Does Portugal Have The Answer To Stopping Drug Overdose Deaths? : Consider This from NPR Brian Mann covers the U-S opioid and fentanyl crisis for NPR. That means he talks to a lot of people struggling with addiction. Again and again, he's heard stories of people who have succumbed to their addiction — last year 112, 000 — more than ever in history.

But when Mann traveled to Portugal to report on that country's model for dealing with the opioid crisis, he heard a very different story. Overdose deaths in Portugal are extremely rare.

The country has taken a radically different approach to drugs – decriminalizing small amounts and publicly funding addiction services – including sites where people can use drugs like crack and heroin.

Portugal treats addiction as an illness rather than a crime. No one has to pay for addiction care, and no one scrambles to navigate a poorly regulated recovery system. Could Portugal's approach help the U-S fight its opioid epidemic?

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Does Portugal Have The Answer To Stopping Drug Overdose Deaths?

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JUANA SUMMERS, HOST:

Brian Mann covers the U.S. opioid and fentanyl crisis for NPR, and that means he talks to a lot of people struggling with addiction. And he hears lots of stories like this one from harm reduction activist Louise Vincent.

LOUISE VINCENT: We've had an entire community swept away. You can't even think of all the people that I know that have died. I mean, so many people are dead. My own - my daughter died. Our mentors are dead. I can barely stand to be here sometimes because of all the trauma and all the people that we've lost.

SUMMERS: Overdoses killed more Americans than ever last year - more than 112,000. That's why what Mann learned on a recent reporting trip to Portugal is striking.

LILIANA SANTOS: Cocaine is my drug, but I smoke brown.

SUMMERS: Brian met Liliana Santos outside a government-run drug consumption clinic in Lisbon. The brown she's talking about is a form of heroin she buys on the street. But here's where the picture starts to look a lot different than here in the U.S. Santos says she's never lost anyone to drugs.

BRIAN MANN, BYLINE: Have you had friends overdose?

SANTOS: No.

MANN: Have you overdosed?

SANTOS: No.

MANN: No.

SANTOS: No.

SUMMERS: This is why Brian was in Portugal. The country has taken a radically different approach to drugs, decriminalizing small amounts and publicly funding addiction services, including sites where people can use drugs like crack and heroin. And it's worked. People in Portugal are 45 times less likely to die from overdoses than in the U.S.

MIGUEL MONIZ: The statistics really speak for themselves.

SUMMERS: That's Miguel Moniz, an anthropologist at the University of Lisbon who's studied drug policy and addiction in the U.S. and in Portugal for decades.

MONIZ: Someone who has problematic drug use isn't someone who's a criminal or has a moral failing.

SUMMERS: Rather than follow the U.S. drug war model, which focused on arresting people, often giving them lengthy prison sentences, Moniz says Portugal prioritized health care.

MONIZ: They're someone who has a physical or mental health problem, and that is a tremendous societal shift.

SUMMERS: CONSIDER THIS - Portugal treats addiction as an illness rather than a crime. No one has to pay for addiction care, and no one scrambles to navigate a poorly regulated recovery system. Could Portugal's approach help the U.S. fight its opioid epidemic?

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SUMMERS: From NPR, I'm Juana Summers. It's Tuesday, February 20.

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SUMMERS: It's CONSIDER THIS FROM NPR. The simple fact is that overdose deaths are incredibly rare in Portugal. Drug deaths number in the dozens rather than tens of thousands. No one thinks Portugal's model is perfect. Drugs still cause a lot of suffering. But two decades of data shows Portugal's approach of prioritizing health helps a lot more people stay alive, keeps them out of prison and offers chances to recover when they stumble. NPR addiction correspondent Brian Mann joined me to talk about what he learned about how addiction is treated in Portugal and whether those strategies could be used in the U.S. Hi, Brian.

MANN: Hi, Juana.

SUMMERS: So Brian, just help us understand the stakes here. How stark is the drug crisis here in the U.S. compared with Portugal?

MANN: You know, it's a heartbreaking disparity. The U.S. and Portugal both experienced deadly opioid epidemics beginning back in the early 2000. But Portugal's response appears to have really worked. Drug deaths there are now incredibly rare, while they're common in the U.S. Fatal overdoses are now a leading cause of death for young Americans. Here's one data point that really stunned me. Portugal has roughly the population of the state of New Jersey. But while New Jersey sees nearly 3,000 drug deaths a year, Portugal averages fewer than 80.

SUMMERS: That's incredible. Brian, what can you tell us about what accounts for that sharp difference?

MANN: Yeah. Fentanyl is part of it, right? The powerful street opioid is killing a lot of Americans right now. And it hasn't caught on yet among drug users in Portugal. No one's really sure why. But even before fentanyl hit, the U.S. and Portugal were moving in really different directions. Over the last 20 years, the U.S. responded to rising rates of addiction with tough drug laws, spending hundreds of millions of dollars on police and prisons. Portugal, by contrast, invested in drug treatment and health care. Keith Humphreys is at Stanford University. He's one of the top U.S. experts on addiction, and he's studied the Portugal model.

KEITH HUMPHREYS: I think they showed when you make services extremely available to people who are struggling with problems with drugs, you get a lot of good outcomes.

