Portugal eased its opioid epidemic, while U.S. drug deaths skyrocketed

https://www.npr.org/2024/02/24/1230188789/portugal-drug-overdose-opioid-treatment

by rntn • 2 years ago

86 107 2 years ago

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.

In Portugal, by contrast, government data shows roughly 90% of people referred to drug counseling sessions by police do turn up, at least for an initial session.

Why?

lkdfjlkdfjlg5• 2 years ago

I'm from Portugal and I've lived in the US (not Oregon).

Maybe related, maybe not, but I've noticed that people in the US seem to have a chronic distrust for the police, government, or generally any authority figure. Do you agree? In Portugal if you're asked to go talk to police/gov/drug counseling/etc, you show up because that's what you're supposed to do.

silverquiet2• 2 years ago

"Government is not the solution to our problem, government is the problem."

That's a very famous quote by one of our presidents. Like all other American pathologies that have festered since I was a child, I assume it will get worse before it gets worse.

wonderwonder2• 2 years ago

In the US its not going to go well for me if I tell my boss I have to take the afternoon off to go to drug counseling.

martinald3• 2 years ago

Terrible article. In Portugal if you don't attend the meetings you can get a sanction of some sort (or at least you used to): https://en.wikipedia.org/wiki/Drug_policy_of_Portugal#Laws_a...

This is quite different to giving someone an information card.

For what it's worth there is increasing problems in Portugal with drugs. The overdose rate is starting to really spike again, there was a good article somewhat recently about this which I can't find, but you can see the trend here: https://www.statista.com/statistics/911927/drug-overdose-dea...

WarOnPrivacy2• 2 years ago

The overdose rate is starting to really spike again

From 50 deaths skyrocketing up to 70 deaths. This is the kind of spike the US dreams about.

The stats you link to do a pretty good job of countering the pORtIgaL iS ON dRUg FIrE narrative.

     When compared with the rest of Europe, Portugal has a fairly low incidence of drug deaths.

So thanks for posting them.

ptsneves• 2 years ago

It is not mandatory for consumption, but that is not the problem anyway. The problem is that actual crimes are done while under the influence and in that situation the court will give out mandatory participation in rehabilitation. If you fail to do so the court’s social services will advise the judge for other measures.

If you think of it nobody bothers with alcohol consumption but if you have an accident under the influence of alcohol it is pretty reasonable the judge prescribes AAA participation, instead of just punishing you. Failure to do so can then lead to the judge finding you guilty on more severe charges like involuntary manslaughter or just plain contempt. Of course crimes related to heavy drugs are often much more severe so if you don’t play nice you will go to jail and not come out for some time. Portuguese prisons are also overbooked and known for being very miserable.

arp242• 2 years ago

there was a good article somewhat recently about this which I can't find

Perhaps this one?

Once hailed for decriminalizing drugs, Portugal is now having doubts - https://news.ycombinator.com/item?id=36638752 - Jul 2023 (638 comments)

lastdong• 2 years ago

The overdose rate is starting to really spike again

One of the issues is that when the number of drug addicts was significantly reduced, we saw investment in the programs being reduced year on year.

This tells you the effort against drugs never ends.

I believe this is now being re-evaluated by the Portuguese authorities (returning budget to these programs). It’s a lot more effort than one thinks to ensure the correct support at every stage.

lazyasciiart4• 2 years ago

What’s the demonstrated effectiveness of calling a hotline vs attending a group?

atlantic• 2 years ago

I live in southern Portugal, and over the years I've observed big differences in how natives and foreigners react to Portuguese drug laws.

The native Portuguese feel that it's not ok to consume drugs, but that for those that do, the law provides a path of rehabilitation before resorting to punishment. And this is in fact the intention behind the decriminalization of drug consumption.

On the other hand, younger foreigners often seem to take the laws as a license to consume, some becoming unable to work and spending their days smoking pot. And their older counterparts similarly fall into alcoholism, wine and beer being very cheap here.

My point is that Portuguese laws are made for Portuguese people, who tend to do things in moderation. There is no universal solution, and no guarantee that the Portuguese model would work anywhere else.

akira25012• 2 years ago

"If we stopped arrests and did nothing else, that's a positive intervention because of the well-documented harms of incarceration [on people with addiction]," said Morgan Godvin, a former heroin user who now studies drug policy in Portland, Ore.

"Instead of fixing the system, let's just ignore it, then pretend it's actually a greater good to just degrade these people and let them die in the gutter."

I also don't buy that the Portuguese alternative is really any different:

Experts here say people who use drugs are constantly nudged toward health care and addiction treatment, including methadone programs and housing.

