Article by Anthony Faiola and Catarina Fernandes Martins
PORTO, Portugal — Addiction haunts the recesses of this ancient port city, as people with gaunt, clumsy hands lift crack pipes to lips, syringes to veins. Authorities are sealing off warren-like alleyways with iron bars and fencing in parks to halt the spread of encampments. A siege mentality is taking root in nearby enclaves of pricey condos and multimillion-euro homes.
Portugal decriminalized all drug use, including marijuana, cocaine and heroin, in an experiment that inspired similar efforts elsewhere, but now police are blaming a spike in the number of people who use drugs for a rise in crime. In one neighborhood, state-issued paraphernalia — powder-blue syringe caps, packets of citric acid for diluting heroin — litters sidewalks outside an elementary school.
Porto’s police have increased patrols to drug-plagued neighborhoods. But given existing laws, there’s only so much they can do. On a recent afternoon, an emaciated man in striped pants sleeping in front of a state-funded drug-use center awoke to a patrol of four officers. He sat up, then defiantly began assembling his crack pipe. Officers walked on, shaking their heads.
Portugal became a model for progressive jurisdictions around the world embracing drug decriminalization, such as the state of Oregon, but now there is talk of fatigue. Police are less motivated to register people who misuse drugs and there are year-long waits for state-funded rehabilitation treatment even as the number of people seeking help has fallen dramatically. The return in force of visible urban drug use, meanwhile, is leading the mayor and others here to ask an explosive question: Is it time to reconsider this country’s globally hailed drug model?
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“These days in Portugal, it is forbidden to smoke tobacco outside a school or a hospital. It is forbidden to advertise ice cream and sugar candies. And yet, it is allowed for [people] to be there, injecting drugs,” said Rui Moreira, Porto’s mayor. “We’ve normalized it.”
Reexamining drug policies
Cocaine production is at global highs. Seizures of amphetamine and methamphetamine have exploded. The multiyear pandemic deepened personal burdens and fomented an increase in use. In the United States alone, overdose deaths, fueled by opioids and deadly synthetic fentanyl, topped 100,000 in both 2021 and 2022 — or double what it was in 2015. According to the National Institutes of Health, 85 percent of the U.S. prison population has an active substance use disorder or was jailed for a crime involving drugs or drug use.
Across the Atlantic in Europe, tiny Portugal appeared to harbor an answer. In 2001, it threw out years of punishment-driven policies in favor of harm reduction by decriminalizing consumption of all drugs for personal use, including the purchase and possession of 10-day supplies. Consumption remains technically against the law, but instead of jail, people who misuse drugs are registered by police and referred to “dissuasion commissions.” For the most troubled people, authorities can impose sanctions including fines and recommend treatment. The decision to attend is voluntary.
Other countries have moved to channel drug offenses out of the penal system too. But none in Europe institutionalized that route more than Portugal. Within a few years, HIV transmission rates via syringes — one the biggest arguments for decriminalization — had plummeted. From 2000 to 2008, prison populations fell by 16.5 percent. Overdose rates dropped as public funds flowed from jails to rehabilitation. There was no evidence of a feared surge in use.
“None of the parade of horrors that decriminalization opponents in Portugal predicted, and that decriminalization opponents around the world typically invoke, has come to pass,” a landmark Cato Institute report stated in 2009.
But in the first substantial way since decriminalization passed, some Portuguese voices are now calling for a rethink of a policy that was long a proud point of national consensus. Urban visibility of the drug problem, police say, is at its worst point in decades and the state-funded nongovernmental organizations that have largely taken over responding to the people with addiction seem less concerned with treatment than affirming that lifetime drug use should be seen as a human right.
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“At the end of the day, the police have their hands tied,” said António Leitão da Silva, chief of Municipal Police of Porto, adding the situation now is comparable to the years before decriminalization was implemented.
A newly released national survey suggests the percent of adults who have used illicit drugs increased to 12.8 percent in 2022, up from 7.8 in 2001, though still below European averages. Portugal’s prevalence of high-risk opioid use is higher than Germany’s, but lower than that of France and Italy. But even proponents of decriminalization here admit that something is going wrong.
Overdose rates have hit 12-year highs and almost doubled in Lisbon from 2019 to 2023. Sewage samples in Lisbon show cocaine and ketamine detection is now among the highest in Europe, with elevated weekend rates suggesting party-heavy usage. In Porto, the collection of drug-related debris from city streets surged 24 percent between 2021 and 2022, with this year on track to far outpace the last. Crime — including robbery in public spaces — spiked 14 percent from 2021 to 2022, a rise police blame partly on increased drug use.
‘What happens when the police leave?’
On the south side of Porto, the hillside city’s sweet wine bars and medieval churches give way to rough-edged public housing complexes. Only one block from police headquarters stands a squat building. It’s a new state-funded drug use center, opened in the hopes of giving the growing ranks of street people with addictions to heroin and cocaine a place to use outside of public view.