MANN: And, Juana, Portugal's drug treatment programs are free. They're widely available, part of the taxpayer-funded national health care system. And, again, this is a huge contrast with the U.S., where even now in the midst of this deadly overdose crisis, it's often really, really hard to find affordable, high-quality addiction care.

SUMMERS: And, Brian, I mean, listening to you describe Portugal's approach, it sounds like it's very promising. So what makes it so controversial here in the United States?

MANN: A lot of it really comes down to a debate over the role of police. Beginning back in 2001, Portugal decriminalized personal use amounts of marijuana. That made a huge difference for people living on the streets with addiction, like Ronnie Duchandre, who I met on the street of Portugal's capital, Lisbon.

RONNIE DUCHANDRE: Nice to meet you.

MANN: Duchandre lives in a tent outside a church in Lisbon. He's addicted to alcohol and hashish and also sometimes smokes crack.

DUCHANDRE: (Speaking Portuguese).

MANN: Duchandre told me he fell into addiction gradually. "I believe with some help, maybe with some education, I will come out of it," he said. Like most people who use drugs in Portugal, he's getting a lot of help - counseling and medical care, again, all of it free - which means Duchandre has a much lower risk of dying compared with drug users in the U.S. And he's also not afraid of being arrested. When I asked about police, Duchandre actually got excited.

DUCHANDRE: (Speaking Portuguese).

MANN: "The police are our friends," Duchandre said. "As long as I'm respectful, they're respectful and helpful." I spoke about this very different role for police in Portugal with Dr. Joao Goulao. He's Portugal's national drug czar. He said convincing law enforcement to shift from a get-tough approach to drugs to this focus on health care changed everything.

JOAO GOULAO: Decriminalizing drug use is a good step - treatment, harm reduction measures, shelters.

MANN: Now, it's important to say, Juana, that police do still play a big role in Portugal with street drug use. But instead of making arrests, cops are trained to counsel and nudge people in addiction toward treatment.

SUMMERS: So police in Portugal - they're more like social workers?

MANN: Yeah, part of the time, that's right. And they regularly do get people in addiction to go to these addiction counseling sessions. Street cops in Portugal, of course, do more traditional work as well. They break up drug gangs. They work to protect neighborhoods from drug-related crime. And they've actually had a lot of success disrupting the kind of open-air drug markets that we've seen in some U.S. cities, like Philadelphia and San Francisco. I spoke about this with Miguel Moniz. He's the anthropologist at the University of Lisbon we heard from earlier.

MONIZ: There's an impression in the U.S. that if you decriminalize, then everybody is - then it's a Wild West where everyone uses drugs. That hasn't been the case in Portugal.

MANN: And this really is the major fear in the U.S. among politicians and other critics who oppose the Portugal model. They worry that if we decriminalize drugs and change the role of police in the way Portugal's done, we'll see a lot more rampant drug use, more drug-related crime.

SUMMERS: But if Portugal's system is saving lives there without creating chaos, why couldn't or wouldn't that work here?

MANN: Yeah, this is interesting. I mean, some experts believe the U.S. is just culturally different. In Portugal, people who use drugs still live in fairly tight-knit communities. They're surrounded by families. Keith Humphreys, the researcher at Stanford who we heard from a moment ago, he thinks people experiencing severe addiction here in the U.S. don't have those kinds of support networks.

HUMPHREYS: The challenges we have here is they don't have a job that's putting any pressure on them. They don't have relationships. They're isolated. And if there's no law pressure, there is no pressure at all.

MANN: So Humphreys thinks police in American cities will have to keep playing a more aggressive, forceful role, arresting drug users and using courts to get them off the streets and into treatment.

SUMMERS: And Brian, as I understand it, despite those concerns, there are places here in the United States where some parts of the Portugal model are being tried. Tell us about that. How's it going?

MANN: Well, it's been rocky. A lot of cities across the U.S., especially in states like California, New York and Oregon, have slowly turned away from the drug war model, adopting some of Portugal's strategies. That means fewer drug arrests, more of a focus on harm reduction and physical and mental health care. Supporters hoped that would quickly reduce drug deaths. But so far, it really hasn't worked out that way. Drug deaths have continued to rise. One problem appears to be that, in some places, drugs have been decriminalized before really good treatment programs are widely available to pick up the slack. I spoke about this with Morgan Godvin. She's a drug policy expert and activist in Portland, Ore., where drugs were decriminalized in 2020.

MORGAN GODVIN: We still suck at access to voluntary treatment - treatment on demand for everyone who wants it. I want our policymakers to see that decriminalization does not equal chaos.

MANN: So a lot of addiction experts I talked to do believe creating a treatment system more like Portugal's would save a lot of lives in the U.S. and help get people off the street, but it would take time. And meanwhile, a lot of people, including a lot of voters and politicians, are impatient right now. They want public drug use cleaned up. In Oregon, there's a big movement to recriminalize drug use that looks like it might succeed. There's growing pressure in California to toughen drug laws again and boost arrests. Juana, no one I talked to believes we're going to make the kind of big pivot away from drug war-era policies that put Portugal on this very different path.

SUMMERS: NPR addiction correspondent Brian Mann. Brian, thank you.

MANN: Thank you.

SUMMERS: This episode was produced by Connor Donevan and Megan Lim. It was edited by Courtney Dorning and Andrea DeLeon. Our executive producer is Sami Yenigun.

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SUMMERS: It's CONSIDER THIS FROM NPR. I'm Juana Summers.

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