Yet, they don't describe their conversion rate or their results in "successfully" getting people to trade one addiction for another and then accept welfare.

Meanwhile, drugs are the obvious issue in and of themselves. If you don't want to criminalize people for possession then you need to openly confiscate drugs and do as much as you can to prevent people from possessing and using them.

copx2• 2 years ago

Are drugs really the issue though?

In my experience people who ruin their life with drugs have underlying mental health issues which are the cause of their self-destructive usage patterns.

What is the difference between a Wall Street banker and a homeless junkie? Not the regular use of hard drugs..

Pure addiction therapy thus almost never works. The homeless junkies have PTSDs, personality disorders, bipolar disorder, severe cases of ADHS etc. all of that needs to be treated together with the addiction for a reasonable chance of success.

johnea• 2 years ago

Its funny you mention this.

While working for some years in the south bay tech hub (san jose), I knew a guy who was a VP at a tech company.

Everyday he would lock his office door at lunch and do a shot of heroin. He'd lay back at his desk and zone out for an hour or so, then wash his face and go back to work.

When I left the bay area and lost track of him, he was still in the same cycle and not spiraling into destruciton.

A big difference in outcomes is dictated by WHY a person is using drugs. Someone with mental health problems (and/or major life problems in general) is going to do far worse than someone who just wants a little temporary escape.

After growning up in the US souteast, I can athoritatively say that a big part of the US situation is due to the uneducated, uninformed, hateful, religous population that mmakes up a significant part of the total...

akira25012• 2 years ago

Do you have experiences which would give you good perspective and the wide range of drug abuse that occurs within our society? Do you have a sense of how much of it goes unnoticed? Who do you think paid rehabilitation clinics are for exactly?

I think drugs are the issue. People have plenty of other problems outside of the scope you mention. These typically provide negative feedback which leads the person towards solutions.

Drugs interfere with this and turn them into positive feedback loops which just drags the person further into addiction. And these problems are most definitely commonly experienced outside of the "homeless junkie" caste, which is a very recent problem in the grand scheme of this issue and _seems_ to be correlated with recent changes in drug policy and resulting availability.

I am with you though in that treating the _addiction_ is insane. The drugs are just a response to other conditions and unless you treat and examine those you stand no chance of improving someones life. The best you can hope for is they hurt themselves badly enough that the trauma causes them to recognize their circumstances for what they really are.

Which is why I think criminalization is also insane; however, that doesn't mean the state just has to stand by while massive quantities of illicit substances change hands freely across our country. That's a problem you can address without even having to jail anyone other than dealers and traffickers.

And at the end of the day, even this minor action would bring massive improvements, by preventing people from prolonging their problems with addictions that destroy their lives, health and wealth.

wonderwonder2• 2 years ago

To the best of my knowledge, Europe does not have a fentanyl problem comparable to that of the US with last I checked 50+% of overdoses in the US having traces of it in their system. Our wide open southern border [not a comment on immigration] allows this poison to spread far and wide.

OxyContin and similar prescription drug addictions are widespread, at one time (still?) heavily pushed by deep pocketed pharmaceutical companies. I think that was a uniquely American situation. I wonder how many of the people now addicted to other opioids in the US were initially exposed via these prescription drugs.

spamizbad2• 2 years ago

Fentanyl is smuggled into the United States by US citizens[1] and by closing the border may have accelerated its adoption. And yes, while it does come from our southern border, data suggests it's being carried over by US citizens who have the right to come and go across the border legally.

Or are we using the term "open border" to suggest freedom of US citizens to leave (and re-enter) the country?

[1] https://www.cato.org/blog/fentanyl-smuggled-us-citizens-us-c...

pineaux• 2 years ago

This fentanyl is produced in china. It comes from factories producing it in large quantities, then smuggled to Mexico and into the us.

lazyasciiart4• 2 years ago

But the difference in drug laws predates the arrival of fentanyl in the US black market.

herbst2• 2 years ago

Ive seen plenty of European drug culture and heroin is only a last resort drug for lost souls, fentanyl is basically still unheard of as a street drug as far as I can tell.

Junkies even test their heroin more often because they don't want that dirty stuff to be here.

I for one don't understand at all what goes wrong in America. But those images are scary.

levocardia• 2 years ago

Didn't both Seattle and Portland try Portugal-style decriminalization + treatment incentives, only to see a massive spike in drug overdose deaths, even compared to similar US cities which did not pass such policies?

