The American activists couldn't wrap their heads around it. Sitting in a dingy office in a nondescript building in central Lisbon, they were being provided a fine-grained explanation of what happens to people caught with small amounts of drugs in Portugal, which decriminalized the possession of personal use amounts of drugs 17 years ago.
The activists, having lived the American experience, wanted desperately to know when and how the coercive power of the state kicked in, how the drug users were to be punished for their transgressions, even if they had only been hit with an administrative citation, which is what happens to people caught with small quantities of drugs there.
Nuno Capaz was trying to explain. He is vice chairman of the Lisbon Dissuasion Commission, the three-member tribunal set up to handle people caught with drugs. He had to struggle mightily to convince the Americans that it wasn't about punishment, but about personal and public health.
"The first question," he explained, "is whether this person is a recreational user or an addict."
If the person is deemed only a recreational user, he may face a fine or a call to community service. If he is deemed an addict, treatment is recommended—but not required.
"But what if they don't comply?" one of the activists demanded. "Don't they go to jail then?"
No, they do not. Instead, Capaz patiently explained, they may face sanctions for non-compliance, but those sanctions may be little more than a demand that they regularly present themselves to a hospital or health center for monitoring.
In a later hallway conversation, I asked Capaz about drug users who simply refused to go along or to participate at all. What happens then? I wanted to know.
Capaz shrugged his shoulders. "Nothing," he said. "I tell them to try not to get caught again."
Welcome to Portugal. The country's low-key, non-headline-generating drug policy, based on compassion, public health, and public safety, is a stark contrast with the U.S., as the mind-boggled response of the activists suggests.
Organized by the Drug Policy Alliance and consisting of members of local and national groups working with the drug reform organization, as well as a handful of journalists, the group spent three days in the country last month seeing what an enlightened drug policy looks like. They met with high government officials directly involved in creating and implementing drug decriminalization, toured drug treatment, harm reduction, and mobile methadone maintenance facilities, and heard from Portuguese drug users and harm reduction workers as well.
The Portuguese Model and Its Accomplishments
They had good reason to go to Portugal. After nearly two decades of drug decriminalization, there is ample evidence that the Portuguese model is working well. Treating drug users like citizens who could possibly use some help instead of like criminals to be locked up is paying off by all the standard metrics—as well as by not replicating the thuggish and brutal American-style war on drugs, with all the deleterious and corrosive impacts that has on the communities particularly targeted for American drug law enforcement.
Here, according to independent academic researchers, as well as the UN Office on Drugs and Crime and the European Monitoring Center of Drugs and Drug Abuse, is what the Portuguese have accomplished:
Drug use has not dramatically increased. Rates of past year and past month drug use have not changed significantly or have actually declined since 2001. And Portugal's drug use rates remain among the lowest in Europe, and well below those in the United States.
Both teen drug use and problematic drug use (people who are dependent or who inject drugs) have declined.
Drug arrests and incarceration are way down. Drug arrests have dropped by 60 percent (selling drugs remains illegal), and the percentage of prisoners doing time for drug offenses has dropped from 44 percent to 24 percent. Meanwhile, the number of people referred to the Dissuasion Commission has remained steady, indicating that no "net-widening" has taken place. And the vast majority of cases that go before the commission are found to be non-problematic drug users and are dismissed without sanction.
More people are receiving drug treatment—and on demand, not by court order. The number of people receiving drug treatment increased by 60 percent by 2011, with most of them receiving opiate-substitution therapy (methadone). Treatment is voluntary and largely paid for by the national health system.
Drug overdose deaths are greatly reduced. Some 80 people died of drug overdoses in 2001; that number shrunk to just 16 by 2012. That's an 80 percent reduction in drug overdose deaths.
Drug injection-related HIV/AIDS infections are greatly reduced. Between 2000 and 2013, the number of new HIV cases shrank from nearly 1,600 to only 78. The number of new AIDS cases declined from 626 to 74.
"We came to the conclusion that the criminal system was not the best suited to deal with this situation," explained Capaz. "The best option should be referring them to treatment, but we do not force or coerce anyone. If they are willing to go, it's because they actually want to, so the success rate is really high. We can surely say that decriminalization does not increase drug usage, and that it does not mean legalizing drugs. It's still illegal to use drugs in Portugal, it's just not considered a crime. It's possible to deal with these users outside the criminal system."
Dr. Joao Goulao, who largely authored the decriminalization law and who is still general director for intervention on addictive behaviors—the Portuguese "drug czar"—pointed to unquantifiable positives resulting from the move: "The biggest effect," he said, "has been to allow the stigma of drug addiction to fall, to let people speak clearly and to pursue professional help without fear."
They Take the Kids!
The American activists know all about fear and stigma. And the cultural disconnect—between a country that treats drug users with compassion and one that seeks to punish them—was on display again when a smaller group of the activists met with Dr. Miguel Vasconcelos, the head psychologist at the Centro Taipa, a former mental hospital that now serves as the country's largest drug treatment center.
As Dr. Vasconcelos explained the history and practice of drug treatment in Portugal, one of his listeners asked what happened to drug users who were pregnant or had children.
"They take the kids," Vasconcelos said, smiling. But his smile turned to puzzlement as he saw his listeners reacted with disappointment and dismay.
For the Americans, "they take the kids" meant child protective services swooping in to seize custody of the children of drug-using parents while the parents go to jail.
But that's not what Vasconcelos meant. After some back and forth, came clarity: "No, I mean they take the kids with them to treatment."
Once again, the Americans, caught firmly in the mind-set of their own punishing society, expected only the worst of the state. But once again, light bulbs came on as they realized it doesn't have to be like that.
Now that cadre of activists is back home, and they are going to begin to try to apply the lessons they learned in their own states and communities. And although they had some abstract understanding of Portuguese drug decriminalization before they came, their experiences with the concrete reality of it should only serve to strengthen their desire to make our own country a little less like a punitive authoritarian one and bit more like Portugal.
PBS star and travel guidebook author Rick Steves is a prominent advocate of marijuana legalization and drug reform. For years, he has advocated a more moderate, European-style approach to drug policy.
He has played a leading role in bringing the public around in Washington state, which legalized weed in 2012, and continuing to make his high-profile calls for more enlightened drug policies. But now, the Trump administration, and Attorney General Jeff Sessions in particular, are trying to put the brakes on, and that got Steves thinking.
In response, as Rolling Stone reports, Steves has combined his travel savvy and his drug reform advocacy to propose an eye-opening, pot-centric European travel itinerary tailor-made for Sessions in the hope some Old World tolerance would rub off on him.
Here are the three must-sees on the European drug policy tour Steves created for Sessions.
1. Switzerland. "I would take him to Switzerland and we'd go to a heroin maintenance clinic," Steves said, referring to the country's pioneering, non-criminal approach to opioid addiction.
2. Barcelona. Cannabis clubs are allowed there. "In Spain they can't sell marijuana but they can grow it. In practice, they don't want to grow it so they join a club that grows it collectively, and they can enjoy the harvest."
3. The Netherlands. Steves would take the attorney general to one of those famous Dutch "coffee shops" where adults can legally purchase small amounts of weed. "After the coffee shop, we'd visit a mayor and a policeman and have [Sessions] listen to the mayor and policeman explain why they'd rather have coffee shops than have marijuana sold on the street," Steves says.
Although Steves inexplicably neglected it, there is one other European destination that could be an eye-opener for Sessions: Portugal. The Iberian nation decriminalized the possession of all drugs in 2001. Not only is it still standing, Portugal has drug use levels similar to other European countries, but without all the arrests.
Of course, Sessions is unlikely to take Steves up on his offer and even more unlikely to be convinced by saner European approaches, but Steves' point is still made: There are better ways of dealing with drug use and abuse. We just have to acknowledge them.
When 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.
Ã�lvaro 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 ruleunder 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 EduÃno 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.
A nurse hands out methadone to addicts in Lisbon. Photograph: Horacio Villalobos/Corbis via Getty Images
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: one, that there’s no such thing as a soft or hard drug, only healthy and unhealthy relationships with drugs; two, that an individual’s unhealthy relationship with drugs often conceals frayed relationships with loved ones, with the world around them, and with themselves; and three, 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.”
