NDP MP for Courtenay-Alberni Gord Johns spent a couple weeks in Portugal in July on an unofficial visit, meeting with policy makers and  frontline workers to discuss the country’s harm reduction model. 

Johns was travelling with  Liberal MP Brendan Hanley, former chief medical officer of health for  Yukon, who asked to join Johns’ trip. Johns says it has been  “invaluable” to have a Canadian public health expert travelling with  him. 

Johns spoke with The Tyee July 14 from Portugal about what he’d learned on his travels, which he paid for himself.

He says his constituency has been particularly hard hit by the toxic drug crisis. 

“I can’t count on two hands  the number of people I know who have died, it’s unbelievable,” he says.  “Kids that I’ve watched grow up, adults that I know, professionals that  fell through the cracks and people that are recreational drug users.” 

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, Johns says. Portugal has had  six deaths per million, he adds. 

“We’re literally off the charts for  overdose deaths per capita. I represent a riding very hard hit by the  toxic drug crisis, especially for ages 19 to 44, who have a death rate  almost five times the provincial average,” he says. 

“More people died in Canada last year from overdose than the whole European Union,” Johns says. “We’ve got a lot to learn.” 

Johns  says it’s his job as a leader to find solutions, so he decided to head  to Portugal and see if their model could be imported to Canada. 

In the early 2000s there was a high rate of heroin use in Portugal, with around one per cent of the country or 100,000 people  estimated to be dependent on opioids. At the same time HIV was  spreading as people shared needles. Around 70 per cent of new HIV cases  were attributed to intravenous heroin use. 

This sparked an overhaul of the country’s  drug policy. The national government introduced a “compassionate,  health-based approach that is integrated top-to bottom,” he says. 

Despite B.C. dealing with a similar total  population impacted by drug use — the Ministry of Health says around  100,000 British Columbians have opioid use disorder and are at high risk  of accidental overdose if they get drugs from the unregulated illicit  market — Canada doesn’t have a national strategy. 

In late 2021 Johns tabled a private member’s bill  to decriminalize certain substances, expunge certain drug-related  convictions and create a national strategy to address the harms caused  by “problematic substance use.” 

The bill was defeated half a year later in the House of Commons. 

A year later Canada still hasn’t created a  national strategy or dedicated the “major public resources” needed to  save lives, Johns says. 

Johns says based on his calculations of the 2023 federal budget, the government has spent $512.6 billion on pandemic-related spending but only $800 million since 2017 on the toxic drug crisis. 

To follow Portugal’s example  Canada needs to decriminalize personal possession of illicit substances  across the country, offer safe supply and treatment on demand and focus  on recovery, prevention and education, Johns says, adding this was all  outlined in his defeated private member’s bill. 

“The Liberals constantly use jurisdiction  as a barrier, but they proved through COVID several ways to work through  this and to rapidly respond,” he told The Tyee. 

This comes down to a lack of political “courage,” something Johns says the Portuguese model isn’t lacking. 

Portugal uses a patient-centred integrated  care model that focuses equally on treatment, harm reduction,  rehabilitation and prevention, he says. This brings together law  enforcement, psychologists, health-care workers, social workers, doctors  — “everybody is working cohesively with NGOs on the front lines to give  people the best chance they can to live the best life they can,” Johns  says. 

In 2001 the country decriminalized all  substances but set limits on quantity, so an individual is generally  allowed to carry up to 10 days’ worth of a personal supply.  Carrying more than that can lead to criminal charges. This wasn’t a  dramatic change for the country’s drug policies because before 2001,  police rarely criminalized people for drug use, instead mainly relying  on fines to deter people, according to a 2014 review of Portugal’s drug policies.

In B.C. a person 18 years or older can carry up to 2.5 grams worth of certain substances without breaking the law. 

Portugal’s harm reduction services mainly  focus on opioid substitution treatment and needle and syringe exchanges,  according to a 20-year review of the country’s drug policies. 

