Welcome guys to episode 138 of Behind the Shield podcast.
As always, my name's James Geering
and this introduction is gonna be a little bit longer
because I really need to set the stage for my next guest.
As a firefighter paramedic for 14 years,
I have lost count of how many people I've lost
as far as patients due to opioid overdose
and other drug related either crimes or overdoses.
As a firefighter paramedic, I have also been heartbroken
to see how many of my peers in my profession,
law enforcement, have succumbed to this addiction as well
and we've lost numerous people to overdoses.
So this is very, very close to my heart.
And as you guys probably know,
if you've listened to the podcast for a while,
I look outside our country's barriers for solutions
if they're not within the US.
And we had Tom, excuse me, Tom Eberhardt on the show,
who was the governor of Bastogne, the prison in Norway,
an incredible prison system that they have over there.
And I was fortunate enough having two of my family members
living in Portugal to be told that Portugal
actually decriminalized drug use.
Now, not drug sales, not drug smuggling,
but the user, the addict became viewed
as a medical patient, not a criminal,
unlike what we do here in England
and many other places around the world.
And prior to this happening, they had an epidemic.
They went from a dictatorship,
then just got absolutely saturated with drugs
and basically had one of the highest levels of addiction,
HIV and all the associated problems that we see with drugs
in the whole of Europe.
When they decriminalize this,
and what happened was they went to the people.
The people had basically had enough
and the people pushed this vote.
So imagine that the actual people of driving the country,
they had forums and cinemas and theaters,
and this was pushed through.
And within about 10 years,
they had gone from the highest level of addiction
to the lowest level of addiction,
their HIV, their crime, all the associated problems
that you have with drug addiction fell as well,
and they revolutionized the country.
So I was fortunate enough to be in Portugal last week
for my little brother's wedding.
And I reached out to my guest, Dr. João Goulão,
who is the general director for intervention
on addictive behaviors and dependency,
to give him his full title.
But simply put, was one of the men
that actually spearheaded this decriminalization
going through.
And it was an incredible interview.
So he talks about setting the scene,
what Portugal was like before,
why there was such a drug problem after some of the wars
that the Portuguese soldiers have been in,
and then how this was pushed through, like I said,
by the progressive politicians and the people.
They reached out to the people and the people spoke.
And then the amazing success they've had,
and then some of the issues they've had
trying to bring that model to other countries.
And that's why I do this podcast,
is the only way that we're gonna have something like this
in England, in the US, and anyone else that's listening
that has this kind of epidemic in their country,
is us, the people, the citizens, the first responders,
hearing of a model like this and starting to push
and question those that can start the ball rolling
and make this model in our country.
There is no reason why we can't do that.
To underline a statistic from when I spoke to Tom,
in the US, in America specifically, in the 1970s,
we had about 330,000 prisoners.
Today, 2018, we have 2.3 million prisoners.
So whatever political rhetoric is being thrown around,
the bottom line is our quote unquote war on drugs
and war on crime is not working.
And we need to reinvent the way we do prisons,
the way we look at addiction to make our streets safer
and try and reduce the violent crime
and all the horrendous things
that we see happening every day.
This will empty out our prisons,
make life on the street a lot safer
for our first responders, make our schools safer
and lessen the chance of any of our family members
having addiction.
Just to point out what Portugal's was like,
1% of their country, 1% was addicted.
That is a huge statistic.
Every single family pretty much had an addict
in their family.
So with that all being said, to take this model
and then revolutionize the health of a country,
I think is extremely powerful.
So I urge you to listen to this,
but most importantly, I urge you to share it as well.
Because I always ask at the end of every episode,
please share, this needs to go viral.
This needs to be heard by every single person on the planet
so that we understand that there is a solution
over and above arresting drug users at the ground level
and throwing them into a prison where chances are
their addiction is gonna get worse.
As I always say, please subscribe to the show,
please go on iTunes or whatever you use,
give us a rating, give us a review.
