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When the drugs came, they hit all at once. It was the eighties, one in ten residents slipped into the deep of heroin addiction—bankers, university students, carpenters, socialites, miners—and Portugal fell into a panic. I met Pereira three decades later. He was sprightly and charming, with a trim athletic build, thick wavy white hair that bounced when he walked, a gravelly drawl, and a seemingly bottomless reserve of warmth.
It had long been his way. A general practitioner can get to know his community of patients fairly intimately in a small town. His wife, an educator, came to know generations as students or parents at the local schools. Local headlines terrified with news reports of overdose deaths, of rising crime. Portugal morning blonde treat the national average meant one in every one hundred Portuguese was battling a problematic heroin addiction at that time, the was higher in the south. He described how desperate patients and families began beating down his door, terrified, bewildered, begging for help.
To be fair, back then nearly everyone in the country was ignorant. First, in a literal sense: the authoritarian rule of Salazar, whose forty-year regime died a few years after he did inhad suppressed education, thinning out institutions and lowering the minimum legally required schooling level to the second grade in a strategy to keep the population docile. Coca-Cola was banned under his regime, and owning a cigarette lighter required a. When marijuana, then heroin, and then other substances began flooding in, the country was utterly unprepared.
Pereira tackled this growing wave of addiction the only way he knew how: intimately, and one patient at a time. The twenty-something student who still lived with her parents might have her family involved in her recovery; the forty-something man, estranged from his wife and living on the street, faced different risks and needed other support. Rather than being arrested, those caught with a personal supply might be given a warning, assessed a small fine, or sent to have a Portugal morning blonde treat with a local dissuasion commission—a doctor, a lawyer, and a social worker—about treatment, harm reduction, and support services available to them.
A bold stance was taken, an opioid crisis stabilized, and the ensuing years saw dramatic drops in problematic drug use, HIV and hepatitis infection rates, overdose deaths, drug-related crime, and incarceration rates. HIV infection rates, for example, plummeted from an all-time high in of The data from what is now a decade and a half of largely positive have been studied and held up as example, and have given weight to harm-reduction movements around the globe.
In many ways, the law was merely a reflection of transformations that were already happening in clinics, in pharmacies, and around kitchen tables across the country. The language people used began to shift, too. The Portuguese opioid addiction epidemic was contained, not made to disappear. The consequences of the eighties and nineties weigh heavily today, as the oldest generation of chronic users and ex-users grapple with complications that include hepatitis C, cirrhosis, and liver cancer. The long-term costs of problematic drug use are a burden on a public healthcare service that is still struggling to recover from a recession filled with cutbacks.
Many Portuguese harm-reduction advocates have been frustrated by what they see as stagnation and inaction; they criticize the state for dragging its feet on establishing supervised injection sites and drug consumption rooms, for not making the anti-overdose medication naloxone more readily available, for not implementing needle exchange programs in prisons, and for not demonstrating the same bold leadership that led the country to decriminalize drugs in the first place.
In the U. Overdoses are now the leading cause of accidental death, and the leading cause of death period for Americans under fifty, with prescription drugs and the synthetic opioid Fentanyl to blame for much of the horrific jump. More than a quarter of global overdose deaths happen in the United States, according to the most recent UN World Drug Report, with an overwhelming fifty-nine thousand overdoses recorded just last year.
Families and communities are being ravaged, as they were during a wave of heroin and then crack addiction in African-American communities in the s and s respectively—epidemics that were largely demonized, criminalized, and untreated. Drugs were called evil, drug users called demons, and proximity to either was criminally and spiritually punishable. Treatment approaches and experiments sprang up throughout the country as doctors, psychiatrists, and pharmacists worked independently to address the flood of drug dependency disorders piling at their doors, sometimes risking ostracism or arrest in order to do what they hypothesized was best for their patients.
His efforts earned him vicious public backlash and the insults of his peers, who considered methadone therapy nothing more than state-sponsored drug addiction. In Lisbon, Odette Ferreira no relation to the authorthen a sixty-something pharmacist and pioneering HIV-2 researcher, took on death threats from drug dealers and legal threats from politicians when she started an unsanctioned needle exchange program to address the growing AIDS crisis.
