Oregon leaders say Portugal trip was ‘eye opening’

Part 1
Janie Gullickson is the Executive Director of the Mental Health & Addiction Association in Oregon.
Published: Nov. 14, 2023 at 10:29 PM PST|Updated: Nov. 15, 2023 at 10:46 PM PST
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Last month a delegation of Oregon lawmakers, elected officials, and organizations went to Portugal and met with leaders to discuss the country’s drug decrimina

PORTLAND Ore. (KPTV) - Janie Gullickson is the Executive Director of the Mental Health & Addiction Association in Oregon.

“Some of the things in the work we do at the Mental Health & Addiction Association of Oregon: peer work. Where people who have been there, experienced mental health and addiction challenges and recovery ourselves. We’re reaching out to the community in a variety of ways to support people in exploring and accessing support and recovery services, treatment services, many things that have been funded by Measure 110. We hope to partner with a broader variety of community partners including law enforcement in ways that collaborative, not adversarial. Not that they have been adversarial before, but we haven’t’ been aligned in an intentional way that I think we will be in now.”

Gullickson says the trip to Portugal was eye opening and informative in many ways. She says one of her biggest takeaways from the trip is seeing Portugal’s healthcare approach to addiction after over 2 decades.

“The opportunity to get to hear from people who were the original committee members who designed Portugal’s approach to decriminalization and addiction as a health care issue, not a criminal or moral failing was incredible,” said Gullickson. “That’s almost a generation of people who are treated as patients when they have drug use issues or addiction. They could not wrap their heads around it being a criminal issue. Some of the questions, some of the conversations we would have with not only providers, even law enforcement, or people who used drugs themselves asked why they would be afraid of police or why would we be unable to seek care. Many of them that we talked to, people who use drugs, felt respected, valued, and that their lives mattered.”

She also appreciated the large group who got to go on the trip; the delegation had lawmakers, advocates, law enforcement, and more from across the state.

“25 people going on this fact-finding trip and being able to spend such concentrated time together, to hear each other, to bring up not only challenges, personal feelings, and professional experiences, ideas, brainstorming,” said Gullickson. “It was an incredible time of collaboration that, the opportunity just hasn’t been here in the day-to-day work.”

Gullickson hopes that collaboration can continue as everyone returns to Oregon.

“100% would love for that collaboration to continue and I think we all plan on it continuing and making the time,” said Gullickson. “We all come back to our day jobs and there’s a lot of work to be done, but what we all walked away with is that we are going to do this together and that’s what’s going to make a difference.”

She wants Oregonians to know recovery is possible, but it takes time.

“It took Portugal 8 years to see results they were hoping to see from their drastic change from a criminal approach to addiction to a health care approach,” said Gullickson. “So it’s going to take time, innovation, and collaboration. We’re year 3, right? We got some time and we will need some time and grace from the community while we all work together to try and help people and solve this issue. What I would like the community and Oregonians to know more than anything is that recovery is real and possible. At MHAAO there is 170 staff proving that true every day that we walk out into the community, in the streets to support someone still struggling. It takes time when an incredible, innovative law gets enacted to actually putting everything in place and see the outcomes that we were hoping to see. I think we are on the right track, so please just give us grace and time.”

Another person who went on the trip was Multnomah County Chair Jessica Vega Pederson.

“One of the biggest takeaways from me is the fact that multiple people that we spoke with who are experts, who have history, who were part of creating it, said that decriminalization is the least important piece of what they’ve done to respond to addiction and drug use within Portugal,” said Vega Pederson. “It was really fundamentally about creating a system that responded to the needs of people who are who are using drugs and really understanding there’s a difference between people who have substance use disorder, who are addicted to drugs, and those people who are just using it. They treat that differently. For people who are addicted, it is truly treated as a health issue, as a health care issue.”

Vega Pederson says Portugal has set up 18 different ‘dissuasion commissions’ throughout the country where people who are cited for using drugs go.

