Gord Johns visit to Portugal- IN THE NEWS: NDP MP Learns Drug Crisis Lessons in Portugal

Thanks to Tyee health writer Michelle Gamage for reporting on the lessons learned during my unofficial visit to Portugal where I met with policy makers and frontline workers to discuss the country’s harm reduction model. As Michelle says, I was accompanied by Liberal MP Brendan Hanley, former chief medical officer of health for Yukon who asked to join me. As I told her ““I can’t count on two hands the number of people I know who have died, kids that I’ve watched grow up, adults that I know, professionals that fell through the cracks and people that are recreational drug users.” She reports that Port Alberni has been particularly hard hit by the toxic drug crisis.

Over the last year Port Alberni has had over 1,000 deaths per million people, compared to all of B.C. which has had 438 deaths per million, while Portugal has had six deaths per million. I was able to witness first hand the patient-centred care model that is at the centre of its national strategy. Sadly, our country does not have a strategy which was the purpose of my private members bill for health-based approach to substance use in 2021. It was supported by all NDP, Bloc and Green MP's along with 14 Liberals including Dr. Hanley. The truth of the matter is that while this minority Liberal government spent $512.6 billion on pandemic-related spending it has only allocated $800 million since 2017 to address the toxic drug crisis. Please share Michelle’s story with friends who are concerned about this public health emergency and let them know that I will not let up until the government responds.

Gord Johns visit to Portugal- Ending Remarks & Thank You's

Gord Johns visit to Portugal- Ending Remarks & Thank You's

My trip to Portugal to investigate its public policy approach to problematic substance use would not have been possible without the assistance of Élise Racicot, Ambassador of Canada to Portugal, Political Counsellor Jeffrey Heaton and Embassy staff. They have provided help organizing and coordinating my schedule for which I am immensely grateful. Their insight into Portuguese and connections with key players has been invaluable. I have learned much from direct contact with Portuguese policy makers, health professionals and clients of programs and services and very much look forward to continuing the fight for a health-based approach to substance use in Canada.

Here’s a couple of screen shots of Wednesday's story in The Hill Times about my visit to Portugal where my colleague Liberal MP Brendan Hanley and I met with officials and frontline workers behind the Portuguese policy of patient-centred integrated care for users of illicit drugs. In Canada, our governments continue to use piecemeal half-measures to address the toxic drug emergency and the result has been tragic for thousands of families in every province and territory. The Hill Times was interested in knowing more about “mandated" or “forced” treatment which is advocated by many on the political right in our country. As I told the reporter, in Portugal “there is absolutely no appetitive to return to the criminal model…and…they made it clear that the evidence says forced treatment does no work.” No question that we need a "made-in-Canada" model but we also need to learn from Portugal because what we’re doing clearly is not working. Further, we need to invest. The federal government has spent less than one per cent of what it spent on COVID-19 support programs to address the toxic drug public health emergency which is responsible for over 35,000 deaths since 2016.

Gord Johns visit to Portugal- Day 3: Gord meets Psychologist Hugo Faria

Gord Johns visit to Portugal- Day 3: Gord meets Psychologist Hugo Faria

One of the highlights of my trip to Portugal was meeting psychologist Hugo Faria, the Coordinator and his team with the Mobile Low Threshold Methadone Program. It's van is one of two operating in Lisbon and was established in 2001 and provides an intervention-program that is part of an integrated harm reduction strategy. They are paired with a safe consumption site which allows both injectable and inhaling services.

The vans serve between 1300 and 1400 patients each day as they move throughout the community. The team take blood samples and urinalysis, screening for active disease such as HepC, HIV and TB. It is part of an integrated information system working directly with doctors and social workers as part of a patient-centred approach. The goal is to help people move towards a better life, stabilize themselves while staying connected to services.

The Portuguese model is based on this kind of connection and a belief it is better to have an inclusive system with a “wide open door” helping more people than to push them out through applied pressure which cuts them off from necessary resources. They don’t look at treatment as an institution or as a project, instead it’s a program based on meeting people where they are at and finding different ways to help support them towards recovery. People using drugs in Portugal aren’t dying the first time they use them, there is a difference between the substances available in Portugal vs what we are seeing in Canada. During national financial crises, such as in 2008 and 2012, consumption rates rise significantly. As Portugal deals with current inflationary pressures, it is quickly ramping up their systems because they are seeing a recent spike in relapses related to stress.

