Drugs: The Portuguese fallacy and the absurd medicalization of Europe

13 Pages·2015·0.64 MB·English

by  Revista Motricidade

Motricidade © Edições Desafio Singular
2015, vol. 11, n. 2, pp. 3-15 http://dx.doi.org/10.6063/motricidade.7188
Drugs: The Portuguese fallacy and the absurd medicalization of
Europe
Drogas: a falácia portuguesa e a “medicalização” absurda da Europa
Manuel Pinto Coelho1*
CARTA AO EDITOR | LETTER TO THE EDITOR

Dear editor, year of 1999 (when the total was nearly 400) to
In the early Spring of 2009, Mr. Glenn 2006 (when the total was 290).”
Greenwald (Greenwald, 2009), an American
“Prevalence rates (for drug abuse) for the age
lawyer and author, fluent in Portuguese, was
group from 15 to 19 have actually decreased in
invited to Portugal to undertake an assessment
absolute terms since decriminalization.”
of the results of the Portuguese drug decrimi-

nalization policy. The funding for this work
“Most significantly, the number of newly re-
was provided by the Cato Institute – a Wash-
ported cases of HIV and AIDS among drug ad-
ington DC based libertarian think-tank well dicts has declined substantially every year since
known for its radical campaigns on drug policy. 2001.”
Mr. Greenwald stayed in the country for 3
weeks. The report based upon his visit pre- In the light of these claimed positive out-
sented Portuguese drug policy as an unparal- comes a number of influential and highly re-
leled success and an example for the world to spected publications have reported the fact
follow. Greenwald’s report for the Cato Insti- that many countries are looking to replicate
tute has been widely cited in political, profes- the Portuguese drugs decriminalization policy.
sional and media debate around the world, The UK Guardian Newspaper for example re-
however, a key question to be addressed is ported on September 5 of 2010– “Britain looks
whether the information and evidence con- at Portugal’s success story over decriminalizing
tained within the report presents an accurate personal drug use” (Beaumont, Townsend, &
picture of the Portuguese experience. As I will Helm, 2010); The Economist on August 27 of
show in this paper the answer to that question 2009 – “The evidence from Portugal since 2001
is a resounding “no” it does not present an is that decriminalization of drug use and pos-
accurate picture of the situation in Portugal session has benefits and no harmful side-
and Portugal certainly does not stand as a bea- effects” (The Economist, 2009); and the Por-
con of the claimed benefits of drugs decrimi- tuguese newsmagazine Visão on May 7 of 2009
nalization. – “Portugal inspires Obama” (Fernandes,
The report produced by Greenwald contains 2009).
a number of bold claims, including: Greenwald’s account however presents a
highly partial and inaccurate picture of the
“The total number of drug-related deaths has situation within Portugal. Gil Kerlikowske,
actually decreased from the pre-decriminalization Director of the US Office of National Drug
Control Policy, in a letter (Kerlikowske, 2010)

Letter received October 17th, 2014
1 Manuel Pinto Coelho, MD, PhD, graduated in 1972 in Medicine and Surgery – Medical University of Lisbon,
and holds a Ph. D in Educational Sciences by University of Trás-os-Montes and Alto Douro, Vila Real, Portu-
gal.
* Corresponding author: Gaveto da Av. 25 de Abril, R. José Carvalho de Araújo nº 262, 3º piso, sala 20 - Edifí-
cio Regata, 2750-396 Cascais, Portugal E-mail: [email protected]
4 | MP Coelho
0to a member of the International Task Force Drug-induced deaths in Portugal, which de-
on Strategic Drug Policy and Drug Watch In- creased from 369 in 1999 to 152 in 2003, rose to
314 in 2007 – significantly more than the 280
ternational, has stated that:
deaths recorded when decriminalization started

in 2001” (European Monitoring Centre for Drugs
“… after a careful review of all available data
and Drug Addiction, 2008).
on this subject….our analysts found that claims

that decriminalization has reduced drug use and
In relation to Greenwald’s claimed reduc-
had no detrimental impact in Portugal signifi-
cantly exceed the existing scientific basis. This tion in the prevalence of drug use amongst
conclusion largely contradicts the prevailing me- young people in Portugal following decriminal-
dia coverage and several policy analyses made in ization other data have shown a notable in-
Portugal and in the United States.” (Kerlikow- crease in the rates of drug use for certain age
ske, 2010)
groups:

