03/30/18 Joao Goulao

Dr Joao Goulao, Portugal's Drug Czar sits down to a lengthy interview with DTN Reporter Dean Becker + Sanho Tree discusses his Op-Ed in NYT: "The War on Drugs Breeds Crafty Traffickers"

Cultural Baggage Radio Show
Friday, March 30, 2018
Joao Goulao
Drug Czar



MARCH 30, 2018


DEAN BECKER: 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 27.

Joao Goulao, MD: 27. Yes.

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, when talking about addiction, we are talking about 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 problems 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?

Joao Goulao, MD: Yes.

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: Yeah.


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.

Joao Goulao, MD: Yeah.

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.

But, that's for the future, I suppose.

Joao Goulao, MD: That's why I'm -- we are not just running behind those new experiences.


Joao Goulao, MD: We are trying to wait and see what is going to happen with the young populations, with the states that have approved it, the recreative use of cannabis, and that what is going to happen. Will cannabis use among youngsters just --

DEAN BECKER: Skyrocket?

Joao Goulao, MD: Skyrocket, or what is going to happen? Nowadays, with our experience, we have 17 years of experience to show, okeh, our data on this, I insist, it's not solved, we still have problems, we have new challenges every day, and new things, and new responses to offer, but, the overall evaluation of our system is positive. I think there's --

DEAN BECKER: Oh, I agree. I heartily agree.

Joao Goulao, MD: I still do not have the time enough for Uruguayan experience, from your experience in the States, or in several states, and I'm not -- we are not facing the desperate situation here, so we can take --

DEAN BECKER: Take a little time.

Joao Goulao, MD: Take our time. Okeh?

DEAN BECKER: I, and again, I want to agree with you. There was a situation, I think it was two summers ago, a very hot day, 95 degrees, hundred degrees, and these youngsters, you know, probably 16 to 20, or 25, passed out in the park because they had smoked this synthetic marijuana. Their temperatures rose to 104, 105 degrees, they had ambulances hauling to the hospital quick as they could. We do have to be careful moving forward, I agree with you.

Joao Goulao, MD: I should think so, I think --

DEAN BECKER: Taking a little break here to remind you, you are listening to Cultural Baggage on Pacifica Radio and the Drug Truth Network. We are speaking with the drug czar of Portugal, Doctor Joao Goulao.

Joao Goulao, MD: I have a lot of sympathy for some movements that are struggling for human rights of drug users and all that, but that's not exactly the same, to say okeh, no problems about using drugs.

DEAN BECKER: Oh yeah. I'm with you, sir. I touched on this earlier, and you're becoming aware of it, the taxi drivers are becoming aware of it, each person I mention this to, that in the US, you know, we arrest 1.6, 1.7 million for minor possession of drugs each year, crowding our jails. We demonize them, and then we make them jump through so many hoops to prove they're worthy individuals again. Many times, they can't get credit, housing, a job, any respect, and you guys don't -- you may put people behind bars for a short time, but once they get out, you don't hold it against them forever, like we tend to do in the United States.

Joao Goulao, MD: No. No, we try to keep them in contact with our structures, having a professional as a reference, that can help them to deal with the difficulties in everyday life. Okeh? We have, for instance, the problem, when someone comes to one of our treatment facilities, he is evaluated by the treatment team, and immediately at the same time, same week, is evaluated by the reintegration team.


Joao Goulao, MD: And, along with the treatment plan, there's a reintegration plan. What are the needs of this guy? Housing? Meeting his family again? Connecting to, finding a job, professional training for something?


Joao Goulao, MD: Does he have -- ever studied, or is a complete -- sometimes it's not reintegration, it's integration for the first time, people -- okeh? So, we try to build a plan, and be with that, trying to find the adequate responses.

For instance, the positive discrimination problem that we have, it ended during the financial crisis, was the problem with vida emprego, life employment.


Joao Goulao, MD: Which was a problem based on microcompanies. Okeh? And we had our social workers knocking the doors of those companies, and convincing people, convincing the employers, okeh, I want to bring you a new worker to work with you. We have nothing to spend with him, you just -- you are going just to spend your time teaching him how to do a job.

DEAN BECKER: Give him a chance.

Joao Goulao, MD: Give him a chance. You are going to have tax benefits during his time with you, and we will pay the minimum wage. That's set for six months. Okeh?

By the end of it, you only have to be aware that there are some difficulties that you are going to notice on him. Difficulties in dealing with time. Okeh? Which is a very difficult dimension. Yeah? But please evaluate his work by the end of the week, and now -- and not by the end of the day. Okeh?

Because probably he's going to come half an hour late, and to try to leave two hours before time, but the next day he will stay until night, and, well, by the end of the week you evaluate.