Adrop-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”. But 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 Рa 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 Olḥo: the Unidade de Desabitua̤̣o, 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 number one killer of Americans under the age of 50 isn’t cancer, or suicide, or road traffic accidents. It’s drug overdoses. They have quadrupled since 1999. More than 52,000 Americans died from drug overdoses last year. Even in the UK, where illegal drug use is on the decline, overdose deaths are peaking, having grown by 10% from 2015 to 2016 alone. The “war on drugs” continues – but it’s a war we’re losing.
Most drug-related deaths result from the use of opioids, the molecules that are marketed as painkillers by pharmaceutical companies and heroin by drug lords. Opioids, whatever their source, bond with receptors all over our bodies. Opioid receptors evolved to protect us from panic, anxiety and pain – a considerate move by the oft-callous forces of evolution. But the gentle impact of natural opioids, produced by our own bodies, resembles a summer breeze compared to the hurricane of physiological disruption caused by drugs designed to mimic their function.
Most street opiates (including heroin) are now laced or replaced with fentanyl – the drug that killed the singer Prince – and its analogues, far more powerful than heroin and so cheap that drug-dealing profits are skyrocketing at about the same rate as overdose deaths. The UK’s National Crime Agency said that traces of fentanyl have been found in 46 people who died this year. Users don’t know what they’re getting and they take too much. Fentanyl is recognised as a primary driver of the overdose epidemic.
Society’s response has been understandably desperate but generally wrongheaded. We start by blaming addicts. Then we blame the pharmaceutical companies for developing and marketing painkillers. We blame doctors, for overprescribing opiates, which pressures them to underprescribe, which drives patients to street drugs – cheaper, home delivery via the internet, and zero quality control. We say we’re going to reignite the war on drugs, recognised by experts as a colossal failure from the 1930s onward. We also continue to view addiction as a chronic brain disease, so the benefits of education, social support, psychological intervention, and personal empowerment receive far too little attention. Yes, addiction involves brain change, but ongoing medicalisation does little to combat it.
There has been some progress: There are pockets of activity here and there where prescribed opiates – like methadone and Suboxone – are made more easily available to addicts. That’s a good thing, because increasingly desperate addicts are often driven to the street, where they’re most likely die. The availability of naloxone, which works as an antidote, is slowly wending its way through the drug policy jungle, providing a simple resource to deal with an overdose on the spot. But in most segments of most communities in the US and elsewhere, it is still too difficult to obtain.
There are smarter answers at hand – but also smarter questions to be asked. The overdose epidemic compels us to face one of the darkest corners of modern human experience head on, to stop wasting time blaming the players and start looking directly at the source of the problem. What does it feel like to be a youngish human growing up in the early 21st century? Why are we so stressed out that our internal supply of opioids isn’t enough?
The opioid system evolved to allow us to function, not panic or shut down, when we are under threat or in pain. Support from other humans also helps us cope with stress, but that support is underpinned by opioids too. Our attachment to others, whether in friendship, family or romance, requires opioid metabolism so that we can feel the love. Opioids grant us a sense of warmth and safety when we connect with each other.
You get opioids from your own brain stem when you get a hug. Mother’s milk is rich with opioids, which says a lot about the chemical foundation of mother-child attachment. When rats get an extra dose of opioids, they increase their play with each other, even tickle each other. And when rodents are allowed to socialise freely (rather than remain in isolated steel cages) they voluntarily avoid the opiate-laden bottle hanging from the bars of their cage. They’ve already got enough.
In short, mammals need opioids to feel safe and to trust each other. So what does it say about our lifestyle if our natural supply isn’t sufficient and so we risk our lives to get more? It says we are stressed, isolated and untrusting. That’s a problem we need to resolve.
Many have proposed targeted education, community support and interpersonal bonding through group activities. Johann Hari’s powerful book, Chasing the Scream, reviews how such initiatives have worked in diverse societies. An intriguing example is the compassionate, blame-free dialogue that has evolved among high-school students in Portugal, highlighting the dangers of hard drugs and urging the most vulnerable to abstain – not because they’re going to get in trouble, but because addiction is miserable and dangerous. This dialogue has paralleled the decriminalisation of drug use.
Portugal had an astoundingly high heroin addiction rate 16 years ago. It now boasts the second lowest overdose rate on the continent. Social inclusion actually works against addiction while punishment only fuels it.
But the peculiar appeal of opioids tells us more about ourselves as a society, as a culture, than the tumultuous ups and downs of addiction statistics. Today’s young people come of age and carve out their adult lives in an environment of astronomical uncertainty. Corporations that used to pride themselves on fairness to their employees now strive only for profit. The upper echelons of management are as risk-infected as the lowest clerks. Massive layoffs rationalised by the eddies of globalisation make long-term contracts prehistoric relics. I ask the guys who come to the house to deliver packages how they like their jobs. They can’t say. They get up to three six-month contracts in a row and then get laid off so the company won’t have to pay them benefits.
People pour out of universities with all manner of degrees, yet with skills that are rapidly becoming irrelevant. But people without degrees are even worse off. They find themselves virtually unemployable, because there are so many others in the same pool, and employers will hire whoever comes cheapest. The absurdly low minimum wage figures in the US clearly exacerbate the situation. As hope for steady employment fizzles, so does the opportunity to connect with family, friends and society more broadly, and there is way too much time to kill. Opioids can help reduce the despair.
The opportunity to settle into a viable niche in one’s family and one’s society is being blown away by the winds of unregulated capitalism in a globalised world. As for the intimacy and trust we humans have always sought in each other, in friends, colleagues, and lovers, the bonds are shaky these days. Even if we have the opportunity to connect we’re still too stressed and depressed to get to know each other well, to develop trust, to give and receive compassion. Urban life requires juggling high-stress relationships past the point of mental and emotional exhaustion.
The early 21st century offers less structure and stability through religion or extended family than we humans have experienced in millennia. And maybe that’s just the way it is. But we don’t have to throw away the basic currency of security and interconnectedness entirely. We can build social structures – governments, corporations, community organisations, and systems of education and care – that encourage stability, hope, and trust in our day-to-day lives. Like the school kids in Portugal, we can offer compassion and inclusion as an alternative over heroin. If we fail to do that, we may as well hook ourselves up to an opioid pump. Just to endure.
Filmmaker Michael Moore never shies from taking on tough issues and challenging the status quo. His latest film "Where to Invade Next" is a clever spoof of U.S. foreign policy that encourages our military leaders to "invade" other countries and import their policies that can improve our quality of life.
Moore visits blissed out Italians who enjoy enviable state-sanctioned vacation time and even an extra month of salary at the end of the year to enjoy it. And Moore makes our mouths water over the healthy and thoughtfully prepared school lunches that kids get in French public schools. He shows us how Finland's schools became the best in the world by, among other things, eliminating homework (something that I am sure would interest every child in America). But particularly noteworthy from a drug policy perspective, Moore highlights Portugal's policy of all-drug decriminalization and also features Norway's humane and effective rehabilitative-focused prisons.
Many Americans may not be aware of Portugal and its foray into becoming a global leader in drug policy innovation. Nearly fifteen years ago, in response to a growing opiate misuse public health crisis, the government of Portugal shifted their entire approach to drug use away from arrest and punishment and towards public health.
No one in Portugal gets arrested for simple drug use or low level possession for personal use anymore, even if they relapse or show no interest in treatment. The resources to handle these cases have all been diverted from the criminal justice system, in favor of the department of health, and everyone is encouraged and supported to be as healthy as they can be, even if they are not "drug-free."
Sale and manufacturing of certain drugs still remains illegal and the police are in charge of enforcing those laws. When it comes to drug use, on the other hand, it's doctors, social workers and public health officials who lead the policies and practices. Portuguese police are encouraged to treat drug users as human beings. In Moore's film, he interviews three Portuguese cops who talk about how concern for "human dignity" is the most important part of their training, which for Americans is a remarkable thing to hear from law enforcement.
Moore also interviews Nuno Capaz, who serves on the health commission in Portugal and is responsible for helping to administer the decriminalization policy. I met with Nuno and others who work with providing services to drug users when I visited Portugal last summer. What's perhaps most remarkable about listening to Nuno detail how the system works is how much it sounds not so much political as it is a simple practice based on common sense.
Coupled with increased harm reduction services, like clean needles, overdose prevention and access to treatment on demand, decriminalizing drug use and removing the fear of punishment has meant fewer barriers to accessing vital health interventions, and a general reduction and stabilization of rates of death, disease and addiction. People stop living in fear of law enforcement and low and behold they become more open to the services that can help them and the rest of the community to be healthier and less at risk.
