12 ms·

Pointers from Portugal on Addiction and the Drug War

206 points by elsewhen 6y ago

opiate_recovery 6y ago
This is the key from my perspective: "Moreover, as of 2008, three-quarters of those with opioid use disorder were receiving medication-assisted treatment. Though that’s considered the best approach, less than half of Americans who could benefit from medication-assisted treatment for opioid addiction receive it." Buprenorphine has saved my life and I wish everyone could have access to it and that it would be provided for free. Pay for it from grabbing back cash from the Sackler's. I'm surprised in the article the phrase 'less than half' which sounds like it's on the higher end towards 50. I would have guessed much lower. I can't find a great source but this has some numbers [1]. Says only 36% of rehabs have access to at least one replacement therapy. And that's people who can access rehab... To be able to prescribe Suboxone - from what my Dr. has told me - MDs have to have a specific DEA certificate. And they limit the number of patients one single Dr. can treat at a few hundred. In my state there aren't many prescribers - not nearly enough for the number of addicts. And I live in a liberal state. It's easier for Drs to dole out opiates than prescribe buprenorphine. We can also learn from Portugal in more community and healthcare intervention. The big problem here to get there is that DAs, sheriffs, mayors are elected and there are 50 states. We will need to shift public opinion everywhere to make meaningful progress outside of big cities. Plus with Barr's Justice Department catholic radicalization who knows what happens if they get another 4 years. It's gross that in America those who are poor, BIPOC, are far more likely to have their lives ruined by unequal drug prosecutions. If we ever start treating addiction not prosecuting it, I hope we'll do better than marijuana and clear old records/convictions for small drug possession. https://nam.edu/improving-access-to-evidence-based-medical-treatment-for-opioid-use-disorder-strategies-to-address-key-barriers-within-the-treatment-system/ https://nam.edu/improving-access-to-evidence-based-medical-t...
- nefitty 6y ago
  Why are opiate treatment drugs so highly controlled? Do they have a high risk for recreational abuse, or extreme side effects, or is something else wrong?
  - greencar 6y ago
    They give you a good buzz, especially if you are a relatively opiate naive person. If you happen to have an addict friend that wants to sell their methadone or suboxen to buy real stuff, then it ends up being a lose lose for people trying to stop overall use
    - opiate_recovery 6y ago
      Bupe + naloxone doesn't give any buzz and it blocks you from getting high from other opiates. i guess maybe if you were opiate naive maybe it would IDK. but that would be really dumb to take if you want to get high take the real shit Definitely can from methadone especially mixed with a benzo for sure people sell it but they're going to use with or without it. studies have shown that those who don't get long time sober and do replacement therapy on and off nonetheless have longer periods of abstinence and lower death time frames (not sure how to phrase that they dont die as much/soon)
      - eecc 6y ago
        Methadone is even more dangerous than the real stuff: just withdraw syndrome can be fatal.
        opiate_recovery 6y ago
        yeah it's gross. i'm 100% for just giving actual pure opiates out for free to addicts that don't yet want to get clean. in a lot of ways it would be safer. clean, known dose, less theft to pay for drugs, less violence no cartels
  - opiate_recovery 6y ago
    i believe it's 100% because of stigma and 'values preaching' and the history of methadone buprenorphine + naloxone is nothing like methadone suboxone has few to none of the externalities of methadone just in general with drugs and treatment we would be so much better off if those who force their personal values upon others had some sympathy and compassion
- yborg 6y ago
  The current system in the US is a virtuous cycle - companies like Purdue make tens of billions creating a huge population of addicts, and then the resulting crime justifies the expansion of heavily militarized police to wage war "on drugs", which then can funnel the losers of the battle into a for-profit prison system. Imagine the profit potential of a nation of 150 million junkies. Actually solving the problem costs money.
  - justinclift 6y ago
    > virtuous cycle That example would probably be called a vicious cycle, rather than a virtuous one. ;)
    - sidkshatriya 6y ago
