03/23/18 Joao Goulao

Dr Joao Goulao, Portuguese General Director of Addictive Behaviors (Drug Czar) & Asha Bandele of Drug Policy Alliance conference on changing America's drug laws/perspectives.

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MARCH 23, 2018


DEAN BECKER: Hi folks, this is Dean Becker, this week, reporting from the Tivoli Avenida Liberdade Hotel in Lisbon, Portugal. This is Cultural Baggage.

So far this week, I've met with Lucas Wiessing, he's the Chief Scientist for the European Monitoring Centre for Drugs and Drug Addiction. I hope to have that show for you next week, once we get approval. Also been with the Drug Policy Alliance at this conference to learn from the Portuguese, how they stopped arresting so many of their young kids, how they found ways to diminish the violence, the death, the disease, and the attraction to the youth.

I'm here as one of 70-plus attendees, partners if you will, with the Drug Policy Alliance, who have come to learn from good folks like Doctor João Goulão, who's the General Directorate [sic] for Intervention on Addictive Behaviors and Dependences, in essence Portugal's drug czar, the man who designed this system.

In the United States, where the drug czar hides from the Drug Policy Alliance, here, Doctor Goulão came to the hotel and spent the day answering our questions and giving guidance on how we might move forward in the United States.

My radical perspective seems to have caught the good doctor's attention. We had dinner together, lunch together, and tomorrow we'll do our interview for the Drug Truth Network.

To kickstart the day, to rouse these reformers, we have the ever-effervescent Asha Bandale.

ASHA BANDALE: We are the single largest delegation that has ever come to Lisbon, Portugal, to learn about their successful 17 year experiment in drug decriminalization.

It's a little hard to probably explain. We have it all documented somewhere, what exactly it takes to ensure that we have the fullest conversation and see as many places as we can, and learn as much as we can, in the short time we have together.

So, for 13 years at Drug Policy Alliance we've worked together to build a network of aligned organizations to oppose the drug war, to see it in an intersectional frame that includes all people, black, Latino, colonized people, trans people, women, everybody is included because everyone is effected by the drug war.

And so as many of the people you see around the room today, but also to ensure we have the best conversation -- can we have some water? -- we needed to bring into this space as many of our friends from Portugal as possible. And that has happened because of truly one woman. We came to Portugal on November Thirteenth after many discussions with Nuno Capaz, and we came on the ground, and I brought Mariela who had started literally less than two months before at Drug Policy Alliance, and between her and Laini and then Michelle came back on the second visit, we have -- how many guests do we have from Portugal in the room today?

I'll tell you this, all I know is that every day, Mariela said, we just need to invite one more person. We just need to -- so I just turned to Mariela and was like, you know, we only have a certain -- I said do what you need. And so, so much of the magnificence that we are experiencing and so much of the discussion we're experiencing is due to the work that Mariela Alburges has done for us, not even six months on the job. Please welcome Mariela.

MARIELA ALBURGES: So, as Asha mentioned, you know, it's been a long process. A long, beautiful process to get to today. I hope everyone took away a lot from yesterday's site visits. I've been hearing amazing things. I really do want to honor and recognize the Portuguese hosts who actually made that possible.

So, first and foremost, I don't see Doctor -- Doctor João Goulão, which we have been meeting over the last couple of days, just a reminder again, he is from SICAD, the national health ministry. We also have here Nuno Capaz, which we are awaiting. We have Chefe Joaquim Gordicho, who is actually here from the Lisbon Municipal Police Department.

We have here Mister Ricardo Fuertes, who actually previously, not too long ago as of December, used to work with IN-Mouraria, which is again the project that Adriana Curado, our friend, has coordinated, and now he actually is the adviser to the councilman Ricardo Robles, and that's from the municipal offices here in -- right? -- the city council here in Lisboa.

And I'm so delighted to see Mister Luís Mendão. He's actually the executive director of GAT, Grupo de Atavistas et Tratamento, which is actually the larger network in which Inmoredia is housed, and we're so delighted to have you here. Thank you.

Also here are members of Crescer, which is the organization that we met yesterday, with regards to the street team. Absolutely.

DEAN BECKER: For the sake of expediency, I cut out a lot more introductions. Let's get to the heart of the matter.