The letter from Kerlikowske concluded:
“[…] the report makes claims about Portu-
guese drug legalization success. However, it pro-
“Drug Legalizers’ Claims Exceed Supporting claims a decline in the lifetime prevalence rate
Science – In addition to the complications associ- for the 15-19 age group between 2001 and 2007,
ated with using lifetime prevalence data to assess while disregarding a larger lifetime prevalence
the impact of drug policies, and to the challenges increase in the 15-24 age group and ignoring the
presented by evidence that is not fully considered substantially larger lifetime prevalence increase
in the Cato Institute report, it is generally diffi- in the 20-24 age group over the same period
cult to be certain whether shifts in drug-related (Greenwald, p.14). Furthermore, the report em-
results in Portugal and other countries are due to phasizes decreases in lifetime prevalence rates
changes in drug policy or to other factors.” (Of- for the 13-18 age group between 2001 and 2006
fice of National Drug Control Policy, 2010) and for heroin use in the 16-18 age group from
1999 to 2005, but once again downplays increas-
According to the US Drug Czar the claimed es in the lifetime prevalence rates for the 15-24
benefits of the policy of drugs decriminaliza- age group between 2001 and 2006, and for the
16-18 age group between 1999 and 2005.”
tion in Portugal have been exaggerated by
(Greenwald, 2009, pp. 12–14).
those seeking to promote the policy drugs de-

criminalization when in reality a good deal
Despite an assertion in the Cato Institute
more information is required on the impact of
report that increases in lifetime prevalence
that policy within Portugal before any persua-
rates for the general population are ‘virtually
sive case can be made for the wider replication
inevitable in every nation’, EMCDDA data
of the Portuguese policy. In the remainder of
indicate that several countries have been able
this paper I discuss some of the additional data
to achieve decreases in lifetime prevalence
that is now available which reveals a very dif-
rates (including Spain) for cannabis and ecsta-
ferent picture of what has happened within
sy use between 2003 and 2008” (European
Portugal to the image contained within
Monitoring Centre for Drugs and Drug Addic-
Greenwald’s Cato Institute report.
tion, 2010).
In relation to drug related deaths for exam-
Within the Cato Institute report Greenwald
ple, further data provided by the European
concentrates on the drug prevalence data for
Monitoring Centre for Drugs and Drug Addic-
the 15 to 19 year old age range whilst making
tion, have revealed not a marked reduction in
only passing reference to the older 20 to 24 age
mortality but a notable increase in the number
range where in fact there has been a 50% in-
of deaths recorded following the implementa-
crease in rates of drug use. In figure 1 below
tion of the policy of drug decriminalization:
data from the Instituto da Droga Toxicode-
Drugs: Portuguese fallacy | 5
pendência de Portugal reveal an increase in  Heroine: from 0.7% to 1.1% (15-64
lifetime drug use prevalence for each of the age years old)
range presented. Similarly in Figure two there  Ecstasy: from 1.4% to 2.6% (15-34
has been a notable increase in drug prevalence years old)
for each of the substances noted with cannabis
consumption increasing 150% from 2001 to
2007 and only a slight decrease in 2006.
There is only a slight decrease in 2006
(with the exception of heroin). Although sub-
sequent years’ numbers are still not available,
there is a general consensus that the figures
are still mounting: if we pay attention to the
data of the group under 34, we can confirm an
escalation of almost 50%.

