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LESSONS FROM How a radical approach to an

addiction crisis, from free

PORTUGAL
treatment to decriminalization
NEWS of drugs for personal use, led
CRIME to a dramatic drop in overdose
Province suing deaths and drug use. A12-13
gangsters for
cars, cash  A4

ECONOMY
Budget update
paints a rosy
picture A11, A17

WEEKEND
REVIEW

In a weeklong series from Lisbon, Vancouver Sun columnist Daphne Bramham looks at how Portugal has achieved one of Europe’s lowest rates of drug,
alcohol and tobacco use and reduced overdose deaths from an average of 360 a year in the 1990s to just 26 in 2016. GET T Y IMAGES

TODD
Criticism of
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M A S S AC R E

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VAN01268500_1_1
A12 S A T U R D A Y, S E P T E M B E R 8 , 2 0 1 8
A patient is handed his daily dose of 85 milligrams of methadone by nurse João Matos from a van parked near Praca Espanha in 2017 in Lisbon, Portugal.
The daily methadone program is run by the Ares do Pinhal Association for Social Inclusion.  H ORACI O VI L LALOBOS / CORBI S VI A GE T T Y IMAGES
WHY DECRIMINALIZATION
ISN’T A SILVER BULLET
In the 1990s, Portugal was in the throes of a national crisis, averaging 360 drug overdose
deaths a year in a country of 10 million. Today, it has one of Europe’s lowest rates of
drug, alcohol and tobacco use and the number of overdose deaths in 2016 was 26. In
a weeklong series from Portugal, Vancouver Sun columnist Daphne Bramham looks at
the lessons to be learned from the country’s radical approach to addiction treatment.
DA PH N E B R A M H A M
Lisbon, Por tugal
Almost every day, foreigners knock
on João Goulão’s door seeking a
solution to their countries’ drug
addiction problems.
Goulão is Portugal’s director-
general of drug policy and the
architect of its radical approach,
which included decriminalizing all
drugs for personal use. Among the
pilgrims who have come here are
philanthropist Richard Branson,
Canadian Justice Minister Jody
Wilson-Raybould and, recently,
an army of politicians and policy-
makers from Norway.
Fortunately, the former family
doctor is infinitely patient, as he’s
been answering the same ques-
tions for almost 20 years.
In the late 1990s, Goulão and 10
others were charged with advising
the government how to deal with
the 100,000 people — one in every
100 citizens — using heroin. Over-
dose deaths were averaging 360 a
year in the country of 10 million
and Lisbon was called the junkie
capital of Europe.
Goulão was an unusual choice.
He had no training in addictions
and, rare among Portuguese, no
direct connection with addictions.
The closest family connection he
has to drugs is a niece, who is in
her 40s and living in a therapeu-
tic community with schizophrenia
caused by drug use.
As for his four children, “Hope-
fully, none of them will have prob-
lems.”
Because of its interventions,
Portugal now has one of Europe’s
lowest rates of drug, alcohol and
tobacco use across all ages, and
the lowest infection rates for
HIV/AIDS and hepatitis that are
associated with injection drug use.
In 2016, the number of overdose
deaths dropped to 26 from 40 the
previous year.
VA N C O U V E R S U N
The only thing that most outsid-
ers know about Portugal’s laws is
that all drugs for personal use are
decriminalized. But what most
fail to understand is that all drugs,
other than alcohol and tobacco, re-
main illegal.
If police find you with illicit
drugs, you’ll be arrested and taken
to a police station where the drugs
will be weighed. If the amount is
above the strictly enforced thresh-
old limits — designed to be a 10-
day supply for personal use, or 25
grams of cannabis, five grams of
cannabis resin, two grams of co-
caine, or one gram each of ecstasy
or heroin — you can be charged as
a trafficker. If convicted, jail terms
range from one year to 14 years.
If the amount is below the limit,
you’ll be sent the following day to
the Commission for the Dissua-
sion of Drug Addiction — even if
you’re a tourist. There, you will
be interviewed by a psychologist
or social worker before appearing
before a three-person panel that
will offer suggestions aimed at
stopping your drug use.
From there, you’re fast-tracked
to whatever services you’re willing
to accept. If you refuse help, you
João Goulão is the architect of Portugal’s 2001 overhaul of drug policy that
included decriminalizing drugs for personal use.  DAPH N E BRAM H AM
can be asked to do community ser-
vice or even, eventually, facing a
fine, perhaps even having posses-
sions confiscated and sold to pay
the fine.
It’s why Goulão is so quick to
point out that Portugal’s success
isn’t because of decriminalization.
It’s because, in 2001, his country
made a commitment to providing
whatever its citizens need to be
as healthy and as fully engaged in
society as possible.
“Decriminalization is not a silver
bullet,” he said. “If you decriminal-
ize and do nothing else, things will
get worse.
“The most important part was
making treatment available to
everybody who needed it for free.
This was our first goal.”
Underlying the policies is a na-
tional conviction that addiction is
a chronic, recurring disease best
dealt with through treatment not
jail.
“Our approach is based on re-
spect,” said Goulão. “It’s incremen-
tal. Our system works by asking
citizens what he can give at that
given moment.
“If he is completely dependent,
I cannot appeal through force of
will. I have to help him with his
limited capacity to make his own
choices. And, step-by-step, the
ability of the citizen increases.”
Portugal created pathways to
health that aren’t punitive. This re-
quired investing in treatment and
recovery services and establishing
a network that connects citizens
to whatever they need in a timely
manner, whether that’s outpatient
counselling, time in a detox centre,
even up to three years in a thera-
peutic recovery community.
And it meant that the govern-
ment made a long-term commit-
ment to ensuring that those ser-
vices wouldn’t disappear when the
economy crashed in 2008.
One of Europe’s poorest coun-
tries before 2008, Portugal was es-
sentially insolvent after the global
meltdown. The US$115-billion
bailout from the International
Monetary Fund and the European
Union came with strings. The gov-
ernment had to increase taxes and
cut spending. Yet, the addictions
treatment and recovery services
survived almost unscathed.
Helped by a boom in tourism,
Portugal’s economy is recovering.
Even so, its coalition government
We had to
sacrifice some
things —
studies,
research and
surveys. But
the health
responses
and treatment
facilities,
we kept them.
CITY
ADDICTION:
WINNING
T H E WA R
TODAY
World comes to study Portu-
gal’s grand experiment.
Day 2
Dissuasion commission aims
to set users straight.
Day 3
Life today for drug addicts in
Portugal.
Day 4
Outreach workers have a
long-term goal.
Day 5
Harm reduction just a piece
of the puzzle.
Day 6
Treatment centres abound;
so do waiting lists.
Day 7
Applying the Portuguese
model to B.C.
cut spending by 30 per cent in most
areas this year. Again, the excep-
tion was addictions treatment and
recovery.
“We had cuts of 10 per cent be-
cause we could explain to politi-
cians that to disinvest would cost
more later on,” said Goulão. “We
had to sacrifice some things —
studies, research and surveys. But
the health responses and treat-
ment facilities, we kept them.”
It shows how far Portuguese pol-
iticians, citizens and even bankers
have come in understanding what
has been accomplished here.
The country’s drug policy has
not only saved lives, it’s saving
Portugal money. In the first five
years, the social costs related to
drug abuse dropped 12 per cent,
according to a peer-reviewed study
in the International Journal of
Drug Policy in 2014.
Within the first decade, the cost
saving had jumped to 18 per cent.
Those reductions are in the health
costs of drug use and overdose
deaths, but also savings to the le-
gal system associated with drug-
related criminal prosecutions and
reductions in lost income and lost
production of individuals serving
time in jail for drug offences.
Of course, that wasn’t initially
obvious to many. In 2001, the
United Nations threatened sanc-
tions to punish Portugal for de-
criminalization and some in the
European Union threatened to
close the borders.
The first indication of change
came in 2002. The left-wing party
that brought in the changes was
defeated, but the right-wing gov-
ernment stuck with it because the
first indication of the improve-
ments were becoming obvious.
CITY
Today, António Guterres, the
prime minister who enacted the
policies, is the UN secretary-gen-
eral and Norway is about to follow
the Portuguese model.
“Our first goal is to help people to
resume their dignity,” Goulão said.
“An addict has to do whatever to get
his fix each day, I cannot ask him
or her to behave as a free citizen.”
Often the first task is getting what
Goulão described as “the citizen-
ship tools that they need — an iden-
tification card and a health card.”
If they are acutely addicted to
heroin, they’ll be offered enrol-
ment in an opioid substitution
program so they can get metha-
done or buprenorphine to curb
their cravings as they move to the
next step.
Once users are stabilized, Goulão
said, “I can ask for more from
them, but always with them being
assisted with those new focuses.”
These days, Lisbon is no Vancou-
ver. There are no cannabis shops,
let alone one on almost every cor-
ner. The smell of marijuana doesn’t
permeate downtown streets, or
any streets for that matter.
Medical marijuana was only le-
galized in June. The notion of le-
galizing recreational marijuana is
anathema here.
No addicts openly inject heroin,
smoke or inhale illicit substances,
and there is no drug market where
dealers openly sell.
No fentanyl has yet been detect-
ed in the illicit drugs. So there’s no
need for take-home naloxone kits,
pop-up treatment tents or special-
ized training and trauma counsel-
ling for first-responders.
Until July, there were no super-
vised injection sites. Three opened
in July — two in Lisbon and one in
Porto, the country’s second largest
city. When you ask citizens what
they’d do if they saw someone sell-
ing or using drugs in public, most
say they’d either tell them to do it
somewhere else or they’d call the
police in hopes the user could be
coaxed into treatment and recov-
ery.
There is a national opioid re-
placement program that provides
free methadone to addicts as a
means to stabilize them and get
them into treatment. A dispensing
van circulates through the city on
Visit flairair.ca
Nuno Capaz
a regular schedule for those whose
doctors don’t allow them multiple
doses to take home.
Despite the easy access to opioid
substitution therapy, use is stable
with a slight drop in 2016 (the
last available statistics) to 16,368
people. It mirrors the generally de-
creasing trend in opioid addictions.
Abstinence — defined as free-
Our first goal is
to help people
to resume their
dignity. An
addict has to do
whatever to get
his fix each day,
I cannot ask him
or her to behave
as a free citizen.
dom from any form of illicit drug
use — is the long-term goal for all
addicts, according to Goulão, and
Nuno Capaz, vice-president of Lis-
bon’s commission for the dissua-
sion of drug use. Both do, however,
acknowledge that it may be impos-
sible for all addicts.
In B.C. with a population of 4.7
million, there were 27,553 people
with methadone or buprenorphine
prescriptions in 2016, twice as
many as a decade earlier, with the
number forecast to rise to 58,000
by 2020.
Despite that, provincial guide-
lines for opioid substitution pro-
grams approved last year raised
concerns about “low retention
S A T U R D A Y, S E P T E M B E R 8 , 2 0 1 8 VA N C O U V E R S U N A13
rates” — people quitting metha-
done and buprenorphine — and an
under-utilization of opioid replace-
ment therapy as a treatment op-
tion, particularly in northern B.C.
In 2016, there were only 27 over-
dose deaths in Portugal, down
from 40 the previous year.
In B.C., 993 people died of illicit
overdoses in 2016. The total rose
to 1,422 last year.
During two weeks here, I saw
no more than half a dozen people
who were clearly high. The most
obvious were two in Lisbon’s un-
derground Metro. Another was
screaming and dancing in the
middle of a street in the upscale,
Chiado shopping district, while a
couple of others were curled up in
parks or on church steps sleeping
off the effects of drugs or alcohol.
Even the small shantytown that
I went to with outreach workers
didn’t come close to what’s become
normal in Vancouver’s Downtown
Eastside or in the tent cities that
have sprung up in this province.
Goulão still can’t get over what
he saw when he visited Vancou-
ver’s Downtown Eastside last fall.
“I was shocked. What I saw took
me back to the end of the 1980s
and 1990s in Lisbon with the pub-
lic visibility of drug use and nui- Lisbon is colourful and graffiti-rich, especially in the neighbourhood where
sance,” he said. “What shocked me IN-Mouraria, a harm-reduction centre, is located. DAP HNE BR AMHAM
was that there are lots of responses
but they do not seem to communi- is washing over North America. companies and we were convincing
cate. They’re not centred on what Goulão noted that heroin — opi- them to employ these guys.”
citizens need. … Citizens should be oids in general — have little ap- The companies would be given
able to move through the system peal, especially among Portugal’s tax deductions and government
and get what they need.” youth who have been regaled with help with the wages. The recover-
It’s got worse since his visit, with tales of the bad days in the 1990s ing users would have access to a
the overdose deaths only moder- and learned the lessons from their therapist who was available to as-
ating slightly in the spring as B.C. parents and grandparents about sist and motivate.
entered its third year of a public its serious consequences. But since 2008, those compa-
health emergency. Also, European doctors have not nies have been closing. The gov-
He was asked about what would prescribed painkilling opioids in ernment subsidies disappeared in
happen in Lisbon if an opioid user anywhere near the quantities that the mandated cost cutting because
had to be revived with naloxone have been handed out in North they weren’t directly linked to ad-
multiple times in a week. America. “Portugal’s system is dictions treatment and recovery.
“It wouldn’t happen,” Goulão not perfect,” said Goulão. “But I “That’s a problem — the sustain-
said. “If it did, he’d probably be believe we have the tools to meet ability of these kinds of programs.
in a hospital under intensive psy- the challenges.” These people lost their new lives.
chiatric treatment. Four times in Among its challenges is how to They collapsed like a house of
a week is not an accident. It has to deal with thousands of former cards and they relapsed. So now,
be intentional. So he would need heroin addicts who are returning they’re not as confident in our sys-
intensive therapy. … But I don’t to drug use in their older age. tem of care,” said Goulão.
know of somebody who would “Twenty years ago, it was pos- “Now, we are opening injecting
have overdosed so many times.” sible to find jobs for thousands of rooms because they will not accept
He acknowledges that Portugal people at the final part of their (ad- our invitation to treatment.”
and Europe are lucky to have been dictions) treatment,” Goulão said. dbramham@postmedia.com
spared the wave of fentanyl that “There were a lot of small and micro Twitter: @daphnebramham
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CA N NA B I S
Post-secondary
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L E BA N O N
Mom has few
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father abducts
their kids  A4

