Drug decriminalization is a topic almost too hot to handle in the United States, but Portugal quietly took the plunge 10 years ago. Since then, overall drug use has increased slightly, but the prevalence of “problematic” (e.g., intravenous) drug use is estimated to have declined, report Australian drug policy researchers Caitlin Elizabeth Hughes and Alex Stevens.
Portugal’s decriminalization policy was a response to growing concern in the 1980s and ’90s about the spread of diseases such as HIV/AIDS, tuberculosis, and hepatitis B and C among users of heroin and other intravenous drugs. Drug use rates in Portugal, a land of 11 million people, have historically been pretty low. In 2001, fewer than eight percent of Portuguese 15-to-64-year-olds admitted to ever having used an illegal drug, compared with about a third of Britons. Yet by 1999 Portugal’s rate of drug-related AIDS was the highest in the European Union. Since the policy went into effect, the prevalence of drug users thought to be injecting drugs has declined from 3.5 per 1,000 people to 2.0.
Because of the concern about drug-related diseases, a key rationale for decriminalization was to provide “a more health-oriented response.” The number of users enrolled in drug treatment programs increased by around 60 percent between 1998 and 2008, from a little under 24,000 to more than 38,000.
The greatest success has been in reductions in drug-related mortality, HIV, hepatitis C, and tuberculosis. In particular, there has been a large reduction in opiate-related (i.e., heroin-related) deaths, likely because more heroin addicts are receiving treatment. And the number of HIV/AIDS diagnoses among drug users has declined substantially, from 1,413 in 2000 to just 375 in 2008.
Portugal stands out not because of decriminalization—other nations have done that—but because of its emphasis on treating addiction, which seems to have produced an Iberian success story.