07/17/19 Dr Joao Goulao

Cultural Baggage Radio Show
Joao Goulao

Dr Joao Goulao, Portugal's Drug Czar sits down to a lengthy interview with DTN Reporter Dean Becker

Audio file


JULY 17, 2019


DEAN BECKER: Hi folks, this is Dean Becker, the Reverend Most High. Last year, I was in Europe, Lisbon, Portugal to be exact, and while there I got a chance to meet with the drug czar, in essence, of Portugal, Doctor Joao Goulao.

I am Dean Becker, your host. Our goal for this program is to expose the fraud, misdirection, and the liars whose support for drug war empowers our terrorist enemies, enriches barbarous cartels, and gives reason for existence to tens of thousands of violent US gangs who profit by selling contaminated drugs to our children. This is Cultural Baggage.

So proud of today's program, from Lisbon, Portugal.

Today, I'm in the office of the General Directorate for Intervention on Addictive Behaviors and Dependency. I'm speaking with Doctor Joao Goulao. Sir, you were a big part of the Drug Policy Alliance gathering here in your city of Lisbon, Portugal. What's your takeaway from that group?

JOAO GOULAO, MD: I think it's a very interesting group of very interesting people.


JOAO GOULAO, MD: Very committed, and very well informed about drug policies, not only at your domestic level, but also a little bit about what is happening in other places of the world.

And, I believe they were really very much engaged and interested in knowing better the Portuguese way to address those problems. And we were happy to do so, and to explain as far as we can what we have been doing here.

DEAN BECKER: Right. Well, and the numbers speak for themselves. One that speaks to me, last year, in the US, we had approximately 60,000 deaths from overdose, and tell me again, the number that died in your country.

JOAO GOULAO, MD: In '16, 2016, we had 27 overdose deaths.

DEAN BECKER: That's zero two seven.


DEAN BECKER: The, you know, I talk to the taxi drivers as I tour around your city, and kind of filled them in on why I'm here, and when I tell them our statistics, that, you know, we're five percent of the world's population with twenty five percent of the world's prisoners, and it blows their minds, so to speak.

It just seems like such an aberration. What is your thought, sir, are there things that you would recommend our country consider?

JOAO GOULAO, MD: Well, what I would recommend is to think, well, is that kind of policy effective? Are you having results on the good -- for the good of the people? And I don't believe that you are having good results with that policy.


JOAO GOULAO, MD: So, and based in our own experience, of course, I must say that we did not solve the drugs problems in Portugal. Not at all. But we are very happy and very comfortable with the things we have done, and those things are based in the idea that we are dealing, when talking about problematic drug use or when talking about addiction, we are talking about a disease, with the same dignity that other diseases have, and, that's a phrase that illustrates what we are doing.

The Portuguese state is trying to combat the disease, not the people who suffer from it. Okeh? And so, and I think -- I think this is a good point to illustrate this. Of course, we have set a package of responses to this harder on the supply side, and I think it's important to say that in Portugal, it is still prohibited to use drugs. Trafficking, selling drugs, is prohibited, and it's a criminal offense. But using it is not a considered as a criminal offense.

So, the whole system is trying to assess the kind of needs that drug users may have. If they are problematic, if they are addicted, we try to offer, and we invite them, to seek for treatment, or any kind of support. We offer a good range, I would say, of harm reduction and risk reduction facilities.

We invest also on prevention, preventive work, not insisting too much on drugs, but insisting in a health-oriented life of youngsters, and to the capacity to make informed choices. And, also reintegration in labor, in the workplace, we work for -- on all those areas.

And all this, based in that idea that we are dealing with a health and social condition, and according to that, we decided to decriminalize drug usage and possession for use.

DEAN BECKER: And that's been in place for how long, sir?

JOAO GOULAO, MD: Since 2000. It was approved by the Parliament in 2000, and the whole package is available since 2001.

DEAN BECKER: And, you mentioned that treatment is freely available. In the US, you have to sometimes wait weeks, months, before a bed will open, before treatment is available, and many people change their mind in that delay, and, you know, don't go to treatment, and it seldom works out for that delay.

JOAO GOULAO, MD: Yes, we built really good -- I must say that we faced a couple of years ago, couple of decades ago we faced a very severe, what we'd call an epidemic of heroin use, and our responses were very much built, trying to respond to that problem. And we have a, I would say, a solid network of health services addressing those problems.

