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Drugs & dissuasion: Portugal's pragmatic policy could show Ireland a path to control addiction

As the debate around decriminalisation of drugs rages here in Ireland, The Journal recently traveled to Lisbon to look at how the Portuguese model works.

SIT DOWN WITH any official involved in Portugal’s drugs policy and the spectre of the country’s heroin crisis of the 1990s is present immediately. 

A collective trauma, it is constantly referenced – spoken of like a warning from history.

It is now more than 20 years since the Portuguese Government, dealing with an opiod crisis in its major cities, decided that a radical new approach to addiction was needed. 

Meanwhile, Ireland is currently holding a Citizens Assembly on Drugs Use to discuss the merits of a change from using its punitive criminal justice system to deal with narcotics to a more health based and decriminalised policy.

During the discussions at the meetings there have been repeated mentions of Portugal and its approach. 

At a recent meeting, Brendan Hughes, head of drug legislation at the European Monitoring Centre for Drugs and Drug Addiction, spoke of the critical role played by the health ministry in Portugal, telling the Citizens’ Assembly that this ethos is the key distinction of its model, rather than decriminalisation.

Gino Kenny, an advocate for a more health based nuanced approach, has also said: “We are talking about people who should be alive today. A model that saves lives is in place in Portugal.”

Senior gardaí, including Assistant Commissioner Justin Kelly who heads up the garda Drugs and Organised Crime Bureau and former Deputy Commissioner Michael O’Sullivan, however have voiced their opposition to a change in perspective.

O’Sullivan, a well-known former member of the undercover team that confronted the heroin epidemic in the 1980s and 1990s in Dublin, has said any move away from the deterrence of arrests, court and prison would have a detrimental societal impact. 

He added that the Portuguese model would not work here because Irish criminals are more likely to use murder than those on the streets of Lisbon, Porto or other locations on the Iberian Peninsula.  

The team that O’Sullivan was part of was known as the ‘Mockies’ and one of his targets was a young Christy Kinahan. He has previously spoken to The Journal - when he was head of the European Union funded Maritime Analysis Operations Centre-Narcotics – about interdiction operations targeting shipments arriving into Europe by sea. 

With such polarising views about Portugal’s policies on display at the Assembly, The Journal travelled to Lisbon to examine the efficacy (or not) of the model in more detail, including speaking directly to the people involved in the design and implementation of the policy.

In 2001, the Lisbon Government moved away from police, arrests and court: essentially it decriminalised consumption of all drugs for personal use. If a person is caught by police in possession of drugs, they are entered into a diversion programme. 

The lead agency is SICAD,(translated as the General Directorate for Intervention on Addictive Behaviours and Dependencies) and is based in an office building in a hospital campus in the suburbs of Lisbon. 

Many of the people involved in the Portuguese system have a background in psychology and its deputy director Manuel Cardoso and Sofia Albuquerque – who is a coordinator of the dissuasion policy – are no different.

Cardoso recalled how the heady days of the 1990s crisis moved the Government to act.

“At that time, in 1998, we had around 1% of our population using heroin. And even in addiction treatment 98% of the people had heroin dependency and from those 49% were using it by injection.

“All the HIV infections were from this population, this group were drug addicts,” he said.

IMG_5276 Manuel Cardoso and Sofia Albuquerque of SICAD. Niall O'Connor / The Journal. Niall O'Connor / The Journal. / The Journal.

Cardoso explains that it placed approximately 50,000 people of the Portuguese population of 10 million as heroin addicts.

He said that during that time there were also 350 fatal overdoses per year and it was that combined with life-ending diseases caused by harmful consumption that pushed Portugal to a new way.

Now death rates from overdose, according to statistics from Portugal’s National Institute of Forensic Medicine, are dramatically less than the 1990s.  

The lowest, since these new records began in 2008, was in 2011 with just 19 deaths but for most years, it has been sitting between 40 and 55 deaths in 12 months. 

A recent increase – in the midst of the pandemic – meant 74 deaths in 2021.

Cardoso explained: “In the late 1990s, drug addiction was considered by the Portuguese population as the worst problem in society and the government asked a group of people with expertise in the area to prepare a report, to bring a new strategy to deal with this.” 