Johns says he was impressed by the speed  with which Portugal was able to scale up methadone distribution.  Methadone is a long-lasting opioid used as a substitute for people  addicted to heroin or morphine. The drug was affordable because the  government used its own pharmaceutical labs and personnel to manufacture  and scale up production, instead of asking pharmaceutical companies to  manufacture the drugs for them, which he says is what Canada does. 

In previous reporting about safe supply programs in B.C.,  The Tyee spoke with doctors, drug policy experts and people with lived  experience who said offering people who use drugs alternatives to  illicit street drugs has its perks and drawbacks. Offering people  regular, safe access to alternatives to illicit street drugs can help  people stabilize their lives and reduce the risk of overdose but the  substitutions need to match the potency and combination of street drugs  the person was using before, otherwise it won’t be effective, The Tyee  heard. 

In 2001 Portugal had 200 people using methadone and two years later they had 35,000 people using it, Johns says. 

Johns says he got to spend a day riding  around in the “Mobile Low Threshold Methadone Program,” also known as  the “Methadone Mobile Van.”

There are two vans in Lisbon run by Ares do  Pinhal, an NGO for social inclusion, that each distribute around 1,350  doses of methadone per day, Johns says. The van will drive to a set  location, park for about an hour and greet the people from all walks of  life who walk, drive or cycle up to it. People can also access chest  X-rays, blood tests and Hepatitis C treatment in the van. After an hour  the van will drive to its next set location and repeat the process. 

Johns says his time in Portugal has also  helped dispel some myths he’s heard about the Portugal model, like how  there’s mandatory treatment or how people can go to jail if they refuse  treatment. 

“The Portuguese officials were very clear with me: not a single person has gone to jail by not going to treatment,” he says. 

A police officer can assign someone to a  “dissuasion committee” with a member of the judiciary, a health-care  worker and social worker. They help connect you with resources so it’s  more about creating connections and ensuring patients are aware of what  resources are available to them, he says. 

Portugal has a much more self-driven process where patients decide what they want, Johns says. 

Forced treatment doesn’t work, he says.  Instead there are programs such as the methadone van, which dispenses  methadone but also gets a team out in the community to help connect  people with housing and harm reduction supplies and to ensure people are  staying connected with their families. 

Treatment is also viewed as a long-term  support system, unlike in Canada, where treatment is institutional and  people can stay for 30 to 60 days before having to leave, he says. 

It’s important to build relationships so  that people can access support when they need it, Johns says. When the  economy crashes, like in 2012 and again recently with inflation, there’s  a “huge spike of relapses,” he says. 

Because of the success of the Portuguese  model the government had been scaling back resources as demand for  treatment beds shrank and the country grappled with its own health care  crisis due to a lack of health-care workers.

Now that relapses are rising the country is  once again scaling up its national model and preparing for the arrival  of synthetic drugs like fentanyl, Johns says. “They’re really forward  thinking,” he adds. 

Johns says he is “dumbfounded” that Canada  still doesn’t have a national strategy to reduce overdose deaths despite  B.C. declaring a public health emergency in April 2016. There have been  36,442 toxic drug deaths in Canada between January 2016 and December  2022, which is around 20 deaths per day, according to Health Canada.  Since the public health emergency was declared 12,264 British  Columbians died from toxic drug poisoning, according to BC Coroner’s  Service. 

Johns and Hanley aren’t the only politicians who have visited Portugal. In July 2017  then health minister Jane Philpott and Justice Minister Jody  Wilson-Raybould, as well as Canada’s current chief public health officer  Dr. Theresa Tam visited the country. At the time Wilson-Raybould said  she learned a “great deal” and would “continue our review of Canada’s  criminal justice system.” 

Since that visit 10,897 British Columbians have died due to unregulated drugs, according to the BC Coroners Service. 

“I’m not going to let up until the government responds,” Johns says.

By Michelle Gamage, Local Journalism Initiative Reporter

Original Published on Jul 27, 2023

This item reprinted with permission from   The Tyee   Vancouver, British Columbia

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