Highs and lows of drug decriminalisation

Those who want to see drug laws liberalised have pinned their hopes on Portugal, a country that has now survived 10 years of drug decriminalisation without the sky falling in. Americans are especially drawn to the Portuguese model: the Cato Institute published a report extolling it in 2009, and it was the subject of a major feature in the New Yorker earlier this month (17 October).

Seen from a US perspective, Portugal’s experiment does indeed appear radical. Possession of small amounts of drugs ceased to be a criminal offence on 1 July 2001, and addiction was redefined as a problem calling for treatment rather than sanctions. But just how different is Portuguese law from that of the rest of Europe, and how well has it worked? João Goulão, chairman of the Portuguese Institute on Drugs and Drug Addiction, a department of the Ministry of Health, spoke to the BMJ on a recent visit to London.

He argues that the changes must be seen as a whole. “It’s very difficult to identify a causal link between decriminalisation by itself and the positive tendencies we’ve seen,” he said. “It’s a total package. The biggest effect has been to allow the stigma of drug addiction to fall, to let people speak clearly and to pursue professional help without fear.

“You have to remember that we had emerged from 48 years of fascism. People were reluctant to approach a doctor with a drug problem because they feared they would be referred to the police. But addiction was very widespread.

“In the late 1990s, if you asked people in the streets what their main worry was, they would say the problems arising …