The War on Drugs has been raging for decades. As rates of drug abuse have risen, so have public health crises, fatal overdoses, and criminal activities as addicts steal to fund their habits, dealers fight violent street conflicts, and cartels wage bloody wars against governments. To fight the misery of crime and suffering created by drug abuse, countries like the United States (US) and the United Kingdom (UK) have cracked down severely, spending billions incarcerating users and dealers alike. However, as these countries take an aggressive stance to the war on drugs, one country has taken a diametrically opposite position.
In 2001, Portugal gambled on a monumental social experiment: in the late 80s, one in every 100 Portuguese had a heroin addiction, and the country had the highest rate of HIV infections in the European Union. To combat this, the country instead took a radical health-based approach. The government decriminalized the use of illicit drugs, from ‘soft’ drugs such as cannabis through to ‘harder’ drugs like cocaine and heroin. Instead, provided a person was caught with less than ten days’ supply, they would be given a warning, or told to appear before a commission where they would be offered treatment and support. 17 years on, it’s clear to see which approach has worked better. Portugal has the lowest rate of drug-related deaths in Western Europe, with 3 overdose deaths per million citizens, compared to 44.6 per million in the UK. In America, the war on drugs can only be described as a catastrophic failure, as 46,000 Americans die of overdoses per year, the same as were killed in the Vietnam, Afghan and Iraq wars combined.
Portugal stands as the clear leader of evidence-based policy-making in harm reduction, benefiting the lives of both its drug using and sober citizens. Yet this approach has been wholly rejected by governments elsewhere. The aim of the war on drugs is the eradication of their usage and the suffering they bring; the failure to realize that goal is set in resource heavy, costly yet ineffective policies that spill blood on the streets, bring terror to communities and ruin countless lives. Perhaps now more than ever, it is time to look to the Portuguese model as a way of achieving what so far seems to be impossible.
Criminalizing drug use: the flaws and the consequences
Drug usage, overdoses and deaths are complicated phenomena. However, the aggressive response of harshly criminalizing drug users seems to have more significantly detrimental effects than the Portuguese public health centric model, both on the health of the users and the crime experienced by the wider community.
Drug abuse is associated with a myriad of health issues, including increased rates of blood borne infections like HIV from users sharing needles, mental health problems and overdose related deaths. In societies where drug use is criminalized, abuse and addiction is more commonly viewed as taboo. Public health centric approaches such as providing free needle exchanges have proven effective in improving health outcomes, for example by reducing the rates of HIV infections, and have been adopted by several countries. However, in countries such as Russia, drug abuse remains highly stigmatized and services are unavailable, often owing to public disapproval. Consequently, the lack of public health measures perpetuates the health problems faced by drug users. In addition, drug policies of criminalizing usage create a climate of fear, meaning that when an individual overdoses others are less likely to call emergency services for fear of being arrested, leading to more preventable deaths.
The relationship between drugs and crime is equally vast and complex. At the lowest level, there is often a vicious cycle between poverty, addiction, and crime; many people turn to illegal activities such as theft, prostitution or dealing because they do not have the income to fulfill their habits. In a society where criminal penalties mean one offence can hamper an individual’s career, this can make it difficult for life to return to normality, further perpetuating a cycle of crime and also endangering other individuals in the community. In addition, the sale of these drugs funds a chain of criminality from street dealers up to powerful cartels. Anti-narcotics drives have made some cartels so wealthy that they can bribe their way through entire nations in West Africa and Central America, destabilizing nations and leaving cities afflicted with staggeringly high homicide rates.
The litany of public health and crime related issues plaguing societies, countries if not entire continents prove just how unsuccessful the approach of criminalizing drugs has been. It is now time to look at the radically different Portuguese approach and its results to see if a global pattern of public health crises and crime can be reversed.
The Portuguese model: successes, flaws, and possible lessons?
In 1999, Portugal was gripped by one of the worst epidemics of drug abuse as opioid crises spread across the world. The country had the highest rate of drug-related AIDS in the European Union and was swept up in a wave of drug-motivated robberies, muggings and other violent crimes. Perhaps unsurprisingly, when the government made the decision to decriminalize all drugs in 2001, they were met with sharp condemnation from the International Narcotics Control Board, and ridicule from skeptics who projected that the number of drug users would skyrocket. However, in the ensuing years the country has undergone a drastic transition. The projected rise in usage failed to materialize: instead, drug-related HIV diagnoses fell by 90%, drug-related deaths fell to the lowest in Western Europe, and drug-related crime rates are low throughout the country.
