Category Archives: Drug Addiction

The Portuguese Experience. Drug Decriminalisation: A Love Story – Susana Ferreira.

Portugal’s radical drugs policy is working. Why hasn’t the world copied it?

Since it decriminalised all drugs in 2001 Portugal has seen dramatic drops in overdoses, HIV infections and drug related crime.

The drugs came, they hit all at once. It was the 80s, and by the time one in 10 people had slipped into the depths of heroin use – bankers, university students, carpenters, socialites, miners – Portugal was in a state of panic.

Álvaro Pereira was working as a family doctor in Olhão in southern Portugal. “People were injecting themselves in the street, in public squares, in gardens,” he told me. “At that time, not a day passed when there wasn’t a robbery at a local business, or a mugging.”

The crisis began in the south. The 80s were a prosperous time in Olhão, a fishing town 31 miles west of the Spanish border. Coastal waters filled fishermen’s nets from the Gulf of Cádiz to Morocco, tourism was growing, and currency flowed throughout the southern Algarve region. But by the end of the decade, heroin began washing up on Olhão’s shores. Overnight, Pereira’s beloved slice of the Algarve coast became one of the drug capitals of Europe: one in every 100 Portuguese was battling a problematic heroin addiction at that time, but the number was even higher in the south. Headlines in the local press raised the alarm about overdose deaths and rising crime. The rate of HIV infection in Portugal became the highest in the European Union. Pereira recalled desperate patients and families beating a path to his door, terrified, bewildered, begging for help. “I got involved,” he said, “only because I was ignorant.”

In truth, there was a lot of ignorance back then. Forty years of authoritarian rule under the regime established by António Salazar in 1933 had suppressed education, weakened institutions and lowered the school-leaving age, in a strategy intended to keep the population docile. The country was closed to the outside world; people missed out on the experimentation and mind-expanding culture of the 1960s. When the regime ended abruptly in a military coup in 1974, Portugal was suddenly opened to new markets and influences. Under the old regime, Coca-Cola was banned and owning a cigarette lighter required a licence. When marijuana and then heroin began flooding in, the country was utterly unprepared.

Pereira tackled the growing wave of addiction the only way he knew how: one patient at a time. A student in her 20s who still lived with her parents might have her family involved in her recovery; a middle-aged man, estranged from his wife and living on the street, faced different risks and needed a different kind of support. Pereira improvised, calling on institutions and individuals in the community to lend a hand.

In 2001, nearly two decades into Pereira’s accidental specialisation in addiction, Portugal became the first country to decriminalise the possession and consumption of all illicit substances. Rather than being arrested, those caught with a personal supply might be given a warning, a small fine, or told to appear before a local commission – a doctor, a lawyer and a social worker – about treatment, harm reduction, and the support services that were available to them.

The opioid crisis soon stabilised, and the ensuing years saw dramatic drops in problematic drug use, HIV and hepatitis infection rates, overdose deaths, drug-related crime and incarceration rates. HIV infection plummeted from an all-time high in 2000 of 104.2 new cases per million to 4.2 cases per million in 2015. The data behind these changes has been studied and cited as evidence by harm-reduction movements around the globe. It’s misleading, however, to credit these positive results entirely to a change in law.

Portugal’s remarkable recovery, and the fact that it has held steady through several changes in government – including conservative leaders who would have preferred to return to the US-style war on drugs – could not have happened without an enormous cultural shift, and a change in how the country viewed drugs, addiction – and itself. In many ways, the law was merely a reflection of transformations that were already happening in clinics, in pharmacies and around kitchen tables across the country. The official policy of decriminalisation made it far easier for a broad range of services (health, psychiatry, employment, housing etc) that had been struggling to pool their resources and expertise, to work together more effectively to serve their communities.

The language began to shift, too. Those who had been referred to sneeringly as drogados (junkies) – became known more broadly, more sympathetically, and more accurately, as “people who use drugs” or “people with addiction disorders”. This, too, was crucial.

It is important to note that Portugal stabilised its opioid crisis, but it didn’t make it disappear. While drug-related death, incarceration and infection rates plummeted, the country still had to deal with the health complications of long-term problematic drug use. Diseases including hepatitis C, cirrhosis and liver cancer are a burden on a health system that is still struggling to recover from recession and cutbacks. In this way, Portugal’s story serves as a warning of challenges yet to come.

Despite enthusiastic international reactions to Portugal’s success, local harm-reduction advocates have been frustrated by what they see as stagnation and inaction since decriminalisation came into effect. They criticise the state for dragging its feet on establishing supervised injection sites and drug consumption facilities; for failing to make the anti-overdose medication naloxone more readily available; for not implementing needle-exchange programmes in prisons. Where, they ask, is the courageous spirit and bold leadership that pushed the country to decriminalise drugs in the first place

In the early days of Portugal’s panic, when Pereira’s beloved Olhão began falling apart in front of him, the state’s first instinct was to attack. Drugs were denounced as evil, drug users were demonised, and proximity to either was criminally and spiritually punishable. The Portuguese government launched a series of national anti-drug campaigns that were less “Just Say No” and more “Drugs Are Satan”.

Informal treatment approaches and experiments were rushed into use throughout the country, as doctors, psychiatrists, and pharmacists worked independently to deal with the flood of drug-dependency disorders at their doors, sometimes risking ostracism or arrest to do what they believed was best for their patients.

In 1977, in the north of the country, psychiatrist Eduíno Lopes pioneered a methadone programme at the Centro da Boavista in Porto. Lopes was the first doctor in continental Europe to experiment with substitution therapy, flying in methadone powder from Boston, under the auspices of the Ministry of Justice, rather than the Ministry of Health. His efforts met with a vicious public backlash and the disapproval of his peers, who considered methadone therapy nothing more than state-sponsored drug addiction.

