In the 1990s, Portugal was plagued by an opioid epidemic so intense that Lisbon was known as the heroin capital of Europe.
But drug use “is no longer the main concern of the country”, says Ricardo Fuertes, who helped set up the city’s first mobile drug use center three years ago, along with Adriana Curado, where people can inject heroin under supervision.
A third is currently underway as plans to create Scotland’s first country remain blocked by UK drug laws.
In 2019, there were 72 drug-related deaths in Portugal, compared to 1,264 in Scotland – the highest in Europe, prompting a £250million treatment plan.
Figures released this week show the number of deaths has fallen by 20% in the past year – to 1,187 – a death rate that Drug Policy Minister Angela Constance admitted to be “still way too high.”
Drug policy has been informed by morality rather than rationality and knowledge
Labor MP Paul Sweeney has now launched a consultation aimed at knocking down legal barriers that have prevented the Scottish government from opening a drug center in Glasgow.
The simplest approach would require the UK government to update the Misuse of Drugs Act, but Tory ministers have insisted they have no desire to do so.
“We know that drug consumption rooms work,” says Mr Fuertes, who oversees harm reduction policy in the Portuguese capital.
“They reduce overdose deaths by reducing risk and connect marginalized people to the health and social care system.
“However, we know that around the world it is the type of drug service that faces the greatest opposition.
“To set up a drug consumption room there is usually a very long and exhausting process and creative legislative solutions in other countries had to be invented to make it possible – pilots, research projects, legal exceptions.
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“So many obstacles to the creation of a formal health service, while on the other hand drug consumption is already done informally everywhere in the street, toilets, cars, private homes.”
He believes laws should be relaxed to allow for the rapid establishment of injection sites and other services, but believes much of the opposition is because drug policy is influenced by “morality rather than expert knowledge and rational thought”.
On July 1, 2001, Portugal became the first country in the world to decriminalize the possession of drugs, including heroin.
In five years, the number of deaths due to drug overdoses has fallen from 400 to 290 per year.
“In a way, building a drug policy in Portugal was one of those examples of building public policy through a new vision without judgment,” Fuertes said.
“Towards the end of the 1990s, the problems had accumulated. There was high visibility of heroin use, 58% of new HIV cases per year were due to shared syringes or needles, there was a high number of overdose deaths (369, 1999)). petty crime, overcrowded prisons, unnecessary suffering, hopeless families.
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“Faced with these problems and growing public concern, the government of the day asked a renowned scientist, Alexandre Quintanilha, to help design the National Anti-Drug Strategy.
“He hesitated, he had never worked in this field, but the decision to choose him was intentional.
“He was someone who was ready to analyze the situation, to look for solutions, to identify the shortcomings.
“And Portugal didn’t want to replicate what was already being done and not working. ”
Based on its recommendations for prevention, treatment and support, Portugal approved in 2000 and 2001 a set of laws that made the country a world reference.
Mr Fuertes points out that it is still not legal to use drugs in Portugal (penalties such as fines and community service are still applied), but the approach is to consider serious addiction as a health problem rather than a punishable crime.
Other pieces of Portugal’s groundbreaking legislation are lesser known but played a pivotal role in reducing drug deaths, he says. Needle exchange services have been in place since 1993 while drug users have access to services where the composition of substances is verified to reduce the risk of harm or overdose.
“The difficulties [in setting up drug consumption rooms] are probably related to the fact that we have all been living under a prohibitionist paradigm for almost a century already,” he says.
“It becomes very difficult and counter-intuitive to convince society that providing a safer space for drug use is not just a matter of public health, which benefits everyone, but also a human rights approach. .
“No community benefits from leaving part of its population unprotected, marginalized and without access to care.
“But unfortunately, and this is not uncommon, drug policy has been informed more by morality than by rationality and knowledge.
“There is still a long way to go before accepting the use of substances (now considered illegal) and before accepting the right to pleasure and changing our minds, or even recognizing the role of substances in social interactions.
“We accept all of this in the case of alcohol and tobacco, and we understand that their regulation is a protection for those who consume them and for society at large.”
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He said he wouldn’t assume which approach would work best in Scotland and cautions against other countries blindly replicating their policies, but says there is a ‘catalogue of tested and workable solutions’ many of which do not require years of complex legal negotiations.
“The problem with role models, in the sense of an example to follow or to imitate, is that they risk becoming static,” he says.
“Many signs today show that it is necessary to readapt the Portuguese model to new profiles – to those who have aged and also to those who have started using drugs in the 21st century.
“We’ve read about what’s happening in Scotland, but ultimately it’s drug users and professionals who will know best what works.
“Treatment, social support and harm reduction respond to different people or to the same person at different times.
“Alone, none of these services is a miracle solution, in fact it is all of the various solutions combined that work.
“It’s better to have different small services than a big one that isn’t needed, or that takes many, many years and resources to implement.
He added: “If we listen to what people have to say and respect their rights and experience, services will be useful and relevant, the impact of drugs will be minimized, creating a better situation for everyone.
“Nothing is simple, but it may be simpler than it seems.”