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Welcome to the inquiry from the BBC World Service. I'm David Baker. Each week, one question, four expert witnesses and an answer. It's a shocking sight. Images on Portugal's evening news program Journal de Noyte zoom in on blood filled syringes discarded near a children's playground in central Lisbon. Men smoke crack in the street as shoppers squeeze past. Drug dealers openly do business in side streets just minutes away from the city's tourist attractions. And local residents are voicing their concerns. This woman, who lives in a street favoured by dealers and users, says a friend of hers has to accompany her daughter everywhere as it's too dangerous for children to leave the house by themselves. In 2001, Portugal decriminalized the use of all drugs in the country as an alternative to the idea of waging a war on drugs. But now, 25 years on, that decision is showing its age. So for the inquiry this week, we're asking, is Portugal's drugs policy in need of reform?
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Part 1 rehab rather than prison
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Our
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first witness is Joanna Teixeira, Executive board president of ICAD, Portugal's National Institute for Drug Addiction. By the late 1990s, drug use was rife in Portugal. Joanna says that some drug users were even weaponizing used syringes.
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Citizens were afraid because there was a lot of syringes and a lot of crimes, and sometimes the syringes were used to threat people in the streets.
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The drug many of those people were using was heroin, which had been mainly introduced into the country in the 1970s by Portuguese soldiers returning from wars in the country's newly independent colonies.
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They were returning from Angola, Mozambique and Guinea Bissau, and they had been exposed to various illicit substances, and they came to Portugal and bring those substances with them.
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This was a time of rapid social change in the country. Portugal had only just come out of almost 50 years of dictatorship, and it had gone quickly from near isolation to full exposure to European drug markets, with very little preparation or infrastructure to cope. By the 1990s, an estimated 100,000 people were using heroin in the country, 1% of the country's population.
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Addiction of heroin was spread along all classes, so poor families or the most richer families also had drug addiction problems in their families.
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That soon turned into a public health emergency. By the end of the 1990s, more than 350 people a year were dying from drug overdoses. And the country had the highest rate of HIV infection among injecting drug users in Europe, with more than 1,000 new cases a year. It was time to act.
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We had so big health problem and social problem in our society that the government allowed these measures in a desperate solution to see if this could really help control of the situation in our country.
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The proposal, which had virtually unanimous cross party support, was to change the law so that drug use was treated as a health issue and rather than as a matter for the courts. And in 2001, Portugal decriminalised the possession and consumption of all illicit drugs for personal use.
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The main purpose of the law was the basic concern to give priority to treat the offenders rather than applying sanctions. So it was better to send a drug addict for treatment than to prison.
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And that approach still guides Portugal's drugs policy today.
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When an individual is caught with a small amount of drugs for personal use, and the police do not suspect or have evidence that this person is involved in drug selling or dealing, the drugs are apprehended and the case is sent to the Drug Addiction Dissuasion Cross Commission. The commission makes a psychological and social evaluation of the offender and will then apply the appropriate decision according to the profile of the individual. If the offender is not willing to undergo treatment, then the hearing is suspended and the offender is sent to the technical unit in order to convince him or her to accept treatment.
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That technical unit comprises psychologists, addiction counsellors and social workers. But Joanna says the key difference to how other countries deal with drug users is that they're not sent to prison,
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they are not in custody in the commission. Commission is in the community and in health system, not in justice system.
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And that also brings a financial benefit for the state.
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If someone goes to jail, it's more expensive than to Treat the individual almost instantly.
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The new policy delivered results. By 2003, just two years into the program, deaths by overdose and new cases of HIV among injecting drug users had both more than halved. But now, 25 years after decriminalization was introduced, new drugs and new demographics are starting to challenge the way the policy works. Time for our second expert witness.
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Part 2 the arrival of crack cocaine.
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All the programs and the services established in the late 90s and the beginning of this millennium were addressing the big and most problematic use that was heroin.
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Our second witness is Luis Mendou, Director General of Grupo de Atavistas Intratamentis, or gatt, a non governmental body that works with drug users focusing on health and harm reduction. He was also closely involved in the discussions in the 1990s that led to Portugal's decriminalization policy. GATT is based in the capital Lisbon, in the district of Muraria, the very area of the city we heard about in the news reports at the beginning of the program. He says that while heroin use has declined, the country has seen a rise in the use of crack or crack cocaine, a smokable, highly addictive form of cocaine that produces an intense but short lived high.
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Currently we have an epidemic among the poor of crack and of other stimulants, and we don't have as good medical interventions or even harm reduction tools for these new substances.
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One of the impacts of crack has been a sharp increase in demand for GATT services. And that has been compounded by the arrival of a large number of migrants into Lisbon.
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One of our main goals was to bring people to health care, to harm reduction and stop injecting and smoking in the streets. And I think that until COVID epidemic we were very successful. But there was a huge increase in drug consumption in Lisbon after Covid that was concentrated more in people that did relapse in drug use and also in migrants. And many, many of them are also from countries where there is a tradition culture of substance use and when they go out in the streets, lose their jobs, are in very precarious situations, the consumption tends to increase.
