
Portugal treats addiction as a disease, not a crime - fanf2
https://www.nytimes.com/2017/09/22/opinion/sunday/portugal-drug-decriminalization.html
======
chicob
I used to live not far away from Casal Ventoso, in the 80's. Anyone crossing
that neighborhood in those days would easily see hordes of alienated people,
in soiled clothes, gazing idly, sitting in the sidewalk and sometimes even
injecting right there. Whenever you saw them running in one direction, you'd
know some drug dealer had arrived. There is a cemetery nearby, and so it
looked like death ruled the place.

Today it is still a poor neighborhood, but you don't see that kind of thing
anymore. Taking the bus there is no longer a gamble. You still see a couple of
people looking somewhat emaciated, but nothing like the walking cadavers of 30
years ago.

There were some slums outside Lisbon, like Pedreira dos Húngaros, where the
police (other than SWAT teams) simply wouldn't go. It was just too dangerous.
One would occasionally hear the blasts of fireworks, telling people drugs had
arrived, or gunshots, warning drug dealers an intervention squad was near.
This slum no longer exists, and many others are simply gone.

It's nice to see this article in HN, for many reasons.

António Guterres is an engineer, and when he graduated he was the best student
of his year. From what I know, he considered a PhD in Physics before taking
his chances in politics. Back in those days, his university (Instituto
Superior Técnico) didn't have a Physics course, so many of its first faculty
members came from IST's Electrical Engineering course or Physics courses from
other universities. He lectured Theory of Systems and Telecommunication
Signals.

Guterres is an intelligent man, and he would've probably become a great
physicist, an excellent teacher, or a renowned engineer. Instead he chose
politics, and now he's Secretary-general of the UN. His drug policy from his
Prime-minister days saved thousands of lives and definitely changed Portugal
for the better. I think that was a really nice hack.

~~~
galfarragem
As a Portuguese, I have to add:

Guterres is a worldclass facilitator full of good will. That's his edge - not
intelligence - and how he got his position in UN.

In 2001, Guterres was forced to resign from his job as Prime Minister of
Portugal. Not the best indicator of great leadership or management skills.

~~~
epmaybe
From Wikipedia:

> In December 2001, following a disastrous result for the Socialist Party in
> the local elections, Guterres resigned, stating, "I am resigning to prevent
> the country from falling into a political swamp".

Could you clarify why you believe resignation implies a lack of leadership or
management skills?

~~~
galfarragem
Why do you think the Socialist Party got "a disastrous result in the local
elections"? Because their leader showed great managing skills and charisma?

(IMO) his fall, on the eyes of the public opinion at the time, started here:
[https://en.wikipedia.org/wiki/Hintze_Ribeiro_disaster](https://en.wikipedia.org/wiki/Hintze_Ribeiro_disaster)

Few years later, Guterres found the perfect employer for his skills: UN.

------
sulizilxia
I've often thought that substance access needs to be completely deregulated,
for drugs of abuse as well as other medications. This would increase access
and competition among providers, and avoid rent-seeking kinds of economic
problems in the health care market. It would also lead to better treatment of
substance use problems, and kill cartels by decreasing their monopoly on
production and distribution.

In doing so, you could move to a kind of competency-based system akin to what
happens with people who have dementia or cognitive impairments. Basically,
you're legally entitled to buy whatever meds you want, until you're deemed
incompetent to make that decision. Processes could be set up whereby mental
health professionals (psychiatrists, psychologists), ethicists, and the
judicial system could make determinations that an individual is not competent
to make decisions about the substance use purchasing due to addiction.

This might sound kind of draconian, but decisions about competency could be
make pretty thorough, requiring a petition, stringent evaluation criteria
involving panels and a judicial decision. It would also be dramatically less
restrictive than the current system, that basically assumes everyone is
incompetent to make drug-related decisions based on the specific drug.

It would also emphasize that the lack of competency is a health-related
problem, and not a criminal problem.

~~~
KGIII
There are loads of problems with that. I agree, in principle, but I'll give
you an example of a problem that already is happening.

