![]() The Portuguese model is based in humanism-seeing people with drug problems as people with an illness, says psychologist Domingos Duran, head of the treatment division of the government's Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências. "It's not possible to have an effective health program if people are hiding the problem." Emphasizing harm reduction "You cannot work with people when they're afraid of being caught and going to prison," says psychologist Francisco Miranda Rodrigues, president of the Ordem dos Psicólogos Portugueses. Delegates from the United States and other nations-including APA's Amanda Clinton, PhD, senior director for international affairs-arrive regularly to see the model firsthand. The number of HIV diagnoses caused by injection drug use has plummeted by more than 90 percent. Portugal now has the lowest drug-related death rate in Western Europe, with a mortality rate a tenth of Britain's and a fiftieth of the United States'. According to a New York Times analysis, the number of heroin users in Portugal has dropped from about 100,000 before the law to just 25,000 today. Shifting from a criminal approach to a public health one-the so-called Portugal model-has had dramatic results. If that happens and the person doesn't appear before the commission again during the six-month period, the case is closed. However, the commission can decide to suspend enforcement of these penalties for six months if the individual agrees to get help-an information session, motivational interview or brief intervention-targeted to his or her pattern of drug use. Nonaddicted individuals may receive a warning or a fine. The commission assesses whether the individual is addicted and suggests treatment as needed. (Dealers still go to jail.) Instead of facing prison time and criminal records, users who are caught by police go before a local three-person commission for the dissuasion of drug addiction, a panel typically composed of a lawyer plus some combination of a physician, psychologist, social worker or other health-care professional with expertise in drug addiction. ![]() ![]() With the backing of psychologists and other health-care professionals, the law decriminalized the use and possession of up to 10 days' worth of narcotics or other drugs for individuals' own use. But thanks to an innovative law that went into effect in 2001, Portugal has turned its crisis around. Like the United States today, Portugal in the 1990s was in the grip of an opioid epidemic so intense that Lisbon was known as the "heroin capital" of Europe. ![]()
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