Figure 2. Lifetime Prevalence According to the
Type of Drug (Instituto da Droga e da Toxicodepen-
dência, 2008)

Figure 1. General Population, 2001-2007 Lifeti-
me Prevalence (Instituto da Droga e da Toxicode-
pendência, 2007)
Figure 3. Annual Prevalence for adult drug use
Looking at the numbers related to the prev- (15-64) 2001-2007 (European Monitoring Centre
for Drugs and Drug Addiction, 2008).
alence in the Portuguese population (figures 2

and 3), there isn’t a single drug consumption
In relation to Cannabis use the European
category that has decreased since 2001.
Monitoring Centre for Drugs and Drug Addic-
Between 2001 and 2007, the drug con-
tion have noted that:
sumption in Portugal increased by 4.2% in

absolute terms – the percentage of people who
“It is difficult to assess trends for the inten-
have experienced drugs at least once in their
sive cannabis use in Europe, but among the
lifetime climbed from 7.8% in 2001 to 12% in
countries that participated in both field trials be-
2007 (Instituto da Droga e da Toxicode- tween 2004 and 2007 (France, Spain, Ireland,
pendência, 2007). Greece, Italy, Netherlands and Portugal), there
The prevalence of selected drug use for the was an average increase of approximately 20%.”
15 to 34 age range in Portugal is illustrated (European Monitoring Centre for Drugs and
below comparing years 2001 to 2007 (Instituto Drug Addiction, 2008).

da Droga e da Toxicodependência, 2007):
In relation to Cocaine the EMCDDA have
 Cannabis: from 12.4% to 17% (15-34
pointed out that:
years old)

 Cocaine: from 1.3% to 2.8% (15-34
years old)
6 | MP Coelho
“There still remains a notorious growing con- diminish radically when compared to 2000. In
sumption of cocaine in Portugal, although not as fact, it was the opposite.
severe as what is verifiable in Spain. The increase

in consumption of cocaine is extremely problem-
“With 219 deaths due to drug ‘overdose’ per
atic.” (Gotz, 2009).
year, Portugal has one of the worst records in

Europe, reporting more than one death every two
Within the 2008 Annual Report of the days. Along with Greece, Austria and Finland,
EMCDDA it is noted that “Trends of cocaine Portugal is one of the countries that recorded an
use”, the new data (surveys from 2005-2007) increase in drug overdose deaths by over 30% in
confirms the escalating trend in France, Ire- 2005.” (European Monitoring Centre for Drugs
and Drug Addiction, 2007).
land, Spain, United Kingdom, Italy, Denmark,

and Portugal (European Monitoring Centre for
In 2007, the number of deceased individu-
Drugs and Drug Addiction, 2008). While am-
als that tested positive for drugs at the Portu-
phetamines and cocaine consumption rates
guese Institute of Forensic Medicine was 314,
doubled in Portugal, cocaine drug seizures
which represented a 45% rise since the previ-
increased sevenfold between 2001 and 2006
ous year: 216. This represents the highest
(figure 4), rating this country as the sixth
numbers since 2001 – roughly one death per
highest in the world (United Nations Office on
day –, therefore reinforcing the growth of the
Drugs and Crime, 2010).
drug trend since 2005 (figure 5).

Figure 4. Kilograms of cocaine seized in Portu-

gal, 2001-2007 (United Nations Office on Drugs
Figure 5. Toxicology tests and autopsies, and
and Crime, 2009)
their relation to positive results on drugs. Source:

Forensic Institute of Portugal
Heroin and Drug related Deaths and Homi-

cides
Since decriminalization was implemented in
In Portugal, heroin is the drug most re-
Portugal, the number of drug related homi-
sponsible for confinement in drug rehabilita-
cides has increased by 40% (United Nations
tion facilities and for overdose deaths. Second
Office on Drugs and Crime, 2010), again ac-
to Luxembourg, Portugal has the highest rate
cording to the European Monitoring Centre for
of consistent drug users and IV heroin depend-
Drugs and Drug Addiction Portugal:
ents (Instituto da Droga e da Toxicodependên-

