An Interview With Morgan Dandie Hannah: Part Six, the Portuguese Model

In my last post on this subject, I cited a short clip from Morgan where we discussed legalizing addictive drugs in order to deal with overdoses and the crushing cost of addiction. Since then, there's been a general election in the USA and the state of Oregon passed a popular referendum that decriminalizes all forms of street drugs. There's a nuance to this new legal framework that I think readers should understand. Decriminalizing all drugs isn't the same thing as legalizing them. It just means that people no longer get anything more than a fine if they get caught with them. This doesn't lower the cost of the drugs addicts can buy, nor does it ensure consistency in the potency and safety of what they inject into their arms. 

Nor, oddly enough, does it necessarily cut down on the number of people in jail. I can remember hearing a cannabis activist describe the paradoxical effect that decriminalization had in Australia. According to him, it turned out that when several states reduced cannabis possession from a criminal to an administrative sanction (ie: jail to fine), the result was an increase in the incarceration rate of native (aboriginal) Australians. The way it worked was that many police had been of the opinion that the paperwork and court time involved in charging someone for cannabis possession wasn't worth the hassle. So they just tossed the drugs and sent people on their way. (This happened here to friends of mine during prohibition.) But since all they had to do after decriminalization was to write a ticket they tended to intervene more often. For middle-class people this was annoying. But for the really poor (predominantly native Australians) they were beyond their means to pay. This meant that they ended up doing time in jail for unpaid fines. 

I see the above example as a salutary tale that should make people think very carefully about the subtle nuances involved in any sort of change to drug policy.

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Hannah ended up by citing the Portuguese model as an example of how to really help addicts. She isn't the only one, so I'm going to do a quick run-through of how it works. 

First, I think it's tremendously important to understand historical context of its introduction. That's because I suspect that it really isn't all that revolutionary to most experts on drug treatment. What is amazing is that it managed to get introduced and supported long enough to show results. My suspicion is the problem isn't that experts don't know what should be done, it's there are always powerful interests in society that block any real attempt to do so.

In 1933 Portugal became a Fascist dictatorship after a military coup d'etat. This continued until 1974 when a leftist military coup plus a popular uprising (the "Carnation Revolution"), brought in a liberal democracy more in keeping with modern European traditions. In addition, between 1961 and 1975 Portugal was involved in battles with other nations (India, 1961) and popular insurgencies (Angola, Guinea-Bissau, Mozambique). This was just as traumatic to the nation as the Vietnam War was to the USA. It created large numbers of dispirited, traumatized veterans, many who suffered from serious wounds---just the sort of people who are vulnerable to addiction. Moreover---because of Portugal's close proximity to Africa plus it's numerous trade and cultural connections to Asia, Africa, and, South America---the country has always lots of opportunities for smugglers.

All of this created something of a "perfect storm" for heroin use that culminated with very high levels of addiction. To illustrate this, take a look at the following bar graph that I got from a Cato Institute report written by Glenn Greenwald. It shows the rapid increase of drug-related deaths (overdoses?) in Portugal over 12 years.

Just to put these deaths into a context, Portugal's total population was something like 10 million during the time span of this graph. That means that the 1999 drug deaths of 400 comes to something like one person out of 25,000. Last year Canada had a population of 38 million and 3822 people died of overdoses, or, one person out of 9900. So, as per opioid deaths Portugal at the height of its drug epidemic had nothing on Canada.  

Where Portugal did have a big problem was in the transmission of HIV through injected drug use. The problem was those colonial wars in Africa. One of the areas of conflict, Guinea-Bissau, appears to have been the origin area of HIV-2. (There are various different strains of HIV. The main culprit for AIDS is HIV-1, but the second strain, HIV-2, also causes the disease. It is key to the Portuguese part of the pandemic.) As a result, there were high rates of HIV in both Portuguese soldiers (through both blood transfusions and sexual contact) and refugees from the conflict who ended up in Portugal. This "base line" of infection created a reservoir of the disease that then spread through the use of shared needles among injection drug users. As a result, Portugal ended up with (and still has) the highest rates of HIV infection in Europe. 

