What Are Some Of The Health Services In Other Countries

Drug addiction is a global problem, affecting the people of every country in the world. The means those governments react offering a plethora of new ideas in budgeted the questions of helping addicts, removing the stigma of substance corruption, and starving the black markets that exploit vulnerable people. While the efforts of the United States take hold of the nigh headlines, how other countries deal with addiction and treatment adds vital pieces to the puzzle of fighting back against drug abuse.

The Portuguese Experiment

Portugal experiments with drug addiction treatments According to Gil Kerlikowske, the former Director of the National Drug Command Policy, "85 percent of all drug treatment research is conducted or funded in the United States," but in 2012, he traveled to Portugal, Italy, United mexican states, and Colombia to talk with authorities and health officials virtually their respective habit treatment programs. Kerlikowske noted that Portugal's unprecedented 2001 move of not arresting, trying, or imprisoning people with personal supplies of recreational drugs has opened a large number of doors and ideas for new and innovative ways that governments tin can aid their addicted and at-risk citizens.^[1]

Portugal'due south experiment, at present well over a decade former, has long been a topic of involvement in the public health umbrella of medicine and offense and punishment.TIME magazine reports of how the westernmost country of mainland Europe became the first in the continent to "officially cancel all criminal penalties for personal possession of drugs," from marijuana and cocaine to heroin and methamphetamine.^[ii]

The plan came nearly as a response to the country's debilitating drug bug in the tardily 20th century. Lisbon, the majuscule city, was a focal signal for drug smuggling and "a devastating heroin epidemic," writesMedical Daily. As a result of the needle sharing, HIV and hepatitis spread rapidly, and well-nigh of the 10.29 one thousand thousand people of Portugal knew, or knew of, someone addicted to heroin.^[three]

Portugal's Heroin Problem

Portugal native struggling with heroin addiction The problem arose from the stop of the dictatorship of the 2nd Republic, an authoritarian authorities that ruled the state with an iron fist from 1933 to 1974. The group was inspired by, based on, and enforced conservative and authoritarian principles; when information technology fell, an entire generation of Portuguese people indulged themselves on freedoms that had long been denied to them. Atop that list, saysMedical Daily, were drugs. Soldiers returning from newly liberated, former African colonies (Angola, Portuguese Guinea, and Mozambique) brought home cannabis, and blackness marketeers imported heroin and cocaine.

Dr. João Castel-Branco Goulão, one of the architects of Portugal'due south drug policy, explained that his state was "completely naive" about drugs. Under the rule of the Second Republic, Portugal had been closed off from the exterior world, with no social liberties for its people. When that authorities ended, drug and alcohol abuse was non only commonplace, it was practically encouraged.

Unsurprisingly, when the party concluded, the heroin was notwithstanding at that place, and in a few short years, the country was suffering. Other European nations had the time to detect what not to do with drugs, said Dr. Goulão, merely Portugal was thrust into the deep stop of the learning curve. By the time government realized what had gone wrong, "nosotros had a huge amount of people who were addicted mainly to heroin."

By the 1990s, nigh 1 percent of Portugal's citizens had a heroin addiction. The epidemic became the number i public health issue in the land. In response, the government created a chore force consisting of doctors, judges, and mental and social healthcare workers. Dr. Goulão was 1 of the people tasked with saving his country. In 1998, he and his squad came upwardly with a programme that no one saw coming: decriminalizing all drug use, and creating new policies and programs that would care for addicts and fix them for reintegration into Portuguese society.

Changing the Conversation

If addiction is a affliction, argues Dr. Goulão, then why arrest sick people? The task force operated under the supposition that the habit epidemic was medical in nature, non an outcome of law and order.

To that effect, Portuguese citizens who were apprehended with drugs were offered therapy instead of jail sentences. Fear of prison is what makes addicts get surreptitious, and incarceration costs taxpayers more than treatment. Dr. Goulão'southward team could logically brand the argument that in that location was less to lose past providing drug addicts with health services that would really address their bug.

