Translating Portugal's Approach to Drugs and Addiction

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.

In 1995, following high rates of deaths by heroin overdose, France implemented new policies that allowed primary care physicians to prescribe buprenorphine, a drug that helps curb opiate cravings, to patients suffering from opioid addiction, drastically reducing overdose deaths. In the U.S., doctors are required to go through a special addiction training to be able to prescribe buprenorphine, meaning that very few U.S. doctors can prescribe it.

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.

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.

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.

By prioritizing treatment over law enforcement, Switzerland dramatically reduced its drug problem. In 1994, the country adopted a progressive policy to treat heroin addiction as a public health crisis, focusing on harm reduction, treatment, and prevention in addition to traditional law enforcement. The policy, which embraces medicated-assisted treatment and universal access to services, helped greatly reduce issues such as the incidence of HIV, drug overdoses, and deaths over the long-term.

Librarians across the nation are being trained to administer naloxone, a drug that can reverse an opioid overdose. In Denver’s Central Library, 350 staff members were trained to administer the drug. “Libraries in New Orleans, Philadelphia, San Francisco and Salt Lake County, Utah, among others, are also stocking the overdose reversal drug.”

Hand Up Health Services is a syringe services program that provides clean needles to addicts, also known as “needles exchange” programs. The program is only one of two in New Hampshire. While there's a lot of stigma behind these types of programs, data from the Centers for Disease Control and Preventions shows that “ people who inject drugs are five times more likely to enter treatment if they connect with an SSP.”

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.

The state of Utah passed legislation in 2016 that made Naloxone, a life-saving overdose reversal drug, available over the counter to non-medical personnel as part of an initiative to reduce opioid related overdose deaths. An organization called One Voice Recovery brings Naloxone kits to addicts in heavily drug addicted areas in an attempt to reduce harm. In addition, One Voice Recovery helps addicts who want to seek treatment get the help they need.