Portugal’s Health Response to Addiction Offers Hope, Policy Considerations for Oregon


On the third anniversary of Measure 110’s passage, Oregon stakeholders visited Portugal to learn how the country built out its healthcare response to addiction more than 20 years ago – and what lessons can be applied to Oregon.

Contact: Devon Downeysmith

PORTLAND, OR – A 25-person delegation of Oregon stakeholders returned from Portugal this weekend, where they spent time with Portuguese addiction recovery providers, law enforcement, and policymakers to learn how the country built out a comprehensive healthcare response to the country’s addiction crisis. During their week in Portugal Oregon delegation members met with: 

  • Dr. João Goulão, chief architect of Portugal’s drug decriminalization program and General-Directorate for SICAD, the country’s Service for the Intervention on Addictive Behaviors and Dependencies;
  • Dr. Miguel Vasconcelos, psychiatrist and head of Taipas, one of Lisbon’s two publicly funded outpatient treatment centers;
  • Employees of Portugal’s Mobile Low Threshold Methadone Program, which provides Medication Assisted Treatment to 1,300 residents daily at the one location alone that the delegation visited;
  • Staff from local non-profit organizations that provide support services to people struggling with addictions, from harm reduction to social reintegration services and more;
  • Members of Portugal’s Commission for the Dissuasion of Drug Addiction, the administrative body charged with enforcing Portugal’s decriminalization law. They work to dissuade drug consumption, and promote health and accountability among people who use drugs; 
  • Law Enforcement from the Public Security Police, the national civil police force of Portugal; and
  • Alexandre Quintanilha, member of Portuguese Parliament and an author of Portugal’s comprehensive National Strategy for the Fight Against Drugs, the report that formed the basis for Portugal’s drug decriminalization program more than two decades ago. The report took a pragmatic and health-centered approach, decriminalizing drug possession but not supply and providing policy guidance around drug addiction prevention, treatment, harm reduction and social reintegration. 

“This trip was incredibly valuable and provided helpful lessons on how we can improve Oregon’s approach to substance use disorder,” said Tera Hurst, Executive Director of the Health Justice Recovery Alliance, the advocacy organization that organized and sponsored the educational trip. “We learned about Portugal’s patient-first approach and discovered that much of their work is relevant to what is happening here in Oregon. We saw firsthand what a health approach to substance use looks like after more than 20 years of implementation.”

The Oregon delegation was the largest group of its kind that Portuguese officials had ever received. Trip participants included: 

  • Rep. Rob Nosse
  • Rep. Lily Morgan
  • Sen. Floyd Prozanski
  • Senate Majority Leader Kate Lieber
  • Sgt. Aaron Schmautz, Portland Police Association (PPA)
  • Detective Scotty Nowning, Salem Police Employee’s Union (SPEU) 
  • Kimberly McCullough, Oregon Department of Justice (DOJ)
  • Channa Newell, Multnomah County District Attorney’s Office 
  • Chair Jessica Vega Pederson, Multnomah County
  • Monta Knudson, Bridges to Change 
  • Mark Harris, Oregon Black Brown Indigenous Advocacy Coalition (OBBIAC)
  • Shannon Olive, Women First Transition & Referral Center
  • Mercedes Elizalde, Latino Network
  • Janie Gullickson, Mental Health & Addiction Association of Oregon 
  • Paul Soloman, Oregon Criminal Justice Commission
  • Fernando Peña, NW Instituto Latino
  • Andy Ko, Partnership for Safety & Justice
  • Morgan Godvin, drug policy researcher, Oregon Alcohol & Drug Policy Commission, Measure 110 Oversight & Accountability Council
  • Joe Bazeghi, Recovery Works NW 
  • Theshia Naidoo, Drug Policy Alliance
  • Iris Chavez, Equity Action Partners 
  • Tera Hurst, Health Justice Recovery Alliance
  • Ron Williams, Health Justice Recovery Alliance
  • Devon Downeysmith, Health Justice Recovery Alliance
  • Diana Nuñez, Health Justice Recovery Alliance

The trip left attendees with a deeper understanding of the need for a fully-integrated healthcare response to the addiction crisis, and the importance of working together on solutions. 

“My main takeaway from this trip is that seeing is believing,” said Rep. Rob Nosse. “There’s no real disagreement between policymakers and law enforcement leaders in Portugal when it comes to this law — they are united in the belief that people struggling with addictions are better served as patients needing healthcare, and they’ve built out the integrated system to get people the care they need. This trip confirmed what I’ve been studying about this model. There is much from their program and approach that we can apply to our work here in Oregon.”  

