A 'say no to the War on Drugs' poster featuring Nancy Reagan, the First Lady and spokesperson for the infamous 'Just Say No' campaign in the 1980s (Max Harris). Right: trams on a Lisbon street (Getty)

‘Aren’t we all drug users after all?’: What drug law reform in Portugal can teach NZ

Writer and social theorist Max Harris travelled to Lisbon to discover how drug decriminalisation there is working in practice, and the lessons for New Zealand politicians considering the future of our own drug laws.

“Some people call this place The Living Room,” the young man I’ve just met tells me. And looking around the room, you can see why. Several people are relaxing on two comfy-looking couches. There are sandwiches on the table. A couple of guys are sitting on steps leading out onto a busy street in central Lisbon. Someone’s on Facebook at the counter. The xx are playing in the background. It could almost be an inner-city art collective, or an activist meet-up spot.

But several things suggest this is no ordinary living room. A poster on the wall says, ‘Aren’t We All Drug Users After All?’ Another: ‘Say No to the War on Drugs.’ People are coming and going into side-rooms, where a social worker in casual clothes occasionally shows her face. The young guy next to me is handing out snacks to people who approach him with a numbered slip of paper.

This place, I discover, has a few different functions. It’s a Harm Reduction Centre, run by GAT (Grupo de Ativistas em Tratamentos), a Portuguese HIV organisation. The GAT Centre links people to social services and helps people navigate the health system. It provides injecting and smoking materials, including syringes and crack pipes. It takes used syringes, deposited in a closed container behind the counter. It offers basic services to those living in the streets, including access to the internet and a phone, clothing, and hygiene products. The model focuses on relationship-building. One employee explains: “Maybe first, people come in for a drug kit and leave straight away. The next time they come in, we encourage them to have a coffee and take a kit. The time after, they might see a social worker or a nurse. We hope it builds from there.”

It feels different from other social service centres I’ve spent time in. People wear colourful clothing. One user of the centre comes up to chat, and leaves me with a band name to look up. There’s less shame about why people are there.

The centre was set up in 2012, eleven years after Portugal decriminalised all drugs. It’s a product of the country’s unique approach to substance addiction.

There’s probably no better person to explain decriminalisation than Dr. João Goulão, director-general of SICAD: the Centre for Intervention on Addictive Behaviours and Dependencies. Known as Portugal’s ‘drug czar’, Goulão has a modest office in a hospital complex in the north of Lisbon. The walls are bare. On one side of the room there’s a small cluster of framed photographs of Goulão with dignitaries. On the other side a long, thin window looks out to a park and the street.

Dr. João Goulão, director-general of SICAD: the Centre for Intervention on Addictive Behaviours and Dependencies, in Lisbon, Portugal. Photo: Max Harris

Portugal’s drug problems can be traced back to the country’s colonial wars in places like Mozambique, Angola, and Cape Verde, Goulão explains. Colonial foot-soldiers taking part in brutal occupations consumed large amounts of alcohol and other drugs. Young Portuguese men were sent to Portugal’s colonies, and drug use was tolerated, even encouraged, by the Portuguese military. The return of these men to Portugal coincided with the country’s democratic revolution in the mid-1970s. Portugal became less isolated, but drug use also exploded, including because of tourists and visitors. “By the end of the 1980s,” Goulão observes, “we had 100,000 people hooked on heroin: 1% of our population.”

In the 1980s, drugs became a problem that cut across “all layers of society”, Goulão tells me. The Minister of Justice’s daughter, he tells me, died of an overdose at this time. And that cross-cutting experience sparked a shift in empathy for drug users across society: “The mindset started … to be: ‘This guy, my son or nephew, is not a criminal. He’s someone in need of help.” In 1987 an inter-ministerial project called Project Vida (Project Life) was established, bringing together eight ministries – including justice, health, and education – to approve measures they could each take to address the drugs crisis. A major health centre was set up in Lisbon to address drug use, training doctors from smaller centres. This was when Goulão got involved. “I had no preparation to deal with it,” he says. “The only thing I had to offer was my availability, my empathy.” A family doctor at the time, he attended training and took the approach he’d learned back to the Algarve in the south of Portugal. By 1990, Portugal had 60 health centres focused on drug use.

But by the late 1990s there was still a “lack of a clear strategy,” Goulão says. “We were throwing money through the window: media campaigns, TV spots, [with] very low returns.” And there was a widely felt contradiction between increased drug treatment and laws condemning drug users. “It was complicated,” Goulão points out, “to give [out] a syringe in the name of the same state that criminalises you.” In 1998 Prime Minister Antonio Gutteres (now Secretary-General of the UN), whose sister was a psychiatrist in contact with Goulão, invited a group of nine people to write a report on a different strategy. The report recommended just one change to Portugal’s laws: a shift in the criminalisation of personal use of drugs and possession for use. A series of public discussions followed where there was “huge acceptance of the idea”. So – following parliamentary approval – ‘decriminalisation’ was born, with the new law coming into force in 2001.