Inside, a 47-year-old man struggled to mix ashy heroin with fragments of crystal crack, crushing both into a souped-up speedball. Observed by a nurse, he took the needle and jabbed it into a vein in his neck. “The veins on his hands have all dried up,” the nurse said matter-of-factly.
“I can’t use at home,” said another person at the center. “It causes too much trouble. So I make the drive an hour and a half here.”
In the tourist quarter in the shadow of Porto’s fortresslike cathedral, a social worker with a government-funded nonprofit, SAOM, handed out clean syringe packages to people who use heroin. When crack pipes are available, the social workers give them out. There’s no judgment, few questions, and no pressure to embrace change.
Summing up the philosophy, Luísa Neves, SAOM’s president, said: “You have to respect the user. If they want to use, it is their right.”
Elsewhere in the world, places implementing decriminalization are confronting challenges of their own. In Oregon — where the policy took effect in early 2021 openly citing Portugal as a model — attempts to funnel people with addiction from jail to rehabilitation have had a rough start. Police have shown little interest in handing out toothless citations for drug use, grants for treatment have lagged, and extremely few people are seeking voluntary rehabilitation. Meanwhile, overdoses this year in Portland, the state’s largest city, have surged 46 percent.
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Some places that were early adopters of liberal drug policies have moved to curb permissive laws or backed away from more radical change. Amsterdam — a city long famous for its pot cafes — last month instituted a new ban on smoking marijuana in public places. In Norway, a Portugal-like plan to decriminalize drugs collapsed in 2021, and the country opted instead for a more piecemeal approach.
“When you first back off enforcement, there are not many people walking over the line that you’ve removed. And the public think it’s working really well,” said Keith Humphreys, former senior drug policy adviser in the Obama administration and a professor of psychiatry at Stanford University. “Then word gets out that there’s an open market, limits to penalties, and you start drawing in more drug users. Then you’ve got a more stable drug culture, and, frankly, it doesn’t look as good anymore.”
An eight-minute walk uphill from Porto’s safe drug-use center, in a neighborhood of elegant two-story homes with hedgerows of roses and hibiscus, neighbors talk of an “invasion” of people using drugs since the pandemic. Some gravitated here earlier, from a notorious public housing complex condemned and demolished nearly a decade ago. Others arrived more recently.
Over the last 18 months, a drug encampment sprung up below a school. More homes have been burgled. One neighbor said she found a person, naked from the waist down, shooting up outside her house gate. Another had her laundry stolen three times. Residents have launched U.S.-style neighborhood watches and hired private security guards — something exceedingly rare in Europe. Police deployed in force to the area three months ago to crack down on dealers, who can be and are being arrested. Patrol cars are now stationed in the neighborhood 24 hours a day, scattering people using drugs.
“But for how long?” said Rui Carrapa, one of the founders of the residents’ association Jardim Fluvial Free of Drugs. “We have to do something with the law. We know they can’t stay here forever. What happens when the police leave?”
Porto’s mayor and other critics, including neighborhood activist groups, are not calling for a wholesale repeal of decriminalization — but rather, a limited re-criminalization in urban areas and near schools and hospitals to address rising numbers of people misusing drugs. In a country where the drug policy is seen as sacred, even that has generated pushback — with nearly 200 experts signing an opposition letter after Porto’s city commission in January passed a resolution seeking national-level changes.
Tenuous gains
Experts argue that drug policy focused on jail time is still more harmful to society than decriminalization. While the slipping results here suggest the fragility of decriminalization’s benefits, they point to how funding and encouragement into rehabilitation programs have ebbed. The number of users being funneled into drug treatment in Portugal, for instance, has sharply fallen, going from a peak of 1,150 in 2015 to 352 in 2021, the most recent year available.
João Goulão — head of Portugal’s national institute on drug use and the architect of decriminalization — admitted to the local press in December that “what we have today no longer serves as an example to anyone.” Rather than fault the policy, however, he blames a lack of funding.
After years of economic crisis, Portugal decentralized its drug oversight operation in 2012. A funding drop from 76 million euros ($82.7 million) to 16 million euros ($17.4 million) forced Portugal’s main institution to outsource work previously done by the state to nonprofit groups, including the street teams that engage with people who use drugs. The country is now moving to create a new institute aimed at reinvigorating its drug prevention programs.
Twenty years ago, “we were quite successful in dealing with the big problem, the epidemic of heroin use and all the related effects,” Goulão said in an interview with The Washington Post. “But we have had a kind of disinvestment, a freezing in our response … and we lost some efficacy.”
Of two dozen street people who use drugs and were asked by The Post, not one said they’d ever appeared before one of Portugal’s Dissuasion Commissions, envisioned as conduits to funnel people with addiction into rehab. Police were observed passing people using drugs, not bothering to cite them — a step that is supposed to lead to registration for appearances before those commissions.
“Why?” replied one officer when asked why people were not being cited and referred to commissions. The officer spoke on the condition of anonymity because of not being authorized to speak with the press. “Because we know most of them. We’ve registered them before. Nothing changes if we take them in.”
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