In Lisbon, Odette Ferreira, an experienced pharmacist and pioneering HIV researcher, started an unofficial needle-exchange programme to address the growing Aids crisis. She received death threats from drug dealers, and legal threats from politicians. Ferreira – who is now in her 90s, and still has enough swagger to carry off long fake eyelashes and red leather at a midday meeting – started giving away clean syringes in the middle of Europe’s biggest open-air drug market, in the Casal Ventoso neighbourhood of Lisbon. She collected donations of clothing, soap, razors, condoms, fruit and sandwiches, and distributed them to users. When dealers reacted with hostility, she snapped back: “Don’t mess with me. You do your job, and I’ll do mine.” She then bullied the Portuguese Association of Pharmacies into running the country’s – and indeed the world’s – first national needle-exchange programme.

A flurry of expensive private clinics and free, faith-based facilities emerged, promising detoxes and miracle cures, but the first public drug-treatment centre run by the Ministry of Health – the Centro das Taipas in Lisbon – did not begin operating until 1987. Strapped for resources in Olhão, Pereira sent a few patients for treatment, although he did not agree with the abstinence-based approach used at Taipas. “First you take away the drug, and then, with psychotherapy, you plug up the crack,” said Pereira. There was no scientific evidence to show that this would work – and it didn’t.

He also sent patients to Lopes’s methadone programme in Porto, and found that some responded well. But Porto was at the other end of the country. He wanted to try methadone for his patients, but the Ministry of Health hadn’t yet approved it for use. To get around that, Pereira sometimes asked a nurse to sneak methadone to him in the boot of his car.

Pereira’s work treating patients for addiction eventually caught the attention of the Ministry of Health. “They heard there was a crazy man in the Algarve who was working on his own,” he said, with a slow smile. Now 68, he is sprightly and charming, with an athletic build, thick and wavy white hair that bounces when he walks, a gravelly drawl and a bottomless reserve of warmth. “They came down to find me at the clinic and proposed that I open a treatment centre,” he said. He invited a colleague from at a family practice in the next town over to join him – a young local doctor named João Goulão.

Goulão was a 20-year-old medical student when he was offered his first hit of heroin. He declined because he didn’t know what it was. By the time he finished school, got his licence and began practising medicine at a health centre in the southern city of Faro, it was everywhere. Like Pereira, he accidentally ended up specialising in treating drug addiction.

The two young colleagues joined forces to open southern Portugal’s first CAT in 1988. (These kinds of centres have used different names and acronyms over the years, but are still commonly referred to as Centros de Atendimento a Toxicodependentes, or CATs.) Local residents were vehemently opposed, and the doctors were improvising treatments as they went along. The following month, Pereira and Goulão opened a second CAT in Olhão, and other family doctors opened more in the north and central regions, forming a loose network. It had become clear to a growing number of practitioners that the most effective response to addiction had to be personal, and rooted in communities. Treatment was still small-scale, local and largely ad hoc.

The first official call to change Portugal’s drug laws came from Rui Pereira, a former constitutional court judge who undertook an overhaul of the penal code in 1996. He found the practice of jailing people for taking drugs to be counterproductive and unethical. “My thought right off the bat was that it wasn’t legitimate for the state to punish users,” he told me in his office at the University of Lisbon’s school of law. At that time, about half of the people in prison were there for drug-related reasons, and the epidemic, he said, was thought to be “an irresolvable problem”. He recommended that drug use be discouraged without imposing penalties, or further alienating users. His proposals weren’t immediately adopted, but they did not go unnoticed.

In 1997, after 10 years of running the CAT in Faro, Goulão was invited to help design and lead a national drug strategy. He assembled a team of experts to study potential solutions to Portugal’s drug problem. The resulting recommendations, including the full decriminalisation of drug use, were presented in 1999, approved by the council of ministers in 2000, and a new national plan of action came into effect in 2001.

Today, Goulão is Portugal’s drug czar. He has been the lodestar throughout eight alternating conservative and progressive administrations; through heated standoffs with lawmakers and lobbyists; through shifts in scientific understanding of addiction and in cultural tolerance for drug use; through austerity cuts, and through a global policy climate that only very recently became slightly less hostile. Goulão is also decriminalisation’s busiest global ambassador. He travels almost non-stop, invited again and again to present the successes of Portugal’s harm-reduction experiment to authorities around the world, from Norway to Brazil, which are dealing with desperate situations in their own countries.

“These social movements take time,” Goulão told me. “The fact that this happened across the board in a conservative society such as ours had some impact.” If the heroin epidemic had affected only Portugal’s lower classes or racialised minorities, and not the middle or upper classes, he doubts the conversation around drugs, addiction and harm reduction would have taken shape in the same way. “There was a point whenyou could not find a single Portuguese family that wasn’t affected. Every family had their addict, or addicts. This was universal in a way that the society felt: ‘We have to do something.’”

Portugal’s policy rests on three pillars:

1. That there’s no such thing as a soft or hard drug, only healthy and unhealthy relationships with drugs.

2. That an individual’s unhealthy relationship with drugs often conceals frayed relationships with loved ones, with the world around them, and with themselves.

3. That the eradication of all drugs is an impossible goal.

“The national policy is to treat each individual differently,” Goulão told me. “The secret is for us to be present.”

A drop-in centre called IN-Mouraria sits unobtrusively in a lively, rapidly gentrifying neighbourhood of Lisbon, a longtime enclave of marginalised communities. From 2pm to 4pm, the centre provides services to undocumented migrants and refugees; from 5pm to 8pm, they open their doors to drug users. A staff of psychologists, doctors and peer support workers (themselves former drug users) offer clean needles, pre-cut squares of foil, crack kits, sandwiches, coffee, clean clothing, toiletries, rapid HIV testing, and consultations – all free and anonymous.