It all seems overwhelmingly effective and no-brainer. This is perhaps why Nuno's shrugging response to any suggestion of controversy or moral dilemma that Michael Moore offers about Portugal's drug policies comes across as fairly comical in the film. I got a similar reaction when I peppered Nuno with questions searching for the point in the process where the drug user ends up getting arrested. "What about after relapse? The second relapse? The hundredth relapse?" The answer was always "no." Barring any harm to others, a person suffering from a chronic and recurring health concern around drug use gets treatment for their health instead of punishment.
Watching Moore's film may be the first time many Americans get a bird's eye view of Portugal's groundbreaking approach to drug policy. It may also be the first time many of them see the prisons in Norway, where inmates are taught how to reintegrate into society by allowing them to live as much like normal people and as little like prisoners as possible.
Kudos to Michael Moore for showing what's possible when we shift the focus from punishing people to finding ways to helping them become the best people they can be. Hopefully, people will notice and help soften the ground for similar policies in the U.S., where political will and vision are needed more than ever to combat our dual national crises of mass incarceration and opiate dependency. The Portuguese and Norwegians seemed more than willing to let us "invade" their borders to steal a few smart ideas to take back home.
Orsola Costantini, senior economist at the Institute for New Economic Thinking, is the author of a new paper that exposes the disturbing history of how a budget approach cloaked in scientific and technical jargon became a tool to manipulate public opinion and serve the interests of the powerful. In the following conversation, she reveals how austerity has been sold to the public through a process that hurts the people, consolidates knowledge and power at the top and compromises democracy. As economic inequality reaches new heights and austerity programs are debated around the world (most recently, in Spain and Portugal), learn how a lie becomes a political and economic “truth." (This post originally appeared on the blog of the Institute for New Economic Thinking.)
Lynn Parramore: Your recent work deals with something called the “cyclically adjusted budget.” What is it and what does it mean in the lives of ordinary people?
Orsola Costantini: The Cyclically Adjusted Budget (CAB) is a statistical estimate that aids government officials when they decide what to spend money on and how much they’re going to tax you. It is mostly federal governments that use it, but also international institutions like the International Monetary Fund (IMF).
Economists will tell you this tool is imprecise. Yet national and international institutions still rely on it to justify important decisions about government spending and taxation.
But there’s something the experts aren’t telling you: the cyclically adjusted budget can be easily maneuvered depending on which way the political winds are blowing. And it appears technical and obscure enough so that regular people tend to look at it as objective and undisputable. That’s where the trouble comes in.
Politicians and government officials using the CAB can limit the range of political choices that appear viable to a community. Policymakers can avoid the hassle of taking political responsibility for these choices, too. We had to do it! The budget says so!
Look at what happened all over Europe in 2008: It’s one thing to say to students in the streets that their education and economic wellbeing are not a priority for the government while saving banks is. It’s quite another to say that politics has nothing to do with it and the economy requires taking certain actions, sometimes painful.
LP: You indicate that this approach to budgeting was invented as a way of making the New Deal acceptable to the business community. How did that work? Over time, who has benefitted from it? Who has lost?
OC: Back in the 1940s, workers were fighting for their rights, class struggle was heating up, and soldiers would soon be returning from the fronts. At that point, a new business organization, the Committee for Economic Development (CED), came together. Led by Beardsley Ruml and other influential business figures, the CED played a crucial role in developing a conservative approach to Keynesian economics that helped make policies that would help put all Americans to work acceptable to the business community. The idea was that more consumers would translate into more profits — which is good for business. After all, the economic experts and budget technicians said so, not just the politicians. And the business leaders were told that economic growth and price stability would go along with this, which they liked.
But things changed progressively over the 1970s and early 1980s. Firms went global. They became financialized. The balance of power between workers and owners started to shift more towards the owners, the capitalists. People were told they needed to sacrifice, to accept cuts to social spending and fewer rights and benefits on the job — all in the name of economic science and capitalism. The CAB was turned into a tool for preventing excessive spending — or justifying selected cuts.
Middle class folks were afraid that inflation would erode their savings, so they were more keen to approve draconian measures to cut wages and reduce public budgets. People on the lower rungs of the economic ladder felt the pain first. But eventually the middle class fell on the wrong side of the fence, too. Most of them became relatively poorer.
I suppose this shows the limits of democracy when information, knowledge, and ultimately power are unequally distributed.
LP: You’re really talking about birth of austerity and the way lies about public spending and budgets have been sold to the public. Why is austerity such a powerful idea and why do politicians still win elections promoting it?
OC: Austerity is so powerful today because it feeds off of itself. It makes people uncertain about their lives, their debts, and their jobs. They become afraid. It’s a strong disciplinary mechanism. People stop joining forces and the political status quo gets locked down.
Even the name of this tool, the “cyclically adjusted budget,” carries an aura of respect. It diverts our attention. We don’t question it. It creates a barrier between the individual and the political realm: it undermines democratic participation itself. This obscure theory validates, with its authority, a big economic mistake that sounds like common sense but is actually snake oil — the notion that the federal government budget is like a household budget. Actually, it isn’t. Your household doesn’t collect taxes. It doesn’t print money. It works very differently, yet the nonsense that it should behave exactly like a household budget gets repeated by politicians and policymakers who really just want to squeeze ordinary people.
LP: How does all this play out in the U.S. and in Europe?
OC: The European Union requires its members to comply with something called a cyclically adjusted budget constraint. Each country has to review its economic and fiscal plans with the European Commission and prove that those are compatible with the Pact. It’s a ceiling on a country’s deficit, but it’s also much more than that.
Thanks to the estimate, the governments of Italy or Spain, for example, are supposed to force the economy toward some ideal economic condition, the definition of which is obviously quite controversial and has so far rewarded those countries that have implemented labor market deregulation, cut pensions, and even changed the way elections happen. Again, it’s a control mechanism.
In the U.S. this scenario plays out, too, although less strictly. Talk about the budget often relies on the same shifty and politically-shaded statistical tools to support one argument or the other. Usually we hear arguments that suggest we have to cut social programs and workers’ rights and benefits or face economic doom. Tune in to the presidential debates and you’ll hear this played out — and it isn’t strictly limited to one party.
LP: How do we stop powerful players from co-opting economics and budgets for their own purposes?
OC: Our education system is increasingly unequal and deprived of public resources. This is true in the U.S. but also in Europe, where the crisis accelerated a process that was already underway. When children don’t get good educations, the production of knowledge falls into private control. Power gets consolidated. The official theoretical frameworks that benefit the most powerful get locked in.
In the economic field, we need to engage different points of view and keep challenging dominant narratives and frameworks. One day, human curiosity will save us from intellectual prostitution.
When it comes to the War on Drugs, there are few people in a better position to comment on the futility, brutality and tragedy of the endeavor than retired Major Neill Franklin. He spent over 30 years participating in, and directing, state and local police anti-drug efforts before retiring to become the executive director of Law Enforcement Against Prohibition (LEAP), which advocates for the legalization of drugs and a law enforcement approach that defends human rights and views drug misusers as persons in need of treatment as opposed to punishment. He describes the evolution of his personal philosophy and his efforts to produce change in this week’s Professional Voices…Dr. Richard Juman
Richard Juman: Can you tell our readers something about your history in law enforcement, and especially the experiences that you've had which eventually led to your involvement with LEAP?
Neill Franklin: My law enforcement history begins with the Maryland State Police in 1976. After a short time in patrol, I went undercover in the Washington D.C. suburbs of Maryland. I arrested a countless number of people for drug law violations and most of those people, by far, were arrested for simple marijuana possession and some minor dealing. Even back then in the early 1980s, the so-called drug kingpin was very difficult to find.
In the mid-1980s, I was assigned as a detective sergeant to the Division of Corrections Investigative Unit. We were responsible for investigating all crimes within Maryland's Division of Corrections. Interestingly enough, most of our cases involved correctional officers smuggling drugs into the very institutions they were supposed to serve. Even without widespread cellphone technology, inmates were calling the shots—inside and outside of prison. The enormous amount of cash generated from the illicit drug trade made it easy for drug-dealing gang members to bribe and coerce correctional officers into smuggling drugs and weapons. Hell, we can't even keep drugs out of our most secure facilities, yet we expect to keep them out of our neighborhoods in a free society.
