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Comment by kranke155 | Hacker News Reader

Its obviously a health problem. Portugal has one of the most successful drug programs in the world, and it was done through decriminalisation, support for drug users, and taking care of the pandemic of heavy drug usage as a health problem.

Being Portuguese I've heard the people who were in charge of the decriminalisation program talk on podcasts. They directly talk about it as a "pandemic", and that they saw similar transmission profiles as a contagious disease when they studied the growth in users.

Their solution was to decriminalise personal usage, support users to prevent HIV transmissions through needle reuse (one of the the biggest successes of the program was the enormous reduction in HIV transmission) and treat the issue as a public health problem - send addicts to psychiatrists, not jail.

The result is Portugal, a middle-high income country is somewhere in the top 10 safest countries in the world, and drug usage is either same as its neighbours or lower.

View on HN

Recently there’s been talk about how it isn’t working after all:

https://archive.is/DmMeN

I also work with someone from Portugal who says it isn’t all that it’s cracked up be.

I know San Francisco has tried to pilot this but hasn’t been successful.

I also know Vancouver has a problem with dealers fighting over turf near safe consumption sites.

When NY opened up a safe consumption site, the same thing happened.

I've just read this article. Have you?

"not working at all" is an overstatement, but might be logical since they cut funding by 60-70% or so (news to me but helps explain recent issues).

It contains two "criticisms".

First Porto's well connected mayor, Rui Moreira, and his people, saying that the problem is out of control. It very likely is, in Porto. I live there and it's kind of shit since the pandemic.

The second one (and in my view the only one that matters) is by the architect of the program Joao Goulao.

"João Goulão — head of Portugal’s national institute on drug use and the architect of decriminalization — admitted to the local press in December that “what we have today no longer serves as an example to anyone.” Rather than fault the policy, however, he blames a lack of funding.

After years of economic crisis, Portugal decentralized its drug oversight operation in 2012. A funding drop from 76 million euros ($82.7 million) to 16 million euros ($17.4 million) forced Portugal’s main institution to outsource work previously done by the state to nonprofit groups, including the street teams that engage with people who use drugs."

So yeah here's the thing.

No one is having second thoughts about the program, they've just massively defunded it to the point its architect says it barely works, and the Porto mayor got to complain about it to the Washington Post, likely because he has a really good PR company.

That's it. Rui Moreira is not even a part of any major party. No data on Portuguese support for the program is ever mentioned. No major politician is ever quoted.

It's been far less successful in the USA, and I think the reason is probably that US governments don't know how to do anything except tax and police. So we decriminalize, which removes the law enforcement deterrent, but then we do little to nothing when it comes to treatment, counseling, rehabilitation, etc. We will pick up the body when they die on the street from an OD though, so that's something.

As far as I know, the US decriminalised with little funding for the health programs that follow it. that's been the main criticism I've heard.

Even Portugal seems to be having second thoughts on the matter.

Where did you get this from? No one I know seriously considers changing the structure that's in place. Maybe some politician said something and it somehow reached your news feed.

"The number of Portuguese adults who reported prior use of illicit adult drugs rose from 7.8% in 2001 to 12.8% in 2022 — still below European averages but a significant rise nonetheless. Overdose rates now stand at a 12-year high and have doubled in Lisbon since 2019."

That is just the first Google hit.

https://knowledge.wharton.upenn.edu/article/is-portugals-dru...

"still below European averages" being literally my point.

The prediction (at the time) by those against the program was that Portugal would become a giant Amsterdam, and drug tourism would rise and the country would be awash in drugs and drug users.

None of that happened. We are still around or below European averages.

> The number of Portuguese adults who reported prior use of illicit adult drugs rose from 7.8% in 2001 to 12.8% in 2022

Isn’t this consistent with decriminalization that people aren’t afraid to talk about past drug use? You see similar statistics with, say, people coming out of the closet when homosexuality is decriminalized; which conservatives like to paint as “legalization making people gay”. The OD cases could also be from people more readily calling for help rather than trying to cover up.

OP was saying this as if the Portuguese were having second thoughts, not a US institute report.

And those increases run in conjunction with decreased funding and outsourcing of the programs.

Portuguese here: I read that the current program is underfunded and having issues.

https://www.publico.pt/2023/10/31/sociedade/noticia/consumo-...

I don't know about Portuguese politics, but at least here in the US ~90% of the time when I hear that something is "underfunded" or "had funding cut" and look into it the reality ends up being "funding for the program was not increased at the rate at which advocates wanted" but actual funding levels stayed the same or continued to increase. Are there any hard numbers for actual past funding levels compared to the present?