Not every drug you take is limited to impacting just you. A good example is
antibiotics. We are having serious issues with drug-resistant bacteria.
Allowing people to just take antibiotics of their own free will is absolutely
certain to increase the number of drug-resistant bacteria. This will, with
absolute certainty, result in an increase people being killed through no fault
of their own.

Could this be prevented? Nope. One might say people could be educated and that
they'd make the right choices, but the very idea of that is farcical. The
planet is not populated with people who make bright choices and exhibit a
propensity for long-term thinking.

I very much believe in allowing autonomy over self, and I've strongly
supported these ideals. However, that has to have limits in a functioning
society. As much as I'd like to say we should be able to take all the drugs,
there is a need to draw some lines. We can move those lines, and I think we
should, but eliminating them entirely is absolutely certain to harm innocent
people at a level I am unwilling to support.

~~~
xpinguin
Do you really think, that general populace's misuse of antibiotics could cause
the development of resistant bacterial strains en masse?

I might be wrong, and if so, please don't hesitate to provide some factual
paper, yet my intuition suggests that in order to obtain solely by selection
(under the pressure of a _single_ bioactive substance), a bacterial strain,
that is, simultaneously:

\- resistant to the aforementioned substance

\- stable: resistance is not lost after the generation or so, past the moment
when exposure is over

\- contagious: strain is resistant to different immune systems (w/o losing its
resistance to the substance, of course),

one either needs to perform a directed selection (eg. like that for apple-
trees), or to create an environment, where really _huge_ bacterial population
could thrive and persist for a long time: like that in hospitals or farms, -
where not only frequent turnover of living organisms along with the regular
exposure to antibacterial substances do happen, but also some intermediate
vessels (medical instruments, ground, water supply, etc.) are available for
bacteria to flourish in-between living hosts.

~~~
croatially
> Do you really think, that general populace's misuse of antibiotics could
> cause the development of resistant bacterial strains en masse?

Of course not. There's 7 billion people, and just a tiny percentage uses
antibiotics.

There's around 60 billion land mammals raised by humans every year, throughout
their life most of them use the strongest antibiotics. It speeds up growth, it
prevents silly deaths, increases profit.

Diseases, plagues will come from livestock, as they always did, not from
humans.

------
shasheene
"The [Portuguese] Health Ministry spends less than $10 per citizen per year on
its successful drug policy. Meanwhile, the U.S. has spent some $10,000 per
household (more than $1 trillion) over the decades on a failed drug policy
that results in more than 1,000 deaths each week."

That's a intellectually dishonest and misleading statement: it's comparing
Portuguese annual cost per citizen to US cumulative multi-decade cost per
household.

~~~
astronautjones
You're implying that the US has a more effective drug policy than Portugal,
which is absolutely ridiculous

~~~
skrebbel
Not at all. GP is implying that there's some shitty journalism going on.

Your comment bothers me more than it should. Why do people who feel strongly
about stuff allow, or even encourage, shitty reporting and intellectual
dishonesty as long as it suits the narrative they support?

I mean, you're calling out a commenter for being 100% right, putting words in
their mouth and then calling those words ridiculous. What's the point?

------
notadoc
Addiction is a chemical dependency. It is neither a disease or a crime, it's
usually a symptom of something else.

Substance abuse and addiction tends to originate from either a variety of
sociological factors, or treatment (self or prescribed). A very large number
of addicts are simply self medicating for one reason or another. Or at least
they started off that way.

Even if society determines addiction and substance usage to be criminal, it's
a victimless crime and a waste of resources.

~~~
dingo_bat
> it's a victimless crime

Not always, not for the worst drugs out there. Heroin and meth addicts
regularly commit violent crimes as a direct result of their addiction. You can
say that the actual violence is the crime, but if there is a common root cause
for a lot of crimes, doesn't it make sense to criminalize the root cause?

~~~
flomble
Heroin and meth addicts regularly commit violent crimes in order to procure
more heroin/meth. The only reason they need to is because prohibition makes
those drugs orders of magnitude more expensive than they would otherwise be.
The only reason the drug cartels engage in ruthless violence is because they
operate outside of the law and thus outside of the government's monopoly on
force. Criminalization _is_ the root cause of the crime.