cia, 2007). Concerning drug-related deaths,
“..was the only European country with a sig-
Portugal recorded 219 in 2005, representing an
nificant increase in [drug-related] murders be-
increase of 40% when compared to 2004, when tween 2001 and 2006.” (European Monitoring
156 people died (Instituto da Droga e da Toxi- Centre for Drugs and Drug Addiction, 2010).
codependência, 2007). In 2006, the total num-
ber of deaths caused by drug overdose did not
Drugs: Portuguese fallacy | 7
HIV and AIDS
In relation to HIV and AIDS, far from the "The impact of the law that decriminalized
picture of a clear decline there is evidence of drug use in Portugal confirms the result of the
the opposite occurring within Portugal follow- most anticipated experiences of decriminaliza-
tion: - has little or no effect on drug use and ad-
ing decriminalization.
diction. The decriminalization of consumption

does not interfere decisively in the evolution of
“The highest HIV/AIDS mortality rates
consumption indicators" (Quintas, 2013 Apre-
among drug users are reported for Portugal, fol-
sentação da análise da experiência portuguesa da
lowed by Estonia, Spain, Latvia and Italy; in most
descriminalização do consumo de drogas, na As-
other countries the rates are much lower.” (Eu-
sembleia da República, pelo “Grupo de Trabalho
ropean Monitoring Centre for Drugs and Drug
Toxicodependência e Álcool).
Addiction, 2007).

Finally, Portugal where every citizen may
Portugal remains the country with the
carry out in his pocket any drug at all from
highest incidence of related intra-venous use
cannabis derivate to heroin and crack cocaine
drugs with AIDS and it is the only country
until 10 days that is considered for personal
recording a recent increase. 703 newly diag-
use and sanctioned only with a pecuniary fine,
nosed infections, followed by Estonia with
banned the production import export advertis-
191, and Latvia with 108 reported cases (Euro-
ing distribution sale and provision of the New
pean Monitoring Centre for Drugs and Drug
Psychoative Substances in it´s entire territory
Addiction, 2007, p. 82). The number of new
(DL 54/2013, 2013 Prevenção e proteção con-
cases of HIV/AIDS and Hepatitis C in Portugal
tra a publicidade e comércio das novas
recorded among drug users is eight times the
substâncias psicoativas) today´s world´s num-
average of other countries of the European
ber one thrill accordingly the recent June 26
Union (European Monitoring Centre for Drugs
2013 World Drug Report.
and Drug Addiction, 2007). According to the
So accordingly the recently released legisla-
Portuguese Ministry of Health:
tion, referring the so called smartshops, all

“stores that sell the so called "legal highs" are
“Portugal keeps on being the country with
forced to close”.
the most cases of injected drug related AIDS in-
“Is an important step in responding to an
fections (85 new cases per million of citizens in
2005, while the majority of other EU countries alarming phenomenon” stated the Secretary of
do not exceed 5 cases per million) and the only State of Ministry of Health Fernando Leal da
one registering a recent increase. 36 more cases Costa.
per million of citizens were estimated in 2005 Accordingly the new Decree-Law “Is pro-
comparatively to 2004, when only 30 were re-
hibited each and every activity, continued or
ferred.” (European Monitoring Centre for Drugs
isolated, production, importation, exportation,
and Drug Addiction, 2007, p. 82).
advertisement, distribution, possession, sale or

simple delivery of the new psychoactive sub-
In short:
stances. Is also determined the closure of plac-
“Portugal´ s drug policy – as with all other
es used for such purposes" one may read in a
national drug policies – is unlikely to be a “mag-
ic bullet”. The country still has high levels of statement issued after this afternoon meeting
problem drug use and HIV infection, and does of the Government.
not show specific developments in its drug situa- The new substances covered by the new di-
tion that would clearly distinguish it from other ploma are those that "in pure form or in a
European countries that have a different policy”
preparation can be a threat to public health
(European Monitoring Centre for Drugs and
compared with the substances already listed in
Drug Addiction, 2011, p. 24).
legislation".
8 | MP Coelho
In this new list are 48 phenylethylamines , nally charged for any type of drug-related
33 cathinone derivates, 36 synthetic canna- crime, unless they possess a higher quantity
binoids, 4 cocaine derivatives / analogues, 5 than what is estimated for a 10 day supply
plants and respective constituent assets and 12 (figure 6).
miscellaneous items, including fertilizers and
fungi.
The new law provides for a gradual upgrade
of the substances to ban.

