Treatment and Prevention of Drug Problems

Europe Moves Drug War From Prisons to Clinics

By T.R. Reid

LISBON -- The last time the cops nabbed Miguel, he was carrying one envelope with several grams of heroin and another with a slightly smaller stash of cocaine. "I thought, 'Oh Lord, here we go again,' " Miguel said, grimacing at the memory. "I figured I was headed straight back to Leiria," the dank national prison where he has served two terms on drug charges.

As it turned out, Miguel did not do another stretch behind bars -- not because of a clever defense lawyer, but because of Portugal's fundamentally new battle plan in the long-running war on drugs: This nation of 10 million has decriminalized all drug use.

Director of the nation's biggest drug treatment center, Dr. Luis D. Patricio favors Portugal's decision to decriminalize hard drugs. "In prison, you turn an amateur drug user into a professional," Patricio says.

Today Miguel remains a free man, dividing his time between part-time work as an auto mechanic and outpatient treatment at Lisbon's biggest drug treatment clinic.

"It's a good deal, because what I really want is to give up drugs," said the 29-year-old addict, who admitted that he has sold small amounts of drugs on occasion to support his habit. "And I could never do that in prison; in there, the dealers are living right next to you."

The way Portugal has handled Miguel (under clinic rules, his full name cannot be disclosed) and thousands of people like him reflects a shifting attitude toward drugs in many West European countries. Increasingly, drug users are viewed not as criminals, but as victims of a drug culture that tough laws could not control.

Spain, Italy and Luxembourg have also decriminalized possession and use of most drugs, and several other countries have effectively done the same by waiving criminal penalties for addicts who are not found to be dealing.

The director of the European Union's Monitoring Center for Drugs and Drug Addiction, Georges Estievenart, noted that this more tolerant stance applies not just to users of such "soft" drugs as marijuana, but also to heroin and cocaine addicts. "The general trend across Europe," Estievenart said, "is an approach that focuses on the traffickers and does not pursue the drug user as a criminal. The premise is that it is not in the interest of society to put these people in jail, where they don't get treatment but do get fairly easy access to all kinds of drugs.

"Some people refer to this as the 'pragmatic' approach," he said. "It assumes that drug use is a fact of life that society can't stop, so policymakers should try to control the damage. The U.S. perspective, of course, is different. They seek to eliminate drug use by prohibition."

Drug policy is not uniform across Europe. Some countries, notably Sweden and Greece, have held fairly firmly to a U.S.-style, "just-say-no" approach. But in most of Western Europe, said Jonathan Cave, a drug policy expert at Warwick University in Britain, "the general direction is harm reduction rather than use reduction."

"As the U.S. experience shows, people do obtain and use drugs, even if you spend billions trying to stop them," Cave said. "So now the goal [in Europe] is to have it happen without the risk of overdose, of HIV, of random crime to support the habit."

The ethos of harm reduction was set forth succinctly by Vitalino Canas, the former Portuguese government minister who has championed the new approach here. "Of course our message is, 'Don't use drugs at all,' " Canas said. "But people don't always listen. So then we say, 'If you use, do not use hard drugs. And if you use hard drugs, do not inject them. And if you inject, do not share needles.' We think this is more realistic than 'just say no' all by itself."

Europe's approach has drawn some sharp criticism, not least from the International Narcotics Control Board, the U.N. agency set up to enforce several international treaties that ban the sale or use of narcotics.

The control board argues that uniform global prohibitions are essential to stop the use and movement of drugs. Western Europe's policy amounts to defeatism, said the board's president, Hamid Ghodse. "It may not be possible to eliminate all forms of drug experimentation, use and abuse," Ghodse said. "But the difficulty of the challenge should not be used as an excuse not to take action."

U.S. drug enforcement officials have also sniped at European drug policies, saying that legalization encourages use.

To date, there is little clear evidence as to the impact of the new policies. "We are eagerly awaiting studies," said the EU's Estievenart. "But so far, we don't have the data to show whether or not the pragmatic solution can reduce the use of drugs."

The shift toward tolerance began decades ago. In the 1970s, the Netherlands was a leader, tolerating use of such so-called soft drugs as marijuana, or cannabis, as it is generally known in Europe. The famous "hash houses" that opened along the old canals of Amsterdam still draw a steady clientele of locals and tourists.

Customers can order from two different menus. One has coffee -- espresso, cappuccino and the like. The other has an even wider selection of hashish, a form of cannabis -- "Nepal," "Kashmir," "Thai," "Kabul." The barman will also roll joints, which cost about $3 each.

