"Portugal also reminds us that decriminalization is only one tool in addressing substance use disorder."
In this July 3, 2023, file photo, people take pictures at a viewpoint overlooking downtown Lisbon, Portugal, as the sun sets. Credit: Armando Franca / AP

The BDN Opinion section operates independently and does not set news policies or contribute to reporting or editing articles elsewhere in the newspaper or on bangordailynews.com.

Robert W. Glover is an associate professor of political science and honors at the University of Maine. Karyn Sporer is an associate professor of sociology at the University of Maine. These are their views and do not express those of the University of Maine System or the University of Maine. Both are members of the Maine chapter of the Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members’ columns appear in the BDN every other week.

Portugal has been hailed as a leader in approaching substance use as a public health issue since decriminalizing the possession of drugs more than two decades ago.

However, Portugal also reminds us that decriminalization is only one tool in addressing substance use disorder. Decriminalization’s impacts can be powerful, but remain conditional on health care access and social support, and our capacity for empathy.

Earlier this year, we traveled to Portugal in preparation for an upcoming University of Maine study abroad program. Portugal offers a fascinating example of drug policy innovation. However, we have recently seen decriminalization efforts struggle amid the country’s economic realities and the shadows of COVID-19.

Portugal’s decriminalization emerged from its own opioid crisis in the 1990s; nearly every family and community had been affected directly by problematic drug use and overdose. As an entrypoint to Europe, easy access to heroin decimated the society. Public use and sale of drugs were common. Overdose and drug-related fatalities surged. Blood-borne diseases like HIV and hepatitis C were widespread.

In response, Portugal passed laws in 1993 that increased penalties for trafficking in illicit drugs and diversion of drugs from legally sanctioned sources. However, many felt this strategy actually worsened the crisis.

In 2001, Portugal decriminalized the possession of small amounts of drugs for personal use (while trafficking and manufacturing illicit drugs remained criminal offenses). Today, individuals intercepted with drugs for personal use face a “dissuasion commission” that educates them regarding risks and provides pathways to treatment, and offers support in seeking housing, employment or social benefits. In addition, the country has invested in harm reduction and health interventions for those who use drugs: hygienic injection equipment, opioid reversal medication, supervised consumption sites and more.

Two decades on, this policy experiment offers important lessons. Decriminalization successfully countered the worst dimensions of the crisis. Portugal’s overdose rate remains among the lowest in Europe. While overdose has increased since COVID-19, it occurs much less frequently than in the late 1990s. If the U.S. had the same rate of death due to drug use we see in Portugal, we would be saving a life every 10 minutes.

HIV transmission through IV drug use has become virtually non-existent in Portugal. And thousands have sought access to treatment and services through the system.

In addition, decriminalization has reduced stigma toward people who use drugs. In a socially conservative country, the Portuguese increasingly view substance use as a health issue, not a moral failing.

Yet no policy is perfect. Decriminalization requires a robust, nimble public health infrastructure to support intervention, harm reduction and treatment. And those using substances must be ready to seek treatment and support. Both have varied as Portugal has weathered an austerity crisis and COVID-19.

Portugal’s challenges mirror those in Maine: exploding housing costs, wages that have not kept pace with costs of living and strained public investment in health care and social services. On Portuguese streets today, one even sees reminders of the dark past with public drug consumption and petty crime.

Decriminalization can help dismantle stigma surrounding substance use disorder, while saving lives and creating pathways to recovery for those who are ready. Yet in the U.S. where health care access and social support is so fragmented, we cannot expect immediate or perfect results (and we cannot prematurely call decriminalization a failure when implementation confronts these challenges, such as Oregon’s recent rollout).

Portugal reminds us to calibrate expectations for what one policy can do. Performance must be assessed alongside our commitment to equitable opportunities and basic services for all members of our society.

Decriminalization alone won’t fix underlying gaps in access to health care or economic opportunity, as architects of the Portuguese policy frequently warn. In fact, short term, it will likely make gaps painfully obvious.

The challenges faced by those initiating ambitious approaches elsewhere are an opportunity to learn and do better, not an excuse to abandon policy innovation in our own country or communities.