MARIELA ALBURGES: So, without further ado, I'd like to bring up Asha, as well as Doctor João Goulão, which we will enter in conversation with regards to the historical framework in which the decriminalization legislation was actually introduced here in Portugal.

ASHA BANDALE: To the maximum extent possible, we're going to try to make this like a kitchen table discussion, a very large kitchen table discussion, but one nonetheless. I'm going to talk with Doctor Goulão for just a short period, and we have some people who are going to respond to our conversation, and then we would like all of you to join in as you please with any questions or comments.

And so, what I wanted to do, and just jump right into it, is, you know, when I think about Portugal in a historical context, we understand that Portugal goes, has a revolution in 1974, and within a single generation, it becomes one of the most open countries in western Europe. And I'd like to talk a little bit about that process leading up to how you even created a world where drug, all drug decriminalization could be possible, because in many ways, in the United States right now, we have our own challenges, and need our own revolution, so it would be helpful for us to understand how you undertook that process.

JOÃO GOULÃO, MD: Thank you for organizing this session, and congratulations for finding all the relevant players. Mariela, you -- you did a wonderful job.

ASHA BANDALE: We're just blaming you, we're blaming you.

JOÃO GOULÃO, MD: Yes, because I think you found the -- all the people who can give us, give you an input, an overview, on the Portuguese policies, and I want to thank you also to invite me to join you, it's a pleasure, and an honor, and I hope that you take all the benefits that you may from this visit.

It is wonderfully organized, thank you for inviting me for dinner yesterday, it was very pleasant also. Well, and I would like to -- I briefly tried to start explaining to you yesterday morning. It was almost impossible for us, mostly for my young population, to travel abroad, because at the same time, during the last years of the regime, we were dealing also with a colonial war in the ancient Portuguese colonies: Angola, Mozambique, and so on.

And, all the young population was sent there, against their will, mostly. Okeh? But it was a very democratic process. People from all social groups were sent there. So, it was middle class, upper classes, political class, everybody was sent to that war. And down there, differently from what happened here, in the mainland, drug use was tolerated or even incentivated, a little bit like the Americans in Vietnam, you know? To keep people -- mind, with their minds occupied with other kinds of things.

Whiskey was cheaper than water --

ASHA BANDALE: Say that again. Whiskey was cheaper than water.

JOÃO GOULÃO, MD: Yeah. Yeah. And cannabis was broadly available, and everybody -- and it was tolerated, nobody would do -- repress their usage. Suddenly, in '74, as you said, the Twenty-Fifth of April, we had our Carnation Revolution, the democratic revolution, with a sudden explosion of openness to new things.

Shortly after we had the decolonization process, we had the return of soldiers and sailors, coming from those colonies. One million people came back to the mainland, suddenly, bringing their habits and bringing literally tons of cannabis, of grass, that suddenly was available for everybody. For us, who were living here, there was a kind of an extreme curiosity to those new things.

We started to travel abroad. I was 20 at the time, so, the revolution was in April. In June, I was taking my bag and traveling through Europe for the first time. I had never crossed the border. And, we became fashion, so, young people from all over Europe and other parts of the world started to visit us, so there was a huge explosion on those contacts.

Of course, for us, who were living here, the new contact with substances that we were -- we did not know before, started to be broadly experimented. Right? And shortly after, other people, other organizations, let's call them criminal organizations, brought into our territory all the other substances. So suddenly we had everything: heroin, cocaine, LSD, you name it, in a completely unprepared society to deal with it.

ASHA BANDALE: Was there a vibrant health structure in Portugal at that time, health infrastructure?

JOÃO GOULÃO, MD: No. No. No, it was a new issue, popping up, so we had no responses for that. But, still in the '70s, in the late '70s, the first responses were built. As I said, it was completely cross-cutting our society. Everybody was experimenting, from all social groups, and one of those groups was the political group, and I must say that, it's not a secret, by that time, a doctor of our Ministry of Justice died from overdoses.

And we decided to build, to create, some responses on prevention, on treatment, and this is problematically in my view, they were installed under the Ministry of Justice, even if they intended to address health problems. Right?

ASHA BANDALE: So, I'm just, to understand, when the first attempt at forming a response to drug policy, it was still located in the Ministry of Justice. It doesn't begin in the Ministry of Health.