Gord Johns Visit to Portual- Meeting with Dr. João Augusto Castel-Branco Goulão

Gord Johns Visit to Portual- Meeting with Dr. João Augusto Castel-Branco Goulão

One of the most important experts I connected with during my visit to Portugal to study its policies and practices that addresses substance use was meeting with Dr. João Augusto Castel-Branco Goulão. Dr. Castel-Branco Goulão was an architect of Portugal's drug policy in 2000 and is the current national drug coordinator for Portugal. A lot has been written about the "Portugal Model" as legislators, public health, justice and social services experts along with those with lived and living experiences have watched with interest. Unfortunately, considerable misinformation is disseminated about the model- too often, deliberately by those with political or other vested interests. 

Dr. Castel-Branco Goulão explained the evolution of Portugal’s approach which has its genesis. In the 1980’s when HIV infection was spreading along with increased overdose deaths related to heroin use and criminality including a high rate of petty crimes. The government of the day held the view that it was a health issue not a criminal issue and that people needed help. They believed that users of illicit substances would not benefit from being criminalized or from going to jail. It was not a justice issue, it was a public health social issue. In 1998, the Prime Minister identified a group of eight leading professionals including law enforcement leaders, medical practitioners and other experts to develop a national strategy to respond to what had become a “drug crisis”. The strategy became the framework for the current “Portugal Model”. It included provisions for individuals who were unable or unwilling to seek recovery and recognized the fundamental human right that they are entitled to the same benefits as those who do, through harm reduction. The object was to support a better quality of life and longer life expectancy for all. 

Additionally, during my meeting with Dr. João Augusto Castel-Branco Goulão, we discussed Portugal’s work on recruitment which is important to support its healthcare system by diverting problematic substance users to the appropriate areas that can meet their needs. A timely response is essential as their “dissuasion commission” finds that 85% of those who are referred show up after first meeting with a social worker or a psychologist to review where they are in their life. Starting where people are at is a critically important feature of the model. Contrary to disinformation that is currently being pushed out as part of our political discourse, there is no mandatory treatment in Portugal.

Dr. Castel-Branco Goulão emphasized that one should not be stigmatized for the rest of ones life which is what happens with criminal charges. He also emphasized the importance of recognizing that the system must understand and accommodate relapse. It is a “chronic relapsing disease,” he told me, “so when you build up the systems, you need to maintain and keep them in place because people do relapses.” He said, “you should learn from us, but don’t copy us, this is your opportunity to take action.” 

Gord Johns visit to Portugal- Day 3: Meeting with GAT Portugal

Gord Johns visit to Portugal- Day 3: Meeting with GAT Portugal

It was great to connect with President of GAT João Santa Maria and Director Luis Mendão who founded the Portuguese Activist Group in 2001. The GAT advocates for legal and policy changes that positively affect the health, rights, ad quality iof life of people living with HIV or at risk of becoming infected. We are very much appreciative of their comprehensive reporting on the history of harm reduction in Portugal. 

In 1995, there were over 100,000 chronic users of heroin in Portugal which is about 1% of the total population. Today there are less than 20,000 injectable users. 70% of HIV transmission was through intravenous drug users, costing over 1000 lives annually. Today, the intravenous drug use is responsible for less than 2% of all HIV transmission in the country.

The government considers harm reduction measures to be a response to a human rights issue in the midst of a national emergency. When I asked what these two international experts would recommend to address Canada's toxic drug overdose public health emergency, their response was to "be bold, make it easy to access safer substances and substitution replacement therapy, scale it up rapidly, remove barriers and create a national action plan". 

Substitution replacement therapy is considered to be an "exit drug" in this country, an instrumental policy element. How do compare? Portugal has an overdose death rate per million of 6; B.C. is 430 and in the Alberni Valley, it is 1030 (for ages 19 to 44), it is 2100). B.C. alone currently has double the number of substance users per capita that Portugal had in 1995 at the height of its emergency. In just two years, they went from 200 patients using methadone to 35,000. Lives have been saved in Portugal, as a result. Sadly, lives are being lost in Canada without this kind of bold action. It is time to abandon our federal government's incremental and piecemeal process and take the essential actions that countries like Portugal have taken. 

Gord Johns visit to Portugal- Day 2

Gord Johns visit to Portugal- Day 2

July 12th 2023- Thank you to Miguel Vasconcelos, the coordinator of the Addictive Behaviours and Dependencies Intervention Division of the Regional Health Administration of Lisbon for taking time with my colleague MP Brenda Hanley to discuss the Portugal's success in addressing problematic substance use over the last twenty-five years.