The Portuguese government agreed. Under the 2001 laws, citizens constitute guilty of possessing pocket-size amounts of drugs (no more than a ten-twenty-four hour period supply of the given substance) were sent to a panel made up of a psychologist, a social worker, and a legal advisor, who would so devise an advisable handling plan. The citizen in question would be given the right to turn down to accept the decision of the panel without criminal punishment. Jail would not exist office of the arrangement.

Response and Results

Unsurprisingly, the new plans were not universally accepted at first. Portugal was a poor, socially bourgeois, and majority Catholic land; the word on the street was that decriminalizing drug possession would do zippo but make Portugal a haven for drug tourists and make the preexisting drug problem worse. Portugal was already home to the highest levels of illegal and dangerous drug use across Europe; removing jail from the response prototype seemed like national suicide.

But in 2009, a written report issued by Washington, DC's Cato Institute revealed that five years later on personal possession of drugs was decriminalized in Portugal, the furnishings beyond the country far exceeded expectations:

Illegal drug use by teenagers dropped.
Rates of HIV infections by sharing contaminated needles dropped.
The number of people seeking treatment for substance abuse more than doubled.

drug use statistics on lifetime use of heroin The Cato Institute's research was conducted by Glenn Greenwald, a former lawyer,New York Timesbestselling author, and renowned journalist and political commentator. Greenwald toldSalon mag that an empirical evaluation of Portugal's decriminalization policy shows that the programme "has been an unquestionable success" across the board. The focus on handling, and not punishment, has helped Portugal manage its drug problems and use "far better than most Western nations," which persist in treating consumption and addiction every bit problems of crime, not health.^[4]

Every metric, said Greenwald, showed that Portugal's decriminalization has been wildly successful. The report by the Cato Establish showed that compared to both the European Marriage and the Usa, Portugal had the lowest charge per unit of lifetime cannabis consumption, both in Europe and America. More Americans take used cocaine than Portuguese have smoked marijuana.

Furthermore, between 2001 and 2006, the amount of lifetime utilize of heroin – the drug that was causing the most bug for Portugal – roughshod by 2.5 percent to one.viii percent amid those 16-18 years old. Illegal drug utilise by children in grades 7-nine dropped from 14.1 percent to ten.6 percent. HIV infections and fatalities caused past heroin and other drugs declined by more than fifty percent.

1 of the most notable statistics to come out of Portugal'southward decriminalization plan was the number of people who enrolled in methadone and buprenorphine treatment for drug addiction: from six,040 before the policy to 14,887 later. The amount of coin saved on law enforcement measures also funded drug-gratuitous treatment options.

A Different Approach

drug dealer being arrested for trafficking Greenwald draws a very clear line between Portugal's success and the efforts made past the United States and other major countries to solve the drug problem. He specifically mentions the decades-long "War on Drugs" as one of many "criminalization approaches" that are "abject failures," because they exacerbate problems instead of properly addressing them.

What the Portuguese task force did differently to police enforcement agencies in other countries, argues Greenwald, is that it removed ideological questions about imprisoning adults who choose to swallow drugs, respected constitutional rights over drug criminalization methods, and ensured that money was used for handling first and prosecution second.

But the key in Portugal's success was that its government recognized, as early on equally the 1990s, that pursuing criminal action against drug users did not respond the questions of poverty that fueled the drug crisis; and, further, that such criminal activity made the state of affairs of poverty even worse. The current consensus in Portugal is that decriminalization gave the government the resources to control the drug problem with a greater degree of efficiency and effectiveness than e'er earlier, and the doomsday scenarios envisioned by naysayers – of Portugal condign a center for drug tourism and the entire country becoming a ghost town of heroin overdoses – never happened.

In the international conversation almost what to practice about the abuse, trafficking, and treatment of drugs, Portugal's experiment stands out. Officials in the United states have studied Portugal'due south success, mindful of how the drug wars in Fundamental and South America have destabilized governments and created a thriving blackness marketplace that have kept American citizens addicted for generations. In particular, American lawmakers are looking for alternatives to the tough-on-crime, zero-tolerance policies that created winning headlines and stump speeches in the 1970s, simply have been largely discarded and discredited as decades' worth of research and evidence have shown that America retains the highest rates of cocaine and marijuana use in the world.