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One of the services GATT offered until recently were two consumption rooms, one for injecting users and the other for people who smoke drugs, where users could take drugs in a safe environment and have access to information and support. But two years ago the organization had to shut the smoking room down due to over demand.
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The problem is that our facilities are very, very small. 90% of the people consumption in the streets are smoking with pipes, crack and other drugs. And we don't have physical capacity to attend the smokers in the consumption room. There were moments when we had 200 people on the streets waiting in line to enter for smoking. And this is creating no safety for anyone.
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And he'd like to see more consumption rooms like gatts opened around the city. But funding is hard to come by. Portugal's economic crisis and subsequent austerity measures in the early 2010s led to budget cuts for drug services. And current issues like the rising cost of living have contributed to a shift in people's focus.
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The investment is too small. Currently, drug use is very low in the priorities for the Portuguese population. So politicians tend to not invest in something that is not in the center of the media debate.
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And not everyone, of course, would welcome the idea of a drugs consumption room near where they live. But Louis says after some initial resistance, GATT's relations with its neighbors are now good.
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It's old people mainly that live there because the houses became too expensive. So they were very suspicious. They said, we don't want a service next door. But also the people using drugs that were hired and work in Molaria were very gentle to these old people. And they helped them with the shops, things that they buy. And after probably six months, this old lady, as the head of the group, saying that we approve your presence here and that you are contributing to our safety for the well being of these poor people that are using drugs, etc. So this is something that we are very proud.
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Luis is convinced of the value of consumption rooms like gatt's, not only to get drug users off the streets, but to help them rebuild their lives. And he's open about his desire to see drugs not just decriminalized, but available in a way that undermines the dealers in Portuguese.
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We need to go further on providing more places, one stop shop with different services, including consumption. We need to offer also services to drug shacking because we have huge problems with the quality of the street drugs. And we need to increase the legal possibility of safe places for cannabis or medical prescription or other ways of access to medical products. So in order to take out the power of the narco crime that is invading our societies, how optimistic are you
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that we will see that future in Portugal?
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I am skeptical, but I believe that we are right and that we need to bring the better among us and the best knowledge together to go. Be it in small reforms, be it in a more complete system, we need to go there.
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you're listening to the inquiry from the BBC World Service. Our third expert witness is coming up in a moment, but just a quick reminder, you can catch past episodes wherever you get your podcasts including Are synthetic opioids a global problem or can seawater save Venice from sinking? Just search for the inquiry in your podcast app and thanks for listening.
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Part 3 Fighting crime
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Portugal is not different from other parts of Europe. Right now we have an increasing number of cases with cocaine. Because there is a huge number of seizures in Europe. There are a lot of individuals that are consuming a huge amount of doses daily.
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Our third witness is Antonio Leitauda Silva, a police superintendent and the chief of police in Braga, a region in the northwest of Portugal. Before that he was based in Porto for 18 years. He says that drugs are now more visible on Portugal's city streets.
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I have to say that the public exposure right now is higher than it was in the past. If you have more drugs circulating, few support structures for supervised consumption facilities and less investment, inevitably you will see more drug companies consumptions taking place in public spaces. And if we have an increase of drug use, it's most likely we're going to have an increase. I'm not talking about just petty crimes, but property crimes.
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Drugs may be decriminalised, but they're still illegal. Police still have the powers to stop and search. The difference, as we heard from our first witness, is that anyone caught with drugs is referred to the dissuasion commission to hopefully access treatment. Separating users from dealers, however, is not straightforward.
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Most of the drug users dealers, they are carrying small amounts of drugs that they can usually justify, that is for their own consumption. It requires a little bit more of effort from the police side just to gather evidence saying that this particular individual is not just carrying drugs for their own consumption, but for drug dealing. But if you have enough evidence, we can put him or her straight to the criminal system.
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What is the attitude amongst your police colleagues to decriminalization? Do they all welcome it or is there some resistance?
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I think that this will require a change of the police mindset and probably is a challenge for a generation of police officers, because, you know, the police mind is not something that you switch immediately. But at this stage, well, my police officers are not facing drug uses as they did before 2001.
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He himself remains a strong supporter of Portugal's drug decriminalization policy.
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It would be a huge step back if someone would change the law, because we are talking about human beings, we are talking about a disease much more than a criminal activity. Unfortunately, all of us, we have connections from our family, from our friends. We have always identified an individual that has problems with drugs.
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And although he acknowledges that the policy is not without its challenges, he's confident the country is heading in the right direction, especially compared with other countries in Europe. In 2021, the latest figures that are available, Portugal had 11 drug induced deaths per million people. Ireland, by contrast, had 82.