And with that being said, I introduce to you
Dr. João Goulão, enjoy.
I wanna start by welcoming Dr. Goulão to the podcast.
I wanna preface this by saying that we are sitting
in his office, so thank you so much for having us.
Thank you, thank you for your visit.
Thank you, and we're in Lisbon and Portugal.
So I always like to start with a very brief history
of who you are and where you're from.
So were you born in Lisbon here?
No, I'm from a small city in the interior, Sertão,
mid Portugal.
Mid Portugal.
But I worked for several years in the Algarve
since I ended my course of medicine from 1980 to 97.
And then, meanwhile, I started to work
in the field of addictions.
And in 97, I became the responsible for the network,
for the Portuguese network addressing those problems.
So since then, I'm the responsible for those policies.
Okay, so and you went to traditional medical school before
as a doctor? Yes, yes.
Okay. Here in Lisbon.
In Lisbon, okay, so you kinda came back
to where you started. Yes.
So just before we talk about where we are now,
what was the education on addiction
and use of pain medication when you went through
your traditional training?
Well, almost none, almost none.
You know, the drugs problems in Portugal started later
than in most of the European countries.
As you know, probably we lived for a long time
under dictatorship, during which we had no drugs problems.
We were protected to the evil of drugs.
It was the Salazar dictatorship.
I don't know if it sounds to you,
but it ended in 74 with our democratic revolution.
But by the end of the ancient regime,
in the last decade, we were dealing with the colonial war
in our ancient colonies of Angola, Mozambique, and so on.
Right. Okay.
And at that time, it happened a little bit the same
that happened with Americans in Vietnam.
Drug use down there was tolerated or even incentivated.
Right, so in the soldiers themselves?
Yes. Okay.
While here in mainland, it was severely repressed.
Suddenly after the democratic revolution,
our carnation revolution, we had the return
of all those soldiers and settlers
from the ancient colonies that came back to mainland
with their habits and bringing literally tons of cannabis
that suddenly was made available for everybody.
Okay. Yeah.
So, and the drug use spread very, very, it was very fast.
And what is important to mention in my view
is that it raised among all social classes, social groups.
It was not something that happened
only among disorganized people or minorities.
Yeah, yeah. It happens through mid-class, medium-class,
high-class, everybody.
So suddenly everybody was using, starting with cannabis.
Of course, some, let's call them some criminal organizations
came into our territory, bringing all the others
that were made available.
So suddenly everything was available.
So, heroin, cocaine, LSD, you name it,
in a completely unprepared society.
Suddenly everything was available.
That was something that came with freedom.
So that was a kind of attraction for everybody to experiment.
And as we were completely naive about drugs,
it was easy to shift from one to the other.
So the escalate at that time was really present.
It was easy to start with the cannabis
and then jump into heroin, cocaine, whatever.
So suddenly in just a couple of years, in a decade,
it was almost impossible to find a Portuguese family
that had no problems related to drugs.
Okay?
Yeah.
So it started to become higher and higher
in the ranking of political priorities.
By the impact in public health and individual health,
AIDS came along to complicate things at that time.
Okay?
So in the 80s, and it started to attain all families.
Coming back to your question about my training,
I had almost no training in the university,
but working from the beginning of the 80s in the Algarve
as a family doctor,
I started to be confronted with problems,
with people coming to me, families, or even individuals,
young people, or less young,
coming to me and seeking for help
to deal with their dependency.
I got involved on that.
I started to study about it.
I was available.
It was my only tool.
The only tool that I had was being available
and being willing to help people,
but I had no technical preparation for it.
So when the opportunity came to attend a training here
in Lisbon at the Center of Taipas,
which was our first big center addressing those problems,
I was invited to attend the training for six months,
which I did,
working with colleagues on a daily basis,
shoulder by shoulder,
and watching what they were doing.
And then I went back to the Algarve
with the capacity to open,
to create the first center down there
to address these problems.
So I slowly moved from my training center
moved from my general practice
into becoming deeper,
more and more involved in this problematic.
