National Public Radio reported recently on drug use, overdose, and drug policies in Portugal ("How Portugal eased its opioid epidemic, while U.S. drug deaths skyrocketed," Feb. 24, 2024), noting the stark contrast between outcomes in Portugal and the US:

"In the U.S., drug deaths are shatteringly common, killing roughly 112,000 people a year. In Portugal, weeks sometimes go by in the entire country without a single fatal overdose.

"Portugal has roughly the same population as the state of New Jersey. But while New Jersey alone sees nearly 3,000 fatal drug overdoses a year, Portugal averages around 80."

As reporter Brian Mann noted:

"What's different in Portugal? In the late 1990s, the country faced an explosion of heroin use. The drug was causing roughly 350 overdose deaths a year and sparked a wave of HIV/AIDS and other diseases linked to dirty needles.

"Portugal's leaders responded by pivoting away from the U.S. drug war model, which prioritized narcotics seizures, arrests and lengthy prison sentences for drug offenders.

"Instead, Portugal focused scarce public dollars on health care, drug treatment, job training and housing. The system, integrated into the country's taxpayer-funded national health care system, is free and relatively easy to navigate."

Here's how it works:

"Cops still work aggressively to break up major drug gangs and arrest people committing drug-related crimes like theft. They also disrupt open-air drug markets like the ones that have emerged in some U.S. cities.

"But when street cops in Portugal encounter people using small, personal-use amounts of drugs, there's no arrest. Instead, police schedule meetings for drug users with teams of counselors.

"While these sessions aren't compulsory, police are trained in strategies designed to encourage people to attend.

"'In the beginning, most policemen were very, very skeptical about this policy,' said Artur Vaz, who leads Portugal's national police unit focused on drug trafficking.

"In the U.S., this role for law enforcement, serving as a bridge to social service programs, has faced a backlash and is often seen as ineffectual.

"In Oregon, for example, where small amounts of drugs were decriminalized in 2020, police regularly hand out information cards referring people to a drug counseling hotline. Court data shows drug users rarely call."

What the article fails to note is that Portugal's system has built its success over a period of two decades. Oregon's decriminalization resulted from the passage of Ballot Measure 110, which was approved in the November 2020 general election and went into effect at the beginning of 2021. The Oregon Association of Chiefs of Police was one of the organizations that opposed the measure in the general election.

The article notes that the debate is far from settled:

"There are now efforts underway to recriminalize drugs, and toughen law enforcement's response, in California and Oregon.

"Humphreys, at Stanford University, says he still supports dramatically expanding access to addiction care, similar to Portugal's model.

"But he doesn't support decriminalization and believes police and criminal courts in the U.S. will need to play a more aggressive role forcing people with severe addiction off the streets and into treatment.

"'They don't have relationships, they're isolated, so if there's no law [enforcement] pressure, there's no pressure at all,' he said.

"Miguel Moniz, the anthropologist at the Institute of Social Sciences, University of Lisbon, disagrees. He says the data shows Portugal's approach, combining decriminalization and health care, is more humane and more successful.

"People in Portugal are now 45 times less likely to die from drug overdoses, compared with people in the U.S. — and street crime in cities like Lisbon has dropped.

"'There's an impression in the U.S. that if you decriminalize drugs, it's a Wild West where everyone uses drugs,' Moniz said. "That hasn't been the case in Portugal."

"But as the death toll from the U.S. overdose crisis mounts, Moniz voiced skepticism that American policymakers will have the political will or patience to pivot to a focus on health care and social services.

"'There's a different political environment in the U.S," Moniz said. 'The way health care is funded is completely different. The role of police in American society is different. So to talk about the Portuguese experience [being adopted in the U.S.] is complicated.'"