7 ms·

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

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
varispeed 6y ago
> which lead to an HIV, Hepatitis B/C, AND Tubercolosis epidemic It seems like these problems are not directly caused by the drug, but by the fact users cannot buy clean medical grade with a safe method of administration. Portugal model doesn't seem to address that, but only makes consumption slightly more "comfortable" to the users.
- base 6y ago
  Portugal have needle exchange programs and places with health practitioners for people to shoot drugs, this last point was very controversial when it was implemented. Nowadays there are even mobile sites for this: https://idpc.net/alerts/2019/07/inside-portugal-s-first-mobile-safe-consumption-site https://idpc.net/alerts/2019/07/inside-portugal-s-first-mobi...
  - varispeed 6y ago
    That is helpful, but even with a clean needle they will administer something possibly contaminated anyway. Good program would also give out medical grade clean heroin like they do in Switzerland. Clean heroin is relatively safe contrary to popular opinion. This removes the dealers from that segment of the market or at least severely reduces the sales volume.
    - howlgarnish 6y ago
      Needle exchanges are more about preventing multiple people from using the same needle, which is an excellent way to transmit diseases like hepatitis, HIV, etc.
      - varispeed 6y ago
        Yes this is helpful in that way, but call me cynical - without removing the market from the hands of criminals, what it does is ensures that the consumer will be a paying client a little bit longer. But if a dealer messes up and mixes the Fentanyl unevenly, the clean needle won't help much.
adamcharnock 6y ago
I've been living in rural Portugal for a little while now, and these are some excellent comments. Especially the first point. I'd also add that there is still a Heroin problem, albeit diminished. It is not unusual to see someone walking though the local village, out-of-their head drunk at 9am on a Wednesday. It isn't alcohol though, it's Heroin. But it is also an economically poor area. The weather is amazing and the place is gorgeous, but for someone raised here who doesn't manage to escape it can also be a trap. Many of the older people work in the fields in the morning, the in the late afternoon they meet in the cafes and chat about village life. Coffee is $0.15, a beer is $0.7. There a very few younger people. Those that can leave have left for a city. The ones who remain are that ones who were not able to leave. I spoke with the local President last week and he himself said that the area has become a skills desert. So yes, I think the route to Heroin addition looks something like this. Get financially stuck in the local area. Get a bad reputation for being lazy. Try to become YouTube/Insta famous. Give up. Turn on those that tried to help. Drink & smoke weed as an escape. When those stop working try Heroin. I know a couple of people in my village that are on this path right now. There is some crime here. It seems to fall into two categories. First is petty crime where something goes missing that's worth about $100. That's enough to quickly sell for immediate cash (likely for some form of drug). This has happened to me twice, and I don't really mind. There is more 'organised' crime where a place gets methodically burgled when someone is away. I know people this has happened to. There is a rapidly growing contingent of foreigners here now, and we're mostly accepted. Economically, I get the impression that most businesses prefer to deal with the foreigners. Even the guy that sells firewood says that 95% of his customers are now foreigners, and that he prefers it that way. There are lots more foreigners arriving too (leaving cities due to covid, basically), very few Portuguese people being added. Most people in my village are over 60. It'll be interesting to see how the demographics play out over the coming years. Anyway, maybe that is of some interest. The region of Portugal I am in is Castelo Branco. I'm starting an ISP here too: https://gardunha.net https://gardunha.net
- hypnotist 6y ago
  starting ISP - that is very cool! What about Portuguese language ? do you need to able to speak to be accepted there ?
glaberficken 6y ago
>"...healthcare is universally free in Portugal..." In principle only. In practice: how much have you spent on dentist bills in the past year?
- CraigJPerry 6y ago
  Child birth. Heart attack. Broken leg. Brain tumour. Flu. It’s free in practice.
  - glaberficken 6y ago
    Yes, most things are free in practice. Just so happens that something critical for day to day general health and well-being (dental health) is not. It's not by accident that Portugal has oral health on par with the poorest Eastern European countries.
galfarragem 6y ago
It's not the first time the NYT insists in this idea. Ok, it's good advertisement to our tourism but this is just fake news. I grew up in one of the "drug towns" of the late 80's/early 90's in Portugal. It was bad, really bad. There wasn't any extended family without a drug problem. That generation, bornt after the 1974 revolution, now in the mid 40's, was almost erased from there. Some died and those remaining, after a life of petty crime and prison, eventually escaped. Completely agree with your comment. I would just add another relevant factor to the roll: decriminalization gave even more visibility to the addiction problem and newer generations didn't like what they saw. It wasn't cool to use drugs anymore.
- f-securus 6y ago
  Personally, growing up in Appalachia in the 90s it was more likely my extended family was abusing drugs than not. Cracking down on pill mills and making Oxy less abusable has pushed more and more to heroin/meth/synthetics. The drug problem is still rampant in the area. People need help and the barrier to receiving help in this country is too high. I had a friend begging for help with treatment and the only in patient place at the time for substance abuse in the area had an 8 week waiting list... and you had to pay your way so unless you had a family/friend with extra resources you were on your own. We wonder why the drug problem still exists in this country where we punish those struggling instead of help them.
  - tonyarkles 6y ago
    Your description of the in-patient problem sadly reflects the state of affairs up in Canada too, where most, but not all, healthcare is free (eyes and teeth are strange exceptions). I’ve got an older friend who did a lot of drugs back in the day, but got his life mostly figured out until a few years ago when he had to get shoulder surgery. Prescribed Oxy for recovery, even after telling the surgeon about his past addiction struggles. As expected, they become less effective over time, he likes getting high, so he starts taking larger doses. Gets to the end of his prescription and can’t get a refill. Did he make bad choices here? Definitely. But then the health care system screws up: “I want to detox and get clean again.” “Sorry, you’ve never overdosed, so you can’t detox in the hospital. Maybe you can get on a waiting list for a private (out of pocket) facility. Oh, and no refills, you’re an addict” “Maybe I can be a short-term patient at a mental health facility?” “Sorry, you’ve never tried committing suicide because of your drug use. Maybe you can get on a wait list at a private facility? Oh, and no refills, you’re an addict!” So... what does an opioid addict who is in withdrawal and can’t get support from the health care system do? Goes and scores some heroin... Today he’s mostly clean again. I think he pops a pill here and there but isn’t high all day. But... this could have all been avoided. The health care system had many opportunities to help out here, but didn’t. Edit: one last note: the private facilities are quite expensive and have massive waiting lists. Even if he had had the cash to go, he would have still been in limbo for weeks-to-months with no access to clean drugs nor support to get clean.