When I was promoted to lieutenant, I was placed in charge of seven drug task forces in the western territories of Maryland. So the drug arrests continued, sending more people into prison for mostly non-violent drug offenses. Now I had seven teams of state police, sheriff deputies, town police officers and others doing the work for me. Later, after two more promotions to major, I became the Northeast Regional Commander for the Bureau of Drug and Criminal Enforcement, overseeing nine drug task forces. The final two years of my Maryland State Police career I spent as the commander of the Education, Training and Career Development Command.
Retiring in 1999 from the Maryland State Police, I was recruited by the Baltimore Police Department (BPD) to reconstruct its Education and Training Division. I commanded training for the BPD for four years before moving on to a third police agency for six more years, but it was during my tenure with the BPD when I finally began to see the War on Drugs for what it really is, an abject failure. Not only was it a failed policy, but it was counterproductive to what I had signed on for, improved public safety. The War on Drugs was making our communities far more dangerous than need be.
My life-changing moment was this: ​Maryland State ​Trooper Ed Toatley, a very good friend of mine​, was working undercover while assigned to an FBI task force in Washington, DC. On October 30, 2000, Ed was making the last buy of cocaine from a mid-level dealer before the planned take-down and arrest. The dealer had other plans, plans to murder Ed and keep both the drugs and the money. He shot Ed at point blank range in the side of his head during the transaction.
​Ed's murder affected me deeply, causing me to question our methods and the War on Drugs itself and to search for like minds in law enforcement. I began scouring ​the Internet for answers and stumbled across LEAP, which was the brain-child of police officers Jack Cole and Peter Christ back in 2002. So I was a Lt. Colonel with the Baltimore Police Department when I began speaking out privately regarding the failed drug war. I signed on as a LEAP member then, but did not begin officially speaking for LEAP until the fall of 2008.
​Many other events had helped to solidify my belief that our community violence was spawned from our failed policies of drug prohibition. As examples, soon after Ed's murder, two Baltimore City Police officers lost their lives at the hands of street corner drug dealers. And in 2003, the Dawson family of seven was murdered in one night by one drug dealer in east Baltimore. The mother, Angela, was working with the police to get him and his crew arrested and removed from her neighborhood to protect her boys. She did not want them recruited into, or harmed, by this crew, so she did what we want good citizens to do; work with the police. The drug dealer got wind of this and set their home on fire during the middle of the night, killing the entire family. In 2010, I finally hung up my gun and badge to become LEAP's executive director.
I'm wondering how your former colleagues in law enforcement reacted when you left that realm and started to devote yourself to advocating for this diametrically opposite position?
There were a couple who came with me in concept and some in actual work, but the vast majority thought I had lost my mind. One thing that most of my close comrades knew about me was that I rarely followed the crowd, I spoke my mind. My Facebook page had some very interesting comments on it. Today, it's a different story, even for my Facebook page.
Although there was one distinct event, the murder of Trooper Ed Toatley, which really caused me to stop and think, this was actually a long reforming process for me. In the same manner, it is taking my comrades a while, too. It's quite a bit to digest in order for the deprogramming to take hold. It's also very difficult for those, such as myself, who spent quite a bit of time working in drugs (undercover and commanding drug task forces) to accept the fact that all of this hard work was for naught. And in some cases, harmed the communities in which we worked. Now, the vast majority of my close comrades get it! Most of the men and women working the streets get it! They know that their communities and jobs would be considerably safer if prohibition was to end. Most cops didn't sign on to this work to enforce morality, they signed on to protect people from violent people.
It can still be risky for police officers to speak in opposition of the failed War on Drugs. They risk being transferred, they risk not being transferred to a sought after assignment, not receiving a promotion, and ultimately, they risk being terminated. When you have a family to support, this is a very difficult decision to make, so most hold their tongues. For the few I know who were terminated, properly negotiated lawsuits won them their jobs back for First Amendment violations, but who wants to endure years of legal sparring?
When you think about the history of the War on Drugs, are there any elements of our approach that you would say we are getting right and should be continued? Assuming that you don't feel that law enforcement should have no role at all in dealing with the drug problem and addiction, what aspects of law enforcement would you continue to apply if you were in charge? And what types of law enforcement activities would you stop pursuing?
Great question. And the first part of my answer is, not one!
I'm going to approach the second part of this question from two perspectives; first, what can law enforcement do immediately, absent any significant changes in the law, and second, what should law enforcement's role ultimately be, once we legislatively end drug prohibition.
Immediately, law enforcement can move the enforcement of low-level drug crimes to the lowest of priorities. Stop pursuing and arresting people for drug possession. Adopt Law Enforcement Assisted Diversion (LEAD) programs for those who have problematic drug use, which is a very small population of overall users. These are people who commit crimes and/or sell drugs to support their habits. The LEAD program, as adopted by Seattle law enforcement, enables trained police officers to divert these drug offenders directly into wraparound treatment services in lieu of arrests and jails. At the end of the day, if they choose to enter into the program, they don't even receive an arrest record.
Law enforcement could also choose to bow out of any financially incentivized policing initiatives, such as civil asset forfeiture and grant funding where arrest numbers are a major qualifier in the application process. By adopting these few basic practices, law enforcement would become more focused upon preventing and solving violent crime.
Zero tolerance policing would screech to a halt, paving the way for improved police/community relations, wasted law enforcement funding could be diverted into drug education and treatment programs, which we know are far more effective in reducing drug abuse.
When we finally end our failed War on Drugs and drug prohibition, and instead move into a place of legalization, regulation and control, we immediately put 90% of all violent drug gangs and the cartels out of business. This change by itself would enable us to focus our police officers like a laser on murder, rape, robbery, burglary, domestic violence, crimes against our children and identity theft, just to name a few. These are crimes that truly impact people, families and neighborhoods. Police will then have an opportunity to become peace officers once again and champions of the community.
Law enforcement would have a very small drug policy enforcement role absent prohibition laws, similar to that of alcohol and tobacco enforcement. Personally, I believe that law enforcement can remove itself from some of what it does in alcohol and tobacco enforcement. We should not be pursuing and arresting people for selling loose cigarettes on the street. This should be an administrative function where tobacco control enforcers can write civil citations just like parking control units. Even tobacco smuggling can be averted, or at least greatly reduced if we did not place such high taxes upon products.
At the end of the day, law enforcement would be practically out of the drug business, taking a backseat to healthcare practitioners. Law enforcement would no longer be a part of morality policing, arresting people for engaging in consensual adult activity. We would go after and arrest people for their illegal behavior in harming people who do not wish to be harmed.
Are there any places around the world—other countries—that you think get the ideology right, that come pretty close to an ideal balance between ​law enforcement, social interventions and treatment?
Yes, there are countries that come close, but there are no countries that have ended the prohibition of all drugs. The prohibitive United Nations' drug treaties, initiated from the 1961 Single Convention on Narcotic Drugs, and pressure from the United States, make it extremely difficult for countries to support policy other than punitive prohibition. The only country to legalize marijuana is Uruguay, with the United States having four of its states to do the same.
There is one country with the right ideology and that is Portugal. Thirteen years ago Portugal decriminalized the possession of all drugs up to a 10-day supply. They decided to place the attention upon the people instead of the drug. By doing so, health becomes the priority, not criminal drug enforcement. When a person is found in possession of drugs they are given on-demand treatment if they want it. People are more inclined to seek treatment if the stigma and fear of arrest has been removed.
So what are the results of this health-centered approach? They have experienced a 71% reduction in new cases of HIV for intravenous drug users. They have experienced a 52% reduction in overdose deaths and they have experienced a 22 to 25% decline in overall drug use among middle- and high-school children. I love saving lives and seeing smart choices made by educated children, but what is also of great interest to me is that the Portuguese police love this approach. They are now able to focus upon serious crimes and are not at odds with the general public. Closing prisons due to low enrollment is nothing to sneeze at either.
