14 Years After Decriminalizing Drugs, Portugal’s Bold Risk Paid Off
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They shifted a significant chunk of money to health services. If it proves anything, it is only that health services can reduce drug related health issues. Without a control, there is nothing to point to regarding criminalization vs decriminalization. People are now paid to go out to drug dens and offer medical help. You can't simply say "people were scared to get help before" when instead you start sending help straight to their location.
Even when an article mentions the change in spending/focus, it is framed in the context of legalizing drugs. No one is making articles titled "After years of improving health services, Portugal's drug policy paid off".
I get that some folks want to legalize drugs, but make an argument for it that doesn't involve this twisting of results to match the desired outcome.
After decades of prohibition, we can conclude the "War On Drugs" is a lost cause and people will always seek out drugs. If people are going to take drugs regardless, let's make sure they're clean and the profits of sale don't fund criminal gangs.
Beyond removing the criminal element, the fentanyl epidemic should make the destructive nature of our current policy so obvious as to warrant the complete legalization (and regulation) of heroin. People are dying at incredibly high rates because they are not getting pure substances - they are receiving substances cut with something that can kill at tiny doses. Not only do heroin addicts have to deal with heroin overdoses (which are still quite possible), but they have to deal with fentanyl overdoses. Every time they use unregulated product, they are gambling with their lives. Our drug policy in America is completely ignorant of this reality.
I can understand "ordinary people" not reading up on it, but at this point I personally consider politicians who continue to oppose large scale drug reform to be morally responsible for contributing to mass murder.
I accept they're not legally responsible, but I genuinely believe most of them should be in prison on murder charges for their parts in perpetuating these violent policies unless they've at the very least voted in opposition to these policies if/when they've had the chance.
That is separate from saying that changing the legality of it impacts the usage though. There is not reason to take the result beyond what it indicates.
Taking Sweden as control, for example, they spend loads on health services and treatment; but without decriminalisation, their numbers are still terrible.
You would probably not want this kind of prescription to be signable by just any MD though, but that's another story.
You can not before treatment and for keeping it illegal.
These are mutually exclusive, as treatment for drug addiction has to be voluntary on the part of the user, and often time criminal convictions, and stress of legal issues are what drive people to use drugs.
But everyone knows this, it's the obvious corollary of decriminalization and has been stated over and over.
I think one of the main things is that people stopped being considered criminals to being considered "sick" - they have addiction, they need help, so they require health care.
If the police catches you with weed - you'll need to go psychological counseling for example.
The biggest difference I see comparing the Portuguese reality to the Swedish one is the lack of social stigma regarding drugs. Drugs are just openly discussed in Portugal and addicts are well integrated in society. I have friends whose parents are heroin addicts and for the most part they are a normal family with jobs and responsabilities. Sometimes they relapse but it's not a big deal because they have a network and feel safe to get help quickly and the state sponsors replacement therapies in the meanwhile.
These are people that started doing heroin in the late 80s and for the most part still raised a family and are good parents and neighbors.
It's just a disease like any other and Portuguese people see addiction that way.
You see this in terms of policies on things like alcohol and drugs in particular, but also areas like prostitution, where the attitude is often that the people involved are sinners who both need help and punishment, and where there is an attitude of "we know best" about legislation and treatment options.
The Nordic countries often looks liberal on the surface, but while they have secularised rapidly there is still an undercurrent of Christian moralistic ideas that have had a very firm grip in many areas, aided by the long lasting state churches (e.g. the Norwegian Lutheran church was a state church with the government appointing key people until 2012).
All of them are rather urgent, but instead we get virtue signalling and distancing from the nationalist party, pseudo debates about tax-levels (55% or 54%) and endless mantras regarding "healthcare" and "schools" while ironically those systems are still good but are slowly deteriorating due to New Public Management, unhinged privatisation and a good deal of incompetence. None of which is discussed except maybe the last few weeks when a properly virtue-signalling but spectacularly incompetent General Director managed to outsource classified information to Serbia of all places.
It's obvious that the drug politics has failed. The only thing we need to do is to look at the facts (almost worst in EU), think and discuss, and then modify. But no.
