Opioid Crisis Compels New York to Look North for Answers

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.

Rather than treat opioid users like criminals, Vancouver has deemed it a public health crisis. The city, especially its downtown east side, witnessed 1,500 deaths in just one year from opioid use. Its approach is unique and multi-pronged – making Narcan, an overdose antidote, available to everyone, opening safe injection sites, and having a police presence – without arrests – on blocks where using remains high.

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.

While the decriminalization effort Measure 110 failed to fully meet the mark, the Health Justice Recovery Alliance joined forces with local law enforcement to create a pilot program that helped locals struggling with addiction. Through the program, police can contact an outreach worker who will come to the scene and connect the person struggling with addiction to support services such as detox care and housing, helping lead them toward long-term recovery. So far, the pilot program has helped over 200 people.

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.

As the opioid crisis continues to impact all areas of the United States, local governments are starting to try solutions they previously had dismissed. In Ohio, this means implementing needle exchange programs with the aim of reducing the spread of communicable diseases.

The drug crisis has reached new extremes in many parts of the country, as meth and opioids continue to tear families apart and funnel even more children into an already-strapped foster care system. In rural Montana, law enforcement and communities are trying a new approach to battling drug addiction, focusing on supportive family counseling and "drug courts" to help treat - rather than imprison - those struggling with addiction. In Lake County, Family Drug Treatment Courts are working to divert addicts from the vicious cycle and keep more families together.

In one year, the drug overdoses in Roanoke, VA have taken 12 lives and another 76 have overdosed but survived. The police department developed a new program called the Roanoke Valley Hope Initiative, designed to provide rehabilitation without arrest for those who seek it. The program simulates the successful national effort to help drug abusers instead of incarcerating them.

Fifty years on, America's war on drugs has failed at its principal goals: to eradicate illicit drug use and sales, to repair communities damaged by the drug trade, and to prevent drug-related deaths. Despite massive amounts spent on law enforcement, which has created great social harms and fueled incarceration, drug use has rebounded to 40-year highs, drug overdose deaths are peaking, and supply of illegal drugs is abundant. Policy advocates say a combination of legalization and public-health approaches to the problems would accomplish more than the wasteful, ineffective "war" mentality used to date.

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.