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I know that this debate surrounding supervised consumption rooms remain complex and sometimes controversial. I know that are critics that usually argue that these facilities may normalize drug use or maybe create concerns within local communities. But I tend to believe that the harm reduction measures grounded in public health evidence, aim to protect both individual and society as a whole. For example, the drug consumption facilities in Lisbon, they just opened in 2021, and in Porto in 2022. In Porto, since 2022, there were 400,000 consumptions made inside of this facility. That means we had 400,000 consumptions that were taken out from the streets. If we compare our numbers, for example, drug related deaths with other countries, well, our system at the end of the day works.
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So if it does indeed work, why hasn't Portugal's approach been replicated elsewhere? Time for our final witness.
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Part four Exporting the model.
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The interest in Portugal in the last 25 years has been extraordinary.
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Our fourth witness is Keith Humphries, professor of psychiatry at Stanford University in the US and a specialist in addiction and drug policy.
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At the same time, usually when people have said, we're doing what Portugal did, they've often done something different. So there's the real Portuguese policy, and then there's the Portuguese policy as translated to different nations around the world.
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One of the problems replicating Portugal's policy elsewhere, he says, is that Portugal is a conservative society. And whatever the law says there is social pressure not to do drugs.
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Our behavior is shaped by both law and culture. Portugal is a country that was a dictatorship in living memory, has a Catholic inflected communitarian culture, strong families. Often it's not just that your parents live down the street, but also that they're going to keep a watch over you. And if you use drugs on the street, your mom might find out. In other countries where families are more scattered, where there's more of an ethic of you should do your own thing, the law forbidding drug use could be much more consequential. And that's been forgotten as people have adapted from Portuguese policy to other places.
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A case in point, he says, is the state of Oregon in the Pacific Northwest in the United States, which decriminalized drug possession in 2020, only to reverse the policy in 2024.
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Oregon adopted what at least the activists claimed was the Portuguese model, although they didn't bring over all of it. Possessing, using drugs in small amounts was essentially legalized. Possessing large amounts of drugs, for example, potentially for sale, was made a much less serious offense. Any pressure to seek services was eliminated. And there was supposed to be a investment of money into more care for people who had problems with drugs. Although that for the most part didn't actually happen. And it was done in a state that has a pretty individualistic and libertarian culture. So it wasn't a perfect translation in that sense. And that may have account for why the results were so disappointing.
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One of the issues was that drug users in Oregon were mostly taking fentanyl, an extremely powerful opioid. And that, combined with the state's hyper liberal culture, led to catastrophic results.
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At a time when violent crime was dropping in the United States, it went up in Oregon. At a time when property crime was dropping in the United States, it went up in Oregon. Oregon had the fastest increase of overdoses out of all 50 states. Those are the official statistics. But the other thing that may have mattered even more, as I saw when I went to Oregon quite often during this time, was just the decay of community life. So more people wanting to take their kids to the park, but you couldn't take your kids to the park because the park was full of people using and dealing drugs. Not being able to walk down sidewalks in some towns because people were laying on the sidewalk unconscious from drug use, those kinds of things reversed what was once a popular policy into something that people became quite strongly in favor of. Repeal, which in fact is what happened.
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That sounds a lot like a more extreme version of the kind of scenes we heard about in the news report from Lisbon at the beginning of this program. But Keith is still sure that Portugal has been right to treat drugs policy as a social rather than a criminal issue.
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Drug addiction is often referred to as a wicked problem in the sense that it is extremely hard to solve and touches many different sectors at once. So intertwined with it are problems in housing, in employment, in mental health, in family breakdown, and therefore the extent progress has been made on it through the years, it has tended to be when governments have made it a priority and made a lot of different agencies that usually don't work together actually join up and exert a concerted response to it.
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Keith recognizes that Oregon's experience has given drugs decriminalization a bad name at the moment.
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Liberal approaches to drug use, I say, are in the shadow when a policymaker from somewhere in the US or another country calls me and says, we'd like you to help us. We're changing our drug policy, but we don't want to be like Oregon. And that's the watchword for failure that has set back efforts in this area, I think, pretty severely.
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So to return to our question, is Portugal's drugs policy in need of reform? Well, drug deaths and HIV infections are still far below the levels the country was facing before 2001, and the policy has taken a huge number of people out of the country's criminal justice system. But as we've heard, it does need tweaking. The arrival of crack cocaine and increasing homelessness in places like Lisbon and Porto are making life miserable for many people who live in those cities, and that has put pressure on a system that was designed for a very different world. In 2001, Portuguese politicians and activists came together to design a policy that would lift the country out of a severe drugs crisis. Perhaps it's now time for new voices to start shaping how the next 25 years will be managed. Thank you for listening to the Inquiry from the BBC World Service. You can find more episodes wherever you get your podcasts. Try Are Orcas okay? Or maybe should we mine the moon? Just search for the enquiry and hit subscribe so you don't miss an update. This episode of the Inquiry was written and presented by me, David Baker. The producer was Jill Collins, editor Tom Bigwood, and technical producer Toby James.
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Summary6 min read