      I think the word "virtuous" was used sarcastically. And it is virtuous from the perspective of those entities profiting from the above cycle...
- tacocataco 6y ago
  The purpose of the drug war isn't to prevent drug use or help people quit drugs.
ttul 6y ago
British Columbia’s medical health officer recently gave nurses the ability to prescribe opioid replacement drugs to improve the supply. Many more people are dying from toxic street drugs than are dying from COVID-19. It’s a “shadow pandemic” that has been raging for decades and is only getting worse as border closures make it harder for gangs to move drugs like heroin and fentanyl across borders, leading to shortages of “safe” ingredients and a shift toward exotic, extremely toxic alternatives like carfentanyl.
- edogg 6y ago
  do you think some pay back from China for the opium wars is part of the dynamic?
  - ttul 6y ago
    That’s going back a ways...
    - edogg 6y ago
      To the century of humiliation starting in 1839 with the opium war [1]. I’m told saving face is very important in Chinese culture. I could see it being quite easy for people in China whose job it might be to prevent the export of fentanyl or fentanyl precursors to only do the minimum to keep up appearances. not nearly as blatant as the British but were but we aren’t getting any help from China in preventing the deadly drugs from being shipped here. It would be better if they would just send actual heroin instead of having casual mdma and cocaine users dying from fentanyl. [1] https://en.wikipedia.org/wiki/Century_of_humiliation https://en.wikipedia.org/wiki/Century_of_humiliation
  - pjc50 6y ago
    The opiates crisis was driven and enabled by US pharma marketing practices. Internationally-mailed fentanyl was only a small part of the problem.
    - monoideism 6y ago
Icedcool 6y ago
The only country to truly “win” the war on drugs.
- scns 6y ago
  What you figh gets stronger. Siddhatha Gautama
bismuthsalt 6y ago
To note, in 2001 Portugal has decriminalized possession of small quantities of drugs, for first time offenders. Drug trafficking is still just as illegal as ever. There are no cannabis shops or pervasive cannabis advertisement, as opposed to US liberal states, for example CO or WA. > But Portugal’s experience is often misunderstood. Although it decriminalized the use of all illicit drugs in small amounts in 2001, including heroin and cocaine, that’s different from making them legal. And it did not decriminalize drug trafficking, which would typically involve larger quantities. > Portugal’s law removed incarceration, but people caught possessing or using illicit drugs may be penalized by regional panels made up of social workers, medical professionals and drug experts. The panels can refer people to drug treatment programs, hand out fines or impose community service. > A lot of the benefits over the years from Portugal’s policy shift have come not from decriminalization per se, but in the expansion of substance-use disorder treatment. Such a move might bring the most tangible benefit to the United States.
- rmrfstar 6y ago
  Take a look at the US per-capita incarceration rate over time [1]. Since the war on drugs began, it has grown 5x over what appears to have been a long-term steady state. The war on drugs is a make-work jobs program for people who can't build anything useful. Relative to skill, these are well-paying stable jobs. [1] https://upload.wikimedia.org/wikipedia/commons/thumb/4/48/U.S._incarceration_rates_1925_onwards.png/1200px-U.S._incarceration_rates_1925_onwards.png https://upload.wikimedia.org/wikipedia/commons/thumb/4/48/U....
Synaesthesia 6y ago
There was a RAND study many years ago which showed that, from a pure cost benefit point of view, the best way to deal with drugs is through education and treatment, not policing and punishment. Eg Americans today smoke a lot less tobacco and drink less coffee too. Education works!
- m463 6y ago
  (it has all switched to sugar/processed carbs!)
- ChuckNorris89 6y ago
  By contrast some European countries, like Austria, drink a lot of coffee and smoke a lot of tobacco(they just banned indoor smoking last year). National culture plays a huge role in what vices people take on.
  - unwind 6y ago
    According to [1], Europe is the world's largest coffee market, at 33% of production. North America consumes 19%. Consumption per capita up here in the wonderful Nordics is quite high, with Finland typically leading at 12 kg/person. The corresponding number for the US is around 4.2 kg (9.3 lbs). The Telegraph has a fun list [2] showing the top 20 consumers. [1] https://www.cbi.eu/market-information/coffee/trade-statistics https://www.cbi.eu/market-information/coffee/trade-statistic... [2] https://www.telegraph.co.uk/travel/maps-and-graphics/countries-that-drink-the-most-coffee/ https://www.telegraph.co.uk/travel/maps-and-graphics/countri...
