Oregon Delegation Explores Portugal’s Healthcare Approach to Substance Use Disorder
A 24-person delegation of Oregon stakeholders recently returned from Portugal, having embarked on a groundbreaking mission to learn from the country’s comprehensive healthcare response to the addiction crisis. During their week in Portugal, members of the Oregon delegation engaged with a diverse range of stakeholders, including addiction recovery providers, law enforcement officials, and policymakers. This unique journey provided valuable insights into Portugal’s approach and how it could inform Oregon’s strategy for addressing substance use disorder.
Key Meetings and Participants
The Oregon delegation had the privilege of meeting with various influential figures and organizations during their fact-finding mission, including:
- João Goulão: Widely recognized as the chief architect of Portugal’s drug decriminalization program and the head of the General-Directorate for SICAD (Service for the Intervention on Addictive Behaviors and Dependencies). Dr. Goulão played a pivotal role in shaping Portugal’s approach to addiction.
- Miguel Vasconcelos: A prominent psychiatrist and the head of Taipas, one of Lisbon’s publicly funded outpatient treatment centers. This facility stands as an example of Portugal’s commitment to accessible treatment.
- Mobile Low Threshold Methadone Program: Delegates were introduced to Portugal’s innovative program, which provides Medication Assisted Treatment to around 1,300 residents daily. This program showcases Portugal’s dedication to harm reduction and treatment accessibility.
- Local Non-Profit Organizations: Delegates engaged with staff from organizations providing vital support services to individuals grappling with addiction. These services range from harm reduction strategies to social reintegration programs.
- Commission for the Dissuasion of Drug Addiction: This administrative body is entrusted with enforcing Portugal’s decriminalization law. Their mission involves dissuading drug consumption, promoting health, and fostering accountability among individuals who use drugs.
- Law Enforcement: Delegates met with representatives from the Public Security Police, Portugal’s national civil police force. These interactions provided insights into the role of law enforcement in Portugal’s healthcare approach to addiction.
- Alexandre Quintanilha: A member of the Portuguese Parliament and an author of Portugal’s comprehensive National Strategy for the Fight Against Drugs. This strategy laid the foundation for Portugal’s drug decriminalization program over two decades ago, emphasizing a pragmatic and health-centered approach. It decriminalized drug possession while maintaining control over supply, offering guidance on drug addiction prevention, treatment, harm reduction, and social reintegration.
Historical Delegation
Notably, the Oregon delegation was the largest group of its kind that Portuguese officials had ever received. It comprised a diverse group of participants from various sectors, reflecting Oregon’s dedication to addressing substance use disorder comprehensively. The delegation included:
- Elected officials, including Representatives Rob Nosse and Lily Morgan, Senator Floyd Prozanski, and Senate Majority Leader Kate Lieber.
- Law enforcement representatives, including Sgt. Aaron Schmautz from the Portland Police Association and Detective Scotty Nowning from the Salem Police Employee’s Union.
- Officials from key government bodies, such as Kimberly McCullough from the Oregon Department of Justice, Channa Newell from the Multnomah County District Attorney’s Office, and Chair Jessica Vega Pederson from Multnomah County.
- Representatives from organizations committed to substance use disorder issues, including Monta Knudson from Bridges to Change, Mark Harris from the Oregon Black Brown Indigenous Advocacy Coalition, Shannon Olive from the Women First Transition & Referral Center, and Mercedes Elizalde from the Latino Network.
- Advocates and experts in the field of addiction, such as Janie Gullickson from the Mental Health & Addiction Association of Oregon, Paul Soloman from the Oregon Criminal Justice Commission, and Fernando Peña from the NW Instituto Latino.
- Leaders from advocacy and research organizations, including Andy Ko from the Partnership for Safety & Justice, Morgan Godvin, a drug policy researcher serving on the Oregon Alcohol & Drug Policy Commission and Measure 110 Oversight & Accountability Council, Joe Bazeghi from Recovery Works NW, and Theshia Naidoo from the Drug Policy Alliance.
- Representatives from organizations focused on equity and justice, including Iris Chavez from Equity Action Partners, Tera Hurst, Ron Williams, Devon Downeysmith, and Diana Nuñez from the Health Justice Recovery Alliance.
Valuable Lessons and Common Ground
The delegation’s experiences in Portugal yielded invaluable insights into how Oregon could enhance its approach to substance use disorder. They observed Portugal’s patient-first approach, which has been in practice for more than two decades. This approach aligns with the shared goal of seeing addiction as a public health issue rather than a criminal offense. Portugal’s emphasis on treatment, prevention, harm reduction, and social reintegration strongly resonated with the delegation.
The conversations held within the delegation were equally crucial. They found common ground on the issues that require addressing and identified areas where collective action could bring about meaningful solutions. The complexity of the addiction issue became more apparent, underscoring the importance of working together to tackle it effectively.
Policy Imperatives
This transformative trip highlighted several critical policy imperatives that Oregon must consider in its approach to substance use disorder:
- Fully Funded Treatment Services: Treatment services must be adequately funded and easily accessible to those in need. Portugal’s experience demonstrated that cuts to treatment funding can lead to increased drug use and overdose rates. Oregon is committed to investing in treatment funding and enhancing a public health response to addiction.
- Decriminalization and a Public Health Approach: Portugal’s experience reinforced the importance of decriminalizing addiction and treating it as a public health issue. This approach aims to address the overdose crisis caused by the rise of synthetic opioids, similar to the situation in Oregon.
- Collaboration with Law Enforcement: The delegation observed that law enforcement plays a vital role in building a healthcare response to addiction. Collaborative relationships and mutual trust between law enforcement and other stakeholders are essential for effective solutions.
- System-Wide Integration: Portugal’s approach involves coordination between health officials, addiction recovery providers, state-run facilities, non-profit organizations, law enforcement, and other stakeholders. Oregon recognizes the need for similar coordination at the state level to succeed in addressing substance use disorder comprehensively.
- Discouraging Public Drug Use: The delegation emphasized the need for strategies to discourage public drug use while simultaneously working to guide individuals into services and recovery. Law enforcement should have non-criminal, pre-arrest procedures to address public drug use effectively.
A Call to Action
The insights gained from the Portugal trip have provided a deeper understanding of the challenges posed by substance use disorder and the urgency of taking action. Oregon is committed to advancing real solutions and addressing these challenges with a sense of urgency. The lessons learned will inform the Joint Committee on Addiction and Community Safety, a critical initiative that unites law enforcement, providers, policymakers, and advocates in their efforts to create a more effective, compassionate, and holistic approach to substance use disorder in Oregon.
The delegation’s interactions with Portuguese addiction experts, members of the dissuasion commission, a member of parliament, and various law enforcement officers underscored the critical importance of these policy imperatives. Oregon is dedicated to building out a full system of care, identifying multiple funding sources, and developing policy solutions to address the multifaceted challenges presented by substance use disorder. Portugal’s journey serves as a powerful reminder that no single policy solution can fully address addiction; it requires a comprehensive and integrated approach.