We must consider alternatives to criminalisation and incarceration of people who use drugs, and focus criminal justice efforts on those involved in supply. We should increase the focus on public health, prevention, treatment and care, as well as on economic, social and cultural strategies.
–Ban Ki-moon, former UN Secretary-General, on World Day Against Drugs, 26 June 2015
On a global basis, the evidence shows that imposing punitive sanctions on people who use drugs, regardless of how severe, does not reduce drug consumption. Indeed, in many cases prohibition and punishment have had disastrous consequences. The global war on drugs has failed, with devastating consequences for individuals and societies around the world. Sixty years after the initiation of the UN Single Convention on Narcotic Drugs, and 50 years after President Richard Nixon launched the US government’s war on drugs, fundamental reforms in national and global drug control policies are urgently needed. Today, the criminalisation of drugs has typically resulted in shame and stigma for drug users which, together with a fear of criminal prosecution, has often made access to treatment much more difficult for those who have developed dependency on drugs.
Moreover, drug-related deaths have continued to increase over the years. In 2019, there were 4,393 such deaths recorded in England and Wales, with 1,264 deaths in Scotland. There is now a growing acceptance by governments that we will never police drugs out of society and many politicians and policy makers are more willing to look at effective evidence-based examples of what works.
In the 1990s, Portugal was in the grip of its own deadly drugs crisis where one in every 100 people became dependent on heroin, and HIV and hepatitis infection rates were recorded as being the highest in the European Union. To address the growing drugs problem, the government decided against emulating the repressive approaches of other countries, which it saw as ineffective and mainly counterproductive. Instead, the Portuguese government took a bold step in introducing more humane policies, underpinned by a public health approach, instead of a criminal justice approach, to dealing with drug use. As part of this new approach, on 29 November 2000, Portugal became the first country in the world to introduce a new law decriminalising the consumption of all drugs.
Decriminalisation not Legalisation
It is important to note that the new law did not legalise* drug use in Portugal but rather decriminalised the use, possession and acquisition of all types of illicit substances for personal use, which was defined as being up to ten days supply of that substance. Possession of drugs in larger quantities has remained prohibited by Portuguese law and criminal penalties are still applied to drug growers, dealers and traffickers. However, not punishing drug possession for personal use through the criminal justice system has significantly lowered the costs associated with policing, solicitors, courts and probation services in dealing with these issues, as well as the costs of imprisoning people for drug related offences. However, decriminalisation was only one part of the new approach.
A Health Led Approach
The Portuguese government took the pragmatic approach that while it did not condone drug use, the creation of a drug-free society was an illusion that would never become a reality. Indeed, one minister stated at the time that such an aspiration was like trying to create a society where drivers will not exceed the speed limit. In place of the criminal justice system, Portugal’s new approach resulted in the creation of Dissuasion Commissions which are made up of a legal expert, a health professional and a social worker. These commissions seek to inform people and dissuade them from drug use.
A primary role of the commissions is to provide accurate information about drugs, the potential risks of drug use, and harm reduction strategies, in a non-judgmental way. The goal is for people who use drugs to become better informed and develop healthier relationships with drugs. Thus, people who use drugs can do so without risking punishment. However, the commissions also have the power to impose sanctions for non-compliance and to refer people to treatment on a voluntary basis. In addition to harm reduction services, such as needle exchange and the provision of the heroin substitute methadone, funding of accessible treatment and rehabilitation programmes was also a vital part of the Portuguese government’s response under its health led approach.
Our Policies Are Not Working
The UK’s existing drug policies are a legacy of the ‘war on drugs’ approach and continue to fail many who are caught up in dependency. One such person who the system failed was Mark. He was trapped in a spiral of chaotic drug use for over 18 years, and spent a total of six and a half years in prison for drug-related crimes. For most of the time that Mark was using drugs, he was injecting heroin. His drug use exacerbated his mental health issues, deep rooted trauma brought about as a result of physical and sexual abuse when he was a child. As a consequence of his drug use and mental health issues, he ended up homeless for many years. He was in and out of hospital after overdosing many times, and also for general poor health problems associated with living on the streets. At various times over the years, he wanted to change and tried to access treatment, but was unable to do so and was invariably sent back to prison. Ironically, it was through prison that he eventually got a place on a treatment programme and he is now doing well. However, Mark is one of the lucky ones who survived. While not holding out any one particular approach to drug dependency as a magic wand, one would have to think that if we had the type of humane supports that exist in Portugal, the cost to Mark and to wider society might have been averted.
What Can We Learn from Portugal?
Despite the enormous progress made over the course of 21 years, the current government response is not without criticism. Some of those involved in working with people who use drugs say the government needs to develop more supervised injection sites and drug consumption facilities, and to make the anti-overdose medication naloxone more readily available.
However, in the main, the evidence of the last 21 years speaks for itself. Even the most ardent critics of decriminalisation back in 2000 have accepted that their fears of Portugal becoming a destination for drug tourists, and decriminalisation causing a rise in drug consumption, have proven to be unfounded. Back in 1999, Portugal experienced 369 overdose deaths and in 2016, the number was just 30. The number of new HIV diagnoses due to injecting plummeted from 907 in 2000 to 18 in 2017. The new laws have also had an impact on incarceration, with the number of people behind bars for drug offences falling from 3,863 in 1999 to 1,140 in 2017.
We need a different approach to our present failed policies if we are to avoid another 50 years of losing more lives to the war on drugs. We can learn a lot from Portugal and other countries that have introduced health led, not criminal justice led approaches. However, it will take courageous politicians and bold thinking by our policy makers to replace our current failed policies.
As former UN Secretary-General, Ban Ki-moon said,
“We must consider alternatives to criminalisation and incarceration of people who use drugs …….. and increase the focus on public health, prevention, treatment and care”
Editor: *the distinction between legalisation and decriminalisation is an important one. Drugs remain illegal. Decriminalisation (taking offenders out of the criminal justice system) affects those who use rather than deal, smuggle or produce.