The decriminalization of drugs marked an enormous cultural shift in how the Portuguese view drug use and addiction, making it easier for social policies to be accepted and effective. Portugal was the first country to offer free needle exchanges, facilitating safer and more hygienic usage to combat blood-borne infections in injecting drug users. As a result, drug-related HIV cases fell from 104.2 new cases per million in 2000, to just 4.2 in 2015. In addition, Portugal also pioneered opioid substitution programmes, and methadone treatment is now standard. By contrast, just 10% of addicts have access in America, where treatment is expensive and hard to come by. The unequivocal result is that Portugal’s drug mortality rate is one-fiftieth of the US. A positive side-effect of the programme is that because treatment is freely available, addicts are able to sustain their careers. This reduces petty crimes like theft, as users have a stable income and safe source of drugs, thus encouraging a more peaceful, productive society. Portugal has also been able to shrug off the epidemic of so-called legal highs, like spice and bath salts which have become the newest scourge affecting other parts of the world. The simple reason why is that users aren’t bothered with using ‘fake’ drugs, which often have dangerous side effects, when ‘real’ drugs aren’t criminalized.
In terms of drug-related crime, the approach to decriminalization isn’t a perfect solution. Dealers are still sent to prison, yet the sale and supply is not regulated, thus continuing to make money for dangerous cartels who afflict misery on the rest of the world. However, the ensuing years following decriminalization have seen dramatic drops in problematic drug use, reducing income for dealers and cartels. There has also been a significant fall in drug related-crimes and incarceration rates. The additional benefit is that it is incomparably cheaper for Portugal to treat users rather than to jail them. The Portuguese health ministry spends less than $10 per citizen per year on its drug policy, whereas the U.S has spent above $10,000 per household over the decades on its drug policy, which results in more than 1000 deaths per week.
In a surprising twist of fate few would have expected in 2001, Portugal is lauded as an example of best practices in harm reduction for drug abuse, and the European Monitoring Centre for Drugs and Drug Addiction is based in the capital, Lisbon. Despite this recognition, many governments are vehement in their rejection of such progressive policies. The movement in some countries towards medicinal or decriminalizing cannabis may represent a positive step, but is still overshadowed by the crime and suffering wrought by aggressive drugs policies.
Perhaps one of the key messages of the Portuguese approach is the public attitudes towards addiction; this makes it easier to implement supportive public health measures, and helps remove the stigma which empowers addicts to seek help. Where the Portuguese approach fails however, is that the illicit drugs trade still fuels dangerous criminal organizations. In the spirit of radical drug policies, a means of removing income and subsequent power from cartels could be highly regulated state controlled sale and supply of drugs. From the 1920s to early 1930s, Prohibition took hold across the United States. The production, sale, and consumption of alcohol was banned in an attempt to foster a more moral society. Whilst the movement succeeded in cutting alcohol consumption and subsequent illnesses like liver cirrhosis, the unintended consequence was the creation of new markets for criminal organizations. Bootleggers supplied illicit spirits like moonshine, some of which contained methanol and other dangerous chemicals which caused blindness and organ failure. Following the end of Prohibition, companies made alcohol in quality controlled environments, making consumption safer. Whilst the re-legalization of alcohol has not resolved issues of antisocial behaviour amongst drinkers, it succeeded in removing significant income from criminal gangs, which remains a key problem of the modern war on drugs.
Prohibition serves as a mirror image for the modern war on drugs. A fresh, if highly controversial approach could be the state controlled and highly regulated market of drugs. Perhaps a radical step forward the world needs would be to take power out of the hands of violent criminals, instead regulating and making safe what is already a mass consumed product. Portugal’s decision to decriminalize drugs and support users is not a perfect solution, and neither is this. Yet for an issue so vast and complex, a perfect solution is unlikely to exist. What the global war on drugs needs to recognize, however, is the abject failure for the thousands of lives taken by the aggressive approach. More than ever, a paradigm shift is needed in order to prevent many more decades of tragedy to come.
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