Portugal has emerged as a promising worldwide mannequin for tackling a lethal drug and habit disaster. The nation has used a deal with well being care and neighborhood assist to avoid wasting lives.
LEILA FADEL, HOST:
The U.S. is going through its worst overdose disaster ever, and assist with addressing this epidemic could also be discovered over 4,000 miles away in Portugal. NPR habit correspondent Brian Mann traveled there and realized how deadly overdoses dropped 80%.
UNIDENTIFIED PERSON: (Talking Portuguese).
BRIAN MANN, BYLINE: It is a spring-like day in Lisbon, Portugal’s capital, and I’ve come to part of the town most vacationers by no means see – a blue-collar sprawl of house blocks house to a government-run drug consumption clinic. Liliana Santos, who has a tragic, weathered face, sits outdoors, having fun with the solar.
LILIANA SANTOS: Cocaine is my drug, however I smoke brown.
MANN: Brown is a type of heroin that Santos buys on the road. Contained in the clinic, women and men sit at a desk surrounded by plumes of smoke, utilizing their crack and heroin pipes. In a room subsequent door, Ana Batista, a soft-spoken lady in her mid-50s, has introduced heroin to inject.
ANA BATISTA: (Talking Portuguese).
MANN: “It is completely different utilizing medicine right here,” Batista tells me – safer than utilizing alone on the road. This clinic is a part of a nationwide community of habit providers, a part of Portugal’s wider taxpayer-funded nationwide well being care system. This is without doubt one of the elementary variations in Portugal. Not like the U.S., nobody right here has to pay for habit care. Nobody scrambles to navigate the sort of difficult, expensive and infrequently poorly regulated restoration system we’ve got within the U.S. As I talked to drug customers on the clinic, I hear one thing else very completely different. Within the U.S., habit is lethal. However after I ask Batista if she’s misplaced anybody to medicine, she appears to be like startled.
BATISTA: No, no. No.
MANN: Liliana Santos, the girl who smokes cocaine and heroin, tells me the identical factor.
Have you ever had pals overdose?
SANTOS: No.
MANN: Have you ever overdosed?
SANTOS: No.
MANN: No?
SANTOS: No.
MANN: The straightforward truth is that overdose deaths are extremely uncommon right here. Portugal has roughly the identical inhabitants because the state of New Jersey. However whereas new Jersey sees roughly 3,000 deadly drug overdoses a yr, Portugal – the whole nation – averages roughly 80.
MIGUEL MONIZ: The statistics actually communicate for themselves.
MANN: Miguel Moniz is an anthropologist on the College of Lisbon who studied drug coverage and habit within the U.S. and Portugal for many years. He says Portugal’s method to habit shifted within the late ’90s, when the nation skilled its personal opioid disaster. Moderately than comply with the U.S. drug battle mannequin, which centered on arresting folks, usually giving them prolonged jail sentences, Moniz says Portugal prioritized well being care.
MONIZ: Somebody who has problematic drug use is not somebody who’s a legal or has an ethical failing. They’re somebody who has a bodily or psychological well being downside, and that could be a super societal shift.
MANN: Whereas the U.S. was constructing state and federal prisons to accommodate lots of of 1000’s of drug offenders, Portugal decriminalized private use quantities of medication and invested in a really completely different infrastructure.
MONIZ: So there’s coaching for jobs, varied strong remedy applications, the involvement of police at each stage.
MANN: Moniz talked about police. One other large distinction right here is how Portugal reinvented the function of cops coping with road medicine. Police nonetheless break up drug gangs in Portugal and arrest folks committing drug-related crimes like theft. Additionally they work to disrupt open-air drug markets like those which have emerged in some U.S. cities. However when Portuguese police encounter folks utilizing small, personal-use quantities of medication, there is not any arrest. As an alternative, cops schedule conferences for folks utilizing medicine with counselors. Police are skilled in methods to persuade and encourage folks to attend these classes.
ARTUR VAZ: (Talking Portuguese).
MANN: Artur Vaz heads the nationwide police unit in Portugal that targets drug trafficking. To start with, he tells me, most policemen had been very, very skeptical about this coverage. Within the U.S., this type of method has additionally been controversial. In Oregon, for instance, the place small quantities of medication have been decriminalized, police repeatedly hand out info playing cards referring folks to a drug counseling hotline. Courtroom information exhibits drug customers not often name. In Portugal, it’s extremely completely different. Nationwide information in Portugal exhibits roughly 90% of individuals referred by police for counseling flip up.
VAZ: (Talking Portuguese).
MANN: “Most police have come to consider it is a balanced method,” Vaz says. “Individuals who eat medicine needs to be handled by the well being system, not the legal system.”
Police referrals are just one pathway to remedy. Portugal’s nationwide system nudges drug customers continuously towards restoration applications – all voluntary, all freed from cost. Dr. Joao Goulao is Portugal’s nationwide drug czar. He says one motive the system works is there is not any stigma within the course of – no risk of punishment or prosecution.
JOAO GOULAO: It isn’t truthful to deal with this illness differently from what we do with different illnesses.
MANN: The outcomes are placing. During the last 20 years, U.S. drug deaths saved surging, first with heroin, crack cocaine and prescription ache capsules, now with methamphetamines and fentanyl. Throughout that very same interval, Portugal reduce drug-related HIV/AIDS instances in half. Individuals right here now are 45 instances much less prone to die from a drug overdose in contrast with the U.S.
GOULAO: We’re completely happy that the majority of them are there, alive.
MANN: Issues aren’t excellent in Portugal. Like all over the place on this planet, habit is commonly wrenching. In the course of the COVID pandemic, drug use in Portugal bought worse – nothing just like the U.S., however there was an uptick of overdoses. Individuals right here additionally fear concerning the arrival of fentanyl, which, thus far, hasn’t gained recognition on Portugal’s streets. Partly to arrange for the specter of fentanyl, the federal government is as soon as once more spending extra money on well being care and habit applications.
Again on the road in Lisbon, I encounter yet another large distinction in the way in which Portugal treats individuals who use medicine. Elda Coimbra is a neatly dressed, middle-aged lady who not too long ago began utilizing medicine once more.
ELDA COIMBRA: (Talking Portuguese).
MANN: And have you ever additionally used heroin?
COIMBRA: Yeah.
MANN: Within the U.S., the place habit care is commonly abstinence-based, this type of relapse usually means individuals are kicked out of remedy. They lose housing and different assist. Portugal’s system, against this, views Coimbra’s battle as a painful however regular a part of habit.
COIMBRA: (Talking Portuguese).
MANN: Coimbra tells me she is getting assist, together with housing and a job. “I can get my life again collectively,” she says.
Once more, nobody right here thinks Portugal’s mannequin is ideal. Medicine nonetheless trigger a variety of struggling. However 20 years of knowledge exhibits Portugal’s method helps much more folks keep alive, retains them out of jail and presents possibilities to get better once they stumble.
Brian Mann, NPR Information, Lisbon, Portugal.
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