NP Nuno Capaz, vice-president of Lisbon’s Commission for the Dissuasion of Drug Addiction, says Portugal was able to radically reduce drug addiction
by using homegrown solutions that took into account the country’s health care and policing systems.  R ICHAR D LAM

Portugal’s ultimate goal is setting

WO R L D
Far right party
makes gains
in Swedish
vote NP1 drug users on the path to recovery
CA NA DA
In the 1990s, Portugal that people who show up at the “People are normally not happy
Rural ski averaged 360 drug overdose nondescript office of Lisbon’s when they come here,” he said.
deaths a year in a country of Commission for the Dissuasion “They’ve been caught by police
slopes face 10 million. Today, it has one of Drug Addiction might be a bit and are not fully aware of the
uphill battle of Europe’s lowest rates of intimidated. process. But if they show up
drug and alcohol use and Capaz, 41, is the commission’s unhappy, in the end they will be
to survive NP2 there were just 26 overdose vice-president. happier.”
deaths in 2016. In a week- DA PH N E B R A M H A M He has a doctorate in sociol- Capaz is bemused by the sheer
long series from Portugal, Lisbon, Por tugal ogy and it’s his job to try to put number of foreigners and media
Daphne Bramham looks at the Portuguese drug users on a path who show up at his door.
lessons to be learned from the Nuno Capaz is a tough-looking to recovery and ensure that they On my way out, I passed a
country’s radical approach to guy, tall, unshaven and slow are contributing members of Belgian TV crew in the lobby.
addiction treatment. to smile. So, it’s not surprising society. S E E P O R T U G A L   O N A7

