Portugal: When Heroin Was King

In 1974, Portugal rose up, deposed it's dictatorship and embraced democracy. It was a heady time, filled with freedoms bottled up during over 40 years of totalitarian regime.

At about the same time, with Portugal's former colonies claiming their independence, shiploads of Portuguese soldiers and bureaucrats were returning home -- hundreds of thousands of newly unemployed bringing drugs of far away lands into this potent mix of a moment.

By the late 1980s, the country had greater freedom of press, of speech and of justice -- and also a serious drug habit. Heroin was king, with an estimated 100,000 people -- almost 1% of the country's population - addicted.

Lisbon's Casal Ventoso neighborhood, home to many unemployed dockworkers and soldiers, was at the center of the new drug scene. It became known as "Europe's drug supermarket." Junkies openly injected themselves in the alleyways, dirty syringes piled up in the gutters, streets reeked of garbage, and HIV and Hepatitis infection rates were soaring.

The government did everything it could to combat the scourge: passing tough anti-drug laws, making arrests, and throwing users in jail -- but the problem only grew.

And then, they decided to try something drastically different.

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At the time Joao Goulao was a young family practice doctor in Algarve, who found himself with more and more patients with drug addiction problems, and a dilemma about reporting them to the police.

"It seemed everyone at the time had family or a friend with a drug habit. These were not 'outsiders,' but part of our communities. These were decent people with problems," he says.

Goulao soon joined a new government task force searching for a way forward. They traveled to other countries with innovative drug policies, studied theoretical models, consulted psychologists and lawyers and social workers. And they came up with a plan.

The plan, which soon became law, was based on changing the categorization of drug users, from criminals who needed to be punished -- into sick who needed help.

And, following this logic, Portugal proceeded to take the revolutionary step of decriminalizing all illicit drugs, from marijuana thru heroin -- becoming the first such country in the world to do so.

"What was unique was that, for the first time ever, there was a focus on the rights of drug users," says Caitlin Hughes, from the Australian National Drug and Alcohol Research Centre, who has long studied Portugal's drug policies. "That, and a willingness to take a risk even if it was unclear that it would work."

This month, the country quietly marked the decade anniversary of those groundbreaking drug laws, and turned its attention to assessing what has, and has not been accomplished.

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"To begin with, it's decriminalization, not legalization," says Goulao, now president of the Ministry of Health's Institute of Drugs and Drugs Addiction, or as he is widely known, Portugal's drug czar.

Drugs are and remain illegal in Portugal, he explains, sitting down in his sunny Lisbon office, taking out his drug of choice -- a cigarette -- and lighting up. This means, that, in theory at least, anyone using drugs, including tourists, can and will be picked up by police.

It is what happens next that is unique. Instead of being sent to a criminal court, offenders are given three days to present themselves before one of the Health Ministry's special panels, compromised of psychologists, doctors, social workers and judges.

The panel evaluates each case and makes recommendations. Anyone found with more than the quantity deemed "reasonable" for ten days of personal use (for example, one gram of heroine, 10 of opium, 25 of cannabis etc) is sent into the criminal justice system, where they can be and are prosecuted and punished for trafficking.

Among the others, a differentiation is made -- between "addicts" and "casual users." Those deemed to be casual users get off with a warning or maybe a fine, usually between 50-60 euros, while "addicts," are directed to one of the country's 79 treatment centers where they can, if they want, get all forms of help, from counseling to methadone replacement treatment.

In 2008, the last year for which figures are available, more than 40,000 people went though these treatment programs. The bill is footed by the Ministry of Health to the tune of about €50 million a year, with an additional €20 million provided through a charity funded by Portugal's national lotteries.

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According to Goulao, his teams, and the majority of Portugese, the use of treatment instead of punishment, coupled with harm reduction efforts, has been a clear success.

Proof? Hard core addiction has fallen by about half since the early 1990s -- with the number of heroin users in Portugal today hovering at about 55,000. The rate of HIV and hepatitis infection among drug users -- common health issues associated with needle-sharing -- has also fallen since the law's rollout.

Even decriminalization's strongest proponents do not go so far as to give the laws sole credit for the reduction of heroin users in the country, and freely admit the drop could also be attributed to the drug's declining popularity and the rising popularity of other drugs, like cocaine. But, there is little doubt it has been a contributing factor to the change.

Today, Casal Ventoso does not really even exist. In an effort to erase what was once such a sorry place, bulldozers have cut through the neighborhood, adding streets, closing others and pushing out the druggies. A whole block of new apartments went up. A long row of shacks was taken down, and the neighborhood, say old timers, is barely recognizable.

No, the addicts have not totally disappeared, but their numbers have clearly dwindled.

"Will you pay us if we talk to you?" ask two thin men with dreadlocks, rolling down the window to their parked car and peering out. On their laps are tin foil sheets, on which they are spreading a brown sticky paste. Soon, they will heat up the foil from beneath with a cigarette lighter and take in a "hit" of heroin.