On the day I visited, young people stood around waiting for HIV test results while others played cards, complained about police harassment, tried on outfits, traded advice on living situations, watched movies and gave pep talks to one another. They varied in age, religion, ethnicity and gender identity, and came from all over the country and all over the world. When a slender, older man emerged from the bathroom, unrecognisable after having shaved his beard off, an energetic young man who had been flipping through magazines threw up his arms and cheered. He then turned to a quiet man sitting on my other side, his beard lush and dark hair curling from under his cap, and said: “What about you? Why don’t you go shave off that beard? You can’t give up on yourself, man. That’s when it’s all over.” The bearded man cracked a smile.

During my visits over the course of a month, I got to know some of the peer support workers, including João, a compact man with blue eyes who was rigorous in going over the details and nuances of what I was learning. João wanted to be sure I understood their role at the drop-in centre was not to force anyone to stop using, but to help minimise the risks users were exposed to.

“Our objective is not to steer people to treatment – they have to want it,” he told me. But even when they do want to stop using, he continued, having support workers accompany them to appointments and treatment facilities can feel like a burden on the user – and if the treatment doesn’t go well, there is the risk that that person will feel too ashamed to return to the drop-in centre. “Then we lose them, and that’s not what we want to do,” João said. “I want them to come back when they relapse.” Failure was part of the treatment process, he told me. And he would know.

João is a marijuana-legalisation activist, open about being HIV-positive, and after being absent for part of his son’s youth, he is delighting in his new role as a grandfather. He had stopped doing speedballs (mixtures of cocaine and opiates) after several painful, failed treatment attempts, each more destructive than the last. He long used cannabis as a form of therapy – methadone did not work for him, nor did any of the inpatient treatment programmes he tried – but the cruel hypocrisy of decriminalisation meant that although smoking weed was not a criminal offence, purchasing it was. His last and worst relapse came when he went to buy marijuana from his usual dealer and was told: “I don’t have that right now, but I do have some good cocaine.” João said no thanks and drove away, but soon found himself heading to a cash machine, and then back to the dealer. After this relapse, he embarked on a new relationship, and started his own business. At one point he had more than 30 employees. Then the financial crisis hit. “Clients weren’t paying, and creditors started knocking on my door,” he told me. “Within six months I had burned through everything I had built up over four or five years.”

In the mornings, I followed the centre’s street teams out to the fringes of Lisbon. I met Raquel and Sareia – their slim forms swimming in the large hi-vis vests they wear on their shifts – who worked with Crescer na Maior, a harm-reduction NGO. Six times a week, they loaded up a large white van with drinking water, wet wipes, gloves, boxes of tinfoil and piles of state-issued drug kits: green plastic pouches with single-use servings of filtered water, citric acid, a small metal tray for cooking, gauze, filter and a clean syringe. Portugal does not yet have any supervised injection sites (although there is legislation to allow them, several attempts to open one have come to nothing), so, Raquel and Sareia told me, they go out to the open-air sites where they know people go to buy and use. Both are trained psychologists, but out in the streets they are known simply as the “needle girls”.

“Good afternoon!” Raquel called out cheerily, as we walked across a seemingly abandoned lot in an area called Cruz Vermelha. “Street team!” People materialised from their hiding places like some strange version of whack-a-mole, poking their heads out from the holes in the wall where they had gone to smoke or shoot up. “My needle girls,” one woman cooed to them tenderly. “How are you, my loves?” Most made polite conversation, updating the workers on their health struggles, love lives, immigration woes or housing needs. One woman told them she would be going back to Angola to deal with her mother’s estate, that she was looking forward to the change of scenery. Another man told them he had managed to get his online girlfriend’s visa approved for a visit. “Does she know you’re still using?” Sareia asked. The man looked sheepish.

“I start methadone tomorrow,” another man said proudly. He was accompanied by his beaming girlfriend, and waved a warm goodbye to the girls as they handed him a square of foil.

In the foggy northern city of Porto, peer support workers from Caso – an association run by and for drug users and former users, the only one of its kind in Portugal – meet every week at a noisy cafe. They come here every Tuesday morning to down espressos, fresh pastries and toasted sandwiches, and to talk out the challenges, debate drug policy (which, a decade and a half after the law came into effect, was still confusing for many) and argue, with the warm rowdiness that is characteristic of people in the northern region. When I asked them what they thought of Portugal’s move to treat drug users as sick people in need of help, rather than as criminals, they scoffed. “Sick? We don’t say ‘sick’ up here. We’re not sick.”

I was told this again and again in the north: thinking of drug addiction simply in terms of health and disease was too reductive. Some people are able to use drugs for years without any major disruption to their personal or professional relationships. It only became a problem, they told me, when it became a problem.

Caso was supported by Apdes, a development NGO with a focus on harm reduction and empowerment, including programmes geared toward recreational users. Their award-winning Check!n project has for years set up shop at festivals, bars and parties to test substances for dangers.

I was told more than once that if drugs were legalised, not just decriminalised, then these substances would be held to the same rigorous quality and safety standards as food, drink and medication.

In spite of Portugal’s tangible results, other countries have been reluctant to follow. The Portuguese began seriously considering decriminalisation in 1998, immediately following the first UN General Assembly Special Session on the Global Drug Problem (UNgass). High-level UNgass meetings are convened every 10 years to set drug policy for all member states, addressing trends in addiction, infection, money laundering, trafficking and cartel violence. At the first session – for which the slogan was “A drug-free world: we can do it” – Latin American member states pressed for a radical rethinking of the war on drugs, but every effort to examine alternative models (such as decriminalisation) was blocked. By the time of the next session, in 2008, worldwide drug use and violence related to the drug trade had vastly increased. An extraordinary session was held last year, but it was largely a disappointment – the outcome document didn’t mention “harm reduction” once.

Despite that letdown, 2016 produced a number of promising other developments: Chile and Australia opened their first medical cannabis clubs; following the lead of several others, four more US states introduced medical cannabis, and four more legalised recreational cannabis; Denmark opened the world’s largest drug consumption facility, and France opened its first; South Africa proposed legalising medical cannabis; Canada outlined a plan to legalise recreational cannabis nationally and to open more supervised injection sites; and Ghana announced it would decriminalise all personal drug use.