    - ciceryadam 6y ago
      wow, 1 kg per month means 133 shots of espresso a month - roughly 4.5 espresso shots every day, including weekends.
      - gspr 6y ago
        Sounds about right for me here in Norway. I really need to cut back.
AlexTrask 6y ago
During the last years Portugal is doing a great job in a lot of fields like education or economy. A great example for southern Europe countries
- odshoifsdhfs 6y ago
  We did a lot of good things, but I wouldn't say those are the samples we want to use as examples for other countries.
- sergiosgc 6y ago
  Thanks. It's good to hear this opinion from the outside. The Portuguese are, as a group, pretty pessimistic. I often have to state that, in '74, when the dictatorship ended, we were massively illiterate. The education evolution is extraordinary, albeit inevitably slow: it takes a couple generations to change the education profile of a country. It is a country far from perfect, but the people are nice, the cuisine is excellent, the weather is amazing and it is consistently moving in the right direction.
DoingIsLearning 6y ago
A lot of anglo speaking countries like to quote Portugal as an example, I would just like to add some reality to the picture perfect descriptions I read: - The main public opinion driver for both the needle exchange programs and the decriminalization was a _massive_ Heroin epidemic which lead to an HIV, Hepatitis B/C, AND Tubercolosis epidemic, the last one of those is particularly airborne contagious. I often see the lumping of 'heavy' drugs but (although decriminalized) Cocaine consumption in Portugal was marginal at the time (mostly because the majority of the population couldn't afford it). The main precipitator was Heroin consumption. - These programs served as a 'trojan horse' anchor point to bring these, often homeless/missing, people back into the healthcare system. For added controversy for the americans out there, healthcare is universally free in Portugal. - There was a clear rupture point both in crime rates and the prison system capacity due to the heroin epidemic. Police forces could no longer be bothered with the 'noise' of the numerous small possessions of 'non-heavy' drugs like haxixe or marijuana. Offloading that to mental health practioners was also logistically useful for law enforcement. - It took a considerable amount of additional healthcare funding for these programs to be implemented. This would _not_ have been possible for an economy like Portugal without supplementary funds from the European Union economic development programs. - I am very suspicious of the counter-argument insinuation that the program initially _caused_ an increase in crime rates and consumption, because the start of the program also matched the start of a fairly large economic downturn. The main idea of the program was that people could go and ask for help, without the fear of being put in jail. If you have a desperate person, willing to do desperate things, not pushing them against a corner is usually a good policy for crime rates.
- JetSpiegel 6y ago
  > - The main public opinion driver for both the needle exchange programs and the decriminalization was a _massive_ Heroin epidemic There were politicians that publicly spoke about their personal experiences. Others that had family members that were caught up with it. It was a widespread issue across all classes, not just the poor. Here's a recent interview about one of the main drivers of this policy (in Portuguese). https://www.perguntarnaoofende.pt/pno/joao-goulao https://www.perguntarnaoofende.pt/pno/joao-goulao
- 6y ago
europoorr 6y ago
Funny how Europeans aren’t trigger happy - they wont immediately jump to killing people or imprisoning them, but look at alternative solutions. Americans need a war, be it at home or abroad, classwars, wars on drugs, wars on each other over who is a dem who is a rep. They could simply learn lessons from the old world and adopt them and they would be better off in many areas. Instead they start “wars”.
varispeed 6y ago
