Dissuasion — the Portuguese Approach

Traveling with a group of legislators last week, I had the opportunity to sit down for an extended discussion with the Vice President of the Commission for the Dissuasion of Drug Addiction of Lisbon — Nuno Capaz.

In 2001, Portugal reviewed and completely revised its approach to combatting drug addiction, shifting away from a punitive approach to a public health approach. It appears that they have reduced some of the harms of drug use without increasing drug use.

They consolidated all of their efforts to help people with addiction under a single public-health-oriented umbrella agency and now rely heavily on treatment, often medically assisted treatment, for people with opioid addiction.

They have not legalized drugs. Convictions for drug sales still result in imprisonment.

But possession of drugs for personal use is no longer a crime. It is still illegal and can result in fines and other penalties, but those fines are not imposed by the courts. Instead, when a person is found in possession of an illegal drug, they are sent to the Dissuasion Commission.

The very name of the agency, “Dissuasion Commission”, says a lot about how Portugal has chosen to view drug addiction.  The central goal of their policy is to reduce drug use, but they want to dissuade users — to help users change behavior instead of punishing them.  The DC focuses its attention on the chronic users who have substance use disorders. It seeks to get them into treatment voluntarily.

If a person simply refuses to work with the DC, the DC does have the ability to increase pressure. They can levy fines and if the fines are unpaid can then take the property of the user — for example, their cell phone or their stereo or their game box. Usually the threat of taking away toys is enough to engage the user.

They frequently offer methadone and suboxone as treatments. These are both drugs that, when properly prescribed, are not intoxicating but allow people to function without experiencing the cravings that result in relapse. Their view is that these drug treatments, while not entirely ending abuse of other drugs, have big benefits in behavior change. These treatments are also much cheaper than residential treatment. And, indeed, medically assisted treatment is much more consistent with the emphasis on voluntary treatment — users will take these drugs much more readily than they will enter residential programs.

In the United States, we spend a lot of money locking up drug users — sometimes in prison for the crime of use or more commonly in some form of compelled residential treatment. Many U.S. leaders are not comfortable with the idea of giving people drugs to get off drugs. When users seem to be unable to control their drug cravings, many leaders feel better about physically restraining the users than about giving them drug treatments to reduce their cravings.

Mr. Capaz ridiculed these punitive, moralistic thought patterns. We do not, he pointed out, lock up overweight people who cannot control their food intake. We do not lock up people who insist on smoking their way to lung cancer. Instead, we offer them drugs that work to help them control their behavior.

I came away from the conversation with deeper conviction that we need to make medically assisted treatment more available in Massachusetts. Decriminalization is a step that we should not be afraid to further consider.  I believe it would make it easier to reach users and give them help — the threat of incarceration pushes them into the shadows.

Published by Will Brownsberger

Will Brownsberger is State Senator from the Second Suffolk and Middlesex District.

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38 Comments

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  1. I favor a year trial program, anything to
    Cease this terrible plight.

    Drug dealers should be convicted, illegal
    immigrant should be deported. Huge effort
    Should be made as a first step to eliminate
    The drugs.

  2. This seems to be a reasonable and effective way to deal with addiction crisis. Putting people with addictions in prison is condemning them to a lifetime of addiction.

  3. Let’s not allow Boston to become San Francisco. The idea on its face has some merit, but it’s a fallacy to compare food addiction to drug addiction. Obesity affects the individual almost exclusively. Drug addiction often results in behaviors that negatively impact others in addition to the individual. I see this behavior on what has become a daily basis where I live in the Fenway.

    1. With respect, obesity does affect all of us, too. Indirectly, through tax dollars paid to Medicaid and Medicare, is one of the ways. I agree that we need to make careful policy choices, but the main difference between food addiction and opioid addiction is that there are alternatives to pain treatment, but there are not alternatives to food. The difference you stated is not really correct.

  4. I don’t have an issue with this – But I think we can also build on current state hospital sites – drug rehab communities where they are not prisons but they can not leave the grounds freely either. Just something in the middle – a drug treatment center that is not a prison. For Example the Fernald School in Waltham is a perfect place for such a rehab or assistance center. Medfield state hospital – We have many areas that can be reutilized and should also stay in the hands of the state instead of being given off to the private interests

  5. I had read about this interesting program in Portugal, so it’s great to get your feedback based on first-hand exposure to it. I agree with your conclusions, and if we can just divorce morality from the debate, we might be able to move to a more constructive, effective solution here too the way we eventually did with gay marriage.

  6. So the police in Portugal still prosecute drug dealers and still bust down doors to get at illegal drugs.

    Drug users are still arrested but go to a re-education camp instead of to a court.

    Portugal, the star of Europe. Maybe we should all move there.

  7. It should have been done many years ago in the U.S. The war on drugs has always been lost and will never be won. There is just to much money in it. The benefits in decriminalization in the crime rate, domestic abuse and enhancing the stability of third world countries like Mexico would be world changing. The savings to the domestic economy in law and border enforcement could easily fund treatment.

  8. I have long been championing Portugal as a model for addressing substance abuse. Thank you for the thoughtful consideration.