And by the end of the six months, we will take off the wheels of the bicycle.


Joao Goulao, MD: The small wheels, and you decide, you keep him or not. And then, you just offer him an employment, normal work. Okeh? I just bring him in order that you know each other.

DEAN BECKER: So much cheaper than throwing him in a cage.

Joao Goulao, MD: We found jobs for thousands of new employees. Okeh?


Joao Goulao, MD: We have problems nowadays with this program, because during the financial crisis, those small companies, those small enterprises, closed at hundreds, so, most, they went to bankrupt. So, some of those new employees have lost their jobs, and their new lives ruined.

This is to tell you that not everything is perfect in our system.


Joao Goulao, MD: Because we could not anticipate that it was going to happen.


Joao Goulao, MD: And, it poses a problem of sustainability to the responses that you -- that we built. But anyway, I think it was a good experience, anyway.

DEAN BECKER: Well, yeah, and with many positive results, right? Yes sir. You know, I feel privileged that I got to speak with you at dinner the other night, we had lunch together yesterday. I'd like to think that we -- we understand each other, that we respect each other's positions quite a bit, and, I mentioned to you that it was, I don't know, 8 or ten years ago, I worked real hard, then current drug czar in the US, John Walters, was coming, and I contacted his office, I learned about it, I tried to set up an appointment, I wanted to do an interview with him.

I captured the audio from his presentation, and when it was over I walked up, and, Mister Walters, I'm Dean Becker, I've been trying to contact you. He finished packing his briefcase, four guards gathered around him, and escorted him out of the building, and as he was leaving, I said, Mister Walters, will you at least take my card and one of his guards stepped out, reached his hand inside his coat, and said he doesn't want to talk to you. And that was the only response I've ever gotten through 16 years of trying to interview US drug czars, and other high echelon officials. They hide from me. Your response to that, please.

Joao Goulao, MD: Then, my response is, sorry if I am not very modest, but I think my response is my attitude towards you, and towards the group, and the way that yesterday I faced some critics from Portuguese drug users and former. Of course, we are aware that things must be -- could be better. Okeh? But I don't fear to discuss it publicly with them, and we learn something from each other, from that discussion.

So, I do not -- I do not avoid any kind of contact.

DEAN BECKER: No sir, I don't think you do.

Joao Goulao, MD: So, a couple of months ago, I was in Macao, China, presenting our drugs policies to representatives of countries like the Philippines, Singapore, Indonesia, and they were completely astonished about what I was saying.


Joao Goulao, MD: And they seemed to be very critical in their faces, but by the end of my presentation, they came to me asking for more questions, and could you explain it better how it went, something new, and I believe that our responsibility is also to leave a seed on those minds that have completely different ways to address this problem.

DEAN BECKER: I commend you for having done so. We in the US seem to be regressing. Our attorney general and especially our president is talking about maybe it's time to start killing drug sellers, as much like Duterte in the Philippines, much like in Singapore and in China as well. Your response there, please.

Joao Goulao, MD: My response. Well, I think this is not the way, and we have -- we only can give our example, and our results. And that's my response.

DEAN BECKER: I want to take a break to remind you you're listening to Cultural Baggage on Pacifica Radio and the Drug Truth Network. We are speaking with the drug czar of Portugal, Doctor Joao Goulao.

Got a couple of questions left for you. One is, I mentioned yesterday, Harry Anslinger convinced everybody that prohibition was the way to go in the United States and then he convinced the United Nations, and the globe said okeh, we'll do it, but, there are provisions within your agreements with the UN that you could forego, or you can opt out of, and with a six month warning, I think it is. Your thought there, sir, is there -- is there a means or need to redirect the UN's focus to -- more in line with your policy?

Joao Goulao, MD: I believe that things are changing, even at the United Nations. Okeh? Once again, the current Secretary-General of the United Nations is António Guterres, who was the prime minister of Portugal when we decriminalized drug use. And his mindset on this subject is important, I believe.

But I also believe that there are some movements inside United Nations bodies, UNODC but mostly on IDPC -- INCB, sorry, International Narcotics Control Board, who are the guardians of the treaties.

Last year in New York, at the UNGASS -- let me talk. When we first approved our decriminalization law, United Nations bodies were very critical about it. We had some visitors coming to Portugal, and they were very, you know, those Portuguese, they did so -- in 2009, for the first time, the UNODC report started to say, even if the Portuguese decided to decriminalize, the results seem to be positive. Yeah?

In 2016, at the UNGASS in New York, the president of the INCB showed a slide saying Portugal is an example of best practices within the spirit of the United Nations. Well. It's still a prohibitionist paradigm. Okeh? But, the evolution of the mindset in the United Nations bodies has changed a lot, and I also believe that Portugal worked a little bit like a snow cleaner, opening the way for others to make the same kind of movements, and -- but I also believe that our main responsibility within the United Nations context is to call those who are left behind: Philippines, Singapore, to come into more humanistic approaches. Okeh?