The biggest change in global attitudes and policy has been the momentum behind cannabis legalisation. Local activists have pressed Goulão to take a stance on regulating cannabis and legalising its sale in Portugal; for years, he has responded that the time wasn’t right. Legalising a single substance would call into question the foundation of Portugal’s drug and harm-reduction philosophy. If the drugs aren’t the problem, if the problem is the relationship with drugs, if there’s no such thing as a hard or a soft drug, and if all illicit substances are to be treated equally, he argued, then shouldn’t all drugs be legalised and regulated?

Massive international cultural shifts in thinking about drugs and addiction are needed to make way for decriminalisation and legalisation globally. In the US, the White House has remained reluctant to address what drug policy reform advocates have termed an “addiction to punishment”.

If conservative, isolationist, Catholic Portugal could transform into a country where same-sex marriage and abortion are legal, and where drug use is decriminalised, a broader shift in attitudes seems possible elsewhere. But, as the harm-reduction adage goes: one has to want the change in order to make it.

When Pereira first opened the CAT in Olhão, he faced vociferous opposition from residents; they worried that with more drogados would come more crime. But the opposite happened. Months later, one neighbour came to ask Pereira’s forgiveness. She hadn’t realised it at the time, but there had been three drug dealers on her street; when their local clientele stopped buying, they packed up and left.

The CAT building itself is a drab, brown two-storey block, with offices upstairs and an open waiting area, bathrooms, storage and clinics down below. The doors open at 8.30am, seven days a week, 365 days a year. Patients wander in throughout the day for appointments, to chat, to kill time, to wash, or to pick up their weekly supply of methadone doses. They tried to close the CAT for Christmas Day one year, but patients asked that it stay open. For some, estranged from loved ones and adrift from any version of home, this is the closest thing they’ve got to community and normality.

“It’s not just about administering methadone,” Pereira told me. “You have to maintain a relationship.”

In a back room, rows of little canisters with banana-flavoured methadone doses were lined up, each labelled with a patient’s name and information. The Olhão CAT regularly services about 400 people, but that number can double during the summer months, when seasonal workers and tourists come to town. Anyone receiving treatment elsewhere in the country, or even outside Portugal, can have their prescription sent over to the CAT, making the Algarve an ideal harm-reduction holiday destination.

After lunch at a restaurant owned by a former CAT employee, the doctor took me to visit another of his projects – a particular favourite. His decades of working with addiction disorders had taught him some lessons, and he poured his accumulated knowledge into designing a special treatment facility on the outskirts of Olhão: the Unidade de Desabituação, or Dishabituation Centre. Several such UDs, as they are known, have opened in other regions of the country, but this centre was developed to cater to the particular circumstances and needs of the south.

Pereira stepped down as director some years ago, but his replacement asked him to stay on to help with day-to-day operations. Pereira should be retired by now – indeed, he tried to – but Portugal is suffering from an overall shortage of health professionals in the public system, and not enough young doctors are stepping into this specialisation. As his colleagues elsewhere in the country grow closer to their own retirements, there’s a growing sense of dread that there is no one to replace them.

“Those of us from the Algarve always had a bit of a different attitude from our colleagues up north,” Pereira told me. “I don’t treat patients. They treat themselves. My function is to help them to make the changes they need to make.”

And thank goodness there is only one change to make, he deadpanned as we pulled into the centre’s parking lot: “You need to change almost everything.” He cackled at his own joke and stepped out of his car.

The glass doors at the entrance slid open to a facility that was bright and clean without feeling overwhelmingly institutional. Doctors’ and administrators’ offices were up a sweeping staircase ahead. Women at the front desk nodded their hellos, and Pereira greeted them warmly: “Good afternoon, my darlings.”

The Olhão centre was built for just under €3m (£2.6m), publicly funded, and opened to its first patients nine years ago. This facility, like the others, is connected to a web of health and social rehabilitation services. It can house up to 14 people at once: treatments are free, available on referral from a doctor or therapist, and normally last between eight and 14 days. When people first arrive, they put all of their personal belongings – photos, mobile phones, everything – into storage, retrievable on departure.

“We believe in the old maxim: ‘No news is good news,’” explained Pereira. “We don’t do this to punish them but to protect them.” Memories can be triggering, and sometimes families, friends and toxic relationships can be enabling.

To the left there were intake rooms and a padded isolation room, with clunky security cameras propped up in every corner. Patients each had their own suites – simple, comfortable and private. To the right, there was a “colour” room, with a pottery wheel, recycled plastic bottles, paints, egg cartons, glitter and other craft supplies. In another room, coloured pencils and easels for drawing. A kiln, and next to it a collection of excellent handmade ashtrays. Many patients remained heavy smokers.

Patients were always occupied, always using their hands or their bodies or their senses, doing exercise or making art, always filling their time with something. “We’d often hear our patients use the expression ‘me and my body’,” Pereira said. “As though there was a dissociation between the ‘me’ and ‘my flesh’.”

To help bring the body back, there was a small gym, exercise classes, physiotherapy and a jacuzzi. And after so much destructive behaviour – messing up their bodies, their relationships, their lives and communities – learning that they could create good and beautiful things was sometimes transformational.

“You know those lines on a running track?” Pereira asked me. He believed that everyone – however imperfect – was capable of finding their own way, given the right support. “Our love is like those lines.”

He was firm, he said, but never punished or judged his patients for their relapses or failures. Patients were free to leave at any time, and they were welcome to return if they needed, even if it was more than a dozen times.

He offered no magic wand or one-size-fits-all solution, just this daily search for balance: getting up, having breakfast, making art, taking meds, doing exercise, going to work, going to school, going into the world, going forward. Being alive, he said to me more than once, can be very complicated.

