Portugal decriminalized drugs 25 years ago, but the real lesson is what it built around this policy
Providing drug users with clean syringes is part of Portugal's harm-reduction approach to substance use. Horacio Villalobos/Corbis News via Getty Images Nearly 70,000 Americans died of a drug overdose in 2025.
In 2025, nearly 70,000 Americans died from drug overdoses, a decline from the peak of 108,000 in 2022. This figure highlights the severity of the opioid crisis in the US, where the overdose death rate was 68% higher than Canada’s and nearly five times that of Australia. Substance use disorder, or addiction to drugs, costs the US hundreds of billions of dollars annually in healthcare, criminal justice, and lost productivity. These costs do not account for the broader social impact on families and communities. For decades, US drug policy has focused on reducing drug use by disrupting supply chains, punishing possession, and promoting abstinence. This approach contrasts with alternative strategies that prioritize public health and harm reduction, such as Portugal’s model.
In 2001, Portugal decriminalized the possession of all drugs for personal use, marking a shift toward a public health-centered approach. This policy does not legalize drugs but removes criminal penalties for possession of small amounts. Instead, individuals may be referred to dissuasion commissions, which connect them with health or social services or impose minor administrative sanctions. Drug trafficking and manufacturing remain criminal offenses. The policy emerged from a devastating heroin crisis in the late 1990s, where injection drug use fueled one of Europe’s worst HIV epidemics, with overdose deaths rising sharply. By 2000, Portugal had the highest HIV incidence in the EU among people who injected drugs.
Portugal’s approach is built on the assumption that people will use drugs, and public policy should focus on reducing the harms associated with use rather than solely preventing it. This includes providing sterile drug-use equipment to reduce HIV transmission, expanding harm-reduction services to educate users about substances, and operating overdose prevention sites where drugs can be used under medical supervision. These measures do not treat drug use as harmless but recognize that reducing harm is valuable in itself. Keeping people alive and healthy is seen as a first step toward recovery. The strategy also addresses underlying issues like housing and unemployment, which can hinder sustained recovery.
Portugal’s drug policy reform began in 1998 when the government appointed a multidisciplinary commission of experts, including physicians, psychiatrists, psychologists, legal experts, and researchers. Their recommendations formed the basis for a national strategy adopted in 1999, which integrated prevention, treatment, harm reduction, and social reintegration. This strategy was implemented alongside decriminalization in 2001. The policy has remained in place despite financial crises and budget cuts, demonstrating sustained political support. The country continues to invest in healthcare and treatment for people who use substances, addressing social determinants that complicate recovery.
Since adopting its new approach, Portugal has seen dramatic improvements in drug-related outcomes. Drug-related deaths fell sharply and remain low by European standards, with 105 fatal overdoses recorded in 2023, up slightly from 96 in 2022 but far below the crisis levels of the early 2000s. New HIV diagnoses linked to injection drug use dropped from 583 in 2005 to just 19 in 2024, a 97% decline. In 2023, over 24,000 people received care through Portugal’s specialized public outpatient system, which provides medical care and connections to other health and social services. Problematic drug use is increasingly viewed as a health and social issue rather than a moral failing.
Portugal’s model has become an international reference for drug policy reform, but its success depends on factors difficult to replicate. British Columbia, Canada, implemented a decriminalization pilot in 2023 that reduced possession offenses but showed little broader health benefit due to lack of integrated services, funding, and police buy-in. Oregon, US, passed Measure 110 in 2020 to decriminalize drug possession and fund treatment, but implementation suffered from unstable leadership, delayed services, and poor coordination. Unlike Portugal, Oregon failed to secure law enforcement support, and public frustration grew over visible drug use and rising fentanyl deaths. In 2024, Oregon recriminalized possession before assessing the policy’s impact.
Portugal’s experience suggests that decriminalization alone is not enough to reduce drug harms. The most critical lesson is the need to build and sustain an integrated system connecting people with treatment, healthcare, and social support without requiring abstinence as a precondition. This requires political commitment, institutional buy-in—including from law enforcement—and sustained funding. Changing drug laws can support this goal, but the harder work lies in creating the institutions and services that make a public health approach effective. Portugal’s model demonstrates that such a system can yield significant benefits over time.