Right now we are just feeding the criminal gangs earning money on lighter drugs such as cannabis where there is an unstoppable demand, while coming down so hard on the heavier users that they literally die on the streets. One mistake or relapse while on a program - and they are kicked out on the street again.
But why? I honestly don't know. Swedish government bodies seems to have a very hard time changing their position, especially when it involves admitting that they have been wrong. Swedes are also very conformist - almost like a big insecure high school class where everyone say the same thing, wear the same things, and bully anyone that sticks out even just a little bit, so it could be hard to discuss sensitive topics.
I could rant for hours on alcohol and tobacco policy in the UK. A little knowledge of the field of Harm Reduction opens a lot of avenues for criticism. Particularly increasing taxation, which extracts most from the working class and is effective in few use-cases. The UK isn't alone: look up the EU's May 2017 'Tobacco Product Directive' regarding E-cigs. Read: lobbying from groups that are responsible for millions of deaths and public cost are strangling and monopolising a market and technology that is an incredible source of harm reduction... I'm struggling to hold my tongue at this point.
We have a large problem with a political class who don't listen to reason or evidence, simply an innately conservative discourse makes the problem look smaller than it really is. It's fantastic to read a positive outlook on Portugal's policy - it has been smeared countless times here.
No matter how harmless a drug is, there are always inherent issues bound to it's consumption.
Mindset/cultural attitudes are the central question. Say if the UK's binge-drinking culture transposes to binge-consumption, and introducing legality is considered an opened door, then the healthcare structures are critical. It's also probably quite hard to educate GPs - who seem to be big on drinking away their stresses at uni but avoiding other drugs - into an open mindset that identifies the right problems.
The pros and cons seem to accommodate a careful optimism and evolution-of-culture outlook. Not necessarily sweeping reforms. The problem for this view is that those with vested interests support sweeping anti-reform, whatever way you want to look at it.
If you blame Calvinism for either medievalism or postmodern bureaucracy, let alone the drug war, I suggest you don't know what Calvinism is. I'm for drug legalisation, but if you want the UK to adopt the policies of Portugal (or something similar) it will not help to blame the problem on the wrong people. You ought to be directing your anger at the social planners and the nanny state. That group, I can assure you, is very decidedly anti-Calvinist in nature.
I admit I probably only know a little more than the average about Calvinism, but far less than those who 'know' about it, so I didn't understand your point entirely. You prompted me to do more reading, which was interesting, so thank you for that.
More seriously, I think the causes are so multi-faceted it's difficult to interpret precisely where to place the blame. I think 'Reaganism' is a fine target, but it's a little short-sighted to lay all the blame there. 'Social planners' triggers associations with Edward Bernays' and his legacy, and what else I know from Manufacturing Consent, if that's your gist. Would you mind expanding on your view?
Besides that, people are a whole lot more likely to voluntarily go for help if they know they won't be arrested for what they have been doing.
Criminalizing drugs has negative externalities like boosting the profits of organized crime, but is often argued to outweigh those side effects by suppressing drug use, which is harmful.
If we found a way to make drug use much less harmful, then why would we not decriminalize drugs concurrently, given that its positives are negated so there's no argument remaining that they outweigh its negatives?
Even if the critical factor in reducing drug use harms was health services, the argument for concurrent decriminalization is overwhelming.
If to get treatment they basically have to turn themselves in, and are liable to go to jail, I doubt many would make that choice.
So you decriminalise to allow addicts to come forth and accept clean needles and other help, while simultaneously investing more money to provide that help.
It's a two prong "attack" and it's pretty simple actually.
Criminalization means, they send the police to address the issue.
De-criminalizaton means, they no longer send the police to address the issue.
This isn't hand-waving, the term really means what has happened: since people are no longer treated as criminals, humanity has been added to the mix - and, appears to be helping solve the problem.
I think you maybe just don't understand the term. Yes, in fact, de-criminalization is the key issue: patients, not criminals.