Not sure why this policy is touted as a champion example how to deal with the drug "problem". Only thing it does it reduces exposure of drug consumers to law enforcement harassment while at the same time helps organised crime making more money. I would rather look into why some people promote this and maybe look into their finances. Drug use is natural for intelligent beings and prohibition of that is like trying to ban music or sex. It will never work, but will create a plethora of problems that we experience. From the rise of organised crime to people being unable to access medication they need. It is being tolerated by the population because of massive propaganda and manipulation (for example someone done something bad? Make sure to mention they used cannabis or other drug even if that had nothing to do with the thing that has been done). It is in a way similar to how it was possible to ban same sex intercourse in some countries - people were made to believe it was a "sin". Many health issues are caused by the contamination in drugs available on the streets, that are attributed to drugs themselves. Some popular drugs could be much safer if you could buy a medical grade. In other words it is another money maker based on people suffering and deception and promotion of Portugal model looks very suspicious.
- joaomval 6y ago
  How are the drug dealers making more money if there are alot less people consuming?
  - varispeed 6y ago
    Do you have evidence that this is the case? Drug use comes from natural urge to explore consciousness and people take drugs regardless of the law around it. If they are no longer being harassed by law enforcement, then it is easier for them to pursue this and Portugal's policy does that. If I recall the drug use is estimated from surveys and people lie when it comes to that (for example there is thinking what if they start to investigate me if I respond "yes", even if the survey is "anonymous"). Other way to estimate is by looking at numbers of people caught with the system. Now, because the harassment has been relaxed obviously fewer LE will bother going after consumers and from that it is easy for propaganda machinery to tout the policy is working. Well, it is working for those involved in the trade. You sell more if your customers are not being harassed, simple fact of life.
kyrers 6y ago
This is one of the things that makes me proud to be Portuguese. Also, does anyone remember the name of the doctor that started this whole movement? I think the first name is João, but I can't remember or find it. I might be tripping, pun intended.
- joaofs 6y ago
  https://en.wikipedia.org/wiki/Jo%C3%A3o_Castel-Branco_Goul%C3%A3o https://en.wikipedia.org/wiki/Jo%C3%A3o_Castel-Branco_Goul%C...
  - kyrers 6y ago
    Thanks!
    - JetSpiegel 6y ago
      https://www.perguntarnaoofende.pt/pno/joao-goulao https://www.perguntarnaoofende.pt/pno/joao-goulao He even gave a recent interview about all this.
mytailorisrich 6y ago
One issue with drugs policy, I mean in general total prohibition, is that it has come about for moral and emotional (even religious in some case) reasons, like the prohibition of alcohol in the USA once had. This can be seen in the fact that use is usually a crime. There are no other substances, however nasty they might be, that are a crime to drink/eat/inject. To me this elevates the use of drugs to some sort of sin for, really, arbitrary reasons. This makes taking a pragmatic and facts-based approach difficult.
x87678r 6y ago
I saw somewhere there was some confusion in translation what decriminalization means, as Portugal has Roman Law as opposed to Common Law found in English speaking countries. Portugal "decriminalization" of drugs left it in a similar state to British law anyway. I can't find a reference now though - does anyone know more?
- JetSpiegel 6y ago
  From what I heard, the change led to treating drug usage as health problem, and removing the law enforcement aspect from the loop. The police can still refer drug users to the healthcare institutions that deal with the problem. Another interesting tidbit is that the Netherlands did not in fact legalized cannabis. They just decline to prosecute that crime. There's no legal framework to regulate its sale, like for any other consumable good. This leads to silliness like people in "coffee shops" being allowed to smoke weed, but not tobacco since that is regulated for all indoors venues.
sloshnmosh 6y ago
Drugs will never be decriminalized fully here in the US. There is too much untraceable money involved. It is said that after the housing bubble burst around 2008 that there was very little “liquid” cash floating around and that dark money from drug trafficking was one of things that helped the US from going completely under. Add to that all the covert operations to overthrow governments and bribe crooked foreign leaders that require vast sums of money that doesn’t leave a paper trail. The “war” on drugs is too keep drugs illegal and to sustain the flow of dirty monies.
blackflame7000 6y ago
The opposite of addiction is connection.
macca321 6y ago
Teeth are a luxury.

