How Portugal treats drug addicts – Hint, Think Compassion, NOT Incarceration

July 3, 2009 – At “The End of the World” I met Maria. Beneath a tent of blankets on a steep bank, surrounded by discarded syringes and blood, she unfolded her foil and proceeded to smoke heroin.

The district in which she lives near Lisbon gained its name and reputation from illegal drugs. But as I sat on a rock and watched her daily ritual, I was aware that Maria is part of an extraordinary and controversial experiment. In almost every other place in the world, what she is doing is crime. Here, though, she can be confident her drug use will not end in prison.

Exactly eight years ago today, on July 1st 2001, Portugal decreed that the purchase, possession and use of any previously-illegal substance would no longer be considered a criminal offence. So, instead of police arresting users, at The End of the World, health and social workers now dispense the paraphernalia of heroin use.

Paula Vale de Andrade told me how her “street teams” have been able dramatically to cut HIV infections and drug deaths since the new law.

“When drug use was a crime, people were afraid to engage with the teams. But since decriminalisation, they know the police won’t be involved and they come forward. It has been a great improvement.”

Many had predicted disaster – that plane loads of “drug tourists” would descend on Portugal knowing that they couldn’t end up in court. But what one politician called “the promise of sun, beaches and any drug you like” simply hasn’t materialised.

In fact, overall drug consumption appears stable or down – government statistics suggest a 10% fall.

Among teenagers, the statistics suggest that the use of every illicit substance has fallen. The table below is from the Cato Institute’s white paper Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies.

I know there is some doubt over the methodology used in compiling some of these data, but what strikes me is that there is absolutely no evidence that drug use has risen.

Drug trafficking remains a serious criminal offence: Portugal hasn’t legalised drugs. But people caught with a quantity of drugs deemed for their personal use (roughly ten days’ supply) are sent to a local dissuasion commission panel.

The one I attended consisted of a social worker and a legal expert and they were looking at the case of Joanna, a heroin addict. The commission has the power to issue fines – while no longer a criminal offence, possession is still prohibited in Portugal – but the user here is addicted to drugs, so a fine is ruled inapplicable. The commission encourages her to go into treatment by offering to suspend other sanctions.

Some remain unconvinced that the new philosophy is working. The police officers I met on patrol in one of Lisbon’s more “notorious” districts question the statistics, particularly the suggestion that decriminalising drugs has caused drug use to fall. There is clearly frustration that people who were villains yesterday are victims today. But there’s also annoyance that in roughly a third of cases, drug users fail to attend the commission hearings when police send them there.

In the eight years since Portugal shocked the world with its drug policy, the idea that users need care not punishment has swept across Europe. In 10 EU countries, possession of some, if not all illegal substances is not generally pursued as a crime. In Britain, while officially the use of banned drugs is a criminal offence, Ministry of Justice figures (cited in UK Focal Point report [908Kb PDF]) show that 80% of people dealt with for possession are given a warning or a caution. Less than 1% – around 1,000 people a year – go to jail.

Portugal’s government is proud of its drugs policy. The prime minister stresses his personal role in its introduction, claiming the results are conclusive and the philosophy is popular.

Some question aspects of the system, but what Portugal’s controversial experiment has demonstrated is that, if you take the crime out of drug use, the sky doesn’t fall in. Source.

 

Baltimore – A more humanistic approach – Overdose stats show treatment beats jail

July 2, 2009 – A generation ago, former Baltimore Mayor Kurt Schmoke urged lawmakers to consider abandoning the criminal justice model for dealing with the country’s rampant drug problem and focus instead on treating people for their addictions. He was roundly criticized for the idea, and America went on to prosecute a fruitless “war on drugs” that two decades later it is still clearly losing.

But last week city health officials announced a small but significant victory in that struggle that may yet vindicate Mr. Schmoke’s more humanistic approach to the scourge of substance abuse. Officials reported that deaths from alcohol and drug overdoses declined for the second straight year in the city and are now at their lowest levels in more than a decade. The reason? Expanded treatment opportunities for heroin users and programs that teach addicts how to avoid life-threatening overdoses even if they aren’t able to completely break the cycle of dependence.