Contrary to Amsterdam's freewheeling reputation, the hash houses tend to be quiet and controlled. At risk of police closure, the shops strictly enforce the mandatory age limits -- customers have to be 18 to buy drugs there, two years older than the legal drinking age.

"Decriminalization has worked fairly well in the Netherlands," said Cave, the drug policy expert at Warwick University, adding that few hash-house customers have been found to move on to hard drugs.

Amsterdam's approach to cannabis spread widely through Europe. Today, by statute or in practice, police officers in most European countries ignore users of marijuana or so-called recreational drugs such as amphetamines and ecstasy.

The latest convert is Britain, where the Home Office (roughly the equivalent of the U.S. Justice Department) said in March that it would downgrade cannabis from a "Class B" to "Class C" drug. This would eliminate criminal penalties and treat possession or use like a parking violation.

With the approval of the central government, some local police departments in Britain have already taken that step in practice. In the south London neighborhood of Brixton, the local police commissioner announced last year that his officers would no longer bother to arrest pot smokers. Today it is commonplace to see young Londoners lighting a "spliff" on the sidewalk outside Brixton's police station.

A recent study by the Joseph Rowntree Foundation, a London research group, concluded that the Brixton experiment was a resounding success. Ignoring marijuana offenses, the study concluded, allowed the police to direct money and personnel to more serious crimes and "removed a major source of friction between the police and the community." The report said the more relaxed approach was "unlikely" to lead to greater use of marijuana or more harmful drugs. It offered no data to support this conclusion.

For the most part, the non-enforcement policy toward soft drugs has gone over well with European voters. But Europe's new moves to decriminalize such drugs as heroin and cocaine can be a tougher political sell.

Nobody knows that better than Vitalino Canas, an urbane, articulate former law professor who was a Portuguese government minister. It was Canas who led this socially conservative, overwhelmingly Roman Catholic country to abandon its long-standing prohibitionist policy toward hard drugs.

Canas spent a year or more discussing the plan with the Catholic Church, the medical community and the police before introducing legislation. The key political step, he said, was rejecting any suggestion that decriminalization amounts to a stamp of approval for drugs.

"You have to be very careful about the message you send," Canas explained. "We do not say, we have never said, that it is good to use heroin or cocaine. These drugs are still forbidden. What has changed is the means we use to prevent their use."

Portugal's new drug law is so protective that it rejects terms such as "addict" or "user." Rather, the person hooked on hard drugs is referred to as a "consumer."

In the real world, the distinction between "consumer" and "dealer" is not always clear, of course. To draw the line, Portugal has made rules based on quantity. Anyone arrested with less than 10 days' personal supply of each drug is considered to be in possession of the drugs for personal use and is not prosecuted. Anyone arrested with more than 10 days' supply can be charged with dealing.

A drug user picked up by the police is initially sent to one of 18 civilian "drug commissions" around the country. The commission is supposed to deal with each case individually, but users of cannabis or amphetamines are generally given educational material and released, while those using hard drugs are assigned to a treatment program.

A user who accepts treatment faces no further punishment, Canas said. Those who duck out of treatment, or are caught offending again, face administrative penalties similar to those for speeding or failing to file a tax return. Initially, there are fines, beginning at about $22. More serious violators can lose their driver's license or the right to travel abroad, or be assigned to such public service jobs as cleaning graffiti off the city's walls.

Elza Pais, who runs the local drug commission for Lisbon, said most consumers turned over by police say they want to break the drug habit and that they readily accept treatment. A few would actually prefer to go to prison, she said, perhaps because drugs tend to be easier to obtain there. "But we no longer have that option."

Like most of the people arrested for drug use in Lisbon, Miguel was dispatched to the sprawling four-story treatment center on Taipas Street in Lisbon's Bairro Alto neighborhood. There he came under the friendly but firm ministrations of the center's energetic director, Luis D. Patricio.

"We have inpatients and outpatients here," Patricio said, leading a tour of his center like a hotel manager showing off a fancy new resort. "We have young mothers and aging pensioners. We have people who genuinely want to end their addiction, and people who probably just think it is easier to come here for methadone than to scratch up the money for a fix on the street.

"But for all of them, we have the same message now: You are not a criminal. You do not have to fear the government or the doctor. With good treatment you can get over addiction, and we are going to help you do it."

After two decades of treating Lisbon's drug problem, Patricio said he is certain Portugal's new policy is the best course. "In prison, you turn an amateur drug user into a professional," he said. "That's what America is doing; in Europe, we are looking for other solutions."

Canas, the former government minister, acknowledges that the long-term result of the policy is unclear. "We only put the law into effect last July," he said. "Perhaps in a year or so, we will be able to draw some conclusions about the impact.

"For now, the fact is that we are experimenting."