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CITY
While possession of drugs for personal use is illegal in Portugal, it is no longer a crime. Portuguese police concentrate much more on tracking down traffickers.  AFP/GET T Y IMAGES/FILES
DRUG STRATEGY MULTI-FACETED
P O R T U G A L   F R O M A1
An Irish crew was there the day
before. The steady stream of
visitors to the commission is tes-
tament to the global problem of
drug addiction that Portugal may
have among the few solutions on
offer.
“What makes me mad is that
normally people hear decrimi-
nalization and they mix it up
with legalization or they are
thinking that it is a free-for-all,”
Capaz said.
“It’s not like that at all.”
He also bristles at the sugges-
tion that there even is a Portu-
guese model, despite the fact that
what this country of 10.5 million
has done is unique.
“It works for us because it
was devised for us because we
knew our health care system and
our policing system. We knew
what our options were.”
If other countries should take
anything from Portugal’s experi-
ence, he said, it’s the process that
was used to devise the policy.
Portugal put together a com-
mittee of experts, users and
former users in 1998. People
with personal experience added
a human element to the facts and
figures, which made it more dif-
ficult for politicians to ignore.
The recommendations were
widely debated by politicians
and by the public. It took several
years before some changes,
including decriminalization,
were implemented. Others,
including supervised injection
sites and medical marijuana use,
have only been approved within
the past few months.
“Drug addiction is a complex
problem that we’re likely not
going to solve,” he said.
“The best we are likely to do is
manage it and we need to devise
ways to better manage the situa-
tions that we’re faced with.”
Capaz suggested that the per-
sonalizing of the issue by grieving
parents and others has skewed
some of the decisions being made
in Canada and the U.S.
“It’s differences of opinion that
result in the best ideas,” he said.
“But you need to maintain the
logic part because in the end it’s
decided at the political level … by
guys in grey suits and ties.”
When Portugal decriminal-
ized possession of illicit drugs
for personal use in 2001, it was a
radical idea born in crisis. By the
late 1990s, an estimated 100,000
people — almost one per cent
of the population — were using
heroin and there was an epidem-
ic of heroin overdose deaths.
Decriminalization was only a
small part of that basket of mea-
sures aimed at curbing Portu-
gal’s crisis but that one measure
initially put the country at risk of
being ejected from the Union Na-
tions. Its European neighbours
threatened to tighten border
controls.
The underlying philosophy was
and is that addiction is a chronic,
recurring disease from which
people can recover with treat-
ment, and that it can be prevent-
Nuno Capaz, a top official in Portugal’s strategy to reduce drug use, says sanctions can be applied if drug users
will not voluntarily enter treatment.  DAPH N E BRAM H AM
ed through education and subtle,
early intervention before drug
use becomes abuse.
As with other illnesses, ad-
diction treatment and services
are covered by Portugal’s public
health care system. The Commis-
sion of Dissuasion was set up as a
fast track to those early interven-
tions and a link to services for
the most acutely addicted.
Capaz said that while possess-
ing and using illicit drugs in Por-
tugal is not a criminal offence,
it remains illegal. And the sale
and purchasing of those drugs
remains a criminal offence. As
a result, there is no tolerance
here for drugs in public places.
Police still arrest people found
in possession of drugs. They con-
fiscate the drugs and weigh them,
comparing the weight against the
limits set by law for what’s accept-
able for personal use. For can-
nabis, the threshold is 25 grams.
For hashish, it’s five grams, for
cocaine two grams, and for heroin
or ecstasy it’s one gram.
João Goulão, the national drug
policy co-ordinator, has said
those thresholds are outdated
and need to be reviewed because
when the cannabis limit was set,
its potency was more or less the
same as five grams of hashish.
Today, marijuana is much more
potent. Goulão said Portugal
has no intention of following
Canada’s lead and legalizing
marijuana, let alone all drugs
as some Canadian activists are
demanding.
Anyone found with more than
the personal use limit in Portugal
faces criminal charges. People
with drugs for personal use are
written a summons to appear
before the dissuasion commis-
sion the following day.
Addiction — whether to illegal
drugs, alcohol, tobacco, gambling
or even the internet (all of which
fall under the dissuasion commis-
sion) — is considered a chronic
disease that affects individuals
differently and therefore requires
tailor-made recovery plans.
“If people are willing to comply
with what we recommend, good,”
Capaz said. “If not, that’s their
problem.”
That’s not entirely true.
Drug users don’t have to take
the commission’s advice.
But if they don’t, the commis-
sion has a variety of punitive
measures that it can take. It can
levy fines and confiscate prop-
erty if those fines aren’t paid.
If addicts and people with HIV
don’t comply with the commis-
sion’s orders to seek treatment
If people are
willing to
comply with what
we recommend,
good. If not, that’s
their problem.
and meet regularly with their
family doctors, the commission
can ensure that their govern-
ment benefits such as social
assistance are “interrupted.”
Vitor Gonsalves was both ap-
prehensive and defiant when he
showed up for his assessment
meeting with a clinical psycholo-
gist, Raquel Lopes.
Like most Portuguese, he
didn’t have a clear understanding
about what the Commission for
the Dissuasion of Drug Addic-
tion does, even though it handles
about 11,000 cases a year. But
M O N D A Y, S E P T E M B E R 1 0 , 2 0 1 8
Gonsalves was also defiant,
insisting on his right to cannabis
for personal possession.
His story is a familiar one here.
Gonsalves said police came
to his village after a complaint
about some youths who were
partying. Since decriminaliza-
tion, police don’t go looking for
people with small quantities of
drugs, although they put consid-
erable resources into tracking
down traffickers.
But police do check for them
if they’re called to complaints
about public disorder — noise,
shooting heroin in public, smok-
ing dope near children, break and
enter, theft and so on.
Gonsalves said he was going
to the café for an espresso when
the police stopped and searched
him. That was the day before.
And now, here he is.
By the end of his meeting with
Lopes, Gonsalves was more re-
laxed. He’d been assured that he
would not have a criminal record
and that whatever recommen-
dations the commission made
— it might be family counsel-
ling, referrals to social workers
for help in finding housing or
employment tor even long-term,
government-funded treatment
in therapeutic communities — he
would not be forced to follow any
of them.
But part of the commission’s
role is to motivate people to
make the necessary changes.
“Treatment has to be volun-
tary,” said Capaz. “But if there
is not voluntary compliance, we
can apply sanctions. For addicts,
that wouldn’t be a fine. It would
likely be community service.”
But for addicts agreeing to
treatment, commission staff ar-
range it and, if needed, will even
drive them from the office to
VA N C O U V E R S U N A7
ADDICTION:
WINNING
T H E WA R
Day 1: World comes to study
Portugal’s grand experiment.
TODAY: Dissuasion
commission aims to set
users straight.
Day 3: Life today for drug
addicts in Portugal.
Day 4: Outreach workers
have a long-term goal.
Day 5: Harm reduction just
a piece of the puzzle.
Day 6: Treatment centres
abound; so do waiting lists.
Day 7: Applying the
Portuguese model to B.C.
where the services are available.
If a person doesn’t appear as
ordered before the commission,
it asks police to serve another
warrant. If the person doesn’t
appear the second time, the com-
mission will make recommenda-
tions and orders in absentia.
If people don’t pay their fines,
the commission has the power to
order police to seize and sell us-
ers’ assets with the proceeds go-
ing to help pay for treatment and
recovery services. Seizures can
be appealed through the courts.
Of those who appear before
the commission, 90 per cent are
recreational cannabis users and
most are young men. A third of
those who appear here are in
need of some sort of referral
because they have some prob-
lems that they’re attempting to
mask with substance use.
Fewer than 10 per cent are
addicts, which helps explain why
it’s called the dissuasion commis-
sion. Its primary role is to deter-
mine the root causes of people’s
drug use and remedy that before
use escalates to addiction.
Yet for all of the focus on illicit
drugs, Capaz said the most prob-
lematic cases are alcohol-related.
Asked what advice he had for
Canada, Capaz replied: “If you
go back to Canada and copy what
we did, it probably will not work.
You shouldn’t do what we did.
But you should do like we did to
come up with your own system.”
Portugal put together a group
to study everything about drug
use and addictions services.
It made recommendations
and then several years went by
as people discussed it and politi-
cians argued over it.
In the end, the group’s propos-
als were only partially imple-
mented. Dropped were the rec-
ommendations for legalization
of cannabis, legalized medical
marijuana and the establishment
of supervised injection sites.
It wasn’t until this June that
medical marijuana was ap-
proved. In July, three supervised
injection sites opened as pilot
projects. Before there was the
so-called Portuguese model,
Capaz said it was the Portuguese
experiment.
What was that like?
“The experiment part felt like
we were mice in a lab looking for
a way out.”
dbramham@postmedia.com
A8 M O N D A Y, S E P T E M B E R 1 0 , 2 0 1 8
Martha May Kahnapace believes a Gladue report, which provided the judge with background on her upbringing, made a difference in her sentence and in her life.
GLADUE REPORTS, RESOURCES
HAVE HAD LIMITED REACH
Background, other factors are considered following conviction of Indigenous offenders
KEITH FRASER
Martha May Kahnapace believes
in Gladue reports, the court-
ordered documents that provide
judges with background informa-
tion on Aboriginal offenders.
The B.C. woman has nothing
but praise for the writer who pre-
sented a report to the judge at her
sentencing after she was convict-
ed of killing her partner during a
drunken, drug-induced fight.
“If they’re done properly, they’re
very, very helpful,” said Kahna-
pace, who is a member of the We
Wai Kai (Cape Mudge) First Na-
tion, which is based on Quadra
Island and in Campbell River.
“Judges need to be more open to
accepting them.”
Kahnapace received a sentence
of time served after an 8½-year
court battle during which two
murder convictions were over-
turned and eventually substitut-
ed with a conviction for the lesser
offence of manslaughter.
She didn’t know until a year after
he died that her father, whom she
described as being “angry, bitter
and an alcoholic,” had been in a
residential school.
“I didn’t understand the way
things were at the time because
I didn’t know a lot about it. I didn’t
know about residential schools. To
me our way of life was normal. If
it was someone else looking in, it
would be totally dysfunctional and
not just the normal way of living.”
She spent much of her childhood
in foster homes. She become an
alcoholic and an intravenous drug
user at a young age.
Those details and others were
outlined in her Gladue report and
were considered by the judge in
crafting the sentence.
PAT C H W O R K SY S T E M
Gladue reports are routinely
ordered for the most serious of-
fences, but critics say the systems
for delivering them in B.C. and
elsewhere in Canada are a patch-
work at best.
The reports are aimed at trying
to deal with the grossly dispro-
portionate number of Aboriginal
offenders incarcerated in Canada,
a problem that has plagued the
country for more than two decades
and is on the rise.
Figures on the Statistics Cana-
da website note that, in 2015-16,
Aboriginal adults accounted for
27 per cent of provincial and terri-
torial jail admissions, while repre-
senting only about three per cent
of Canada’s population.
The incarceration rates for
Aboriginal women — they make
up 38 per cent of committals — are
even more worrying.
A recent study by an Ottawa
think-tank found that B.C. has one
of the most disproportionally high
levels of Indigenous incarceration
VA N C O U V E R S U N
in Canada. In 1996, Parliament
recognized there was a crisis and
amended the Criminal Code to di-
rect judges to look at all available
sanctions, other than just prison,
that are reasonable in the circum-
stances, with particular attention
to Aboriginal offenders.
In 1999, the Supreme Court of
Canada released its Gladue deci-
sion, which also dealt with a B.C.
Aboriginal woman who was con-
victed of manslaughter.
The ruling set out factors that
should be considered in the sen-
tencing of Indigenous offenders,
urging judges to use a restorative
justice approach to sentencing.
Restorative justice involves
bringing together the victim, of-
fender and some members of the
community to discuss the effects
of crime and includes such things
as Aboriginal healing circles.
In 2012, a second ruling from
Canada’s highest court basically
repeated the message of Gladue,
finding that the situation had got
worse.
“There’s a complete lack of any
kind of national strategy in rela-
tion to it,” said Doug White, co-
chair of the B.C. Aboriginal Justice
Council and the secretary of the
Gladue Writers Society of B.C.
“You see across the country,
there’s a very ad hoc approach to
the implementation of Gladue.
“Some provinces do nothing,
some provinces take a very im-
poverished approach. The only
two provinces that have anything
that is remotely like a significant
approach are Ontario and British
Columbia.”
S L OW PR O G R E S S I N B.C.
In B.C., the first Gladue reports
were written in 2009 following
An increase in funding means more Gladue reports will be created for Indigenous offenders but one of the big
challenges that remains is finding Indigenous people to write them.   NATH AN D E N E T T E / THE CANADIAN P R ES S
consultation with Aboriginal
communities who felt the most
important thing to improve their
experience in the criminal jus-
tice system was to provide the
reports.
The Legal Services Society of
B.C., which provides legal aid in the
province, until recently has been
getting about $100,000 in non-
governmental funding for Gladue
reports from the Law Foundation
of B.C.
There’s a lot of
barriers because
it’s preferable
that the writers
are Indigenous
themselves but
that’s difficult.
About 75 reports a year were
being written, at a cost of about
$1,500 a report.
Last year, for the first time, the
provincial government kicked
in money, providing another
$100,000 to the society for the
reports.
Increases to legal aid will re-
sult in an anticipated $500,000 in
funding next year for the reports,
which are contracted out to writ-
ers around the province.
That’ll allow several hundred
more reports to be written, but
it’s still scratching the surface as
thousands more Aboriginals in the
system will not get reports.
In the spring budget this year,
the B.C. government set aside
$750,000 in funding, some of
which will likely go to more Gla-
due reports, but exactly how the
money will be allocated has not
been determined.
“That money isn’t earmarked
for the reports necessarily be-
cause we’re going to work with the
Aboriginal Justice Council on what
the Gladue process looks like,” said
Kurt Sandstrom, a B.C. assistant
deputy Attorney-General.
“Maybe it’s an Indigenous or-
ganization that takes over some
of it, a hybrid between the Legal
Services Society and other orga-
nizations.”
Mark Benton, chief executive
officer of the Legal Services Soci-
ety, said that after a “generation” of
waiting for some progress on Gla-
due, he’s optimistic that changes
will happen.
Benton, who said he’s not di-
rectly involved in the discussions
surrounding how the $750,000 will
be spent, said that despite the long-
term involvement of his society,
they’d be happy if somebody else
was to take it over.
“Some of the stuff that’s happen-
ing right now suggests it may go
in that direction, but nothing has
been decided yet.”
White said he appreciates the
work that has been done by the
society over the years, but imag-
ines that ultimately it will be in the
hands of some kind of Aboriginal
justice entity in B.C.
R E P O RT S
Gladue factors that judges must
consider when sentencing an
offender include the effects of
colonialism, residential schools,
dislocation, isolation and racism.
The reports, which take several
months to write and run to about
15 pages, focus on each individual
offender and are just one element
CITY
  GER RY KAHR MANN
considered by a judge in deciding
on a sentence.
As much as possible, the reports
are written by people familiar
with an offender’s Aboriginal
community and involve inter-
views with the offender, family
and other community members.
The Gladue Writers Society has
a roster of about 15 writers who
have been producing many of the
reports in B.C.
Pamela Shields, a lawyer who
trains Gladue writers across Can-
ada and is the former manager of
Aboriginal services at the Legal
Services Society of B.C., says that
it’s been an “uphill battle” from
the beginning to get the reports
written.
She organized the program that
resulted in the first Gladue report
being written.
“I realized that the bench and
the bar knew very little about
Gladue. Rather than doing full
reports, which were done in
Ontario, the courts were relying on
pre-sentence reports from proba-
tion officers. It wouldn’t delve into
Gladue factors.”
Shields said they developed poli-
cies and because there was very
little funding, she had to routinely
decline requests for reports.
“We set priorities that were
women with children.”
Female Aboriginal offenders
often lose their children to govern-
ment care if the moms are incar-
cerated, she said.
As a result, she said, children
“grow up in care, they often be-
come parents themselves and it’s
just a continuous cycle. Gladue
reports are one way to break that
cycle and provide a remedy and
support and acknowledgment and
try to stop the kids from going into
care and the kids becoming part of
the justice system.”
Another challenge was finding
the people to write the reports,
which need to be neutral, accurate
and corroborated, said Shields.
“And there’s a lot of barriers
because it’s preferable that the
writers are Indigenous themselves
but that’s difficult. There’s a cer-
tain level of writing skills that’s
required for the court.”
In 2013, an evaluation of the Gla-
due pilot project in B.C. found that
Aboriginal offenders who received
a Gladue report prepared by a
Legal Services Society-trained
writer had fewer jail sentences
than comparable offenders with-
out a report.
The study found that when jail
was imposed, those with Gladue
reports were incarcerated an aver-
age of 18 days compared to 44 days
for those who did not benefit from
such a report.
And offenders being sentenced
for a repeat offence received a
shorter sentence with a Gladue
report in 76 per cent of the cases.
CITY M O N D A Y, S E P T E M B E R 1 0 , 2 0 1 8 VA N C O U V E R S U N A9