The Inquiry – BBC World Service

Episode Title: Is Portugal’s drugs policy in need of reform?
Date: June 2, 2026
Host: David Baker

Overview

This episode of The Inquiry examines whether Portugal’s much-lauded drugs decriminalization policy, implemented in 2001, is still fit for purpose. The country’s bold approach has long been lauded as a model for public health–oriented drug reform. However, dramatic changes—including the rise of crack cocaine, persistent public concerns, and social pressures—are prompting fresh scrutiny. Through interviews with four expert witnesses, the episode dissects the origins, outcomes, and current challenges facing Portugal’s policy, and situates its experience in a global context.

Key Discussion Points & Insights

1. The Origins and Initial Successes of Portugal's Drug Policy

Expert: Joanna Teixeira, Executive Board President, ICAD (Portugal's National Institute for Drug Addiction)
Timestamps: 02:49–07:29

Pre-2001 Drug Crisis:
- By the 1990s, heroin addiction affected about 1% of the population ("100,000 people"), crossing all social classes (04:13).
- High crime rates and fear; syringes were used as weapons (03:05).
- Health disaster: highest HIV infection rates among injecting drug users in Europe (>1,000 new cases/year) and 350 drug-related deaths annually (04:26).
Policy Shift to Decriminalization (2001):
- Cross-party consensus: treat drug use as a health—and not solely a criminal—issue (05:03).
- People caught with small amounts for personal use are referred to "Dissuasion Commissions," staffed by health professionals who promote treatment over punishment (05:41).
- Quote: “The main purpose of the law was … to give priority to treat the offenders rather than applying sanctions. So it was better to send a drug addict for treatment than to prison.” – Joanna Teixeira (05:22)
- Policy proved cost-effective and effective; deaths by overdose and HIV cases more than halved in two years (07:02).

2. New Challenges: The Arrival of Crack Cocaine

Expert: Luis Mendou, Director General, GATT (Grupo de Atavistas Intratamentis, harm reduction NGO)
Timestamps: 07:36–14:14

Evolving Drug Scene:
- Heroin use has declined, but a “crack epidemic” now affects the most vulnerable, particularly among the poor and migrants (08:33).
- COVID-19 triggered increased drug consumption and relapsing among users (09:02).
- Portugal lacks effective harm reduction infrastructure for crack as opposed to heroin (08:33).
Consumption Rooms & Community Relations:
- GATT ran two drug consumption rooms (injecting/smoking); the smoking room closed due to over-demand, sometimes with 200 people waiting outside (10:18).
- Funding for drug services has not kept up with need, especially after austerity (11:10).
- Initial “not-in-my-backyard” opposition was overcome through community engagement and collaboration; local elderly residents became supporters over time (11:32).
- Quote: "After probably six months this old lady, as the head of the group, [said] ... we approve your presence here and that you are contributing to our safety..." – Luis Mendou (11:43)
Calls for Reform:
- More consumption rooms and legal avenues for safe access to drugs to undermine the criminal market are needed (12:58).
- Quote: “We need to increase the legal possibility of safe places for cannabis or medical prescription ... to take out the power of the narco-crime that is invading our societies.” – Luis Mendou (12:58)

3. Policing, Crime and Public Order

Expert: Antonio Leitauda Silva, Chief of Police, Braga
Timestamps: 15:30–19:29

Increased Public Drug Use:
- Drugs are more visible on public streets, partly due to fewer supervised consumption spaces and less investment (16:02).
- Drug-related crimes (not just petty but property crimes) tend to rise with drug consumption in public spaces (16:02).
Law Enforcement’s Role & Attitude:
- Police still separate users (referred for treatment) and dealers (processed criminally), but the distinction is often difficult to prove (16:49).
- Attitudes among Portuguese police are changing, but a generational shift is still underway (17:27).
- Quote: "We are talking about human beings, we are talking about a disease much more than a criminal activity." – Antonio Leitauda Silva (17:51)
Portugal Compared to Europe:
- Notwithstanding challenges, Portugal's drug-induced mortality remains much lower than elsewhere: 11 per million versus Ireland's 82 per million (18:12).
- Police support for supervised consumption rooms is growing due to their effectiveness at removing drug use from public view (18:31).
- Memorable statistic: In Porto, 400,000 drug consumptions were moved off the streets and into facilities since 2022 (18:31).

