Portugal’s medical model of drugs
Kids are still dying at Australian music festivals – the latest, Callum Brosnan, 19, died in the early hours of Sunday morning after a suspected overdose at Sydney Olympic Park. Sixteen others were hospitalised at the event, Knockout: Games of Destiny, with a further 130 seeking treatment. In September, it was Diana Nguyen, 21, and Joseph Pham, 23, who both died at the Defqon.1 music festival in Western Sydney.
New South Wales Premier Gladys Berejiklian still rules out pill testing, instead favouring “harsh penalties” for dealers. She is far from alone in her “tough on drugs” stance. Around Australia, during the past decade, the number of people imprisoned for illicit drug offences has more than doubled.
Globally, one in five of the world’s 10 million prisoners is in jail for drug offences, mostly minor. Drug-related deaths reached 450,000 in 2015. In the past decade, cocaine and opium production have increased massively, despite $US100 billion spent each year on eradication. Prohibition continues to empower and enrich criminal syndicates, morphing the countries that produce the world’s illicit drugs into narco-states. Mexico has had 250,000 killings and 32,000 disappearances since 2006.
But opinion is shifting. Earlier this month, the Vatican invited Sydney harm-reduction campaigner Alex Wodak to share his views. “The time has come when the abject failure of global drug prohibition can no longer be denied,” Wodak said in his address. “Sometimes policy intended to reduce harm causes even more harm than the drugs themselves.”
His speech echoed the stance of former New Zealand prime minister Helen Clark, who said earlier this year that the “war on drugs” approach had failed. She called on New Zealand to rethink its drugs policy. “We look at the United States and Russia, which both have very harsh policies at the federal level – they also have very high rates of drug-induced death,” she said. “We have to look at the evidence of what works, and if we looked at Portugal or to Switzerland or any number of countries now we see more enlightened drug policies, which are bringing down the rate of death and not driving up prison populations.”
Clark supports 170 non-government organisations worldwide that are pushing for decriminalisation of drug use and a broader shift towards harm reduction, which advocates that drug use be seen as a health issue, not a criminal justice problem. In Australia, these reformers have also attracted high-profile and perhaps unexpected supporters, including former Australian Federal Police chief Mick Palmer. “The main reason that people are dying at festivals – or anywhere else for that matter – is almost always that they didn’t understand the content or the toxicity of the drugs they bought from the black market, simple as that,” Palmer said after the deaths of Nguyen and Pham. “Had they known what they bought, they wouldn’t have taken them.”
Reformers point to the Portugal model as proof of concept. Since 2001, the possession of less than 10 days’ personal supply has been decriminalised in the country, with users instead referred to “dissuasion commissions” for counselling. There are modest fines, community service and treatment referrals – and pill testing is commonly available. Nuno Capaz is a pioneer with Lisbon’s dissuasion commission. Recently, he was brought to Australia by NSW Deputy State Coroner Harriet Grahame to testify at an inquest into six overdose deaths.
While in Sydney, Capaz spoke with Hamish McDonald.
Hamish McDonald How did you get into this field?
Nuno Capaz I had just finished my degree [a PhD in sociology] in 2001 when the reforms were made. The Ministry of Health was looking for younger people without preconceived ideas. I was just lucky to be in the right place at the right time.
HM Why did Portugal have such a severe heroin crisis, [which prompted] this radical new approach?
NC The problem started in the late 1970s after the democratic revolution in 1974. When people returned from the African colonies they brought cannabis with them. Then we started seeing a lot of hashish, cannabis resin, from North Africa. Then heroin. People weren’t informed about the difference between smoking hashish and smoking heroin. They tried and eventually became injecting addicts too. By the 1990s, we had a full heroin epidemic with a huge rate of HIV, hepatitis, tuberculosis infection among users, and a huge number of overdose deaths.
HM Was the habit mostly among certain classes?
NC It was across the board. That’s one of the reasons for the change in the law. A lot of people with influence were also affected by it, or at least knew someone who was – a colleague from kindergarten, a neighbour, a cousin, a nephew. It was very visible, much bigger than say in England or Germany, with syringes in the streets and people being robbed at the point of a syringe.
HM What was the reaction from the anti-narcotics bureaucracy and the police?
NC In the beginning, the police were not happy [with decriminalisation]. In particular, they thought it would lose their leverage over arrested users to get information about the dealers. But they found it’s much easier now to get that information on an informal level. Previously, if the user had made and signed a statement that would be presented in court, the drug dealer would have access to it. His lawyer would know he has to protect his client so the chances of getting information with the lawyer sitting right next to him was much lower. Now the police actually move up a step in the dealing chain, from the street pusher to the medium-sized dealer. Less arrests are made but the quantity of drugs seized is higher. But does it solve the problem of accessibility? Of course not. Everybody knows that it doesn’t matter how much you seize, there will be more coming into the market.