Outpatient clinics all over the country, in every capitol cities, run by the state, and freely available, with no cost for the patients. We are now facing some difficulties to remain without waiting lists, but the most you can wait for an appointment is, I would say, two, three weeks at maximum. And I insisted, no cost involved for the patient, even if we have some migrants, or people without tools of citizenship, they are -- they will have the care they deserve, without being kept out of it.

DEAN BECKER: Well, and I would think many people in that circumstance, they're maybe down on their luck, don't maybe have the money to, you know, pay an exorbitant amount to get that treatment.

JOAO GOULAO, MD: No. In those state facilities, everything is for free. We have a complimentary network to that state-run net of treatment centers, that are the inpatient facilities.

So, therapeutic communities, for instance we have a network of NGO-run therapeutic communities, around 60 all over the country, with 1,600 beds available, for which the state pays eighty percent of the costs. The remaining 20 is up to the family or to the patient, if he can pay.

DEAN BECKER: Yes, sir.

JOAO GOULAO, MD: If he cannot pay, he is not kept out out of it. Someone -- someone will pay. Security, social security, or the municipality, someone will support the remaining -- remaining 20 percent.

We have a broad range of models of intervention in those therapeutic communities. The common ground is that they have professionals working on it, psychiatric responsibility, they have psychologists, social workers, nurses, working in multidisciplinary teams.

They may use the model that they wish, given that they submit that model to the state authorities, and we just approve it. Okeh, right? And we establish contracts with them. So, we send you the patients, and we pay for it.

DEAN BECKER: Sadly, in the US, we have many of these, I'll say quote "treatment centers," where former patients are given the responsibility to control the newly admitted patients, and some terrible things can happen, abuse and even torture have happened over the years to those being admitted to, forced into --

JOAO GOULAO, MD: Yes, we had that kind of problem also at the beginning, in the '80s, when private responses were popping up everywhere. We had no regulation at all, but in '97 we introduced clear rules, so any facility, any entity that wants to explore that kind of facility, must submit approval, and must fit into the rules that were negotiated with them, not only in what concerns the multidisciplinary thing, but also the hotel, the kind of facilities they use.


JOAO GOULAO, MD: In the beginning, we had lots of problems with inhumane conditions in some places.


JOAO GOULAO, MD: It's not the case nowadays, insisting in the idea that those patients have the same dignity that others have, the facilities are wonderfully presented, clean, with rules for the space, that beds must have, so that's -- it's clearly established by law.

So, they must fit into those rules in order to have the opportunity to work complementarily with the state facilities.

DEAN BECKER: Wonderful.

I interrupt to remind you that you are listening to Cultural Baggage on Pacifica Radio and the Drug Truth Network. I'm speaking with the General Directorate of Intervention and Addictive Behaviors and Dependency, the Ministry of Health, in Portugal, Portugal's drug czar, Doctor Joao Goulao.

Now, in the US, we lead the world in our incarceration rate, we have -- my city of Houston, thank god, has improved, but we used to have people sleeping under the bunks, sleeping in the hallways. They would each morning haul a busload to another town because they were just at capacity.

That's gotten better, but it still exists in many cities, in many locales in the US, where prisoners are often treated as workers, made to work for their meals, made to, even in the treatment centers, they -- there's one in particular where they make them work plucking chickens all day long in order to have a roof over their head and to get the treatment.

My point I'd like to get to, sir, is that we have always been abusive to drug users, consider them to be lesser than, to be, you know, unworthy of respect, and it's good to learn in your country, each person I talked to informs me that everything you're saying is true. This works here, and it's not -- it's actually saving you money, rather than the cost of imprisoning people. Am I right?

JOAO GOULAO, MD: No doubt. No doubt, I think, this -- this complete set of responses that we have installed, mostly on the health side, is very much cheaper than putting people in jails and basing the policy in incarceration and all the law enforcement side.

Of course, and, I would like to tell this, because I think I forgot to say to your colleagues, to your group, even the police authorities are quite happy nowadays with this model, you see, because one of their main tasks is to decrease, to lower the availability of drugs, the market, you know, on the streets. But instead of acting with the -- interacting with the drug users and the street dealers, because it is not a criminal offense, so they had to change their way to work.

Instead of picking someone using drugs, they shake a little bit, you have some information, you go to next corner, okeh, this is the small dealer. You shake him and you find one or two steps more in the steps of the, in the share -- in the stairs of the traffic. Instead of doing it, they had to increase their cooperation between the several police forces, with international forces, with the intelligence, and instead of seizing grams or kilos, at the state level, they seize tons in containers, in open sea.

So, if we use that metric to evaluate their efficiency, they are happy with how things work. Yeah.