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

varispeed 6y ago

> which lead to an HIV, Hepatitis B/C, AND Tubercolosis epidemic It seems like these problems are not directly caused by the drug, but by the fact users cannot buy clean medical grade with a safe method of administration. Portugal model doesn't seem to address that, but only makes consumption slightly more "comfortable" to the users.

base 6y ago
Portugal have needle exchange programs and places with health practitioners for people to shoot drugs, this last point was very controversial when it was implemented. Nowadays there are even mobile sites for this: https://idpc.net/alerts/2019/07/inside-portugal-s-first-mobile-safe-consumption-site https://idpc.net/alerts/2019/07/inside-portugal-s-first-mobi...
- varispeed 6y ago
  That is helpful, but even with a clean needle they will administer something possibly contaminated anyway. Good program would also give out medical grade clean heroin like they do in Switzerland. Clean heroin is relatively safe contrary to popular opinion. This removes the dealers from that segment of the market or at least severely reduces the sales volume.
  - howlgarnish 6y ago
    Needle exchanges are more about preventing multiple people from using the same needle, which is an excellent way to transmit diseases like hepatitis, HIV, etc.
    - varispeed 6y ago
      Yes this is helpful in that way, but call me cynical - without removing the market from the hands of criminals, what it does is ensures that the consumer will be a paying client a little bit longer. But if a dealer messes up and mixes the Fentanyl unevenly, the clean needle won't help much.