"In this moment we did already identified
159" Fernando Leal da Costa stressed, adding
that the update will be made for periods not ex-
ceeding 18 months and "whenever there is a
need.

This law thus gives answer to the problems
associated with the use of new psychoactive sub- Figure 6. Amount of drugs for a 10 day supply
stances, which have been developed at an in- according to the Portuguese law
creasing rate and that are not included in the ban
substances lists on United Nations Conventions, With the new Portuguese law, the drug de-
transposed into Portuguese law", refers the doc- pendent is no longer a criminal, but a sick in-
ument just released. dividual requiring treatment of his ‘disease’.
(http://www.theportugalnews.com/news/smart The belief on the part of the architects of
shop-drugs-to-be-illegalised/27524)
the Portuguese drug policy was that by elimi-

nating the social stigma associated with crimi-
Decriminalization and CDTs
nalized drug consumption, the drug depend-
“In July 1st 2001, Portugal drug law changed.
ents could be more easily attracted to enroll in
The Law 30/2000 was adopted, decriminalizing
drug dissuasion programs. This idea is based
the use, acquisition or possession of all illicit
on the view that most drug dependents’ avoid
drugs once proven that the substance is only for
personal consumption. Before that, illicit drug treatment due to their fear of criminal charges.
possession, acquisition, and use were considered In an article dedicated to Portugal´s drug poli-
criminal offenses punishable by fines or up to 3 cy, The Economist, in one of its printed edi-
months in prison. Possession of more than 3 dai- tions, states: “Officials believe that, by lifting
ly doses of an illicit drug increased the maximum fears of prosecution, the policy has encouraged
prison term up to 1 year […] After July 2001, the
addicts to seek treatment. This bears out their
possession of illicit drugs remained prohibited,
view that criminal sanctions are not the best
and the cultivation or trafficking of illicit drugs
solution. ‘Before decriminalization, the addicts
remained a criminal offense. However the con-
were afraid to seek treatment because they
sumption, purchase, and possession of illicit
drugs for personal use – defined as the quantity feared they would be denounced to the police
for a period of consumption of 10 days for one and arrested,’ says a deputy director of the
person – became administrative offenses to be re- Institute for Drugs and Drug Addiction, Portu-
ferred to Commissions for the Dissuasion of gal´ s main drugs-prevention and drugs-policy
Drug Addiction instead of the Portuguese crimi- agency. ´Now they know they will be treated
nal justice system.” (Kerlikowske, 2010).
as patients with a problem, and not stigma-

tized as criminals’.” (The Economist, 2009).
In other words, this means that whilst it
The image of Portugal which has been pre-
remains illegal to sell purchase and consumed
sented within reports such as that from the
drugs in Portugal citizens will never be crimi-
Cato Institute is one in which the drug user is
Drugs: Portuguese fallacy | 9
not seen as a criminal but as someone who is appointed to deal with users, 2.816 of them
suffering from a medical condition. However were classified as being non-dependents, 2.075
the distinction between those selling drugs and still pending evaluation, and 783 considered to
those using drugs in Portugal is by no means be dependents. Of these 783, 661 voluntarily
easy to maintain. According to the INA - Insti- accepted to be treated in order to temporarily
tuto Nacional de Administração (National suspend the legal process. From this group of
Institute of Administration) which was given 661 people, 166 never had any prior contact
the responsibility for assessing the impact of with treatment facilities, 127 that resumed
the National Strategy Against Drugs “it is very treatment had already abandoned it before, and
hard to distinguish between dealer and con- 368 were already following treatment when
sumer, since it is very easy for a dealer to or- they got caught practicing the legal offense.
ganize his distributing method with smaller (Instituto da Droga e da Toxicodependência,
quantities, which don’t stand as a crime of- 2009). On this basis it would appear that the
fense” (Tavares, Graça, Martins, & Asensio, CDT teams, operating in every district in the
2004). country, with a total of 99 technicians, only
Since this neutral report was published in managed to lead 166 addicts toward treatment,
1999, until today, very little has been done to since the remaining (127 + 368) were already
improve the situation. And despite the disap- referred and being followed in non-emergency
pointing results, the Portuguese strategy was medical facilities (CAT) (figure 7).
renewed up until 2012. Within Portugal now The danger here is one of interpreting the
there is a growing sense of fearlessness on the statistics on referrals as indicating the success
part of those selling small quantities of drugs, of the CDT initiatives when in reality a sub-
since most police officers don’t think it is wor- stantial proportion of those coming into this
thy of their time to arrest drug sellers. The system are already in contact with treatment
impression of individuals being allowed to sell facilities.
small quantities of drugs is very evident to
anyone walking through the crowded streets of
Lisbon’s Cova da Moura ou Mouraria or
through other areas in the city where more
often than not they will be approached by indi-
viduals with hashish, cocaine and other drugs
to sell, sometimes in broad daylight. This situ-
ation was nonexistent five years ago in such
places (Audibert & Araujo, 2009).
Another part of the Portuguese drug policy
was the creation of CDT (Commissions for the
Dissuasion of Drug Addiction). When users