ASHA BANDALE: Say how we began to move to the --

JOÃO GOULÃO, MD: So then -- so those three centers in the main cities, Lisbon, Porto, and Coimbra, were created, still in the '70s, in the late '70s, and then for a while, nothing else happened, because at the time when private responses popped up everywhere, some of them quite [unintelligible] that are still present. Ares do Pinhal, who runs the vans of methadone, for instance, were created at that time.

But, mostly those responses were very problematic, even in terms of human rights respect, and some exploitation of problematic drug users.

ASHA BANDALE: Can you say more about that? In what ways they were problematic initially.

JOÃO GOULÃO, MD: Yes. Some clinics were very, very expensive, and for instance they had some kind of practices, such as, okeh, you come here, I invite you, come here for us, and you pay at the beginning six month's of treatment. So if you leave in the next day, the money's already here, so pfft. And, --

ASHA BANDALE: What about -- what about police responses in that period?

JOÃO GOULÃO, MD: Well, the state was in fact very much focused on other kind of issues in our society. But, of course, there was, the law was repressive, inspired in the laws that we could find in other parts of Europe. And the focus was very much on repression. Right?

So, but then, for a while, nothing happened at the level of the Ministry of Health, and it took until '87, through the creation of Taipas Center, that you visited yesterday. It was the first big center under the Ministry of Health to be created in Portugal.

From that, it was a powerful center with some dozens of psychiatrists, psychologists, social workers, a multidisciplinary team, offering outpatient work, but also inpatient, an inpatient clinic for detoxification from heroin, an emergency room, a day center. It's quite comprehensive.

And since then, we started to build, under the influence of the leaders of Taipas, we started to create a network of centers all over the country.

ASHA BANDALE: And, were these, when you started doing that, Doctor Goulão, those were free, unlike the other ones, where they were paying upfront, these were for all intents and purposes treatment as asked, as required, or on demand?

JOÃO GOULÃO, MD: Yes, yes. The attempt at that time is to offer treatment to all those who seek for it. Okeh? Taipas was very rapidly submerged with the people coming from all over the country, so the leaders of Taipas, Nuno Miguel, Luis Patrício, Rodrigo Coutinho, who probably you met also, I don't know, Mariela, Rodrigo from Xabregas.

ASHA BANDALE: Mariela's met everybody in Portugal, there's not a single Portuguese person Mariela doesn't know.

JOÃO GOULÃO, MD: Well, they started to look around, to the provinces, searching for professionals that could join, and help them to deal with the problem down there. So, that's when I come in. I'm a family doctor. I worked in the Algarve at that time. And I had no preparation to deal with addiction problems. But my families, my patients, started to come to me seeking for help and orientation towards treatment. I had no preparation, as I said. I came from the university without knowing anything about it.

But I tried to be useful, to be available to deal with it. And those leaders from Taipas located me there and they invited me to come for training, which I did. I came for six months for Taipas and then I went back with the capacity of creating a new center in the Algarve.

And what happened with me, happened with colleagues from all over the country. We started to build those small centers, like antennas of Taipas, on the periphery cities. In 1990, a service under the Ministry of Health was created to coordinate all those services, that was SPTT, service of prevention and treatment of drug addiction, and under that service, all those, Taipas and the other new centers, and the ones that were created under the Ministry of Justice, were put together, with national coordination for it. Okeh?

ASHA BANDALE: So, oh, so they all came under the Ministry of Health, because I think that, you know, what would be interesting to think of, you know, like, this is, you're having all the centers and it seems proactively addressing the needs of people who are struggling with addiction. Why was the need, or what precipitated the need to actually decriminalize, because I think in the United States, there are many, and perhaps not necessarily in this room, but generally in the United States, people would agree that people should have treatment if they need it.

I don't know that people would agree that you need treatment and to decriminalize all drugs, and so, how is it that we make that shift in this society?

JOÃO GOULÃO, MD: Okeh. It came a little bit later. So, as I said, we started to develop a network of services, offering treatment to all those who needed it. But we started to clearly identify the need of a clear guidance to address those problems, because it was quite chaotic, you know, some responses were moving in one direction, others in a -- there was huge pressure from official responsibles about prevention, for instance.