It seems relevant that the background and current context in the US is much different: we are fresh off two decades or so of big pharma and consulting firms attempting to "turbocharge" prescription opiate sales (and succeeding). The current turn to heroin adulterated with fentanyl is certainly downstream of that.

twisteriffic• 2 years ago

This is worth a watch if you want some background into why those type of measures have been less successful in the US and Canada, and how grifters have been taking advantage.

https://youtu.be/o6dAkkqE5XE?si=pBHVORAFzIiVOpx4

macspoofing4• 2 years ago

Didn't both Seattle and Portland try Portugal-style decriminalization + treatment incentives, only to see a massive spike in drug overdose deaths

They didn't do 'Portugal-style' decriminalization/treatment because in Portugal a drug addict can be forced into drug treatment, fined or mandated community service. Open drug use is also not allowed.

nonethewiser• 2 years ago

a drug addict can be forced into drug treatment, fined or mandated community service. Open drug use is also not allowed.

Was this always the case ( I would assume so), or did it come with the decriminalization changes?

These policies seem not only reasonable but obvious. But I don’t think the motivations in the US for decriminalizing are consistent with committing addicts and stopping open drug use. And unfortunately they arent standards in Portland, Seattle, or anywhere else with this problem in the US really.

So basically, i dont see that happening in the US. Its the same story for mental and behavioral health. People that were dangers to themselves and society used to be committed to institutions but we decided it was more humane to empty these institutions out on the streets.

WarOnPrivacy2• 2 years ago

because in Portugal a drug addict can be forced into drug treatment, fined or mandated community service.

Each of these things seems more reasonable than US's two options 1) ignore them or 2) dispense varying lengths of the same punishment that brutally awful convicts get.

zeroCalories2• 2 years ago

The problem, and why we will never get these programs, is that no one actually wants to put up the resources to help drug addicts. If you've actually talked to the gen-x population that has control over these cities, you'll find someone that likes to pretend they're an enlightened progressive hippie, that scoffs at southern and middle american conservatives, but is just as selfish and careless. They harbour deep resentment at having to pay so much in taxes, and sabotage any policy that could move resources away from them. This kind of hands-off policy is exactly the kind that the gen-x Hillary loving house wives can trick themselves into feeling good about, while not costing them anything substantial.

cardy31• 2 years ago

Are they forced in? I thought they were given a choice of pursuing a treatment program funded by the state, or getting a more conventional punishment such as jail time.

turkey99• 2 years ago

Portland closed mental health institutions before (unrelated to) decriminalisation.

The west US just isn’t the same as Portugal in terms of care. It’s not there.

abirch• 2 years ago

The US doesn't allow for manufacturer of hard drugs. Any drug can be laced with fentanyl these days and lead to an OD.

15457345234• 2 years ago

The US and Europe opiate situations can never be compared because in Europe opiates have always been drugs of last resort, used in palliative care or inpatient scenarios only.

Self-administered opiates just aren't part of the treatment regime, much as they weren't part of the US treatment regime in the 70s and 80s.

It's an entirely US problem created by the doctors-are-salesmen paradigm that is US healthcare, and it's only a problem because of the way the 'product' was 'marketed.'

martinald3• 2 years ago

That's the general perspective but it's incorrect. Something like 1 million people are getting long term opioid prescriptions via the NHS (in the UK): https://www.england.nhs.uk/long-read/reducing-long-term-opio...

It's definitely not true to say they are the drugs of last resort in the UK. They may not be the drug of 'first resort' like they were in the US, but there is still an awful lot of people getting Oxycodone etc via the NHS, especially in certain areas (tend to be rural and deprived... very similar to the US): https://ichef.bbci.co.uk/news/976/cpsprodpb/166DF/production.... The top regions on that graph is actually higher than the US rate (https://www.cdc.gov/drugoverdose/rxrate-maps/index.html)

hn72774• 2 years ago

Portugal refers criminal cases to drug treatment.

Seattle took a hands off approach. The prosecutor can't be bothered with drug related arrests, so the police don't bother responding. There is no diversion opportunity.

lazyasciiart4• 2 years ago

That’s garbage PR from the campaign of the current city attorney, who loved yelling that the incumbent never prosecuted drug felonies. Unfortunately she and her voters were all so flat ignorant that they didn’t know the city attorney cannot prosecute felonies, only misdemeanors - so she hasn’t done so either. But she has cancelled drug court programs and cut options for rehab and services! And she claims to have caught up on a backlog of cases, without mentioning that she did so by throwing all of them out.

INTPenis• 2 years ago

You can't compare Portugal to Seattle or Portland. First of all it's a country, but more importantly they have free public health care and safety nets for homeless and jobless people.