From the Washington Post article. https://web.archive.org/web/20230816172031/https://www.washi...

I could try and find this if you're that interested. Likely I can find a portuguese level source for it.

The commenters seem to me to be more saying that the program itself is somehow flawed. What flaws it has, of course, are always quite nebulous, and seem to apply more to US efforts than our own.

Not the guy you replied to but: https://news.ycombinator.com/item?id=36638752

A paywalled article by the Washington Post.

If you want to hear from the people who implemented the program itself, their thoughts and how successful they were, there are Portuguese language podcasts. Maybe OAI Whisper can translate them.

There's plenty of coverage in local media about the issues with the program. Many related to underfunding. Something like 80% less than it was in previous years, according to the comments in your HN link. The points I made - focus on public health - psychiatrists instead of jail - HIV transmission massively reduced - remain.

Without paywall:

https://archive.is/v5UA8

Thank you. Finally read it, and like I thought, it's completely incoherent with the idea that "The Portuguese are having second thoughts."

It's mostly a complaint piece by Porto mayor Rui Moreira. Joao Goulao, the actual architect of the program points to what actually happened.

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It's an evergreen topic on north american conservative talk radio. Our local right wing talking head brought it up this week as part of an effort to erode support for the existing supervised consumption site in our city. As evidenced by a few comments in this thread, a lot of people see drug use solely as a sign of moral failing on the part of the user and will refuse to accept any solutions that don't involve punishment.

They would likely accept it if it came with strict requirements that the addicts must also undergo counseling and engage in a job/housing search if they are currently unemployed or homeless. It’s not punishment that most people on the right want, it’s personal responsibility of which being punished for criminal activity is just a small component. If the addicts using these centres were demonstrated to be making real progress towards getting clean and reintegrated into society then the vast majority of conservatives would support them. The opposition is to a policy that is essentially no different from legalizing opium dens that support only the habit without requiring treatment.

The right wing people I know would never accept it, even if it came with counseling and all that. They have rejected Portugal's approach and said that that's just giving in to the druggies.

There might be some conservative people that agree with you, but I think most strongly religious conservatives wouldn't. IMO it does come down to punishment. Druggies have sinned and must be punished, spare the rod and all that.

This is such a bizarre idea. Thanks to this thread, I learnt that the entire Portuguese drug program now costs something like 16€ million. The results for that is - top 10 country in safety in the world - pretty average results in drug usage in the population.

For 16! Million! That's a preposterous result.

There are some "right wing" ideologies that basically align with non-interventionist decriminalization: don't fuck with me I won't fuck with you sort of individualistic thinking. Using violence such as taxation to solve it has parallels in some minds to the druggy coming up and robbing you. They don't want either, just the option to defend theyself or possibly engage in voluntary charity/assistance.

> Maybe some politician said something and it somehow reached your news feed.

Yes, except that instead of politicians, it's "police" (and statisticians); and instead of a news feed, it's literally the article we are commenting on.

Please quote the part of the article that's being commented on that refers to the police being against decriminalisation in Portugal.

All I found was "Crimes such as robbery in public spaces rose 14% from 2021 to 2022, which police have in part blamed on the rise in drug use."

Are you American? Is this some point of pride for you to be agaisnt this kind of program?

> Portugal decriminalised consumption of all drugs for personal use in 2001; it technically remains against the law, but instead of prison, users are registered by police and referred for help (attendance is voluntary). In the early days, it appeared to be an unequivocal success: HIV transmission rates via syringes dropped, as did the number of overdoses, and prison populations were down 16.5% by 2008. But a recent national survey shows illicit drug use up from 7.8% to 12.8% between 2001 and 2022; overdose rates are at a 12-year high, having nearly doubled in Lisbon between 2019 and 2023 (this is still below the European average). In Porto, there has been a 24% jump in drug paraphernalia being collected from city streets in the year to 2022, with this year set to outpace that. Crimes such as robbery in public spaces rose 14% from 2021 to 2022, which police have in part blamed on the rise in drug use.

(italics for emphasis)

> Are you American?

Yes

> Is this some point of pride for you to be agaisnt this kind of program?

On the contrary! I am in favor of this kind of program. I am very critical of my country's war on drugs. It is a war with one singular belligerent: US.

> People whose jobs depend on something claim that thing is getting worse, without any further evidence

That's not one bit compelling, and doesn't support what you're saying

You are not quoting me.