“My darling,” he told me, “it’s like I always say: I may be a doctor, but nobody’s perfect.”

The Common Line

DRUG LAW REFORM. Public safety most important thing – Ross Bell, NZ Drug Foundation.

In response to a piece from Herald columnist John Roughan, the Drug Foundation’s Executive Director Ross Bell argues that public health and safety should be our starting point for debate on drug law reform, not the cost of enforcing the law.

Legalising and regulating cannabis is something John Roughan says would be like reliving the bad early days of the ill-fated Psychoactive Substances Act. But what happened after the passing of the Act in 2013 is a bad predictor of the prospects for drug law reform.

When outlets selling “legal highs” were drastically cut overnight we witnessed people congregating outside the few stores still selling the substances. The public outrage was palpable. It was a classic PR disaster. Public education about the purpose of the Act was sorely missing and a beleaguered regulatory authority struggled to put proper rules in place.

To assuage the public, MPs amended the Act, making it unworkable. Sadly, we are now reaping the results of this. Rather than low harm substances being regulated for sale with government oversight, all substances are illegal.

The result is a myriad of novel psychoactive substances now for sale on the black market, where their safety cannot be assessed. As was extensively reported last year, some of these new drugs are deadly.

The other law covering illicit drugs is the Misuse of Drugs Act. This was written in 1975 to deter people from using drugs like LSD, heroin, cocaine and cannabis. It is just not working. Every year thousands of people are convicted for possessing or using drugs, but New Zealand still has some of the highest rates of use in the world. Police, many MPs and researchers all say that we can’t arrest our way out of this situation.

Fortunately, we have plenty of examples to draw on of countries that have reformed their drug laws. None of the dire things predicted have come to pass.

The Drug Foundation – established by doctors in 1989 – argues there is a strong case for significant law reform. This will take more than changing the status of cannabis.

Building on the Law Commission’s 2011 recommendations to amend the Misuse of Drugs Act (1975), we argue the current law should be replaced with one focused on health.

There are three pillars.

The first of three is the removal of criminal penalties for possession or use of ANY drug.

This is what we mean by decriminalisation. A caution would be issued by Police if they come across someone using drugs. A referral for a health intervention would be part of this.

Police could then concentrate on serious crime, including the supply of dangerous drugs, and people could get help early before their drug use becomes a serious problem. Conviction and punishment is restricted to those supplying drugs.

With lower risk cannabis, we call for a different approach – legalisation rather than decriminalisation. It would be legal to grow, sell or use cannabis, within a carefully regulated market. Measures would be taken to protect young people and keep health protections central.

The finer detail requires thorough debate.

The cost of enforcing these regulations shouldn’t be seen as an obstacle to sound policy. For instance, under a legal model the costs of administering regulations can be recovered through a levy on sales.

As a society we regulate many things that are risky, including alcohol sales, tobacco use, sky diving, the list goes on. Even if we don’t agree with the choices some people make, a caring society looks out for everybody, including those that use drugs. The suggestion that people are on their own if they do this is devoid of the compassion we so desperately need.

In our proposal Whakawātea te Huarahi: a model drug law to 2020 and beyond, we show that in countries which reformed their drug laws significant public health and safety gains have been made. This is why Canada is just months away from allowing legal cannabis sales to adults.

The first two pillars will only work if the third is implemented: increase funding and capacity of those delivering education, prevention and treatment.

In the lead-up to the referendum on cannabis, we look forward to debating workable solutions that put health and safety first.

Ross Bell, NZ Drug Foundation Executive Director

NZ Herald

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New Zealand Drug Foundation

Whakawātea te Huarahi – A Model Drug Law to 2020 and Beyond (July 2017)

The way New Zealand responds to drugs is not keeping up with a changing world. A move to treating drug use as a health issue rather than a criminal one is long overdue. In July 2017 the Drug Foundation released Whakawātea te Huarahi, a bold roadmap for drug law reform in Aotearoa New Zealand.

The model drug law is based on evidence and research from New Zealand and around the world about the best way to reduce the harms caused by both drugs and our current drug law.

‘Whakawātea’ means to clear, free up, cleanse or purify spiritually, while ‘huarahi’ is a pathway, road or track. The title of our model drug law is intended to signify a fresh start for the debate on drug policy and a sense of movement towards a better future.

Our model drug law proposes:

– Removing criminal penalties for the possession, use and social supply of all drugs
– Developing a strictly regulated cannabis market
– Putting more resources into prevention, education and treatment.

The current laws prevent people accessing help when they need it, and they leave thousands every year with a conviction that impacts on employment, relationships and travel. Implementing the model drug law will minimise the harms caused by drug use, while promoting human rights and improving equity for Māori.

New Zealand Drug Foundation

Download Whakawātea te Huarahi PDF

This 30 minute talk by Kali Mercier, Principal Policy Adviser, presents Whakawātea te Huarahi: A model drug law to 2020 and beyond. Recorded 5 July 2017.

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Moving to a healthy drug law by 2020

New Zealand prides itself on being a trailblazer in progressive reform: think marriage equality, the anti-nuclear act, the welfare state and women’s suffrage.

In 2017, we again have the chance to lead the way by burying the failed War on Drugs and putting health at the core of our drug laws and policies.

Both in the political and the public spheres, we have many areas of consensus to build on. For example, we all agree that drugs can – and do – cause harm to some individuals and to wider society. A key goal of law change, therefore, should be to reduce the risk of harm.

There is also sweeping agreement that our current drug control efforts are themselves causing harm. In a democratic country, punishment should be proportionate to the injury caused by the crime.

This is not the case at present. What we have is a regime that burdens young people with drug convictions that stay with them for years and sometimes for their lives. This makes it difficult – if not impossible – for them to obtain jobs and participate fully in society.