So I moved from the general,
working as a general practitioner
into a more addressed activity to this area.
And it happened until 97,
down there from 98 until 97.
In 97, I was invited by the Minister of Health
to become the coordinator of the network
that meanwhile had been created.
And since then, I'm in charge.
The man.
Yeah.
Well, I want to ask you a couple of things
about what you said.
So firstly, when Portugal was a dictatorship,
how were they successfully able to keep drugs
out of the country during then?
You know, we were very isolated
in a very controlled society.
We had a very strong political police.
It was almost impossible for us to travel abroad
because of the war.
Mostly for male young population,
it was almost impossible
because you needed a military license
to travel in the country.
To travel even to Spain or whatever.
It was very complicated and people just gave up.
I had never traveled abroad before our revolution.
So I was 20 at the time,
never crossed the border before.
On the other side,
we were not a very sexy destination
for visitors to come.
Okay, so we lived there, closed, poor,
sad, it was not a very nice society.
And of course, I can say,
I cannot be sure that there was no drug use.
Some persons, some small...
Isolated cases.
Some health professionals, for instance,
that could assess some substances at the hospitals and so on.
But it was not a massive subject.
But I cannot say, okay,
we didn't have any drugs available.
It's not true.
But it was not a massive problem.
After that, yes, there was an explosion.
After the revolution, there was an explosion.
The state was dealing with many other problems
and did not pay attention to this one for a while.
So people, even if our role on drugs was quite repressive
and inspired in the ideas of the war on drugs,
in fact, it was not very effective.
Yeah, well, that brings me to the next question
because as you know, from where I come from,
England and America, war on drugs,
especially in America, is our term.
And in my very basic knowledge of what I see at work,
it doesn't appear to be working.
We're not winning that war at all.
So if you wouldn't mind that leading up to year 2000,
what were the initial tactics of what you were trying to do
to combat drugs?
And then obviously we can talk about how you changed
the whole shift.
Yes, of course, there was the supply side activity
by police forces and the customs and so on.
They were quite active on that basis.
But from the beginning, we started to work with users
and mostly with problematic drug users on the demand side,
on offering them treatment when needed,
developing preventive work, trying to inform
and to talk about the problems and the differences
between the several substances available and so on.
And very, very early, we started to develop
some harm reduction policies such as sovereign exchange.
I must say that on the mindset of the population,
it was facilitated by the fact that it was cross cutting
all society, as I told you.
Okay, yes, all different classes and races.
Yeah, so it's different if you have, for instance,
medium class housewife discussing with the priest,
oh, my boy has problems, okay, he's not a criminal,
he's someone in need of help.
Okay, and this idea made his way
among our society.
I would say that our policies are mostly known
because we decriminalize drug use.
And you may think it was a bright idea
from some illuminated politician or professional, whatever.
I must say that I feel that it was a kind of bottom up
movement among society.
Okay, and politicians and the law came just to confirm
and to ensure that that was the way to address it.
So, and it made the difference.
Of course, we were before, prior to that decriminalization,
we were working in the development of a network
of centers for treatment, a network of therapeutic
communities, we have a kind of a complementarity
between the state run facilities and the NGO run.
We did a lot of work on that.
The facilities and the NGO run, we do not compete,
we just complement ourselves, which is good.
Yes, doesn't happen everywhere.
The state supplies mostly outpatient treatment
and inpatient clinics such as therapeutic communities
are mostly run by NGOs and we pay for it.
Okay, so we pay for each patient.
And this is good instead of being all the existing tension
between both sides.
So we started to work in to develop a network
of treatment facilities, we started working in prevention,
in harm reduction, in reintegration of people,
prior to the criminalization.
The decriminalization introduced a kind of a coherency
in all this, okay, because everything was based
in the idea that we were dealing mostly with
a health condition and social condition
rather than the criminal one.
Okay, yeah.