Decriminalisation is not the same as legalisation. Under Portugal’s system, if you are caught with anything less than a 10-day personal supply of any drug, you can receive an ‘administrative sanction’ – but you’ll have no criminal record. It’s the kind of sanction you get when you’re caught driving over the speed limit. The police can refer you to a ‘Commission for the Dissuasion of Drug Addiction’ within 72 hours. These are panels, usually made up of psychologists, social workers, and lawyers, that recommend treatment (if the user is willing), community service, fines, or periodic appearances at a designated place. People can still go to prison for supply and drug dealing. Under a system of complete legalisation, there’d be no administrative sanctions, no panels, no imprisonment for supply or dealing.

At the time of decriminalisation, Goulão tells me, critics claimed that Portugal “would become a paradise for drug addicts from all over the world.” But that hasn’t happened. There have been declines in ‘recent users’ and specifically amongst young adults, according to SICAD statistics. Far from young people falling under the spell of drugs, experimentation with cannabis is happening later now, at around 15 or 16, as opposed to age 12. SICAD materials report that an “increase of treatment demand amongst cannabis users”. The number of opiate addicts has halved, according to Goulão. As of 2017, Portugal had only 3 overdose deaths per one million citizens, the second lowest in all of Europe; the European average is 17 deaths; in the United Kingdom it’s 45. HIV infections (admittedly the product of multiple factors) dropped from 104.2 new cases per million in 2000 to 4.2 cases per million in 2015. There’s less stigma associated with drug-taking, too, according to SICAD, and the number of people in prison for drug-related offences has gone down from 44% to 24%. The evidence is irrefutable: even taking into account variations over time (Goulão notes a slight recent increase in cocaine use), drug decriminalisation in Portugal has reduced drug use and lowered rates of drug-related harm.

Patients are handed their daily doses of 85 milligrams of methadone by male nurse Joao Matos from a van parked in Lisbon, Portugal. The number of heroin addicts in Portugal has gone down by half from 100,000 people before the policy began and the country has one of Europe’s lowest drug mortality rates. The number of people with HIV also dropped, from 1,001 new cases in 2001 to 56 cases in 2012. (Photo by Horacio Villalobos – Corbis/Corbis via Getty Images)

‘Dissuasion Commissions’ have been well-covered in the international media. But other features of the Portuguese model are less well-known, and Goulão is keen to explain them.

As he starts to discuss the role of police, he pauses. “Will you be shocked if I smoke a cigarette?” he asks. I laugh and shake my head. He opens his window, and says quietly, “It’s my project for the holidays to quit”, before going on.

Alongside the Dissuasion Commissions, there is a complementary system of 60 private therapeutic communities, with 1600 beds, for which the state pays 80% of the costs. (Families pay the reminder, though the state or local government can step in if needed.) The Minister of Health has responsibility for drug policy in Portugal, reflecting the fact that drug use is seen mainly as a health – rather than a criminal justice – matter. And there’s been ‘positive discrimination’ in employment, where social workers seek out small companies able to employ people who have been addicted to drugs. The state has offered tax breaks and pays the minimum wage for six months, after which employers can choose to keep on new employees. 80% of employees have stayed, with jobs found for 10,000 people. The programme was paused during the global financial crisis, but might shortly be reintroduced. There are also programmes in schools on drug use, and “smaller projects addressing specific populations: such as institutionalised children, children of drug addicts or alcoholics.” Goulão tells me that with low-level drug use off the plate of the police, they can “direct their means, their time, to big bulk trafficking.”

A pamphlet produced by SICAD describes the model as “based on the assumption that the drug user is a citizen who needs support in the health and social areas.” This makes me think of the people talking together in The Living Room – the GAT Harm Reduction Centre. These are people in the end: not ‘junkies’ or ‘addicts’.

Another Portuguese guy I speak to sums it up well. At the LX Factory, a slightly hipster-fied street of shops in the west of Lisbon, I strike up conversation with a bearded man in his early 30s, a skater and a graphic designer. He’s positive about the reforms. What’s important, he tells me, “is not just the laws: it’s the state of mind.”

But no system is perfect. There is a tendency to romanticise and simplify policy success stories in other places. In fact, this is often done in articles written about New Zealand in overseas outlets. It makes us all feel better, in bleak times, to believe that somewhere else, some other society has got things just right. We should resist this in the case of Portugal’s drug decriminalisation.