206 points by elsewhen 6y ago

This is the key from my perspective: "Moreover, as of 2008, three-quarters of those with opioid use disorder were receiving medication-assisted treatment. Though that’s considered the best approach, less than half of Americans who could benefit from medication-assisted treatment for opioid addiction receive it." Buprenorphine has saved my life and I wish everyone could have access to it and that it would be provided for free. Pay for it from grabbing back cash from the Sackler's. I'm surprised in the article the phrase 'less than half' which sounds like it's on the higher end towards 50. I would have guessed much lower. I can't find a great source but this has some numbers [1]. Says only 36% of rehabs have access to at least one replacement therapy. And that's people who can access rehab... To be able to prescribe Suboxone - from what my Dr. has told me - MDs have to have a specific DEA certificate. And they limit the number of patients one single Dr. can treat at a few hundred. In my state there aren't many prescribers - not nearly enough for the number of addicts. And I live in a liberal state. It's easier for Drs to dole out opiates than prescribe buprenorphine. We can also learn from Portugal in more community and healthcare intervention. The big problem here to get there is that DAs, sheriffs, mayors are elected and there are 50 states. We will need to shift public opinion everywhere to make meaningful progress outside of big cities. Plus with Barr's Justice Department catholic radicalization who knows what happens if they get another 4 years. It's gross that in America those who are poor, BIPOC, are far more likely to have their lives ruined by unequal drug prosecutions. If we ever start treating addiction not prosecuting it, I hope we'll do better than marijuana and clear old records/convictions for small drug possession. https://nam.edu/improving-access-to-evidence-based-medical-treatment-for-opioid-use-disorder-strategies-to-address-key-barriers-within-the-treatment-system/ https://nam.edu/improving-access-to-evidence-based-medical-t...

nefitty 6y ago
Why are opiate treatment drugs so highly controlled? Do they have a high risk for recreational abuse, or extreme side effects, or is something else wrong?
- greencar 6y ago
  They give you a good buzz, especially if you are a relatively opiate naive person. If you happen to have an addict friend that wants to sell their methadone or suboxen to buy real stuff, then it ends up being a lose lose for people trying to stop overall use
  - opiate_recovery 6y ago
    Bupe + naloxone doesn't give any buzz and it blocks you from getting high from other opiates. i guess maybe if you were opiate naive maybe it would IDK. but that would be really dumb to take if you want to get high take the real shit Definitely can from methadone especially mixed with a benzo for sure people sell it but they're going to use with or without it. studies have shown that those who don't get long time sober and do replacement therapy on and off nonetheless have longer periods of abstinence and lower death time frames (not sure how to phrase that they dont die as much/soon)
    - eecc 6y ago
      Methadone is even more dangerous than the real stuff: just withdraw syndrome can be fatal.
      - opiate_recovery 6y ago
        yeah it's gross. i'm 100% for just giving actual pure opiates out for free to addicts that don't yet want to get clean. in a lot of ways it would be safer. clean, known dose, less theft to pay for drugs, less violence no cartels
- opiate_recovery 6y ago
  i believe it's 100% because of stigma and 'values preaching' and the history of methadone buprenorphine + naloxone is nothing like methadone suboxone has few to none of the externalities of methadone just in general with drugs and treatment we would be so much better off if those who force their personal values upon others had some sympathy and compassion
yborg 6y ago
The current system in the US is a virtuous cycle - companies like Purdue make tens of billions creating a huge population of addicts, and then the resulting crime justifies the expansion of heavily militarized police to wage war "on drugs", which then can funnel the losers of the battle into a for-profit prison system. Imagine the profit potential of a nation of 150 million junkies. Actually solving the problem costs money.
- justinclift 6y ago
  > virtuous cycle That example would probably be called a vicious cycle, rather than a virtuous one. ;)
  - sidkshatriya 6y ago
    I think the word "virtuous" was used sarcastically. And it is virtuous from the perspective of those entities profiting from the above cycle...
tacocataco 6y ago
The purpose of the drug war isn't to prevent drug use or help people quit drugs.

