Winning The War On Drugs
typesetter who became hooked on heroin 30 years ago, told me as he sipped from a paper cup of methadone supplied by a mobile van. The vans, a crucial link in Portugal’s efforts, cruise Lisbon’s streets every day of the year and supply users with free methadone, an opioid substitute, to stabilize their lives.
“If I couldn’t come here, I don’t know if I’d still be alive,” Mr. Oliveira told me.
Yet Portugal’s approach is no magic wand.
“I’m homeless and jobless and addicted again,” said Miguel Fonseca, a 39-year- old electrical mechanic. He spends about $100 a day on his habit, and has turned to theft to support it.
Nearby, Mario, the fisherman, was showing little interest in Ms. Lopes’s outreach. He scoffed at using methadone as an alternative to heroin. Workers like Ms. Lopes may never be able to get Mario to give up drugs, but she can help keep him alive.
Portugal switched to its health focus under the leadership of a socialist prime minister named António Guterres, who is now the United Nations secretary general. The new approach was a gamble. “We were facing a devastating situation, so we had nothing to lose,” recalled João Castel-Branco Goulão, a public health expert and the architect of the policy.
So let’s be clear on what Portugal did and didn’t do. First, it didn’t change laws on drug trafficking: Dealers still go to prison. And it didn’t legalize drug use, but rather made the purchase or possession of small quantities (up to a 10- day supply) not a crime but an administrative offense, like a traffic ticket.
Offenders are summoned to a “Dissuasion Commission” hearing — an informal meeting at a conference table with social workers who try to prevent a casual user from becoming addicted.
The public health approach arises from an increasingly common view worldwide that addiction is a chronic disease, comparable to diabetes, and requires medical care rather than punishment. We don’t just tell diabetics, “Get over it.”
So how effective is the program? I thought I’d ask some real experts: drug dealers.
“There are fewer customers now,” complained one heroin dealer.
Joaquim Farinha, 55, was skeptical that methadone was costing him much business. “Business is still pretty good,” he said, interrupting the interview to make a sale.
The evidence is that drug use has stabilized or declined since Portugal changed approaches, particularly for heroin. In polls, the proportion of 15- to 24-year- olds who say that they have used illicit drugs in the last month dropped by almost half since decriminalization.
In 1999, Portugal had the highest rate of drug-related AIDS in the European Union; since then, H.I.V. diagnoses attributed to injections have fallen by more than 90 percent.
Another factor in Portugal’s favor: The economy has grown and there is a robust safety net, so fewer people self-medicate with drugs.
It’s also cheaper to treat people than to jail them. The Health Ministry spends less than $10 per citizen per year on its drug policy. America has spent some $10,000 per household over the decades on a failed drug policy that results in more than 1,000 deaths each week.
The lesson that Portugal offers the world is that while we can’t eradicate heroin, it’s possible to save the lives of drug users — if we’re willing to treat them not as criminals but as sick, suffering human beings who need helping hands, not handcuffs.