“There they have a 45 minute interview with a with a team of experts, nurses, psychologists, social workers, all of that to really understand what their needs are,” said Vega Pederson. “Then there’s an administrative piece where they really make sure that this is an individual user. This wasn’t somebody who was dealing because it’s definitely treated as a crime in Portugal. But if a person who is an addictive drug user goes to treatment, then they don’t have sanctions. Their treatment really is that pathway. If they if they decide not to take advantage of treatment, then they would have some sanctions, but their sanctions look like getting connected to employment services, meeting with a nurse, meeting with a social worker, having an appointment to learn more about housing. It’s a completely different system than what we have here.”

Vega Pederson said she heard the country keeps track of who is accessing services and compared to other European countries, Portugal sees less overdoses.

“I don’t think they do this specifically because they are trying to stop it. They are really want to make sure they are being as most effective as possible for people who are using drugs, who are addicted, and getting them connected with effected treatment.”

When it comes to taking what was learned in Portugal and translating it into actions in Multnomah County, Vega Pederson says she had two main takeaways.

“One is the person focused response that they had created in Portugal is absolutely something that we can bring here to Multnomah County, to the state of Oregon. So looking at the holistic needs of somebody who is using drugs and where all of the different resources to be able to plug in and to be able to help that person on their next stage of recovery, their next stage of treatment, their next stage of where they need to get to more safety and stability in their system. That’s something that we can absolutely do a better job of doing. I think the fact that we had so many people who are on that trip who were from different areas of the state doing different work, we had state legislators, we had people from DOJ, people from the district attorney’s office. We had local elected officials, we had service providers, we had law enforcement, we had drug policy experts. There was a lot of conversation. There was a lot of synergy about ways that we could be working together better in the future and how we can really leveraging the resources that we’ve put in to create a better system and to have better outcomes for people and ultimately to change what we’re seeing of the experience of drug use in our community and on our streets.”

She noted there differences in Portugal’s rollout of drug decriminalization compared to Oregon’s.

“One of the things that I was feeling in our initial meetings with folks learning more about the system was a little bit of anger that we had such a push for decriminalization without all of the fundamental foundational supports and services and resources we really need to have in place to be able to respond to this drug crisis in a way that centers people’s health care needs,” said Vega Pederson. “So for me, a huge takeaway is that we need to ramp up access to recovery services, to treatment. The fact that we went in with Measure 110 and we were the 5th lowest level of resources per capita for people in the country, that is something that we absolutely need to change.”

Vega Pederson, like others on the trip, want the collaborations they had in Portugal to continue here in Oregon.

“We have the building blocks in place,” said Vega Pederson. “We just need to do a better job of aligning resources. We need to have the state investing in higher levels of treatment for folks. We need to have health care partners on board. We need to have local governments like the county all working together on this.” Last month a delegation of Oregon lawmakers, elected officials, and organizations went to Portugal and met with leaders to discuss the country’s drug decriminalization, passed in 2001, in hopes of finding ways to improve Measure 110.

Portugal was a model for those who backed Measure 110, which was passed in 2020.

See Also: Roundtable discusses Oregon’s addiction crisis and measure 110

“I think it was very clear to me in seeing how Portugal is doing things that this is not apples to apples,” said District 3 Representative Lily Morgan. “They do not have the same circumstance that we have in Oregon and their solution is not our solution. We do still need to come up with the Oregon way to find a way to save lives in Oregon. We have not strategized or invested in the things that would actually save lives which is detox, which is residential treatment beds, helping people get off of drugs and have a future.”

Portland Police Association President Aaron Schmautz agrees there are differences between the problems Portugal faces and Oregon faces.

“I thought it was a great opportunity to see people dealing with similar issues in a different way,” said Schmautz. “Honestly there are so many differences in the culture and the things they are dealing with. They don’t have the level of toxic drugs. They don’t have fentanyl. They don’t have the kind of meth that we have. When we met with the officials from Portugal they flat out said ‘we are not a model’. They said don’t try to model yourselves after what we are doing. We are all kind of rats running a different race. I think that’s very important. Anytime you look at a place dealing with similar issues, you can kind of try to work together to try and figure out what worked and what didn’t. But what we are dealing with here is very different; the degree of desperation and the depths that we are at is significantly more serious.”

Both agree it was a productive trip.