There’s little doubt that treatment can save lives. Two years ago, a total of 281 people died of drug overdoses in Baltimore. That number dropped to 176 last year, a decline of nearly a third. Health officials say the improved statistics are directly attributable to more drug treatment slots made possible by a $1.1 million federal grant, and to education and outreach efforts such as the city’s Staying Alive program, which instructs addicts how to spot the signs of overdose and intervene before it’s too late.

The numbers would be even better if treatment were more widely available. Last year, a staggering 74,000 people in Baltimore required treatment for substance abuse by some estimates. Yet the city could only accommodate a fraction of that number — some 16,000. Facilities that treat heroin addicts with buprenorphine, a semi-synthetic drug that health officials say can help decrease overdoses, have waiting lists of more than a year, and even addicts who have decided to seek help often can’t get in.

Despite these limitations, the treatment model remains by far the more promising strategy for reducing the harm caused by substance abuse. Drugs and alcohol destroy families, communities and lives and drive most serious crime in the city. That’s why Mr. Schmoke was right to insist that the only practical course lay in treating addiction as a public health problem rather than as a criminal justice matter. With addiction at epidemic levels — nearly one in every six people in Baltimore struggles with a dependence on alcohol or drugs — there’s no way we’re going to make a dent in this problem simply by locking more people up. Source.

 

Drug Decriminalization Works in Portugal

July 2, 2009 – In 2001, with the number of HIV-related deaths skyrocketing, Portugal tried a novel approach: try to limit the number of infections that came from shared needles by decriminalizing low-level drug possession. Instead of throwing folks in jail, they began to focus on prevention and treatment. A new study has the early results, and they’re pretty inspiring. From Scientific American:

Five years later, the number of deaths from street drug overdoses dropped from around 400 to 290 annually, and the number of new HIV cases caused by using dirty needles to inject heroin, cocaine and other illegal substances plummeted from nearly 1,400 in 2000 to about 400 in 2006.

The plan didn’t change any of the penalties for dealing. But if you’re caught with less than a 10-day personal stash, instead of going in front a judge, a three-person panel—with at least one judge or lawyer and at least one heath care professional—decide whether you should pay a fine or receive treatment. Though it’s still early, and some experts say the numbers were helped by an overall drop in marijuana use around the world, here’s hoping that Obama’s new drug czar, Gil Kerlikowske, takes a good look across the pond. Source.

 

After Jackson, US agency renews warnings on drug abuse

June 28th, 2009 – Amid questions about the possible role of drugs in Michael Jackson’s demise, the US Drug Enforcement Administration Friday renewed concerns about rising deaths from misuse of prescription pills. Some people close to the 50-year-old pop icon revealed Friday they had been concerned for some time about his use of drugs, a day after he collapsed and died apparently from cardiac arrest at his rented Los Angeles home.

In response to numerous calls triggered by the singer’s sudden death, the DEA put back up on its website a May report into prescription drugs that showed more than 8,500 people died from misusing them in 2005.

It warned that more people died from drug abuse than in shootings, and in the category of accidental deaths it came only second to car accidents. The LA coroner was carrying out an autopsy on Jackson Friday, and toxicology results are not expected for several weeks.

But celebrity website TMZ.com — which broke the news of Jackson’s death — reported Friday he had been administered an injection of the powerful painkiller Demerol about an hour before he lost consciousness.
Los Angeles Police Department Officer Karen Rayner said investigators spoke with the doctor who gave Jackson the dose but they wanted to speak with him again. Late Thursday night, officers impounded the doctor’s car, which was parked at the mansion.

The overuse of prescription pain-killers, stimulants or tranquilizers — either opium-based or synthetically manufactured — is on the rise in the United States. In 2005, the last year for which figures are available, there were more than 8,500 deaths nationwide, an increase of 114 percent on 2001. Hospital admissions due to an overdose of such drugs leapt 74 percent from 2002 to 2006, and emergency room visits were up 39 percent, the DEA said.

