Portugal, drugs and decriminalisation

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.

After the fall of an oppressive and isolating regime, Portugal found itself utterly unprepared to deal with the rapid distribution of narcotics in the 1980s, creating a crisis that left 1 in every 10 people struggling with addiction. The country took a radical approach to rectifying opioid use through a huge cultural shift in the way it viewed and treated addicts - prioritizing support services and pioneering programs like needle-exchange and substitution therapy, and eventually decriminalizing hard drugs so that users could more easily get help, and drug rates have since plummeted.

By addressing drug addiction as a medical—rather than criminal—issue, Portugal has been able to reduce drug use as well as deaths caused by drugs. Strategies implemented include decriminalization, increased access to treatment, changes in prescribing patterns related to opioids, and ‘dissuasion’ courts.

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.

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 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.

South Dakota’s “24/7 Sobriety” initiative breathalyzers tens of thousands of people every day in an effort to curb drunk driving. Rather than legislation that takes penalizes offenders by taking away their license, the state addresses the behavioral issue instead. In counties that use the “24/7 Sobriety,” they’ve seen a 12% decrease in repeat drunken-driving arrests.

Drug court programs serve as an alternative to incarceration for people dealing with substance abuse. The treatment-based approach provides medical treatment, counseling, education assistance, and employment assistance.

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.