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Reflexive Opposition

Mark Kleiman, the director of the drug policy analysis program at the University of California, Los Angeles, tellsFourth dimension magazine that the American addiction of being "reflexively opposed" when the topic of decriminalization is brought upwards hampers whatever disquisitional and artistic thinking in how to resolve the problem. Given how desperately the United states of america has struggled to make a meaningful dent in drug crime and treatment, and how successful new and alternative policies have been, Kleiman advocates taking seriously the suggestion that the focus on "anti-user enforcement" has failed to make an bear upon.

However, Kleiman is quick to signal out that simply applying Portugal's model to the U.s.a. volition not piece of work. The 2 countries are vastly dissimilar in size (at 10.46 million people in 2013, Portugal is smaller by population than the state of Ohio) and culture, a indicate echoed past Peter Reuter, a professor of criminology and public policy at the University of Maryland. Reuter also points out that drug epidemics come in cycles, regardless of the policies that are in identify, and that Portugal'due south upward swing in combating its drug problem may be more a case of timing than strategy.

The Decriminalization Dilemma

But it's hard to ignore Portugal's success, with some senators in the US taking a cue from their Portuguese counterparts and calling for the creation of a multidisciplinary task forcefulness to examine questions of prison house reform and mandatory minimum sentencing policies. Senator Jim Webb noted that while the United States is dwelling to 5 percent of the world's population, 25 percent of the globe'southward prisoners are in American jails.

It's a bespeak that Glenn Greenwald feels speaks to the problem that America has had and that Portugal has solved. Despite overwhelming evidence to the opposite, much of the American approach to drug policy is based on speculation, fearfulness-mongering, and outdated methodologies and ideologies, instead of the empirical evidence that allowed the Portuguese chore force to focus on specifics of poverty. The result, says Greenwald, was that the biggest health problem in Portugal had go neutralized.

Despite reservations by Greenwald and Peter Reuter, Dr. Goulão stands by his results. He is now the president of the Institute on Drugs and Drug Addiction in Portugal; he formerly served as chairman of the European Monitoring Centre for Drugs and Drug Addiction; and he served as a delegate at the Un Committee on Narcotic Drugs. Decriminalization, he says, has had a significant impact in the life of Portuguese families and society, enabling police to turn their attention to cracking the networks of dealers and smugglers, and not to the addicts.

Heroin-Assisted Handling in the U.k.

heroin assisted treatment in the UK

Elsewhere in Europe, the United Kingdom has also retuned its drug policies. In 2009, the union concluded a four-year experiment where chronic heroin addicts were given daily injections of heroin, as part of a treatment programme aimed at gradually getting the addicts off heroin. Initial results suggested that the trial was effective in reducing drug utilise and drug-related crime amongst participants, leading the Great britain to join Switzerland, the netherlands, Kingdom of denmark, and Deutschland to offer heroin clinics every bit part of respective national health programs. These permanent facilities, funded by the government, would treat addicts with the most serious of heroin problems.^[v]

Understandably, the program is a controversial ane. John Strang, a researcher at the National Addiction Centre admits toFourth dimensionmagazine that "it's a less than perfect treatment," merely when dealing with users who do not respond to ane of the standard drugs used in typical replacement therapy programs (like methadone or buprenorphine), a 2007 article published in theBritish Journal of Psychiatryoffered some insight. A study of 1,015 people who were dependent on heroin revealed that heroin-assisted treatment was successful for people who were severely addicted to the drug and for whom methadone therapy was ineffective. The written report found that of the ane,015 people in its sample size, 67.ii per centum of the patients who were given heroin connected with treatment, whereas but 40 pct of the patients given methadone stayed. The heroin group also showed a "significantly greater response" in the improvement of their physical and/or mental wellness and a subtract in their utilize of illegal drugs.

