Legislators should consider this successful public policy to deal with overdose deaths

This guest post was written by Adrian Comollo, with collaboration from Andrew Bjelland.


For over 15 years now, Portugal has had the lowest overdose death rate among developed countries. This is not because the people of Portugal are any more virtuous than people in other countries. In fact, between 1980-2000, Portugal had one of the highest overdose death rates among developed countries. The overdose death rate amounted to a national catastrophe, and Portuguese authorities tried all sorts of regulations and stiff penalties, but these did not improve the situation. A very different approach, however, did prove effective.

The improved situation occurred only after Portuguese authorities adopted a results-based public policy, very different from the usual criminalization and punishment.

The policy? Instead of criminalizing all drug possession, the law was changed to limit incarcerations to drug dealers or users who possessed large quantities of drugs. Citizens who possessed smaller quantities of ANY drug for personal use–up to ten days of personal use—were considered to have a mental illness and received mandatory treatment at medical facilities.  ‘Any drugs’ includes the hard ones, like heroin and cocaine.

This pragmatic policy was initiated in 2002 and gradually decreased overdose deaths with a smaller price tag. Turns out it’s more costly to send people to jail than to focus on treatment. Criminalization also results in secondary costs from associated consequences: thefts, prostitution, robberies, and medical bills. When drug users were considered criminals, many drug users, at great cost, were recurrently in and out of jail.      

Europe’s overall drug-overdose death rate is closer to that of Portugal than the US. Throughout Europe, the mental-health approach to drug use–similar to that of Portugal–is being gradually adopted by all its countries, and it has proven to be much more effective than the criminalization approach still dominant in the US today. Indeed, the US overdose death rate is over eight times that of the overall European overdose death rate, and the overall European rate is a little over three times that of Portugal.

Fortunately, in these last few years, the criminalization trend toward illegal drugs has been softened in the US by those states that have decriminalized marijuana, but Utah in not yet one of them.

In Utah, the possession of marijuana, even under one ounce, is still considered a misdemeanor. Upon the third arrest it becomes a felony. Possession of hard drugs like heroin, cocaine, and meth is immediately considered a third-degree felony, with years in prison as penalty. Clearly, Utah’s views on drugs are very different from the views in Portugal. But is Utah’s approach working?

Just a couple years ago, Utah adopted a new approach called Justice Reinvestment Initiative that prioritizes medical treatment for some offenders, but it is still too early to evaluate the results.

In 2015, Utah had an overdose death rate of 224 per one million, which is higher than the national rate of 185 per one million. A large percentage of inmates are incarcerated for drug-related offenses. Recidivism is high, and because illegal drugs can be expensive, addicts are prone to criminal behavior to pay for their addiction. Medical programs for drug rehabilitation still have limited funding which makes access to the programs difficult for most who need it.  

Isn’t it time to treat drug addiction as a mental illness, rather than a crime? The Portuguese approach to this problem certainly deserves to be reflectively evaluated and, we believe, implemented.

Adrian Comollo has a PhD in Italian Medieval Literature and an MA in philosophy from the University of Torino, Italy. Adrian taught for many years at the University of Wisconsin, University of Utah, and BYU, Provo. 
Andrew G. Bjelland, PhD, is a professor emeritus in the Philosophy Department of Seattle University. His teaching specialties include Social and Political Philosophy, Bio-Medical Ethics, Logic and a variety of courses in the history of ideas.
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