T R O U B L E D SY S T E M
But there were problems with
the system, with some defence
lawyers raising objections in court.
Terry La Liberté, an experienced
Vancouver criminal lawyer, had
one Aboriginal client who didn’t
qualify for legal aid and was there-
fore facing a hefty bill to pay for
a Gladue report of his own.
His client had been sexually
assaulted by residential school em-
ployee Arthur Plint.
“This man was actually raped.
A lot of people say, well, yeah, he’s
blaming residential school his-
tory. This guy was a victim right
out front and he would have to pay
for a Gladue report. That is of itself
offensive in the extreme.”
Victoria lawyer Kevin Mc-
Cullough and his colleague, Tim
Russell, have applied for a stay of
proceedings for a client arising
from delays in getting the court-
ordered report.
“The government in this case,
the defence says, farted around
for six months after the court had
ordered a Gladue report. They kept
saying, well, go to Legal Services
and there’s a program to fund it,
they’ll pay for the Gladue report.
And our position has been, no, no, Almost a decade ago the Supreme Court of Canada dealt with a B.C. Aboriginal woman convicted of manslaughter, resulting in a ruling setting out
these are court-ordered reports.” factors that should be considered in sentencing Indigenous offenders.  S E AN KI LPATR I CK / THE CANADIAN P R ES S
There have also been some con-
cerns raised by judges about the Gord McVicor, the college’s dean Some travelled from as far away
quality of the reports. of continuing studies. as Thunder Bay, Ont.
Currently there is no accredita- “People couldn’t afford to travel. Jonathan Rudin, director of
tion or certificate required for the Other opportunities came up for the Aboriginal Legal Services in
Gladue writers, which means that people, but all in all seven people Ontario, says his program makes
theoretically anyone can write one. did complete that course.” use of a full-time staff including
A pilot program to train Gladue McVicor said that since the pro- 14 writers whose sole job is to write
writers through Vancouver Com- gram finished, there have been a Gladue reports.
munity College was launched ear- number of inquiries from institu- “Our reports don’t say what the
lier this year, in part to provide tions across Canada that are inter- sentence should be, because that’s
a more systematic approach to the ested in the course. part of our realm. We will do a
writing of the reports. “So we do get these inquiries, but Gladue report for any Indigenous
“We’d like to see the Gladue we’re not really advertising that person facing a sentence of 90 days
writing be an accredited compo- we’ve got this program because or more if it’s requested, ” said Ru-
nent to ensure the quality and we recognize that we’re still de- din, who added the reports were
educational background of those veloping it.” first written in Ontario in 2001.
individuals who are writing those The requirements for the course “If what’s being requested is a
reports,” said David Wells, dean of include Grade 12 English, some sentence of less than 90 days, then
the school of arts and sciences at knowledge of Indigenous cul- our Gladue case workers write Gla-
the college. “We know that there ture and history, knowledge of due letters, which are less lengthy
is a huge shortfall of people able to the Canadian judicial system and and take less time to prepare.” Increases to legal aid will result in an anticipated $500,000 in funding for
write those reports.” awareness of community support Between 400 and 500 reports Gladue reports for Indigenous offenders in B.C.  AR LEN R EDEKOP
A total of 15 people started the services. are being written every year by
college’s pilot program, which was The first students in the program the Ontario program. ing a book on Aboriginal justice ly no reports in Manitoba and
free, but only seven completed it included people with various back- “Every year the numbers keep issues, said that Gladue reports are Saskatchewan.
in March. grounds such as Aboriginal justice going up. The demand goes up and being produced in Nova Scotia and “Alberta has a fairly robust pro-
“There were a couple of reasons workers, justice and public safety we have more staff, so we’re able to Prince Edward Island and some in gram but is very different from
why people never finished, like the students, native court workers and serve that demand.” Quebec. ours.”
travel was a bit of a problem,” said social service workers. Rudin, who just finished writ- But he said there are effective- kfraser@postmedia.com