On top of that, drugs cost us a lot. The New Zealand Drug Harm Index estimated the total social cost of illicit drug-related harms at $1.8 billion in the 2014/15 year. In that year, the Ministry of Health spent $78.3 million on interventions, while the Police, courts and Department of Corrections spent $273.1 million, mostly on enforcement of our laws.

Money is accordingly being used on ineffective attempts at enforcement rather than being spent constructively on a health-focused approach. We would reverse the ratio of spending. The public is ready to support change. A poll commissioned by the NZ Drug Foundation last year found 64 percent of respondents believe possession of a small amount of cannabis for personal use should either be legal (33 percent) or decriminalised (31 percent).

The results confirm a shift in the community’s mood: regardless of party affiliation, there is consistent support for moving away from the current criminal justice approach to drugs.

We also have growing political support for a new approach, including progressive drug policies developed by United Future, the Greens and The Opportunities Party.

We are fortunate that reforming our drug law does not require us to start from scratch. Within the confines of the Misuse of Drugs Act 1975, we are already under way with positive change.

Excellent drug harm-reduction policies we currently have in place include our needle exchange programmes, opioid substitution treatment, Police warnings and diversion for minor offences and the Alcohol and Other Drug Treatment Court, Te Whare Whakapiki Wairua, in Auckland.

There are also iwi and community justice panels operating in some parts of the country. These provide a constructive means of dealing with minor offending. On top of that, a lot of the thinking needed to underpin a new, health-based approach to drug regulation has already been done. The Law Commission spent four years researching and consulting the public about drug laws between 2007 and 2011.

More than 3,800 submissions were made on its review, meaning that a very broad cross-section of New Zealand was canvassed before the Commission released its final 350-page report.

The Commission made 144 detailed proposals for reform, including calling for repeal of the Misuse of Drugs Act and its replacement with a new law administered by the Ministry of Health.

The report recommended adopting a more effective approach to personal drug use by directing people away from the criminal justice system and into education, assessment and treatment.

New Zealand’s National Drug Policy 2015–2020 dovetails with that approach. It aims to prevent and reduce the health, social and economic harms linked to drug use and to promote and protect health and wellbeing.

The policy regards drug use as a health and social issue and emphasises health-based approaches. This makes it a good springboard from which to launch change.

Five goals we should all be aiming for

Model drug law

In 2017, the time is ripe for us to set a new course and make real our vision of an Aotearoa free from drug harm. So we’ve come up with a model drug law that is about just that. It is built on evidence, research and experience. But it is not our final say – it is a conversation starter. We want to hear from you about how we can improve it.

The model drug law we propose has five key goals (see right), including safer communities as a result of less drug-related crime and minimising the harm individuals, whänau and the community experience from drug use.

These aims have been developed from community workshops we have held around New Zealand over the past year, and they also mesh well with international research on drug reform.

Decriminalise use

The first part of our model drug law is based on the Law Commission’s 2011 recommendations and the Portuguese model of reform. Portugal decriminalised the use of all previously illicit drugs in 2001 and invested heavily in prevention, treatment and harm reduction.

Drug use is still prohibited in Portugal, but it does not result in criminal penalties in most cases. Portugal’s experience has been that this approach has decreased drug use among young people, led to fewer people in jail and reduced HIV infections and overdoses.

We support repealing the 42-year-old Misuse of Drugs Act and replacing it with a new law administered by the Ministry of Health. Possession, use and social supply would be decriminalised, and possession of drug utensils would no longer be an offence.

As recommended by the Law Commission, Police coming across someone in possession of drugs would issue a caution notice, provide information about how to get help and confiscate the drugs.

After a set number of cautions –depending on the legal classification of the drug – a person would be required to attend a brief intervention session or be prosecuted. Brief interventions would involve a preliminary screening and a discussion about the risks of drug use and whether the person would benefit from social support or treatment.

People who failed to attend the brief intervention session would be prosecuted. As the aim is to keep the focus on improving health outcomes, the small number of people convicted would face low fines or the option of attending treatment programmes.

The model drug law would also require us to review and reclassify current scheduled drugs according to the harm they pose, as there are many inconsistencies in the current classifications.

We also think the current penalties for dealing and manufacturing drugs need review. For example, the current maximum penalty of life imprisonment for dealing in Class A drugs puts such activity on a par with murder, which we consider to be disproportionate.

Portugal has invested heavily in drug treatment and prevention

Regulate cannabis

Our model also has a separate section covering cannabis. Social and cultural norms about cannabis are changing, as demonstrated by the 2016 poll and by the legalisation of cannabis in eight American states as well as some type of decriminalisation or legalisation in 44 countries.

We know that a majority of people use cannabis without serious health harm. However, a small proportion experience negative impacts such as anxiety, depression, memory loss and mood swings.

Those with sustained use face long-term health risks such as respiratory disease (if smoked) and mental illnesses such as schizophrenia, at least for those who may be predisposed.

Cannabis also carries the risk of dependency in around one in 10 users. Heavy use by young people has been linked to poorer outcomes in education and employment as well as a reduction in IQ points, although the research on this is mixed.

We want to create a system that will make it more difficult for those under 18 to access cannabis than it currently is and will make it easier for anyone struggling with their use to access support. Our regime also aims to discourage mixing alcohol, tobacco and cannabis and to provide excellent prevention, education and treatment. We believe this can be achieved by replacing our current prohibition system for cannabis with a regulatory system.

This certainly does not mean open slather or a free commercial market. In an entirely profit-driven market, companies would target heavy users and increase harm from cannabis (as indeed occurs currently). For that reason, we need to regulate any market.

The NZ Drug Foundation’s proposal for a model drug law would start with very strict controls, which could be amended as appropriate over time. We want to avoid making the same mistakes that were made with alcohol and tobacco, where powerful industries with vested interests resist regulatory changes intended to put health before profit. It makes sense to start cautiously and monitor the impacts as we go.