are caught in the act, they are sent to CDTs for
Figure 7. Activities Report – CDT (Instituto da
evaluation. If justified, they are persuaded to
Droga e da Toxicodependência, 2009)
follow some treatment in order to avoid ad-

ministrative fines and other light penalties. In
The medicalization of Europe
order to understand a little more about of this,
Anand Grover, the United Nations Special
we can read more statistical insight about the
Rapporteur on the Right of Everyone to the
CDT:
Highest Attainable Standard of Physical and
Within the 2008 Activities Report (Insti-
Mental Health, in a 25 page report presented at
tuto da Droga e da Toxicodependência, 2009,
the United Nations’ General Assembly in New
p. 55) from a total number of 7.346 processes
10 | MP Coelho
York on October 26, 2010, recommends Gov- here the concerns appear to be changing, with
ernments to: questions being asked about the long-term re-
sults of those under care.” (European Monitoring

Centre for Drugs and Drug Addiction, 2010, p.
“Ensure that the rights of people who use
5).
drugs are respected, protected and fulfilled”;

“ensure that all harm-reduction measures (as
“Overall, the EMCDDA estimates that about
itemized by UNAIDS) and drug-dependence
670.000 Europeans now receive opioid substitu-
treatment services, particularly opioid substitu-
tion treatment, representing about half of the es-
tion therapy, are available to people who use
timated number of problem opioid users.” (Eu-
drugs, in particular those among incarcerated
ropean Monitoring Centre for Drugs and Drug
populations”; “create a permanent mechanism
Addiction, 2010, p. 17).
with the necessary protection of the health and

human rights of drug users and the communities
“Substitution treatment is the predominant
they live in as its primary objective”; “take a hu-
treatment option for opioid users in Europe.”
man rights-based approach to drug control, and
(European Monitoring Centre for Drugs and
devise and promulgate rights-based indicators
Drug Addiction, 2010, p. 31).
concerning drug control and the right to health”;

“decriminalize or de-penalize possession and use
“The general European trend is one of growth
of drugs.” (United Nations General Assembly,
and consolidation of harm-reduction measures.”
2010).
(European Monitoring Centre for Drugs and

Drug Addiction, 2010, p. 32).
Quite surprisingly this high-ranking official

highlighting two important issues – health and
“Putting science into practice in drug treat-
human rights – is revealing that he was not
ment: drug treatment has often been lethargic
able to resist to the pressure and seem to have about adopting scientifically tested methods in
surrendered. Unexpectedly, his report came its clinical practice. The limited provision of opi-
out coincidently while notorious pro- oid substitution treatment in several European
legalization organizations, like Drug Policy countries and the rare use of contingency man-
agement for the treatment of cocaine dependence
Alliance, Cato Institute, Transnational Insti-
are examples of this gap between science and
tute, Beckley Foundation, Encod, among oth-
practice.” (European Monitoring Centre for
ers claim that the war on drugs can never be
Drugs and Drug Addiction, 2010, p. 48).
won and that a crime committed by someone

on drugs can’t be considered as an offence but
“Opioid substitution treatment, combined
as indicative of the individual having a health with psychosocial interventions, was found to be
problem. the most effective treatment option for opioid
Very recently, on November 10, 2010, the users.” (European Monitoring Centre for Drugs
EMCDDA released its Annual Report signed and Drug Addiction, 2010, p. 78).

