REDUCING OVERDOSES
There is no silver bullet for North America’s fentanyl crisis, according to the architect of Portugal’s drugpolicy framework, widely considered the most progressive in the world.
“It is a difficult problem,” Dr. João Goulão told the Straight by phone. “I have no magical insight for it.”
Illicit drugs are on track to kill more than 1,500 people in B.C. this year, up from an annual average of 204 deaths recorded between 2001 and 2010. So far in 2017, the B.C. Coroners Service has detected fentanyl, a synthetic opioid, in 78 percent of drug fatalities.
In a wide-ranging interview, Goulão recounted how beginning in 2001, his country decriminalized all illicit narcotics, including cocaine and heroin.
Portugal did not legalize hard drugs, which would have involved regulating their sales similarly to how Canada deals with alcohol and tobacco. But it took a step in that direction, removing criminal penalties for personal possession.
At the same time, Portugal essentially flipped how it spends money on citizens who struggle with an addiction, noted Goulão, now Portugal’s national drug coordinator. Whereas the country once spent about 90 percent of funds on enforcement and 10 percent on treatment, after 2001, that ratio was reversed.
“Since then, we have had dramatic improvements in all available indicators,” Goulão said. “Overdose deaths, HIV infections, and the number of problematic drug users have all dropped since then.”
In Portugal in 2015, the rate of fatal overdoses was three people per 100,000, according to the European Monitoring Centre for Drugs and Drug Addiction. The B.C. Coroners Service has reported that as of June 2017, the rate of overdose deaths per 100,000 residents of this province is 32.5.
On September 7, Goulão is scheduled to visit the Lower Mainland for the first time as a keynote speaker at the Recovery Capital Conference of Canada, in New Westminster. Ahead of his trip, he answered questions about North America’s fentanyl problem and discussed what lessons Portugal’s experience might have to offer policymakers here.
Goulão began by emphasizing that if Canada were to decriminalize drugs as Portugal did, this would not address the issue of fentanyl. That’s because it would leave supply in the hands of dealers. However, he said that removing criminal penalties for personal possession could be helpful.
“Decriminalization is important because drug users will no longer fear approaching [health-care] responders,” Goulão explained. “It would be an important step. Everything is easier in an environment of decriminalization than it is in an environment of criminalization. Of course, it will not solve every problem. But it would constitute a success for drug users and help drug users with responses.”
His trip to Vancouver follows a recent meeting Goulão had with Canada’s former minister of health, Jane Philpott, and minister of justice, Vancouver’s Jody Wilson-raybould. The pair travelled to Portugal in July.
In a brief telephone interview, Health Canada spokesperson Andrew Mackendrick said the trip was focused on Portugal’s health-based approach to addiction and not the country’s record with decriminalization. In a similar vein, Prime Minister Justin Trudeau has repeatedly said the Liberal government is not considering decriminalizing or legalizing hard drugs such as heroin.
That’s despite a growing number of B.C.’S top health officials calling on the federal government to at least consider such a move in response to the province’s out-of-control increase in drug-overdose deaths.
Goulão repeatedly told the Straight that decriminalization should not happen without a government enacting complementary reforms to its justice and health-care systems.
“The results that we’ve had since then [2001] are the result of a set of policies, not only decriminalization by itself,” he said.
Asked if the answer to the fentanyl problem could be in legalization and regulation, Goulão paused and responded “Probably.”
“Legalization and the regulation of markets, controlling the quality of the substances, and making them available only in appropriate places, it would be positive,” he added.
But Goulão noted legalization remains a tough sell, even in Portugal, where “everybody agrees on the positive effects of our current policies.”
He said what’s required to move governments toward legalization is careful study and evidence. For example, he’s closely watching Colorado, where in 2014 state laws were changed to allow recreationalmarijuana sales.
Goulão said that’s one reason he’s looking forward to visiting Vancouver. His itinerary includes a tour of the city’s Downtown Eastside, where one clinic offers heroin by prescription to a select group of patients and where another doctor is treating more than 20 cases of severe-addiction disorder with hydromorphone, a drug very similar to heroin.
“We are following, very attentively, the steps that other countries are taking,” Goulão said. “I believe that when we have the evidence of the effectiveness of legalization, it probably will be possible to go in that direction.”