The researchers writing in the periodical concluded that heroin-assisted treatment is a good strategy to treat people who are heavily addicted to heroin. While acknowledging that in that location is a great deal of risk associated with giving heroin addicts more heroin, the researchers argued that such a measure out "should be considered for treatment resistance under medical supervision."^{[half dozen]}

At the National Addiction Centre, John Strang admits that for some chronic heroin users, the purpose of heroin-assisted handling is simply to "get them from a bad place, to a less bad place." Existence given medically controlled admission to heroin constitutes their kickoff incremental steps toward getting away from recreational abuse. For everyone who comes to a heroin-assisted treatment facility, the accent is on helping them take their first incremental steps abroad from recreational corruption.

The original experiment took 127 heroin users and divided them into three groups: one group received heroin handling, and the other two received methadone intravenously and orally. Participants in all iii groups received counseling and social services, and thus displayed concrete and mental health improvements, but the heroin grouping made much meliorate progress than the methadone groups. Six months after the experiment started, around 75 percent of the heroin group had stopped consuming heroin recreationally, and researchers were enthused by the significant drop in criminal offense charge per unit by the people in the heroin group. In the 30 days before the programme started, the full number of crimes committed past the heroin group members was i,700; in the kickoff six months of the experiment, the number was 547.

Highly Persistent Improvement

Ane of the study's participants, Sarah, who started handling with a 20-year long heroin addiction, toldTIME that because of daily heroin injections at the dispensary, she got housing help, counseling services to amend her depression, and was fifty-fifty given the chance to mentor inmates who were released from jail. One twelvemonth into the trial, Sarah reduced her injections down from twice a twenty-four hours to once, eventually going off heroin completely and switching to a mixture of morphine and methadone instead. She hopes to gradually improve to the signal where she won't need the medication at all.

British doctors have traditionally been allowed to prescribe heroin in cases of severe and chronic heroin apply, simply it was a collaboration with scientists from Switzerland (where heroin utilise was spiking nationally) that led to conversations about heroin-assisted treatment facilities beyond the Britain.

I of the scientists was Ambros Uchtenhagen, a professor of psychiatry at the University of Zurich. Uchtenhagen had established clinics in Switzerland where heroin users would inject themselves, but only with the supervision of a doctor, and receive mental health counseling. Uchtenhagen toldTIME mag that he "found highly persistent improvement" in patients who subjected themselves to that course of handling. Every bit of 2009, there were 23 such clinics in Switzerland, treating approximately 2,200 heroin addicts (and people with grave narcotic dependencies), a number that accounts for 6 percentage of the land'due south overall heroin addict population. On boilerplate, each person is a patient of the clinic for three years; almost of them go far with well over a decade'southward worth of heroin use. Fewer than 15 percentage of patients relapse.

Uchtenhagen says that heroin-assisted program is a class of step-by-step treatment to help people recover from their corruption of heroin.

Heroin on Trial

a study on how to treat heroin dependence called heroin on trial Equally with Portugal'southward experiment, the idea of adopting a more lenient class of treatment toward drug users was met with doubt from the Swiss public. But in 2008, 68 percent of Switzerland's voters backed a plebiscite to go along heroin-assisted treatment clinics permanently funded by the government.

Similarly, the British adoption of heroin-assisted handling has not been universally welcomed. Mary Brett, the vice president of the nonprofit Europe Confronting Drugs worries that the "hair of the dog"-manner of treatment will result in cocaine being given to cocaine addicts or trying to rehabilitate alcoholics by giving them booze. "The goal should always be abstinence," she said, not perpetuating an aficionado's dependence on their drugs.

But even more recent enquiry on the topic has led credibility to the idea put forward by the Swiss and British collaboration. A study by the Royal College of Psychiatrists, published in a 2015 event of theBritish Journal of Psychiatry on the topic of "heroin on trial," examined the emergence of "supervised injectable heroin" as a form of handling since the plough of the century. The report found that such an approach is an "constructive way of treating heroin dependence" in users whose bug are such that they cannot (or choose not to) respond to standard methadone treatments.