HM Do people still argue you are legitimising drug use?
NC In terms of drug usage, decriminalising doesn’t have a real effect. It just means we do not apply criminal sanctions. It’s still illegal. The difference is that it’s an administrative sanction, like driving without a seatbelt. Are more people driving without a seatbelt because it’s just an administrative penalty? Since 2001, accessibility is exactly the same. If I want to get illegal substances in Portugal I still have to go to the black market. It’s not easier than it was before. There’s no place you can just walk in and buy it. My job at the dissuasion commission in Lisbon is to decide if there will be a fine or community service, or just a suspension as a warning. We don’t give treatment or counselling, but we can make referrals easily for either because we work for the Ministry of Health.
HM And for repeat offences?
NC Theoretically the fines can go up to the minimum wage, around €600. The minimum is €25. If it’s a first-time recreational user, we don’t apply any fine. It goes up with repeat offences. It’s very rare that we go above €100. If someone is caught with five grams of hashish – street value, €10 – we’d usually apply a fine of €30 to €40.
HM Has it lessened the fear about being caught?
NC If you have a 13-year-old and you have a cannabis dealer saying, “You want to try these?”, I’m sure in 99.9 per cent of the cases he will not say, “I don’t want to try it because it’s a criminal offence.” He won’t say, “I’ll try it because it’s just an administrative offence.” It doesn’t have any effect on drug usage. If you had a legal shop it might have some effect, because some people might find it acceptable to buy a substance like that not on the black market. Portugal’s usage figures are the same as other European countries with the punitive approach.
HM What about pill testing at music festivals?
NC We have it in Portugal, at some festivals, normally run by an NGO with some state funding. With cannabis you can smell it, you can burn a little. With cocaine you can taste it. With MDMA you cannot smell it, you cannot try it, you have to take it on trust. The only person who’s going to tell you what it is, is the drug dealer or a friend, and I’m fairly sure they don’t exactly know what it is. The pills look exactly the same. Some pills being sold as MDMA are 20 or 50 times stronger. Kids are taking them thinking it’s fairly safe if they keep a bottle of water handy to avoid dehydrating, but it’s not. That also presents a problem for first responders because they get kids in a clinical state they don’t understand. With the pill testing … they can give an immediate warning, they can print out notices and pin them to trees [at the festival]. The kids will take pills anyway. There’s an unwritten agreement with the police that allows this. The police just stand back: they don’t like kids having psychotic seizures in the middle of nowhere.
HM Would Portugal follow Canada and some United States states in legalising cannabis?
NC Politically, we are following those experiments in Uruguay, the US and now Canada. But I don’t see any move in that direction right away. It’s hard for a country inside the European Union’s Schengen zone to do something like that by itself. There’s no border control. Eventually, the EU will follow, as a whole, with some sort of regulatory market. The UN anti-narcotics conventions are fairly useless – they have not stopped Canada.
HM We have a big ice problem here in Australia – maybe much more a low-income and small-town phenomenon – tied into a Chinese supply system.
NC In Portugal, no. The reason for that is we have cocaine in the market … Australia is an island and it’s hard to get cocaine. But ice can be produced anywhere, either a lab in China or in a basement in Sydney. That’s why I guess cocaine is much more expensive in Australia than it is elsewhere, and [cocaine] is not a working-class habit because they don’t have the money. Ice is much cheaper because it’s easy to produce. It’s also why we don’t have a fentanyl problem in Portugal, because we have heroin in the market and we don’t have a big pharmaceutical industry pushing prescription opioids.
HM Would your system work with an ice epidemic?
NC Our procedure would be exactly the same. If the person has less than 10 days’ personal usage, they are referred to us [the dissuasion commission]. But if there is any sort of criminal activity associated with usage, like fighting or wrecking of property, they will be charged over that. They may be sent to a psychiatric hospital or a prison with a mental wing.
HM Do you have enough places for detox treatment?
NC There is a minor waiting list. We can refer someone for detox or methadone substitution, from a week to a year. If I want to refer someone to a de-addiction centre, I just do it with a phone call because they are my colleagues from the Health Ministry. It’s a medical mindset – the difference is basically that. If you see [drug use] as a moral problem, of someone doing something wrong that is bad for them, our system is probably not the best thing.
HM What could be done to seriously restrict the illegal narco-industry?
NC My personal opinion is that the only way to regulate that is to supply the market. Everyone would prefer to go into a shop [where they] know there are quality controls and they pay their taxes. It’s the same thing with alcohol. With prohibition in the US, quality went down, prices went up. But the usage stayed the same. Same with gambling. People would prefer to go to a regulated casino than a basement full of people with guns.
This article was first published in the print edition of The Saturday Paper on Dec 15, 2018 as "Peace on drugs". Subscribe here.