Major Neill Franklin (Ret) spent over 30 years in law enforcement with the Maryland State Police and the Baltimore Police Department before becoming an advocate for ending the War on Drugs. He is now the Executive Director of LEAP - Law Enforcement Against Prohibition www.AskLEAP.com
With its proposed changes to Ley 20.000 (Law 20,000), Chile joins a growing list of Latin American countries decriminalizing marijuana. The initiative, which would grant Chileans the right to possess up to 10 grams of cannabis and grow up to six marijuana plants at a time, was passed in Chile’s Chamber of Deputies on July 7 with 68 voting in favor and 39 against. The bill must first be adjusted by a health commission and then passed by the Senate before it officially becomes law, but strong support for cannabis legalization in the country illustrates that legalizing marijuana use appears to be the new norm in the Western Hemisphere and, once again, that the War on Drugs has been a failed campaign.[1]
Support for Legalization
The future of legalization is most apparent in the opinion of Latin American young adults on the War on Drugs. In a 2012 poll of 18 to 34-year-olds in the region by Asuntos del Sur (Southern Affairs), 79 percent of Chileans “voiced strong approval” for legalization, 52 percent disapproved of government campaigns attempting to reduce drug use, and 54 percent did not support current government policies on drugs.[2]
In Chilean society at large, those in favor of legalizing the use and cultivation of pot are also in the majority. Fifty percent of Chileans are in favor while 45 percent are against, according to a 2014 poll carried out by Cadem, a Chilean market and public opinion investigation company. When polls address the legalization of medical marijuana, this figure skyrockets to 86 percent in favor.[3] These numbers are especially significant when one considers that Chile is one of the more socially conservative countries in South America and indicate that support for legalization is becoming a mainstream opinion, rather than a progressive pipe dream.[4]
So far, it is legal to smoke marijuana with varying restrictions in Colombia, Costa Rica, Ecuador, Jamaica, Mexico, Peru, and Uruguay.[5] After creating a legal marijuana market in 2013, Uruguay in particular has been deemed a “trailblazer” on this issue.[6] However, there have been delays in implementing the government-regulated system. In March, the Spanish newspaper El PaÃs reported that cultivating the drug had become legal in Uruguay and that an estimated 2,000 people had enrolled in the official register, a slower registration rate than originally expected. One factor slowing implementation of the law in Uruguay is concern surrounding the safety of marijuana on the part of some pharmacy chains in the country.[7]
Responding to Questions of Health and Safety
In Chile, safety has also become a central argument against marijuana decriminalization. In the days after the measure passed in Chile’s Chamber of Deputies, the right-leaning newspaper La Tercera published article after article about safety concerns related to decriminalizing the drug. In one article published on July 11 titled, “Doctors Warn [the Public] About the Risks of Consuming Marijuana,” President of the Chilean Society of Pediatrics Luis Felipe González was quoted saying, “In the framework of the publication of the National Study of the Consumption of Drugs and the debate underway about the legislative change regarding the use and production of cannabis, the Medical Societies of Chile are taking note of our concerns about the significant increase of marijuana consumption, especially in young people and the harm that it brings them and society.” He went on to say that the initiative proposed by Congress is counterproductive, since it will only add to these risks.[8]
The following day, the same publication posted an article in which Jo McGuire, director of the U.S. based Drug and Alcohol Testing Industry Association, updated the newspaper on the current status of marijuana legalization in Colorado and suggested that Chile is not ready for decriminalization. McGuire somberly declared, “We are still waiting to see something positive come out of the decriminalization of marijuana” in Colorado. She asserted that the number of people dying in car accidents who tested positive for marijuana use had increased after the state legalized medical marijuana in 2001. She also pointed out that marijuana causes addiction in one out of six young people and one in 10 adults and that the recent legalization has caused an increase in the number of marijuana users in the state.[9]
McGuire is correct in saying that marijuana use has increased since it was legalized for recreational purposes in 2012 via Colorado Amendment 64. One in every eight Coloradans over the age of 12 say they have used marijuana in the last month, making it the state with the second highest percentage of regular cannabis users, after Rhode Island.[10] However, the increased usage is not as negative as McGuire makes it out to be, and her comments regarding traffic fatalities are misleading.
The medical marijuana industry in Colorado is now a tightly regulated retail industry, and the sales from this industry are taxed by the Colorado Department of Revenue. The majority of the funds coming from this tax, which in October 2014 totaled more than $40 million USD, go toward marijuana use prevention programs for youth and general mental health programs. According to Art Way of the Drug Policy Alliance, this system is already having positive effects: A year after legalization, there was actually a decline in the number of young people using marijuana in the state.[11]
McGuire’s other claim that more people are dying in car accidents due to marijuana use is deceptive since the only way to test for marijuana in someone’s system is through the presence of marijuana metabolites, which can linger in the body for days or weeks after first using the drug. Therefore, this test is not entirely accurate in that it cannot determine whether the person in question has actually smoked that day or not and, therefore, does not prove that marijuana was the cause of these accidents. In fact, roadway fatalities are at near-historic lows in Colorado and have actually decreased since marijuana was legalized.[12]
Taken in broader context, the situation in Colorado proves that cannabis use has not created the treacherous atmosphere that McGuire and other critics insist it generates. Although it is important to be cautious about this kind of psychoactive substance, the consumption of cannabis is actually less damaging to an adolescent’s health than the consumption of alcohol, according to Ibán RementerÃa, a member of the Faculty of Social Sciences at the Central University of Chile.[13] The legal drinking age is 18 in Chile, and in 2014 the World Health Organization found that Chile had the highest rate of alcohol consumption per capita in Latin America.[14] If alcohol is a normalized part of Chilean society and marijuana legalization does not appear to have the chaotic implications that opponents assert, then there are few negative arguments left regarding cannabis decriminalization. In fact, the consequences of not decriminalizing this drug are even more dangerous.
Why Chile Should Pass This Measure
As in the case of Colorado, one of the benefits of decriminalization is the ability to enact prevention programs that demystify cannabis smoking and provide for education rather than incarceration. As RementerÃa emphasizes, such programs make marijuana use safer, since they offer alternatives to the drug for young users or suggest how to reduce sanitary risk. Also, if marijuana were decriminalized, the government would be able to regulate the sanitary quality of the drug, a crucial benefit, since, “the majority of diseases and deaths associated with its consumption are due to the toxicity of its additives.”[15]
A third benefit of decriminalization is perhaps the most significant. RementerÃa asserts that it “distances users from illicit markets with their risk of violence, criminalization, and fraud.”[16] Chile certainly does not suffer from the same violence linked to the drug trade that Central America or Mexico experiences; from 2007 to 2012, 48,000 people were killed in drug-related violence in Mexico alone. By contrast, Chile, with a rate of 3.1 per 100,000 habitants, has the lowest number of homicides of any country in Latin America.[17]
At the same time, Chile incarcerates a high percentage of its population for drug-related offenses. Between 1993 and 2008, Chile’s imprisoned population grew by 238 percent, and Chile’s rate of detainees per 100,000 habitants in 2008 was 305, well above the global average incarceration rate (145) and that of South America overall (154). Among crimes that result in imprisonment, drug trafficking results in the third highest rate while the “Ley 20.000 microtrafficking control” results in the fifth highest rate. Regarding gender differences in jail sentencing, the majority of female inmates are imprisoned due to drug trafficking.[18] If the proposed change to Ley 20.000 is passed, Chile could make great strides in reducing its prison population, while helping to prevent some of the thousands of deaths that plague its neighbors throughout the Hemisphere. Although Chile is not in the thick of the drug trade, its proposed actions could well provide a model for curbing the crippling violence and hardship the illegal drug trade has perpetuated.
However, there are signs that the social stigma around decriminalizing hard drugs is starting to change. Since 2009, individuals in Mexico can no longer be prosecuted for possessing small amounts of pot, cocaine, heroin, and other drugs for personal use. The government only takes note of incidents of drug possession and provides the users with information regarding treatment options.[20]
Portugal is widely seen as the biggest success story in drug decriminalization. Since 2001, possession and use of small quantities of any kind of drug have been treated as a public health issue. As in Mexico, anyone found with a drug is referred to a treatment program instead of being put in jail. The results have been astounding. Drug use is down, especially among young adults, and new HIV cases have plummeted due to health programs that have been instituted in the country. In addition, Portugal touts the second lowest rate of drug overdose deaths per 1 million people in the European Union. While Christopher Ingraham of The Washington Post points out that there could be other factors at work here in achieving these positive results, he also argues that Portugal’s example certainly weighs against the idea of keeping all drugs illegal.[21]
A Call to Action
The favorable results in countries and states, such as Portugal and Colorado, that have successfully begun to decriminalize marijuana and other drugs will be key to influencing the final decision on whether to regularize the use of cannabis in Chile. As can be seen in the articles written on this story by La Tercera, the main opponents of this step have distorted facts about legalization in Colorado and have used health and safety statistics that do not accurately reflect what decriminalization could mean in a society. Therefore, those in favor of this measure must actively promote the benefits of decriminalization while warning of the dangers of unsanitary practices and the drug violence that will continue if action is not taken. Although allowing the use of marijuana in one country will not solve all of the problems associated with the War on Drugs, if Chile does pass the proposed changes to Ley 20.000, it could advance the movement of Latin American countries and states in the United States taking action to end the status quo.