There's a fascinating documentary called American Addict on what nearly happened before this happened:
"In 1971 President Richard Nixon declared war on drugs. He proclaimed, “America’s public enemy number one in the United States is drug abuse. In order to fight and defeat this enemy, it is necessary to wage a new, all-out offensive(Sharp, 1994, p.1).” Nixon fought drug abuse on both the supply and demand fronts." [source]
Before criminalization, the trend in society was to start treating people who are afflicted with addictions like the sick people they are, rather than like criminals. There was an entire movement toward recovery as a necessary way of life for some people who cannot moderate alcohol intake (or drugs or whatever), just like insulin is a way of life for diabetics whose pancreases can't moderate insulin.
Addiction is not a moral issue; it should not be criminalized. It is a medical issue. It is a mental health issue. When it's caught early enough, and treated with the proper mental health regimen, it does not have to be debilitating.
Instead, what happened with war on drugs was mass-market criminalization... essentially forcing alcoholics and addicts forced into debilitation (hiding / shame)... leading to further desire for escapism through the addiction. It's a terrible cycle, and the worst part of it is that some counties have made things like DUIs into their bread-and-butter mainstream source of revenue.
It's hard to say what the trend today is going toward. The privatization of jails is especially disconcerting; like society wants to trick itself into thinking that the more people it has locked up the "safer" it is.
[source]http://web.stanford.edu/class/e297c/poverty_prejudice/parado...
Not that there aren't extenuating circumstances, not that it's a "terrible crime", but, it is a vice in which people for the most part, at least initially, have some choice.
Again, I'm in favor of most everything you suggest, particularly decriminalization (which just makes sense). Still, in my view people need to take a little more personal responsibility. There are always excuses if we look for them.
The best way to encourage people to take a little more responsibility? Probably most of what you suggest as well as giving people healthy environments and opportunity and something to be optimistic about.
But traditionally shaming works a little as well. As unpleasant as this may sound. We appear to have come to a spot we think people shouldn't be shamed for anything. Well, except for being a racist or using PHP maybe. Shame was an effective social control for a long time and if we are going to do away with it we need to find a replacement.
I don't know, I'm not an expert on addiction and human psychology. But I have known a few and most of them weren't either.
At least in this case, perhaps it's not just a moral failing. Maybe it's an education issue? Or some other way we should help prevent situations like this.
Watch the documentary I mentioned above. Also try this one: http://www.imdb.com/title/tt4079250/ Addiction is a mental health issue before it becomes a debilitating physical health issue ... one that (very often) leads to suicide or death. To suggest that unwell people have the strength to fight it on their own with the strength of "morals" is really damaging to your argument.
Besides: the healthy environment you want to "give people" is totally subjective. Who decides what is "healthy" for whom? Now you're back to policing and criminalizing ... these things do not work to improve the mental health of sick people.
Shaming doesn't help the addicts, and probably hurts them by making help less available, but it absolutely helps those people who do not yet have a drug habit. The stigma definitely helped me decline when a bunch of my friends started with marijuana (and I'm sure some did worse, but by then we had become distant).
Although decriminalization is the right move to help addicts, it will also have an effect on non-users who were curious but shied away from doing something illegal and getting in trouble. Personally, I think drugs should be available on a prescription for everyone who actually needs them, but off-limits to those who just want to try them out.
Regarding your aside: I'm not sure what kind of dystopia you imagine a "healthy environment" would be. I interpreted it as making sure that people can feel happy without drugs, e.g. by giving them a stable source of income, fostering community and so on. Do you disagree that those would be a good thing?
The Just say No campaigning of the 80s and 90s didn't work. It became a parody and undermining of the core issue which is the invisible line people cross when they cross into abuse. The IMDB link I posted for mythrwy explains this very well as it shows another class of addicts on the edge of a very religious community: those whose addictions started with prescriptions from their doctors.
Certainly no one has a beer or fills a prescription from an MD with the intent of becoming an alcoholic or addict, but that is what happens sometimes; the invisible line into abuse territory is, in fact, invisible to most people who find themselves on the other side of it. And on the other side, they find themselves increasingly powerless to control. The more isolation society heaps upon them for being unable to "control" it, the further they stray from the territory where it's possible to reach them for help. The Audioslave guy. Robin Williams. Famous people and non-famous people. Addiction is an equal-opportunity destroyer.