At the time the Portuguese drug model was created (2001), they were in the middle of a rapidly-spreading epidemic of HIV (tuberculosis and hepatitis too!) and they found that 50% of the spread was coming through addicts sharing needles. Since the drug model came about---which brought in a great many harm-reduction tactics, such as needle-exchanges---the country has managed to almost eliminate this mode of transmission. To illustrate this, consider the following 2019 graphic from the European Centre for Disease Prevention and Control (ECDC).

Click on the image to get a bigger, more easy to see version.

 

As you can see, now Portugal has almost no transmission of HIV by way of needle-sharing---unlike other countries like the Baltic states where it is still quite common. 

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This was a brutal pig of an article to research. There were lots of things on the web that talked about how groovy the Portugal response to drug addiction really is, but the details were kinda hard to find. Moreover, there wasn't an awful lot I could find that brought it together into a whole. So I had to wade through microscopic detailed policy papers, "feel good" stories that didn't have any detail at all, and, shiny, graphic-heavy "factoid cards" that had obviously been written by European Union public relations departments. Perhaps if I could read Portuguese it would have helped---.

Either way, the above whining is just my way of saying that writing these articles really is hard work. And as a general rule I think that if someone does hard, useful work they should get paid for it. If you can afford it, therefore, why not subscribe? It's easy to do through Patreon and Pay Pal.  

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I've started off this discussion with the origins of the Portuguese model because I am really interested in understanding how it came about and whether or not these provide insights into what barriers Canadians might have if they tried to bring something similar here. As I see it, there were two key elements:

The conservative elements in society had been totally discredited because of generations of Fascist rule plus a catastrophic colonial war that went on for far, far too long. I suspect that after the Carnation Revolution a "breathing space" opened up and more liberal elements of society were given a breathing space to attempt science-based public policy free from sabotage by people ideologically opposed to it.

I also suspect that because of the rapid spread of HIV---and the real terror people had of it---the government was so afraid of the disease getting out of control that it "swallowed" any repugnance it might have had towards addicts. This would explain why they were willing to do almost anything to cut the spread of the disease---including treating addicts with dignity and humanity.

(Please be aware that this is me "reading between the lines" of a totally different culture. But one thing I've learned over the years is that scientists won't make value judgments in their reports and politicians won't say anything that makes them look bad. The result is a "sanitized" version of history becomes the public record. I'm just looking at the facts I see before me, adding in the results of my personal experience, and, hypothesizing about what seems to be the most plausible conclusion. If someone can direct me towards evidence that would suggest otherwise, please do so I can correct this part of the article.)

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The way the Portuguese Model works is fairly simple. Ultimately, it involves treating addicts like sick people with a social/physical ailment that needs treatment instead of as criminals that require punishment. Moreover, the government decided that it would actually provide the resources to actually help people instead of just mouthing platitudes. 

The European Monitoring Centre for Drugs and Drug Addiction published a monograph titled Drug Policy Profiles: Portugal that describes the key elements of the policy.

The first part was that even though the possession of drugs is still illegal, the principle of punishment was totally removed. Instead, the only emphasis is on rehabilitation. As quoted from the above document, the preamble to the law states:

‘the drug user is sanctioned ... in a quasi-symbolic manner, in which the contact with the formal justice system is designed to encourage him or her to seek treatment’

This difference is a key part of how Portugal defines their decision to "decriminalize" the use of all drugs. I mentioned how "decriminalization" resulted in an increase of native Australians being incarcerated for Cannabis possession. That's because of the "mindset" that accompanied this change. The European Monitoring Centre for Drugs and Drug Addiction did a nice job of spelling out the intricacies of the definition in a statement that was quoted by Glenn Greenwald's report.

“Decriminalisation” comprises removal of a conduct or activity from the sphere of criminal law. Prohibition remains the rule, but sanctions for use (and its preparatory acts) no longer fall within the framework of the criminal law.

[By contrast],“depenalization” means relation of the penal sanction provided for by law. In the case of drugs, and cannabis in particular, depenalization generally signifies the elimination of custodial penalties.

Understanding the distinction and using the European language, one would see that Oregon and Australian "depenalized" drugs, but they didn't "decriminalize" them. This is absolutely key to understanding the system.  

