PORTUGAL'S DRUG POLICY PAYS OFF; US EYES LESSONS

These days, Casal Ventoso is an ordinary blue-collar community --
mothers push baby strollers, men smoke outside cafes, buses chug up
and down the cobbled main street.

Ten years ago, the Lisbon neighborhood was a hellhole, a "drug
supermarket" where some 5,000 users lined up every day to buy heroin
and sneaked into a hillside honeycomb of derelict housing to shoot
up. In dark, stinking corners, addicts -- some with maggots squirming
under track marks -- staggered between the occasional corpse,
scavenging used, bloody needles.

At that time, Portugal, like the junkies of Casal Ventoso, had hit
rock bottom: An estimated 100,000 people -- an astonishing 1 percent
of the population -- were addicted to illegal drugs. So, like anyone
with little to lose, the Portuguese took a risky leap: They
decriminalized the use of all drugs in a groundbreaking law in 2000.

Now, the United States, which has waged a 40-year, $1 trillion war on
drugs, is looking for answers in tiny Portugal, which is reaping the
benefits of what once looked like a dangerous gamble. White House
drug czar Gil Kerlikowske visited Portugal in September to learn
about its drug reforms, and other countries -- including Norway,
Denmark, Australia and Peru -- have taken interest, too.

"The disasters that were predicted by critics didn't happen," said
University of Kent professor Alex Stevens, who has studied Portugal's
program. "The answer was simple: Provide treatment."

Drugs in Portugal are still illegal. But here's what Portugal did: It
changed the law so that users are sent to counseling and sometimes
treatment instead of criminal courts and prison. The switch from
drugs as a criminal issue to a public health one was aimed at
preventing users from going underground.

Other European countries treat drugs as a public health problem, too,
but Portugal stands out as the only one that has written that
approach into law. The result: More people tried drugs, but fewer
ended up addicted.

Here's what happened between 2000 and 2008:

. There were small increases in illicit drug use among adults, but
decreases for adolescents and problem users, such as drug addicts and
prisoners.

. Drug-related court cases dropped 66 percent.

. Drug-related HIV cases dropped 75 percent. In 2002, 49 percent of
people with AIDS were addicts; by 2008 that number fell to 28 percent.

. The number of regular users held steady at less than 3 percent of
the population for marijuana and less than 0.3 percent for heroin and
cocaine -- figures which show decriminalization brought no surge in drug use.

. The number of people treated for drug addiction rose 20 percent
from 2001 to 2008.

Portuguese Prime Minister Jose Socrates, one of the chief architects
of Portugal's new drug strategy, says he was inspired partly by his
own experience of helping his brother beat addiction.

"It was a very hard change to make at the time because the drug issue
involves lots of prejudices," he said. "You just need to rid
yourselves of prejudice and take an intelligent approach."

Officials have not yet worked out the cost of the program, but they
expect no increase in spending, since most of the money was diverted
from the justice system to the public health service.

In Portugal today, outreach health workers provide addicts with fresh
needles, swabs, little dishes to cook up the injectable mixture,
disinfectant and condoms. But anyone caught with even a small amount
of drugs is automatically sent to what is known as a Dissuasion
Committee for counseling. The committees include legal experts,
psychologists and social workers.

Failure to turn up can result in fines, mandatory treatment or other
sanctions. In serious cases, the panel recommends the user be sent to
a treatment center.

Health works shepherd some addicts off the streets directly into
treatment. That's what happened to 33-year-old Tiago, who is
struggling to kick heroin at a Lisbon rehab facility.

Tiago, who requested his first name only be used to protect his
privacy, started taking heroin when he was 20. He shot up four or
five times a day, sleeping for years in an abandoned car where, with
his addicted girlfriend, he fathered a child he has never seen.

At the airy Lisbon treatment center where he now lives, Tiago plays
table tennis, surfs the Internet and watches TV. He helps with
cleaning and other odd jobs. And he's back to his normal weight after
dropping to 50 kilograms (110 pounds) during his addiction.

After almost six months on methadone, each day trimming his intake,
he brims with hope about his upcoming move to a home run by the
Catholic church where recovered addicts are offered a fresh start.

"I just ask God that it'll be the first and last time -- the first
time I go to a home and the last time I go through detox," he said.

Portugal's program is widely seen as effective, but some say it has
shortcomings.

Antonio Lourenco Martins, a former Portuguese Supreme Court judge who
sat on a 1998 commission that drafted the new drug strategy and was
one of two on the nine-member panel who voted against
decriminalization, admits the law has done some good, but complains
that its approach is too soft.

Francisco Chaves, who runs a Lisbon treatment center, also recognizes
that addicts might exploit good will.

"We know that (when there is) a lack of pressure, none of us change
or are willing to change," Chaves said.