by its Chairman and its Director, respectively
“Deaths showing the presence of substances
João Goulão (the Portuguese SICAD – Serviço
used in opioid substitution treatment are also
de Intervenção nos Comportamentos Aditivos
reported each year. This reflects the large num-
e Dependências, Director and Portuguese Drug
ber of drug users undergoing this type of treat-
Policy Coordinator) and Wolfgang Gotz. In this
ment and does not imply that these substances
important document we can read: were the cause of death. Overdose deaths among
clients in substitution treatment can be the re-
“The estimated 1 million people now under- sult of combining drugs, as some treatment cli-
going drug treatment testifies the work that has ents still use street opioids, engage in heavy
been done to ensure that care is made available drinking and use prescribed psychoactive sub-
to those in need […]. Opioid substitution treat- stances. However, most deaths due to substitu-
ment remains the biggest sector in this area, and tion substances (often in combination with other
Drugs: Portuguese fallacy | 11
substances) happen among people who are not more than a half of all European opioid de-
in substitution treatment (Heinemann et al. pendents in treatment. In political terms, this
2000).” (European Monitoring Centre for Drugs
also means that the well intentioned officials,
and Drug Addiction, 2010, p. 86)
like the Portuguese and many others in Eu-

rope, realize that curing drug dependents is
The model of society (concerning narcotic
indeed a very difficult task. The majority of
dependence) that used to strive for drug free
them relapse many times when they try to stop
and viewed drug dependence as unacceptable
using drugs. The position of João Goulão, pres-
and marginal, appears not to have given way to
ident of EMCDDA and Portuguese SICAD
a completely different model, promoted by
director, can be seen in some of his state-
representatives of the United Nations and Eu-
ments:
rope: one that considers the idea of a utopian

