Dr. João Goulão has received international attention for the lead role he played in Portugal’s fundamental shift in drug policy. It culminated with a massive investment in treatment options and, in 2001, the decriminalization of illicit narcotics, including cocaine and heroin. In subsequent years, such progressive policies resulted in invitations from around the world.
This morning (September 6), Goulão visited Vancouver for his first time. He began the trip with a tour of addiction and harm-reduction programs in the Downtown Eastside. Goulão said he was shocked by what he saw.
“This concentration, in a single spot, I was not expecting it,” he told reporters who met on the street after he completed his walk around the neighbourhood.
“Even in the difficult ‘90s, when we had a huge epidemic of heroin, the population was quite different from what I have seen here,” Goulão continued. “We cannot compare to the size and the kind of population that you have here. And we are not facing, yet—I hope we will never face—the problem of fentanyl.”
CKNW’s Jeremy Lye asked if he believes Canada’s fentanyl crisis should be declared a national health emergency.
“I really think so,” Goulão responded. “Because of the number of overdose deaths that you are having. It’s a very, very important problem of public health. And so you have to deal with it in a brave way.”
The number that Goulão referred to is expected to surpass 1,500 in B.C. this year, up from 269 fatal overdoses just five years earlier, in 2012.
In an August 28 interview with the Straight ahead of his trip to Vancouver, Goulão cautioned that if Canada were to follow Portugal’s example and decriminalize the personal possession of drugs like cocaine and heroin, it would not solve the problem of fentanyl (because decriminalization leaves supply in the control of organized crime). But he did say that removing criminal penalties for drug possession would be a helpful step.
“Decriminalization is important because drug users will no longer fear approaching [health-care] responders,” Goulão explained. “It would be an important step. Everything is easier in an environment of decriminalization than it is in an environment of criminalization. Of course, it will not solve every problem. But it would constitute a success for drug users and help drug users with responses.”
Speaking outside Vancouver’s Crosstown Clinic this morning, Goulão was obviously troubled by what he saw in the Downtown Eastside, but also said he was “impressed”.
“You have more responses in terms of harm reduction and social support in a square kilometre here than what I have in my whole country,” he explained.
Goulão said he prefers to avoid advising other governments on how to deal with their problems and instead only shares his experience. But he did offer one piece of policy advice based on his work in Portugal.
“There are a lot of responses [in Vancouver] but probably there is a need for a coordination body or something more effective in adding to the potential of these responses, instead of each one working for themselves,” he said. “I am the national coordinator [of drug policy], so I work with representatives of 11 ministers, from justice to social welfare….We meet every month to understand what is going well, what is going wrong.”
In addition to Crosstown Clinic—the only location in North America where heroin is dispensed on a prescription basis—Goulão also visited a new addiction-treatment facility called Connections and Insite, which was the continent's first government-sanctioned supervised-injection facility. He's in Vancouver for the Recovery Capital Conference of Canada, where he's scheduled to present his work in Portugal as the keynote speaker on September 7.
Goulão cautioned he sees no simple answer to B.C.’s fentanyl crisis, but added it was similarly not easy for Portugal to transform how it responds to the challenge of addiction.
“We had a lot of difficulties with the United Nations bodies when we decided to decriminalize,” he explained. “Now, 15 years later, those bodies present Portugal as an example of best practices. So some choices that states decide to have, they must go on with them without fearing reactions.”More