DEAN BECKER: I got the chance to meet a couple of, one police chief and a commissioner, as I understand it, that's not exactly the top guys, more --

JOAO GOULAO, MD: Yeah. Yeah.

DEAN BECKER: -- a sergeant or something. Right? But he was happy, as you say, to, to focus on what matters, rather than having a goal of getting all, everybody in jail.

JOAO GOULAO, MD: No, that's it. That's it. The aiming of our system is organized, if you are a dealer, if you are a large scale dealer, of course, the criminal system acts on you, and you can end up in jail.


JOAO GOULAO, MD: But, if you are just using, or if you are selling drugs to survive, to support your, your dependence, the main goal is to send you for the health system. Okeh? And to provide you the tools to get rid of your dependence. Or, better still, if you are not an addicted person, but you are a drug user, the system, the Dissuasion Commission, where you end up, the main -- their main goal is to assess and to -- to soon, as early as possible, in the process.

Okeh? I'm using drugs, but I have some personal problems, or family problems, or social problems, so the aim is to mobilize social responses that can help you to deal with some difficulties that coexisting with drug use, mainly due to problematic use. So, the aim, the goal, is to interrupt that as soon as possible.

DEAN BECKER: Well, this brings to mind a situation that exists in the US, where the laws are so draconian that even for minor amounts you can get years in prison, and when a person ODs, whether they're by themselves or with friends, nobody wants to call for help, for fear of being arrested, for fear of those years. That may be why our numbers of overdoses are so high, because no one dares to call.

JOAO GOULAO, MD: Yeah, they fear to call the police or the fireman or whatever the SOS, because probably I will have problems with it. That's not the case here, because, if, you know, seeking for treatment has been facilitated by decriminalization also.

DEAN BECKER: Well, sure.

JOAO GOULAO, MD: Yes, because people -- don't forget that we lived under a fascist regime for a long time.


JOAO GOULAO, MD: And during that time, people feared police, and feared being contacted, and I remember when I started in the, working in this, in this area, I remember being, talking to a patient of mine, and suddenly he turned to the telephone set that was on my desk and, there's someone listening the next door, they were afraid of being spied, you know?

DEAN BECKER: Sure. Paranoia.

JOAO GOULAO, MD: Paranoia.


JOAO GOULAO, MD: And, some of them feared to approach health service, this because they were afraid to be referred to the police. Okeh, I give you the names and the --

DEAN BECKER: And we -- that exists in the United States.

JOAO GOULAO, MD: Not here. Not at all. Not at all. We have a completely separate registration of patients, even at the dissuasion system, which is still connected necessarily, but it's completely separated from the criminal system and the systems of the police, of the judiciary police and also, all that. We have our own registration that we do not share at all with other kind of authorities from law enforcement.

DEAN BECKER: Now, as I understand it, there -- if a policeman catches someone with, what you guys have determined is a ten day supply, ten day supply or less, that they won't be arrested, that they will be requested to visit the Dissuasion Committee?


DEAN BECKER: And, give us an idea of what those amounts are, what a ten day amount might be of various drugs.

JOAO GOULAO, MD: For drugs, for cannabis, 25 grams. I think it could be higher, but I think it's that. Heroin, one gram. Cocaine, I think it's one gram also. Hashish, five grams. And, you know, we know that this is a long-lasting table of amounts, and we are aware that we must affect those amounts, because things have changed, even the purity of substances has, have changed.

But in any case, having that objective threshold seems to be very useful, because it provides that -- the policeman has to act as a judge on spot. Okeh? Because if you do not have that objective threshold, it's very subjective. Okeh, you are -- you are caught with a small amount of drugs, but, okeh, you are good looking, good families, white, young man, okeh, go in peace, you are just a user. But if you happen to be Spanish, or --

DEAN BECKER: You're a bit, I hear the word "Gypsy".

JOAO GOULAO, MD: Yeah, Gypsy, or whatever, probably will be charged. So, having that objective limit is important in my view, to avoid that discretionarity.


JOAO GOULAO, MD: And then, you might have on you a bigger amount of substances, of illicit substances. You go for trial, you go for a criminal -- the criminal system, but is -- it is in the criminal system that someone has to make an evidence that you were selling. Because if there is no evidence, the judge may send you to the commission, and that's all.

DEAN BECKER: Yeah. And if I understand, once you've been sent to the commission, that there are some people that say, I'm a drug user, I will continue to be a drug user, I will not be a seller, and they will just be released. Is that?