We advocate for a regulated market for cannabis, which keeps health interests central. There is already a regulatory system set out in the Psychoactive Substances Act 2013 that could be modified to accommodate the development of a cannabis market. The purpose of that Act aligns perfectly – it aims to regulate the availability of psychoactive substances to protect health and minimise harm.

We propose that licensed premises would sell only cannabis, cannabis-related paraphernalia and plant seeds. Businesses would be prohibited from selling alcohol and tobacco alongside cannabis to minimise the risk of compounding harms or creating new cannabis markets.

The locations and opening hours of licensed premises would be strictly regulated. There would be no retail outlets near schools, for example. Communities would have a say in whether premises were permitted in their areas.

Workers in cannabis shops would have training in health issues relating to cannabis, such as keeping an eye out for signs of dependency. Only those over 18 would be allowed entry, and all products would be stored securely behind the counter.

From a purely health perspective, setting the age limit at 20 or even higher would be the best option. However, this would create avenues for a black market to flourish, as a large percentage of those who already use cannabis are between the ages of 18 and 20. It makes sense to align the cannabis age with the legal alcohol purchase age and then focus on minimising harm through health interventions.

The alternative to prohibition does not have to be a free commercial market. There is a whole spectrum of different policy options, as shown by this diagram from the Global Commission on Drug Policy

We do not want to encourage the development of a wide range of cannabis products, as this could encourage new users, especially young people. It would go against public principles to allow THC gummy bears for sale or for people to sell special brownies at farmers’ markets, for example. Therefore, if edible products are to be available, these should be licensed for sale on a case-by-case basis. A licence could only be issued if manufacturers demonstrate a low risk of harm and meet other criteria.

We also want to keep profits in communities and stop Big Cannabis from gaining a stranglehold on the market. We would therefore restrict farm size by keeping each grower below a maximum number of plants. A government body would license all suppliers, but the number of suppliers and amount of product produced would depend on the market. We support supply models that will enable disadvantaged regions to benefit from growing cannabis. This could be done by keeping licensing requirements simple and inexpensive and helping current small-scale suppliers move from the black market into a regulated market – for example, by providing pre-approved packaging and assisting with taxes and forms.

A levy would be taken at the point of sale, with the money collected going back into covering administration costs as well as education, treatment and prevention programmes. Our model also provides for people to grow their own plants. We think three plants per adult, with a maximum of six per household, would be a reasonable number. There is no science to setting a limit on the number of plants allowed. Some jurisdictions – such as Washington State – allow none, while others allow six or more. Our compromise of three plants would allow people to grow enough for their own needs but not so much that a black market would be created.

It is worth noting that, in New Zealand, people are allowed to grow tobacco and brew their own alcohol, but very few people actually do either.

We envisage the situation would be the same with cannabis once the novelty of growing plants at home wore off. Restricting advertising is a key way to reduce demand for a product, so we support plain packaging with health warnings, limited shop frontage advertising, no advertising outside licensed venues and no sponsorships or gifts. We don’t envisage seeing The Cannabis Shack netball or rugby team.

We want to avoid the product looking too glamorous and exciting. At the same time, we do not want it to be so standardised that the black market steps in to fill already-existing niche requirements for products. For those reasons, it is important the growers can establish brands by displaying their logos and information identifying the provenance of the cannabis and its effects.

Licensed premises would be required to display public health information prominently, explaining to people how to moderate use and detailing how to access help for drug-use issues.

There would be a limited online market, possibly organised similarly to a Trade Me page. Obviously, there are risks that those under 18 could seek to purchase online, but these can be guarded against by ensuring that the person who accepts the product delivery is the same person named on the credit card used for the purchase.

Another option would be using a RealMe account to prove identity. Even in a legal market, there need to be penalties for not sticking to the rules.

Once again, the Psychoactive Substances Act already provides a good model. This would mean those selling cannabis to people under 18 could be fined up to $5,000, while under 18-year-olds buying cannabis would face fines of up to $500. There would be penalties for manufacturing or selling without a licence and for making misleading licence applications.

The government would control cannabis prices to restrict demand – as it does for alcohol and tobacco. We suggest minimum pricing as well as a regime of levies that would be earmarked to fund treatment services.

We have learned from regulating the tobacco industry that keeping prices high is one of the key ways to reduce use. Cannabis would be taxed according to its potency. Those using higher-potency products are most at risk of harming themselves, so consumption of high potency products would be moderated by higher prices.

The NZ Drug Foundation supports regular reviews of the law to ensure it is working and not having negative health impacts.

As well as improving health and reducing the long-term harm and stigma of convictions, our approach makes economic sense. A Treasury official in 2016 calculated that legalising cannabis would save $400 million a year on drug prohibition enforcement and reap an extra $150 million in tax revenue.

There would be no need for separate laws regulating medical cannabis because the therapeutic use of cannabis would no longer be illegal. Cannabis-based medicines would continue to be available through the pharmaceutical approvals model.

We would like these medicines to be easier to access and fully subsidised.

What’s in it for Māori?

An important element of our model law is Māori equity. Te Tiriti o Waitangi provides guarantees to Māori about their status and treatment.

The disproportionate drug prosecution and conviction rates for Māori – who comprised 41 percent of those given jail terms for drug offences between 2010 and 2014 – is discriminatory. Among cannabis users, 3.4 percent of Māori , compared with 1.9 per cent of others, reported legal problems from their cannabis use in the past 12 months.

We believe the model law will benefit Māori by reducing health harms from drug use and drastically reducing the number of drug convictions. Equity could actively be promoted by ensuring Māori experience any economic benefits of law changes.

In the United States, indigenous American tribes from California to New York legalised cannabis in their tribal areas in 2015, and a number of tribes began tribal cannabis-growing operations. We are actively seeking Māori/iwi feedback on this proposal to explore whether there is similar potential for Māori communities in New Zealand.