ttul 6y ago

British Columbia’s medical health officer recently gave nurses the ability to prescribe opioid replacement drugs to improve the supply. Many more people are dying from toxic street drugs than are dying from COVID-19. It’s a “shadow pandemic” that has been raging for decades and is only getting worse as border closures make it harder for gangs to move drugs like heroin and fentanyl across borders, leading to shortages of “safe” ingredients and a shift toward exotic, extremely toxic alternatives like carfentanyl.

edogg 6y ago
do you think some pay back from China for the opium wars is part of the dynamic?
- ttul 6y ago
  That’s going back a ways...
  - edogg 6y ago
    To the century of humiliation starting in 1839 with the opium war [1]. I’m told saving face is very important in Chinese culture. I could see it being quite easy for people in China whose job it might be to prevent the export of fentanyl or fentanyl precursors to only do the minimum to keep up appearances. not nearly as blatant as the British but were but we aren’t getting any help from China in preventing the deadly drugs from being shipped here. It would be better if they would just send actual heroin instead of having casual mdma and cocaine users dying from fentanyl. [1] https://en.wikipedia.org/wiki/Century_of_humiliation https://en.wikipedia.org/wiki/Century_of_humiliation
- pjc50 6y ago
  The opiates crisis was driven and enabled by US pharma marketing practices. Internationally-mailed fentanyl was only a small part of the problem.
  - monoideism 6y ago

Icedcool 6y ago

The only country to truly “win” the war on drugs.

scns 6y ago
What you figh gets stronger. Siddhatha Gautama

bismuthsalt 6y ago

To note, in 2001 Portugal has decriminalized possession of small quantities of drugs, for first time offenders. Drug trafficking is still just as illegal as ever. There are no cannabis shops or pervasive cannabis advertisement, as opposed to US liberal states, for example CO or WA. > But Portugal’s experience is often misunderstood. Although it decriminalized the use of all illicit drugs in small amounts in 2001, including heroin and cocaine, that’s different from making them legal. And it did not decriminalize drug trafficking, which would typically involve larger quantities. > Portugal’s law removed incarceration, but people caught possessing or using illicit drugs may be penalized by regional panels made up of social workers, medical professionals and drug experts. The panels can refer people to drug treatment programs, hand out fines or impose community service. > A lot of the benefits over the years from Portugal’s policy shift have come not from decriminalization per se, but in the expansion of substance-use disorder treatment. Such a move might bring the most tangible benefit to the United States.

rmrfstar 6y ago
Take a look at the US per-capita incarceration rate over time [1]. Since the war on drugs began, it has grown 5x over what appears to have been a long-term steady state. The war on drugs is a make-work jobs program for people who can't build anything useful. Relative to skill, these are well-paying stable jobs. [1] https://upload.wikimedia.org/wikipedia/commons/thumb/4/48/U.S._incarceration_rates_1925_onwards.png/1200px-U.S._incarceration_rates_1925_onwards.png https://upload.wikimedia.org/wikipedia/commons/thumb/4/48/U....

Synaesthesia 6y ago

There was a RAND study many years ago which showed that, from a pure cost benefit point of view, the best way to deal with drugs is through education and treatment, not policing and punishment. Eg Americans today smoke a lot less tobacco and drink less coffee too. Education works!

