Friday, September 04, 2009

Illness or Crime?

It's always strange to me when they depict drug addicts in movies because they tend to be shown as both really pitiful souls and horrible criminals; it's probably accurate, of course, and most humans contain some measure of wretchedness and wickedness, but there are few other groups that demonstrate that dichotomy so vividly. The dual nature of drug addicts- both seriously ill and violently at odds with their society- raises the question of what should be done with them: should we stack them in the prisons like cord wood, like they do in California; or should we put them in some sort of hospital and help them get clean and healthy? Or should we let them decide? Are they sick, or are they criminals?

Portugal went to a policy of decriminalization of all drugs in 2001. Decriminalization is different from legalization: the drugs are still illegal, but it's not a criminal matter, which means you might pay a fine, but you won't be shoved in jail. When they catch a drug user, the police confiscate the drugs; then, the user appears before a "dissuasion committee", made up of social workers and psychiatrists. Apparently, this is something like an intervention, and the goal is to get the drug user into a treatment program. In other words, the government is treating drug addiction as a health issue instead of a criminal matter.

This has been going on since 2001 and it's easy to be skeptical about the program's success. Indeed, when decriminalization was announced, several people predicted a boom in drug use and drug-related crimes for Portugal. According to The Economist, they were wrong. Citing a Cato Institute report by Glenn Greenwald, they note:
"Mr Greenwald claims that the data show that “decriminalisation has had no adverse effect on drug usage rates in Portugal”, which “in numerous categories are now among the lowest in the European Union”. This came after some rises in the 1990s, before decriminalisation. The figures reveal little evidence of drug tourism: 95% of those cited for drug misdemeanours since 2001 have been Portuguese. The level of drug trafficking, measured by numbers convicted, has also declined. And the incidence of other drug-related problems, including sexually transmitted diseases and deaths from drug overdoses, has “decreased dramatically”.
"The number of addicts registered in drug-substitution programmes has risen from 6,000 in 1999 to over 24,000 in 2008, reflecting a big rise in treatment (but not in drug use). Between 2001 and 2007 the number of Portuguese who say they have taken heroin at least once in their lives increased from just 1% to 1.1%. For most other drugs, the figures have fallen: Portugal has one of Europe’s lowest lifetime usage rates for cannabis. And most notably, heroin and other drug abuse has decreased among vulnerable younger age-groups, according to Mr Cardoso.

The share of heroin users who inject the drug has also fallen, from 45% before decriminalisation to 17% now, he says, because the new law has facilitated treatment and harm-reduction programmes. Drug addicts now account for only 20% of Portugal’s HIV cases, down from 56% before. “We no longer have to work under the paradox that exists in many countries of providing support and medical care to people the law considers criminals.”

There are different approaches to drug addiction prevention and treatment. Claire tells me that some social workers are taking a "harm reduction" approach, aimed at making drug addicts functional instead of clean. But, it does seem that one roadblock to treatment is in seeing addicts as both sick people and criminals. Indeed, the answer might be to stop seeing them as criminals.

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