drug-free society as unrealistic.
"The heroic attempt to stop addiction to

heroin does work in some cases, but rarely.
Health The diabetics need insulin, some people need
In contrast to the suggestion that we should an opiate – more and more scientific evidence
place health at the centre of drug policy there suggests this. There is, in the very sensitive
is a strong case instead for placing “well being” area of brain receptors, a deficit that is in-
at the centre of polcy. Viewing drug dependen- stalled in the production of certain chemical
mediators, which requires that these people
cy as a ‘treatable health condition’ is a way to
need an opiate to achieve a socially, family
call it a disease, as labeled by ED countless
and professionally well integrated life. Very
times: “drug addicts need treatment as much
often, when trying to stop, these addicts give
as patients of chronic diseases such as cancer,
up and return to consumption, demolishing
diabetes and tuberculosis.” (United Nations
all the work already achieved. Hence, the IDT
Office on Drugs and Crime, 2009). But what prefers to keep the users in programs that
does treatment in this context actually mean? work for the discontinuity of these treat-
Maintaining a lifetime chemical dependency ments." (Maia, 2009).
is considered a treatment? Can we interpret
It would seem that UNODC´s 2008 slogan,
the 700,000 Europeans, representing about
“use music, use sports, do not allow drugs to
half of the estimated number of opioid users in
come into your life” was replaced in Portugal
all Europe (and now on opioid substitution
and other European countries, in a symbolic
programs), as being in treatment? Can we in-
way, by something like “use methadone, use
terpret the massive 70% majority of depend-
buprenorphine, don’t allow drugs to abandon
ents on opioid substitution programs in Portu-
your life”. But what is the alternative and does
gal to be an indicator of success? Can drug
abstinence work?
dependents aspire to a life free of drugs? Can a
Even if drug therapists do not teach that
drug-free treatment lead to this goal? The fun-
abstinence and spontaneous remission are very
damental question is, must the drug dependent
frequent occurrences, a well-known and reput-
be a condemned victim of his own biology or
ed study revealed that people who successfully
can he overcome the problem when he be-
completed a treatment program (in some cas-
comes aware of it?
es, one year after the beginning of abstinence)
Based on this assumption, harm reduction
reduced their illicit activities by 60%. The drug
strategies are used as the main tool to fight
trades fell almost 80%, imprisonment de-
drug dependency, as we see by consulting both
creased more than 60%, homeless drug de-
EMCDDA 2010 and 2011 Annual Reports.
pendents decreased almost 43%, dependence
This is confirmed by the abnormal percentage
on Social Institutions fell 11% and employ-
of drug dependents in substitution programs –
12 | MP Coelho
ment increased 20% (Leshner, 1997). By trans-
ferring the problem to the medical profession, To further support this idea through sci-
politicians have successfully managed to trans- ence, an important study led by Neil McKe-
form political problems into medical ones re- ganey, director of the Scottish Centre for Drug
quiring specialized medical intervention. This Misuse Research, focusing on Scottish drug
deprives society of the responsibility to cor- dependents reality, says, ”[…] almost 60% of
rectly and accurately research the true causes individuals said that abstinence was the only
of entering and exiting drug dependency. goal that they were seeking to achieve […] on
Medicine takes care of the consequences of the whole drug users contacting drug-
drug dependence, but may not explain how treatment services in Scotland tend to be look-
people get into it. This points to the idea that ing for abstinence rather than harm reduction
drug dependents need psychological help, not as the change they are seeking to bring about.”
medical: while medical doctors prescribe medi- (McKeganey, Morris, Neale, & Robertson,
cines, psychologists ‘prescribe’ psychotherapy. 2004).
Psychologists are essential in this process, by On the other hand, a wide range of life situ-
providing fundamental emotional control ations, such as deaths of relatives or close
strategies and skills so that people understand friends, relationship break ups, difficulties at
how to avoid the situations that usually lead to work, drug dependence, or sexual abuse have
drug abuse. been transformed into chemical problems. The
The following quote from an official of one human being, with his own life history and
of the most prestigious world drug dependence uniqueness, in this way is reduced into a bio-
Centers, San Patrignano, in Italy, reiterates this chemical entity – in many cases, just missing
idea: what life is about. The message that drugs can
heal our problems has profound consequences.
“Many countries’ social policies reflect the It encourages people to perceive themselves as
belief that drug addiction is a disease and that re- helpless victims of their own biology. As a
lapse is inevitable. Believing that it is impossible
result, drug dependents all over the world,
to cure addiction, the general goal became the
with the support of tax payers, keep on getting
reduction of social harm, by the stabilization of
the message that they are sick, and the gov-
drug addicts rather than their full rehabilitation,
ernments keep on trying to treat them.
with the illusion that this is also the more con-
There is the need for a new paradigm about
venient option in a financial point of view. Even
when accounting only the direct costs of drug drug dependency: the creation of a culture of
addiction, such as methadone distribution, nee- caring, a culture where one should look at the
dle exchange and everything for medical, psychi- drug dependent instead of looking at the drug
atric and legal assistance, the expense is enor- dependency. A new paradigm which holds a
mous: in 2005 Italy spent 800 million euros,
different understanding of drug dependence,
France spent 1000 million, and the United King-
an alternative model which maintains that this
dom almost 2000 million. With 2000 million eu-
is not a chronic disease, recurrent and progres-
ros, in one year we could have placed 41,600
sive, but instead “the result of a complex inter-
people into San Patrignano’s program. Four years
action between culture, immediate environ-
later, 31,200 of these people would have been
fully recovered and living their lives free of ment, individual availability and substance”
drugs. But with the actual situation, these (Peele, 1985).
41,600 can only be multiplied over and over The focus should be directed to individual
again into an ever increasing number of individ- health, with its social, familial, economic and
uals subsisting on replacement therapies and re-
psychological idiosyncrasies, thus switching
volving clinic and prison doors.” (Luppi & Bar-
from the one size fits all model and returning
zanti, sem data).
to the model tailored to the individual that