To suggest that anybody has the intent to become a drug addict is absolutely ridiculous. Decriminalization helps a society address the core issue sooner (keeping them in touch with society) and saves lives.
I've only known a few people who fell down the deadly spiral of drug abuse. But each one hid their addiction because of shame until it was so terrible they couldn't. And I believe if it had been less shameful they might have gotten support before they completely ruined their lives.
There is a very large subgroup that doesn't regard these things as shameful. This often becomes the main group of people involved with drugs. And it keeps sucking them back in, sometimes when they would otherwise get and this is exactly the problem I'm talking about.
If so, a less judgemental environment might very well help more people out of the addiction cycle, and a more judgemental environment might very well make it harder to escape.
It's not at all clear that making it into something shameful has any positive effects.
Best for anti-drug folks to take some responsibility for creating this "war on drugs", its attendant culture and the lives lost.
It addresses (among other things) the personal responsibility component of American attitudes towards drug use. I found it informative and an excellent read.
I don't know what downvoters are trying to accomplish here, frankly.
And who knows, maybe the willfully irresponsible will also be helped by this approach, and the state will be saved the greater expense of imprisioning then.
Should we set the bar for behaviour so low?
Even if drugs were legalized, the cost for treatment would be high (and presumably be bourne by the tax payer).
Japan imprisons a very small percentage of people compared to the USA.
Furthermore,it is a personal choice only if the other individual's choice does not have negative externalities.
Yet, a casual stroll through San Francisco 's mission district would tell you that this is not the case.
Who would have thought that drug use by the mentally unstable would result in a bad outcome...
> You are an authoritarian,
Perhaps. But when I compare the outcomes of Japan/ Singapore to that of the US, it is simple to see which model is the best.
So we should ban every personal choice with negative externalities? There goes alcohol, twinkies, contact sports, driving, etc. It's a personal choice as much as anything else, so just estimate the cost of any negative externalities and cover that through taxation.
> Yet, a casual stroll through San Francisco 's mission district would tell you that this is not the case.
Of course you don't know any of those people and can't say for sure whether drug abuse is what lead them to the behavior that you disapprove of.
> But when I compare the outcomes of Japan/ Singapore to that of the US, it is simple to see which model is the best.
The model of inhumane prisons and death sentences? Actually the US has a pretty similar model to that already, so I'm not sure what your point is.
I am pretty sure the needles on the sidewalk is just there because everyone suffers from diabetes, right?
I think that, fortunately for most IT people like us, we can live in nice neighborhoods, where none of the social ills of drug-ridden neighbortlhoods affect us. So, we can support drug legalization, without being affected by the consequences.
> The model of inhumane prisons and death sentences?
Japan/Singapore imprisons much less people for drug crimes than the US - due to the USA's lenient laws on drugs (grey line vs. red line). The ill effects of drug use in japan is virtually non-existent.
You can moralize all you want, but it is a better system with less actual harm.
The author is a ex-prison doctor who's spent his career working with the convicted and the mentally ill.
Japanese people drink. Japanese people also are major users of over the counter drugs which we in the west can't get hold of, notably benzodiazepines like flutazolam and flutoprazepam are available to buy there.
> Japanese people also are major users of over the counter drugs
Japan is much stricter with medicine than US. Several medicibes that are OTC in US are illegal in Japan: https://jp.usembassy.gov/u-s-citizen-services/local-resource...
I am sure that there are abuse of prescription drugs. But I have not heard anything about a systematic, widespread problem (comparable to prescription drug abuse in US).
A cursory reading of the WP says that the legal status of the drugs you mentioned is more or less the same as the US:
At the time, I was writing a book about the politics of drug prohibition. I started to ask Ehrlichman a series of earnest, wonky questions that he impatiently waved away. “You want to know what this was really all about?” he asked with the bluntness of a man who, after public disgrace and a stretch in federal prison, had little left to protect. “The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”
The increase in drug use observed among adults in Portugal was not greater than that seen in nearby countries that did not change their drug laws.
Assuming that's true, pointing out the spike, without also mentioning the drop is — at best — ignorant, if not deceitful.