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VANSAI15416_1_1
CITY
ADDICTION CRISIS
FORCED COUNTRY
TO TAKE ACTION
Portugal did much more than decriminalize
drugs; it improved treatment and recovery
In the 1990s, Portugal was in the
throes of a national crisis, averag-
ing 360 drug overdose deaths a
year in a country of 10 million.
Today, it has one of Europe’s
lowest rates of drug, alcohol and
tobacco use and the number of
overdose deaths in 2016 was 26.
In a weeklong series from Por-
tugal, Vancouver Sun columnist
Daphne Bramham looks at the
lessons to be learned from the
country’s radical approach to
addiction treatment.  Portugal’s grand experiment
DA PH N E B R A M H A M
LISBON, PORTUGAL  Adelaide An-
tunes has a strong, but careworn
face that hints at tragedies that
have affected her family, her
friends and her country deeply.
There’s scarcely a Portuguese
family that survived the 1990s
without losing at least one
member to a heroin overdose.
Antunes was lucky. She lost only
friends. Her husband survived
and recovered. And because of
Portugal’s massive overhaul of its
drug laws in 2001, she was able to
rescue her younger brother.
“The whole country decided to
change because we didn’t want to
see young people taking drugs,”
Antunes, 50, explained when we
met to talk about Portugal then
and now.
Initially, her 20-year-old
brother was on methadone, an
opioid-replacement drug used
to curb cravings, and living with
her. She was responsible for
giving him his daily dose. But
methadone wasn’t enough of a
high. He stole from her as he’d
stolen from others to get enough
money to buy heroin.
Antunes went to the police
for advice. “If you love your
brother, it is better to take him
to jail. That’s what they told me,”
she said. “I remember that day.
I cried and cried. I remember
them saying, ‘If you want to see
your brother tomorrow, you have
to send him to jail.’”
But when he appeared in court,
he was given a choice between
jail or going to a therapeutic
community for two years for
treatment and recovery. He
emerged clean, sober. He’s never
relapsed, has a family of his own
and now works quietly within his
community telling young people,
including Antunes’ son, what
heroin addiction was like.
Her husband was also an addict
in the 1990s. Now 48, Jorge
Antunes tries to explain what it
was like then.
ADDICTION:
WINNING
T H E WA R
Day 1: World comes to study
Day 2: Dissuasion com-
mission aims to set users
straight
TODAY: Life today for drug
addicts in Portugal
Day 4: Outreach workers
have a long-term goal
Day 5: Harm reduction just
a piece of the puzzle
Day 6: Treatment centres
abound; so do waiting lists
Day 7: Applying the Portu-
guese model to B.C.
Like most kids, he started with
alcohol, but made the switch to
injecting heroin when he was 16
or 17.
The drug suddenly began flood-
ing into the country as Portugal
emerged from 40 years of dic-
tatorship and soldiers returned
from the colonial wars in Angola,
Mozambique, Guinea and Cape
Verde.
“I don’t know if it was a form
of rebellion,” Jorge said. “But
there was no information about
heroin and it was a new thing. I
was already working. I’d started
working early and I never left my
work. It’s where I got the money
for the heroin.
“I was very innocent, naive.
Because all my friends jumped
for that, I did as well to be ‘social,’
to belong.”
In those days, there were whole
neighbourhoods where people
lined up to buy heroin and then
shoot up in parks, regardless of
whether there were children or
others present.
Two of his close friends over-
dosed. But they didn’t stop using
and neither did he. All drugs —
other than alcohol and tobacco
— were illegal.
But Jorge said he and his
friends never worried about the
law.
He got arrested a couple of
times. Once, he told the officer
he was an addict and needed the
drug. The officer left him alone
with his heroin.
“I stopped using at some
moment of consciousness. I
said, ‘Enough is enough. I want
to live and I know this is not liv-
ing.’ I wanted to taste things …
to embrace things around me. It
was because of the simple things.
I hadn’t tasted those — not the
cinema, not dating.”
Joao Crespo, 20, is a dual citizen of Portugal and Hong Kong who moved to Portugal because of easier and cheap-
er access to drugs. Even though drugs are decriminalized for personal possession, Crespo was arrested for having
more than the legal limit of hash, and expects to be sentenced to community service. DAP HNE BR AMHAM
Jorge Antunes
That moment coincided
with the government’s policy
changes in 2001 that included a
guaranteed minimum wage, an
educational campaign, decrimi-
nalization of drugs for personal
use, and free enhanced treat-
ment and recovery options,
including outpatient community
services and long-term residen-
tial recovery communities.
Jorge, now a massage therapist,
said those changes “gave me the
tools to recover.”
It took a rising overdose death
toll and nearly a decade of often-
heated public debates before
consensus was reached on most
of the recommendations made
by the 11-member panel charged
with finding a solution to the
crisis.
Like most Portuguese citi-
zens, the Antuneses are proud
that even in the face of severe
economic constraints over
the past two decades, Portugal
has continued its support of
enhanced education, prevention,
treatment and recovery services
and that it has never wavered in
its recognition that addiction is a
T U E S D A Y, S E P T E M B E R 1 1 , 2 0 1 8
Adelaide Antunes
health matter, not a criminal one.
They’re surprised to learn that
most outsiders believe the only
thing Portugal did was decrimi-
nalize drugs for personal use.
“It’s not OK to do drugs here,”
said Jorge, noting their 30-year-
old son has never done drugs.  and ecstasy.
“The problem is that drugs
are toxic things. They have a
destructive effect. If I had been
informed, I’m sure I wouldn’t
have done drugs.”
Had Portugal only decriminal-
ized drugs and not improved
access to treatment and recovery,
Jorge said, “then, it would just
have been a party and people
would have been lost … It would
have been a mess.”
Of course, there are those who
do come for the drugs and to
party. Lisbon, in particular, is
an increasingly popular tourist
destination, especially for the
young.
On hot summer nights, large
groups of young men and women
move up and down the wide
streets of Chiado, Baixa and the
Alfama. Their drug of choice
seems to be alcohol, which is
VA N C O U V E R S U N A5
freely and widely consumed on
the streets.
But others, like João Crespo,
come for the drugs.
A dual citizen of Hong Kong
and Portugal, the 20-year-old
arrived a year ago.
He’d been told drugs were
more readily available and of a
higher quality. And Crespo also
knew that if he were caught with
them, the penalty would be much
lower than in Hong Kong, where
buying, selling or smoking mari-
juana carries a maximum penalty
of seven years in jail and a fine of
up to $1 million.
Since coming to Lisbon, he has
overdosed once on a combina-
tion of Xanax, Adderall, alcohol
He’s been arrested and charged
after police found him with 5.7
grams of hash — 0.7 grams over
the quantity legally allowed for
personal use.
He’s awaiting his sentencing.
Having chosen not to get any
treatment or pay a fine, Crespo
expects to be sentenced to some
form of community service.
Exactly what, he doesn’t know
yet.
The skateboarding musician is
certain that he doesn’t have an
addiction problem. He’s con-
vinced he’ll know when it’s time
to stop.
Although he said he prefers
Hong Kong to his adopted home
in Lisbon, Crespo said he won’t
be moving back any time soon.
“The drugs here are too good.”
dbramham@postmedia.com
Twitter: @daphnebramham
VAN01285182_1_1
CITY
HARM REDUCTION JUST ONE PART
OF PORTUGAL’S WAR ON DRUGS
DA PH N E B R A M H A M
In the 1990s, Portugal was in
the throes of a national crisis,
averaging 360 drug overdose
deaths a year in a country of
10 million. Today, it has one of
Europe’s lowest rates of drug,
alcohol and tobacco use and the
number of overdose deaths in
2016 was 26. In a weeklong series
from Portugal, Vancouver Sun
columnist Daphne Bramham
looks at the lessons to be learned
from the country’s radical ap-
proach to addiction treatment.  a piece of the puzzle
LISBON, PORTUGAL  It’s only after
being assured that there are
no police around that a wan,
skinny heroin addict emerges
from a shack that’s been cobbled
together from spare boards and
cardboard.
The shack is surrounded by
discarded drug paraphernalia,
but no needles. It’s on a dry hill-
side, below a government hous-
ing project and not too far from
the national cemetery where for
centuries Lisbon’s most powerful
citizens have been laid to rest.
The addict’s name is Jose.
He doesn’t give a last name. He
brightens at the sight of social
worker Andreia Alves and nurse
Rita Abrantes. The outreach
team is here to check on Jose and
about a dozen other addicts who
hunker here and they bring sup-
plies aimed at reducing the harms
associated with his drug use.
That includes syringes of dif-
ferent gauges — smaller ones
for users who inject in their legs
and groin, bigger ones for use on
arms, legs and neck — and pack-
ages of distilled water and citric
acid. The water and citric acid
are used to dissolve heroin.
Abrantes rips a length of alumi-
num foil off a roll and hands it
to him. Later, Jose will use it to
cook and then smoke his heroin.
The outreach workers ask him
how he’s doing. Can they help in
any way? Does he know about
the methadone van that makes
the rounds? Does he need to see
a doctor? During their conver-
sation, Jose tells them it’s his
birthday.
As evening sets in, we sing
Happy Birthday in English.
While we sing, his roommate
huddles behind the shack beside
a pile of used wrappers. He
couldn’t wait to use one of the
clean syringes to inject his drugs.
It is the saddest birthday I’ve
ever witnessed.
Earlier, the outreach team was
barely out of the van when an
older man with deep wrinkles
and no teeth approached, asking
for aluminum foil.
He told the strangers with
them that these workers were
“very good.”
“They come here every day
to help raise people up and give
them what they need,” he said,
tapping his heart before mean-
dering away.
“Sometimes we are the only
people who they talk to who
A homeless addict shoots up at the Casal Ventoso slum in Lisbon in 2000. The shantytown has since been razed,
with new social housing units built for its residents who weren’t addicts. G AE L CORN I E R/ TH E AS S OCI ATE D PRE S S
ADDICTION:
WINNING
T H E WA R
Day 1: World comes to study
Portugal’s grand experiment
Day 2: Dissuasion com-
mission aims to set users
straight
Day 3: Life today for drug
addicts in Portugal
TODAY: Outreach workers
have a long-term goal
Day 5: Harm reduction just
Day 6: Treatment centres
abound; so do waiting lists
Day 7: Applying the Portu-
guese model to B.C.
don’t use drugs or sell drugs,”
Alves said.
Although the focus of Portu-
gal’s national drug strategy is
treatment and recovery, it does
fund harm-reduction programs
including outreach teams like
this one.
Like everything else in the
strategy, the results have been
impressive. Through education
and prevention, there has been
a sharp drop in injection-drug
use. Now, there are an estimated
33,290, high-risk, opioid users,
down from an estimated 100,000
in the late 1990s.
Infection rates for HIV/AIDS
and hepatitis have also fallen.
The most recent data indicate
that HIV diagnoses related to
injection drug use dropped from
nearly 500 in 2006 to 30 in 2016.
Despite that decline, 1.35 million
syringes were distributed in 2016
through programs like this one.
As we carried on down the worn
path, Alves and Abrantes pointed
out horses grazing in the distance.
But then they quickly reminded
us to keep our heads down and
watch for used needles. At a bend,
two junkies appeared startled at
the sound of our approach.
Police come here often looking
for drugs, drug users and deal-
ers. Depending on the officer,
some make arrests and confis-
cate drugs. At the police station,
if they’re found to have only
enough for personal use, police
will write them a summons to
appear the following day at the
Commission for Dissuasion
of Drug Use, where they’ll be
offered a fast track to help.
But sometimes, they say, offi-
cers threaten them, demanding
information about their dealers in
exchange for not arresting them.
Assured by the outreach work-
ers that none of us was with the
police, one man dug two handfuls
of used syringes out of a bag and
dropped them into the bright
yellow bucket that Alves carries.
A neatly dressed man came up
the path as they talked. He was
returning from another, larger
shack down in the valley. There
Antonio, a 20-year methadone
user and former heroin user,
has fashioned what he calls a
supervised injection site. It’s
surprisingly tidy inside, despite
Social worker Andreia Alves and nurse Rita Abrantes are part of an outreach team that visits shantytowns to pro-
vide basic harm-reduction supplies to addicts and help motivate them to seek treatment. DAP HNE BR AMHAM