JOAO GOULAO, MD: Yes. They go, okeh. What the commission does is, in the first contact, usually they invite people. Okeh, you are a drug user, you are -- you feel problems with drugs? Do you need help, do you want to access a treatment facility?


JOAO GOULAO, MD: No. I don't want, I'm not -- I'm happy with what I do. We say, okeh. Okeh, you are free to go, to do so. Don't forget, it is prohibited to use, so if you come here, I -- your folder stays open, let's say for six months. Please do not come back in the next six months, because if you come, I will have to apply you a penalty.

An administrative one, you do not get a criminal record, you do not go to jail, but I can apply you any kind of such, so as to prohibit you to -- of attending some places or joining some people, I must apply you a penalty of social work, or things like that. If you are not an addicted people, I may even apply you a fine, a monetary fine. Fine.

DEAN BECKER: Again, I mentioned, 60,000 deaths in the United States. They're talking about, you know, and this is not in your system, as yet, but they talk about marijuana often being a means for people to escape from the harder drugs, the heroin or meth, or cocaine.


DEAN BECKER: As a harm reduction measure. Now, as I understand it, you guys don't quite have that, but you do have the perspective that it's better than heroin.

JOAO GOULAO, MD: Yes. Yes, but we keep in mind that nowadays, as I told you, we faced a heroin epidemic, with a very severe impact in our society. That's not the case nowadays. The heroin is fading, slowly, but it's fading.


JOAO GOULAO, MD: We have older addicts, and -- but now, the biggest impact in our society comes from cannabis use. Okeh?


JOAO GOULAO, MD: So. Even if we are nowadays discussing at the Parliament therapeutic cannabis, we try not to [inaudible], and say okeh, it's okeh, you just -- it was what we did when heroin was --

DEAN BECKER: Yeah. Enormous.

JOAO GOULAO, MD: So, you just smoke cannabis. No matter, no, we don't give any attention to that. Nowadays, with new forms, with synthetic cannabinoids, with the new forms of cannabis, with the high potency of THC and all that, we have bigger impact in emergency results, psychotic episodes, panic in people, approaching and seeking for treatment for cannabis use.


JOAO GOULAO, MD: Nowadays, it's the top cause for the -- for seeking for treatment, is cannabis.


JOAO GOULAO, MD: So, I am quite -- I am not in favor, okeh, let's make cannabis available for everyone, as a treatment or whatever. No? There are very specific pathologic entities that in fact seem to benefit from cannabis use. They have nothing to oppose to that. But, to generalized, and to --

DEAN BECKER: No, I hear you.

JOAO GOULAO, MD: -- and to tell people, okeh, you may use cannabis freely because it's so good that it even is used to deal with some diseases, that is quite problematic.

DEAN BECKER: Well, Doctor, I tend to lean the other direction in that, for me, 32-plus years ago, I gave up alcohol. I smoke maybe two grams a week, you know. I don't let it interfere with my life, but the one thing I would agree with you on, sir, some of this marijuana is so powerful, you don't know what you're getting, and some it is not even really marijuana and it's even deadlier. And --

JOAO GOULAO, MD: Yes. That's it.

DEAN BECKER: In the US, we have what we call the controlled substances, and I think that's the biggest oxymoron that ever was, because there is no control of these substances, and I would hope that if you guys could actually control the growth, the development, what is in that bag being sold, that you might reconsider at that time.

We'll have the rest of our discussion with Portugal's drug czar Doctor Joao Goulão on next week's program.

It's time to play Name That Drug By Its Side Effects! Confusion, skin rash, agitation, nervousness, constipation, diarrhea, dizziness, headache, nausea, hallucinations. Time's up! The answer: Mylanta AR, or Pepcid AC. Two more FDA approved products.

MUSIC ["Eternal War" by Adult Users]: Pfizer and Merck kill more of us
Than the cartels crap ever could.
They thank us for our silence,
Each year’s hundred billion dollars,
And the chance to do it forever more.
Drugs, the first eternal war.

DEAN BECKER: Thank you for being with us on this edition of Cultural Baggage. I hope you'll join us next week when we'll continue our discussion with Joao Gouloa, the drug czar of Portugal. And again I remind you, because of prohibition you don't know what's in that bag. Please, be careful.

To the Drug Truth Network listeners around the world, this is Dean Becker for Cultural Baggage and the unvarnished truth. Cultural Baggage is a production of the Pacifica Radio Network. Archives are permanently stored at the James A. Baker III Institute for Public Policy. And we are all still tap dancing on the edge of an abyss.