiser

Not just the nuclear family but the extended family. Hence menopause in women. The decision to allow adulthood at 18 a cynical ploy to get the youth vote in UK . One of the unintended consequences was that care system stopped at 18 instead of persisting to 21 and universities stopped taking 17 years old and ceased to have the same responsibilities for undergraduates.
I recommend the Tom Nelson podcasts on climate change.

Andrew Fisher
Andrew Fisher
2 months ago
Reply to  Sue Whorton

In most societies people would marry well before 18, and men would be fighting wars by that age. The knights of the middle ages were astonishingly young, we could add the majority of the dead of the First World War.

Charles Stanhope
Charles Stanhope
2 months ago

One might have thought that after its experience of 13*years of Prohibition, the US might have learnt its lesson.
Sadly it has NOT!

(* 1920-1933.)

Albert McGloan
Albert McGloan
2 months ago

Prohibition caused a dramatic reduction in American alcohol consumption that lasted for decades. It was very popular with WASPs like yourself and only overturned by those wicked, wicked Catholics you hate so much. But with your online persona one can imagine you selling opium to the Chinese. Supply and demand, old boy!

Charles Stanhope
Charles Stanhope
2 months ago
Reply to  Albert McGloan

It may well have caused a “dramatic reduction in America alcohol consumption” but did it not see an enormous increase in (violent) crime, particularly amongst the Italian-Catholic masses?
Still it is interesting that it was Catholic elements that got it overturned. “Every cloud has a silver lining “ as they day.

As to Opium, yes those were great days indeed when the fabulous East India Company could grow the stuff by the ton, and then sell it for a fortune to the addled Chinese.

Of course you will recall that this was shortly after the abolition of the Slave Trade, and other avenues of investment were always welcome. All part of the “White Man’s Burden” as we used to call it.

Presumably from your mildly insolent tone, your forebears were searching for potatoes in the Emerald Isle at the time? What terribly bad luck!

Albert McGloan
Albert McGloan
2 months ago

(Removes flatcap) Well shir whun dey weren’t grubbin’ for ‘taters in de bog dey wus doin’ sum killin’ for de empire, so dey was. Begorrah dey even turnt protestant (makes sign of the cross).

Charles Stanhope
Charles Stanhope
2 months ago
Reply to  Albert McGloan

Did you pass the Irish Leaving Certificate or Scrúdú na hArdteistiméireachta, May I ask?

Albert McGloan
Albert McGloan
2 months ago

To be sure aul I know is the tunes on me fiddle an’ turnin’ taters into potcheen.

Charles Stanhope
Charles Stanhope
2 months ago
Reply to  Albert McGloan

I do hope that Peadar Laighléis, an erudite commentator on this forum is NOT observing you somewhat stereotypical plastic Paddy performance.

Albert McGloan
Albert McGloan
2 months ago

Peter Lesley, sure wasn’t he the gombeen man of Carrickmacross? The divil take him!

Andrew Fisher
Andrew Fisher
2 months ago
Reply to  Albert McGloan

Prohibition also led to a huge increase in crime, not to mention vast corruption!

Some people hate human freedom and agency, but I’m pretty suspicious of anti drug laws which don’t exactly appear to be a great success, let alone one attempting to ban a drug that pretty much all human societies have used for millennia

States should not be trying to enforce ideal behaviour of people – that is tyrannical and pretty much what China now tries to do.

William Simonds
William Simonds
2 months ago

And while, It’s reasonable to treat drug addiction like a disease, in need of treatment rather than prison time, doing so doesn’t mean leaving people free to suffer the consequences of their addictions. 

This seems to me to be the crux of the issue. Treating it like a crime criminalizes the actions of using drugs, not the consequences of addiction. Treating it like a disease focuses only on the consequences. You are free to use drugs, but if you get addicted the state accepts the responsibility to make sure you don’t suffer too much as a result of that addiction.
Really? It is the state’s responsibility to free us from the consequences of our choices and behaviors…to make drug use consequence free? I recognize that addiction may very well be a disease. But the choice to use drugs in the first place is not. Portugal’s model may be “humane” but it is terribly illogical: It’s OK to use drugs, just don’t get addicted, but don’t worry…if you do, you won’t have to suffer the consequences of your choices or your resulting addiction.
It seems to me the real lesson of Portugal is that there is not enough money or “dissuasion” placement options to handle “the consequences” of a problem that only ever grows. Calling those “recent troubles” makes it sound like they are a speed bump, a mere hiccup that is only temporary. Logic says those “recent troubles” are most likely never going to get solved in Portugal or anywhere for that matter.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
2 months ago

The Portugese chose to move the drug addiction problem from the public order to the public health domain. Money and effort was put into harm reduction, education of schoolchildren, outpatient treatment units etc.
Initially they saw big reductions in HIV, Hepatitis B and C, incarcerations in prison, usage rates and drug deaths however, these optimistic outcomes have not been entirely sustained over 20 years for all sorts of political and finanial reasons as outlined in these 2 good articles :
https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-021-00394-7
https://transformdrugs.org/blog/drug-decriminalisation-in-portugal-setting-the-record-straight
From a cost benefit point of view I remember one analysis (lost in my deep litter filing system) which indicated that this sort of holistic, health approach, in the long term (20 years +) was a darn sight cheaper than tossing a lot of people into prison and having them repeatedly rotate through the criminal justice system and hospitals.
This is not the first time a public health approach has been attempted to deal with undesirable public behaviour :
https://www.scotsman.com/regions/solution-to-knife-epidemic-could-come-from-colombiavia-glasgow-1419945

jane baker
jane baker
2 months ago

Legalizing drugs or drug use or whatever format of the complex web available will not lead to the death and end of the illegal drugs trade for several reasons. First: a lot of drug consumers do not want to buy their supply all nice and hygienically packaged in Boots or any other nice ,shiny clean pharmacy and both enrich Mr Branson AND PAY TAX. Why would you? If you have chosen to devote your life to a transgressive behaviour you do not want to pay tax. Especially now when you know it is funding war. And going in bank accounts
The illegal drug traders will still be there to supply this lucrative market. People who phone in to the radio to say I only grow a bit in the garden for my old granny,or I’m a lifelong respectable Christian and churchgoer and I just take it to assuage my pain. Liars. Maybe the latter would meekly go to Boots etc but as for the former,you.can grow the leafy plant in this country yes,it’s not called weed for nothing. But as we don’t have equal 12 hour night+days or the requisite heat for long stretches you cannot ripen the active substances in it. So liar,liar.
Legalizing drugs use would complicate matters immensely and make our society even more nasty and criminal. And be extremely good business for crime.

Andrew Fisher
Andrew Fisher
2 months ago
Reply to  jane baker

Why, precisely, is alcohol exempt from your anathema? It undoubtedly causes a lot of harm to others..Vast numbers of people take drugs, and most in face do not end up as human wrecks.

It is strange that many people take exactly the opposite position regarding alcohol and tobacco as they do for marijuana and indeed other drugs.

Last edited 2 months ago by Andrew Fisher