Eliminating harms

We are very realistic about our proposals. Smarter drug regulation cannot by itself eliminate drug harm. Reform needs to be accompanied by upscaled harm prevention. We need effective education, strong drug harm prevention standards, better access to treatment and drug early-warning information systems. Portugal’s success with its decriminalisation policies to a large extent rests on the fact it combined new drug laws with a hefty investment in prevention, education and treatment.

We are calling for a doubling of investment in addiction treatment and support services to eliminate waiting lists. The $350 million spent every year on drug-related issues should be targeted away from enforcement and into treatment, support and prevention. In the past year, around 50,000 people wanted help to reduce their alcohol or drug use but did not receive this support. At present, we only spend 3 percent of the total health budget on addiction services, and this needs to increase. We would also like to see increased spending on community-based and whänau-centred services, including those that focus on young people.

Low-threshold approaches such as online and self-help options should be made available, and there should be a government-funded destigmatisation campaign to reduce negative public perceptions of people who use or depend on drugs or who are in recovery from drug use. Likewise, those in prison should have much. better access to drug and alcohol treatment, both in jail and after their release.

The NZ Drug Foundation also supports helping young people remain in education by strengthening supportive school cultures to reduce disengagement and exclusion resulting from drug or alcohol use.

The NZ Drug Foundation’s timeline for reform takes us to 2020 and beyond

Where to from here?

We see a staged approach to bringing in the model law. A review of the offences and penalties for drug use and possession required by the National Drug Policy is due to start in the second half of this year, which makes now an ideal time to start working on introducing a Portuguese-style model of decriminalisation here.

To do this, we propose the government drafts a new drugs Bill in 2018 to be administered by the Ministry of Health. A public information campaign on the Bill could take place in 2019 prior to submissions being called by select committee. We would like to see the new law in force by 1 February 2020.

Meanwhile, the Psychoactive Substances Act is up for review in 2018. This is therefore the right time to reform it, both to make it work as it was intended and with an eye to bringing the regulation of cannabis into the revised Act. After 2020, cannabis could be removed from what is currently the Misuse of Drugs Act 1975 and reclassified as a low-harm substance falling under the Psychoactive Substances Act.

This would enable a regulated market to be developed. Five-yearly reviews of the Psychoactive Substances Act and the new drugs law would be built into the legislation.

The War on Drugs has been raging for more than four decades. In that time, it has consumed billions of dollars and failed utterly to cure the harms it seeks to address.

In May, the Police admitted that this country’s meth problem was getting worse and that their battle against it had achieved “no visible impact”. In fact, in 2016, the Police seized more than twice as much meth as in any other year, but this had no impact on the drug’s availability.

We know our proposals are likely to cause controversy and concern. But it is time for a new, evidence-based approach that will actually curtail the harms New Zealand must urgently address.

Tough talk on drugs might sound good, but it is achieving nothing.

New Zealand Drug Foundation

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Portugal decriminalised drugs 14 years ago – and now hardly anyone dies from overdosing.

The country has 3 overdose deaths per million citizens, compared to the EU average of 17.3.

Chris Ingraham, 6 June 2015

Portugal decriminalised the use of all drugs in 2001. Weed, cocaine, heroin, you name it — Portugal decided to treat possession and use of small quantities of these drugs as a public health issue, not a criminal one. The drugs were still illegal, of course. But now getting caught with them meant a small fine and maybe a referral to a treatment program — not jail time and a criminal record.

Among Portuguese adults, there are 3 drug overdose deaths for every 1,000,000 citizens. Comparable numbers in other countries range from 10.2 per million in the Netherlands to 44.6 per million in the UK, all the way up to 126.8 per million in Estonia. The EU average is 17.3 per million.

Perhaps more significantly, the report notes that the use of “legal highs” – like so-called “synthetic” marijuana, “bath salts” and the like – is lower in Portugal than in any of the other countries for which reliable data exists. This makes a lot of intuitive sense: why bother with fake weed or dangerous designer drugs when you can get the real stuff? This is arguably a positive development for public health in the sense that many of the designer drugs that people develop to skirt existing drug laws have terrible and often deadly side effects.

Drug use and drug deaths are complicated phenomena. They have many underlying causes. Portugal’s low death rate can’t be attributable solely to decriminalisation. As Dr. Joao Goulao, the architect of the country’s decriminalization policy, has said, “it’s very difficult to identify a causal link between decriminalisation by itself and the positive tendencies we have seen.”

Still, it’s very clear that decriminalisation hasn’t had the severe consequences that its opponents predicted. As the Transform Drug Policy Institute says in its analysis of Portugal’s drug laws, “The reality is that Portugal’s drug situation has improved significantly in several key areas. Most notably, HIV infections and drug-related deaths have decreased, while the dramatic rise in use feared by some has failed to materialise.”

As US state legislatures debate with issues like marijuana legalisation and decriminalisation in the coming years, Portugal’s 15-year experience may be informative.

The Independent

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Epidemic of drug addicted parents sweeps the United States. 

Passed out on the supermarket floor, her daughter pulls at her limp body, crying out for help.

It’s a confronting scene; toys are spilt across the floor and the mother is well and truly out cold – despite her daughter’s desperate attempts to rouse her.

This is just one of the faces of the parental opioid epidemic – one that is sweeping the United States with aggressive speed.

Police say the woman, who was charged with child endangerment, overdosed on an oral version of the drug heroin, or an opiate-based narcotic that’s becoming increasingly ingested by addicts and their children.  NZ Herald 

The Marijuana Boom Is Contributing to the Climate Crisis. 

A new report finds that marijuana cultivation accounts for as much as 1 percent of energy use in states such as Colorado and Washington. The electricity needed to illuminate, dehumidify, and air-condition large growing operations may soon rival the expenditures from big data centers, which themselves emit an estimated 100 million metric tons of carbon into the atmosphere every year. TakePart 

We ought to grow it outdoors in places suitable for it. Seems logical. There are plenty of suitable places around the world to grow pot on a large scale commercially.