Decriminalization of Drugs in Portugal: Lessons for Public Health Kellen Russoniello, JD, MPH

1. 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 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. • 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 Lessons for the United States 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. How Decriminalization in Portugal Works Towards the end of the last millennium, Portugal recognized barriers to treatment caused by criminalization prevented an effective approach to drug use and related consequences. As a result, the government implemented a strategy based on principles of harm reduction, prevention, and reintegration of drug users into society. A key component of the policy is the decriminalization of the personal use and possession of all drugs. Instead of criminal penalties, a person caught with a quantity of drugs that does not exceed a personal supply will be referred to a Commission Countries with the Most Number of Prisoners (in thousands) The criminal justice system has also benefited. The total number of criminal drug offenses has decreased by nearly two-thirds, allowing police to focus on more serious drug offenses. The reduction in criminal sentences for drug offenses also contributed to a reduction in prison overcrowding (from 199 to 101.5 per 100 prison spaces between 2001 and 2005). The number of offenses committed under the influence of drugs or to fund consumption decreased by over 50 percent between 1999 an 2008. • 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 uniquechallenges • 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 • for the Dissuasion of Drug Addiction (CDT).CDTsexist outside the criminal justice system, andare comprised of a legal expert and two experts in drug addiction who assess the individual’s economic status, circumstances of use, and whether the individual is addicted. CDTs can impose a variety of sanctions, including: • Restriction from: • Practicing certain professions; • Visiting certain places or people; or • Obtaining firearms; • Sanctions can be suspended if the CDT determines that it is appropriate or if the individual agrees to enter treatment. Each determination is made on the individual’s particular circumstances. • Importantly, Portugal passed accompanying legislation that created a regulatory framework of harm reduction and treatment services. Drug policy expenditures more than doubled to facilitate an increase in treatment capacity, syringe exchange programs, methadone replacement therapy, and provision of clothes, food, and medical services to individuals who use drugs. Decriminalization of Drugs in Mexico In 2009, Mexico decriminalized personal possession of all drugs in order to focus efforts on drug trafficking (unlike Portugal, who did so for public health reasons). Under the system, those found in possession of drugs within the amount defined for personal use will still be arrested and detained, but will receive a warning from the court for the first two offenses. The third offense results in mandatedtreatment. At the sametime, penalties for possession of quantities over the amount defined for personal use increased. With a heavy emphasis on criminal justice solutions to drug abuse, Mexico’s law has had little effect in the short-term and may actually increase the societal problems Mexico is already experiencing, such as corruption, backlog of cases in the criminal justice system (especially pretrial detention), and overcrowded prisons. In fact, because the amounts of personal possession are so low, the law may actually detract from its own stated purpose of focusing on large-scale drug traffickers. • Requiring periodic check-ins; • Termination of public benefits; • Community service; and • Fines 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). 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).