------
smsm42
The headline reads eerie, almost as a quote from some anti-utopian novel.
"This weird place treats diabetes as a disease, not a crime!". "That weird
country over there treats depression as a disease, not a crime!". I mean, how
messed up should we be to not see this as the only way to treat it?

~~~
omegaham
The difference is that addicts are _actively malicious_ to their family
members and broader society.

Depressed people and diabetics are hurting themselves either through action or
inaction, but I've never been threatened by a diabetic or depressive outside a
Circle K. I _have_ been threatened by a criddler outside a Circle K.
Similarly, few people get all of their stuff stolen out of their house by a
diabetic or depressive. They do all the time when their son is addicted to
heroin. Depressives don't prostitute their kids to drug dealers for crack,
etc.

Drug addiction is one of the few diseases where the patient actively attacks
all of the people who are in a position to help him. That generally alienates
people who tend to be otherwise generous toward the down-and-out. The laws
reflect that, and it takes a superhuman effort of rationality to say, "Yes,
addicts do terrible things. Other solutions produce better results than the
natural impulse of doing terrible things back to them."

Edit: We see this in the nastier forms of mental illness, too. People are
generally compassionate toward those with OCD, eating disorders, and so on.
Those with borderline personality disorder or bipolar disorder tend to be
relegated to "batshit insane" and viewed with utter contempt. Again, the
difference is that someone with anorexia nervosa isn't going to pull a Carrie
Underwood[1] on your car, but someone with BPD might.

[1][https://www.youtube.com/watch?v=WaSy8yy-
mr8](https://www.youtube.com/watch?v=WaSy8yy-mr8)

~~~
smsm42
> I've never been threatened by a diabetic or depressive outside a Circle K

Mentally ill people can be dangerous to the surrounding people, especially if
not treated properly. This is known, and it is also known that the way to deal
with it is to address the disease, not hurt them and yell at them "snap out of
it, you bastard!"

> The laws reflect that, and it takes a superhuman effort of rationality to
> say, "Yes, addicts do terrible things. Other solutions produce better
> results than the natural impulse of doing terrible things back to them."

Calling this "superhuman" only reveals how low the expectations of "human"
are. It is truly sad state of affairs that acting rationally and trying to do
something that actually might make dent into a solving the problem instead of
instinctively biting back is something that is considered "superhuman". If
going a tiny step above animal is "super-human", what is left for "human"?

------
chrischen
I think if you polled American's on whether the legal drinking age should be
lowered from 21, most people, if not a significant majority would probably be
in favor of it. In fact, a majority have probably violated such a law.

If it turns out true, then it means there's something fundamentally wrong with
the legal and voting system where somehow it completely restricts itself from
the ability to enact a change in the laws in this area. And if this can't be
achieved, there's no hope for any progressive drug use laws.

~~~
KGIII
They have done that poll. It's exactly opposite of what you think. They've
done this poll lots of times. The results are rather consistent.

Here is one such example:

[http://politicalticker.blogs.cnn.com/2014/07/24/do-you-
want-...](http://politicalticker.blogs.cnn.com/2014/07/24/do-you-want-the-
drinking-age-lowered/)

That was just the first result.

Anyhow, we don't always want majority rule. At one time, the majority of
people felt it was okay to own people. I suspect you can find areas where the
majority of people don't think we should have equal rights for certain classes
of people.

~~~
Clubber
>Anyhow, we don't always want majority rule.

You do in a democracy.

>At one time, the majority of people felt it was okay to own people.

Until they decided it wasn't ok, and an abolitionist president was elected.

>I suspect you can find areas where the majority of people don't think we
should have equal rights for certain classes of people.

Like civil rights for gays. Also solved by voting.

The problem I have with the 21 year old drinking age is it now allows police
to jail college kids at will, essentially limiting their life's prospects.
Again the punishment is worse than the crime.