Worldwide, a record 93 countries offered alternatives to jail time
for drug abuse in 2010, according to the International Harm Reduction
Association. They range from needle exchanges in Cambodia to
methadone treatment in Poland.

Vancouver, Canada, has North America's first legal drug consumption
room -- dubbed as "a safe, health-focused place where people inject
drugs and connect to health care services." Brazil and Uruguay have
eliminated jail time for people carrying small amounts of drugs for
personal use.

Whether the alternative approaches work seems to depend on how they
are carried out. In the Netherlands, where police ignore the peaceful
consumption of illegal drugs, drug use and dealing are rising,
according to the European Monitoring Centre for Drugs and Drug
Addiction. Five Dutch cities are implementing new restrictions on
marijuana cafes after a wave of drug-related gang violence.

However, in Switzerland, where addicts are supervised as they inject
heroin, addiction has steadily declined. No one has died from an
overdose since the program began in 1994, according to medical
studies. The program is credited with reducing crime and improving
addicts' health.

The Obama administration firmly opposes the legalization of drugs,
saying that it would increase access and promote acceptance,
according to drug czar Kerlikowske. The U.S. is spending $74 billion
this year on criminal and court proceedings for drug offenders,
compared with $3.6 billion for treatment.

But even the U.S. has taken small steps toward Portugal's approach of
more intervention and treatment programs. And Kerlikowske has called
for an end to the "War on Drugs" rhetoric.

"Calling it a war really limits your resources," he said. "Looking at
this as both a public safety problem and a public health problem
seems to make a lot more sense."

There is no guarantee that Portugal's approach would work in the U.S.
For one, the U.S. population is 29 times larger than Portugal's 10.6 million.

Still, an increasing number of American cities are offering
nonviolent drug offenders a chance to choose treatment over jail, and
the approach appears to be working.

In San Francisco's gritty Tenderloin neighborhood, Tyrone Cooper, a
52-year-old lifelong drug addict, can't stop laughing at how a system
that has put him in jail a dozen times now has him on the road to recovery.

"Instead of going to smoke crack, I went to a rehab meeting," he
said. "Can you believe it? Me! A meeting! I mean, there were my boys,
right there smoking crack, and Tyrone walked right past them.
'Sorry,' I told them, 'I gotta get to this meeting.'"

Cooper is one of hundreds of San Franciscans who landed in a court
program this year where judges offered them a chance to go to rehab,
get jobs, move into houses, find primary care physicians, even remove
their tattoos. There is enough data now to show that these
alternative courts reduce recidivism and save money.

Nationally, between 4 and 29 percent of drug court participants will
get caught using drugs again, compared with 48 percent of those who
go through traditional courts.

San Francisco's drug court saves the city $14,297 per offender,
officials said. Expanding drug courts to all 1.5 million drug
offenders in the U.S. would cost more than $13 billion annually, but
would return more than $40 billion, according to a study by John
Roman, a senior researcher at the Urban Institute's Justice Policy Center.

The first drug court opened in the U.S. 21 years ago. By 1999, there
were 472; by 2005, 1,250.

This year, new drug courts opened every week around the U.S., as
states faced budget crises exarcebated by the high rate of
incarceration on drug offenses. There are now drug courts in every
state, more than 2,400 serving 120,000 people.

Last year, New York lawmakers followed counterparts across the U.S.
who have tossed out tough, 40-year-old drug laws and mandatory
sentences, giving judges unprecedented sentencing options. Also, the
Department of Health and Human Services is training doctors to screen
patients for potential addiction, and reimbursing Medicare and
Medicaid providers who do so.

Arizona recently became the 15th state in the nation to approve
medical use of marijuana, following California's 2006 legislation.

In Portugal, the blight that once destroyed the Casal Ventoso
neighborhood is a distant memory.

Americo Nave, a 39-year-old psychologist, remembers the chilling
stories his colleagues brought back after Portuguese authorities sent
a first team of health workers into the Casal Ventoso neighborhood in
the late 1990s. Some addicts had gangrene, and their arms had to be amputated.

Those days are past, though there are vestiges. About a dozen frail,
mostly unkempt men recently gathered next to a bus stop to get new
needles and swabs in small green plastic bags from health workers, as
part of a twice-weekly program. Some ducked out of sight behind walls
to shoot up, and one crouched behind trash cans, trying to shield his
lighter flame from the wind.

A 37-year-old man who would only identify himself as Joao said he's
been using heroin for 22 years. He has contracted Hepatitis C, and
recalls picking up used, bloody needles from the sidewalk. Now he
comes regularly to the needle exchange.

"These teams ... have helped a lot of people," he said, struggling to
concentrate as he draws on a cigarette.

The decayed housing that once hid addicts has long since been
bulldozed. And this year, Lisbon's city council planted 600 trees and
16,500 bushes on the hillside.

This spring they're expected to bloom.