What UK can learn from Portugal’s drug decriminalisation success

I had the privilege of speaking recently at a conference in Lisbon focused on harm reduction and homelessness. It was both enlightening and inspiring. As we seek solutions to reduce drug-related deaths in the UK and to improve our approach to individuals facing drug dependence and homelessness, Portugal’s experience provides invaluable lessons.

In England and Wales, approximately three million adults aged between 16 to 59 use drugs. In 2021, nearly 5,000 individuals died from drug poisoning, a 6.5% increase from 2020 and the highest drug-related deaths since record-keeping began in 1993. Over the past decade, heroin-related deaths more than doubled, and cocaine-related deaths have surged fivefold. The situation is even more severe in Scotland, earning the country the unfortunate title of the drug death capital of Europe.

Portugal’s situation in the 1990s was not dissimilar. The country faced a significant public health crisis due to drug abuse, with one of the highest drug-related death rates in Europe. Growing up in Portugal during that time, I was personally affected, as were vast swathes of the population.

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The Portuguese government realised that a radical new approach was needed. In 2001, it became the first country in the world to decriminalise the consumption of all drugs for personal use, including the purchase and possession of 10-day supplies. It shifted from the punitive approach of most nations and instead began to treat drug addiction as a public health issue.

Consumption remains technically against the law but, instead of jail, people who misuse drugs are registered by police and referred to ‘dissuasion commissions’. For the most troubled people, authorities can impose sanctions including fines and recommend treatment. The decision to attend is voluntary.

The result? Within a few years, the country moved from one of the highest drug death rates in Europe to one of the lowest. The policy not only saved lives but has also contributed to a huge reduction in HIV infections among intravenous drug users; transmission rates via syringes plummeted by 95%.

Drug-related crimes fell, as did the proportion of prisoners sentenced for drugs, from 40% to 15%. Overdose rates dropped as public funds flowed from jails to rehabilitation. There was no evidence of a feared surge in use.

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None of the parade of horrors that opponents of decriminalisation in Portugal predicted, and that decriminalisation opponents around the world typically invoke, came to pass.

Several European countries, including the Czech Republic, Switzerland, Spain, and Italy have adopted a progressive approach by decriminalising drug use and personal possession, alongside investments in harm reduction programmes. Unfortunately, the UK government lags behind – it persists in treating drugs primarily as a criminal justice concern, centred on punishment rather than embracing a public health perspective rooted in support.

This perspective is shortsighted, particularly considering the poignant experiences observed in cities like Glasgow, London, Dundee, and in the north-east, underscoring the profound link between drug addiction and homelessness.

A study by Glasgow University published in The Lancet revealed that individuals who had experienced opiate dependence were more than seven times likely to die prematurely than those who had not. When factoring in additional challenges such as homelessness, prison, or psychosis, the likelihood of premature death increased to 11 times.

From speaking to harm reduction experts in Portugal, the guiding principles of what we can learn from their journey are these.

The UK could and should follow Portugal’s lead and pivot towards a more compassionate public health approach to drugs, focusing on hard reduction through support and rehabilitation. Portugal’s success was driven by data and evidence-based decision-making.

We, too, can prioritise evidence in crafting effective policies in this area. And our efforts should be collaborative. Portugal gave priority to taking stakeholders with them. Should the UK pursue this route, any efforts should take a similar holistic approach.

We should be candid that in its drugs policy the UK is not ahead of the curve but behind. It is clear that drug addiction often plays a significant role in homelessness. By implementing a more compassionate approach to drug policy, the UK could make strides in addressing the interconnected issues of drug addiction, homelessness, and public health.

We have the opportunity to reduce drug-related deaths, alleviate the burden on the criminal justice system, and ultimately, provide better support for those struggling with addiction and homelessness. It is a paradigm shift that may hold the key to a brighter future for all involved.

Ligia Teixeira is chief executive of the Centre for Homelessness Impact.

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