Pubdate: Thu, 31 Aug 2017
Source: Georgia Straight, The (CN BC)
Copyright: 2017 The Georgia Straight
Author: Travis Lupick
Page: 12


There is no silver bullet for North America's fentanyl crisis,
according to the architect of Portugal's drug-policy framework, widely
considered the most progressive in the world.

"It is a difficult problem," Dr. Joao Goulao told the Straight by
phone. "I have no magical insight for it."

Illicit drugs are on track to kill more than 1,500 people in B.C. this
year, up from an annual average of 204 deaths recorded between 2001
and 2010. So far in 2017, the B.C. Coroners Service has detected
fentanyl, a synthetic opioid, in 78 percent of drug fatalities.

In a wide-ranging interview, Goulao recounted how beginning in 2001,
his country decriminalized all illicit narcotics, including cocaine
and heroin.

Portugal did not legalize hard drugs, which would have involved
regulating their sales similar to how Canada deals with alcohol and
tobacco. But it took a step in that direction, removing criminal
penalties for personal possession.

At the same time, Portugal essentially flipped how it spends money on
citizens who struggled with an addiction, noted Goulao, now Portugal's
national drug coordinator. Whereas the country once spent about 90
percent of funds on enforcement and 10 percent on treatment, after
2001, that ratio was reversed.

"Since then, we have had dramatic improvements in all available
indicators," Goulao said. "Overdose deaths, HIV infections, and the
number of problematic drug users have all dropped since then."

In Portugal in 2015, the rate of fatal overdoses was three people per
100,000, according to the European Monitoring Centre for Drugs and
Drug Addiction. The B.C. Coroners Service has reported that as of June
2017, the rate of overdose deaths per 100,000 residents of this
province is 32.5.

On September 7, Goulao is scheduled to visit the Lower Mainland for
the first time as a keynote speaker at the Recovery Capital Conference
of Canada, in New Westminster. Ahead of his trip, he answered
questions about North America's fentanyl problem and discussed what
lessons Portugal's experience might have to offer policymakers here.

Goulao began by emphasizing that if Canada were to decriminalize drugs
as Portugal did, this would not address the issue of fentanyl. That's
because it would leave supply in the hands of dealers. However, he
said that removing criminal penalties for personal possession could

"Decriminalization is important because drug users will no longer fear
approaching [health-care] responders," Goulao explained. "It would be
an important step. Everything is easier in an environment of
decriminalization than it is in an environment of criminalization. Of
course, it will not solve every problem. But it would constitute a
success for drug users and help drug users with responses."

His trip to Vancouver follows a recent meeting Goulao had with
Canada's former minister of health, Jane Philpott, and minister of
justice, Vancouver's Jody Wilson-Raybould. The pair traveled to
Portugal in July.

In a brief telephone interview, Health Canada spokesperson Andrew
MacKendrick said the trip was focused on Portugal's health-based
approach to addiction and not the country's record with
decriminalization. In a similar vein, Prime Minister Justin Trudeau
has repeatedly said the Liberal government is not considering
decriminalizing or legalizing hard drugs such as heroin.

That's despite a growing number of B.C.'s top health officials calling
on the federal government to at least consider such a move in response
to the province's out-of-control increase in drug-overdose deaths.

Goulao repeatedly told the Straight that decriminalization should not
happen without a government enacting complementary reforms to its
justice and health-care systems.

"The results that we've had since then [2001] are the result of a set
of policies, not only decriminalization by itself," he said.

Asked if the answer to the fentanyl problem could be in legalization
and regulation, Goulao paused and responded "Probably."

"Legalization and the regulation of markets, controlling the quality
of the substances, and making them available only in appropriate
places, it would positive," he added.

But Goulao noted legalization remains a tough sell, even in Portugal,
where "everybody agrees on the positive effects of our current policies."

He said what's required to move governments toward legalization is
careful study and evidence. For example, he's closely watching
Colorado, where in 2014 state laws were changed to allow for
recreational-marijuana sales.

Goulao said that's one reason he's looking forward to visiting
Vancouver. His itinerary includes a tour of Vancouver's Downtown
Eastside, where one clinic offers heroin by prescription to a select
group of patients and where another doctor is treating more than 20
cases of severe-addiction disorder with hydromorphone, a drug very
similar to heroin.

"We are following, very attentively, the steps that other countries
are taking," Goulao said. "I believe that when we have the evidence of
the effectiveness of legalization, it probably will be possible to go
in that direction."
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