How Vancouver is saving addicts' lives

In 2001, facing a 20-year opioid epidemic, Portugal decriminalized all personal drug use, meaning people carrying drugs for personal use could no longer face prosecution or jail. The approach, met with public support, offered people access to services like safe injection sites and counseling and showed demonstrable success in declining opioid related deaths, the spread of infectious diseases, and drug use all together. As the rest of the world faces a similar crisis, Portugal could be a model response.

Comprehensive User Engagement Sites (CUES) are currently primarily open to opiate addicts and are equipped to deal with opioid related overdoses and safe administration of the drugs. Some sites are now beginning to distribute materials for safe crack/cocaine use including clean pipes, alcohol swabs, lip balms, and condoms to promote safe sex.

Prevention Point Philadelphia provides needle-exchange, HIV and Hepatitis C testing, counseling groups, mailboxes, and Naloxone (an opioid overdose reversal drug) training to 18,000 people. The center also connects addicts to addiction services and other social programs if they want to seek recovery.

The over-prescription of pain medicine has been a problem in southwest Colorado. Collective efforts of health care providers to standardize opioid prescriptions, clinics to expand recovery programs, and law enforcement to encourage addicts to enter rehab rather than prison, have reduced over-prescriptions of pain medications. However, they also could be unintentionally causing a rise in heroin use.

In less than three and a half years, Safeworks, the only supervised drug-use site in Calgary, saved thousands of people from opioid-overdose deaths and helped users for whom abstinence-based treatment didn't work. The government of Alberta deemed the site a scene of "chaos" and ordered it closed once two new sites open. Safeworks supporters oppose the disruption in harm-reduction work that move would bring, considering how critical personal relationships built on trust are to this kind of service.

In the 20 years since Portugal decriminalized possession of personal amounts of all drugs, deaths from HIV and overdoses declined and more people take advantage of expanded drug treatment programs. Treating the country's addiction-related problems as a health concern rather than a crime has been embraced domestically and copied by other places, including most recently in the U.S. by Oregon. Portugal's experience serves in part as a cautionary tale about tailoring policies to local conditions and following through on ideals with clear, measurable approaches. Copying the program outright is not simple.

Since introducing both the decriminalization of a range of substances like heroin and cocaine and new harm-reduction strategies in 2001, Portugal has seen success in driving down HIV cases, overdoses, and needle sharing. The country attributes their progress to treating the issue of drug use as a human rights issue rather than a criminal one, because they consider external factors that contribute to addiction like gender, class, or race.

The Miami Police Department has joined efforts with health care and social services partners to offer an alternative to prison for opioid users. The Collaborative Law Enforcement Addiction Recovery (CLEAR) program consists of participants signing a binding agreement and entering treatment that lasts for 12 months, all while also helping to build trust between officers and their communities.

Supervised injection sites in Canada have prevented hundreds of heroin overdose deaths. Now, New York City is looking to follow Canada's lead with a city-wide initiative to establish safe injection sites. While the Trump Administration is not in support of such sites, experts believe that it is unlikely that the federal government would interfere with a site if a city is in support of it.

The city of Montreal, Canada is testing how safe injection sites can be used in the fight against opioid overdoses. Montreal has 4 total sites, and one of them, called Cactus Montreal, has already supervised thousands of users in less than a year without a single death. Cactus is often busy with about 100 visitors each day, and they say that their services also prevent public injections and litter of used needles.