------
teabee89
I'm not sure the graph entitled "A Stark Difference: Drug-Related Deaths"
proves any point: Portugal has indeed the best stats and the US the worst, but
you cannot conclude that it results from Portugal's vs US's policy on drugs.
In fact, France, right below Portugal on the graph, still has quite repressive
policies.

~~~
alexnewman
Tell me about these policies. Why are the French policies repressive

~~~
jacquesm
Well, they're repressive enough that the French come to NL and Portugal in
droves to get their drugs.

------
grondilu
This article changed my view on the subject a bit.

Lately, I had been watching various documentaries and YouTube videos about the
opioid crisis in the USA and Canada. Often, the public policy seemed absurd to
me, as it was just as if the first responder services were offering free
customer support for the drug business. They used Naloxone to save the lives
of customers who should normally have overdosed, and with no supervision
afterwards, those addicts were soon back in the street where they keep buying
and consuming.

A drug that is too lethal has very little commercial viability. By decreasing
the lethality of drugs, first responders support the drug business, which is
absurd.

I started reading this article expecting it to enforce my position, but I had
to acknowledge the fact that apparently, this policy did indeed reduce drug
usage in that country. That puzzled me a bit as I was struggling to see how
making consumption easier could reduce consumption, but then they mentioned
how they provide methadone, and that seemed like a sensible explanation. They
don't provide customer support by just giving naloxone for instance, as I saw
they do in US and Canada, they also provide an opioid substitute, which should
hopefully reduce the likelihood of a relapse.

~~~
jacquesm
Many countries take this approach.

[https://decorrespondent.nl/6562/het-zelden-vertelde-
verhaal-...](https://decorrespondent.nl/6562/het-zelden-vertelde-verhaal-over-
het-nederlandse-drugsbeleid-dat-wel-slaagde/831216079738-b19faae6)

Amsterdam, 1985, the government supplied methadone using an old city bus they
transformed into a drug dispensary, they even supplied clean needles for free.

~~~
grondilu
> Amsterdam, 1985, the government supplied methadone using an old city bus
> they transformed into a drug dispensary, they even supplied clean needles
> for free.

In the documentary I was mentioning (sorry, can't find a link or remember the
title), I saw something like that in Canada (IIRC). It was a room with
needles, with a nurse or something to supervise and monitor injections. And of
course there were doses of Narcan in case an OD happens.

But no methadone whatsoever was offered. Or if there was, it wasn't mentioned.
So basically the government was paying to provide an infrastructure for drug
consumption. In other words : customer support. It's as if they were working
for drug dealers. To me that's outrageous.

~~~
jacquesm
> So basically the government was paying to provide an infrastructure for drug
> consumption.

So what?

> customer support. It's as if they were working for drug dealers. To me
> that's outrageous.

What's outrageous is that you'd rather see those people die. That's the
alternative. To get them off the streets, registered and out of the risk of
getting hepatitis or HIV is the beginning of giving them a chance to clean up.
The government even competed with the drug dealers: they gave out free heroin
to those that were already addicted.

And it's not as if any of this isn't a selfish thing by society, the cost of
an addict over the longer term is far higher than the cost of helping them, so
it is actually better for everybody.

I really don't understand these extremist viewpoints when it comes to
healthcare.

~~~
grondilu
> What's outrageous is that you'd rather see those people die. That's the
> alternative.

You're not supposed to save lives at any cost. Not if that means you'd
associate with or reward crime. That's why you don't submit to blackmail, for
instance. In the same way when someone is selling drugs illegally, you're
supposed to put him in jail, not help him with his business.

~~~
jacquesm
> You're not supposed to save lives at any cost.

The cost is quite manageable.

> Not if that means you'd associate with or reward crime.

They don't.

> That's why you don't submit to blackmail, for instance.

What does that have to do with any of this?

> In the same way when someone is selling drugs illegally, you're supposed to
> put him in jail, not help him with his business.

I'm sure you will feel right at home in AG Sessions office or with the
Philippine leader. Me, I'm _much_ more comfortable starting from root cause
analysis rather than to just hunt symptoms, I think hunting symptoms is a
waste of time, effort and resources.

------
anythingnonidin
Great to see this in the NYT.

Drug use should be treated as a health issue, not a criminal issue.