João Goulão accepts there’s a way to go: “Our drug problems are not solved.” And Adriana Curado, project coordinator at the GAT Harm Reduction Centre, is forthright about the ongoing challenges. Curado says the model “is useful for other countries to improve or to move drug policy forward.” She adds: “it was a major step 17 years ago. But we think it’s not enough.” In a tiny office at the back of the centre, Curado says the funding for harm reduction is “very insecure”. GAT is rarely able to claim public funding, despite being “recognised for best practice.” Take-home Naloxone, used to prevent fatal opioid overdoses, was supposed to be available in June. Curado shakes her head: “Until now … we’re still waiting.”

Adriana Curado in her tiny office at Lisbon’s GAT Centre. Photo: Max Harris

Marginalised groups are still more likely to be caught up in serious drug use and to suffer at the hands of the state, says Curado. Of the regular clients at the GAT Harm Reduction Centre, 25% are migrants, “most of them … from former colonies.” João Goulão notes that having an “objective threshold” – a 10 day personal supply that will not lead to criminalisation – reduces discretionary racial profiling. But Curado notes that there continue to be underlying causes of drug misuse that are unaddressed. “[W]e are not doing enough to reduce poverty and social inequality,” she says. It remains illegal in Portugal to collect statistics on ethnicity. She says, further, that Portugal has not yet fully reckoned with its colonial past and its impacts on the present. Curado tells a story of how colonial history is taught in Portugal that is depressingly familiar to New Zealand ears: “What we are taught in school is: compared to other empires, we were … very kind to people. The Spanish were much more aggressive, we were very nice.”

Ultimately, Curado goes on, Portugal remains locked in a prohibition model: drugs are still illegal, with associated problems. There is a black market, even if it’s more limited than in other places, and “people don’t know what they are buying, what they are selling.” There are no permanent drug-checking services in Portugal to test drug quality, with the exception of some testing facilities at music events. As well, the system “is confusing”, with many people believing that decriminalisation means that drugs are legal.

This raises a question I pose to both Goulão and Curado: should drugs be completely legalised in Portugal, not just decriminalised? In parallel with efforts to reform cannabis law in New Zealand this year, Portugal recently voted down a bill proposing to legalise medicinal – including grow-your-own – cannabis, and opted for a more confined law allowing use of some medicinal cannabis.

Goulão and Curado express different views. Both speak about “regulation”, or a “regulated market”, as opposed to legalisation. Curado says: “honestly, in society, I think people are open to … regulation [of cannabis] for adult use, but I think it’s difficult in terms of political agreements … probably we will have to wait some years.” Goulão is similarly skeptical about the political prospects of legalisation, though he observes that the “same logic” applies to legalising marijuana and legalising other drugs. What matters “is the relation the subject has with the substance, and not the substance itself.” He ends on a cautious note: “We acted as a social laboratory. We have our results to show. There are other social laboratories working nowadays. Let’s follow those experiences.”

Adriana Curado with a drug-smoking pipe at the GAT Centre. Lisbon. Photo: Max Harris

I was struck when João Goulão used that phrase, “social laboratory”, because it’s a phrase sometimes used to describe New Zealand. I couldn’t help but wonder again, hearing that phrase, about decriminalisation in Aotearoa. It’s relevant to the current Inquiry into Mental Health and Addiction, and to the Government’s Criminal Justice Advisory Group and Criminal Justice Summit.

Substance misuse is still a taboo in too many New Zealand communities, and drug addiction remains stigmatised, despited repeated government attempts to address it (for example, through the National Drug Policy 2015–2020). Removing stigma, and changing that taboo, requires a cultural shift: a greater willingness to talk honestly about drug-taking and the risks of unhealthy relationships with drugs. It seems like the decriminalisation of drugs could be one contributor to that cultural shift. Decriminalisation might help to encourage conversations about why some people are using drugs in the first place, given that often addiction represents a self-medicating attempt to address other challenges in a person’s life.

I speak to writer and activist Chloe King about this over email. King has written about her experiences with alcohol addiction and recovery. She says, “The stigma around addiction is really huge in Aotearoa, and most of this comes from sheer ignorance and lack of understanding around what the core causes of addiction actually are.” There is a mistaken view that people who experience addiction “lack self-control” or are “selfish”, and that the same people can be “beat[en] … into sobriety.” She goes on: “One of the core causes of addiction is trauma … I know I have been through huge amounts of trauma myself … [which] I just started to numb with alcohol.” King adds that stigma prevented her from getting help for addiction earlier in life: “I didn’t reach out for support for a really long time because I was embarrassed, and I felt really ashamed, and like an absolute failure. … I kept my growing and really dangerous relationship with alcohol a secret from nearly everyone. This isolation and disconnection from whānau and friends just furthered my need to numb and check out.”

