Portugal's radical drugs policy is working. Why hasn't the world copied it?

Health engagement hubs like Washington state’s Buprenorphine Pathways connect people with prescriptions for methadone and buprenorphine to help treat addiction. In addition to medication and a syringe-exchange program, the hub also connects patients to social services, taking a more holistic approach to addiction treatment.

Los Angeles County’s Homeless Outreach & Mobile Engagement (HOME) program uses street psychiatry to get psychiatric medication to people experiencing homelessness in an effort to get them a step closer to housing. The HOME team has 223 full-time staff members and served 1,919 people last year, 22% of whom ended the year housed.

The Olympia Bupe Clinic's walk-in model for treating opioid addiction allows patients to receive medication-assisted treatment with buprenorphine on their first visit without barriers or extensive wait times. This low-barrier approach eliminates the hurdles people often face when seeking treatment. The Clinic also hires staff with lived experience with addiction to build trust and community with patients.

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.

In order to tackle opioid addiction, the state of Virginia found a way to make drug treatment accessible to people with medicaid by boosting “reimbursement rates to addiction treatment providers.” Historically, drug treatment hasn’t been covered by health insurance. Virginia is changing that. Already, “the percent of Medicaid members with an opioid use disorder who received treatment went up by 29 percent from April to December 2017 compared to the same period the previous year.”

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.

Throughout New York City’s five boroughs, the opioid crisis has had a huge impact across class, race, and neighborhood boundaries. In response, several initiatives have been implemented including needle exchanges, providing rehabilitation treatment in the community rather than out of state, asking about drug use during the primary care visits, and integrating methodone services into primary care provision.

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.

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.

For those addicted to opioids, getting treatment can take a long time because not all emergency rooms offer buprenorphine and counseling interventions. Yale-New Haven Hospital has shown that if patients receive buprenorphine at their initial emergency room evaluation, then the immediate action improves the person’s chances in receiving addiction treatment.