The future of funding for Portugal’s exemplary harm reduction services remains uncertain. New evidence from Agência Piaget para o Desenvolvimento (a national harm reduction network in Portugal) suggests that seven harm reduction projects face closure, and funding for Portugal’s specialized drug-related services is subject to systematic delays.

With drug treatment no longer under the IDT, drug users will have to go to regular health clinics or hospitals to access methadone and other drug-related services. For many who depend on this specialized treatment, the prospect of accessing mainstream services is likely to be intimidating, which means they may not go at all. Another concern is that psychologists and other health professionals will be asked to work in other parts of the health service, draining the drug dependence services of their most valuable employees.

In 2001, Portugal decriminalized the possession of drugs for personal use and concurrently initiated a national program of treatment and harm reduction measures. Ten years later a number of key health outcomes have improved: fewer people there die of overdoses and HIV transmission rates amongst drug users as a proportion of all newly diagnosed HIV-infected persons have decreased significantly. This innovative approach to solving drug problems has brought experts from around the world to see what lessons they can learn.

It also brought Richard Branson, a member of the Global Commission on Drug Policy, to Lisbon in early December to a press conference at which he congratulated the country on its drug policy.

With drug possession no longer a criminal offense, the focus shifted to treatment. More public funds are channeled into treatment rather than paying for lengthy stays in prisons, and police do not put up resistance to needle exchanges and other kinds of outreach work. If a person is caught with a small amount of drugs, he or she is sent to a dissuasion committee, which will refer him or her to treatment if necessary.

Outside Lisbon, in an area whose inhabitants are predominantly of African origin, there is a mobile drug treatment unit (Unidade Móvel), which previously belonged to the IDT. Comprised of a one-story building and a bus surrounded by a tall wire fence, the treatment center caters to around 6,000 clients, mainly from nearby Amadora (Portugal’s third-largest city) and Sintra. Every day, between 10 a.m. and 1 p.m., around 200 drug users queue outside the bus. A nurse hands out medicines through a hatch window.

In this "one-stop-shop," patients can access methadone and medicine for TB, HIV, and other illnesses, if there is an agreement with their doctor. Patients can also have informal consultations with health professionals whilst walking around the courtyard.

This exemplary commitment to harm reduction is under attack from some voices among Portugal’s right-wing parties, who favor prohibitionist approaches. In spite of the IDT’s dissolution however, the health minister, Paulo Macedo, continues to show support for existing drug policies.

Investment in specialized harm reduction services such as those provided in Amadora’s Unidade Móvel should not be compromised in the name of austerity. Indeed, there is a danger that short-term, cost-saving measures could prove costly further down the line.

While much is uncertain today for the patients and staff at Portugal’s drug dependence clinics, there is hope that the international praise of Portugal’s drug policy will help keep it firmly in place and that open dialogue based on hard evidence will help protect the country’s impressive achievements to date.

For more on Portugal’s drug policy, see our report Drug Policy in Portugal: The Benefits of Decriminalizing Drug Use.

"I chose life, methadone saved it!" Graffiti depicting members of a methadone patients' association. Photo ©Marta Gaszynska.

Many countries use UN World Drug Day (June 26) as an excuse for persecuting drug users and people involved in drug-related crime. China, for example, has used this day to carry out public executions of drug offenders since the early nineties. Last year, around 20 people were executed.

As an alternative, organizations supported by the Global Drug Policy Program of the Open Society Foundations offered a range of actions to emphasize the need for honest, open debate about drugs and drug use, and for policies which seek to treat, not punish.

In the run-up to World Drug Day, the Guardian published an article about the International Harm Reduction Association's report Complicity or Abolition? The Death Penalty and International Support for Drug Enforcement. It exposes the links between executions carried out and financial contributions from European governments, the European Commission, and the UN Office on Drugs and Crime.  These bodies provide funds to support drug enforcement operations in countries that use the death penalty, such as China, Iran and Vietnam. According to the report, 32 states retain the death penalty for drug-related crimes, which, depending on the country, can range from the possession of illicit drugs, to drug manufacturing.

In a similar vein, "Nice People Take Drugs"—an international campaign headed by Release, a UK-based organization—launched a short film depicting an execution. It seeks to highlight the hypocrisy of politicians' responses and encourage a stigma-free debate about drugs in our societies.