New Zealand has significant services to support drug users: 21 needle exchanges nationwide, opioid treatment services, and methadone programmes, amongst others. There have been encouraging community- and user-led initiatives, too, such as the ‘P Pull’ clinics coordinated by Te Kai Po Ahuriri, Dennis Makalio, Aaron Carter and others, all former users of P. King describes the services as “robust”. But the contradiction that João Goulao identified in pre-2001 Portugal remains in New Zealand. Harm reduction services operate while drugs are illegal, meaning that people are cautious when it comes to seeking out – and speaking about – unhealthy drug use. Criminalisation is a barrier to a more fully-fledged harm reduction strategy. King points to the need for more peer support workers, and “social and medical detox units” in particular. She calls for a reversal of the current pattern of spending 80% of resources on punishment, and 20% on addiction support: “80% [should be] spent on addiction and recovery programmes,” she says, and “20% or much less spent on criminalising.”

On top of existing stigma and a lack of coordinated services, drug criminalisation is adding to our high incarceration rates. New Zealand’s prison population stands at 10,645; we incarcerate (per capita) over 30% more people than Australia, 90% more than Canada, 250% more than Ireland. In 2016, 2,511 people were convicted of drug possession, use and/or use of a drug utensil – with 799 people being imprisoned for those offences alone (and this does not count cases of violent offending where, for example, drug debts are being recovered).

The burden of those facing serious punishment for drug-taking in New Zealand is also far from equal. Recreational drug-taking amongst middle-class people rarely results in prosecution, much less imprisonment, and Māori make up 42% of those convicted for drug offences. I speak to Khylee Quince, co-director of the AUT Centre for Indigenous Rights and Law, about this. “Police have effectively decriminalised possession of cannabis for personal use,” she says, “although the benefit of that de facto regime has not been applied equally to Māori and non-Māori.” There is “a significant difference between Māori and non-Māori in rates of lifetime prevalence for substance abuse disorders”, meaning that “Māori are more likely to be problematic users of drugs, requiring a therapeutic rather than a criminal justice response.”

Quince adds that “drug law reform offers potential economic benefits for Māori communities seeking investment and employment opportunities”, though she thinks reform should proceed with care. Māori are not “unanimous in suporting decriminalisation or legalisation”, and “there are well-voiced fears from some in the community, particularly those who have seen the significant social harms caused by problematic drug use in their whānau.” The key, says Quince, is that “appropriate and effective interventions and treatment regimes and services will be established within reach of all communities – including those remote Māori communities where drug use is often beyond the reach of both law enforcement and current treatment options.”

AUT Professor Khylee Quince has witnessed the effects of the War on Drugs on Māori

A thoughtful model for change, akin to decriminalisation, was proposed by the New Zealand Law Commission in 2011. It recommended that possession of drug utensils no longer be criminalised, and that a tiered cautioning scheme (based on the seriousness of the drug) be adopted for personal possession and use, while large-scale dealing and trafficking remain illegal. The Law Commission suggested the new framework be administered by the Ministry of Health, not the Ministry of Justice.

Some have said to me that New Zealand’s drug profile is different from Portugal’s (especially in terms of problems faced with P), justifying a different approach. Every country’s drug profile is likely to be different. But make no mistake: Portugal was ravaged by serious drugs, in particular heroin, prior to decriminalisation. These were drugs associated with physical harm, and drug-related offending was not unknown to Portugal at the time of reform.

Others have said reform is politically impossible in New Zealand. But Labour, National, and the Greens have all developed proposals to regulate cannabis for medicinal use, showing an opennness to evidence-based, humane, pragmatic drug policy. Medical professionals – including doctors, following the lead of Dr. Goulao – can usefully lift their voices to make the prospect of change more palatable, as can lawyers and judges who have seen the serrated edge of New Zealand’s approach. The voices of people who have experienced addiction deserve particular weight. Legalisation might remain a step too far at present. But faced with a choice between a broken status quo, decriminalisation, and legalisation, decriminalisation appears to be a sensible middle ground.

In Portugal it was only when drugs became a “cross-cutting” societal problem that change became imperative. As João Goulao said, this shifted the mindset of most people towards the view that ‘this guy, my son or nephew, is not a criminal. He’s someone in need of help.”

In New Zealand, drugs are close to becoming that kind of cross-cutting problem. But should we really have to get to that point to change an out-of-date model? Should it take the daughter of a minister to overdose – or for 1 in 100 people to be hooked on heroin or P?

People addicted to drugs are our siblings and our children, our parents and our relatives.

And when we remember that alcohol, caffeine, and nicotine are drugs, it’s hard to find someone who hasn’t been, or isn’t, a drug user. It’s hard to go past the poster up on the wall of the GAT Harm Reduction Centre: “aren’t we all drug users after all?”

 

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