Imho the number one driving factor of the US opioid epidemic is the stress of living in a country where you can literally end up on the streets if you don't have a job. A country where you can go bankrupt if you get sick.

You can't put band aids over the opioid epidemic, it's a systemic issue.

mbgerring• 2 years ago

No, they didn’t — we can’t build safe consumption sites in the US because of Federal law, neither city built the necessary treatment infrastructure to do “Portugal-style” treatment, and police in these US cities seem to resent the approach and don’t take it seriously enough to achieve Portugal’s outcomes.

We can’t just stop addressing drug use and not build the care and treatment infrastructure on the other end. People instinctively understand this, which is why “defund the police” failed as a slogan, but the abolitionist program was always meant to include building social infrastructure as an alternative to police.

Those alternative programs in the US are always an underfunded afterthought, even in cities where they have political support. For example, I still can’t call San Francisco’s crisis intervention team directly — I have to call the cops if I see someone on the street experiencing a crisis, and they still might send a poorly trained goon with a gun to deal with it, because the crisis intervention team doesn’t operate 24/7.

In other words, these policies haven’t failed, they’ve barely even been tried.

ruined• 2 years ago

supportive services are fairly minimal here. for instance the article opens with an interview at a safe consumption site, which is one of the most necessary and effective features of portugese policy that prevents overdose deaths - but such facilities are illegal in america

rainbowzootsuit• 2 years ago

I think it was more like Hampsterdam from _The Wire_.

Tiktaalik• 2 years ago

I wouldn't be surprised if a problem is that Seattle and Portland lack treatment capacity, because that's the big problem just north of the border in Vancouver, which also has a big problem with toxic drugs use.

Having safe drug use sites and replacing the illicit supply of toxic drugs with a safer known, prescribed source does a good job of preventing overdoses and preventing mass deaths, but beyond this there needs to be path ways to treatment.

Where some places have failed and come under criticism is that while they've done the necessary step of implementing some harm prevention policy to keep people alive until they can access treatment, there hasn't been the follow through in creating treatment options.

A major cause of the inability to create treatment options is that it's expensive and there's a severe shortage of doctors and nurses in general. Can't create treatment options if there's no one to work them.

latency-guy28• 2 years ago

Opinion pieces should present all their counters if they want to present themselves as unobjective, and not just the ones they think they have an answer for.

USA is not Portugal, transport, production, and distribution of drugs is not from the same sources. Wide scale economics are not the same either. People are also quite different.

For example, Portugal "solved" their problem, but their rates are annually far beyond what Singapore has in accumulation over decades. Why not aspire to be more like Singapore rather than Portugal, NPR's Brian Mann?

spamizbad2• 2 years ago

Singapore is a police state whereas Portugal is a Liberal democracy.

lkdfjlkdfjlg5• 2 years ago

This. It blows my mind that people have to be explained this.

latency-guy28• 2 years ago

And?

baxtr2• 2 years ago

One naive question, since I have no contact to anyone taking opioids: what is it that people get from the drug? For what is it used for exactly?

If it’s regular pain, then why not “simply” prescribe Aspirin or Ibuprofen instead?

badpun• 2 years ago

Aspirin or Ibupofren have their limits.

herbst2• 2 years ago

That's where opiads (and other substances come in) just not before you hit those limits.

carlmr2• 2 years ago

Ibuprofen is basically the German strategy. It's not super strong, but everything else is only for extreme pain.

Get your wisdom teeth pulled? Ibuprofen. Broke some bones? Ibuprofen.

Burn victim? Maybe some opiates.

The strategy works. Better to have some pain, than to get hooked on opiates.

hef198982• 2 years ago

You do get opiods after surgery so, if you want. Only for limited periods of time so.

overstay89304• 2 years ago

German doctors will unironically tell people to drink tea and go on a walk to treat mental illnesses.

bloopernova2• 2 years ago

I was in a serious road accident decades ago. I have been in pain ever since. This pain is not lessened by over the counter painkillers. Plus over the counter painkillers are harmful to take in large doses over a long term.

My nerves are damaged by something in my back. (it hasn't been determined what, just that the damage occurs) I am in a debilitating amount of pain.

So I take an opioid several times a day. Before the opioid crisis I was taking 10mg morphine twice a day. Now I take Suboxone, I'm in more pain but not a paralyzing amount.