In Brazil, Viva Rio launched the book Drugs and Culture: New Perspectives, in conjunction with the Ministry of Culture, the Federal University of Bahia, and other research institutions. The book’s 17 essays cover everything from the history of drug use in the West to the consumption of drugs as a cultural phenomenon. In an effort to gather creative suggestions to deal with drug-related issues, Viva Rio also held a debate with young police and health agents working in the favelas. Videos by favela-based correspondents for the site Viva Favela were presented.

In Argentina, Intercambios presented the book Contributions for a New Drug Policy in the National Congress. The publication aims to strengthen a work agenda and contribute to rethinking the regulatory model, helping to identify policies that protect public order, public health, and human rights for all citizens.

ESPOLEA, a youth-led organization in Mexico, used Twitter to send facts about drugs to its followers, along with important information for drug users.

Two organizations on different sides of the globe drew media attention with graffiti. In Poland, the European Drug Policy Initiative led the campaign "Treat Instead of Punish," concerning Poland's draconian drug law. Along a major street in Warsaw, graffiti depicts members of JUMP '93, a methadone patients' association, leading public figures, such as a former Minister of Health, a rock musician, as well as Kasia Malinowska-Sempruch of the Global Drug Policy Program, and Professor Wiktor Osiatynski, of the Open Society Foundations Global Advisory Board. (See more photos of the graffiti project.)

Meanwhile, in Rio de Janeiro, Psicotropicus organized a grafitti-painting session on a beach. "One of the screens has PAZ (peace) coming out of a hand. This could be linked to the war on drugs and the peace we're working to achieve," said Luiz Guanabara, director of Psicotropicus.  Passersby were encouraged to sign the Call to Action, an international document signed by Michel Kazatchkine, head of the Global Fund to Fight AIDS, Tuberculosis and Malaria, among others. A lawyer gave free consultations on the Brazilian drug law.

In the United States, an op-ed about U.S. drug policies by the director of the Institute for Policy Studies was published, while the Washington Office on Latin America, Center for International Policy, and the Latin American Working Group Education Fund published the report Waiting for Change, an analysis of the Obama Administration's Latin America policy, including counter-narcotics policy.

Next year will be the 50th anniversary of the UN Single Convention (the first of three UN Drug Conventions). This will be the next major opportunity for advocates of rational, humane drug policies to make a concerted effort to campaign against restrictive international policies.

All grantees active in Latin America mentioned above are cofunded by the Open Society Foundations Latin America Program.

What have been the effects of the U.S.-led “war on drugs” in Colombia?

The effects are mixed. While a lot of resources have been spent in combating illegal drug production and trafficking under Plan Colombia—a joint U.S.-Colombia strategy to fight illegal drugs and organized crime—coca cultivation has remained relatively stable.

Potential cocaine production varied little between 2000 and 2007, and only in 2008 we saw a significant decrease in estimates by the United Nations Office on Drugs and Crime. It remains to be seen if this is just a temporary shock or a permanent one.  The evidence on cocaine prices is consistent with these figures. In particular, cocaine prices remained stable through 2007.

Only very recently have we seen a marked increase, probably reflecting a supply shortage as a result of anti-drug policies implemented in Colombia and the intensification of the war on drugs in Mexico under Plan Merida.

Decriminalization is a topic of hot debate in Latin America today. What are the economic benefits of decriminalizing illicit drugs for personal use and possession?

The main benefit of decriminalizing drug consumption is that it treats consumption as a health issue and not a criminal activity.

In terms of economic benefits, the decriminalization of drug consumption would release pressure on drug prices, thus making drug production and trafficking activities less appealing and profitable.

The main concern that I have about decriminalizing drug consumption is the approach that should be taken in terms of production and trafficking once consumption is decriminalized. It is not necessarily obvious why drug production and trafficking should be criminalized if consumption is not.

Presidential elections are coming up at the end of May. How does drug policy reform fit in to the agenda?

Drug policy is a first-order issue in Colombia and it will definitely feature in the current presidential campaign. The two candidates leading the polls are Juan Manuel Santos, former Defense Minister and a member of the current government coalition, and Antanas Mockus, a former mayor of Bogota running as an independent candidate.