scrounged couches and orna-
ments including a toy — one of
Disney’s 101 Dalmatians — that
stands guard at the entrance.
Until this past summer, Por-
tugal had no official supervised
injection sites. In July, three
pilot projects were launched: two
in Lisbon and one in Porto, the
second-largest city.
Antonio regards himself as a
bit of a hero.
Antonio
“I’m not afraid of the police. I
have nothing to fear because I’m
doing things that nobody else
does. I explain to the police that
it’s better to inject here than near
a school or at a public park. And,
I’ve already sent five people to
institutions to get better.”
He picks up used needles and
when he finds toys, he sells them
to local kids for the equivalent
of a Canadian quarter. It helps
supplement the $640 he receives
each month in social assistance.
At 64, Antonio said he’s lost
too many friends — most of
W E D N E S D A Y, S E P T E M B E R 1 2 , 2 0 1 8
them during the heroin overdose
epidemic in the 1990s. It scared
him clean.
“I hate heroin. Even the smell
of it makes me puke,” he said.
For Antonio, clean means get-
ting a daily dose of methadone.
He can’t get it from a clinic and
bring it home because doctors
fear that he’ll sell it in this shan-
tytown. Instead, Antonio goes
every day to the mobile dispens-
ing van that cruises the neigh-
bourhood on a regular schedule.
“One more year, I’m going to
stay on it,” he said.
Although Alves and Abrantes
offer to get people into detox,
treatment and recovery, they
admit that long waiting times
often keep users from getting
into residential care. In 2016,
there were 27,834 people in
treatment with 2,090 of them
first-time entrants.
“If you want to pay, you could
go tomorrow,” said Alves. “Every-
body who doesn’t pay waits two
or more months. But you can go
to the central treatment centre
in the meantime. There is also a
shelter where they have activities
and you can stay there and have
professional help. And, you can
go to the methadone program.”
If users ask for help and pro-
vide their names and ages, the
team makes the connections to
the services the next day and will
even drive the users to where
they need to be.
“In the past, there were a lot
of tents here. But that’s changed
since they (the government)
started to provide methadone
and to create shelters where
people can go inside even if they
use drugs outside,” Alves said.
Before 2001, when drug use
was decriminalized, the shelters
were only for people who weren’t
users.
At the outreach workers’ first
stop of the night, we met only six
men. Women — other than the
outreach workers — don’t come
here.
Less than 20 years ago, Lisbon
was known as the junkie capital
of the world because it was home
to the largest illicit drug market
in Europe.
In the city’s Casal Ventoso, a
shantytown that attracted up to
5,000 people a day, even grand-
mothers sold heroin. Portugal’s
national drug policy co-ordina-
tor, Joao Goulao, recalls seeing
one elderly woman handing
VA N C O U V E R S U N A7
heroin to addicts out her window
along with bowls of chicken soup.
One in every 10,000 Portuguese
used heroin and overdose deaths
were deemed to be of epidemic
proportion, with 360 dying from
overdoses annually.
The drug crisis had its roots
in war. Just as American sol-
diers came home from Vietnam
addicted, so did Portuguese
soldiers who had been fighting
colonial wars in Angola, Guinea-
Bissau and Mozambique.
Goulao, a family physician,
led an 11-person committee that
convinced the government that
radical change was needed.
“There were many differences
of opinion,” Goulao said. “But
our main guidance was humanis-
tic and respect for the dignity of
people using drugs.”
Since almost every family
had personal experience with
addiction, citizens needed little
convincing that addiction was an
illness and that addicts needed
help, not jail.
Casal Ventoso was bulldozed.
Nearby, the government built
social housing units in apartment
towers for the shantytown’s resi-
dents who weren’t addicts.
Cres Car, the non-profit orga-
nization that Alves and Abrantes
work for, is on the ground floor
of one of them, providing a wide
range of services that include
counselling for addictions and
family problems, help with find-
ing employment and housing,
and specialty services to those
sleeping rough.
Cres Car used to have a needle-
exchange program, but residents
complained when addicts were
shooting up in the underground
parking lot half a block away. So
it no longer hands out needles
and syringes from its office.
As a steady stream of people
came and went, a little girl rode
by on a pink bike. A couple of
little boys ran shouting along the
concrete that separates one high-
rise from another, delighting in
the sound of their voice echoing
in the concrete cavern.
A few doors down from Cres
Car, mothers with babies in arms
drank espresso and exchanged
gossip at the two cafes.
And above it all? Grandmoth-
ers looked down from their win-
dows — the informal enforcers of
public order.
dbramham@postmedia.com
twitter.com/daphnebramham
A8 T H U R S D A Y, S E P T E M B E R 1 3 , 2 0 1 8
HARM-REDUCTION PROGRAM
PROMOTES PATH TO RECOVERY
DA PH N E B R A M H A M
In the 1990s, Portugal was in the
throes of a national crisis, averag-
ing 360 drug overdose deaths a year
in a country of 10 million. Today,
it has one of Europe’s lowest rates
of drug, alcohol and tobacco use,
and the number of overdose deaths
in 2016 was 26. In a weeklong
series from Portugal, Vancouver
Sun columnist Daphne Bramham
looks at the lessons to be learned
from the country’s radical ap-
proach to addiction treatment.  a piece of the puzzle
LISBON, PORTUGAL  Fado is this
country’s two-centuries-old mu-
sical genre that’s characterized
by a deep melancholy, longing
and resignation to one’s fate.
Getting it right requires
plumbing the depths of one’s soul
to produce the right sounds, the
right passion. For guitar player
Francisco, heroin and other
drugs helped him get there.
“It’s a dangerous life because
all of the music is an expression
of the feelings and sensitivities,
so there is a propensity to use
drugs,” he said. “The drugs made
me have more sensitivity. They
help me with my music. In so
much feeling, it helps me to play
and expand what I play … like
Jim Morrison and others.
“I experimented because I
wanted to see with my eyes or to
get into a mental situation that
would give me some news about
feelings that I don’t know. Most
musicians die with drugs, not like
marginalized people, but because
they are trying to conciliate these
feelings into their work.”
Now 55, Francisco said that
GAT’s In-Mouraria office saved
his life. GAT is a non-profit orga-
nization set up to provide harm-
reduction programs to users like
him. Its graffiti-decorated office
is near the heart of Mouraria,
Lisbon’s medieval quarter of nar-
row, cobbled streets lined with
houses that were once home to
sailors and miscreants, the place
where Fado is believed to have
been born.
GAT does the usual harm-
reduction stuff — providing
needle exchange, free hash pipes,
distilled water and citric acid
for dissolving heroin, condoms
and testing for HIV/AIDS and
hepatitis.
But, unlike in Canada, harm
reduction here includes much
more. It provides a pathway
to substance abuse treatment,
either as an outpatient or in a
At the In-Mouraria harm-reduction centre, needles, hash pipes, condoms
and other supplies are handed out to reduce risks of drug use.  there is no reason why it should
VA N C O U V E R S U N CITY
ADDICTION:
WINNING
T H E WA R
Day 1: World comes to study
Portugal’s grand experiment
Day 2: Dissuasion com-
mission aims to set users
straight
Day 3: Life today for drug
addicts in Portugal
Day 4: Outreach workers
have a long-term goal
TODAY: Harm reduction just
Day 6: Treatment centres
abound; so do waiting lists
Day 7: Applying the Portu-
guese model to B.C.
residential recovery program,
and to help with other needs as
well.
Francisco came here looking
for legal help, which the staff
helped him get.
His father had died, throwing
him into depression that deep-
ened as his estranged siblings
tried to claim the house that
Francisco had lived in all his
life. His drug use escalated in
an attempt to salve his pain and
grief.
As he talked about his father’s
death, Francisco wept.
“Heroin is a drug that is so
nice that it’s dangerous,” he said.
“One day you wake up and the
drug controls you. The first thing
you want to do is go and inject.
… Every day, when I wake up, I
think I have come to the jungle
(with the danger always lurking) Francisco is a former heroin user who accessed legal services at a harm-reduction and treatment centre, which
even when I go to the cafe I have led to him accessing more of the centre’s services to stop using heroin.  P HOT OS: DAP HNE BR AMHAM
a little fear (of relapsing).”
With legal help, Francisco But he got much more than Despite those successes,
eventually got sole title to the legal help from GAT. His hepati- Curado is critical of Portugal’s
house. It means that he has some tis C has been cured. By coming drug policies.
stability in his life though he here, Francisco said his drug use “Portugal is still under a
still uses drugs, is unemployed has been reduced to smoking prohibitionist paradigm. Drugs
and lives on €180 a month from hash occasionally and having the aren’t legal and people are still
social assistance bolstered by odd drink. penalized,” she said, noting that
what he makes busking and play- “Coming here creates a kind the police still collect people off
ing the odd gig. of competition to get better,” he the streets and give tickets that
said. require them to go to the Com-
Adriana Curado is GAT’s proj- mission for the Dissuasion of
ect co-ordinator, with a doctor- Adriana Curado Drug Addiction.
Heroin is ate in clinical psychology. Although the commission is
“Harm reduction is about tak- not be available when needed.” supposed to be a fast track to
a drug that is ing care of people regardless of Naloxone is an antidote to an services for those who are willing
so nice that whether they are using drugs or opioid overdose and has proven to accept help, Curado said, “The
not,” she said. important during Canada’s commission penalizes people
it’s dangerous. The cramped office is filled epidemic of deaths from illicit and I don’t agree with that. …
One day you with comfortable sofas. There fentanyl. Increased availability It’s not my role or our role to tell
are books that can be borrowed is something that Portugal’s drug people to stop using drugs.”
wake up and and half a dozen loaves of bread policy director Joao Goulao said What she and her organization
the drug on a shelf. The needles, condoms is under consideration. But both want is full legalization of all
and hash pipes are kept in a he and Curado noted that Portu- drugs, a regulated and legal drug
controls you. locked, glass counter. gal’s overdose death rate is low market.
Eighty per cent of those who — 40 in 2016 — and that fentanyl Of course, she added, “One
come here are men over 40 “with has yet to hit this country. country can’t go it alone.”
long careers in drugs” and little Unlike Canada, where harm At GAT, the word addict isn’t
education, Curado said. Most are reduction has been front and used. “It stigmatizes people,”
unemployed or have no formal centre of its drug policies, Portu- Curado said.
job history. gal has put few resources in harm Francisco disagrees.
“We’re working in a context of reduction, instead choosing to He has no problem describing
poverty,” she said, which is why focus on prevention, education, himself as a former addict. It’s a
GAT is lobbying hard for super- treatment and recovery. It has strong word, he said. And strong
vised injection sites for those resulted in a steep reduction words are the only ones that
who have nowhere else to use in injection drug use with the provoke action.
drugs and more availability of number of high-risk opioid users He also doesn’t think super-
naloxone to reverse the effects of now estimated at 33,290, down vised injection sites are a good
opioid overdoses. from an estimated 100,000 in the idea.
Curado admitted there is a late 1990s. “I can understand drugs, but
naloxone kit on site even though An estimated 1.35 million I can’t accept them,” he said.
GAT isn’t supposed to allow syringes a year are distributed “Doing drugs is an illusion
drugs to be injected here. by outreach teams and organiza- because it is a weight on your
“We have it because we are tion’s like Curado’s, and the most soul.
doing civil disobedience,” she recent data indicate that HIV “Don’t use drugs. Don’t drink
said. “We need to have it because diagnoses attributed to injection and you’ll sleep very nice.”
it is a life-saving medication and drug use has dropped to 30 in dbramham@postmedia.com
2016 from nearly 500 in 2006. Twitter: @daphnebramham
Personal loans for life’s
twists and turns.
Borrow up to $35,0001 with MogoMoney.
C H E C K YO U R R AT E : mogo.ca/money
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VANSAI12608_1_1