And everything changes because people tend to admit,
okay, we are dealing with a disease,
a chronic relapsing disease with the same dignity
as other diseases and patients who suffer from it
have the same dignity as other patients, okay.
It's not a thing, it's not a vicious.
It's not a vicious.
So this change allowed us to have the support
for focused policies, for instance,
in terms of reintegration.
It's not easy to have positive discrimination
towards employment of drug addicts if it is a criminal.
If it is a crime, okay.
But if we consider, okay, it's an important step
in the recovery of people, reintegration of people
in society, being able to have a normal life.
So under this framework of decriminalization
is much easier.
Okay, and a part of the specific way
that we did the decriminalization
with the creation of this question commissions,
I don't know if you were about it.
I'll explain briefly how things work in practice, okay.
But let's go there.
But for the moment, saying that under this framework,
all those policies on the demand side
are much more coherent and well accepted by a society.
What happens in practice?
I must say that decriminalization was included
in our first strategy that was approved in 98, 99.
It was proposed to the government by a group of experts,
nine people from judges to psychiatrists,
psychologists, and so on.
I was included in that group.
So we were invited to present a report on the situation
and with strategic proposals, okay.
And we did it on the supply side,
but mostly on the demand side.
All the strategy was based in the idea
that we were dealing with a health and social issue,
and in line with that, we proposed the decriminalization.
The strategy was adopted in 99,
but the issue of decriminalization
had to be discussed at the parliament,
which happened only in 2000, okay.
So only in 2000, we had the conditions to go further with.
And since then, I must say that all the available indicators
have been dropping, so, and we feel quite comfortable
with this decision.
How does it happen in practice?
If a citizen is intercepted by the police using drugs
or in possession of drugs,
he is conducted to the police station as before.
The drug is apprehended as before.
It is weighted, evaluated in terms of amount.
And there's a table with the amounts for each substance
that constitute the threshold.
If you have more drugs on you
than the calculated amount for 10 days person,
you go to the criminal system as before.
Because it seems like you're selling at that point.
Yes, right.
Okay, so you go for court, for investigation, trial,
so, okay, criminal system as before.
If you have less than that amount on you,
you are just intimated to present yourself to a commission,
a commission that is going to be sent to you.
You present yourself to a commission,
a commission for dissuasion of drug addiction,
which is a body under the Ministry of Health, okay?
It is constituted by three people,
lawyer, jurist, psychologist, and a social worker, usually.
Okay, go there.
In the next 72 hours, you must present yourself there.
And then you have an interview.
There's a report that the technical team prepares,
and then the commission evaluates your situation.
Informs you about the fact that using drugs
is still illegal.
It is not a crime.
It's not under the criminal law,
but it is misdemeanor.
Misdemeanor, yeah, in America it's misdemeanor.
Yes.
That's the term, yeah.
You can compare it to the use or not use of the safety belt
when you drive, okay?
It's not a crime.
You do not go to jail.
You never get the criminal record for it,
but you may have a fine, or in thesis,
you may be obliged to attend a training course
for the drivers, for instance, okay?
So then same with the seat belt.
Same with.
You're doing it because you're actually trying
to prevent the illness and death of this person,
so you're not punishing them so much
as trying to bring them back to good health.
That's it.
That's the idea.
And well, the commission tries to assess,
okay, are you a addicted person,
problematic drug user, or not?
Or just a social, recreational, occasional user?
Okay, this is the first step to,
if you are an addicted person,
you are invited to join treatment facility,
but you are free to refuse.
It's not mandatory, okay?
Okay.
Okay, have you ever thought about treating yourself?
Well, okay, yes, I've been thinking about it,
but it's so complicated.
Do you think so?
What about tomorrow?
Let's start tomorrow.
We have an appointment.
I can find you an appointment for you.
Do you, yeah, okay, let's go.
Phone call, Dr. X, is it possible
to have a new client tomorrow?
Okay, the day after tomorrow.
Okay, 10 o'clock, you have Dr. X expecting you.
Most of them accept.
Because you've made it so easy,
you paved the way for them.