The work commenced and in July 2001, Government enacted the strategy.

Personal use is not measured by the cost of the drugs discovered by police but instead is limited to the equivalent of a 10-day supply. Anything above that is dealt with as an equivalent to Ireland’s offence of sale or supply.  

Personal consumption of the drugs remains technically against the law but instead of appearances in court and a potential prison sentence, the police refer people they find to a dissuasion commission. 

Officials have said that the police paperwork for the referral is purposefully less complex than that for a court case.

The dissuasion commission, which is akin to a clinical assessment, involves a psychologist, a social worker or sociologist and occasionally a lawyer. It evaluates a drug user’s risk and offers them counselling and other supports.

For those at the highest risk level, authorities can impose sanctions including fines and recommend treatment. Attendance is voluntary.

Critically, Portugal has a legal system in which it has a separate criminal mechanism and a so-called administrative sanction – the drugs policy falls into the latter.

According to legal officials in Lisbon, familiar with Irish law, the closest here to the administrative offence would be road traffic penalty point offences but it’s still not a direct correlation. 

Health responses

Cardoso said that while 1998 was the year the process of legislating began, there had already been efforts in Portugal to “prepare health responses”.

What was critical, he said, was the fact that the first report commissioned by the Government was so well drafted it allowed for a significant increase in the pace of change.

“It is now – and was then – decided that a balanced approach between supply and demand was needed.

“The police continues to have the role to catch the dealers and the traffickers and so on…  the other side on the demand there is treatment, prevention or reduction, and reintegration of the addict back into society,” he explained.

Cardoso said that the report was a holistic look across Portuguese society and an examination of the most likely beneficial interventions.

It not only inspected the situation on the streets but in institutions such as prisons and the impact of incarcerating high-risk addicts. He said that SICAD and other agencies have found that prison did little to dissuade addicts from returning to similar behaviours following their jail sentences.

“It’s more or less this, no one who uses drugs is allowed to continue to use it by the law – it’s not permitted here.

“But no one that uses or is found in possession of an amount of drugs only to use for himself can be sent to jail, they cannot be considered as a criminal in our system.

This is the big idea.

“An addict is a sick person to us, this is the main issue. We have to do everything in our power to help them.

“You do not criminalise a smoker who gets lung cancer, you do not criminalise an alcoholic with cirrhosis of the liver so why do it to a drug addict?” he said.

Those addictions, Cardoso and Albuquerque have stressed, are not just limited to drugs, they also said that they want to get the process to also look at alcohol, gambling and even addiction to the toxic online environment. 

Cardoso was keen to stress also that the psychologists have a very defined approach to how they view addicts: “We do not use the word compassion because that means we take pity. We do not show pity, we help the people pragmatically”.

IMG_5283 (1) A Government funded drugs consumption room in the district of Casal Ventoso, Lisbon. Niall O'Connor / The Journal Niall O'Connor / The Journal / The Journal

Increase the reach

The system is reviewed every 10 years but Cardoso and Albuquerque both said that while the Government opted to maintain the course at the last review, they believe there should have been a greater move to increase the reach of the policy. 

“I feel we should have gone further, make it even more than it is but we have to compromise,” Cardoso said. 

They also said that there was a need for greater funding but Cardoso accepted “this is a problem in every country”. 

One key impression from speaking to SICAD is that it is working based on a whole-of-Government approach. The practice of having a dedicated coordination agency to manage all those interactions between the State entities and the various NGOs was repeatedly identified as a critical enabler.

“It is difficult to say what the key is but I will say that to have an integrated approach, with integrated interventions with a pragmatic principle to do what you need to do is what helps the people,” Cardoso added. 

That integrated approach is nuanced, Cardoso said, and through the dissuasion commission is specific to individual addicts.  

“The harm reduction can have many possibilities and there is a lot of work needed to realise the best way to address the harm. 

“The first and most important idea is to have constant contact with them, to give them support, to show them all the branches of possibilities from counselling, to heroin replacement with methadone, to other ideas. 