As you know, politicians love to see media campaigns, TV spots, and so, and we were spending lots of money in campaigns which were completely ineffective. You know? Yeah, they were more or less terroristic, such as, drugs, death and madness, or something like that.

ASHA BANDALE: Sort of like reefer madness, and your brain on drugs, yeah, we had that too.

JOÃO GOULÃO, MD: So. On the other hand, even -- the main problems that we were facing at the time were related to heroin use. Okeh? Because people -- well, while other societies have the capacity to deal with the presence of substance use among them, we were completely unprepared. And shifting from cannabis to others was facilitated by the lack of knowledge about drugs.

So, there was a huge number of people that started using mostly heroin, and we reached the incredible number of, we are ten million people, more or less stable, and we reached the number of, we estimate, one hundred thousand people hooked on heroin, which is one percent of our population.

It was almost impossible to find a Portuguese family that had no problems with it. So it became a major social problem, and also of course a major political problem. Okeh? So, we had -- HIV just came along to complicate things. So, we started to have huge numbers of HIV infections. We started to have overdose deaths, every day. We reached the number of more than 365, one overdose death a day.

At that time, also criminality, we never had a big and violent criminality related to drugs. But, the small petty crimes, acquisitive crimes, were -- we had a very present social nuisance, where also identified as one of the problems. So it became a major political problem. Even about treatment, and even among professionals, we could not agree about the use of methadone, for instance Some doctors were very much in favor of it, but others opposed very violently, you know?

ASHA BANDALE: And just for some of our friends in the room who are not as familiar with methadone, methadone is really considered the gold standard treatment for people who are looking to come off of heroin, and so just to make people aware, because I know we have some journalists in the room who may not be as aware. So you don't actually get high, but it does remove the symptoms of withdrawal, which can be devastating.

JOÃO GOULÃO, MD: Yeah. So, but there was a discussion among professionals about the use and the legitimacy of using that kind of substitution treatment, you know? And the same about harm reduction, for instance. We were pioneers on syringe and needle exchange, because when the responsible for the fight against AIDS here in Portugal was a former researcher of HIV Two type virus. She became the responsible, and she installed a syringe exchange program based on communitarian pharmacists, which was quite innovative at the time, in '93.

But, even among professionals, it was quite strange, okeh. How can I, acting as a doctor, in the name of the state, the same state that criminalizes drug use, provide the tools to the user to keep on committing the crime? You know?

So, it was a strange contradiction. So, by the end of the '90s, in '98, the government, we had huge discussions with the political responsibles about how to deal with it. I had become the responsible for the SPTT, the treatment coordination, in '97, and in '98, the government who's prime minister was at the time the current Secretary-General of the United Nations, António Guterres, invited a group of experts to prepare a strategy, because we needed in fact to reflect and to have a clear guidance.

So, they invited a group of people, nine people, among whom I was included, with some psychiatrists, judges, well, different people. We had all the means to visit other places, to see in place how other countries were dealing with the problems. We visited Switzerland, Germany, the UK, Spain, so then we made our proposals.

The report, a snapshot on the situation of the country, and proposals on the supply side, okeh, but mostly in the demand side. Prevention, treatment, harm reduction, reintegration of people. All that rest in the idea that we were dealing with a health condition, health and social condition, rather than a criminal one.

And, according with that, we proposed the decriminalization of -- I must say, that when we were invited to build that strategy, the only framework, the only boundary, that was put to us, was, okeh, you must, you may propose whatever you want, but you must keep in line with United Nations treaties. Okeh? That, as you know, impose a prohibitionist paradigm.

ASHA BANDALE: There's something that you said that I also want to underscore for our American delegation, is, that was so important, right, that there was a fundamental contradiction between seeking to provide a service for someone and also having to function as law enforcement.

And so we see that in the United States, whether it's the people who work in social services, in many ways, and we'll discuss this later, with Dionna King, one of our colleagues here, in many ways, how the very social service systems that are supposed to be empowered to strengthen families, help people, are actually acting as agents of law enforcement, whether they are teachers in school, whether they are social workers, and sometimes even when they are legal defense attorneys.

So it's just a very important, I didn't want us to miss that point, but I know that there had to be some pushback internally and externally, and I also know that there are challenges that you face today, and I wonder if you could talk with us a little bit about that.

