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The War on Heroin: U.S. vs. Portugal

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Trump's Plan for Battling the Heroin Epidemic

Because heroin usage is widespread, it's not uncommon to hear someone talking about being in a park or a grocery store parking lot with used syringe needles laying around. We are seeing an epidemic of heroin use in the United States.

Donald Trump's plan for beating the opioid epidemic is to make addiction and drug usage an even bigger crime than what it has previously been viewed as by law enforcement. Despite the fact that experts have said that opioid usage and addiction should be treated as a disease, Trump thinks that a “law and order” approach should be taken.

His administration wants to cut Medicaid, which is the largest payer of behavioral health services, by $800 billion. Experts already know this would result in less treatment for addiction. According to federal data, the number of reported overdoses have increased. During the first nine months of 2016, it was estimated by the National Center for Health Statistics that death by drug overdose rose to a new record of 19.9 per 100,000 when in the prior year of 2015 it was 16.7 per 100,000.

The Spread of Disease

It is not just death by overdose that has people alarmed. Used syringe needles carry diseases. In March of 2015 in Scott County, Indiana, H.I.V. was quickly spreading among intravenous drug users. The area of Scott County, which was governed by Mike Pence at the time, was rural, predominately white, and very poor.

Federal health officials were urging Governor Mike Pence to allow clean syringe needles to be distributed to the people with a practice called “syringe access” which has been proven to decrease drug usage and decrease the spread of diseases like H.I.V. Mike Pence opposed syringe access because he believed that it promoted drug usage despite documentation that says it does the opposite. There were 90 new cases of H.I.V. infection reported and although he was being pressured to implement syringe access, two months passed with Mike Pence doing nothing. After two months of inaction, he declared that he was going to pray on it. Two days after his declaration of prayer, an executive order was issued by Mike Pence that allowed syringe access or clean needles in Scott County.

Syringe Access

Once syringe access was implemented alongside drug therapy and more aggressive outreach, the cases of H.I.V. were cut down to a very small amount. It is believed that there was so much drug usage going on in Scott County at the time because of the extreme poverty of the people and the stress that such extreme poverty causes.

According to the Syringe Access Fund, which is the largest collaborative fund in the U.S. focusing on Syringe Exchange Policy and Programs annually in the United States, 3,000 to 5,000 H.I.V. infections and 10,000 Hepatitis C infections are caused by contaminated needles. Studies have been done that have shown syringe access programs increase access to health care, drug treatment, and prevent overdoses, while not increasing drug usage. Also, they save money by preventing disease and the high costs associated with treating diseases. In Scott County, 142 people became infected with H.I.V. in a time frame of fewer than six months. The number of infections in Scott County far outnumbered infections in places like New York City where syringe access had already been implemented. Syringe Access has been used along with other H.I.V. prevention programs and it has reduced the risk of H.I.V. transmission by 80%.

H.I.V. in the United States

H.I.V. in the United States


An example of a place where drug usage and addiction were treated as diseases and what effect that response had on the epidemic of drug use in Portugal. In the year 2000, Portugal decriminalized the possession of illegal drugs. If someone in Portugal is caught with less than a 10 day supply of an illegal substance, they are given a citation and have to appear before a panel of legal, social, and psychological experts. The majority of cases are suspended. If someone repeatedly offends and comes before the panels, they may be prescribed treatment which can range from motivational counseling to opiate substitution therapy.

At first, the United Nations or the International Narcotics Control Board (the somewhat judicial U.N. body that oversees the body founded by the U.N. drug convention system) were very harsh and did not approve of Portugal's plan of treating substance abuse like it was an illness and not strictly criminal activity. Then, as soon as drug users started changing for the better, Portugal became a model for other governments to follow due to its success rate.

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Portuguese official Jaao Goulao said, “It was a combination of the law and these services that made it a success. It is very difficult to find people in Portugal who disagree with this model.” The year the new laws in Portugal took effect they had 1,016 cases of H.I.V. In 2012, the number had fallen to 56. The year the laws took effect, there were 80 recorded overdoses. In 2012, the number had fallen to 16. In comparison, in the United States, 14,000 people died of prescription opioid overdoses in 2014 alone. The drug-induced death rate in Portugal, which is 3 in one million, is over five times lower than the average of the European Union which is 17.3 in one million.

Syringe Access in the United States

Syringe Access in the United States

How it Works

In the year 2000 when drug usage was decriminalized in Portugal, there were hoards of people who thought drug usage would skyrocket. On the contrary, within the past fifteen years, drug usage in Portugal has significantly fallen. They figured out that parallel harm reduction measures such as needle exchange or syringe access and opioid substitution therapy using drugs like methadone and buprenorphine serve as a cushion to prevent the spread of communicable diseases and prevent the rise in overdoses even if the number of users injecting heroin happens to increase for a period of time.


People use drugs for one of two reasons—either to potentiate pleasures or relieve unpleasure—and the types of drugs and the type of people who use drugs carries a lot according to the conditions of life in the county . . . I think harm reduction is not giving up on people. I think it is respecting their timings and assuming that even if someone is still using drugs, that person deserves the investment of the state in order to have a better and a longer life.

— Goulao

The Process

In Portugal, drugs are still illegal. People who deal and traffic drugs are still sent to jail. Typically people who are arrested for drug-related offenses and go before a panel are first time offenders and are recreationally using drugs. Their cases are usually suspended. When someone keeps getting arrested for drugs, the panels then order them sanctions or treatment. They also have implemented syringe access programs where addicts can get clean needles and crack pipes, which has been proven to help get users into state services.

Usually, the focus is on the decriminalization itself, but it worked because there were other services, and the coverage increased for needle replacement, detox, therapeutic communities, and employment options for people who use drugs. It was the combination of the law and these services that made it a success. It's very difficult to find people in Portugal who disagree with this model.

— Project Coordinator Ricardo Fuertes


In conclusion, the type of “law and order” approach that was used in Scott County where there was a major H.I.V. outbreak did not work. What the United States needs to do is implement more programs like syringe access that have been proven to decrease drug usage and the spread of disease. We need to adopt a model more like that of Portugal where it is treated like the disease that it is and not just a criminal activity. If drug usage is only increasingly criminalized then the only thing that is going to do is cause more death, more drug usage, and increase the spread of disease.

Resources Cited:

These articles were assessed between August 21, 2017 and August 25, 2017.

This content reflects the personal opinions of the author. It is accurate and true to the best of the author’s knowledge and should not be substituted for impartial fact or advice in legal, political, or personal matters.

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