How Portugal got the number of fatal overdoses in the country to drop 80%

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Portugal has emerged as a promising worldwide mannequin for tackling a lethal drug and dependancy disaster. The nation has used a deal with well being care and neighborhood help to save lots of lives.

LEILA FADEL, HOST:

The U.S. is dealing with its worst overdose disaster ever, and assist with addressing this epidemic could also be discovered over 4,000 miles away in Portugal. NPR dependancy correspondent Brian Mann traveled there and discovered 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 town most vacationers by no means see – a blue-collar sprawl of condo blocks residence 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 girl in her mid-50s, has introduced heroin to inject.

ANA BATISTA: (Talking Portuguese).

MANN: “It is totally different utilizing medication right here,” Batista tells me – safer than utilizing alone on the road. This clinic is a part of a nationwide community of dependancy providers, a part of Portugal’s wider taxpayer-funded nationwide well being care system. This is likely one of the basic variations in Portugal. In contrast to the U.S., nobody right here has to pay for dependancy care. Nobody scrambles to navigate the sort of sophisticated, 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 totally different. Within the U.S., dependancy is lethal. However after I ask Batista if she’s misplaced anybody to medication, she seems to be startled.

BATISTA: No, no. No.

MANN: Liliana Santos, the lady who smokes cocaine and heroin, tells me the identical factor.

Have you ever had buddies overdose?

SANTOS: No.

MANN: Have you ever overdosed?

SANTOS: No.

MANN: No?

SANTOS: No.

MANN: The easy reality 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 complete 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 dependancy within the U.S. and Portugal for many years. He says Portugal’s strategy to dependancy shifted within the late ’90s, when the nation skilled its personal opioid disaster. Slightly than comply with the U.S. drug battle mannequin, which targeted on arresting individuals, 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 felony or has an ethical failing. They’re somebody who has a bodily or psychological well being drawback, and that could be a large societal shift.

MANN: Whereas the U.S. was constructing state and federal prisons to deal with lots of of hundreds of drug offenders, Portugal decriminalized private use quantities of medicine and invested in a really totally different infrastructure.

MONIZ: So there’s coaching for jobs, numerous sturdy therapy applications, the involvement of police at each degree.

MANN: Moniz talked about police. One other large distinction right here is how Portugal reinvented the function of cops coping with avenue medication. Police nonetheless break up drug gangs in Portugal and arrest individuals 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 individuals utilizing small, personal-use quantities of medicine, there is not any arrest. As an alternative, cops schedule conferences for individuals utilizing medication with counselors. Police are skilled in methods to persuade and encourage individuals to attend these periods.

ARTUR VAZ: (Talking Portuguese).

MANN: Artur Vaz heads the nationwide police unit in Portugal that targets drug trafficking. At first, he tells me, most policemen have been very, very skeptical about this coverage. Within the U.S., this sort of strategy has additionally been controversial. In Oregon, for instance, the place small quantities of medicine have been decriminalized, police repeatedly hand out data playing cards referring individuals to a drug counseling hotline. Court docket information exhibits drug customers hardly ever name. In Portugal, it’s totally totally 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 strategy,” Vaz says. “Individuals who eat medication must be handled by the well being system, not the felony system.”

Police referrals are just one pathway to therapy. 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 is not truthful to deal with this illness another way from what we do with different ailments.

MANN: The outcomes are putting. Over the past 20 years, U.S. drug deaths saved surging, first with heroin, crack cocaine and prescription ache drugs, now with methamphetamines and fentanyl. Throughout that very same interval, Portugal lower drug-related HIV/AIDS instances in half. Individuals right here now are 45 instances much less more likely to die from a drug overdose in contrast with the U.S.

GOULAO: We’re glad that almost all of them are there, alive.

MANN: Issues aren’t excellent in Portugal. Like in every single place on this planet, dependancy is usually wrenching. Throughout the COVID pandemic, drug use in Portugal received 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 dependancy applications.

Again on the road in Lisbon, I encounter yet another large distinction in the best way Portugal treats individuals who use medication. Elda Coimbra is a neatly dressed, middle-aged girl who not too long ago began utilizing medication once more.

ELDA COIMBRA: (Talking Portuguese).

MANN: And have you ever additionally used heroin?

COIMBRA: Yeah.

MANN: Within the U.S., the place dependancy care is usually abstinence-based, this sort of relapse usually means persons are kicked out of therapy. They lose housing and different help. Portugal’s system, in contrast, views Coimbra’s wrestle as a painful however regular a part of dependancy.

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. Medication nonetheless trigger quite a lot of struggling. However twenty years of information exhibits Portugal’s strategy helps much more individuals keep alive, retains them out of jail and affords possibilities to get well after they stumble.

Brian Mann, NPR Information, Lisbon, Portugal.

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NPR transcripts are created on a rush deadline by an NPR contractor. This textual content is probably not in its ultimate kind and could also be up to date or revised sooner or later. Accuracy and availability might range. The authoritative document of NPR’s programming is the audio document.

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