Please check who you are replying to.

I was responding to your comment with a rhetorical device. Your quote is entirely uninteresting because of course police will claim that increased drug use and increased $BAD_THING are linked, and please can they have more funding. There's no evidence behind your quote, and you shouldn't have brought it up in the first place.

You wrote a thing like this

> some text

I assumed that to be a quote. Was it not?

---

> and you shouldn't have brought it up in the first place.

You mean the article we are commenting on shouldn't have brought it up in the first place.

I agree! My point is that it did indeed bring it up. Nothing more.

You are arguing with no one, and directing it at me.

It's a common way of rephrasing what someone said to point out the absurdity in their statement.

I mean that you in particular shouldn't have brought it up. You should apply your reasoning, and not argue using bad arguments. If the article has a bad argument, don't repeat it.

I provided it as context. For fucks sake, this is the article we are writing comments for! God forbid I talk about the OP!

Did you read literally any other part of my comments?!?

You replied to someone that said "No one I know seriously considers changing the structure that's in place" with an irrelevant comment

There is no source for this, and it does not say the police want to change the program at all.

Police as a whole do not have to agree in order for some police to make that claim. In English, we often leave out the word "some", because we recognize that referring to a group of people very rarely includes the entire group.

I agree that this article's claim really should be backed by a source.

Thank you. I find it odd that articles like this and many others go with "the local residents" line.

Unnamed sources have been used since forever by journalists to create stronger articles, but I disagree with their use entirely. If you're going to quote someone, quote them. Don't tell me "local residents", or "local police" think this or that. It seems like a journalistic writing tactic that blurs the truth more than it clarifies.

Also, I suspect you misunderstood the article somewhat?

The increase in drug use that's being described happened in the last 3-4 years. The decriminalisation policy is from 2001. So the increase is not connected to the policy, thus the police is not asking for a repeal of it.

The increase in drug use and decriminalisation are not related, basically. So the sentence you quoted, I don't see how that is a request from the police for a review.

I never said they were. Maybe you are conflating my comment with another user higher in the thread?

https://www.washingtonpost.com/world/2023/07/07/portugal-dru...

Are you happy to post this having read the whole thing or just the headline?

I've read this article since everyone here kept quoting it.

It contains two "criticisms".

First Porto's well connected mayor, Rui Moreira, and his people, saying that the problem is out of control. It very likely is, in Porto. I live there and it's kind of shit since the pandemic.

The second one (and in my view the only one that matters) is by the architect of the program Joao Goulao.

So yeah here's the thing.

That's it.

Rui Moreira is not even a part of any major party.

No data on Portuguese support for the program is ever mentioned.

No major politician is ever quoted.

The statement that "the Portuguese are having second thoughts" remains unsourced, unless you are talking about Rui Moreira.

> Are you happy to post this having read the whole thing or just the headline?

I've read it in July.

Can anyone explain why this comment was downvoted? Multiple sources linked below provide justification for the commenter's statement. Meanwhile, the person claiming otherwise relies solely on personal opinion and attempts to discredit these sources, suggesting they have an ulterior motive. What has been happening lately on Hacker News?

Because it's not true.

The Portuguese are NOT having second thoughts on the matter.

There is a poorly sourced, vague article on the Washington Post.

I've just read this article.

It contains two "criticisms".

First Porto's well connected mayor, Rui Moreira, and his people, saying that the problem is out of control. It very likely is, in Porto. I live there and it's kind of shit since the pandemic.

The second one (and in my view the only one that matters) is by the architect of the program Joao Goulao.

So yeah here's the thing.

Rui Moreira is not part of any major political party.

No major politician is ever quoted in the article.

No data is shown on the topic showing that the Portuguese population is turning against the program.

So the statement that "The Portuguese are having second thoughts on the matter" remains completely unsourced.

Funding of a program is a problem but how funding explains this?

The number of Portuguese adults who reported prior use of illicit adult drugs rose from 7.8% in 2001 to 12.8% in 2022 — still below European averages but a significant rise nonetheless. Overdose rates now stand at a 12-year high and have doubled in Lisbon since 2019. Crime, often seen as at least loosely related to illegal drug addiction, rose 14% just from 2021 to 2022. Sewage samples of cocaine and ketamine rank among the highest in Europe (with weekend spikes) and drug encampments have appeared along with a European rarity: private security forces.

"still below European averages" is the only thing that matters here.

If the decriminalisation doesn't lead to increased drug usage vs its neighbours, what's the problem exactly?