Decriminalizing use helps, but legalizing sales take out the crime and ensures the health of users through clean product.
https://www.drugabuse.gov/related-topics/trends-statistics/o...
You could perhaps consider it as a Darwin award...sell heroin to anyone who wants it, and then if they become addicted and overdose, at least it clears the gene pool of people who are too dumb to use it responsibly. /s
Note, that is not my viewpoint, but I wonder if that's what some of the proponents of legalization are thinking. Obviously heroin has a huge effect on the brain and personality, and it's very difficult to get off it once you're addicted. So there is some rationale to the idea that keeping heroin illegal is helping prevent people from getting involved with it in the first place.
Right now it's (arguably) mostly thrill-seekers or people self-medicating psychological problems or chronic pain (which in itself has a large psychological aspect) using heroin. If you legalize it you potentially open it up to a much larger group who might not have otherwise considered using it.
The current criminalization is extremely darwinistic: only the most violent thugs survive in the supply chain, and only the smartest users.
I don't think legalizing will increase usage of heroin, because its health problems are huge and extremely well-known. Like putting ferrets up your bum, people are not going to do it simply "because it's legal".
It does not recognize any distinction between substances and retains a "shame on you" psy-ops bureau that users caught with minor amounts of said substances are referred to, in lieu of the criminal justice system. This "toxic-dependency" panel has sanctions available including monetary fines and revocation of ones passport or other travel restrictions, to bend one to their ways.
This set of laws does not treat the SUPPLY chain at all!
If one has an amount of substance greater than the threshold one can expect charges of traffic/distribution, which then will collapse after the 1 year investigation results in the non-election to pursue such charges, which has meanwhile resulted in the de-facto punishment of 1 year of weekly(some interval) police-station-sign-ins and a form of house arrest.
It's not a complete set of laws, and while it did manage to dispatch the heroin crisis of years past, it doesn't make any distinction, and thus is impeding efforts towards home cultivation of cannabis being legalized, etc.
De-criminalization, like medical cannabis, has the unfortunate tendency of providing laurels to rest upon, and thus impeding further progress. (observe Spains cooperatives, where signed members cooperatively grow and share in the crop)
Basically, Portugal has a very mature attitude to many things: letting the golden dreams of empire fade as they should, accepting that some people behave rashly and putting an emphasis on harm reduction etc. The emergency services here generally are excellent, professional, and calm in demeanour. I don't think that in practice one notes any major difference in drug usage in society with regards to the rest of Europe, I think one simply notes a bit less paranoia.
By comparison, I find it very odd that more than 15 states in the USA have medical or legal cannabis, yet harm reduction for heroin seems to be missing, and hence I'll just say that some people like to learn the hard way :D
Also it's quite interesting how just about every country that's close to the Netherlands, save for France which criminalizes posession, is at the top of the chart.
I've been to Lisbon and was approached countless times on the street by shady individuals trying to sell drugs, usually mj/hash but also coke, maybe one time out of ten. This is not a widespread thing in the rest of Portugal, just in Lisbon's very touristy city centre where.
They are mostly groups of gypsies selling fake drugs and sunglasses that will escalate to coercion if necessary/possible. Police is normally very permissive.
(I'm not saying that it's a bad policy but why is the article focused on pushing that policy?)
Also what I want to see: What about Portugal makes it work? Could you test that assertion against a different country if you made the contextual changes and the change there?
In other words, it's highly likely that Romania didn't "do better" than Portugal, but rather they're doing a very poor job tracking overdoses at all.
The number of drug induced death has decreased over the past 15 years, and it coincide with the adoption of the liberal policy on drugs. That's what makes Portugal an interesting case study.
Why is that?
The majority of Estonian population view drug users as someone who deserves to die, because of their poor choices. It's hard to get help or any compassion when you're an IV drug user.
Attempts to create needle exchanges are met with fierce resistance from neighbours. There are methadone programs but it's tiny compared to the amount of fentanyl users.
Up to 7.5 grams cannabis is not an criminal offense and smoking weed is quite popular with the younger generation. However, in Estonia it's not uncommon to hear from police that every weed smoker will surely start using fentanyl. Soft and hard drugs are treated the same in state propaganda, which results in many young people not believing that fentanyl is dangerous: since they were lied about weed, how can they trust warnings about hard drugs?