adamcharnock 6y ago

I've been living in rural Portugal for a little while now, and these are some excellent comments. Especially the first point. I'd also add that there is still a Heroin problem, albeit diminished. It is not unusual to see someone walking though the local village, out-of-their head drunk at 9am on a Wednesday. It isn't alcohol though, it's Heroin. But it is also an economically poor area. The weather is amazing and the place is gorgeous, but for someone raised here who doesn't manage to escape it can also be a trap. Many of the older people work in the fields in the morning, the in the late afternoon they meet in the cafes and chat about village life. Coffee is $0.15, a beer is $0.7. There a very few younger people. Those that can leave have left for a city. The ones who remain are that ones who were not able to leave. I spoke with the local President last week and he himself said that the area has become a skills desert. So yes, I think the route to Heroin addition looks something like this. Get financially stuck in the local area. Get a bad reputation for being lazy. Try to become YouTube/Insta famous. Give up. Turn on those that tried to help. Drink & smoke weed as an escape. When those stop working try Heroin. I know a couple of people in my village that are on this path right now. There is some crime here. It seems to fall into two categories. First is petty crime where something goes missing that's worth about $100. That's enough to quickly sell for immediate cash (likely for some form of drug). This has happened to me twice, and I don't really mind. There is more 'organised' crime where a place gets methodically burgled when someone is away. I know people this has happened to. There is a rapidly growing contingent of foreigners here now, and we're mostly accepted. Economically, I get the impression that most businesses prefer to deal with the foreigners. Even the guy that sells firewood says that 95% of his customers are now foreigners, and that he prefers it that way. There are lots more foreigners arriving too (leaving cities due to covid, basically), very few Portuguese people being added. Most people in my village are over 60. It'll be interesting to see how the demographics play out over the coming years. Anyway, maybe that is of some interest. The region of Portugal I am in is Castelo Branco. I'm starting an ISP here too: https://gardunha.net https://gardunha.net

hypnotist 6y ago
starting ISP - that is very cool! What about Portuguese language ? do you need to able to speak to be accepted there ?

glaberficken 6y ago

>"...healthcare is universally free in Portugal..." In principle only. In practice: how much have you spent on dentist bills in the past year?

CraigJPerry 6y ago
Child birth. Heart attack. Broken leg. Brain tumour. Flu. It’s free in practice.
- glaberficken 6y ago
  Yes, most things are free in practice. Just so happens that something critical for day to day general health and well-being (dental health) is not. It's not by accident that Portugal has oral health on par with the poorest Eastern European countries.

galfarragem 6y ago

It's not the first time the NYT insists in this idea. Ok, it's good advertisement to our tourism but this is just fake news. I grew up in one of the "drug towns" of the late 80's/early 90's in Portugal. It was bad, really bad. There wasn't any extended family without a drug problem. That generation, bornt after the 1974 revolution, now in the mid 40's, was almost erased from there. Some died and those remaining, after a life of petty crime and prison, eventually escaped. Completely agree with your comment. I would just add another relevant factor to the roll: decriminalization gave even more visibility to the addiction problem and newer generations didn't like what they saw. It wasn't cool to use drugs anymore.

f-securus 6y ago
Personally, growing up in Appalachia in the 90s it was more likely my extended family was abusing drugs than not. Cracking down on pill mills and making Oxy less abusable has pushed more and more to heroin/meth/synthetics. The drug problem is still rampant in the area. People need help and the barrier to receiving help in this country is too high. I had a friend begging for help with treatment and the only in patient place at the time for substance abuse in the area had an 8 week waiting list... and you had to pay your way so unless you had a family/friend with extra resources you were on your own. We wonder why the drug problem still exists in this country where we punish those struggling instead of help them.
- tonyarkles 6y ago
  Your description of the in-patient problem sadly reflects the state of affairs up in Canada too, where most, but not all, healthcare is free (eyes and teeth are strange exceptions). I’ve got an older friend who did a lot of drugs back in the day, but got his life mostly figured out until a few years ago when he had to get shoulder surgery. Prescribed Oxy for recovery, even after telling the surgeon about his past addiction struggles. As expected, they become less effective over time, he likes getting high, so he starts taking larger doses. Gets to the end of his prescription and can’t get a refill. Did he make bad choices here? Definitely. But then the health care system screws up: “I want to detox and get clean again.” “Sorry, you’ve never overdosed, so you can’t detox in the hospital. Maybe you can get on a waiting list for a private (out of pocket) facility. Oh, and no refills, you’re an addict” “Maybe I can be a short-term patient at a mental health facility?” “Sorry, you’ve never tried committing suicide because of your drug use. Maybe you can get on a wait list at a private facility? Oh, and no refills, you’re an addict!” So... what does an opioid addict who is in withdrawal and can’t get support from the health care system do? Goes and scores some heroin... Today he’s mostly clean again. I think he pops a pill here and there but isn’t high all day. But... this could have all been avoided. The health care system had many opportunities to help out here, but didn’t. Edit: one last note: the private facilities are quite expensive and have massive waiting lists. Even if he had had the cash to go, he would have still been in limbo for weeks-to-months with no access to clean drugs nor support to get clean.