m463 6y ago
(it has all switched to sugar/processed carbs!)
ChuckNorris89 6y ago
By contrast some European countries, like Austria, drink a lot of coffee and smoke a lot of tobacco(they just banned indoor smoking last year). National culture plays a huge role in what vices people take on.
- unwind 6y ago
  According to [1], Europe is the world's largest coffee market, at 33% of production. North America consumes 19%. Consumption per capita up here in the wonderful Nordics is quite high, with Finland typically leading at 12 kg/person. The corresponding number for the US is around 4.2 kg (9.3 lbs). The Telegraph has a fun list [2] showing the top 20 consumers. [1] https://www.cbi.eu/market-information/coffee/trade-statistics https://www.cbi.eu/market-information/coffee/trade-statistic... [2] https://www.telegraph.co.uk/travel/maps-and-graphics/countries-that-drink-the-most-coffee/ https://www.telegraph.co.uk/travel/maps-and-graphics/countri...
  - ciceryadam 6y ago
    wow, 1 kg per month means 133 shots of espresso a month - roughly 4.5 espresso shots every day, including weekends.
    - gspr 6y ago
      Sounds about right for me here in Norway. I really need to cut back.

AlexTrask 6y ago

During the last years Portugal is doing a great job in a lot of fields like education or economy. A great example for southern Europe countries

odshoifsdhfs 6y ago
We did a lot of good things, but I wouldn't say those are the samples we want to use as examples for other countries.
sergiosgc 6y ago
Thanks. It's good to hear this opinion from the outside. The Portuguese are, as a group, pretty pessimistic. I often have to state that, in '74, when the dictatorship ended, we were massively illiterate. The education evolution is extraordinary, albeit inevitably slow: it takes a couple generations to change the education profile of a country. It is a country far from perfect, but the people are nice, the cuisine is excellent, the weather is amazing and it is consistently moving in the right direction.

DoingIsLearning 6y ago

A lot of anglo speaking countries like to quote Portugal as an example, I would just like to add some reality to the picture perfect descriptions I read: - The main public opinion driver for both the needle exchange programs and the decriminalization was a _massive_ Heroin epidemic which lead to an HIV, Hepatitis B/C, AND Tubercolosis epidemic, the last one of those is particularly airborne contagious. I often see the lumping of 'heavy' drugs but (although decriminalized) Cocaine consumption in Portugal was marginal at the time (mostly because the majority of the population couldn't afford it). The main precipitator was Heroin consumption. - These programs served as a 'trojan horse' anchor point to bring these, often homeless/missing, people back into the healthcare system. For added controversy for the americans out there, healthcare is universally free in Portugal. - There was a clear rupture point both in crime rates and the prison system capacity due to the heroin epidemic. Police forces could no longer be bothered with the 'noise' of the numerous small possessions of 'non-heavy' drugs like haxixe or marijuana. Offloading that to mental health practioners was also logistically useful for law enforcement. - It took a considerable amount of additional healthcare funding for these programs to be implemented. This would _not_ have been possible for an economy like Portugal without supplementary funds from the European Union economic development programs. - I am very suspicious of the counter-argument insinuation that the program initially _caused_ an increase in crime rates and consumption, because the start of the program also matched the start of a fairly large economic downturn. The main idea of the program was that people could go and ask for help, without the fear of being put in jail. If you have a desperate person, willing to do desperate things, not pushing them against a corner is usually a good policy for crime rates.

JetSpiegel 6y ago
> - The main public opinion driver for both the needle exchange programs and the decriminalization was a _massive_ Heroin epidemic There were politicians that publicly spoke about their personal experiences. Others that had family members that were caught up with it. It was a widespread issue across all classes, not just the poor. Here's a recent interview about one of the main drivers of this policy (in Portuguese). https://www.perguntarnaoofende.pt/pno/joao-goulao https://www.perguntarnaoofende.pt/pno/joao-goulao
6y ago

europoorr 6y ago

Funny how Europeans aren’t trigger happy - they wont immediately jump to killing people or imprisoning them, but look at alternative solutions. Americans need a war, be it at home or abroad, classwars, wars on drugs, wars on each other over who is a dem who is a rep. They could simply learn lessons from the old world and adopt them and they would be better off in many areas. Instead they start “wars”.