Yes, yes, that's a red carpet, you know?
Yes.
So, I'm not saying they are going to be successful
in that treatment process, but they start.
At least they start the process.
They know the people.
It facilitates the access.
But you are free to refuse.
Okay, I don't want anything.
Okay, you are free to refuse.
Your file stands open for, let's say, for six months.
Please don't come back in the next six months,
otherwise I have to apply you a penalty.
Okay?
And the penalty may be, there's a long list of it,
never a criminal record, never imprisonment,
but you may have drug addicts, never a fine,
financial fine, but you may have social work
or the obligation to attend some consultations.
For instance, you are HIV positive,
you must attend your consultations.
You have to go there every month or every two months
and bring me a piece of paper showing
that you have been there.
So it increases the compliance for other kinds of problems.
Okay.
Are you suggesting that the drug user,
charging a drug user a fine
might not be the best way of doing it,
since they're probably broke?
It is not possible.
Doesn't make sense.
Yeah.
But if you are just a social user, okay?
Okay, I have no problems with drug,
I smoke a joint on weekends with friends,
okay, even then, okay,
must be informed that this is not illicit activity,
this is illegal, okay?
Now you are informed, okay?
Anyway, during the interview, I understand,
okay, my parents are divorcing,
or my father just lost his job,
or myself, I have some problems with my,
some psychological difficulties,
problems with assuming my gender choices or whatever.
Yeah. Okay?
Using the drugs to cope with it.
So, okay, let's leave the drugs problems,
but even then, I may offer you any help, okay?
Do you think, would you like to have a talk
with a psychologist to help you to deal with it,
or with a social worker that can help your family
to deal with unemployment and, okay?
So, even then, we try to address people
to the appropriate responses,
not in a center for the treatment of drug addiction,
but for other responses in society,
and to help people to deal with those difficulties.
The goal is to interrupt a career
that later on may lead you to more difficulties
with drugs, and, okay, drugs may enhance
its position in your life.
Yeah, because you, with that one,
the drugs are the symptom, aren't they?
And you're addressing the cause,
which is the trauma psychologically
that trying to deal with or get away from.
Yeah.
So, with this approach, of course,
most of the people that are
presented to those commissions are not addicted people,
just social users, okay?
In the proportion of, let's say,
80% of non-addicted to 20% of addicted, okay?
But even then, we try to offer them
any kind of help when needed.
We just can assume, okay, drugs are not a problem,
he's well in life, his studies are going well.
And, well, so we are not too much intrusive
to inform people, but the same approach.
Okay, you are not willing to have any kind of,
you don't feel you need any kind of help,
free to go, okay, please don't come back in the next times.
Otherwise, we may apply you a fine
or other kind of penalties also, okay?
So, the term is to dissuade.
I don't know if it sounds also in English.
No, it doesn't.
I love the fact that's the name of the program, dissuasion.
Dissuasion.
And, of course, this is only one of the gates for the system.
Okay, you can assess it directly, spontaneously,
or referred by your family doctor,
or your teacher, or whatever, okay?
Okay, so there's multiple avenues
to get down the same path.
Yeah, well, so this is part of our package of policies.
Okay, it works.
I must say that in the beginning
when decriminalization was discussed at the parliament,
there was a huge discussion.
Prior to that discussion, we, the proponents of the idea,
we organized a huge number of public sessions
to discuss with the population.
And what I keep from that period is that people tended,
mostly, to accept the idea and to be in favor
of the idea of decriminalization.
So, and you were literally, as a nation,
you were listening to the people,
like you said, from the ground up.
Yes, yes.
They were steering this policy.
We organized the sessions in cinemas with huge attendance.
500 people, big discussions,
but mostly people tended to accept this idea.
When things came to the parliament,
things were a little bit more complicated.
With left-wing parties supporting the idea,
proposing the idea, and right-wing parties,
the hard line saying, oh, the treaties,
the United Nations treaties,
the United Nations are going to blame us, to crucify us.
