As the U.S. grapples with the devastating impact of the overdose crisis, we must look at the experiences of other countries to find innovative solutions and valuable insights. 

For instance, in 2001, Portugal took a pioneering approach to its drug crisis and implemented a comprehensive public health-based drug policy approach. This included decriminalization of personal drug possession while maintaining criminal penalties for drug trafficking. At the time, Portugal faced a severe heroin addiction crisis and the highest rate of HIV infections in the European Union.  

Portugal’s approach to drug policy yielded positive results, including drug overdose death rates among the lowest in the European Union.  

Portugal’s experience demonstrates that a comprehensive public health approach to addiction, one that is consistently funded and supported, can yield positive outcomes and save lives. Dr. João Goulão, one of the original architects of Portugal’s drug law, has stressed that the country’s approach was comprehensive, with drug decriminalization as just one part of its plan for reform. Goulao has also emphasized that other countries should not simply “copy and paste” Portugal’s approach, but rather adapt it to fit the social norms of each country.  

Recent criticism of Portugal’s approach only serves to emphasize one of these lessons: Consistent funding is essential to sustained, long-term results. Below are three key lessons from Portugal that could benefit the United States.  

1. Treat substance use disorder as a matter of public health, not a crime. Portugal’s decision to decriminalize drug possession was rooted in recognizing that substance use disorder is a health issue, not a criminal offense. By adopting this perspective, Portugal created an environment where individuals with addiction or problematic drug use could seek help without fear of punishment. Individuals in Portugal who have a 10-day supply of drugs are referred to Commissions for the Dissuasion of Drug Addiction (CTD). The CTD panels consist of trained professionals who provide personalized and targeted assistance to individuals in possession of small amounts of a drug. The commission aims to dissuade new drug users, refer people in need of treatment to services and provide referrals to other needed services. With this tactic, Portugal has created a system that addresses the multifaceted nature of addiction. The U.S. has made some progress in recognizing substance use disorder as a disease and reforming drug policies; however, the emergence of fentanyl in the drug supply has rekindled a focus on criminalization as a response. At Georgetown University Law Center’s O’Neill Institute for National and Global Health Law, where I am director of the Addiction and Public Policy Initiative, we conducted a review of state legislative actions in 2023 and found numerous bills that would increase mandatory minimums for fentanyl possession. A singular focus on incarceration and increasing mandatory minimum sentences has proven ineffective in decreasing drug use and substance use disorder.   
2. Invest substantial and consistent funding in public health services, including treatment and harm reduction.  Portugal’s success in reducing drug-related harms was, at the time, attributed to a commitment and robust investment in evidence-based treatment, prevention and harm reduction strategies. The country expanded its drug treatment facilities, including inpatient treatment centers and transitional housing, to ensure that individuals have access to the support they need to overcome addiction. Additionally, Portugal prioritized harm reduction measures, such as needle exchange programs, which have been crucial in reducing disease transmission through injection. Unfortunately, this initial financial investment has not been sustained. The U.S. has a unique opportunity right now, given opioid litigation proceeds and federal grants, to invest in long-term public health solutions. A 2014 analysis found that $1 spent on treatment saves more than $3  in crime reduction. However, long-term solutions require more than grants and short-term infusions of litigation proceeds.  
3. Allocate robust financial investments to data collection and reporting. The lack of data collection before Portugal’s comprehensive legislation has hindered the assessment of its successes and shortcomings. Recognizing this challenge, the country has made a concerted effort to prioritize data collection by conducting general population surveys and maintaining records for the CTDs. By investing in timely and accurate data collection, the U.S. can gain valuable insights into the effectiveness of measures to curb overdose deaths and provide quality treatment to people with substance use disorder. The Biden administration’s National Drug Control Policy calls for a more precise and timely data collection system to drive our drug policies. States also face these challenges, as seen in an audit conducted by Oregon’s Secretary of State about that state’s recent drug policy reform (Measure 110). The audit of Oregon’s recent efforts to decriminalize drug possession included improved data collection as one of its primary recommendations. 

As with the rest of the world, Portugal has felt the impact of the pandemic, and some circumstances in the country have changed. However, lessons can still be garnered from their experience.

By embracing and staying committed to reform, the U.S. can enhance its response to the overdose crisis. It is time we take decisive steps toward a more compassionate and public health-centered approach to drug policy. One that addresses public safety concerns while prioritizing access to treatment and support for those affected by substance use. By doing so, we can improve outcomes and save lives.  

Regina LaBelle is the director of the Addiction and Public Policy Initiative at Georgetown University Law Center’s O’Neill Institute. She also directs and teaches the Addiction Policy and Practice Master of Science program at Georgetown University’s Graduate School of Arts & Sciences. LaBelle served as the acting director of the White House Office of National Drug Control Policy (ONDCP) in the Biden administration and chief of staff at ONDCP during the Obama administration.