Along with clean needles, she brought in washing machines; collected and distributed donated clothing, soap, razors, condoms; and gave out fruit and sandwiches. He sent a few people for inpatient treatment there, hoping that time away from their dealers and triggers would help their recovery. Initially, the focus there was on abstinence. To get around that—and to avoid the wrath of the psychiatrists at Taipas—Pereira sometimes asked a nurse to sneak methadone south in the trunk of his car. Pereira relished that great Portuguese tradition of self-deprecation, and performed it with gusto.
Tourist dollars and plentiful fishing made scoring dope easy, and the young doctor struggled over how to treat the addicts who began pouring in daily, looking for help. Like Pereira, he ended up specializing in drug addiction treatment by accident.
It had become apparent that the response to addiction had to be as personal and rooted in communities as the damage it was causing. The resulting recommendations, including the full decriminalization of drug use, were presented inapproved by the Council of Ministers inand a new national plan of action went into effect in He has been the lodestar through eight alternating conservative and progressive prime ministers, through heated standoffs with lawmakers and lobbyists, through shifts in scientific understanding about addiction and in cultural tolerance for drug use, through brutal Eurocrisis austerity cuts, and through a delicate global policy climate that only very recently became slightly less hostile.
He travels almost nonstop, invited again and again to present the successes of the national harm-reduction experiment he helped birth to curious, desperate authorities from Norway to Brazil. He found the practice of jailing people for taking drugs to be counterproductive and unethical. Every family had their addict, or addicts. My parents first left Portugal for Angola in the early seventies.
Salazar was still president, my big brother still a wriggling baby, and it would be another decade and an additional transcontinental move to Canada before I came along. Our parents brought us back for summertime visits every five years or so, adamant that my brother and I connect with our vast extended families, and that we touch the mountainous rock and soil of the northern villages that held our roots. Their once-vivid hope that we immigrants would return home grew fainter as the years passed.
The word, heavy with that classic Catholic cocktail of judgment and pity, weighed on both sides of the family. Before the drugs, the hills were filled with the rumble of trucks carrying hefty blocks of granite from any one of the quarries scattered throughout the region. The quarries had long since closed, though. The jobs left with them. Most working-aged men followed, scattering from their families in search of work in Spain, France, Abu Dhabi, Angola. Some of those who stayed turned to heroin. I remember when, decades later, the heaviness began to lift. On a walk with my grandmother a few years before she passed, high in the eucalyptus- and pine-fringed footpaths in the hills above her mountain home, she said what a relief it was to be able to walk without fear of being mugged.
This was where the drogados used to come to smoke their drugs, she said, their used foils discarded throughout. The only smoke in the air now was from nearby forest fires, a lamentably regular summertime phenomenon. But in fact, the inverse happened. Months later, one neighbor came to Pereira for forgiveness. The CAT building itself is drab, brown, two stories, with offices upstairs and an open waiting area, bathrooms, storage, and clinic areas down below. The front doors open every morning atseven days a week, days a year. Patients wander in throughout the day for appointments, to chat, to kill time, to wash up in the toilets, or to pick up their weekly supply of methadone doses, biweekly if they live farther away.
Anyone receiving methadone treatment elsewhere in the country or even outside of Portugal morning blonde treat could easily have their prescription sent over to the CAT, making the Algarve an ideal harm-reduction holiday destination.
Sending patients to other countries, however, could often be trickier. They had a hard time sending methadone patients to France sometimes, the nurse said. Depended on the region. Spain was easy. Pereira turned away from the methadone bottles to face me. The question gave me pause. My first solo trip, inwas also the first time I reported on drug decriminalization. Back in Portugal once more, I wanted to have a closer look at what he meant. I spent weeks crisscrossing the country, visiting community-based programs that nurtured personal connections as a form of harm reduction, accompanying psychologists who spent day after Portugal morning blonde treat seeking out vulnerable users who would much prefer to stay hidden from the outside world.
I drank coffee with users and activists from families that redefined the meaning of love and loyalty in order to stay together, and sat and listened in small towns that were still in the process of shedding shame and healing the wounds from several long, hard decades. These conversations flipped what I thought I knew about addiction on its head.