The Imperial College admitted that heroin-assisted handling "may be less condom than [methadone maintenance handling]," and should have greater clinical and medical attention for reasons of safe; but the intensity of the treatment may exist the only course of action for a population of people who were long considered across the scope of intendance. Unorthodox (and dangerous and controversial) equally supervised injectable heroin treatment may exist, the researchers felt that could "better the impact of comprehensive healthcare provision" beyond the United Kingdom.^[7]

The Worst Places in the World for Drug Habit and Handling

While places like the UK and Portugal are being studied for their progressive and revolutionary approaches to treating addiction, other countries make headlines for the opposite reasons. A senior editor atReason magazine explains that Muslim countries, or nations governed past secular authoritarian regimes, are the worst places to be defenseless possessing even the smallest amounts of drugs, even if there was no intention to distribute.

Singapore is among the worst places in the world for drug addiction treatment

Asian countries account for some of the worst places in the earth for drug addicts to receive treatment. Malaysia, writesThe Ready, mandates the death penalization for drug traffickers; and under Malaysian constabulary, anything from half an ounce of heroin to a few ounces of marijuana makes a suspect a trafficker. People who exam positive for drugs are automatically sentenced to a twelvemonth of compulsory treatment.^[eight]

The Canadian government warns its travelers that Singapore'due south drug laws are some of the toughest such laws in the globe. Possessing small amounts of drugs can lead to a jail sentence of ten years and fines worth tens of thousands of dollars. Having enough of certain amounts of drugs (such as 2 grams of heroin, or 15 grams of cannabis) is grounds for being automatically presumed by constabulary to be trafficking. People caught with higher amounts (15 grams or more of heroin, 500 grams or more of cannabis) will be field of study to a mandatory death sentence.^[9]

In Vietnam, drug users are at the mercy of the "Bureau of Social Evils Prevention and Gainsay," a department of the Vietnamese government's Ministry building of Labour, Invalids and Social Affairs. A person caught taking illicit substances could be sent to "rehabilitation," a euphemism for forced labor and near starvation. Unlike Singapore and Malaysia, Vietnam distinguishes between coincidental drug use and smuggling, simply the deviation doesn't offer a great bargain of condolement: Casual drug users can exist forcibly sent to treatment centers, where the "treatment" consists of severe subject area that borders on torture. Persons defenseless with pocket-sized amounts of heroin or other narcotics can still be sentenced to death.^[ten]

Saudi Arabia'southward practice of Wahhabist Islam ways that non only are there no bars or liquor stores in the country, visitors are besides forbidden from bringing any kind of drugs into the Center Eastern nation. Anyone defenseless using drugs by the infamous religious police tin can be sent to jail, publicly flogged, and deported. Drug traffickers can be executed by hanging.^[xi]

Dealing with the Drug Problem in America

The situation is obviously better in the United States, where the conversation has greatly shifted from the days of the War on Drugs rhetoric. While Dr. João Goulão and Glenn Greenwald were quick to point out that Portugal's success in fighting its drug trouble wouldn't easily apply to America, they lent their voices to a chorus of criticism of America's drug war.

The Guardian, for case, called the War on Drugs "a systematic failure of policy," quoting a 2013 report in theBritish Medical Journalthat specifically noted that trying to control illegal drugs through police force enforcement did not work.^[12],[13] When information technology came to problems of handling, the Brookings Establishment noted that the "penalisation model" practiced by the The states (where jail terms are used as a form of deterrent) had the primary outcome of creating an astronomical fasten in incarceration rates, while having a negligible effect on the consumption and trade of drugs. In 1980, fifty,000 Americans were sentenced to prison terms; in 2015, that number was 210,000, but only a fraction of them were given any course of treatment to help them quit their drug habits.