Most of those needing treatment were aged between 18 to 25, the agency added, and said that between 2003 to 2007 some six percent of Americans in that age group had admitted using prescription drugs for non-medical uses. Most obtain the drugs by stealing them, hooking up to false Internet pharmacies or from friends and relatives. “Diversion and abuse of prescription drugs are a threat to our public health and safety similar to the threat posed by illicit drugs such as heroin and cocaine,” said Gil Kerlikowske, director of national drug control policy. “In 2006, the last year for which data are available, drug-induced deaths in the United States exceeded firearm-injury deaths and ranked second only to motor vehicle accidents as a cause of accidental death.”

 

Report: drug overdose is now the second-leading cause of accidental death in America

June 11th, 2009 – The rapper Eminem recently released a new album in which he discusses the overdose that nearly killed him. At last month’s Cannes Film Festival, Heath Ledger’s last film was shown, reminding viewers and critics of the talent we lost when he died.

We are used to hearing about drug overdoses in the context of fast-lane inhabiting film and music stars. But in fact, deaths from drug overdoses have been rising and have reached crisis levels in our country. A newly-released report by the Drug Policy Alliance documents the extent of the problem: drug overdose is now the second-leading cause of accidental death in America, surpassing firearms-related deaths. And it’s not just young people who are dying of overdoses: overdose is the number-one injury-related killer among adults aged 35-54.

This crisis isn’t only about people who take illegal drugs: while heroin overdose has leveled off in many places as a result of harm reduction efforts, the greatest number of people dying from accidental overdose are those, like Heath Ledger, who used legal, prescription drugs. These drugs are typically painkillers called opioids, which can include both opium-derived drugs like morphine and codeine, and synthetics like Percodan, Percoset, Oxycontin and Vicodin. Some of the drugs involved in overdoses have been diverted to the black market and sold illegally, while others are obtained through legal prescriptions. Pain patients can misunderstand their doctors’ instructions and accidentally exceed their prescribed doses of painkillers.

Many of those affected are young people. Among teenagers there has been a steep rise in misuse of prescription drugs. A December 2008 survey of high school seniors reported that more than 15 percent of high school seniors reported using prescription drugs for non-medical reasons.

There are a number of practical, low-cost interventions that could help to deal with this crisis. In 2007, New Mexico became the first state to pass a “Good Samaritan/911” law, which provides immunity from arrest and prosecution for drug use or possession to anyone who calls 911 to report an overdose. Many lives could be saved if friends of overdose victims weren’t afraid of being prosecuted if the police are called to the scene. Similar legislation is now pending in several states.

Additionally, there is a drug, naloxone (also known as Narcan), which if administered following an opioid overdose can reverse the effects and restore normal breathing in two to three minutes. Naloxone has been used effectively in emergency rooms and by EMTs to reverse overdoses for over 30 years. Tens of thousands of lives could be saved if naloxone were more widely available and more people (including doctors, pharmacists and other health care professionals, as well as law enforcement professionals, many of whom are currently unfamiliar with naloxone), were trained in its use. Providing take-home naloxone to opioid users, along with instructions in its use, could significantly reduce the number of accidental overdose deaths. Naloxone itself has no abuse potential, making it a good candidate for over-the-counter availability.

Cities with programs that increase the availability of naloxone, among them Chicago, Baltimore and San Francisco, have seen their overdose rates decline dramatically. New Mexico, which for years had a high number of deaths from drug overdoses, saw a 20 percent decline in such deaths after the state’s Department of Health began a naloxone distribution program in 2001.

These are common-sense solutions that would save many thousands of lives every year. But efforts to implement these solutions are hamstrung by a drug-war mentality in which there are “good” drugs and “bad” drugs and, by extension, good drug users and bad drug users, the latter seen as somehow deserving of death when they overdose. No one deserves to die by overdose. Everyone deserves a second chance at life, and to be treated compassionately by a health care system that values everyone’s life.

We need to accept the reality that people will always use drugs, whether legal or illegal, prescribed or sold on the street, mood or performance enhancers, pain killers or stress reducers or sleep-enablers. We are a nation of drug users. We must learn how to reduce the harms associated with our drug use, including reducing the unconscionable and unnecessary number of deaths from overdose.

Jill Harris is the Managing Director of Public Policy at the Drug Policy Alliance.