JOÃO GOULÃO, MD: Well, so, the -- that strategy that we were built -- was built in '98, proposed several new ways to address all the problems, but it was a complete package, with -- including the proposal of decriminalization. The government took and approved that strategy, but the issue of decriminalization had to be discussed at the Parliament. Okeh? That happened, one year later, in 2000.

Meanwhile, after the approval of the strategy and the Parliamentary discussion of decriminalization, we organized a huge number of public discussions with the community very much participating, and what I keep from that period was the huge support, social support, completely cross-cutting, of the idea of decriminalization. Okeh?

When it came to the Parliament, things were a little bit different. But I believed that that social support came from the fact that it was almost impossible to find a Portuguese family that had no problems with drugs. So, people tended to say, okeh, my boy, he's not a criminal. He's someone in need of help, but he's not a criminal.

So, the social support was very much present. As to the discussion at the Parliament, things were a little bit different, because we had the bipolarization, left wing parties supporting the idea, right wing parties opposing, and saying, oh, the United Nations, they are going to blame you. Oh, Portugal will become a paradise for drug addicts coming from all over the -- all over Europe, we will have planes coming to Lisbon every day. Oh, our children will start using drugs with the milk bottle. That kind of arguments, you know?

So, but, in fact, of course, it didn't happen. But, we knew that we had to do it right. Okeh? I must also say that, in the next few years, in 2000, came into force in 2001, but in 2002, United Nations bodies came here to inspect and they were very critical. Oh, shame on you, you did it. We had changes in our government, so a right wing government came shortly after. But, the government resisted to the pressure, and did not reverse that measure.

And since then, we started to have quite good results in our policies. We manage to provide treatment to all those in need of it, and --

ASHA BANDALE: Did you find the decriminalization made people feel less stigmatized and able --


ASHA BANDALE: -- to --

JOÃO GOULÃO, MD: Yes, of course. We still have problems at that level, but I think it contributed a lot to lower the stigma of drug related problems, and drug related -- drug users. It became, for instance, it became easier to find jobs for people who had problems with drugs. We created even a program of positive discrimination towards employment. Okeh? So, facilitating the access of former drug users to employment.

So, facilitating the access of former drug users to employment. And it's contributed a lot to the inclusion and to lower the stigma of drug users.

ASHA BANDALE: Let me -- you know, of course, I've had the benefit of having private conversations and so some of the things you've said have been very interesting to me. I want to ask you one more question, and then we have a number of people in the room that I'd, you know, like to give us some feedback as we open it up for discussion.

Right now, with any number of incredible indicators, young people using drugs has actually gone down. Right? Drug use in general has remained relatively flat, it certainly hasn't gone up. HIV infection among people who use drugs, or who are intravenously, is the lowest in the European Union. Is that right?

JOÃO GOULÃO, MD: No. No. Unfortunately, no. But, if you consider three groups: injecting drug users, heterosexuals, homo/bisexuals, if you consider it, IDU were the champions of infection. Now they are the lowest of those three contingents. Okeh? But, the figures in general are still very high.

ASHA BANDALE: And is it -- and also, is it true that drug arrests in general have dropped by something like at least twenty percent with -- of that number, more than forty percent are never referred to criminal court. Is that, yeah?

JOÃO GOULÃO, MD: Yes. Yes, as, I believe, briefly explained yesterday, there's a threshold above which people are sent to the criminal system as before, but most of drug users are referred to the Commissions for Dissuasion of Drug Addiction, which act under the Ministry of Health, so all those procedures tend to facilitate the access of the people to the responses they need, that are most adequate to their needs.

ASHA BANDALE: Yeah, but, with all these successes, I know that there are places you still want Portugal to go, and still things that you would like to see have happen, and so I, before we -- as we turn to our audience, would you talk a little bit about if there were a few things that you would love to see happen during your tenure?

JOÃO GOULÃO, MD: No. We have to fine tune, to new targets, every day. Okeh? So, we had a youth challenge, we did the heroin epidemic, which I may call it so. But, nowadays, we face other challenges. NPS, we look around and we see the huge problems that fentanyl is causing in other societies. We still do not have big problems related to that, but we must prepare, because they are going to come to us in the near future, I'm sure.

