Global Perspectives on Drug Policy

This week dives into the illicit drug policy models of three different countries, each taking a unique approach.

Portugal

Among countries like Czechia, Germany and Mexico, Portugal is famous for decriminalization. In July 2001, Portugal decriminalized all public and private use, acquisition, and possession of illicit drugs including marijuana, cocaine, and heroin. This is referred to as the Portuguese National Strategy for the Fight Against Drugs (NSFAD), or more simply, the Portugal Model. The model emerged after government and public health experts saw how drug addiction and related health issues were resulting in social and economic harm. Rather than relying on punitive policies, Portugal adopted a drug reform – an approach aligned with harm reduction and public health. In addition to decriminalization, Portugal considerably broadened its services for treatment and harm reduction. Portugal is the only member state of the European Union that has openly announced the decriminalization of drug use. The Portuguese Model is internationally cited for its pragmatism and humanism.

Does it work?

Yes. The results of the Portugal Model have been positive, with gains in:

The Social and Public-Health Spheres – one study found that decriminalization did not lead to major increases in drug use and drug-related deaths fell significantly, from 80 per million in 2001 to 16 per million in 2012. Another study found that following decriminalization, there were substantial reductions in drug-related health harms, including HIV and hepatitis infections.

Economic and Criminal Justice Spheres: One paper found a notable decrease in legal expenses related to criminal proceedings for drug-related offenses and a decline in drug-related offenses for consumption between 1999 and 2010. A study demonstrated that arrests and imprisonments fell, reducing the burden on the criminal justice system, especially prison overcrowding

Canada

Oh, Canada. A highly complex, patchwork drug policy system. Let’s get into it:

Canada legalized marijuana in 2018. This model aims to protect public health and safety and divert marijuana away from black markets. But what about other illicit drugs?  The foundation of Canadian drug policy predominantly centers on prohibition, as current laws continue to forbid the unauthorized possession, distribution, and production of substances. Additionally, at the national level, Health Canada leads the Canadian Drugs and Substances Strategy (CDSS). The CDSS uses an integrated approach of prevention, harm reduction, treatment, or recovery services and supports. At the end of the day, drug use policies and programs are the responsibility of provinces, territories, and even municipalities. In British Columbia, for instance, we see a ‘continuum of care’ model that ranges from harm reduction methods (like drug checking or supervised consumption) to prescription opioid agonist therapy, along with treatment centers, detox and recovery. In May 2022, Health Canada granted a three-year exemption from the Controlled Drugs and Substances Act, allowing the possession of specific illicit substances for personal use by adults in British Columbia. The exemption outlines a combined limit of 2.5 g for opioids, cocaine, methamphetamine and MDMA. The exemption was at the request of the province to support the public health response to the overdose crisis. Alternatively, the Alberta model centers around compulsory treatment interventions as the main method for promoting abstinence among People Who Use Drugs (PWUD).

Does it work?

Not really. Because Canadian drug policy still centers on punitive measures (i.e., illicit drugs are criminalized), drug stigma persists.

Numerous public health experts concur that addiction is an illness. The success rate of addressing addiction and the escalating rates of toxic drug-related deaths depends on the chosen model. For instance, research has found that compulsory treatment programs (i.e., abstinence) are ineffective at curbing drug use. On the other hand, safer supply programs (i.e., providing prescription alternatives to “street” drugs) in British Columbia have been found to reduce exposure to an increasingly toxic drug supply and reduce overdose deaths. Notably, over 130 substance use experts have called on the Canadian government to support and improve safer-supply programs because of how beneficial they are evidenced to be.

Although there is some promise towards decreased drug-related deaths in Canada, there’s still work to do, with many urging for legalization and decriminalization, along with safe supply programs.

Switzerland

Switzerland made a pioneering move in 1994 by introducing a revolutionary approach to safe supply – prescribing pharmaceutical-grade heroin (diacetylmorphine or diamorphine) to individuals with long-term drug use. Switzerland pioneered Heroin Assisted Treatment (HAT) programs as part of a comprehensive response to a severe epidemic of injection drug use, HIV, and overdoses among drug users. Switzerland’s drug policy model is based on the four pillars of prevention, harm reduction, therapy and repression, which is a pragmatic and public health centered approach. Swiss law requires that HAT patients must have suffered with OUD (opioid use disorder) for a minimum of two years prior to beginning treatment, must be 18 or older, and must have tried and failed other opioid treatments (i.e., buprenorphine, methadone). Medical directors of HAT programs in Zurich and Geneva see the program as enabling people to live full and meaningful lives.

Does it work?

Resoundingly, yes. Despite facing considerable criticism upon its initial introduction in the 90s, the Swiss safe supply model has become a pivotal influence, prompting other nations such as the UK, Germany, Denmark, the Netherlands, and Spain to adopt similar approaches. The advantages of this model are extensive:

Although the annual cost per HAT patient ranges from 12,700 euros per year in Switzerland, the European Monitoring Centre determined that HAT programs result in significant savings to society, particularly in the reduction of costs from criminal justice proceedings and incarceration of drug users

One study revealed that there were substantial improvements for illicit heroin use, health status, and criminal activity among patients undergoing Heroin Assisted Treatment (HAT).

In another study, over 70% (1378) of patients persisted in treatment for over a year, a significant factor given the positive correlation between longer treatment durations and an increased likelihood of initiating abstinence-oriented therapy. The treatment exhibited favorable effects on both health and social outcomes.

Switzerland’s HAT programs also result in fewer overdose events, as well as falling rates of HIV and hepatitis

That’s it for this week’s newsletter!

👋 Mel, Policy on Drugs

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