To your question about what it's like: strong opioids bring a euphoric numb lightness. If you're in a vulnerable place in your life where you are not well supported and don't experience much joy, then that euphoria can be overwhelming. You might want to feel that again ASAP because compared to being in pain, depressed, anxious, you felt pretty good for a while.

undersuit• 2 years ago

I hope you're doing well as you can. I injured my back many years ago and I was worried about developing a habit. Surgery and PT have got me back to 95% though I occasionally use medical marijuana as a crutch for bad days. I count myself lucky, not everyone can deal with their symptoms with exercise and light medication.

baxtr2• 2 years ago

Thanks so much for sharing. I’m sorry to hear about your injury.

The “euphoric numb lightness” was what I was looking for.

fragmede2• 2 years ago

the way I've heard it described, faced with the ills of the world, heroin/opiate users just wanna crawl back into the womb. methamphetamine/stimulant users want to fix the world/their world.

TillE• 2 years ago

There are tons of occasional recreational oxy users, and at that level the effect is basically a pure euphoria, blissful happiness.

Ironically addiction risk is also low if your usage pattern is 1-2 times per month, much much lower than someone who has been prescribed a small daily dose.

copx2• 2 years ago

..and benzodiazepine users just don't want to care anymore.

lemmox• 2 years ago

Many years ago my wife fell down the stairs and suffered, what turned out to be, a broken fragment of bone that poked into a nerve. It took quite awhile to diagnose it because <medicine is hard>. Along that journey to diagnosis she was almost bedridden, and in excruciating pain, most of the time with with physio, chiropractors, muscle treatments, nerve pain meds, etc, all failing to help her function. The opioids she was prescribed made it so she could function. She was high, "dreamy" (for lack of a better word), reported still feeling the pain, but could function. The day after the neurosurgeon performed her spine surgery she voluntarily stopped the opioids and finished her healing from the procedure with ibuprofen. She never looked back and described never feeling an urge to take the meds again. I wish I could say that this experience gave us some great insight into the complexity of opioids but it didn't. In her case they did their job until she didn't need them anymore and that was that. I don't read anything more into it then that.

zac23or2• 2 years ago

After years of lies from anti-drug and pro-drug guys, I simply don't believe this type of article with data to back it up.

For example, the opioid crisis in America is very different from drug use in Portugal. Do opioids in America kill more easily than the drugs used in Portugal?

The article contains a lot of feelings and no data.

fragmede2• 2 years ago

I simply believe this type of article with data to back it up.

(don't?)

zac23or2• 2 years ago

yes, don't! Thank you.

ElonsNightmare• 2 years ago

are we ready to talk about 'culture' yet?

nozzlegear• 2 years ago

Don’t beat around the bush, just come out and tell us whatever it is you think you’re implying so we don’t have to guess.

overstay89304• 2 years ago

Who still believes this crap? Clearly it doesn’t actually work even in Portugal, drug use has been going up a lot.

Turns out executing drug dealers actually works, who knew people didn’t want to die trafficking fentanyl.

neither_color• 2 years ago

I just wish westerners who visit Asian cities like Singapore would stop gushing over the cleanliness and orderliness there while bashing the US/west if they're not willing to adopt Singaporean drug laws. You can't have it both ways. "Freedom" means accepting the consequences of people exercising it. Some people experiment and tap into massive creative potential(even Steve Jobs went through a phase), others fall into addictive traps.

overstay89304• 2 years ago

I said nothing of what you’re saying, you don’t have to be a dictatorship to enforce the laws we have.

Crime has dropped every single year for the last 30 years until 2017. It’s like how progressives said the war on drugs failed but only as long as you ignore how well it did at reducing crime and drug use.

bitfilped• 2 years ago

I wonder if heroin is still obtainable there, unlike in the US where the only option is a bag of fentanyl cut with whatever the favorite local garbage substitue is. That alone would go a long way toward the differences in OD rates.

InSteady• 2 years ago

I have heard anecdotally that Europe still gets lots of heroin (someone in a similar thread recently said opium poppies come to the EU through Turkish black market trade). No clue how true this is.

It stands to reason that people cultivating opium poppies didn't throw up their hands in despair and decide to do something else with their lives when Chinese fentanyl (which is made in a lab without any opium) started taking over in the US. The opium is going to go somewhere.

In any case, an article using overdose death as the primary metric for success/failure of drug policy should not be ignoring the dramatic difference in fatalities between fentanyl and other opiates.

bouncing• 2 years ago

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.

I’m an American living in Portugal. This paragraph does not ring true. You really (I’m being serious here) walk more than a block or two in a touristy area without being accosted by someone selling drugs. They even do it when I have my 3 year old daughter’s hand in mine.

Portugal eased its opioid epidemic, while U.S. drug deaths skyrocketed

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