“Do what needs to be done. Being pragmatic. It’s not an ideological message – it’s pragmatic,” he added. 

SICAD stressed that Portuguese authorities have not stopped targeting organised crime and, in our discussions with European law enforcement officials in Lisbon, they confirmed that Portugal’s police are seizing tonnes of drugs annually. 

Albuquerque said: “The idea is that with this alternative strategy of decriminalisation for personal use that the police have more time to be concerned with the bigger problems of organised crime.”

New substances are appearing, particularly the synthetic opioid fentanyl and this is causing the authorities to search for answers on how to handle those increased risks.

The current problems

Not everything is positive at the moment though. A recent article in the Washington Post focused on the drugs woes in the city of Porto, claiming that the policy has collapsed.  

That article also reported a rise in the consumption of recreational drugs in Lisbon.

All experts we spoke to stress that the Portuguese model is not designed to halt recreational consumption but rather to deal with the harms of addiction.

The revision of laws around the removal of the 10-day supply threshold for personal use is also working its way through parliament. Once it is enacted, police will now have to prove that, regardless of the quantity, it was intended for sale or supply before a prosecution can be granted.

Ultimately it will make it harder for police to prosecute people who have been found in possession of larger quantities.

Dissuasion

Across town, the Ministry of Health’s Nuno Capaz runs the Dissuasion Commission.

Capaz, who is a sociologist, has travelled to Ireland on a number of occasions and has also spoken at the Citizens Assembly.

“Don’t worry about talking fast, I have a lot of experience of Irish accents now,” he joked as he led us to the room where the dissuasion commission meets referred addicts. 

Capaz told us he is purposefully dressed casually – not wearing a suit – as “we don’t want this to look like a court, it is like going to the doctor”.

This is the centre where people caught with a quantity of drugs are referred by police – the room where the assessment is carried out is like any other meeting room and the open plan office surrounding it like any other work space. 

“This is the law enforcement branch of the Portuguese drug policy, it’s an administrative authority in power to apply sanctions to our residents.

IMG_5323 Nuno Capaz of the Dissuasion Commission at his office in Portugal. Niall O'Connor / The Journal. Niall O'Connor / The Journal. / The Journal.

“It was specifically created to deal with the procedures of people that are caught by police officers in the possession of illicit substances for personal usage,” he said.

Capaz said that his team were committed to addressing the policy as a health approach and compared it to a diabetic getting help from a clinic to “manage their sugar intake”. 

His read on the situation as a Lisbon resident was that the change from the 1990s experience of “open air drugs markets” is dramatic. 

He said those issues, for the most part, have been removed off the streets of the capital city. Capaz said that it wasn’t just about mobile methadone vans and the dissuasion commission, it was also about clearing out parks and other locations of people living rough and consuming drugs in public. 

Capaz, like other experts we met, said that there was an acceptance that drugs and those falling prey to addictive substances could not be eliminated. 

“It has not gone away but it has been reduced – it is not easy to solve the problem but it is fairly easy to manage the problem,” he added. 

The sociologist said that in societies across the globe, like in Ireland, the issue for addicts is that they find themselves, because of their condition, living outside of their communities.

He said key to the Dissuasion Commission part of the strategy is a move to get those addicts back “integrated and engaged” with society. 

Capaz believes his work is having a benefit but said it is difficult to measure. 

“I believe that the proof of the effectiveness of the dissuasion system is that we are not seeing the same people coming back again and again – there are people coming back but it is less and less,” he said.

The sociologist speaks warmly of Ireland and believes it is in a very good position to adopt a model similar to that of Portugal.

“It’s not a matter of political will to solve the problem because everyone has the political view to try and do that – it takes a lot more to refuse to solve it.

“Your next step is to try and manage the problem. And that’s fairly doable. Ireland is not exactly the poorest country in Europe. It’s also not one of the more complex in terms of social stratification, it’s a fairly small, fairly cohesive country, I will say that it’s not hard to have a cohesive plan.

“It is not doable or realistic to have a society where there are no drugs but it is very doable to have a society where there are not huge problems because the issues are well managed,” he said. 

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