‘It is not just about administering methadone, you have to maintain a relationship’

In 2001 Portugal became  – under the leadership of prime minister António Guterres, nowadays UN’s  Secretary-General – the first country to ‘decriminalize’ the possession and consumption of illicit substances, even heroin, and cocaine.

Despite predictions at the time of an increase in drug use and drug tourism by opponents of decriminalization, the opposite happened with huge drops in drug use, overdose deaths, drug-related crime, and HIV infection. New cases of HIV among people who inject drugs (PWID) fell from 907 in 2000 – when the country had the highest rate of HIV among PWID in Europe – to just 18 in 2017.

The country’s policy rests on 3 pillars: (i) there is no distinction between so-called soft and hard drugs, (ii) an individual’s unhealthy relationship with drugs often masks unsatisfactory relationships with the world around and (iii) the eradication of all drugs is an impossible goal.

What did and what did the country not do?
It did not change laws on drug trafficking: dealers still go to prison. And it did not ‘legalize’ drug use but rather made the purchase or possession of small quantities (up to a 10 day supply) not a crime.

Methadone clinics, clean needle handouts, supervised injection sites, drug consumption facilities and a pan-ministerial network of support were set up and are still operational today.

There are currently two Threshold Mobile Units in Lisbon – attending approximately 1,200 people a day – and 170 recovery facilities in a country of 10 million people for treatment and education about the harmful effects of drugs.

This public health approach reflects the view that addiction is more a medical challenge than a criminal justice issue; a chronical disease that requires medical care rather than punishment. An additional benefit of the Portuguese model is that it’s far cheaper to treat people than to jail them.

While other states have developed various forms of de facto decriminalization – whereby substances perceived to be less harmful (such as cannabis) rarely lead to criminal prosecution – Portugal remains the only EU member state with a law explicitly declaring drugs to be ‘decriminalized.’

Bom fim de semana           Enjoy the weekend         (pic Público/NYT/Cato)


If something bad happens, we drink to forget.
If something good happens, we drink to celebrate.
If nothing happens, we drink to make something happen       
(Charles Bukowski)

Global consumption of alcohol will rise another 17% over the next decade, after a 10% rise in the last 25 years. Nowadays one-third of all adults drink alcohol, by 2030 half of them will. The highest alcohol intakes are recorded in Europe with Moldava claiming top spot with more than 15 litres of pure alcohol per adult per year.

While in most European countries alcohol consumption among 15-years-old has been halved in the last decade – in Portugal from 16% to 8% – the Portuguese consumption with 12.3 litres per adult per year is still far above the European mean (9.8 litres) and even higher than in Russia (11.7 litres). Three quarters of the Portuguese men and half of the women drink. Excess drinking is on the increase in adults above 45 years of age, especially in women.

What does this mean for the health of the Portuguese? Excessive alcohol intake is associated with road traffic accidents, cancer, diabetes, heart disease, domestic violence, and suicide attempts.
In 2017 more than one-third of the Portuguese drivers – who died on the road – had too much alcohol (>0.5 g/l) in their blood. The highest number in 5 years.

Drinking is an important cause of cancer in the over-50s, particularly in women. Research in the UK showed that one in 13 breast cancers are alcohol-related and a quarter of cancer deaths in women over 50 linked to drinking habits.

In 2018, the medical journal The Lancet concluded that although alcohol use among youngsters has declined, risky drinking behavior – like binge drinking – remains concerning high.

A more recent study analyzing alcohol consumption under 500.000 adults and published in the same journal, showed that alcohol increases the blood pressure and the risk of stroke. A finding that should ring bells in Portugal, that hasn’t only a substantial alcohol consumption but also the highest prevalence of stroke in Europe.

Given the fact that there is no safe level of drinking, the public health policy should be to prioritize measures to reduce drinking through increasing taxation, setting the price according to the strength of the drink, curbs on marketing and restricting the places where people can buy alcohol.

But the consumer also has the right to be informed about the dangers. Labeling of bottles of wine and cans of beer with ‘alcohol causes cancer’ – like the Irish government proposed last year – might help to inform the general public in a better way. How many women actually know that alcohol causes breast cancer?

One day someone mentioned to Fernando Pessoa ‘ You drink like a sponge’. Portugal’s most famous poet replied ‘Not like a sponge. Like a sponge shop, and with a storeroom attached.’ He died from booze at the age of 47.

Bom fim de semana                Enjoy the weekend
            (pic Sapo/Público)