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How Portugal tackled its addiction epidemic to become a world model

Two decades ago, Portugal was in the grip of a nation-wide drug epidemic. The dire situation led the country's leaders to a radical solution: the decriminalization of all drugs and a health-care approach — rather than a criminal law approach — to deal with addiction. The experiment is now celebrated around the world as the "Portuguese Model." Contributor Megan Williams talks to the doctor who helped set up the system and to drug addicts still alive because of it.

Since decriminalization, Portugal has one of the lowest drug addiction rates in Europe

CBC Radio ·
Portugal's Institute for Drugs and Drug Addiction exchange used needles for new ones and try to direct drug addicts to treatment centres. Portugal decriminalized the use of all drugs in a groundbreaking law in 2000. (Armando Franca/The Associated Press)

In the late 1990s, Paul Mendes was deported from the U.S. back to his birth country of Portugal. And within months of arriving, the former fisherman was hooked on heroin.

"It was crazy," Mendes remembers, standing on the side of a busy street in Lisbon after getting his methadone dose from a white van nearby.

"I'd lived in New York [where they had] drugs in buildings, people doing it in a corner or something. Here? They had lines from here to like to [way] over there, two people, double line-ups. You got a guy with a bag of coke, and bag of heroin — and the guy with the money… So many people died."

At the time, Portugal was in the grip of a nation-wide drug epidemic. 

After the 40-year conservative authoritarian regime of Antonio Salazar ended in 1974, soldiers fighting the country's colonial wars returned to a once closed-off nation where even Coca Cola had been banned as a corrupt, habit-forming drug. But many of these ex-soldiers had become addicted to drugs while abroad.

Dr. João Goulão was tasked with putting together a proposal that included the full decriminalization of drug use, and the recognition of addiction as a disease and a social problem. (Megan Williams)

"More than one million people suddenly came to the mainland, bringing their habits and tonnes — literally tonnes — of cannabis that suddenly was made available for everybody," explains Dr. João Goulão​​​​​, the head of Portugal's Intervention on Addictive Behaviours and Dependencies service.

"In a completely naïve society, we knew nothing, not even the differences between different drugs."

A blueprint intervention

The rates of addiction and overdose soared so high that virtually every family in the small country was affected — one percent of the population. In Canada, that would be 360,000 people at risk of overdose.

The dire situation led the country's leaders to a radical, daring solution: the decriminalization of the possession for use of all drugs and a health-care approach to dealing with addiction, rather than a criminal one. 

Drug dealers (left) in downtown Lisbon, where drug use and addiction are among the lowest in Europe. (Megan Williams)

Goulão was then a young doctor struggling to treat addicts in the south of Portugal. when he was tasked with writing the blueprint for dealing with the crisis. 

At the time, drug dealing was still illegal and was overseen by the courts. But the issue of drug consumption was transferred to the auspices of the Ministry of Health.

Those caught with more than 10 days' worth of anything from cannabis to heroin would receive an administrative order to report to a Drug Dissuasion Commission, where they would meet a psychologist to talk about addiction or any other issues they may have.

There are two Threshold Mobile Units around Lisbon treating approximately 1,200 people a day. They’re part of Portugal’s nationwide, co-ordinated holistic response to addiction. (Megan Williams)

Methadone clinics, clean needle handouts, programs to encourage small businesses to hire addicts in treatment, and a pan-ministerial network of support for those struggling to stay off drugs were set up and are still operational today. 

The results: addiction rates plummeted. As did those for HIV and AIDS. The court system declogged, and what began as the "Portuguese Experiment" is now studied by experts and officials around the world as the "Portuguese Model" — including Canada.

Could the Portuguese Model work in Canada?

In June 2019, the House of Commons Health Committee urged the federal government to look at Portugal's decriminalization of simple possession of illicit drugs and examine how the idea could be "positively applied in Canada."

Some Liberal MPs are working on introducing a private member's bill to have Canada treat drug use as a health issue, and to decriminalize simple possession of any drug currently subsumed by the Controlled Drugs and Substances Act.

However, Conservative critics point out that Canada can't simply copy the Portuguese model. In Portugal, there are 170 recovery facilities for 11 million people. The country also provides mental-health treatment and mandatory education about the harmful effects of drugs.

They argue that it's unrealistic to think Canada could achieve the same results without the same support systems.

Portugal decided in 2001 to decriminalize possessing small amounts of all drugs – from cannabis to heroin. Dr. Goulão says the decision focused on the correlation that the individual establishes with the substance, not the substance itself. (Megan Williams)

A testament of success 

Whatever route Canada takes, Paul Mendes can attest to its success in Portugal.

He's been off drugs for a decade now. He's one of the 1,200 men and women who get their methadone and any other medications they need from one of the two Threshold Mobile Unit vans that moves throughout Lisbon every day. 

And thanks to Portugal's healthcare approach to addiction, he's stayed out of prison, and has been working as a landscaper. He's now cured of the hepatitis C he'd contracted in the days of the epidemic.

Paul Mendez holds a document that shows he is cleared of Hepatitis C. (Megan Williams)

However, there are still elements of the program he doesn't like — the people coming to the van to get their methadone, for instance — who pick up clean needles to then go and shoot up. 

But he says he's convinced the whole world should adopt the Portuguese Model.

"I can think better. I don't have to make money every day to go get high. I have no dope sickness," he says.

"You feel normal. So I'm with this program."
 

Guests in the program:

  • Paul Mendes is a former addict.
  • João Goulão, M.D., is the Director-General of The General-Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD) in Lisbon, Portugal.
  • Hugo Faria is a psychologist at Lisbon's Threshold Mobile Unit.
  • Carolina Marchez is a psychologist at Lisbon's Threshold Mobile Unit. 
  • Emanuel is a former addict.
  • Bruno is a patient of the Dissuasion Commission.
  • Nuno Capaz is a sociologist and head of Portugal's Dissuasion Commission.
     


** This episode was produced by Megan Williams.
 

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