LISBON — I look confused at the sidewalk ahead, up and up it goes with no end in sight, the yellow Portuguese cobblestones dully reflecting the sun like small square moons. A dog barks persistently out of sight. I’d forgotten what walking uphill feels like after six months in the flattest country in Europe, but Portugal’s surprises are only just beginning.
This place holds a mythical place in the mind of the American drug reformer. Unlike in the Netherlands, whose reputation is tainted by its boisterous capital city, Portugal’s national drug policy reforms of 2000 bring a twinkle of hope to the eyes of US advocates for change. Yet just like the Dutch, most Portuguese I’ve met so far go to great lengths to correct the many misunderstandings and oversimplifications held by foreigners like me.
Asking local drug policy experts about a failed decriminalization experiment in Oregon—which advocates in the US state argued was based on the Portuguese model—almost invariably prompts them to roll their eyes in search of patience with another naïve American. But they are just as quick to invite the newcomer to their offices and open their rolodexes to help them understand what’s really going on.
The first point they try to dispel is the supposed hyper-focus on decriminalization because it is but a fraction of the solution and helps only with the criminal justice aspect of any drug-induced crisis. Namely, avoiding burdening people with criminal records that would weigh on them throughout their professional lives. Decriminalization does not solve the overlapping overdose, housing, treatment, poverty, social re-integration and viral infection (HIV, HEP C, tuberculosis) aspects of drug crises.
Prior to the drug policy reforms, it is estimated that 1 percent of the population used heroin regularly—around 80 percent of whom injected the drug. The number had steadily grown over the past 20 years to affect every level of society from the sons of judges on down. Everyone knew someone. It was common to see people injecting drugs on the streets of cities across the country and Portugal held the dubious honor of having the highest HIV infection rate in Europe.
Heroin addiction and overdoses ravaged individuals, families and communities up and down the Atlantic coast. Law enforcement efforts swelled the drug-related prison population to over 40 percent of the total with no beneficial results. It’s a situation many Americans would find familiar today; 0.75 percent of them were diagnosed with opioid use disorder in 2021, according to the National Institutes of Health.
Within 10 years of the reforms, however, the country saw an increase in treatment and social re-integration with simultaneous drops in overdose deaths, HIV infections, incarceration rates, homelessness and illicit drug use. Today, Portugal is the seventh safest country in the world, according to the Global World Peace Index of 2023.
Over the next seven months, I hope to untangle truth from fiction to portray the model as the Portuguese see and experience it. While I will investigate the roots of the heroin crisis and cultural changes that led to the 2000 drug reforms in a future dispatch, for the time being suffice it to say that drug possession for personal consumption in the country became an administrative offense on the level of a parking ticket. But even that is an oversimplification: Decriminalization does not mean depenalization, as I discovered.
The search for truth brings me to a residential neighborhood near the Praça de Espanha in northeastern Lisbon. As my taxi speeds away, all I see is a large, frosted glass door adorning an otherwise nondescript concrete apartment building. Lost, I notice a printed piece of paper taped to the door with a big red arrow pointing toward a doorbell indicating “28A.”
Unsure, I press the button. As the door opens, a teenager and two concerned-looking parents draw up behind me. We are beckoned inside. I’m politely instructed to wait after telling the woman at the desk whom I’m here to see. I sit down on a black cushioned chair, part of a row in the entrance corridor that feels neither inviting nor uninviting. The familiar inescapable insipidity of government customer service. I’m reminded of the last time I renewed my passport.
The teenager and mother stand at the desk filling out paperwork while the father fidgets with his phone next to me, concerned but apparently annoyed at having to spend his Thursday morning in such a way.
Around us is a cross-section of Lisbon society. Two friends in their 30s wearing trainers share some quiet words to sooth their apparent anxiousness. A young man in his 20s tries to be nonchalant as his girlfriend checks his paperwork.
About a dozen of us in all, we wouldn’t be out of place at the grocery store counter waiting to check out. Instead, we are at the offices of the Lisbon district’s drug use dissuasion commission, and the others are waiting for their evaluations and hearings. It is here that people caught with illicit drugs are sent by the police to see what threat they pose to themselves and others. Arrival at a dissuasion commission marks the official transition from law enforcement action to a health care and social work environment.
After a few minutes, Nuno Chapaz—tall, thin, with a greying beard—warmly welcomes me into his office, where I’ve seen a few of my fellow gadabouts enter and exit. He is a sociologist and one of the three members of the commission board, which consists of an additional jurist and a psychologist who make recommendations for people based on their risk assessment and life circumstances. Tired from a long day’s work triaging the morning’s cases, he lights up when explaining the history and effectiveness of dissuasion commissions and the Portuguese model that created them. He has been involved with the Lisbon commission since its inception in 2001.
Portugal is divided into 18 public health districts for addressing illicit drug use, with one dissuasion commission per district. Sixteen of those are on the continent with one in the Azores and another in Madeira. Nuno’s district encompasses a portion of Lisbon that includes 1.2 million residents and handles some 2,000 cases a year.
Nuno explains that most people intercepted by the police with drugs are in the act of committing some civil disturbance, such as causing a raucous noise at a late hour or theft or noticed during a routine traffic stop. He says the police no longer waste time searching for potential drug users, which usually entails socio-economic and racial profiling. All levels of society use drugs and in 23 years on the job, he’s seen them all.
It’s important that the police confiscate all illicit substances from people during such interceptions, unlike in Oregon. If a person is caught committing a crime, that offense is directed separately to the judicial system for processing by a judge like any other criminal charge. When the amount of drugs found is legally considered to be only for personal consumption, those cases are sent to dissuasion commissions.
