Chief Dubord Pens Open Letter Addressing Decriminalization

Editorial - Learning from the Portugal Model of Decriminalization for Meaningful Impact in BC.

The Portugal model of drug decriminalization, hailed worldwide as a pioneering approach in drug policy, is currently being reconsidered. Portugal decriminalized all drugs in 2001; it was a bold experiment aimed at treating drug use as a public health issue rather than a criminal one. Two decades later, "Portugal is now having doubts." 1

The cornerstone of Portugal’s initiative was treatment and recovery. In 2001, Portugal committed USD 82.7 million for drug oversight, which has been reduced to USD 17.4 million over the past 22 years; at the same time, users being funnelled into drug treatment have gone from a peak of 1,150 in 2015 to 352 in 2021.2

Portugal's policy courageously shifted the focus from punishment to health – a much-needed change. However, it underscores the necessity for a comprehensive, sustainable, and flexible whole-system funding model that focuses on a continuum of care. The challenges facing the Portugal model should not be interpreted as a failure of drug decriminalization, but rather as a call for continuous evaluation, improvement and investment to reach the best model possible.

The pilot project involving decriminalization and safe supply of small quantities of drugs in British Columbia (BC) is similarly only a piece in a very complex puzzle that requires an understanding and application of a whole-system approach, addressing the various historical and ongoing silos within our public health and social care systems.

BC's treatment and recovery system is intricate, involving multiple entities such as health authorities, government-funded non-profit organizations, and private businesses, which can cost thousands of dollars. Moreover, there are varying opinions on the outcome measures to evaluate the effectiveness of decriminalization and, more specifically, treatment and recovery initiatives.

Although I agree with the underlying principles of decriminalization, it is evident in the early evaluation that our communities are currently not experiencing the desired outcome from this policy change. The number of overdose deaths in BC, reaching 791 from the time decriminalization was enacted until May 2023, closely mirrors the figures from the same period in 2022 (n=772).3

BC can learn from Portugal’s experiences and, through strong leadership, unwavering resolve, and a whole system approach, make strides toward meaningful progress. The pitfalls of inconsistent policy, lack of oversight and measurement of initiatives, systems working in silos and funding decisions pose risks to the desired objectives of the BC decriminalization pilot project.

A whole-system approach involves creating immediate evidenced-based addiction treatment and concurrent mental health crisis intervention and support. This includes the necessity for more funding for evidence-based addiction treatment.4 When our loved ones struggle with drug addiction, our concerns extend beyond their safety and risk reduction; we also desire them to receive the necessary treatment for recovery and improvement. Decriminalization and safe supply work hand and glove with treatment and recovery. The Portugal model prioritized treatment and recovery as a fundamental aspect of its initiative in 2001. However, in 2022, changes in funding significantly impacted the outcomes of Portugal’s model, compromising treatment and recovery.

The success of BC’s decriminalization pilot hinges on a comprehensive system-wide approach, encompassing sustainable funding, evidence-based addiction treatment with prompt accessibility, concurrent mental health crisis intervention and support, and of course, leadership.

1 Washington Post, (July 7, 2023) Once hailed from decriminalizing drugs, Portugal is now having doubts

2 Washington Post, (July 7, 2023) Once hailed from decriminalizing drugs, Portugal is now having doubts

3 BC Coroners Service – Statistics on Unregulated Deaths – BC

4 Vancouver Police Department (2017) The Opioid Crisis- The Need for Treatment on Demand