4. Can Portugal's Model Be Exported?

Expert: Keith Humphries, Professor of Psychiatry, Stanford University
Timestamps: 19:43–24:03

Portugal’s Unique Context:
- Conservatism, Catholic community values, and strong family structures create social pressure not to use drugs—circumstances not found everywhere (20:21).
- Quote: “Our behavior is shaped by both law and culture. Portugal ... has a Catholic inflected communitarian culture, strong families. ... If you use drugs on the street, your mom might find out.” – Keith Humphries (20:21)
Oregon as a Cautionary Tale:
- Oregon’s 2020 decriminalization failed by dropping pressure to seek treatment, investing inadequately in support services, and operating in a highly individualistic culture (21:06).
- Led to spikes in crime, overdoses, and community decay: “You couldn’t take your kids to the park because the park was full of people using and dealing drugs” (22:02).
- Result: Policy was reversed in 2024, now seen as a model of what not to do (22:49).
- Quote: “When a policymaker ... calls me and says, 'We’d like you to help us. … but we don’t want to be like Oregon.' And that’s the watchword for failure." – Keith Humphries (23:35)
Wider Lessons:
- Addressing addiction requires a coordinated, multi-agency response, touching on housing, employment, mental health and more (23:04).
- Decriminalization abroad is now in the “shadow” of Oregon’s failure, hampering reform efforts elsewhere (23:42).

Notable Quotes & Memorable Moments

"It was better to send a drug addict for treatment than to prison." – Joanna Teixeira (05:22)
“If someone goes to jail, it’s more expensive than to treat the individual almost instantly.” – Joanna Teixeira (06:55)
"Currently we have an epidemic among the poor of crack ... and we don’t have ... harm reduction tools for these new substances." – Luis Mendou (08:33)
“The investment is too small. ... Politicians tend to not invest in something that is not in the center of the media debate.” – Luis Mendou (11:10)
“We approve your presence here and that you are contributing to our safety ...” – Local Lisbon resident, paraphrased by Mendou (11:43)
“We are talking about human beings, ... a disease much more than a criminal activity.” – Antonio Leitauda Silva (17:51)
"Portugal ... has a Catholic inflected communitarian culture, strong families. ... In other countries ... the law forbidding drug use could be much more consequential." – Keith Humphries (20:21)
"We don’t want to be like Oregon." – Keith Humphries (23:35)

Important Timestamps

02:49–07:29 – Portugal’s heroin crisis & shift to public health focus
07:36–14:14 – Harm reduction NGOs & new crack cocaine challenges
15:30–19:29 – Policing, public order, and effectiveness statistics
19:43–24:03 – Portugal vs. US/Oregon: culture clash and reform exportability

Episode Tone

Throughout the episode, the tone is analytical but compassionate. The host and experts combine factual analysis with empathy, emphasizing human stories and drawing a clear distinction between criminalization and health care approaches. There’s realism about current challenges, but also pride in Portugal’s achievements and a call for evidence-based adaptation rather than a return to punitive models.

Conclusion

Portugal’s pioneering drugs policy succeeded in turning a public health catastrophe into one of Europe’s best outcomes for overdose deaths and HIV. However, as Portugal faces new challenges—particularly crack cocaine and social changes—its approach needs updating: more robust harm reduction infrastructure, renewed investment, and perhaps further legal reforms. The international story is more complex; Portugal’s successes don’t always translate elsewhere, as shown in Oregon. As the host concludes, perhaps the next 25 years will require new voices and new ideas to keep Portugal’s model fit for purpose.