A8 F R I D A Y, S E P T E M B E R 1 4 , 2 0 1 8
Quinta das Lapas is the former manor home of a marquis. Today, it houses one of 63 therapeutic communities dedicated to the treatment of substance abuse.  P HOT OS: DAP HNE BR AMHAM
PORTUGAL’S ADDICTION TREATMENTS
RANGE FROM SPA-LIKE TO SPARTAN
DA PH N E B R A M H A M
In the 1990s, Portugal was in
the throes of a national crisis,
averaging 360 drug overdose
deaths a year in a country of
10 million. Today, it has one of
Europe’s lowest rates of drug,
alcohol and tobacco use and the
number of overdose deaths in 2016
was 26. In a weeklong series from
Portugal, Vancouver Sun col-
umnist Daphne Bramham looks
at the lessons to be learned from
the country’s radical approach to
addiction treatment.
MONTE REDONDO, PORTUGAL  The
moat is long gone and so is the
family of the 1st Marquis of Ale-
grete, who built Quinta das Lapas
more than two centuries ago.
Today, the manor’s residents are
recovering substance users. They
live in dorm-style rooms built
behind the main house. But they
have full access to the expansive
gardens, carpentry shop, art room
and, of course, counselling rooms.
Less than an hour outside of
Lisbon, it’s in a picturesque vil-
lage with both old-fashioned and
modern windmills towering over
the winding streets.
“I felt loved here,” said 63-year-
old Jorge Faustino. He’d only
recently completed six months
here at the Quinta das Lapas com-
munity when we spoke, and was
in the third and final stage of his
treatment: re-integration into the
community by working at a restau-
rant job that the staff had helped
him find.
Faustino had been a heroin ad-
dict in the 1990s, recovered, and
then relapsed after 20 years of ab-
stinence. He’d been walking by the
place where he used to use drugs
and thought he’d try it just one
more time.
“It was a bad idea. It was very
hard on me. I had a very violent
reaction,” he said.
Faustino left Quinta das Lapas
after two months in treatment. But
almost immediately, he regretted
it and was allowed to return.
Quinta das Lapas is one of Por-
tugal’s 63 therapeutic communi-
ties — 60 of which are operated by
VA N C O U V E R S U N CITY
ADDICTION:
WINNING
T H E WA R
Day 1: World comes to study
Portugal’s grand experiment
Day 2: Dissuasion com-
mission aims to set users
straight
Day 3: Life today for drug
addicts in Portugal
Day 4: Outreach workers
have a long-term goal
TODAY: Harm reduction just
a piece of the puzzle
Day 6: Treatment centres
abound; so do waiting lists
Day 7: Applying the Portu-
guese model to B.C.
non-profit organizations and three
by government. The goal of the
communities is to treat residents’
addictions and provide them with
the tools they need to avoid re-
lapsing into drug or alcohol use.
This includes building a network
of social supports, employment
training and skills development.
For some, the stay can be as little
as a few months. Others may re-
main in the community for up to
three years
The privately paying patients
here, including foreigners like a
young Portuguese-American who
we met during our visit, pay 3,000
euros or about $4,600 a month.
Those referred here by the Com-
mission for the Dissuasion of Drug
Addiction or by their family doc-
tors pay less. The government
picks up 80 per cent of the tab —
720 euros or about $1,100 — and
the residents or their families
provide the remaining 20 per cent.
But if the families can’t pay or if Pavilion 21B at a former psychiatric hospital is now the Taipas Centre, one of Lisbon’s two out-patient drug treat-
the clients are on social assistance, ment and recovery centres.
their costs are fully covered by the
government. had access then because the treat- the waiting time has increased to lapse, she said, they no longer have
When we visited, eight of the ment wasn’t government funded. up to four months, and during that to worry they might end up in jail.
40 beds were empty even though Now more people have access to time a lot of people lose their mo- About 45 minutes west of Lisbon,
there are 15 people waiting to have therapeutic communities, but they tivation.” another therapeutic community
their applications processed. It have to go through the process of But the legal changes had posi- called Farol (meaning Lighthouse)
didn’t used to be like this, said Rui either having the treatment rec- tive effects as well, according to is tucked into the mountainside in
Martins, the centre’s communica- ommended by addictions special- Dr. Rosalie Francisco, the com- a tony neighbourhood of Sintra, a
tions director. Before the govern- ists at regional treatment centres munity’s technical director. popular tourist destination be-
ment passed laws in 2001 aimed at or by the commission. Those rec- With decriminalization of drugs cause of its beaches, two castles
making it easier to get treatment, ommendations take time. for personal use, people are more and a Moorish fortress that tow-
there were fewer steps and less pa- “Before, people might be waiting likely to admit their substance ers over the valley.
perwork. Of course, not everyone three weeks,” Martins said. “Now abuse and seek help. If they re- C O N T I N U E S O N N E X T PAG E
CITY
The long walkway from the
parking lot to the former college
is shaded with mature trees. Farol
is a collection of classrooms con-
verted into dorms and therapy
rooms. As we walk to the office,
we can hear the shouts of resi-
dents playing volleyball. Like
most people in recovery, 70 per
cent of the residents here are men
ages 28 to 35.
The government handed the
buildings over to the Associacao
para o Tratamento das Toxicode-
pendencias in 1995, and since
then close to 2,000 people have
been treated here.
Despite the promise of fast
pathways to treatment, everyone
who winds up here has had to wait.
The waiting list for the 27 beds is
at least a month.
“It’s not quick to get in,” Farol’s
director, Assuncao Cruz, said.
“It’s never less than a month or a
month and a half on the waiting
list. They can go to a treatment
centre for support once a week
while they wait. But we do lose
many patients during those wait-
ing times.
“Recovery for us is abstinence
and giving the client a different
kind of life with the internal and
external reserves to have a family
and a job. That’s the most impor-
tant thing: To give them the self-
esteem that they’ve lost.”
Ze Dias da Cunha, a 62-year-old
former heroin addict, has been
on the association’s board since
it began more than a decade ago.
He had to go to London for treat-
ment 33 years ago, and when he
returned in 1985 Dias started Por-
tugal’s first Narcotics Anonymous
chapter.
“There are two issues with
treatment in Portugal that I
would change,” he said. “The state
has beds and pays a certain fee per
month for treatment. The prob-
lem is that for 12-step treatment,
the program is very condensed.
People only get supported for
three months, while some other
therapeutic communities that
don’t use 12-step are funded for
a year.”
The second issue is that Dias
believes the government ought
to be spending money research-
ing what kinds of treatment are
the most effective.
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The problem is
that for a 12-
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very condensed.
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supported for
three months ...
ZE DIAS DE CUNHA
beautiful therapeutic commu-
nities like Farol and Quinta das
Lapas, it is a bit like winning the
lottery, which is fitting since they
are the most acutely addicted, in
need of the most intensive and
tender care.
The reality is that most sub-
stance users — whether in Portu-
gal, Canada or any other country
— end up being treated as out-
patients, with some studies sug-
gesting that the results are at least
as good as those for in-patients.
In Lisbon, being an outpatient
means going to the rather grim
Pavilion 21B at the city’s former
psychiatric hospital. Built during
the Second World War, the pink-
stuccoed building has peeling,
white-painted trim. Inside what’s
now called the Taipas Centre,
people wait for appointments in
a dimly lit rotunda with too few
chairs.
They brighten with the arrival
of the irrepressible Miguel Vas-
concelos, a psychiatrist and the
centre’s director.
Ninety five per cent of the pa-
tients are here because they
called the well-publicized phone
number for addictions help, and
some may well be referred for in-
patient treatment.
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Recovery for us
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to give them the
self-esteem that
they’ve lost.
AS SUNCAO CRUZ
by the Commission for the Dis-
suasion of Drug Addiction.
There is no waiting list. During
their first appointment, patients
are asked to talk about their situ-
ation, then informed about the
services the centre has to offer
and the rules of treatment.
Some require immediate treat-
ment and there are six detox beds.
There used to be 15, but when the
financial crisis hit in 2008, nurses
and other staff were transferred
to other institutions because of
budget cuts.
The same thing happened at
Lisbon’s other institution that
deals with alcoholics. Its detox
beds were cut to 16 from 30.
It means that 90 per cent of peo-
ple who are voluntarily going into
withdrawal will do so at home.
Within a week of the first visit,
Vasconcelos and his team of psy-
chiatrists, psychologists, social
workers, nurses and physiother-
apists come up with a treatment
plan.
It’s presented to the patient at
a team meeting, and it might in-
clude methadone therapy, inten-
sive counselling, even laughing
yoga, dancing or art classes.
Those classes are given on the
somewhat cheerier second floor
of the building, where artwork
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It was a bad
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brightens the walls. But there
are still many reminders that
this is an institution, not least of
which the windows in bathroom
doors that allow staff to check to
see if patients are taking drugs or,
worse, have overdosed.
“Treatment is a tailored pro-
gram,” he said. “Sometimes part
of the healing is to reintegrate to
jobs and to school, so it can’t be
done as an in-patient. … But I am
not God. I don’t foresee what will
happen to my patients. I can only
give them my best advice.”
And his best advice is always
aimed at motivating patients to
eventually get entirely off drugs.
“The treatment program here
is directed toward abstinence
and maintaining the rules in the
process of healing,” he said. “But
I will try to ensure prevention of
HIV.”
Among the rules to which pa-
tients must agree when they com-
mit to the plan is that they cannot
be on drugs when they come to ap-
pointments.
The only exception is metha-
done, an opioid replacement. But
it’s considered a short-term ther-
apy needed to get the patient to
the next stage of recovery, which
is abstinence.
Of course, some don’t agree to
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the plan set out for them, prefer-
ring to continue using methadone
or illicit drugs, said Vasconcelos.
“I don’t believe in forced treat-
ment,” he said. “It’s unthinkable
to tell a patient what to do. Noth-
ing is mandatory unless the pa-
tient puts himself at risk or puts
someone else at risk.”
Those who refuse treatment are
told how to get free methadone
from a mobile clinic, and that free
needles, hash pipes and condoms
are available from local organiza-
tions whose mandate is harm re-
duction, not treatment.
“Harm reduction is an attitude
based on the idea that I should
accept whatever someone else
does,” Vasconcelos said.
That’s something the psychia-
trist firmly rejects.
Even before the new law de-
criminalizing drugs for personal
use, he said that medical profes-
sionals here agreed that drug us-
ers weren’t criminals. Now, with
the national guidelines, that’s en-
shrined in law.
Still, despite all the laws, rules
and regulations and even though
this is a small country, Vasconce-
los said there are regional differ-
ences in the types of treatment
and the ways it’s delivered.
“Every region thinks it’s best. So
we have the risk of disaggregating
the national plan.”
If regional differences and dis-
agreements threaten a national
addictions treatment system in
Portugal — a country with a tenth
of the land mass of British Colum-
bia, albeit double the population
— it’s certainly worth considering
the challenges if Canada were to
embark on a national plan.
But it doesn’t mean that Canada
shouldn’t have a national addic-
tions strategy.
We’re used to different inter-
pretations of the Canada Health
Act across 10 provinces and three
territories that stretch over a land
mass that is 100 times larger than
Portugal with more than triple the
population.
Far from viewing regional dif-
ferences as an assault on a na-
tional plan, it could mean that
Canadians’ needs are better met
by programs and services tailored
to their diverse needs.
dbramham@postmedia.com
Twitter: @daphnebramham
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CANADA SHOULD LEARN FROM, BUT