Portugal will become a paradise for drug addicts
from all over the world.
We will have planes coming to Lisbon or to Porto,
every day with people to use drugs freely.
Our children will start using drugs with a milk bottle,
you know, that kind of.
Scare tactics, yeah.
But by the end of the day, it was approved
with a majority and came into force
in the 1st of July of 2001.
Nowadays, there's a consensus,
there's no party trying to go back,
because the results were so good, so convenient,
that there's a consensus in our society,
even at the political level,
about the so-called Portuguese model.
So, of course, there are other problems, other discussions
over the table, legalize, regulate markets,
okay, but as far as we stand in this decriminalization model,
there's an absolute consensus.
Okay, now I just want to kind of highlight an area
that I've seen you talk about on some of the documentaries
that you've done, or you've been in.
So when you decriminalized the drugs,
and like you said, just to be clear, the users drug,
not the smugglers, not the people selling,
and those people are still hunted down and penalized,
what was the effect on the addicts
that before were scared of going to jail,
once it was decriminalized, did they start realizing
that it was safe to come out, as it were,
and seek treatment now?
It facilitated the approach of those users to the centers.
That leads us back to the dictatorship,
during that people were scared to seek for help,
because they were afraid of being referred
to the police forces, and this idea was still present
in the first years after the revolution, so, okay.
So, still fear to be being referred, to be,
and, but after that it facilitated,
everybody was felt free to assume that they have problems
in workplace, in everywhere, in school,
okay, I need help, I go there,
but then I don't lose my job because of seeking for help,
I don't have any kind of legal problems with it,
so it facilitated, and it allowed us to discuss
drugs problems, addiction problems in every setting, okay,
in families, in workplace, in schools,
it's not, it's no longer taboo, you know?
You can discuss it freely without fearing to be,
okay, I must avoid assuming that,
because I have, I will, may, I might have consequences.
Yeah, and by decriminalizing it,
I'm looking at all the problems that make addiction worse
in England, in America, so you throw them in jail,
or in prison, obviously their addiction's gonna get worse,
I just found out, supposedly that they withdrew
all the addiction help in the prison systems in Florida,
which is insane, if that's correct,
so now, but now they're criminals as well,
and like you said, you come out with a criminal record,
and now you're trying to find employment,
you're not gonna get employment,
now you're in a vicious circle,
what you guys have done is, now you're not a criminal,
you come out and you're actually helped,
assisted to find work, when you come out
of the rehabilitation program.
That's it, that's it, it's one of the consequences.
Yeah, okay, so what about the effect
on law enforcement, on the police,
so is it, what are they seeing through their eyes now,
as far as, obviously not having to arrest,
or let me rephrase that, not constantly chasing addicts,
but are they able to direct their resources now
to the real problem, which is the smugglers and the dealers?
That is correct.
So, the usual way to work for police forces
was to pick a drug user on the street,
you shake a little bit, you have some information,
you have where they did you buy it,
you go to the next corner dealer,
then you go there and you pick and shake again,
you have some information, you climb two steps
in the stairs of traffic,
but you do not go further.
And by the end of the day, you pick some grams
or kilos of substances, but nothing but that.
In this new framework, the police forces
have lost their source, this source of information.
So they had to learn how to work differently,
kind of top down, by increasing the sharing
of information with international police
and customs forces, with intelligence,
and so they can address.
They got rid of those tasks of preparing funds
for trial of drug users, huge amount of paperwork.
So they got rid of all that, they just sent those people
to the health system, okay, it's up to you
to deal with that.
So they could address the sharks instead
of the small fishes, they could address the sharks.
By the end of the year, when they show their results
and the metrics is still the amount seized,
they show tones of cocaine, heroin, and so on
that they seize in open sea and in containers,
bulk traffic, instead of the small traffic on the street.
So if the goal is to lower the availability
of drugs at street level, you are much more effective
by going higher and cutting it.
Kind of head off the snake.
Instead of trying to pick the little feet on it.