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Welcome to the inquiry from the BBC World Service. I'm David Baker. Each week, one question, four expert witnesses and an answer. It's a shocking sight. Images on Portugal's evening news program Journal de Noyte zoom in on blood filled syringes discarded near a children's playground in central Lisbon. Men smoke crack in the street as shoppers squeeze past. Drug dealers openly do business in side streets just minutes away from the city's tourist attractions. And local residents are voicing their concerns. This woman, who lives in a street favoured by dealers and users, says a friend of hers has to accompany her daughter everywhere as it's too dangerous for children to leave the house by themselves. In 2001, Portugal decriminalized the use of all drugs in the country as an alternative to the idea of waging a war on drugs. But now, 25 years on, that decision is showing its age. So for the inquiry this week, we're asking, is Portugal's drugs policy in need of reform?
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Part 1 rehab rather than prison
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Our
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first witness is Joanna Teixeira, Executive board president of ICAD, Portugal's National Institute for Drug Addiction. By the late 1990s, drug use was rife in Portugal. Joanna says that some drug users were even weaponizing used syringes.
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Citizens were afraid because there was a lot of syringes and a lot of crimes, and sometimes the syringes were used to threat people in the streets.
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The drug many of those people were using was heroin, which had been mainly introduced into the country in the 1970s by Portuguese soldiers returning from wars in the country's newly independent colonies.
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They were returning from Angola, Mozambique and Guinea Bissau, and they had been exposed to various illicit substances, and they came to Portugal and bring those substances with them.
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This was a time of rapid social change in the country. Portugal had only just come out of almost 50 years of dictatorship, and it had gone quickly from near isolation to full exposure to European drug markets, with very little preparation or infrastructure to cope. By the 1990s, an estimated 100,000 people were using heroin in the country, 1% of the country's population.
[04:13]
E
Addiction of heroin was spread along all classes, so poor families or the most richer families also had drug addiction problems in their families.
[04:26]
A
That soon turned into a public health emergency. By the end of the 1990s, more than 350 people a year were dying from drug overdoses. And the country had the highest rate of HIV infection among injecting drug users in Europe, with more than 1,000 new cases a year. It was time to act.
[04:47]
E
We had so big health problem and social problem in our society that the government allowed these measures in a desperate solution to see if this could really help control of the situation in our country.
[05:03]
A
The proposal, which had virtually unanimous cross party support, was to change the law so that drug use was treated as a health issue and rather than as a matter for the courts. And in 2001, Portugal decriminalised the possession and consumption of all illicit drugs for personal use.
[05:22]
E
The main purpose of the law was the basic concern to give priority to treat the offenders rather than applying sanctions. So it was better to send a drug addict for treatment than to prison.
[05:38]
A
And that approach still guides Portugal's drugs policy today.
[05:42]
E
When an individual is caught with a small amount of drugs for personal use, and the police do not suspect or have evidence that this person is involved in drug selling or dealing, the drugs are apprehended and the case is sent to the Drug Addiction Dissuasion Cross Commission. The commission makes a psychological and social evaluation of the offender and will then apply the appropriate decision according to the profile of the individual. If the offender is not willing to undergo treatment, then the hearing is suspended and the offender is sent to the technical unit in order to convince him or her to accept treatment.
[06:32]
A
That technical unit comprises psychologists, addiction counsellors and social workers. But Joanna says the key difference to how other countries deal with drug users is that they're not sent to prison,
[06:45]
E
they are not in custody in the commission. Commission is in the community and in health system, not in justice system.
[06:53]
A
And that also brings a financial benefit for the state.
[06:56]
E
If someone goes to jail, it's more expensive than to Treat the individual almost instantly.
[07:03]
A
The new policy delivered results. By 2003, just two years into the program, deaths by overdose and new cases of HIV among injecting drug users had both more than halved. But now, 25 years after decriminalization was introduced, new drugs and new demographics are starting to challenge the way the policy works. Time for our second expert witness.
[07:30]
C
Part 2 the arrival of crack cocaine.
[07:37]
F
All the programs and the services established in the late 90s and the beginning of this millennium were addressing the big and most problematic use that was heroin.
[07:50]
A
Our second witness is Luis Mendou, Director General of Grupo de Atavistas Intratamentis, or gatt, a non governmental body that works with drug users focusing on health and harm reduction. He was also closely involved in the discussions in the 1990s that led to Portugal's decriminalization policy. GATT is based in the capital Lisbon, in the district of Muraria, the very area of the city we heard about in the news reports at the beginning of the program. He says that while heroin use has declined, the country has seen a rise in the use of crack or crack cocaine, a smokable, highly addictive form of cocaine that produces an intense but short lived high.
[08:33]
F
Currently we have an epidemic among the poor of crack and of other stimulants, and we don't have as good medical interventions or even harm reduction tools for these new substances.
[08:52]
A
One of the impacts of crack has been a sharp increase in demand for GATT services. And that has been compounded by the arrival of a large number of migrants into Lisbon.
[09:03]
F