We had some -- there are some things that are, I feel, that was not very well prepared, or we didn't anticipate what could happen with that program of employment, for instance. You know, we had the capacity to find jobs for seven thousands people, but the main employers in this positive discrimination program were micro companies. Okeh? They could accept people, and employ people, under this program. But when the financial and social crisis came into our country, those micro companies closed by the hundreds.

So people went back to unemployment, and we had a lot of relapses related to that. People, they had a house of cards in their lives, okeh? And when it dropped, we had a lot of relapses So, this poses a problem of sustainability, when we organize this kind of response. You know?

ASHA BANDALE: And, I know in the immediate, you're looking to make -- we had a -- when we were out with Junior yesterday and Marta, Marta, it was almost painful to watch her retell a story of witnessing an overdose death. She's witnessed three overdoses in the country since she's been doing the work for two years or so. Two were successfully prevented, but one person died.

And some of that has to do with a lack of wide naloxone access, and I wonder if Portugal is responding to that, and would you say more?

JOÃO GOULÃO, MD: Well, naloxone, until now, is only available in emergency services, ambulances and emergency rooms. But, in the last few months, the new presentation of nasal naloxone has been approved by the European agency of medicines, and has been presented to the Portuguese agency. I met them, the direction of the Infarmed, our medicines agency, and we, I think, we can be able to start the distribution of nasal naloxone to the street teams and to other harm reduction teams that act in our cities, in the very near future, probably in June, we can start that program.

In a second step, probably we will introduce naloxone and make it available for families, for peers, but first step will be to start with the street teams and other harm reduction facilities.

ASHA BANDALE: Doctor Goulão, I'm going to begin to bring in some of our colleagues, but as I get up do that, please share your thoughts on legalization as well, and whether or not all drugs should be legalized.

JOÃO GOULÃO, MD: Well, let me tell you, Asha --

ASHA BANDALE: Just a question.

JOÃO GOULÃO, MD: I am very pleased to speak very freely about all those issues, but I cannot forget that I am the Portuguese responsible for drugs policies. My thoughts about the issue are not very relevant. So, what I have to transmit to you is the official position, which I helped -- I contributed to build, and that was built and discussed at the ministerial level, including the Foreign Affairs Ministry, and the position is what follows.

Portugal pioneered this movement towards decriminalization, but we are still within the prohibitionist paradigm. Okeh? When we decided it, we were facing a very complicated situation, a very devastating situation. We had the pressure to make something new, at any cost. Okeh?

That is not the case nowadays. We -- we acted as a social laboratory. Okeh? And we have results to show. Nowadays, there are a new paradigm going on. There are some social laboratories acting. You can see some, United States states, you can see Uruguay, you can see new experiences, and the official position is we will wait for some results, some evidence that, first, drug use and drug problems are not going to increase in this new regulatory paradigm. What is going to be the impact among youngsters? What will happen?

And I believe that we still have some time to watch that. Portugal will probably consider, and discuss, the new paradigm, but not immediately. We do not feel the need of being in the forefront of those policies, you know.

ASHA BANDALE: You stepped out enough already, so let someone else do it first. I said, you stepped out enough already, we'll let somebody else do it first, so they'll -- it's interesting, and I'm going to bring Patricia into the conversation. There's some emerging evidence that would tell us that in the states, in the United States, where we've legalized marijuana, heroin and opiate overdoses have actually declined. So it's just -- just, they're emerging, but Patricia, let me bring you into the conversation.

PATRICIA: Sure. Thank you so much for -- for all of your time and what you've offered us. One thing that has been really sort of fascinating to me, and thinking about the way you've structured things, is the move into the Ministry of Health. Our criminal justice system is so invasive that, you know, our group, when we visited the Dissuasion Commission, kept coming back to, like, but, so after the fourth time, then you put them in jail?

Right, like we just could not comprehend that like, nope, it's just under the Ministry of Health. The criminal justice system does not come back into it, and in the United States, I mean, I think it's difficult for us to even conceive of really moving this entirely out of the criminal justice system, moving into a totally non-court based system, into this dissuasion commission under the Ministry of Health, and so I mean, that's something that I think is really, sort of, fascinating for us.

Oh, slow down. I'm sorry.

ASHA BANDALE: Did you want to respond? Is that mic on?

