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The Portugal model: How one country is winning the war on drugs

In the early 1990s, 100,000 people in Portugal had a heroin addiction. Now, owing to the decriminalization of drugs, that number is closer to 25,000

In the early 1990s, Portugal was in the midst of a heroin and HIV crisis. Approximately one per cent of their 10 million people had a heroin addiction, and the country held the highest rate of HIV infection in the European Union. By the late 1990s, half of the prison population was incarcerated on drug charges, mostly possession. 

But the decriminalization of drugs in 2001, and the shift from a criminal approach to a public health one — the so-called ‘Portugal model’ — has had dramatic results. This shift, one of philosophy and law rather than morality, could potentially work in Canada. 

According to a New York Times analysis, the number of heroin users in Portugal has dropped from 100,000 to just 25,000 today. The number of HIV diagnoses caused by injection drug use has plummeted by more than 90 per cent. Over the last 20 years, levels of drug use in Portugal are consistently under the European average, particularly with young people between the ages of 15-34.

Instead of prison cells, drug-dependent individuals in Portugal are now offered treatment programs that integrate them back into society. Even police officers have benefited, now free to focus on intercepting large-scale trafficking and uncovering smugglers. 

A 2015 study found that since Portugal approved this new national strategy, the per capita social cost of substance use decreased by 18 per cent.

How it began

While most countries struggle with drug use in some form, it was not at crisis level in Portugal until around 1980. Many attribute the quick and strong uptake in drug consumption to the end of the Estado Novo dictatorship.

Lasting four decades, from 1933 to 1974, the Estado Novo was Europe's longest-enduring dictatorship. Developed by Antonio de Oliveira Salazar, the President of the Council of Ministers, the Estado Novo was inspired by autocratic, authoritarian and fascist ideologies, and defended Portugal’s conservative traditional Catholicism. 

After the fall of Estado Novo, Portugal’s borders opened, which brought the outside world, and drugs, to the country. So many years of isolation had left them poorly equipped to tackle the influx of drugs and the country became overwhelmed by addiction, crime and death. 

As is often the case, when a social issue relating to criminal law arises, many governments react with emergency or zero-tolerance policies, toughening the laws that focus on the issue. Portugal decided to enter the war on drugs; within a decade, it appeared that the drugs had won.

How it changed

But in 1998, Portugal decided to do something different. The government appointed a committee of specialists — doctors, sociologists, psychologists, lawyers, and social activists — and asked the committee to analyze the drug issue in Portugal to then formulate recommendations that could be turned into a national strategy. 

The committee recommended the decriminalization of possession and use for both ‘hard’ drugs, like heroin, and ‘soft’ drugs, like cannabis, as the most effective way of limiting drug consumption and reducing the number of drug-dependent persons.

The law decriminalized the use and possession of up to 10 days' worth of narcotics or other drugs for individuals' own use. This only applies to drug users; dealers and traffickers still go to jail. 

Instead of facing prison time and criminal records, users who are caught by police go before a local three-person commission for the dissuasion of drug addiction, a panel typically composed of a lawyer plus some combination of a physician, psychologist, social worker or other health-care professional with expertise in drug addiction.

The commission assesses whether the individual is addicted and suggests treatment as needed. ‘Non-addicted’ individuals may receive a warning or a fine, but the commission can decide to suspend enforcement of these penalties for six months if the individual agrees to get help — an information session, motivational interview or brief intervention — targeted to their pattern of drug use. If the individual completes the program and doesn’t appear before the commission again for six months, their case is closed.

That’s because the committee found that treating drug consumption under criminal law was preventing many drug users from seeking treatment, afraid to ask for medical help for fear of criminal punishment. 

With decriminalization, the state would maintain the rule of prohibition, but take sanctions for drug use outside the framework of criminal law.

Along with these legal changes, there was a new focus on prevention, education and harm reduction. They worked to improve treatment programs for drug dependent persons and helped at-risk groups and current drug users maintain or restore their connections to family, work, and society. 

How it’s going

There are still challenges, of course, and in Portugal, the issue affecting substance users looking to get treatment is much the same as here in Sudbury: a lack of affordable housing. spoke with Hugo Amaral Faria, a psychologist who manages a mobile methadone program run by a nongovernmental organization called Ares do Pinhal, the association for social inclusion in Lisbon, the capital city of Portugal.

The mobile unit is staffed by a doctor, a nurse and two psychosocial technicians — professionals without university degrees who provide education on such topics as safer drug consumption and safe sex. The staff screen for infectious diseases, exchange needles, offer condoms and distribute methadone, along with medication for mental disorders, HIV and hepatitis. The program describes itself as "low-threshold," meaning that individuals aren't required to abstain from drugs to use its services. 

Each of the psychologists and social workers at Ares do Pinhal are responsible for around 100 patients who might need help finding a place to live or a referral to a substance abuse treatment program.

The goal is to empower individuals and help them attain autonomy, said Faria. The organization also offers participants access to regular medical and psychosocial assessment, greater awareness of their health status and access to community health and social services. 

This harm-reduction approach is paying off, said Faria. When the program first started prior to decriminalization, 55 per cent of its clients were HIV-positive; today, just 13 per cent are. And the mobile units don't just improve participants' health, he said. Because staff watch infectious disease patients take their medication and thus ensure treatment adherence, they also help safeguard public health. 

“It’s an integrated model,” said Faria. “We try to look at the clients from a social and health point of view, and I think that is really helpful.”

That includes housing and social inclusion, but also, effective treatment options for those who ask. Faria said that is the most pronounced effect of the decriminalization: the willingness to ask for help without fear of consequences. 

For those who are actively using, Ares Do Pinhal has a safe-consumption site, with options for smoking as well as injecting. For those who ask, treatment is available in the form of methadone and suboxone. These medications mitigate physical effects of withdrawal, and as the user moves further from active substance use, the amount of methadone or suboxone can be lessened until unnecessary. 

In Canada, these medications must be dispensed by a pharmacist, which can make it inaccessible — or too troublesome compared to street purchasing of opioids. But in Portugal, these medications are dispensed by harm reduction groups like Ares do Pinhal, making it easier, and more likely to work. 

And while Sudbury has a greater issue with a toxic supply of drugs than Portugal does, in that the supply of drugs in Portugal is less likely to be ‘cut’ with another substance, there are still overdoses happening there. But in Faria’s mind, the method to avoid overdose is to prevent them. 

“The opioid treatment, it's very easy to get, it's very spread all over the country (Portugal) and I believe that it's a very important preventive action to overdose,” said Faria. “So many people can get methadone in an easy way. If you're out on the street, you can buy it on the street.” 

While the work to manage addiction in Portugal was greatly helped by decriminalization and a move to a public-health based approach to overdose, it was greatly hampered by the COVID-19 pandemic, said Faria. There was a significant uptick of overdoses in 2020, with many going back to the street drugs when methadone and suboxone became harder to access. 

But in Portugal, population 10 million, that meant 72 overdose deaths in 2019. 

In Sudbury, population 166,004, that meant 107 overdose deaths from opioids, three times the Canadian national average and more than the entire country of Portugal.

But again, when a social issue relating to criminal law arises, governments react with emergency or zero-tolerance policies, toughening the laws that focus on the issue. It is the way Canada has attempted to fight the war on drugs; but with the death toll as it is in Sudbury, it may be time to examine other solutions. 

Jenny Lamothe covers vulnerable and marginalized communities for 


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Jenny Lamothe

About the Author: Jenny Lamothe

Jenny Lamothe is a reporter with She covers the diverse communities of Sudbury, especially the vulnerable or marginalized.
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