varispeed 6y ago

Not sure why this policy is touted as a champion example how to deal with the drug "problem". Only thing it does it reduces exposure of drug consumers to law enforcement harassment while at the same time helps organised crime making more money. I would rather look into why some people promote this and maybe look into their finances. Drug use is natural for intelligent beings and prohibition of that is like trying to ban music or sex. It will never work, but will create a plethora of problems that we experience. From the rise of organised crime to people being unable to access medication they need. It is being tolerated by the population because of massive propaganda and manipulation (for example someone done something bad? Make sure to mention they used cannabis or other drug even if that had nothing to do with the thing that has been done). It is in a way similar to how it was possible to ban same sex intercourse in some countries - people were made to believe it was a "sin". Many health issues are caused by the contamination in drugs available on the streets, that are attributed to drugs themselves. Some popular drugs could be much safer if you could buy a medical grade. In other words it is another money maker based on people suffering and deception and promotion of Portugal model looks very suspicious.

joaomval 6y ago
How are the drug dealers making more money if there are alot less people consuming?
- varispeed 6y ago
  Do you have evidence that this is the case? Drug use comes from natural urge to explore consciousness and people take drugs regardless of the law around it. If they are no longer being harassed by law enforcement, then it is easier for them to pursue this and Portugal's policy does that. If I recall the drug use is estimated from surveys and people lie when it comes to that (for example there is thinking what if they start to investigate me if I respond "yes", even if the survey is "anonymous"). Other way to estimate is by looking at numbers of people caught with the system. Now, because the harassment has been relaxed obviously fewer LE will bother going after consumers and from that it is easy for propaganda machinery to tout the policy is working. Well, it is working for those involved in the trade. You sell more if your customers are not being harassed, simple fact of life.

kyrers 6y ago

This is one of the things that makes me proud to be Portuguese. Also, does anyone remember the name of the doctor that started this whole movement? I think the first name is João, but I can't remember or find it. I might be tripping, pun intended.

joaofs 6y ago
https://en.wikipedia.org/wiki/Jo%C3%A3o_Castel-Branco_Goul%C3%A3o https://en.wikipedia.org/wiki/Jo%C3%A3o_Castel-Branco_Goul%C...
- kyrers 6y ago
  Thanks!
  - JetSpiegel 6y ago
    https://www.perguntarnaoofende.pt/pno/joao-goulao https://www.perguntarnaoofende.pt/pno/joao-goulao He even gave a recent interview about all this.

mytailorisrich 6y ago

One issue with drugs policy, I mean in general total prohibition, is that it has come about for moral and emotional (even religious in some case) reasons, like the prohibition of alcohol in the USA once had. This can be seen in the fact that use is usually a crime. There are no other substances, however nasty they might be, that are a crime to drink/eat/inject. To me this elevates the use of drugs to some sort of sin for, really, arbitrary reasons. This makes taking a pragmatic and facts-based approach difficult.

x87678r 6y ago

I saw somewhere there was some confusion in translation what decriminalization means, as Portugal has Roman Law as opposed to Common Law found in English speaking countries. Portugal "decriminalization" of drugs left it in a similar state to British law anyway. I can't find a reference now though - does anyone know more?

JetSpiegel 6y ago
From what I heard, the change led to treating drug usage as health problem, and removing the law enforcement aspect from the loop. The police can still refer drug users to the healthcare institutions that deal with the problem. Another interesting tidbit is that the Netherlands did not in fact legalized cannabis. They just decline to prosecute that crime. There's no legal framework to regulate its sale, like for any other consumable good. This leads to silliness like people in "coffee shops" being allowed to smoke weed, but not tobacco since that is regulated for all indoors venues.

sloshnmosh 6y ago

Drugs will never be decriminalized fully here in the US. There is too much untraceable money involved. It is said that after the housing bubble burst around 2008 that there was very little “liquid” cash floating around and that dark money from drug trafficking was one of things that helped the US from going completely under. Add to that all the covert operations to overthrow governments and bribe crooked foreign leaders that require vast sums of money that doesn’t leave a paper trail. The “war” on drugs is too keep drugs illegal and to sustain the flow of dirty monies.

blackflame7000 6y ago

The opposite of addiction is connection.

macca321 6y ago

Teeth are a luxury.