Portuguese police can and do issue citations to people caught in possession. But the citations that they issue aren't about appearing before a judge. Instead, they are to go before something that would drive most "law-and-order types" into fits of hysteria: "Dissuasion Commissions". These are tribunals that consist of one person appointed by the Ministry of Justice plus two jointly appointed by the Ministry of Health and the government co-ordinator of health policy. One needs to have a legal background and at least one of the others should have a background in medicine or social work. As a general rule, most Commissions have all three. 

By mandate and actual practice, these tribunals have nothing at all in common with courts. Instead, they operate more like social work "teams" who's primary mandate is to help the offender instead of protect society. To that end, their authority is tremendously limited. When a police officer finds someone using illegal drugs all they can do is issue a summons that requires the person to show up before the Dissuasion Commission within 72 hours. Once a person comes before the body, they make a quick decision whether or not there is reason to believe that drug trafficking is taking place. If so, the case is then sent to a regular court.

For the majority of cases they take over at this point and the judicial system is no longer involved. As the title of the tribunal suggests, it's key job is to dissuade people from being drug addicts and offer the ones who seek it, effective treatment. The law provides some "sticks" for them to use---such as social sanctions plus a provision to issue fines of between 25 euros and the minimum wage, but in fact these are rarely levied. Indeed, the law states that if there is no evidence of actual addiction or repeated offences, the fine can only be used as a suspended sentence.

The tribunals don't use threats to get people to enter rehab or detox programs. The individuals have to want the treatment. Indeed, even if a tribunal did try to order someone to go into a program under the law it is not a criminal act to ignore the decision of a Dissuasion Commission. Instead, it is the job of the tribunal to help the addict find the services they want in order to kick their habit. To that end, they have the authority to send anyone who wants it to a detox, treatment, or, drug replacement (methadone) clinic. Moreover, the government has actually funded the creation of this support infrastructure. This means that people who want treatment can actually receive it when they need it, instead of having to wait long times for a space to open up (like we do in Canada). 

After reading the previous articles I've written I hope readers can identify the key points of interest:

1. The lack of sanctions by the Commission mean that they cannot force anyone to go to treatment who doesn't want to go---this means that they don't disrupt the people who do want to be there.
2. The decision to fully fund the different types of treatment mean that the option is always there---even for poor people.
3. Removing the criminal justice system from the process means that there is minimal social stigma and no long-term penalty (ie: a criminal record) that will hold-back a person from reintegrating with society.

Hannah also said that she had no interest in legalizing drugs because she saw the people who sold drugs to addicts as being totally indefensible. I tend to agree with her about the "king pins" who sell really nasty stuff to people---like heroin, fentanil and carfentanil. She did say that the police shouldn't be going after people who sell small amounts so they can afford their habit. The fact that users go before the tribunals and they decide whether or not they should be treated as traffickers strikes me as a useful "firewall" that protects people from the tendency of police departments to only go after the "easy" criminals instead of the difficult ones. 

 

Indeed, according to the Drug Policy Profiles: Portugal paper that I mentioned above,

In 1993, a new drug law was adopted and remains today the primary Portuguese law on supply reduction (see box, page 13). This law transposed the recommendations of the 1988 UN Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, focusing on drug money laundering and control of drug precursors. It maintained the criminalisation of drug use but developed a specific approach to it.

In other words, police policy is to not focus on street level drug sales, but instead to focus on the drug "king pins" who produce and import the drugs, and, the banks that launder the profits. 

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Could Canada Adopt the Portuguese Model?

This is the big question and answering it requires some head-scratching on my part. There does appear to be a real appetite on the part of different parts of Canadian society to deal with our drug epidemic in a new way. It's hard to argue with the obvious success of Portugal. But IMHO there are big, big, big barriers that stand in the way of adopting it here. 

 

First of all, unlike Portugal, right-wing ideology still has a great deal of support in this country. And it doesn't like harm reduction. Instead, it believes in PUNISHMENT. It might not make any sense, but politics often isn't about developing good public policy---it's about whipping people into a frenzy in order to get them to give you donations and vote for you. There are conservative politicians who were trying get people to vote for them in the last few elections because other parties were in favour of legalizing cannabis. You can imagine the uproar they would create if they could use the "Dissuasion Commissions" as a stick to beat their rivals with. 