The Portuguese model is based on the fundamental principle that substance use disorders are health conditions not criminal behaviours. When HIV infections began to spread in the 1980s, overdose deaths related to heroin use also had begun to rise. Criminality related to substance use resulted in a high rate of petty crimes, which entered political and economic spheres. Portuguese recognized this as a Health Issue not a criminal issue. People needed help and Portuguese knew that people wouldn't benefit from jail time, so it became a public health social issue, rather than a justice issue. 

Treatment is medical not judicial. Ninety-five percent of treatment placements are self-referred and services are free. The so-called mandatory or forced treatment is not a practice in Canada. Dr.Vasconcelos recommended that Canada considers a centralized system of services delivered through a national plan that includes investments in education, harm reduction and, when necessary, treatment for between thirty days and twelve months. It was most enlightening to connect with front line staff and patients.



Gord John's Visit to Portugal to learn about National Drug Policies- Day 1

Gord John's Visit to Portugal to learn about National Drug Policies- Day 1

July 11th 2023- On my way to Portugal to learn more about its approach to addressing problematic substance use through harm reduction, recovery and ancillary programs and services. Canada's Ambassador to Portugal has kindly agreed to talk to me as well as Dr. João Augusto Castel-Branco Goulão, national drug coordinator for Portugal. I am also scheduled to visit harm reduction and recovery sites. It's not an official trip so I'm doing this at my own expense. Too many Canadian Families have lost too many loved ones and we need to look for solution wherever we can find them. 

It was only a few weeks ago over lunch that Liberal MP Brendan Hanley and I were talking about my upcoming trip to Portugal to learn more about that country's unique approach to problematic substance use. Brendon is the former chief medical officer of health for Yukon, a territory with the highest per capita toxic drug overdose death rate in the country. He voted for my bill for a health approach to a substance use along with thirteen other members of his party. He called for a couple of dats later and asked if he could come along. Having a trained and experienced Canadian public health expert with me for these meetings has been invaluable. It's pretty unique, I admit two MP's from different parties on a self-funded learning expedition, kind of unheard of in fact, but politics should never be a consideration when lives are at stake. 



Gord Johns statement for International Overdose Awareness Day

August 31st 2023: Today, on International Overdose Awareness Day, we remember all those who have been harmed or lost their lives to overdoses from toxic drugs. We also recommit to fighting the toxic drug crisis with the urgency needed to save further loss of life and to help those who choose a path of recovery from problematic substance use. 

The toxic drug crisis has been devastating for Canada-since 2016, more than 36,000 Canadians have died from overdoses and it's only getting worse. Last year alone, an average of 20 Canadians a day died from this public health emergency. 

The current patchwork approach to addressing substance use in Canada must be replaced with an integrated national health-based plan. it must remove the stigma of illicit substance use through decriminalization, provide harm reduction services to keep people alive, expand the availability of no-wait treatment services as part of our universal health care system and initiate overdose awareness programs nation-wide. 

Every day, more families are ripped apart and left in shambles because of the toxic drug emergency- and this won't change until meaningful and integrated actions are taken. Canadians deserve a government focused on finding solutions and protecting lives. 

My condolences are with all those who have lost loved ones due to toxic drug overdoses. Today, my NDP colleagues and I are recommitting to turning the tide on this emergency so that no more lives are lost. 

IN THE NEWS- NDP and Liberal MPs say Canada can learn lessons from Portugal's "Integrated, Multifaceted, and patient-centred" drug model

IN THE NEWS- Returning from their trip to Portugal to get a first-hand look at what Canada can learn from that country’s successes and recent challenges in addressing its drug overdose crisis, New Democrat MP Gord Johns and Liberal MP Brendan Hanley say that while the toxic drug crisis here at home will need a “made-in-Canada” model, there are plenty of lessons to learn from the Portuguese approach.

Speaking with The Hill Times on July 19, just two days after returning to Canada, Johns (Courtenay–Alberni, B.C.), his party’s mental health and harm reduction critic, said the most significant difference in Portugal’s model is the country’s “integrated, multifaceted, and patient-centred” approach compared to the “piecemeal half-measures” Canada is currently taking. 

“They didn’t just take one approach; they scaled up everywhere,” Johns explained, noting that alongside its move to decriminalize the possession of all drugs in 2001, Portugal also invested heavily and rapidly scaled-up nationwide programs to provide addictions treatment, harm reduction, rehabilitation, recovery, and public education campaigns.

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