NOT COPY, PORTUGAL’S DRUG POLICY
DA PH N E B R A M H A M

In the 1990s Portugal was in the

throes of a national crisis, averag-
ing 360 drug overdose deaths a
year in a country of 10 million.
Today, it has one of Europe’s
lowest rates of drug, alcohol and
tobacco use and the number of
overdose deaths in 2016 was 26.
In a weeklong series from Por-
tugal, Vancouver Sun columnist
Daphne Bramham looks at the
lessons to be learned from the
country’s radical approach to
addiction treatment.

LISBON, PORTUGAL  It’s irrefutable

that Portugal’s radical departure
from conventional wisdom on
how to deal with drug addictions
and an overdose crisis has been
an overwhelming success.
Among the telling statistics is
that Portugal has an overdose
death rate barely a quarter of the
European average. HIV/AIDS
and hepatitis infection rates are
among the lowest in Europe. So
is drug use in every demographic
group.
The other statistics are eco-
nomic. Indirect health costs
related to addictions and over-
dose deaths dropped 12 per cent
in only five years. Over a decade,
the reduction in social costs —
direct and indirect spending on
health care, legal costs including
prosecuting and incarcerating
drug users plus the costs of lost
production and lost income
because of incarceration — have
been estimated at 18 per cent.
A recent report by the B.C. Cen-
tre on Substance Use urged Brit-
ish Columbia to consider Portu-
gal’s robust recovery-oriented
model, which offers universally
accessible, comprehensive and
co-ordinated treatment for drug
users. Four working groups are
developing recommendations for
the B.C. government.
A year ago, Canada’s justice
minister, Jody Wilson-Raybould,
was in Lisbon to take a look,
along with Jane Philpott, who
was then federal health minister.
Since 2001, the Portuguese
government has been taking
measures to treat illicit drug use
as a health problem, not a crimi-
nal one.
A first step was to make all
addiction treatments free, while
ramping up spending on treat-
ment and recovery facilities and
networking those services to
make it as easy as possible for
people to tap into those services.
Part of designing a treatment-
oriented system was decriminal-
izing possession of illicit drugs
for personal use. Anyone found
with quantities of drugs that fall
under the limits set for personal
possession is required to attend
counselling aimed at educating
and discouraging use. Anyone
repeatedly found with drugs
who refuses treatment faces an
escalating series of sanctions,
including confiscation of prop-
erty, to pay fines.
But it bears emphasizing that
possessing drugs other than
alcohol and tobacco is illegal.
Anyone caught with more than
the limit for personal possession
goes through the criminal justice
system. While some can be
diverted from jail to treatment,
others are prosecuted as dealers
and traffickers and are subject to
penalties ranging from one year
to 14 years in jail.
One tangible benefit of these
combined policies is that it has
cleaned up the streets. There
are no longer open drug markets
and, no longer, open drug use.
Portugal has plenty of lessons
for Canada. To start, Canada
doesn’t have free, universal
access to addiction treatment.
While there may be lots of ser-
vices in Canada, users and their
families often can’t afford them
or they can’t find them.
Not only is there no linked
network of services available in
B.C., there isn’t even a central
list of what services are available
ADDICTION:
WINNING
T H E WA R
Day 1: World comes to study
Portugal’s grand experiment.
Day 2: Dissuasion com-
mission aims to set users
straight.
Day 3: Life today for drug
addicts in Portugal.
Day 4: Outreach workers
have a long-term goal.
Day 5: Harm reduction just a
piece of the puzzle.
Day 6: Treatment centres
abound; so do waiting lists.
TODAY: Applying the Portu-
guese model to B.C.
where. In B.C., it’s balkanized by
health region. People are limited
to the services available in their
region and some regions have
more services than others.
It’s further complicated by the
multitude of non-governmental
service providers who are under
contract to heath regions.
Among the other unique
challenges Canada faces are:
the widespread availability of
fentanyl, a deadly scourge that
has yet to strike Portugal; the
over-representation of First
Nations people with addictions,
a legacy of the residential school
system, and; the potential reper-
cussions of this fall’s legalization
of cannabis, which is the No. 3
drug of choice listed by recover-
ing addicts in Canada.
Cannabis use is 90 per cent of
the reason that people are sent to
Portugal’s Commission for Dis-
suasion of Drug Addiction and
from there into treatment.
Using a long lens, what’s most
striking about the Portuguese
model is the cohesiveness of the
society’s beliefs about addiction
and how that translates into
Lisbon is a colourful and graffiti-rich city. But what’s not tolerated on the streets is open drug use, even though
in 2001, the Portuguese government overhauled drug laws, decriminalizing personal possession. It also increased
spending on education, prevention and treatment. DAP HNE BR AMHAM
policy. Those beliefs include
the concepts that addiction is
an illness and that addicts are
citizens with a chronic, relaps-
ing disease who need help to
make the best decisions about
their own health. They are not
regarded as lost causes who are
going to keep using and need
to be kept as safe as possible in
their addiction.
It would be impossible in Por-
tugal for someone to overdose
several times in the same week
or even the same day, as happens
in Vancouver at the epicentre of
Canada’s opioid overdose crisis.  Let’s start with universal access
In Portugal, such a person
would be taken to hospital and
put under psychiatric care.
Children under 18 who refuse
treatment also can be taken into
care in Portugal, either with
their parents’ consent or under
child protection legislation. Care
might include a stay in a psychi-
atric hospital for assessment,
followed by long-term care in a
therapeutic community.
“Our first goal is to help people
to resume their dignity,” said
João Goulão, the architect of
Portugal’s drug policy.
“An addict has to do whatever
to get his fix each day, I cannot
ask him or her to behave as a free
citizen.”
But given help, he said, they
can regain that freedom and also
resume their lives as full citizens.
Having survived their own
overdose crisis in the 1990s,
tight-knit communities in Portu-
gal no longer tolerate the kind of
open drug use and sales that have
been normalized in Vancouver.
Maybe it’s because virtually
every family was touched by that
crisis two decades ago. Maybe it’s
because their much older cities
and villages have such narrow
streets that people’s laundry —
both clean and dirty — is in full
view of their neighbours.
But the result is zero tolerance
for drugs.
There are no city-licensed pot
shops in Lisbon as there are in
Vancouver. There is nothing like
Vancouver’s Downtown Eastside
with its open shooting galleries,
pop-up consumption sites, sanc-
tioned street market for mostly
stolen goods and a lowered
speed limit to protect users who
stumble into driving lanes.
If someone,
a tourist or
a migrant, is in
need of help, he
has exactly the
same access to
the responses
as nationals.
JOÃO GOULÃO
When ordinary people in Lis-
bon were asked what they would
do if they saw someone injecting
heroin — a routine occurrence in
parts of Vancouver — there were
two responses. Some said they’d
approach the user and suggest
they seek treatment. Others said
they’d call police, who they trust
to be a conduit to getting a user
help.
This is the case whether the
user is a citizen or a foreigner.
“We are quite a poor country.
But if someone, a tourist or a
migrant, is in need of help, he has
exactly the same access to the
responses as nationals,” Goulão
said, adding with a rueful laugh,
“That’s why we are poor.”
Universal access to treatment
is what Goulão said Portuguese
citizens are most proud of.
But what works in Portugal
is not a template for Canada.
There are too many differences
between our countries, their cul-
tures and political systems.
That doesn’t mean that there
aren’t things Canada can learn
from Portugal.
to treatment for our citizens,
especially since we are in the
third year of a public health
emergency.
Let’s use the enabling powers
under the Public Health Act to
collect data from private treat-
ment and recovery facilities to
augment information gathered
through publicly funded services
so that we have a complete pic-
ture of what treatment is avail-
able and what works best.
The emergency powers pro-
vided by the act could also be
used by medical health officers to
order the most acutely addict-
ed, who are repeatedly being
resuscitated, into secured care
for their own safety. Naloxone is
never going to be enough until
someone deals with the root of
their problems.
What may be the most impor-
tant lesson, however, is also the
most basic.
Portugal’s system works
because it has widespread sup-
port across political and eco-
nomic lines. Through years of
discussions and conversations at
every level, Portuguese citizens
forged both a comprehensive
national drug plan and a univer-
sal addictions treatment sys-
tem that is tailor-made to their
unique needs.
dbramham@postmedia.com
Twitter: @daphnebramham