In vibrant Lisbon I spent my afternoons at a drop-in center called IN-Mouraria, in a lively neighborhood and longtime enclave of marginalized communities that was rapidly gentrifying. Between and p. A staff of psychologists, doctors, and peer support workers—themselves former drug users—offered clean needles, pre-cut squares of foil, crack kits, sandwiches, coffee, clean clothing, toiletries, rapid HIV testing, and consultations—all free and anonymous.
Rosy-cheeked youth stood around waiting for HIV test while others played cards, complained about police harassment, tried on outfits, traded Portugal morning blonde treat on living situations, watched movies together, and gave one another pep talks.
They varied in age, religion, ethnicity, and gender identity, from all over the country, from all over the world. When a slender, older man emerged from the bathroom, unrecognizable after having shaved his beard off, the energetic young man flipping through magazines to my right threw up his arms and cheered. Both had been longtime drug users, and they understood the language of the people who came in to see them. Failure was part of the treatment process, he told me. And he would know. He had stopped doing speedball after several painful, failed treatment attempts, each more destructive than the last.
He had long smoked cannabis as a form of therapy—methadone did not work for him, nor did any of the inpatient treatment programs he tried—but the cruel hypocrisy of decriminalization meant that although smoking weed was not a criminal offense, purchasing it was. He had already rebuilt his life after his last relapse years prior: after he and his wife temporarily split, he found a new girlfriend, got a new job, and started his own business, at one point presiding over thirty employees.
But then financial crisis hit. In the mornings, I went out with street teams to the crusted extremities of Lisbon. I met Raquel and Sareia—light of step, soft of voice, slender limbs swimming in the large neon vests they wear on their shifts—who worked with Crescer na Maior, a harm-reduction NGO. Six days a week they loaded up a large white van with drinking water, wet wipes, gloves, boxes of tinfoil, and piles of state-issued drug kits: green plastic pouches with single-use Portugal morning blonde treat of filtered water, citric acid, a small metal tray for cooking, gauze, filter, and a clean syringe.
Another man updated them on his online girlfriend, how he had managed to get her visa approved for a visit. The man looked sheepish. He was accompanied by his beaming girlfriend, and waved a warm goodbye to the girls as they handed him a square of foil for a swan-song hit.
The last stop was the once-notorious Casal Ventoso, the neighborhood Odette Ferreira had taken on decades before with her renegade needle exchange project, perched high on a lonely hill overlooking dry bush and freeways. Here we met Carlos, tall and trim with few grey hairs, his swollen hands the only of long-term intravenous drug use. Raquel passed him a few needle kits, and he tucked those into his canvas shoulder bag next to an extra pair of clean socks he carried at all times.
He had learned to take care of his feet in the military, he said. Raquel smiled brightly. I do this for you. He came here every Tuesday morning to down espresso, fresh pastries, and toasted sandwiches with his fellow peer support workers from CASO, the Portugal morning blonde treat association by and for drug users and former users in Portugal. They met to talk out challenges, debate drug policy which, a decade and a half after the law came into effect, was still confusing for manyand argue with the warm rowdiness characteristic of people in the northern region.
I was told again and again in the north: thinking of drug addiction simply in terms of health and disease was too reductionist. Some people are able to use drugs for years without any major disruption in their personal or professional relationships. It only became a problem, they told me, when it became a Problem.
Their award-winning Check! If drugs were legalized, not just decriminalized, I was told more than once, these substances would be held to the same rigorous quality and safety standards as food, drink, and medication. Bills went unpaid, appliances were sold, all in the name of supplying the cash he needed to support his habit. She offered them hot lunches, regular pay, and easy access to the heroin and cocaine they were hooked on as part of her employment package, all in the name of shielding her son—and the sons of others, whose own mothers had turned their backs on them—from further harm.
To these other mothers she was unforgiving.
Twice, she was arrested and jailed. From Porto I took a train and then a car ride into the rural mountains, to the quiet village where my grandmother had raised her children, the air filled once more with the ash of forest fires.Portugal morning blonde treat
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