"We don't care that others quit," they add, almost apologetic, cutting rather lonely figures on a street in which a baby carriage or two is pushed by, a hip cafe has opened, and many former addicts are working towards cleaning up their lives.

Back in his office, Goulao takes out his blackberry and scrolls down for a message he received that week. "Hello, I just saw you on TV and it made me think to write," he reads from the text out loud. "I am just back from a day at the beach with my brother who, bless you, is today fine, healthy and happy. Thank you. Thank you Portugal."

It's little things like the message, says Goulao -- a simple story about an ex-addict regaining hope and dignity, that make it all worthwhile for him.

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But while high level delegations from countries around the world looking to fight their own drug problems -- from Denmark to Mexico to the US -- have applauded the Portuguese model and come to Lisbon to study it over the years, none as yet have followed suit and adopted such a full scale response, and many believe the jury is still out as to whether the experiment has really been a success.

It often seems the Portuguese experiment is something of a Rorschach test -- in the dark blobs on the page, people can see whatever they want to see.

For example, Portugal's drug-mortality rate has risen in the last decade. According to Goulão, this can be explained, in part, by the improved methods of collecting statistics, as well as the fact that many of those dying are those who were long addicted to heroin during the country's 1980s and 1990s epidemic.

Goulao also has a ready explanation for why the amount of drugs seized has increased enormously too. An indication of more drugs out there? No, he argues. Its a sign that police officers, freed up from focusing on small-time possession, have been able to target big-time traffickers.

Some statistics are harder to explain away. Violent crime, for example, while it remains relatively low for Europe, has nonetheless steadily risen in Portugal since the law's passage -- and a 2009 report by the U.N. Office on Drugs and Crime has tentatively linked that with drug trafficking.

Perhaps most worrying to those opposed to drug use, is seems clear the number of Portuguese trying drugs for recreation has climbed from 7.8 percent in 2001 to 12 percent in 2007. The incidence of those trying cocaine has nearly doubled -- from 0.9 to 1.9 percent.

Manuel Pinto Coelho, a Lisbon doctor who wants to end decriminalization, has started a campaign to highlight the negative effects of the drug laws here, hoping to dispel what he sees as the "myths" surrounding their success. "Portugal is a role model -- but a negative one." There has been, he charges a "pathetic manipulation of the figures."

"Knowing the Portuguese reality and what is going on at parties, parks and schools of Lisbon, how can we talk about success? We have an intoxicated society," he charges.

And on the ground, one can get a sense that while a lot of the addicts here might be getting help, a new generation of recreational users is either falling through the cracks of the system or playing it.

"The laws helped us clean up our heroin problem and everything is happy about that," says Ivan, a Lisbon fashion designer. "But other drugs, like hash and coke, are commonplace now, and lets face it, easy to get and use." In practice, he points out, the police usually don't even bother with recreational users and fines are rare -- in ten years, less than 2000 have been given out.

"There is really no risk involved, so why not try?" he shrugs.

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It's nearing midnight and the streets of Bairro Alto are just waking up, with locals and tourists crowding into the hilly narrow streets with plastic cups of cold beer in their hands. The smell of marijuana wafts through the air, mixing with music. Dealers of harder drugs stand around on the corners, looking obvious, and here and there, clusters of friends sniffing this or that are apparent.

Christiana Pires is a 27 year old psychologist, and a leader of one of the Institute of Drugs and Drugs Addiction's "harm reduction teams," which serve as another component of the drug law in the country. These teams work in schools, neighborhoods and bars, explaining the responsibilities and risks of drug use, without, she stresses, "being at all moralistic or judgmental."

"The idea is, if you consume, you should know the best strategies for choosing the moment, choosing the people you are with and the drug and quantity you take," she says, setting up a little stand outside the popular Mexecafe bar together with two volunteers. "We are aiming to talk to young people about managing that line between pleasure and risk."

Pamphlets on different drugs -- from ketamine to LSD -- are laid out, along with free condoms and drug kits consisting things like little silver plates to cut drugs up on, and saline solution to clean out your nose. At music festivals the teams also offer drug testing, to make sure drugs being taken are not contaminated, and in some neighborhoods, the teams offer needle exchanges.

Dozens of people stop by Pires' stand throughout the night, asking for information or taking a free kit or a button. Pires, in shorts and hiking boots, her hair in a ponytail, is chatty.

"A lot of people don't really want to be sniffing with bills because they are dirty," she explains to one youngster, giving him a thick plastic straw. "It's a female condom," she explains to another giggling but curious girl. "If you have any history of heart problems, you should not be mixing red bull and ecstasy," she tells a strung out young man who can barely stand up straight.

Mexecafe's owner, Ricardo Cruz, breezily admits that he himself uses all sorts of drugs, and so, he shrugs, might his clientele. "I live in the reality. But I don't want anyone getting hurt here," he explains, simply. "If we get everyone home safely here in Portugal, can't we just count that as a success?"