~~~
RhysU
Addiction is a health issue. Experimenting prior to addiction is clearly not.

~~~
simonh
This thread is full of smartasses 'well actualy'-ing irrelevant picky
distinctions of no particular substance. I'm not going to go at all of them,
but lucky you!

Medical problems associated with drugs go way beyond just addiction. Kids can
die on their first use of a drug, even on a dose that would normally be forced
be harmless, due to other factors such as dehydration, alcohol consumption or
overheating. Even without becoming addicted, drugs can have other harmful
medical effects. The sheer scale of the simpleminded ignorance of this comment
is staggering.

~~~
empath75
10s of thousands of people go to the hospital every year for Tylenol overdoses
and hundreds die. That doesn’t mean any use of Tylenol is abuse.

~~~
simonh
Of course not. Lots of controlled substances have legitimate medical uses. I
don't get your point.

~~~
zanny
Life is dangerous, and it is more valuable to work to educate people on the
danger around them than to try banning it by rewriting reality to treat
dangers like they don't exist by outlawing them.

It is _why_ kids think "that cannot happen to me". Because its criminal.
Because its the plight of the "other". Because its told like a monster in a
fable rather than a fact of life and an emergent property of our society and
biology.

~~~
simonh
I agree I'm pro-decriminalisation of drug use and for regulated legal
distribution.

------
mattbgates
Having lost several friends to the opioid epidemic, I wrote an article about
it on decriminalization. I wish we would help addicts instead of treating them
like criminals.

The war on drugs has failed. We must not be a part of the suncost fallacy, but
just embrace another way.

[http://www.confessionsoftheprofessions.com/drug-user-
decrimi...](http://www.confessionsoftheprofessions.com/drug-user-
decriminalization/)

------
rbanffy
Are we really, seriously, debating the success of a proven successful program?

------
Pica_soO
The real interesting thing is not whether opiod addiction is a disease or not-
it clearly is - but why the behavior-controll-fraction trys so violently to
clamp down on drug-behaviour with the law.

It just doesn't sound rational. And its not. Many oxy-addicts of today, where
former - "The police should get them" conservatives. So what compels a human
being to want the state to go after his fellow being, which irony- might be
his/her future self.

My guess, at the motivation is a mixture of envy (on a perceived decadent
lifestyle) without hard work, a fear for ones offspring and finally grievances
caused by known addicts (small time theft and crockery).

As long as these emotions are not respected, taken care off and defused, as
long as this is the case, the disease that is drugs can not be handled.

------
mherrmann
An acquaintance of mine runs a rehab center for addicts. I really like his
view on addiction. It's that addicts often had traumatic experiences, eg
during childhood, and that drug abuse is a way of "self medication" to cope
with them.

~~~
jacquesm
I've known quite a few addicts (> 10, this is a direct consequence of living
in Amsterdam and the attraction the city has on drug users and the fact that
pushers would hand drugs to school children when I was in high school, though
fortunately it seems - to me at least - as if the Heroin epidemic is past its
peak). Not a single one of them would fit that category. Most of them were
perfectly ordinary people before sliding into addiction. It was a series of
smaller steps or thrill seeking behavior in all of those cases. Some of the
addicts were actually amongst the smartest people I knew before they got
addicted. I'm sure there are those who use drugs as an escape route from some
miserable experience early on in life but I've yet to meet them.

The life expectancy of addicts is such that I only know of two people that
managed to effectively beat their addiction, both are family members and even
though they got out of it they never fully recovered from their encounter with
hard drugs. Ugly stuff.

~~~
andai
Have you heard of Rat Park?

[https://imgur.com/gallery/pI8Nm](https://imgur.com/gallery/pI8Nm)

TL;DR rats trapped in cages will self-administer drugs, often to the point of
death. Rats which explore freely have a much lower (order of magnitude) rate
of addiction.

------
purplezooey
Wonder what Ayn Rand would have to say on the subject. That will tell us where
our country is headed. She was also a user of amphetamines, btw.

