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B.C.’s mounting overdose death toll has public health officials floating a radical solution: legalize drugs to curb the problem. But what would that look like? Dr. João Goulão has an idea. Portugal’s national drug coordinator helped solve a similar crisis 16 years ago when his own country decriminalized personal drug use. Today, addiction rates are way down, and the system has widespread support—but it isn’t perfect. Is this Vancouver’s future?
Q: What can Vancouver learn from Portugal’s decision to decriminalize drug use?
A: Like Vancouver, we had a very significant overdose problem, but our history in Portugal is unique. We had a dictatorship for 40 years and during that time we had no problems with drugs. Then came the colonial wars and drug use was tolerated, even incentivized, in the colonies. There was a high prevalence of drug use and addiction among the soldiers who returned from those wars in 1974. After the dictatorship, there was this freedom. Criminal organizations introduced heroin, cocaine, and suddenly everything changed. A population that was completely naive about drugs quickly shifted, and it’s important to remember that drug use affected everyone, not just one socioeconomic class. The history is different between Portugal and Vancouver, but this is the point: it became almost impossible to find a family in Portugal that wasn’t affected by addiction, and that changed the attitude. This is a health issue, not a criminal issue. That’s what has to happen in Vancouver.
Q: After nearly 20 years, are there many critics of decriminalization in Portugal?
A: In the beginning, there was talk that babies will be drinking drugs from their baby bottles, that we would get kicked out of the UN. Nowadays there is a political consensus: no one, not even the right-wing parties, will try to dismantle it. I’ve worked with nine ministers of health and no one has talked about replacing me.
Q: In the move to decriminalize, one plan was to open supervised injection sites like we have in Vancouver. But they’ve never opened in Portugal. Why is that?
A: We have legislation that allows us to build injection rooms, but it depends on the common will of municipalities and the central government. When we passed the bill in 2001 we were in need of them, but it was not possible to find a consensus among the government—for eight years we couldn’t find the political consensus we needed. When we finally got political conditions to go forward on that, injection use was dropping so fast that people told me it was no longer needed. The population seeking treatment went from 10 percent injection drug users to three percent in 2015.
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Q: People arrested have to appear in front of a dissuasion panel rather than before a judge. How do these panels work?
A: Citizens who are found in possession of a substance are taken to a police station. The substance is weighed and if the threshold is calculable for use for 10 days or less, it’s allowed and not considered trafficking. If you’re under that amount, the police send you to a dissuasion committee, which includes a lawyer, a social worker and a psychologist. They assess your condition to see if you are a problematic user in need of treatment. You are invited to try a treatment facility and you’re free to accept or not. If you’re not a problematic drug user, the commission assesses: are there problems in your family life, your social life, your psychological status? Do you have any other risk factors? The dissuasion committee provides one moment where people are forced to stop and reflect on their drug use.
Q: How important is that moment?
A: Most of the people, when they have that time to think, assume they have problems with drugs and they could benefit from a treatment process. Most of them, 80 percent of them, accept treatment. I believe this prevents lots of people from becoming more problematic users.
Q: How important is it to have treatment available for them right away?
A: It’s as important as having a threshold that everyone understands. Programs are there right away if the person needs help.
Q: Portugal is dealing now with former addicts coming back and needing treatment. Why is that happening?
A: Portugal is going through a financial crisis. Many social service departments have had budget cuts of 30 percent. had some cuts, about 10 percent, but fortunately the government was sensitive that we will pay later if we just let people get cut off. What was sacrificed was employment policies and programs. As we learned, it is crucial to work right from the beginning of the treatment process with labour and social reintegration of drug users. Our indicators are that this recent outbreak of what’s called “ancient users” are people in their 50s and 60s. They’re not working. It’s a recent phenomenon and directly connected to Portugal’s economic crisis. One of our big challenges is going to be how to stay with this population and help them get old with dignity.
Q: One of the anti-drug ads in Portugal from the 1970s had the slogan “Drugs, Madness, Death.” Portugal’s decriminalization policy is now founded on values of humanism, pragmatism and participation. What are the three words that should define Vancouver and Portugal’s drug policies in the next 20 years?
A: Education is one word. We need to create the way for people to be informed. That would build capacity, and then in the end, we have to let them have the tools to make informed decisions. The last word would be opportunities. That’s my pick: Education. Capacity. Opportunity. Far better than drugs, madness, death.