While Santos would continue with most of Uribe's anti-drug policies and perhaps will push towards a slightly more balanced approach, Mockus, a former member of the Latin American Commission on Drugs and Democracy, would most probably change the approach, concentrating much more on prevention and educational campaigns, and less on the criminalization of drug consumption.

I would say that most presidential candidates today have learned from the experience of Plan Colombia and will be willing to redesign some policies that have not been very effective in reducing cocaine production in the last few years, such as the intense aerial eradication campaigns of coca crops.

In terms of decriminalization, in my view, the candidates are divided. Unfortunately, however, I don’t see the two candidates who are leading today’s polls changing the current Colombian government’s position regarding the criminalization of drug consumption.

Describe your newest book, Illicit Drugs in Colombia.

Illicit Drugs in Colombia aims to contribute to the debate about illegal drugs in Colombia, the type of anti-drug policies, their effectiveness and costs, the different issues of international relations between Colombia and consumer countries regarding drug policy, and the institutional effects of illicit drug markets and the so-called “war on drugs” in Colombia.

The book is a joint effort by more than 20 scholars from the Universidad de los Andes in Bogota, from a broad array of fields including psychology, economics, political science, law and government.

The main goal of the book is to provide an independent and academic perspective to the different dimensions of drugs and drug policy in Colombia. It includes precise policy recommendations aimed at improving the drug policy making process in order to make it more balanced and evidenced-based.

Image from the film International Drug Policy: Animated Report 2009

Whether it's Afghanistan or Colombia, drug-producing countries face strikingly similar challenges: severe control policies push communities deeper into poverty, worsen conflicts, cause rights violations, uproot people, and damage the environment.

At this year's annual conference of the International Harm Reduction Association in Liverpool in April, Damon Barrett, a senior human rights analyst for the IHRA, moderated a panel of experts from Latin America and Southeast Asia.

Harm reduction strategies—such as easily accessible supplies of clean needles, drug replacement therapy using methadone or buprenorphene, keeping nonviolent offenders out of prison—are cheap, effective, and easy to implement. Yet rarely have they been implemented by countries producing illicit crops.

The exception, as Pien Metaal of the Transnational Institute pointed out, is Bolivia. For the last five years, President Evo Morales has been trying to find solutions, among them, assigning a limited number of peasant families a small plot of land growing coca for traditional uses, such as chewing or tea.

"Already 3,000 years ago, people knew about the benefits of consuming the coca leaf. Millions of people in the Andean region use coca as a mild stimulant, comparable to what coffee is for us here. This is legal in several countries, even outside the Andes," said Metaal.

Yet coca chewing should have disappeared almost 25 years ago, thanks to UN drug conventions, which tend to obstruct countries from adopting pragmatic drug policies.

Campaigns to forcibly eradicate illicit crops merely displace the problem, at the same time causing a variety of rights violations. A pastor from Northern Burma, where opium cultivation is traditionally the main income, spoke of how families struggle from day to day, lack access to health services or education, and are often forced to leave for larger cities.

It's a similar story in Colombia, as a local mayor—who has had several attempts made on his life—described: "People keep growing [coca] because there's no infrastructure, access to markets, vehicles, roads—no help. Coca keeps proliferating. There is malnutrition and hunger, and high homicide rates all related to illegal coca production activity."

Government fumigation programs not only eradicate coca but often food crops as well. Various estimates suggest that almost 4 million people in Colombia are displaced in search of food or refuge from violence and aerial fumigation. This figure is around the same as in Sudan. But as these people have been involved in an illicit activity, authorities do not recognize them as officially displaced, and so they're forced to invent another reason to receive aid.

As Tom Kramer of the Transnational Institute put it, drug policies are "always targeting the poorest of the poor."

As the discussion illustrated, prohibitionist policies have failed and experts are calling for a fresh approach that involves the communities at stake. "Harm reduction is about acknowledging rights in general," said the Colombian mayor, who also underlined the need for help from the consumer countries (Spain, followed by the UK, are the biggest consumers in Europe).

"We must involve the cultivators of opium, coca, and cannabis in the debate,"  said Tom Kramer.