S. Monty Ghosh is an addiction physician and researcher, and an assistant professor at the University of Alberta and the University of Calgary.
With conservative values at the helm of Alberta’s drug policy, it came as a surprise when the United Conservative Party announced they would be exploring the Portugal model of drug decriminalization.
When the NDP-led British Columbia government decriminalized personal possession of all substances in January, there was no anticipation that Alberta would follow suit. Yet, to those who evaluate drug policy, the Alberta approach to decriminalization, while progressive, is still reflective of a conservative core.
Decriminalization is an evidence-based policy to reduce the harms associated with the criminalization of substance use. These harms include stigma, criminal records, high-risk drug consumption patterns and transmission of blood-borne diseases. It moves away from addressing substance use with punishment and places it in the realm of health by promoting access to education, general wellness support, harm reduction and treatment services.
Alberta and B.C. have taken very different approaches to decriminalization. B.C. has chosen full decriminalization by obtaining a federally authorized exemption where individuals who possess less than two grams of illicit substances face no legal or criminal penalties and repercussions. This approach is premised on individual autonomy – in this case, the autonomy to carry small amounts of illicit substances and, by implication, to consume those substances or choose if and when to stop doing so.
In contrast, Alberta says it will pursue a form of decriminalization founded on what is known as the “Portugal model.” Portugal sends individuals caught with a limited quantity of any illicit substance to a dissuasion committee. The committee is made up of representatives from health, justice and social services, who evaluate the individual and perform a needs assessment. The case may then be dismissed or referred to health and/or social services as needed for added support. A fine may or may not be levied against the individual.
This model has forced an intricate co-ordination of multidisciplinary teams working on social issues such as employment and welfare, physical and mental health, law enforcement, and education. It is grounded on accountability rather than autonomy.
Criminal accountability, at its essence, is a conservative value. Adopting the Portugal model retains focus on accountability but pivots the means of pursuit from criminal justice to the health system. This is the right move.
With 20 years of experience to back it up, the Portugal model is a compelling one. Since the conservative Portuguese Social Democrat Party implemented the model in 2000, Portugal has a quarter of the drug poisoning rates compared to neighbouring countries. The prevalence of new HIV cases amongst substance users decreased from 518 in 2000 to only 13 in 2019.
Portugal now has some of the lowest rates of substance use for young adults between the ages of 15 to 34. Another conservative value, cost savings, demonstrated that the social costs of drug use, such as costs associated with crime, welfare use and social services, dropped 18 per cent in the first 11 years of the implementation of the program. The program also incentivizes Portuguese companies to hire individuals who exit treatment and recovery-oriented programs.
The Portugal model provides each person within the system with an evaluation from a substance use and social service standpoint and proactively provides support where needed. Others, such as the Oregon model, have pushed for accountability through fines and other penalties. These have had mixed outcomes, lacking the backbone of health and wellness support for individuals using substances.
There are, however, limitations to the Portugal model. For many years the Portugal model placed less emphasis on harm reduction than it perhaps should have – instead focusing on expanding treatment services and beds. This has changed over the last few years, with large numbers of referrals going to harm reduction agencies and supervised consumption sites.
It has also been criticized for penalizing individuals within the dissuasion committee system with non-criminal sanctions. For example, individuals are sometimes barred from leaving the country while subject to committee; others have lost social subsidies or allowances from public agencies; yet others have been barred from visiting certain places or associating with specific people. These can significantly limit autonomy and personal rights and freedoms.
The Alberta government, like Portugal in earlier years of its program, has focused on treatment and recovery options. It would do well to avoid Portugal’s misstep by continuing the province’s current efforts to expand harm reduction services and increase funding to harm reduction programs on top of recovery services and therapeutic communities. It would also be wise to ensure a uniform approach to treatment across all government agencies to avoid unintended outcomes for treatment by non-health government groups.
A line Portugal has not crossed is mandated or involuntary treatment. While Alberta is exploring options for mandatory treatment, Portugal has demonstrated positive outcomes without needing such aggressive measures.
There are still some unknowns that could impact the effectiveness of this model in Alberta. There is no information on personal possession thresholds before criminal prosecution. A low criminal exemption threshold may mean more people are caught in criminal justice rather than the health system.
We don’t know whether the government plans to seek the federal co-operation necessary to remove personal substance possession from the realm of the criminal law. We do not know if they will formally mandate no-arrest orders with local police services, which has been passively done for years.
Many conservative Albertans may believe that decriminalization does not reflect conservative values, but this view, respectfully, ignores longstanding core tenets of conservatism. Decriminalization espouses core conservative values of accountability and cost saving. Conservatism should not be a bar to decriminalization. After all, it wasn’t in Portugal.
Addiction and its many consequences are not going to disappear. Regardless of whether Alberta pursues decriminalization, people will consume illicit drugs and many will suffer consequences from it. The Alberta government is wise to recognize the problem and seek to treat it especially from the lessons learned from other models pursued across the world.
Are Albertans ready for decriminalization? Yes. Now more than ever. Lives depend on it.