“Change the mindset.” Goulao recognized early in the drug reform battle that society’s perception about drugs and people who use them needed to change. Everyday Portuguese people were dying, and they demanded change. People in positions of power needed education: policymakers, judges, prosecutors, doctors, etc. Not unlike this country. We all have gaps in our knowledge. I’m no different: I knew very little about addiction (and absolutely nothing about harm reduction) after medical training. My “mindset” changed when I learned that addiction is a chronic medical disease of the brain, and that most people with addiction–once connected to the appropriate treatment and care–GET BETTER.
In “How to Win a War on Drugs,” published in the NY Times September 2017, Nicholas Kristof describes the impact of Portugal’s decriminalization. Heroin is still illegal, just like it is in the U.S. and Canada. However, unlike in North America, a person possessing and using heroin in Portugal will not be arrested and incarcerated. Individuals possessing a 10-day supply or less of an illicit drug–a threshold set by the government–are referred to the Dissuasion Commission. “Setting a threshold reduces discretionary power from the police officer,” points out Dr. Goulao, now the General Director of the Service for Intervention on Addictive Behaviours and Dependencies (SICAD). Dealers and traffickers still face legal and criminal consequences.
Lifesaving medications need to be widely available. Methadone is highly effective at reducing cravings for opioids like heroin (and was persistently advocated by addiction leader, Dr. Newman). In Lisbon, methadone is distributed in vans (it can also be given as take-home doses, described later). Psychologist Hugo Faria coordinates one of two Low Threshold Mobile Units which not only administer lifesaving methadone, but also provide a wide range of services: blood testing (TB, HIV, syphilis, etc.), syringe exchange, condoms, other medications (e.g. antibiotics) and education. Luis, who last used heroin 8 years ago, says “the van changed my life. I would be dead without it.”