Transcript Decriminalization of Drugs in Portugal: Lessons for Public Health

Decriminalization of Drugs in Portugal: Lessons for Public Health
Kellen Russoniello, JD, MPH
Health Policy Fellow, ACLU of San Diego & Imperial Counties
Student Director, Students for Sensible Drug Policy
Introduction
Effects after Portuguese Decriminalization
Although lifetime prevalence of drug use in the general population has increased
slightly since decriminalization, youth and problem drug use rates have decreased. Further,
general population use rates in Portugal have increased at comparable rates to other
European nations. The number of people seeking treatment for drug addiction rose from
23,654 in 1998 to 38,532 in 2008. Methadone treatment utilization increased from 6,040
recipients in 1999 to 17,780 in 2007.
Negative health consequences associated with drug use have dramatically decreased
since the laws took effect:
• The number of HIV cases among injection drug users decreased by 71 percent
• AIDS cases among injection drug users decreased by 79 percent
• Drug-related deaths decreased by 28 percent
Drug-Related HIV & AIDS Notifications in Portugal by Year
1000
How Decriminalization in Portugal Works
800
Towards the end of the last millennium, Portugal recognized barriers to
600
treatment caused by criminalization prevented an effective approach to drug
use and related consequences. As a result, the government implemented a
400
Drug-Related HIV Notifications
strategy
based
on
principles
of
harm
200
Personal Supply Quantity by
Drug-Related AIDS Notifications
reduction, prevention, and reintegration of
Drug (Portugal)
0
drug users into society.
Source: Institute on Drugs and Drug Addiction
Heroin
1 gram
A key component of the policy is the
Ecstasy
1 gram
decriminalization of the personal use and
Year
possession of all drugs. Instead of criminal
Amphetamines 1 gram
The criminal justice system has also benefited. The total number of criminal drug
penalties,
a
person
caught
with
a
quantity
Cocaine
2 grams
offenses has decreased by nearly two-thirds, allowing police to focus on more serious drug
of drugs that does not exceed a personal
offenses. The reduction in criminal sentences for drug offenses also contributed to a
Marijuana
25 grams
supply will be referred to a Commission
reduction in prison overcrowding (from 199 to 101.5 per 100 prison spaces between 2001
for the Dissuasion of Drug Addiction (CDT). CDTs exist outside the criminal
and 2005). The number of offenses committed under the influence of drugs or to fund
justice system, and are comprised of a legal expert and two experts in drug
consumption decreased by over 50 percent between 1999 an 2008.
addiction who assess the individual’s economic status, circumstances of use,
Decriminalization of Drugs in Mexico
and whether the individual is addicted. CDTs can impose a variety of
sanctions, including:
In 2009, Mexico decriminalized personal possession of all drugs in order to focus
• Requiring periodic check-ins;
• Restriction from:
efforts on drug trafficking (unlike Portugal, who did so for public health reasons). Under the
• Termination of public benefits; system, those found in possession of drugs within the amount defined for personal use will
o Practicing certain professions;
• Community service; and
o Visiting certain places or people; or
still be arrested and detained, but will receive a warning from the court for the first two
• Fines
o Obtaining firearms;
offenses. The third offense results in mandated treatment.
Personal Supply Quantity by
Sanctions can be suspended if the CDT determines that it is appropriate or if At the same time, penalties for possession of quantities
Drug (Mexico)
the individual agrees to enter treatment. Each determination is made on the
over the amount defined for personal use increased. With
Heroin
50 milligrams
individual’s particular circumstances.
a heavy emphasis on criminal justice solutions to drug
40 milligrams
Importantly, Portugal passed accompanying legislation that created a
abuse, Mexico’s law has had little effect in the short-term Ecstasy
regulatory framework of harm reduction and treatment services. Drug policy and may actually increase the societal problems Mexico Amphetamines 40 milligrams
expenditures more than doubled to facilitate an increase in treatment
is already experiencing, such as corruption, backlog of
Cocaine
500 milligrams
capacity, syringe exchange programs, methadone replacement therapy, and
cases in the criminal justice system (especially pretrial
5 grams
provision of clothes, food, and medical services to individuals who use
detention), and overcrowded prisons. In fact, because the Marijuana
The United States has the highest population of incarcerated people and
rate of incarceration in the world. A substantial proportion of those
incarcerated are sentenced for drug offenses. Despite this, the rates of drug use
and addiction have remained relatively stable. Further, only about one in 10
people with addiction receive treatment.
The United States can learn from Portugal’s experience. Decriminalization
of personal drug possession, so long as the amounts defined as personal use
are sufficient, can help reduce criminal justice system backlog and prison
overcrowding. If drug offenses are removed from the criminal justice system,
like in Portugal, then the stigma surrounding addiction will begin to erode.
Resources that were previously used for apprehending and prosecuting those
who use drugs could be used to bolster harm reduction, prevention, and
treatment services. In Portugal, investment in this infrastructure has shown to
be an effective means of reducing drug-related health consequences.
The implementation of the Affordable Care Act provides states with
incentive for decriminalization by requiring that health plans cover addiction
and mental health services. Because offenders would only be able to access
these services outside of incarceration, states may want to consider alternatives
to jail or prison sentences for drug offenses, including decriminalization.
drugs.
Kellen Russoniello, Note, The Devil (and Drugs) in the Details: Portugal’s Focus on Public Health
as a Model for Decriminalization of Drugs in Mexico 12 YALE J. HEALTH POL’Y L. & ETHICS 371
(2012).
Notifications
In 2001, Portugal radically reformed its approach to drug use by
decriminalizing the personal possession of all drugs and investing in public
health infrastructure aimed at reducing the harm caused by drug addiction.
These reforms have been effective in reducing drug-related disease and
death. Portugal’s experience suggests that decriminalization and investment
in treatment and harm reduction can be an impactful means of improving
public health. However, comparison between Portugal and Mexico
demonstrates how different methods of decriminalization can produce very
different outcomes. This poster explains how the lessons learned in Portugal
(and by comparison to Mexico’s decriminalization scheme) can be
implemented into drug policy in the United States to help reduce drug
addiction, drug use-related health consequences, and over-incarceration.
Lessons for the United States
amounts of personal possession are so low, the law may actually detract from its own stated
purpose of focusing on large-scale drug traffickers.
United States
China
Countries with
the Most
Russia
Number of
Brazil
Prisoners (in
India
thousands)
0
500
1000
1500
2000
2500
Conclusions
• Decriminalization should be guided by principles of public health and harm
reduction
• Decriminalization can reduce stigma associated with drug use and encourage
individuals to seek treatment
• Appropriate funding should be allocated for harm reduction and treatment
capacity
• Each country considering decriminalization will face unique challenges
• With the Affordable Care Act, the United States is in a position to radically
change its approach to drug policy, and Portugal’s experience should be used
as a guide
References
GLENN GREENWALD, CATO INST., DRUG DECRIMINALIZATION IN PORTUGAL: LESSONS FOR
CREATING FAIR AND SUCCESSFUL DRUG POLICIES (2009).
Caitlin Elizabeth Hughes & Alex Stevens, What Can We Learn from the Portuguese
Decriminalization of Illicit Drugs?, 50 BRIT. J. CRIMINOLOGY 999 (2010).
INST. ON DRUGS AND DRUG ADDICTION, 2012 NATIONAL REPORT TO THE EMCDDA (2012); 2009
NATIONAL REPORT TO THE EMCDDA (2009).