Yeah, and you've done it from both ends too,
because the other way is supply and demand.
If you take away the demand,
they're not gonna wanna do it as much.
Yeah, but this work on supply is very important
because Portugal is one of the gateways
for drugs for the European market.
Okay, cocaine mostly from Latin America is coming here,
Ashish from Morocco, and we have a very exposed coast.
So we need effective activity
in lowering that availability.
Some of those drugs are addressing the Portuguese market,
but most of them are just passing through.
Okay, so it's important that international cooperation
and those that activity on intelligence and all that
to address this availability.
So I must say that on the first times of decriminalization,
police forces were not very happy about it.
Yeah.
Well, it's changed.
But nowadays they are the most enthusiastic people
about this model because in fact,
they can address what is really important
instead of spending their time working
in a never ending work, which leads to nowhere.
Well, I'm sure like you said,
the police reports and all their paperwork,
but also the court system must have opened up tremendously
when you took all the users out of it.
Yeah, yeah.
So this is, well, and with that,
I think an important part of our policies also,
of our system is the existence of coordinating bodies.
The member of the Portuguese government,
she is responsible for drugs policies,
is the Minister of Health.
Okay.
And on his behalf, the General Director of SICA,
myself, in this case,
I act as the National Coordinator
and I work directly with personal representatives
of 11 ministers.
Okay.
Justice, affairs, education, you name it.
So, and we coordinate our policies.
We build our strategic documents together.
We evaluate them, the action plans and all that.
So I know, I interact with the supply side representatives.
We agree in some priorities.
And we work, not in a daily basis together,
but every two, three months we meet and we discuss
what a part of the main documents, main strategy,
there are some new things that we must adapt to.
Yeah, so just to make sure I'm understanding it.
So to make it work, all the different elements of the system,
whether it's, like you said, attacking the suppliers
all the way through to the addicts and the health side,
you're all working with each other
to make sure that the chain doesn't break.
Okay.
And I think it's from what I know,
at European level, not only at European level,
we have one of the most effective coordination system
at the world level,
because it really works.
We keep informed, we keep in line with the others.
We build new legislation, for instance,
around new psychoactive substances.
For instance, we have the judiciary police,
the forensics, we have the participation of all the bodies
which is defined by law.
It's not in a voluntary basis.
Okay.
Okay, now one thing I wanna kind of underline as well.
So before, when you had the crisis
and you had the surge in the 70s,
you had one of the highest addiction rates.
Was it in Europe?
Yep.
Okay, so after, fast forward now, let's say almost 20 years,
the statistics I've seen is you've got the lowest now.
Is that correct?
Yeah.
So I just wanna kind of highlight that.
It's not even a question, just that in 18,
well, 17 short years, you've overturned it
from one of the worst addiction rates to one of the lowest.
Yes, that's true.
But I insist, I must stress that in my view,
this is not only the consequences of decriminalization,
it's not the silver bullet.
It's the complete package of policies
that are developed in the same way.
We had the financial crisis that led us to
a lot of difficulties for several aspects.
On one side, some people that were,
had already reached some balance in their lives
who were confronted with increased difficulties
and we had a lot of relapses.
We had lots of people
smuggling drugs to survive.
So it increased the pressure to use.
We had some budgetary cuts in the system
in the system, which we could more or less manage.
We had to sacrifice some parts of it,
for instance, knowledge,
studies, polls, we have to sacrifice that.
But we could stand mostly on the supply of care to people.
Okay, so you were so able to reach the addicts.
Yeah.
I must say that everything that we offer,
all those treatment programs,
harm reduction, substitution treatment with methadone
or buprenorphine or whatever, everything is free.
So we are a quite poor country,
but this is seen as an investment.
Yeah, so you're investing in the health of your people,
an unusual concept.
That's it.
It's not insurance.
Yes, you may use cannabis, it's covered,
but heroin is not.
Okay, it's not the case.