~~~
jacquesm
Ayn Rand had lots to say on many subjects but hardly any of it was useful or
constructive. Though that doesn't stop a whole pile of people from worshiping
her every word because it plays into their own wishes for how they'd like the
world to work.

~~~
andai
I haven't read much Ayn Rand but what I've read so far seems pretty
straightforward. I'm curious to learn more, could you tell me about some of
the problems you've found with her ideas?

------
wnevets
I kinda dislike calling addiction a disease. You can't just decide to stop
having cancer unlike addiction. Even tho addiction is all about a person's
brain chemistry being completely out of whack, alcoholics and other addicts
will often have a so called "moment of clarity". No such "moment of clarity"
exist for other diseases.

~~~
wu_tang_chris
That "moment of clarity" is literally just accepting that you are an
alcoholic. Like, that's all it is.

Normies love to pontificate about the causes of and solutions to addiction,
but I never get more than a paragraph in before I find a vacuous statement
that highlights how completely the speaker misses the point. It's fucking
exhausting.

~~~
wnevets
>That "moment of clarity" is literally just accepting that you are an
alcoholic. Like, that's all it is.

and what is one of the results of that "moment of clarity? They stop drinking.

~~~
jacquesm
You wish. Plenty of them are fully cognizant they are addicts and _still_
can't stop.

That's the whole idea of being addicted. It is a dependency at a physical
level outside of any of your abilities to reason. Only very strong people make
it out and almost always with assistance from the outside.

~~~
wnevets
Plenty of them is not ALL of them. The fact that any of them do is my point.
Not a single person with cancer or aids can just decide to not have their
disease.

~~~
Clubber
>Not a single person with cancer or aids can just decide to not have their
disease.

Neither can addicts the vast majority of addicts, that's the point.

~~~
wnevets
Why bring up what the majority of addicts doing? The very fact ANY of them can
just decide to stop is my point. Its pretty simple.

~~~
Clubber
They can't decide to stop any more than you can decide to stop breathing or
eating. They can certainly say they will stop and they can certainly try, but
actually stopping on a permanent bases seems elusive.

I would say most addicts don't want to be addicts at some point, yet they are
still addicts.

I'm addicted to nicotine since I was 12 and I don't want to be, yet I am. I've
quit a few times for a few months, but always get triggered back into starting
up again.

------
newsmania
Make drugs legal. Impose a 15% tax on each sale with all money devoted to
rehabbing addicts. Problem solved.

~~~
KGIII
Complex problems don't usually have solutions that fit comfortably on bumper
stickers.

~~~
dingo_bat
Although I agree with your assessment, you could have tried to actually point
out some problem in the parent's "solution".

I can think of one: you would still have to incentivize people to go the legal
way and pay 15% more. Which could be another intractable problem.

~~~
GordonS
> you would still have to incentivize people to go the legal way and pay 15%
> more

It seems to work just fine for tobacco and alcohol - a black market certainly
exists for these drugs, but it's tiny in comparison with legal sales.

On top of this, the increase in safety - getting a pure product that is what
it claims to be - would likely be a no-brainer for most users.

------
rodolphoarruda
How does it treat the international drug dealing cartels (root cause of the
disease)?

~~~
enjo
The root cause of the disease is that people like drugs. The cartels are a
symptom of the larger problem, not the other way around.

~~~
rodolphoarruda
If you eliminate the cartels, would people continue to use/like drugs? Would
they look for other forms of addiction?

~~~
eat_veggies
People like drugs because they like getting high, not because they like
cartels or doing illegal business or being rebellious.

~~~
ythn
People like drugs because they allow an escape from their normal lives, which
they don't like. Boredom, depression, etc. Read about the rat park experiment,
rats like being high too if their lives suck.

~~~
DonaldFisk
The principal author of the Rat Park paper, Bruce Alexander, has a web site on
addiction: [http://www.brucekalexander.com](http://www.brucekalexander.com)