Also, funding was cut like 65-70%. Any program that loses 65-70% of funding will face issues. That seems self explanatory.

No one said decriminalisation would decrease drug usage, just that it would keep it in check while avoiding - building more jails - criminalising the population - and keeping infectious diseases in check ie HIV, which was a huge reduction.

So what is it exactly that bothers you about these stats? That drug usage didn't go away? I don't believe the program was sold as doing that at all.

The idea was never that we would reduce drug usage. We were just told that the problem wouldn't become significantly worse than our neighbours, which it didn't.

> "still below European averages" is the only thing that matters here.

I don't think it's the only thing that matters. If I would be Portuguese I would like to know the reason for "Sewage samples of cocaine and ketamine rank among the highest in Europe (with weekend spikes) and drug encampments have appeared along with a European rarity: private security forces." that is highest in Europe and trends upwards.

Great that we’ve established you’re not Portuguese, so you are likely talking about the societal structure of a country you haven't visited.

I have no idea who thinks private security is a rarity in Europe. They exist in every European country I can remember.

Seriously perhaps try and be more sceptical of mass media.

Cocaine and ketamine measurements being “among the highest in Europe” continues to make my point. They are not the highest or 2x or 3x higher, which is what a lot of naysayers said would happen. They’re just high but within European levels. Nothing exceptional.

The difference being that Portugal has never engaged in mass incarceration of drug users, or the construction of a police apparatus that would cost 10x the cost of the current program to run so they could chase after drug addicts. Other countries did. And what do they have to show for it? Nothing. Same usage levels as Portugal, which again all naysayers said was on its way to becoming a new Sodom.

Turns out criminalisation makes virtually no difference in usage. The implications of this are more interesting than most comments here about it.

I'm not sure how much to self-congratulate when Portugal has one of the highest rates of antidepressant usage in the world on the back of 20 years of also one of the highest rates of growth in consumption of ADs among all countries: https://www.statista.com/statistics/283072/antidepressant-co...

In my opinion people are just medicating in other ways, but life still sucks.

What the heck makes you think that heroin and AD use is related?

You could make the argument for it, but this seems completely out of left field.

The connection between depression, trauma, etc and substance abuse is widely documented. In tough times people drink more alcohol and do more drugs. https://americanaddictioncenters.org/treating-depression-sub... https://www.addictioncenter.com/addiction/depression-and-add...

> Depression can increase the risk of chronic illness, including the disease of substance abuse. Up to a third of clinically depressed people engage in drug or alcohol abuse. These chemical intoxicants can become a form of self-medication for soothing the feelings of low self-worth, hopelessness, and despair that characterize this mental health disorder.

Perhaps I miss some nuance of what you're questioning because I find it surprising that my point was strange to you and now I'm confused.

Sure, but the OP is about heavy drugs. Antidepressant use is not illegal.

Your question was "What the heck makes you think that heroin and AD use is related?", and I answered. I didn't say they were illegal, I just showed that while some type of substance abuse went down, another type went up. Both related to mental health issues. I don't think this is some wild take.

> I just showed that while some type of substance abuse went down, another type went up.

Abuse vs use, unless you can show people didn't get their antidepressants from a psychiatrist or other mental health professional (don't know who is allowed to prescribe them in Portugal).

Of course drugs given by a doctor are better and safer than drugs given by a street dealer, but the main point, which this series of replies seemed to ignore was this:

> In my opinion people are just medicating in other ways, but life still sucks.

Whatever the source of the issue was, we haven't fixed it. We just got better at dealing with the accute issues created by the hard street drugs, minimizing drug related crime and so on. But the answer shouldn't be to just pump all the would-be drug abusers full of ADs. Or maybe it is, what do I know.

>acute issues created by the hard street drugs, minimizing drug related crime and so on.

You talk about this as if its small potatoes!

These are major major issues that poison society even in richer countries like the UK. Having lived in London for half a decade and seen what a regime of prohibition has led to there - I would take the "flawed" Portuguese program.

My hat is off to Golão and I wish he could get direct funding from EU without local politics intervention. I think the impact at the time was amazing and the results are not debatable. So let me get that out of the way and agree with you in lots of things you've shared in this comment section.

My main point is I think we still have loads of mental health issues in Portugal, possibly masked by the super high rate of AD use in our population, which keeps growing. Daily dosages have more than doubled since 2009 (75 DD per 1000 people to 150 DD per 1000 people) and it's accelerating.

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