Estonia has also a huge alcohol problem. I believe many hard drug users started using because they were drunk in the first place. Alcoholism leads to violence at homes, murders, horrible car accidents, risky behaviours like trying hard drugs and having unprotected sex - you see, Estonia has a HIV epidemic as well.
Not sure what the solution is, but perhaps a combination of stronger penalties for dealers, more resources for treating addiction, and legalising weed.
When you give criminals a monopoly on the supply of recreational drugs, it is predicable that quality will be a problem. Potencies will vary, purity will suffer.
The solution is legalization combined with more health measures.
> stronger penalties
How anyone can think that stronger penalties are going to solve the problem escapes me. We have the evidence of 75 years of unrelieved failure of a punitive approach. This is an example of "If something fails, do more of it - That Might Work!".
I was referring to Fentanyl-laced heroin.
http://www.cbc.ca/news/canada/british-columbia/fentanyl-traf...
It most certainly does make sense to have stronger penalties for dealing drugs that have a high chance of killing people due to being laced with fentanyl. Otherwise it's like having the same penalty for a shoplifter as for an armed robber.
Fentanyl is 100x stronger per gram than heroin. Therefore you can import 100th the quantity and still make (in theory) make similar money on the street. It is exactly because you get a worse sentence for higher quantities that drug dealers have optimised to get the strongest per gram drug. You will get a lighter sentence for 1g of fent vs 100g of heroin, no doubt.
This is a cycle always seen in prohibition - there was a massive shift from beer and wine to spirits in the 1920s US when alcohol is prohibited.
Throwing harsher sentences will not help whatsoever and is likely to be counterproductive.
Yeah, that's why there is pressure to increase sentences for the fentanyl dealers. If you have tougher sentences for the more dangerous drugs, it makes people more likely to use the less dangerous ones.
I mean I find it hard to believe dealers want their clients to die off, they want steady revenue stream just like every other business. If you want to save lives, the way the US does it obviously isn't working. I don't think it's their objective. It seems the main objective for the drug war in US is to give jobs to the FOP and give the government an easier job by eroding liberties, and to make headlines for politicians trying to get reelected.
Often, doses of drugs are converted into a marijuana equivalency weight. 1g of fentanyl might be considered the equivalent of 20lb of marijuana in criminal proceedings.
It's a shift by vendors to higher value density materials.
During U.S. prohibition, vendors replaced illegal beer with gin, moonshine, etc. (higher alcohol/mass and alcohol/volume = smaller shipment volume and probability of detection).
Later, weed fell in favor to hash for similar reasons.
Now we have heroin being potentiated with fentanyl and its derivatives, those being much more powerful, reducing shipment volumes and losses due to detection.
In the U.S., when prohibition was reversed and booze was relegalized, low alcohol beverages returned to the market.
Not an expert, but it appears to me that legalization is required for reduction of overdose rates. It may not be enough by itself, but in its absence, lasting improvement doesn't happen.
That will only work with supervised injection. Otherwise there will still be overdoses (albeit not as many as with fentanyl).
That's a tiny amount. Punishing people that like to buy in larger quantities for convenience seems silly. They should have come up with a another or increased metric to determine who the dealers were.
Not necessarily. Using (harder) drugs is no more an indication of mental health problems than using alcohol. Many people use drugs recreationally without becoming addicted.
Other metrics that are relevant: Has drug use increased or decreased? What about the burden of disease associated with drug use? Also, even more importantly: What has happended to deaths in other countries over time?
USA
150 deaths/million/year
Portugal
3 deaths/million/year
Also the chart supporting less overdose deaths seems to be actually a chart about all drug induced deaths, and not just overdose deaths, which means it could include HIV/AIDS, once a big killer of heroin users which we can now treat for much better.
http://www.huffingtonpost.co.uk/2012/12/10/portugal-decrimin...
If it does, that still supports this theory.
My father in law is a leading portuguese HIV expert, and he credits decreminalisation as a key factor in actually getting those patients into clinics and on treatment.