For comparison, the institution favorably looked at the models of countries similar Spain and Italy, where "depenalization" renders drugs illegal, but citizens are immune to use pocket-sized amounts without fear of prosecution. Another model is holland' "decriminalization" model, where cannabis is sold legally for personal use (albeit with limitations and restrictions).^[fourteen]

America's "punishment model" led the American Psychological Clan to declare the Us as the "incarceration nation" of the world, pointing out (as Senator Jim Webb did) that while 5 percentage of the global population lives in US, 25 percent of the global prison house population alive in its jails. APA further notes that the legacy of the War on Drugs ways that well-nigh of those people are from poor, ethnic minority backgrounds, who exercise non accept the means to defend themselves in court and often live in situations of high exposure to drugs and the pressure to utilize them. A psychology professor at George Stonemason University condemned the punishment model for causing widespread economic and societal damage across the state, for prohibitively niggling benefit.^[15]

From Prohibition to the War on Drugs

prohibition vote dry 1 of the factors affecting how the U.s.a. looks at drug addiction and its treatment is the staunch refusal to consider substance abuse equally anything merely a criminal issue, carried out past weak-willed, morally flawed people. Strong religious lobbies and belatedly 19th century puritan values contributed to the passage of the 18^th Subpoena, colloquially known as Prohibition. Although Prohibition was repealed 13 years afterwards it was ratified by Congress, the effect proved a lasting one.

The 18^th Subpoena, which outlawed the manufacturing, transportation, and auction of alcohol, went into issue in 1919 and was repealed in 1933; but even in 2014, research conducted by the Johns Hopkins Bloomberg School of Public Wellness revealed that a majority of Americans still believe that people who are addicted to drugs and booze should not exist covered by insurance, housing, and employment policies that might help their rehabilitation.^[16]

That idea is held very strongly past some of the enforcers of the War on Drugs, even as they scout in dismay as electric current and futurity presidential administrations effort to roll back some of the far-reaching furnishings. William J. Bennett and John P. Walters, respectively the former Directors for the Office of National Drug Control Policy for Presidents George H.W. Bush-league and George W. Bush, together chosen for the War on Drugs to return, in an opinion slice they collaborated on for theBoston Globein 2015. Basing drug enforcement policy on treatment, instead of punishment, does little to deter people from experimenting with drugs and is too lenient a policy to have any lasting impact, they say. Because of the refocusing abroad from drug use as a criminal problem, "death and addiction [have] spread" beyond America, with an oversaturation of prescription opioids giving way to widespread heroin abuse in areas non typically associated with drug abuse, such as rural towns and suburban neighborhoods.

While non addressing the bug of unfair sentencing and the asymmetric targeting of minorities and disadvantaged demographics that resulted from the War on Drugs, Bennett and Walters praised the 25 years of government policy – from the Nixon assistants to the Clinton era – for forcefully tackling the spread and trade of illegal drugs in the United States.^[17]

A New Conversation for a New Era

Simply as a sign of how much the conversation in America on how to deal with habit and treatment has shifted, even some contemporary Republican presidential hopefuls have moved away from the nada-tolerance policy that their predecessors fabricated cornerstones of their campaigns. Jeb Bush-league, for example, argued that the all-time fashion to help people with substance abuse issues was to remove the cultural stigmas of shame and humiliation that previous generations heaped on addicts. Bush presented addiction as an "illness," ane that requires help and care, not punishment and condemnation.^[18]

The tone is markedly unlike from when Bush'due south father, President George H.W. Bush, said that the United states of america' strategy on drug control meant "more prisons, more than jails, more courts [and] more than prosecutors," which would cost:

$1.6 billion for corrections
$250 one thousand thousand for courts
$3.1 billion for police enforcement
$1.ii billion for prevention and teaching
$925 million for treatment^[19]

On the campaign trail in 2015, Chris Christie related stories of his mother (a lifelong smoker) and a friend who he lost to drug abuse. Christie pointed out that while his mother'south smoking addiction was often looked at with pity and understanding, his friend had to hibernate his substance problem out of fear of stigmatization. There is a consensus in America, said Christie, that people who autumn prey to addiction brand a conscious choice to poison themselves or that they deserve any misfortune befalls them.

Christie's friend had a "great career and family," he said, simply that didn't stop the addiction from worsening. The merely mode to care for such a problem, said Christie, was not to throw a person in jail, but to offer them a way out of their problems.^[20] As other Republican nominees shared their stories of family members who overdosed and drank themselves to death,Vox suggested that "one of the unexpected benefits of the 2016 elections" might be to modify how Americans think and talk about dealing with addiction and handling.^[21]

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Citations

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