One of our main goals was to bring people to health care, to harm reduction and stop injecting and smoking in the streets. And I think that until COVID epidemic we were very successful. But there was a huge increase in drug consumption in Lisbon after Covid that was concentrated more in people that did relapse in drug use and also in migrants. And many, many of them are also from countries where there is a tradition culture of substance use and when they go out in the streets, lose their jobs, are in very precarious situations, the consumption tends to increase.
[09:58]
A
One of the services GATT offered until recently were two consumption rooms, one for injecting users and the other for people who smoke drugs, where users could take drugs in a safe environment and have access to information and support. But two years ago the organization had to shut the smoking room down due to over demand.
[10:18]
F
The problem is that our facilities are very, very small. 90% of the people consumption in the streets are smoking with pipes, crack and other drugs. And we don't have physical capacity to attend the smokers in the consumption room. There were moments when we had 200 people on the streets waiting in line to enter for smoking. And this is creating no safety for anyone.
[10:50]
A
And he'd like to see more consumption rooms like gatts opened around the city. But funding is hard to come by. Portugal's economic crisis and subsequent austerity measures in the early 2010s led to budget cuts for drug services. And current issues like the rising cost of living have contributed to a shift in people's focus.
[11:11]
F
The investment is too small. Currently, drug use is very low in the priorities for the Portuguese population. So politicians tend to not invest in something that is not in the center of the media debate.
[11:33]
A
And not everyone, of course, would welcome the idea of a drugs consumption room near where they live. But Louis says after some initial resistance, GATT's relations with its neighbors are now good.
[11:44]
F
It's old people mainly that live there because the houses became too expensive. So they were very suspicious. They said, we don't want a service next door. But also the people using drugs that were hired and work in Molaria were very gentle to these old people. And they helped them with the shops, things that they buy. And after probably six months, this old lady, as the head of the group, saying that we approve your presence here and that you are contributing to our safety for the well being of these poor people that are using drugs, etc. So this is something that we are very proud.
[12:41]
A
Luis is convinced of the value of consumption rooms like gatt's, not only to get drug users off the streets, but to help them rebuild their lives. And he's open about his desire to see drugs not just decriminalized, but available in a way that undermines the dealers in Portuguese.
[12:58]
F
We need to go further on providing more places, one stop shop with different services, including consumption. We need to offer also services to drug shacking because we have huge problems with the quality of the street drugs. And we need to increase the legal possibility of safe places for cannabis or medical prescription or other ways of access to medical products. So in order to take out the power of the narco crime that is invading our societies, how optimistic are you
[13:45]
A
that we will see that future in Portugal?
[13:48]
F
I am skeptical, but I believe that we are right and that we need to bring the better among us and the best knowledge together to go. Be it in small reforms, be it in a more complete system, we need to go there.
[14:15]
G
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[14:45]
B
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[15:04]
A
you're listening to the inquiry from the BBC World Service. Our third expert witness is coming up in a moment, but just a quick reminder, you can catch past episodes wherever you get your podcasts including Are synthetic opioids a global problem or can seawater save Venice from sinking? Just search for the inquiry in your podcast app and thanks for listening.
[15:26]
C
Part 3 Fighting crime
[15:31]
H
Portugal is not different from other parts of Europe. Right now we have an increasing number of cases with cocaine. Because there is a huge number of seizures in Europe. There are a lot of individuals that are consuming a huge amount of doses daily.
[15:46]
A
Our third witness is Antonio Leitauda Silva, a police superintendent and the chief of police in Braga, a region in the northwest of Portugal. Before that he was based in Porto for 18 years. He says that drugs are now more visible on Portugal's city streets.
[16:02]
H
I have to say that the public exposure right now is higher than it was in the past. If you have more drugs circulating, few support structures for supervised consumption facilities and less investment, inevitably you will see more drug companies consumptions taking place in public spaces. And if we have an increase of drug use, it's most likely we're going to have an increase. I'm not talking about just petty crimes, but property crimes.
[16:29]
A
Drugs may be decriminalised, but they're still illegal. Police still have the powers to stop and search. The difference, as we heard from our first witness, is that anyone caught with drugs is referred to the dissuasion commission to hopefully access treatment. Separating users from dealers, however, is not straightforward.
[16:49]
H
Most of the drug users dealers, they are carrying small amounts of drugs that they can usually justify, that is for their own consumption. It requires a little bit more of effort from the police side just to gather evidence saying that this particular individual is not just carrying drugs for their own consumption, but for drug dealing. But if you have enough evidence, we can put him or her straight to the criminal system.
[17:18]
A
What is the attitude amongst your police colleagues to decriminalization? Do they all welcome it or is there some resistance?
[17:27]
H
I think that this will require a change of the police mindset and probably is a challenge for a generation of police officers, because, you know, the police mind is not something that you switch immediately. But at this stage, well, my police officers are not facing drug uses as they did before 2001.
[17:47]
A
He himself remains a strong supporter of Portugal's drug decriminalization policy.
[17:52]
H
It would be a huge step back if someone would change the law, because we are talking about human beings, we are talking about a disease much more than a criminal activity. Unfortunately, all of us, we have connections from our family, from our friends. We have always identified an individual that has problems with drugs.
[18:12]
A
And although he acknowledges that the policy is not without its challenges, he's confident the country is heading in the right direction, especially compared with other countries in Europe. In 2021, the latest figures that are available, Portugal had 11 drug induced deaths per million people. Ireland, by contrast, had 82.