James K. Galbraith, author of The End of Normal and professor at the Lyndon B. Johnson School of Public Affairs at UT Austin, has an inside view of the crisis leading to the recent referendum in Greece. Galbraith has worked for the past several years with recently departed Greek finance minister Yanis Varoufakis as both a colleague and co-author, and he has just returned from Greece, where he looked down over the rooftops of Syntagma Square as citizens made history in a strong vote against austerity. He discusses the last week’s dramatic turn of events and what is at stake going forward as the austerity doctrine — and the entire neoliberal project — come under threat. This post was originally published on the blog of the Institute for New Economic Thinking.
Lynn Parramore: What’s your take on the attitudes of the creditor powers — the European Central Bank (ECB), International Monetary Fund (IMF) and European Commission (EC) — toward Greece?
Jamie Galbraith: What happened on the 26th of June was that Alexis [Tsipras] came to realize, at long last, that no matter how many concessions he made he wasn’t going to get the first one from the creditors. That’s something Wolfgang Schäuble had made clear to Yanis [Varoufakis] months before.
But it was hard to persuade the Greek government of this because its members naturally expected, as you would when you’re in a negotiation, that if you make a concession the other side will make a concession. That isn’t the way this one worked. The Greeks kept making concessions. They’d present a program and the other side would say —as you can read in the press — oh, no, that’s not good enough. Do another one. Then they’d complain that the Greeks were not being serious.
What the creditors meant by that was this: when you come around and agree to what we tell you, then you’re serious. Otherwise not. This is the way bad professors treat extremely recalcitrant students. You come in with a paper draft and they say, no, that’s not good enough. Do another one.
LP: Have the individual creditors differed on how to treat Greece?
JG: There are some divisions amongst the creditors that are well known. But they’re all variations on the theme of insular, sheltered, cloistered people who do not understand what is happening in Greece and do not know the economics. So, for example, the EC tends to be a little bit nicer, the IMF tends better on debt restructuring but worse on the structural issues, and the ECB was infuriated by the fact that its technocrats couldn’t walk into any ministry in Athens and make demands and be paid attention to. So there were different aspects of this that seemed to trouble different creditors, but it all amounted to the fact that between them there was no basis for arriving at anything other than the original Memorandum of Understanding [bailout program].
LP: What exactly triggered the breakdown that led to the referendum?
JG: What happened was that the IMF took the staff level agreement draft that the Greeks has presented, and marked it up in red ink and presented it back to the Greeks as an ultimatum— this is what we will accept. Or rather [EC president] Juncker presented it back to the Greeks as an ultimatum. And Yanis was told, take it or leave it. So they basically had no choice but to walk away from it, to leave it.
LP: How do you think the referendum has changed the situation? Has it given the Greeks leverage or not?
JG: That’s a difficult question. The recent Ambrose Evans Pritchard piece is very much on the mark [“Europe is blowing itself apart over Greece and nobody seems able to stop it”]. The Greek government and particularly the circle around Alexis, were worn down by this process. They saw that the other side does, in fact, have the power to destroy the Greek economy and the Greek society — which it is doing — in a very brutal, very sadistic way, because the burden falls particularly heavily on pensions. They were in some respects expecting that the yes would prevail, and even to some degree thinking that that was the best way to get out of this. The voters would speak and they would acquiesce. They would leave office and there would be a general election.
But civil society took this over in the most dramatic and heroic fashion. It was an incredible thing to see. The Greeks, amazingly, voted 61 percent no. That, momentarily, gave a jolt of adrenaline to everybody in the government. But the next morning, they were back where they were before. And that’s why, of course, Yanis left at that point. What will happen now really will depend on whether there is anything forthcoming from the creditors in Brussels. It’s a very uncertain situation. It depends a lot on specific people on the Greek team.
LP: What are the alternatives for Greece at this point?
JG: Capitulation or exit. It really depends upon a political judgment in the Greek government, which is opaque to me. There is definitely, let’s say, a concession caucus in the circle around Alexis Tsipras. That is a problem because that is obviously not what the Greek people want.
LP: What does it mean to the rest of the world if Greece capitulates or exits? What’s at stake?
JG: What is at stake is a rather heroic rebellion by a very beleaguered people against a doctrine which has been destroying their lives — the austerity doctrine and the whole neoliberal project. For the rest of us, what is at stake is whether we have the moral courage in the sense of ethical responsibility to stand up to it.
LP: Is the austerity doctrine — which has been widely discredited by economists — under serious threat?
JG: It is definitely under threat from an increasingly emboldened political movement across Europe — certainly in Spain, certainly in Ireland, probably in Portugal, Italy, and France. So the answer is yes. This is what terrifies the European elites about the Greek situation. What Syriza did was to wipe out — and the referendum completed the job — the leadership of the previous sort of condominium of governing parties, which were a neoliberal conservative party and a neoliberlized social party. Now what do you find in the rest of Europe? Look at Germany, look at France. You find exactly the same thing. And of course, the elites in those countries fear the same phenomenon. So what we’re seeing is an allergic reaction to what they regard as a political threat of the first order.
It is now 100 years since drugs were first banned—and all through this long century of waging war on drugs, we have been told a story about addiction by our teachers and by our governments. This story is so deeply ingrained in our minds we take it for granted: There are strong chemical hooks in these drugs, so if we stopped on day 21, our bodies would need the chemical. We would have a ferocious craving. We would be addicted. That’s what addiction means.
This theory was first established, in part, through rat experiments that were injected into the American psyche in the 1980s, in a famous advertisement by the Partnership for a Drug-Free America. You may remember it. The experiment is simple. Put a rat in a cage, alone, with two water bottles. One is just water. The other is water laced with heroin or cocaine. Almost every time you run this experiment, the rat will become obsessed with the drugged water, and keep coming back for more and more, until it kills itself.
The ad explains: “Only one drug is so addictive, nine out of ten laboratory rats will use it. And use it. And use it. Until dead. It’s called cocaine. And it can do the same thing to you.”
But in the 1970s, a professor of psychology in Vancouver named Bruce Alexander noticed something odd about this experiment. The rat is put in the cage all alone. It has nothing to do but take the drugs. What would happen, he wondered, if we tried this differently?
So Professor Alexander built Rat Park. It is a lush cage where the rats would have colored balls and the best rat-food and tunnels to scamper down and plenty of friends: everything a rat about town could want. What, Alexander wanted to know, will happen then?
In Rat Park, all the rats obviously tried both water bottles, because they didn’t know what was in them. But what happened next was startling.
The rats with good lives didn’t like the drugged water. They mostly shunned it, consuming less than a quarter of the drugs the isolated rats used. None of them died. While all the rats who were alone and unhappy became heavy users, none of the rats who had a happy environment did.
At first, I thought this was merely a quirk of rats, until I discovered that there was—at the same time as the Rat Park experiment—a helpful human equivalent taking place. It was called the Vietnam War. Time magazine reported using heroin was “as common as chewing gum” among U.S. soldiers, and there is solid evidence to back this up: some 20 percent of U.S. soldiers had become addicted to heroin there, according to a study published in the Archives of General Psychiatry.
Many people were understandably terrified; they believed a huge number of addicts were about to head home when the war ended.
But in fact some 95 percent of the addicted soldiers—according to the same study—simply stopped. Very few had rehab. They shifted from a terrifying cage back to a pleasant one, so didn’t want the drug any more.
Professor Alexander argues this discovery is a profound challenge both to the right-wing view that addiction is a moral failing caused by too much hedonistic partying, and the liberal view that addiction is a disease taking place in a chemically hijacked brain. In fact, he argues, addiction is an adaptation. It’s not you. It’s your cage.