If you have any citizen, even people,
foreigners living in Portugal,
if they address a center seeking for help,
they have help for free.
Yeah, I love that whole concept,
because again, it's just,
if you are not an addict and you are healthy,
and your money goes to helping people who are worse off,
then I think that's a kind of nice Christian type,
or whatever.
Yeah, but you know, during the crisis,
one of the consequences also was
that we felt that the common citizen
with no problems of this kind
was not willing so much to help others.
People tend to be more selfish during when they feel-
When their life is good.
Yeah, so it was a difficulty either.
Right, now I know we've got to wrap up soon.
Two questions I really want to make sure we ask.
First one, the prescription pain medication.
Do you have an issue with addiction in Portugal with that?
And if not, why compared to other places?
No, you know, we have very different tradition
and very different training about the use of mostly,
namely, opiates.
We use much less frequently opiates.
Even if we are trained and we offer the possibility
to prescribe when needed, really needed,
but we do not overprescribe.
Okay, this is a tradition.
I think mostly in Europe, we have different tradition
towards opiates, namely,
than in the United States or Canada.
I think, I believe the US uses 80% of the world's opiates.
Yeah, there's the pressure of the industry,
and being a doctor in the Algarve,
I remember having, I used to be called to the hotels
to see tourists.
I remember seeing Americans that had brought
in their travel pharmacies, opiates.
It's unsinkable for us.
Oh really, to have opiates on your-
No, no, it's not about, if you need, okay,
you go to a doctor and someone prescribes you,
but you do not bring for the treatment of the array
or something like that, you don't bring opiates.
Okay, this is one difference.
Another one, it's the control of prescription.
All our opiates need a specific prescription,
a special paper for the prescription.
And this prescription is controlled by a centralized body
from all over the country.
Let's imagine that today I start prescribing opiates
to all the people who come to my consultation.
Okay, the next day or the next month,
I will receive a letter from the agency of medicines
asking me what is happening in your practice?
What kind of patients are you having
that you need to prescribe so many opiates?
And of course, they will not forbid me of prescribing,
but at least I have to justify,
I have some supervising body looking at my practice.
This is a kind of a pressure that,
it already happened to us a couple of years ago.
We noticed that buprenorphine had just,
has been overprescribed in a region of Portugal.
Okay, and then they focused
and they found one specific doctor.
That was, and then we had the opportunity to discuss
and to explain the difficulties
and the problems that might arise from that overprescription.
Okay, and it stopped.
So this control system is quite effective also.
Okay, because I wanna highlight that too.
We have a huge opiate addiction
and it's largely from prescription payments now.
And it's interesting, cause you're about to go to Ohio,
which you'll probably be educated even more about that
when you get there, cause I know that's one of the nucleus.
Yes, we do not have much
yatrazenic dependence on opiates.
Brilliant, all right, so the very last one,
cause I need to free you up in a moment.
How do you try and help enable other countries
to adopt their version of the model that you have?
That's the question, their version, okay.
I mean, well, we are happy with the attention
that our model is having all over the world.
And myself personally, I work a lot on that.
I travel a lot.
Next week I will travel to the UK.
Next week I will travel to Mexico to share our experience.
What I think, why didn't not other countries
adopt this model exactly or the version of it?
I think it's a question of demographics
where the problems are present.
Drugs policy are very much used as a power tool.
And when you, let's talk about Brazil for instance.
They try to decriminalize.
Oh really?
Yeah, yeah.
But people tend to say, okay, the problems with drugs
are in the favelas, that's where they must stay.
In the poor areas?
In the poor, it's not an inclusive movement
of having people involved in the normal society
and with the re-assuming their rights.
And so there's a tool to keep, to maintain the...
Yeah, and that's what I think what has changed in America
with the prescription, opiate epidemic.
And a few people have pointed out that there's no classes,
there's no colors to that.
It's kill the very rich and the very poor
and everyone in between.
All right, well thank you so much.
Welcome, it's a pleasure.
Pleasure, thank you for coming.
For more on karting