JOÃO GOULÃO, MD: I -- I apologize, but I had some difficulties in understanding the question, because, you were speaking so -- there is a question, or just a comment?

PATRICIA: Oh, it was just a statement.


JOÃO GOULÃO, MD: A statement, yeah.

ASHA BANDALE: And so -- and we'll also remind that with the translation, perhaps, speaking a little bit slower than we typically do might be helpful, but I also want to bring Juan Cartagena into the conversation. Juan runs Latino Justice, located in New York City, but has national impact, and is a long time organizer, and one of my mentors in the field, not just for -- in drug policy but in criminal justice reform and in racial justice. And so, Juan.

JUAN CARTAGENA: Sure. Bom dia.


JUAN CARTAGENA: First, let me start, Doctor Goulão, muchisimas gracias, many thanks to you, to everybody here, from Portugal, to spend time with us. We are -- speaking for myself, I am honored to learn from you. So thank you. Obrigado.

I want you to help me understand, because in our country, we deal every day with issues of the treatment of marginalized people, the treatment of minorities, the racial treatment of -- in a country that has been struggling with race for a long time. And I want you to help us understand some basic things. As you were considering decriminalization, and even today, to what extent does the pueblo, the population, have perceptions, real or unreal, that drug use is associated with certain people in Portugal? Certain national minorities, certain people from the former colonized places.

You mentioned how the country in the '70s was conscripted into military service, and then when they were in these wars in the colonies, they were exposed to drugs. In the United States, of course, drug use long, long before Vietnam, but if the perception is that drug use was associated with those countries, how is that manifested today, and how did it play into when you were discussing decriminalization? Were there any barriers that were created that you had to knock down to fully accept decriminalization, when we have perceptions or even selective law enforcement for certain groups and not others?

ASHA BANDALE: Thank you, Juan.

JOÃO GOULÃO, MD: Well, I believe that the way -- once again, yesterday, I tried to briefly explain the importance, when established -- when the law of decriminalization was built, the importance of having an objective limit avoids very much of the discrimination that can happen if you do not have a limit. You can discuss the limits, and I, and the amounts that are included in our law, but having that evidence, and we have a police officer here, which I, I would like also to thank you, thank you for your presence.

Having an objective limit avoids some discrimination. If you do not have a limit, okeh. Using drugs is not -- is not a crime in other countries. As I said yesterday, in Spain, they never criminalized drug use, so they did not have to decriminalize. But they do not have an objective limit.

In practice, if someone is caught using drugs in a public place, goes to the police station, and if he's good looking, good family, is well dressed, probably will be sent in peace, as a drug user. Okeh. If he's dirty, Gypsy, black, whatever, probably will be charged as a trafficker.

Having that limit, I believe, is important in our model, because it avoids that -- that the police officer has to act as a judge in place. No? And I believe that these limits -- these limits and the way that decriminalization has been operationalized contributes to lower the stigma of the drug users, whatever group or whatever origin they have. Okeh.

ASHA BANDALE: Thank you, Doctor Goulão, it's interesting just for those of us going backc to the United States. It's something to think about, because even in the case of selective policing, there's an intervention that can be put in place, and in New York, you know, we see the same thing. One black person could have a certain amount of drugs, one white person could have, and one person is charged with possession, and the other is charged with possession with intent to sell because there isn't that threshold, there isn't that objective limit, that is actually determined often by the assistant district attorney.

So how someone's going to be designated. I'm going to bring Nikos Leverenz into the conversation, my longtime colleague. I started at DPA with Nikos when we were four years old in 2005, and Nikos is now a board member of the Drug Policy Forum of Hawaii, and flew 22 hours to be with us. Let me bring you in.

NIKOS LEVERENZ: Good morning, thank you for being with us, not just you, but all of you here. America's drug war is a human rights disgrace, and the drive to mass incarceration over the past 40-plus years, basically since Jim Crow, is -- it -- there's not enough awareness in the larger population in America about, you know, the injustices that are perpetuated, particularly on low income communities of color.

To what extent is drug use, or, and drug policy, talked about in sort of a social justice context? What -- when I was thinking about the, the 1974, were there particular values, were there particular themes, that reformers in the late '90s hear, kind of referred to? You know, the spirit -- what was the spirit of '74, that would sort of manifest in decriminalization?