While the delegation was comprised of a wide variety of stakeholders, the trip seemed to make several critical policy imperatives clear for all who attended, including:

  • Treatment services must be fully funded and made easily accessible when people want help. When Portugal cut funding for treatment, drug use and overdose rates rose again. That’s why Portugal is now working to reinvest in treatment funding and to doubling down on funding a public health response to addiction. We are committed to building out these services here in Oregon, and to identify multiple funding streams to support the full continuum of care. 
  • Portugal is committed to seeing people with addiction as patients in need of care – not punishment(criminals). They recognized that they couldn’t arrest their way out of this crisis. Like us here in Oregon, Portugal decriminalized addiction to address the overdose crisis they were facing due to increased heroin use, much like how we are experiencing here with the synthetic opioid fentanyl. This trip reminded each of us, no matter where we stand on Measure 110, that we all want to see addiction treated as a public health issue – not a crime.
  • People suffering from addiction aren’t the enemy. And neither are the police. Law enforcement are important partners in building out a healthcare response to addiction. In Portugal, law enforcement work alongside addiction experts to respond to addiction. We must give law enforcement the support they need to do the same. Rather than shutting them out of the process, we need to work together to create relationships and trust so we can partner in seeking solutions that will work in our communities on the ground. We all want and deserve safe, thriving communities. 
  • System-wide integration is key. Portugal’s General Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD) program – which operates under the country’s Ministry of Health – works to reduce drug use, prevent addictive behaviors and decrease dependencies. SICAD coordinates with health officials, addiction recovery providers, state-run detox and treatment facilities, non-profit service providers, law enforcement and other stakeholders to ensure people are accessing the tools they need to get healthy – connecting them back into the health care and social services they need to come back to society. Everyone we met made it clear that this system integration is vital. Measure 110 created BHRNs to establish a similar coordination of care and communication within counties, but we need more coordination of services at a state level if we are to succeed. 
  • We must do more to discourage public drug use as we work to get people into services and recovery. Law enforcement needs non-criminal, pre-arrest strategies and procedures that will enable law enforcement to be an effective partner in reducing public use. When Portugal most recently updated its decriminalization law to expand the definition of what constitutes a personal amount of drugs, the expanded definition left too much open to interpretation. Law enforcement voiced frustration with this decision. Seeing this dynamic made it all the more clear that we need to give our law enforcement clear mandates if we want them to be part of the effort to stop public drug use on our streets.
  • Decriminalization of personal possession of small amounts remains the right thing to do, but Measure 110 didn’t go far enough in creating a comprehensive healthcare approach to addiction. We have the opportunity to do that now. We need to identify multiple funding sources and policy solutions to build out a full system of care, rather than relying on any one policy solution to be the answer. When Portugal passed its decriminalization package in 2000, decriminalization was but one of nearly 70 policy solutions proposed to address the addiction crisis. Portugal’s decriminalization program also included extensive public health resources to educate the population around prevention, and to engage people with addictions with vital services. 

“One of the many realizations of this trip was that we must all work together, and that includes law enforcement, to address the suffering we see daily on our streets,” said Janie Gullickson of the Mental Health and Addiction Association of Oregon. “We need to support law enforcement in the reality they are often the first line of response to someone in crisis. Law enforcement and providers both have tools we can use to provide real solutions. We’ve got to transcend the ‘yes or no on Measure 110 conversation’ and make this about solving real problems. The Portugal trip helped us break down a lot of the walls that have been built up between providers and law enforcement. This isn’t political; it’s about helping people. Law enforcement and providers are both in this line of work because we care about our communities. I’m excited to see how we can build on the connections made in Portugal to save more lives here in Oregon.” 

“In Portugal, their crisis was so urgent because it was affecting so many, much like ours,” said drug policy researcher Morgan Godvin. “They responded to their opioid crisis so well that they effectively no longer have one, consistently showing some of the lowest overdose rates in Europe. They achieved this by treating drug users as patients in need of care rather than criminals in need of cuffs. They funded a robust public health approach on a continuum, and have the results to prove it. Empowered by options, Portuguese people make healthier choices. Drug use rates remain low and public drug use is rare. In Oregon, we must expand our services so that no one who needs treatment is locked out of care. If we expect people to make better choices, we must first present them with better options. This is not an impossible task by any stretch; it simply requires steadfast commitment to health and human rights.”