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Ram: Lessons From Portugal

Kesha Ram, courtesy
Kesha Ram, center, at the mobile methadone clinic in Lisbon that’s operated for thirty years and serves more than a thousand people in five stops every day. ";

In 1999, Portugal was the heroin capital of Europe, with fully one percent of the population addicted to hard drugs. But in 2001 they decriminalized all substances and spent a vast amount of their public money on treatment rather than drug enforcement.

Now they’ve reduced overdose deaths to just 30 per year – four times below the European average. So, on a recent visit to Lisbon I looked into this remarkable turnaround and Portugal’s innovative harm reduction treatment model.

Here, we focus mostly on enforcement – but this often means getting tough with those caught in the middle who sell drugs to support an addiction. Involving them in a criminal investigation puts them in physical danger while doing nothing to provide treatment.

In Portugal, addicts aren’t dragged through a criminal process. People caught with a small amount of a substance never see a police officer after that initial encounter. The focus is on reducing the demand for drugs rather than entangling addicts in often futile efforts to reduce the supply.

Those caught with up to 10 days’ worth of a substance work with health professionals and social workers on getting treatment – which comes to the patient or addict with very few barriers. One mobile methadone clinic that’s operated for thirty years serves more than a thousand people in five stops every day. To seek help, all someone has to do is walk up, talk to a nurse, and treatment usually begins that same day.

We tend to administer “tough love” – to curb use we punish people by taking away relationships and resources. One perennial proposal here would require welfare recipients to take drug tests. But it doesn’t help people rebuild damaged lives and manage addiction by threatening their limited stability – it just makes recovery harder.

Portuguese health workers said the best medicine of all is building relationships with those seeking treatment, and helping addicts rebuild relationships with loved ones. And they define success in a way that’s inclusive of all journeys with addiction, acknowledging that some people will struggle with drug cravings for a lifetime.

One addict dismissed the mobile clinic by saying it only provided a way to avoid withdrawal between highs. But then he said that, with the clinic’s help, he now had an apartment, steady work, clean clothes, and had resumed communication with his family.

And that, in my book, is success.

Kesha Ram is a former state legislator and the interim director of the Center for Whole Communities in Burlington. She will study in the Master of Public Administration program at the Harvard Kennedy School of Government this fall.
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