Rats in the Park
If you fall into that state of addiction, is your brain hijacked, so you can’t recover?
After the first phase of Rat Park, Professor Alexander took this test further. He reran the early experiments, where the rats were left alone, and became compulsive users of the drug. He let them use for 57 days—if anything can hook you, it’s that.
Then he took them out of isolation, and placed them in Rat Park. He wanted to know, if you fall into that state of addiction, is your brain hijacked, so you can’t recover? Do the drugs take you over? What happened is—again—striking. The rats seemed to have a few twitches of withdrawal, but they soon stopped their heavy use, and went back to having a normal life. The good cage saved them.
When I first learned about this, I was puzzled. How can this be? This new theory is such a radical assault on what we have been told that it felt like it could not be true. But the more scientists I interviewed, and the more I looked at their studies, the more I discovered things that don’t seem to make sense—unless you take account of this new approach.
Here’s one example of an experiment that is happening all around you, and may well happen to you one day. If you get run over today and you break your hip, you will probably be given diamorphine, the medical name for heroin. In the hospital around you, there will be plenty of people also given heroin for long periods, for pain relief.
The heroin you will get from the doctor will have a much higher purity and potency than the heroin being used by street-addicts, who have to buy from criminals who adulterate it. So if the old theory of addiction is right—it’s the drugs that cause it; they make your body need them—then it’s obvious what should happen. Loads of people should leave the hospital and try to score smack on the streets to meet their habit.
The street-addict is like the rats in the first cage, isolated, alone, with only one source of solace to turn to.
But here’s the strange thing: It virtually never happens. As the Canadian doctor Gabor Mate was the first to explain to me, medical users just stop, despite months of use. The same drug, used for the same length of time, turns street-users into desperate addicts and leaves medical patients unaffected.
If you still believe, as I used to, that chemical hooks are what cause addiction, then this makes no sense.
But if you believe Bruce Alexander’s theory, the picture falls into place. The street-addict is like the rats in the first cage, isolated, alone, with only one source of solace to turn to. The medical patient is like the rats in the second cage. She is going home to a life where she is surrounded by the people she loves. The drug is the same, but the environment is different.
The Opposite of Addiction Is Connection
This gives us an insight that goes much deeper than the need to understand addicts.
A heroin addict has bonded with heroin because she couldn’t bond as fully with anything else.
Professor Peter Cohen argues that human beings have a deep need to bond and form connections. It’s how we get our satisfaction. If we can’t connect with each other, we will connect with anything we can find—the whirr of a roulette wheel or the prick of a syringe. He says we should stop talking about ‘addiction’ altogether, and instead call it ‘bonding.’ A heroin addict has bonded with heroin because she couldn’t bond as fully with anything else.
So the opposite of addiction is not sobriety. It is human connection.
When I learned all this, I found it slowly persuading me, but I still couldn’t shake off a nagging doubt. Are these scientists saying chemical hooks make no difference? It was explained to me—you can become addicted to gambling, and nobody thinks you inject a pack of cards into your veins. You can have all the addiction, and none of the chemical hooks. I went to a Gamblers’ Anonymous meeting in Las Vegas (with the permission of everyone present, who knew I was there to observe) and they were as plainly addicted as the cocaine and heroin addicts I have known in my life. Yet there are no chemical hooks on a craps table.
But still, surely, I asked, there is some role for the chemicals? It turns out there is an experiment which gives us the answer to this in quite precise terms, which I learned about in Richard DeGrandpre’s book The Cult of Pharmacology.
Everyone agrees cigarette smoking is one of the most addictive processes around. The chemical hooks in tobacco come from a drug inside it called nicotine. So when nicotine patches were developed in the early 1990s, there was a huge surge of optimism—cigarette smokers could get all of their chemical hooks, without the other filthy (and deadly) effects of cigarette smoking. They would be freed.
Ironically, the war on drugs actually increases all those larger drivers of addiction.
But the Office of the Surgeon General has found that just 17.7 percent of cigarette smokers are able to stop using nicotine patches. That’s not nothing. If the chemicals drive 17.7 percent of addiction, as this shows, that’s still millions of lives ruined globally. But what it reveals again is that the story we have been taught about chemical hooks is, in fact, real, only a minor part of a much bigger picture.
This has huge implications for the 100-year-old war on drugs.
This massive war—which kills people from the malls of Mexico to the streets of Liverpool—is based on the claim that we need to physically eradicate a whole array of chemicals because they hijack people’s brains and cause addiction. But if drugs aren’t the driver of addiction—if, in fact, it is disconnection that drives addiction—then this makes no sense.
Ironically, the war on drugs actually increases all those larger drivers of addiction. For example, I went to a prison in Arizona—Tent City—where inmates are detained in tiny stone isolation cages (‘The Hole’) for weeks and weeks on end to punish them for drug use. It is as close to a human recreation of the cages that guaranteed deadly addiction in rats as I can imagine. And when those prisoners get out, they will be unemployable because of their criminal record, guaranteeing they with be cut off ever more.
How Portugal Halved Drug Addiction Levels
There is an alternative. You can build a system that is designed to help drug addicts to reconnect with the world—and so leave behind their addictions.
This isn’t theoretical. It is happening. I have seen it. Nearly 15 years ago, Portugal had one of the worst drug problems in Europe, with one percent of the population addicted to heroin. They had tried a drug war, and the problem just kept getting worse.
So they decided to do something radically different. They resolved to decriminalize all drugs, and transfer all the money they used to spend on arresting and jailing drug addicts, and spend it instead on reconnecting them—to their own feelings, and to the wider society.
Decriminalization has been such a manifest success that very few people in Portugal want to go back to the old system.
The most crucial step is to get them secure housing, and subsidized jobs so they have a purpose in life, and something to get out of bed for. I watched as they are helped, in warm and welcoming clinics, to learn how to reconnect with their feelings, after years of trauma and stunning them into silence with drugs.
One group of addicts were given a loan to set up a removals firm. Suddenly, they were a group, all bonded to each other, and to the society, and responsible for each other’s care.
The results of all this are now in. An independent study by the British Journal of Criminology found that since total decriminalization, addiction has fallen, and injecting drug use is down by 50 percent. I’ll repeat that: injecting drug use is down by 50 percent.
Decriminalization has been such a manifest success that very few people in Portugal want to go back to the old system. The main campaigner against the decriminalization back in 2000 was Joao Figueira, the country’s top drug cop. He offered all the dire warnings that we would expect: more crime, more addicts. But when we sat together in Lisbon, he told me that everything he predicted had not come to pass—and he now hopes the whole world will follow Portugal’s example.
We need now to talk about social recovery—how we all recover, together ...
Happiness in "the Age of Loneliness"
This isn’t only relevant to addicts. It is relevant to all of us, because it forces us to think differently about ourselves. Human beings are bonding animals. We need to connect and love. The wisest sentence of the twentieth century was E.M. Forster’s: “only connect.” But we have created an environment and a culture that cut us off from connection, or offer only the parody of it offered by the Internet. The rise of addiction is a symptom of a deeper sickness in the way we live–constantly directing our gaze towards the next shiny object we should buy, rather than the human beings all around us.
The writer George Monbiot has called this “the age of loneliness.” We have created human societies where it is easier for people to become cut off from all human connections than ever before. Bruce Alexander, the creator of Rat Park, told me that for too long, we have talked exclusively about individual recovery from addiction. We need now to talk about social recovery—how we all recover, together, from the sickness of isolation that is sinking on us like a thick fog.
But this new evidence isn’t just a challenge to us politically. It doesn’t just force us to change our minds. It forces us to change our hearts.
Loving an addict is really hard. When I looked at the addicts I love, it was always tempting to follow the tough love advice doled out by reality shows like Intervention—tell the addict to shape up, or cut them off. Their message is that an addict who won’t stop should be shunned. It’s the logic of the drug war, imported into our private lives.
But in fact, I learned, that will only deepen their addiction—and you may lose them altogether. I came home determined to tie the addicts in my life closer to me than ever—to let them know I love them unconditionally, whether they stop, or whether they can’t.
This article is adapted from Chasing the Scream: The First and Last Days of the War on Drugs by Johann Hari. Hari is a British journalist whose work has appeared in the New York Times, Le Monde, The Guardian, The New Republic, and other publications.