[18:32]
H
I know that this debate surrounding supervised consumption rooms remain complex and sometimes controversial. I know that are critics that usually argue that these facilities may normalize drug use or maybe create concerns within local communities. But I tend to believe that the harm reduction measures grounded in public health evidence, aim to protect both individual and society as a whole. For example, the drug consumption facilities in Lisbon, they just opened in 2021, and in Porto in 2022. In Porto, since 2022, there were 400,000 consumptions made inside of this facility. That means we had 400,000 consumptions that were taken out from the streets. If we compare our numbers, for example, drug related deaths with other countries, well, our system at the end of the day works.
[19:30]
A
So if it does indeed work, why hasn't Portugal's approach been replicated elsewhere? Time for our final witness.
[19:38]
C
Part four Exporting the model.
[19:44]
D
The interest in Portugal in the last 25 years has been extraordinary.
[19:48]
A
Our fourth witness is Keith Humphries, professor of psychiatry at Stanford University in the US and a specialist in addiction and drug policy.
[19:57]
D
At the same time, usually when people have said, we're doing what Portugal did, they've often done something different. So there's the real Portuguese policy, and then there's the Portuguese policy as translated to different nations around the world.
[20:10]
A
One of the problems replicating Portugal's policy elsewhere, he says, is that Portugal is a conservative society. And whatever the law says there is social pressure not to do drugs.
[20:21]
D
Our behavior is shaped by both law and culture. Portugal is a country that was a dictatorship in living memory, has a Catholic inflected communitarian culture, strong families. Often it's not just that your parents live down the street, but also that they're going to keep a watch over you. And if you use drugs on the street, your mom might find out. In other countries where families are more scattered, where there's more of an ethic of you should do your own thing, the law forbidding drug use could be much more consequential. And that's been forgotten as people have adapted from Portuguese policy to other places.
[20:55]
A
A case in point, he says, is the state of Oregon in the Pacific Northwest in the United States, which decriminalized drug possession in 2020, only to reverse the policy in 2024.
[21:06]
D
Oregon adopted what at least the activists claimed was the Portuguese model, although they didn't bring over all of it. Possessing, using drugs in small amounts was essentially legalized. Possessing large amounts of drugs, for example, potentially for sale, was made a much less serious offense. Any pressure to seek services was eliminated. And there was supposed to be a investment of money into more care for people who had problems with drugs. Although that for the most part didn't actually happen. And it was done in a state that has a pretty individualistic and libertarian culture. So it wasn't a perfect translation in that sense. And that may have account for why the results were so disappointing.
[21:49]
A
One of the issues was that drug users in Oregon were mostly taking fentanyl, an extremely powerful opioid. And that, combined with the state's hyper liberal culture, led to catastrophic results.
[22:02]
D
At a time when violent crime was dropping in the United States, it went up in Oregon. At a time when property crime was dropping in the United States, it went up in Oregon. Oregon had the fastest increase of overdoses out of all 50 states. Those are the official statistics. But the other thing that may have mattered even more, as I saw when I went to Oregon quite often during this time, was just the decay of community life. So more people wanting to take their kids to the park, but you couldn't take your kids to the park because the park was full of people using and dealing drugs. Not being able to walk down sidewalks in some towns because people were laying on the sidewalk unconscious from drug use, those kinds of things reversed what was once a popular policy into something that people became quite strongly in favor of. Repeal, which in fact is what happened.
[22:49]
A
That sounds a lot like a more extreme version of the kind of scenes we heard about in the news report from Lisbon at the beginning of this program. But Keith is still sure that Portugal has been right to treat drugs policy as a social rather than a criminal issue.
[23:04]
D
Drug addiction is often referred to as a wicked problem in the sense that it is extremely hard to solve and touches many different sectors at once. So intertwined with it are problems in housing, in employment, in mental health, in family breakdown, and therefore the extent progress has been made on it through the years, it has tended to be when governments have made it a priority and made a lot of different agencies that usually don't work together actually join up and exert a concerted response to it.
[23:35]
A
Keith recognizes that Oregon's experience has given drugs decriminalization a bad name at the moment.
[23:42]
D
Liberal approaches to drug use, I say, are in the shadow when a policymaker from somewhere in the US or another country calls me and says, we'd like you to help us. We're changing our drug policy, but we don't want to be like Oregon. And that's the watchword for failure that has set back efforts in this area, I think, pretty severely.
[24:03]
A
So to return to our question, is Portugal's drugs policy in need of reform? Well, drug deaths and HIV infections are still far below the levels the country was facing before 2001, and the policy has taken a huge number of people out of the country's criminal justice system. But as we've heard, it does need tweaking. The arrival of crack cocaine and increasing homelessness in places like Lisbon and Porto are making life miserable for many people who live in those cities, and that has put pressure on a system that was designed for a very different world. In 2001, Portuguese politicians and activists came together to design a policy that would lift the country out of a severe drugs crisis. Perhaps it's now time for new voices to start shaping how the next 25 years will be managed. Thank you for listening to the Inquiry from the BBC World Service. You can find more episodes wherever you get your podcasts. Try Are Orcas okay? Or maybe should we mine the moon? Just search for the enquiry and hit subscribe so you don't miss an update. This episode of the Inquiry was written and presented by me, David Baker. The producer was Jill Collins, editor Tom Bigwood, and technical producer Toby James.
[25:27]
B
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