“I’m glad that I went on the trip and I’m glad that I saw people that had a different viewpoint than I did,” said Morgan. “They care about people as well and they saw that I care. That is important so that we can have those conversations to see how do we move forward. I likened it that my perspective is one of a crisis response, an emergency response. That when you have somebody with a compound fracture, you stabilize, you put pressure on, you deal with the immediate treatment, and then you offer comfort to the patient. But in Oregon, our model has been to offer comfort and not deal with that somebody is bleeding out or that they’re facing a life and death situation. We really need to have that immediate access to treatment. To have that immediate access to detox so that they come off of the substance that they’re on. While under the influence you’re not dealing with the individual. You’re dealing with the individual under the influence and that craving is driving everything. But when somebody can detox and you can meet with them one on one and then say now how do we look forward to where the future of your life is. That you can actually make a plan and help in that capacity. But until they’re off that substance, you’re only speaking to the substance.”

“I think we should never be afraid to explore the unknown,” said Schmautz. “To talk to people who, for a longer period of time, been dealing with some of these issues. But we should not be mistaken that the issues that we are dealing with aren’t unique. The levels that we are seeing it on the West Coast, cities like Seattle, San Francisco, Los Angeles, Portland; we have to start doing something. We have got to start taking action where we can. It’s going to take a long time to fix these problems. All of us must work together and we can’t toss each other out of the public square while we are doing that.”

See Also: Businesses speak on Measure 110 as Portland Metro Chamber hosts discussion panel

In 2001 Portugal decriminalized the personal use and possession of all illicit drugs and reoriented policy for a health-led approach.

“In Portugal they had a heroin crisis in the 90s,” said Morgan. “They had an HIV crisis. They decriminalized and they put some systems in place to deal with it as a public health system. They are not focused on getting people off of drugs. They are focused on helping somebody have a safe encounter while they’re on them and the treatment is offered, but it’s on a completely volunteer basis and there’s not pressure to enter into treatment.”

Morgan says she wants a focus on treatment, accountability to get into treatment, and available detox centers in Oregon.

“It’s important that we as Oregonians remember that they’re individuals we need to come alongside and treat them with respect,” said Morgan. “But the difference is I don’t want to leave them there. I want to give them a hand to get out and stand on their own two feet with sobriety and a way to move on so that they have a full life and not one that is perpetually in the system and perpetually needing assistance because of their addiction. Oregon has not invested in the infrastructure to deal with the crisis of what’s going on right now. For me, that’s where we have to make sure that we start. We need those detox beds, we need those residential treatment beds, and then we need to see what happens after that. I think that you’ll find that both sides agree that we need to increase our capacity in those ways.”

One of the groups the delegation met with was the Public Security Police, the national civil police force of Portugal. Schmautz noted societal differences between Portuguese law enforcement and Oregon law enforcement.

“From my perspective, in Portugal there is an agreement between law enforcement and society about what role they play,” said Schmautz. “There is very clear direction. One big thing that they told us there is that there has been a changing in their law as it relates to arresting narcotics dealers. Very similar to our Hubbell decision here which they are very concerned about. It just felt like there was no lack of understanding about what role law enforcement plays in their different systems. Their law enforcement had direct access to services. Their services didn’t turn to law enforcement and say we don’t want you to be a part of the equation. That to me is very different. We need partners and direct access to them to be a good facilitator for services. We don’t have that here.”

Schmautz says he understands frustrations surrounding Measure 110 in the state.

“I think Oregonians should necessarily be frustrated that they are not seeing solutions,” said Schmautz. “I think that the standard must be set and we have to decide what we want from our government. If tax dollars are being spent on police and tax dollars are being spent on services, there should be an expectation that these services are working together. Not one side can say to the other that there are sides. We are all a part of the solution, but we have to work together. What I heard from people when I go to the community meetings is they are done with the talking, they want to see action and we got to get some things done.”

See Also: Coalition files ballot initiative for changes to Oregon’s Measure 110

Following the trip, Morgan wants Oregonians to know that the state needs address getting people the help they need.

“We need to help people to find recovery,” said Morgan. “We need to find a way for them to find a life that is a thriving life, not a surviving life. We need to work towards listening to all people to get there. I appreciate the groups that are try to bring the two sides together to find a solution, but we can’t stay where we are.”