Mario Seccareccia, a professor of economics at the University of Ottawa, has been outspoken in his warnings that austerity policies have the potential to smash economies and spread human misery. In his work supported by the Institute for New Economic Thinking and elsewhere, he has challenged deficit hawks and emphasized the need for strong government investment in things like jobs, education, healthcare, and infrastructure if economies are to prosper. In the following interview, he talks about why what happened to Greece was entirely predictable, why the Greeks were right to reject austerity in the recent election, and what challenges the country faces in forging a sustainable path forward with the left-wing Syriza party at the helm.
Lynn Parramore: You have long been warning of problems in the Eurozone. What do the Greek elections mean to the debate about austerity and how it impacts economies?
During the discussions, a number of us were already raising very serious questions about a treaty which prevented national governments from doing what they needed to do to stabilize their economies — namely engage in needed deficit spending, regardless of the magnitude, during times of recession for the purpose of stabilizing income and employment. Some of us at the book launch warned of problems that could arise from a European supranational currency and a central bank which was not accountable to any national authority and which would push countries merely to become hostages to the whims of the financial markets. Along with many others, I’ve also raised concerns over what economists call “deflationary bias” in the structure of the Eurozone — that is, the tendency for policies to focus on lower inflation instead of more jobs and growth and to prevent greater public spending as a means to achieve growth.
I could see that Greece would be the country that would be hit first by these problems because it is financially the weakest link in the euro chain, and because of the high public debt ratio when it joined the Eurozone in 2002. What is surprising is that it took until 2010 to reach such a crisis even though the warnings had been there for a long time. Even at the start of the global financial crisis in 2008-2009, most European governments started stimulating their economies or bailing out their banks as we saw in Ireland and Spain. But no major cracks appeared until the end of 2009 when the financial markets got spooked because the Greek authorities were found hiding Greek sovereign debt with the aid of advisors of financial institutions.
From 2010 onwards, Greece achieved notoriety because financial markets recognized that the country might decide not to comply with the terms of loan agreements with banks. Eventually in 2012, European leaders held a summit at the French resort of Deauville and agreed that if the private holders of sovereign debt wanted bailouts, they would be held responsible for the losses. Because of these developments since 2010, deficit hawks everywhere vilified Greece for all the supposed terrible consequences of government over-indebtedness, even though the structure of the Eurozone made it impossible for Greece to manage its economy effectively.
Deficit hawks started preaching long-term austerity, and we’ve seen the awful consequences ever since. People have suffered terrible hardship and dislocation, with countries such as Greece and Spain reaching rates of unemployment worse that what happened in the United States in depth of the Great Depression. You’d be hard-pressed to find examples of such a severe collapse historically, with the possible exception of certain Latin American countries, such as Argentina in 2001. Those who predicted that that this austerity policy would eventually lead to an economic turnaround because of the belief in private sector rebound obviously got it wrong. After five years of negative economic growth, the Greek electorate — with incredible courage — told the so-called Troika that they had had enough, especially with these deep cuts in wages, employment, and pension transfers.
LP: How have the news media and the pundits gotten the story of Greece’s economy wrong?
MS: Ever since the end of 2009 when the story of Greece’s sovereign debt crisis began to unfold, austerity-pushing political leaders around the world have been saying that their country must not become the “next Greece.” Together with much of the international media, they have been perpetuating the view that government deficits are bad and that governments must seek balanced budgets, even if it means some necessary “temporary” hardship. Yet, the experience of the 1930s, which is being repeated with such vengeance in the Eurozone since 2010, is that pursuing austerity policies alone without some other outside stimulus, say, from increased net exports, can’t lead to balanced budgets. Instead, it leads to disaster. These policies destabilize the private sector to such an extent that they actually jeopardize chances of any future recovery. Many Greek citizens felt that they had reached this threshold and wanted a reversal of policy.
LP: Tsipras has promised to reverse some tax hikes and cuts to social services, but Greece is still in the Eurozone. Because, as you mention, it doesn’t have control of its own currency, the Greeks will have to negotiate with the so-called Troika of the European Union, IMF and the European Central Bank. Do you think there is a possibility for meaningful changes given this challenge? And how might internal Greek political problems, especially with Tsipras' possible coalition partners, affect the situation?
MS: This is the “million euro” question: how can the Greek state invest in its economy while still remaining in the Eurozone? Syriza faces a huge challenge politically since the pro-austerity parties in Greece, i.e. New Democracy, LAOS, PASOK, Democratic Left, KIDISO, and POTAMI, still constitute a fairly large block of the vote and the majority of the electorate would seemingly still prefer to remain in the Eurozone. Since it doesn’t have a mandate to take Greece out of the Eurozone, what other options are available?
We have seen already how Germany has warned the new Greek government that it must live up to commitments to its creditors, and with Greece's current bailout program ending in February it will have little breathing room. There may well be a willingness to give the Greek government more time to make its debt payments, but the present Troika seems rather uninterested in outright debt cancellation, even if there may be some desire to negotiate some smaller changes, like the creation of a distinct Eurozone-wide public investment fund which might do things like build and repair roads or support clean energy projects and generate sufficient overall growth, especially in the rest of Eurozone, to perhaps spill over into Greece and turn around its current account balance and also raise government revenues.
All of this means negotiations with many partners that will take time for the present coalition government. On the other hand, the Greeks could get some short-term relief with the depreciating euro in terms of increased net exports for all countries of the Eurozone. Also in the short term, there is the European Central Bank’s commitment to do quantitative easing, or pumping new money into the economy. I have argued that quantitative easing doesn’t work to stimulate private sector spending, but it might help backstop what would have been an eventual financial collapse of a number of Eurozone countries. A lot depends on how big the European Central Bank is willing to go with its plans. If the action was bold enough, Greek banks could benefit indirectly and it could give the Greek government some breathing room and prevent a default, assuming its current creditors demand payment. In the medium term, Greece could create some form of parallel currency set at par with the euro, like Argentina did in the early 2000s. The government in Argentina used “patacones” to buy things and pay employees and they became quite acceptable because ultimately regular people could pay taxes with this currency. The Greeks could have a parallel national currency without altogether abandoning the euro.
So these various short-to-medium-term measures may well be available to prevent default, but, at the end, if the Greek government cannot renegotiate its crushing debt burden — without some form of debt forgiveness in however form it will be disguised — you could see a Greek default happen. If it reaches that point, I don’t think there’s anything in the Eurozone treaties that would prevent Greece from retaining the euro. In this case, it will have to learn from the experiences of dollarized countries such as Ecuador that have been surviving under very severe constraints on fiscal policy but without the oil revenues that until recent times have served well to replenish Ecuador’s coffers.
LP: Lots of countries, like Italy, Spain, Portugal, and maybe even France, are getting close to the distressed economic conditions of Greece. How will a Syriza government in Greece impact them? How do you think those governments will relate to Germany after the election?
MS: I believe that this will give a huge boost to those anti-austerity parties, especially in southern Europe, that are in a similar situation to Greece. That’s going to put further pressure on Germany to accommodate. But it will also boost the support of the nationalist right-wing anti-euro parties, as in France. If all these parties manage to achieve power, it may well be either that the Eurozone countries establish ways for countries to have more latitude in taking action to stabilize their economies.
If some of the right-wing parties come to power, such as the National Front in France, it will mean the end of the euro. The withdrawal of a core country such as France from the Eurozone could lead to currency realignments at the regional levels, without any chances for the survival of the entire Euro bloc.
LP: Do you think there are lessons in what has happened in the Eurozone for students of economics and the way the subject is taught?
MS: Yes, indeed. Ever since the establishment of the modern nation-state in the late eighteenth and nineteenth centuries, the creation of the euro was perhaps the first significant experiment in modern times in which there was an attempt to separate money from the state, that is, to denationalize currency, as some right-wing ideologues and founders of modern neoliberalism, such as Friedrich von Hayek, had defended. What the Eurozone crisis teaches is that this perception of how the monetary system works is quite wrong, because, in times of crisis, the democratic state must be able to spend money in order to meet its obligations to its citizens. The denationalization or “supra-nationalization” of money with the establishment that happened in the Eurozone took away from elected national governments the capacity to meaningfully manage their economies. Unless governments in the Eurozone are able to renegotiate a significant control and access money from their own central banks, the system will be continually plagued with crisis and will probably collapse.
