Portugal halts opioid crisis with decriminalization

In 2001, Portugal became the first country to completely decriminalize the consumption of all illicit substances, reported Amherst College's The Common. Rather than being arrested, those caught with a personal supply might be given a warning, assessed a small fine, or sent to have a chat with a local dissuasion commission—a doctor, a lawyer, and a social worker—about treatment, harm reduction, and support services available to them.

A bold stance was taken, an opioid crisis stabilized, and the ensuing years saw dramatic drops in problematic drug use, HIV and hepatitis infection rates, overdose deaths, drug-related crime, and incarceration rates. HIV infection rates, for example, plummeted from an all-time high in 2000 of 104.2 new cases per million to 4.2 cases per million in 2015. The data from what is now a decade and a half of largely positive results have been studied and held up as example, and have given weight to harm-reduction movements around the globe. It’s misleading, however, to credit these positive results entirely to a change in law.

Portugal’s remarkable recovery, and the fact that it has held steady through several changes in government—including conservative leaders who would have rather ushered in a return of the War on Drugs—could not have happened without an enormous cultural shift and collective change of heart around how the country viewed drugs, addiction, and itself. In many ways, the law was merely a reflection of transformations that were already happening in clinics, in pharmacies, and around kitchen tables across the country.

Decriminalization as an official policy allowed for the pooled support and interconnection of a broad range of health, psychological, employment, housing, social, and cultural services that were already grasping to work together to serve their communities, like in Olhão. The language people used began to shift, too. Those who were referred to sneeringly as “drogados”—“junkies”—became known more broadly, more sympathetically, and more accurately as “people who use drugs” or “people with addiction disorders.” This, too, was crucial.

Portugal’s story also serves as a warning bell.

The Portuguese opioid addiction epidemic was contained, not made to disappear. The consequences of the eighties and nineties weigh heavily today, as the oldest generation of chronic users and ex-users grapple with complications that include hepatitis C, cirrhosis, and liver cancer. The long-term costs of problematic drug use are a burden on a public healthcare service that is still struggling to recover from a recession filled with cutbacks.

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