Personal consumption offenders are handed summonses to present themselves in front of their local dissuasion commissions within 72 hours. Nuno emphasizes the importance of speed: “It has to be quick or else we lose them.” Those who do not show up in time are sent a letter to their mailing addresses. If they still don’t show up, a police officer hand-delivers a summons to their homes.
At this point, 75 percent to 80 percent of people show up for their appointments while those who do not are given financial fines or other sanctions such as community service imposed by dissuasion commissions in absentia. Many of the no-shows are tourists or homeless people who don’t frequent shelters.
Passing through the frosted glass door of the dissuasion commission, subjects cross the threshold from law enforcement into the arms of the Instituto para os Comportamentos Aditivos e as Dependencias (ICAD). It is the agency tasked with all public health administration related to illicit drug use. Its scope encompasses the dissuasion commissions, harm reduction, housing first, treatment, social integration (employment), prevention and many things I have yet to explore. This centralization aligns government initiatives, reduces bureaucratic turf fighting and allows for a more seamless transition for those receiving the various services.
João Goulão, the doctor who heads ICAD, later explained to me that one of the model’s key benefits is that it enables health care services to come into contact with people who are not reached by traditional treatment and harm reduction outreach efforts. Moreover, their ability to help drug-dependent people into treatment in a matter of days has been a cornerstone of the system’s success.
Crucially, people like the those sitting with me in the waiting area are not considered delinquents but people needing help. The goal is to reduce the usage of illicit substances through a variety of personalized options that respects individual freedom. While the threat of penalization hangs over the proceedings, it is used only as a last resort.
After checking in at the front desk, individuals are screened by a psychologist or social worker on duty. Interviews last 35-45 minutes during which the subjects are rated on a scale of low, medium and high risk. Unlike in the Netherlands, there is no defined distinction between hard or soft drugs. The focus is on context and whether people are dependent on substances or not.
To better understand how the approach works in practice, I spoke with one of the evaluating psychologists who agreed to talk off the record. The specialist made clear that while initial evaluations are grounded in the evidence-based Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) developed by the World Health Organization and motivational interviewing methodology, they are conversations at their core—not clinical checklists.
The role of the evaluator is to build a respectful rapport enabling subjects to feel safe to share what type of substances they use, the history and frequency of their use, and, just as important, their situations at home, with friends and at work. Is the substance use an occasional fun escape that doesn’t put their life at work and relationships at home at risk, or is it a coping mechanism to escape a subjectively abject reality that’s negatively affecting the ability to operate in professional settings and pushing away people they care about?
For most people, substance use is somewhere on the spectrum between those two polls. As the psychologist drilled into me during our hour-long interview, it’s all about “context, context, context.” Often, evaluators’ role is to rectify misinformation around the use of various substances, particularly with teenagers and young adults. Processing at the commission is an opportunity to help subjects question the paths they’re on, disrupt bad habits and promote more positive opportunities.
Data from ICAD’s 2022 detailed annual report notes that 79 percent of people who show up at dissuasion commissions do so for cannabis use, with 9 percent for cocaine and 5 percent for heroin. Some 91 percent are men, 87 percent are Portuguese, and 75.5 percent are between the ages of 16 and 34. It’s interesting that 18 percent are students while 60 percent are employed—including 56 percent of those considered drug-dependent. On average, between a quarter and a third of people seen by the commissions are considered to be drug-dependent while the majority are considered medium to low-risk.
On completion of the risk assessment, people are sent to a dissuasion commission board—in this case, Nuno and a colleague who have received the results and other contextual information. Hearings, conducted in an unimposing conference room setting, take around 10 minutes.
“The focus is on the person, what is best for them and their circumstance,” Nuno tells me. “There is no one size fits all.” Examples of types of legally binding recommendations given by the commission include a simple warning, outpatient or in-patient treatment, checking in every few months at a health care facility and appointments with employment or housing services. Those who agree with the board’s recommendations are connected to the relevant services with the help of social workers who track their progress to ensure they comply with the plan.
If someone agrees to a prescribed recommendation and makes good on the follow-up appointment, all legal penalties that arose from the possession of illicit substances are dropped. However, for those who fail to comply with the board’s recommendations and do not show up at follow-up service appointments, the dissuasion commission has no choice but to penalize them according to law.
Following the recommendations of a dissuasion commission does not clear a person from any other criminal charges brought at the time of arrest, but doing so does show good intent and can play favorably with a judge. Because dissuasion commissions act so fast, they often get to work with intercepted individuals weeks if not months before judges see them in court.
What gets Nuno up in the morning and coming back every day are teenagers like the one who walked in with me. “This can be a positive turning point for them, and this is who the system benefits the most,” he exclaims with passion. Instead of criminal records that would follow them for life and leave a bad taste in their mouths for government authority, those teenagers get support and evidence-based information.
By the time our two-hour interview concludes, the waiting room is empty and staff are enjoying a well-deserved lunch. Outside, warm rain begins falling. Giving Nuno a big thank you, I head to the metro processing what I’d seen with my own eyes. A decriminalized system that still penalizes people who use illicit drugs but does so in such a way as to promote personal, familial and societal wellbeing.
When I worked on US Senator Angus King’s (I-ME) staff before my fellowship, he would often tell me that one day seeing is worth a hundred days of reading. Every day of this fellowship so far has proven him right, no less the experience of walking through the dissuasion commission offices. They are so unlike the police stations, drug courts, and jails I’m familiar with that I feel like I just walked out of a futuristic Star Trek version of reality. Facing more uphill climbs, I look forward to the future surprises Portugal has yet to unveil.
Top photo: View from Alfama, Lisbon