Secondly, in the short run it won't be cheap to build enough detox and treatment centres. In the long run the government will actually will save if you cut down on the prison population, avoid all the medical costs, petty crime, etc. But while it might be true that all the money comes from the same tax payers, it still goes into different department budgets. And, the fact of the matter is that there will be a transitional period where the government will have to spend real coin to get the system up and running. As a result, the "all taxes are theft" crowd would be screaming, wailing, and, gnashing their teeth with a vengeance. 

Third, there are a lot of folks with a vested interest in the War on Drugs. It might be that the Chiefs of Police are in favour of something like the Portugal model, but I bet that there would be a lot of officers who've build their careers in the drug squad who would freak at the thought of having their budget slashed. I also suspect that a lot of lawyers would have heart attacks at the idea that an incredibly informal process like the Dissuasion tribunals would take most drug cases away from the courts---not for financial reasons, but because they have a strong personal investment in the ideals of the current adversarial system.

 

Moreover, I think it will be a very cold day in Hell before the government gets serious about going after the source of drugs coming into Canada. Most fentanyl and carfentanil comes from China. We're already in a huge mess over our arrest of Huawei executive Meng Wanzhou and it looks like another is ginning up because  our UN Ambassador, Bob Rae, is trying to defend the Uyghurs (and quite rightly, too!). 

 

As for money laundering, there is the intrinsic problem that most of it is done through the following:

• offshore tax havens
• real estate
• banks
• casinos

It is really, really hard to get the government to scrutinize these with anything like a serious attempt to reign in criminal behaviour. That's because any significant move against drug kingpins with regard to the first three will really piss off a lot of very wealthy, very powerful people. That's not that I believe that most wealthy people are involved in the opioid business, but because the same laws and procedures that protect big crime when it launders money also protects the just plain wealthy when it comes to tax avoidance. 

To understand this point, consider an analogy. Have you ever wondered why it is that the government never gets around to passing laws against puppy mills? It's because any animal welfare law that really did protect dogs from this sort of sleaze would also make it illegal to have a modern factory farm. There's no way to write a law in our legal tradition that says it is cruel and evil to mistreat dogs without also raising concerns about how we treat pigs and chickens. As a result, people get upset---but we still have puppy mills. (Truly, we shouldn't have factory farms either, but that's just a little too far for most people to go right now.)  

As for casinos, the people who's oxen would get gored would be governments. As I pointed out in the article about gambling addictions, both provincial and First Nation's governments are dependent on the revenue that they extract from problem gamblers. They probably also benefit from whatever money laundering goes on within our casinos. This means that there would be a very strong conflict of interest between governments and law enforcement with regard to casino money laundering. (For those of you who don't know this, there is currently something called The Cullen Commission going on in British Columbia that is aimed at this very issue.) 

 

And the very, very last issue is constitutional. Portugal is a unitary state of only 10 million citizens. In contrast, Canada is a federation with significant police, health, and, financial powers decentralized to the provinces. And one thing that I've learned from my years in politics is that elected leaders NEVER GIVE UP AN IOTA OF POWER WITHOUT FIGHTING TOOTH AND NAIL. That means that there would be huge battles between Ottawa and the provincial governments about who gets to make what decision involved in changing our patchwork of enforcement, treatment, and, financial regulations. Canada doesn't have the sort of national consensus that gets built up by rebelling against 40 years of Fascist dictatorship, fighting a ridiculous "forever war" against half of Africa, and, staring down an epidemic that potentially made COVID-19 look like a case of the sniffles.   

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Sorry to be such a "Debbie downer", but putting out this blog has educated me into why so many journalists have drinking problems. It seems that every time I look into a problem in some detail I find that things are worse than I ever imagined. I'm planning on doing one more story on this subject and then it's on to some more positive stuff. 

I hope you are keeping your distance and wearing your mask. I am.

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Moreover I say unto you, the Climate Emergency must be dealt with!