And, for me, it's fundamentally about giving people, you know, a fair shot at life. And, nobody is given a fair shot at life if they're involved in the criminal justice system, for decades, and the impact of being involved in the criminal justice system precludes them from educational opportunities, from employment opportunities, housing, and often even having their children taken away from them.


NIKOS LEVERENZ: So. Thank you.

ASHA BANDALE: Thank you, Nikos, and -- and so I'm going to ask you to raise your hands high so I can take a cue, I saw Susan Burton, I see Reverend -- no? Okeh, Reverend Cribbs. Is there anybody else who had? Dean. My brother right here, I just -- I see you and I just don't know your name. Luis. I see Troy. Marta, and Alex, and can somebody give me a time check? And, my brother, what's your name? Santamaria. And how long -- how long of a session do we? How long can we go today? How long can we go this morning?

VOICE: [inaudible]

ASHA BANDALE: Well, didn't we start a little late today?

VOICE: [inaudible]

ASHA BANDALE: Okeh. Oh, okeh, so we're only half an hour behind, with one, two, three, four, five, six, seven, eight questions. So no pressure. So, I'm going to -- so, we're going to ask to capsule, and, to get the questions in as quickly as possible.

VOICE: Thank you very much, doctor, for being with us this morning. I was struck by your earlier statement about living in a drug free society, and then suddenly there was the presence of heroin. I come from a community that was drug free until 1968, and suddenly there was heroin. Do you have any sense, idea, the source of the drugs that suddenly appeared here in Portugal, and in your observation, from drug free to drug infested, what was the source?

ASHA BANDALE: Did you want to answer that, Doctor?

JOÃO GOULÃO, MD: Yeah. I think it's the same kind of routes that other European countries had. Most of the lost origin for drugs coming to the Portuguese market was through the Netherlands, for instance, but the origin were the Balkans, really, at the time. So, I'm not -- I'm not sure of the origin at the time, but the big, the big source of heroin coming to our market were -- was the Netherlands, at the time.

Through -- how it arrived that -- there, I don't know exactly, how it was.

João Goulão

DEAN BECKER: Suddenly, it was my turn at the mic, and I got a chance to ask my question of Doctor Goulão.

Doctor Goulão, last night, you told me to come up with the most difficult question I can. Nico was talking about it. About -- almost a hundred years ago, a gentleman named Harry J. Anslinger convinced the United States that it was the moral thing to do to have this prohibition. He took that thought to the United Nations, and it became global policy.

My question to you, sir, is, given the fact that this drug war empowers terrorists if they're brave enough to grow flowers, enriches barbarous cartels, it creates violent gangs that prowl our neighborhoods, and I would ask you, sir, given the fact that the morals seem to indicate that it is failing in so many ways, including increasing numbers of overdose deaths, wouldn't the moral thing be to end this prohibition, and let Merck and Pfizer make the drugs rather than criminals who put in contaminants that are killing our children?

All right, now, I hate to do this to you, but to get the answer from Doctor Goulão to this question, you're going to have to tune in to next week's program. As this week's program begins its roll out around the nation and up into Canada, I'll be in Switzerland, Zurich to begin with and then going to Bern, going to interview the founder of their heroin injection facilities, and I'm going to take a couple of days to just be a tourist, but I'll be producing Drug Truth Network programs for you guys.

And I want to say this: The people of Lisbon have been amazing. They know just enough English to help you get around, and get done with what you're doing. They're good folks at the European Monitoring Centre for Drugs and Drug Addictio, were so kind to me, they held a little seminar, I gave a speech there, hopefully if they approve it you'll be hearing some of that next week as well.

But in general, things are a lot better here. There is not this drug war fervor, there is not this need for the cops. I talked to the police chief and the commissioner here in Lisbon, and they were appreciative of the fact that I was informing them of the horrors of the US drug war, and it gives them a new insight, a new means to maybe help us move away from our draconian and miserable drug war.

I've got to wrap it up, but just know this: I love you guys. I wouldn't be doing this, putting in these hours, if I didn't. And again, I remind you, because of prohibition in the United States, you don't know what's in that bag, and I urge you all to please be careful.

Dean Becker Wants YOU to Call the Drug Czar