So, of course we -- you may wish to go a step forward, but wait for those who are left behind, okeh, because there are many thousands of millions of people living there and suffering for those promises. And being -- having a humanistic approach, based on human rights, you can't forget those populations that live in those countries, and that have to face that kind of regime.

DEAN BECKER: Now, my last question is kind of the follow-up, yesterday, my question was kind of interrupted, and I'll try to phrase it more realistic.

Sir, you know, they, we, in the US, it's been about a hundred years of drug war, that has escalated. They used to have five year plans to fix it, but when each five year plan failed I guess they just quit doing that, realizing five years was not going to get it done. But it's my thought, I've been to Bolivia, Mexico, I've seen the horrors that go on in those countries, the abuses, the barbarity, and I guess my question to you sir is that, you know, considering the horrible consequences that do develop from believing in this drug war, should we not reconsider some of the moral superiority that we claim exists within this drug war and nuance the situation to make it actually more moral, more realistic, more human? Your thought please, sir.

Joao Goulao, MD: Okeh. The issue is exactly what you said. The war on drugs is based in stigma, is based in the fact that you consider not drug addiction, not as a disease, but as a vicious, a thing, there are moral focus on it, and shifting from that social representation into the idea that we are dealing with a health condition, and I insist with the same dignity and patience, must have the same dignity that others that suffer from diabetes, hypertension, whatever.

This was thought impossible, or close to, with our model, because the social perception has changed a lot. You know? And nowadays, you can -- you can, if you face -- if you are facing any kind of defeat of this related to drugs, you can discuss it in families, in schools, in workplace. You go to your boss, oh, boss, I have problems with alcohol, drugs, or whatever, I need to go for treatment for six months. Okeh, you go, I keep your post, and you return when needed.

So this is the kind of respect that you can have, if you have any kind of physical or mental disorder that imposes you to stay out of work. With addiction, nowadays it is considered with the same level of dignity. And that makes all the difference. Okeh?


Joao Goulao, MD: So, the moral judgment, a sin, vicious, that is the thing, and words matter. The way people refer to those conditions matters a lot. There's a report from the Global Commission that was presented in the, in Vienna last week, about the impact of, even of words, and expressions that you use in official documents, internal, the mentalities, when speaking about those issues.

DEAN BECKER: Yes sir. Doctor Goulão, I thank you so much. I do appreciate you --

Joao Goulao, MD: Thank you, it was a pleasure.

DEAN BECKER: -- sharing your thoughts.

Joao Goulao, MD: It was a pleasure to meet you, the other day, yesterday, I was very pleased.

DEAN BECKER: Well, that's it. There you have it. I also was very pleased to meet Doctor Goulão, he's a very fine, human, individual, and I hope he's the first of many drug czars that I get to speak with.

It's time to play Name That Drug By Its Side Effects! Nausea, vomiting, diarrhea, cirrhosis, psychosis, and dementia. The number one contributor to domestic violence and deaths on American highways. Time's up! The answer: alcohol. Taxed, regulated, and freely available in all non-Muslim countries.

We just heard the thoughts of Doctor Joao Goulao, he's the drug czar of Portugal, and here to give us his thoughts about the drug war, he had an op-ed just the other day in the New York Times, it was titled up The War On Drugs Breeds Crafty Traffickers. I therefore want to bring on air with us a Fellow from the Drug Policy Project at the Institute for Policy Studies, Sanho Tree.

SANHO TREE: Oh, thanks. You know, it's -- basically, it's a summation of all the talks I've given over the past 20 years on this subject. Right? And I always try to look at, okeh, what's the light bulb moment, what is it that really gets traction with audiences, that they didn't know before, or had a hard time grasping about the failed war on drugs.

And basically it boils down to two basic things. Number one's the economics, that the drug war acts as a kind of price support, if you will, for drug traffickers. These are minimally processed agricultural and chemical commodities that cost pennies to produce per dose in the real world. There's no reason drugs should be valuable.

There are a few drugs, very very few, that might be considered naturally valuable because they're scarce, like peyote buttons, for instance, that kind of cactus takes a long time to grow and it's endangered. Or, certain psychedelic frog secretions that are hard to capture, and they're also very rare. Those might have some actual value on the street.

But things like cocaine, heroin, methamphetamines, marijuana -- these are, again, minimally processed agricultural and chemical commodities. The way they build up value is through drug prohibition, and through a risk premium. And, so what Donald Trump has done, when he declared his support for the death penalty for certain drug offenses, is that he's actually rewarding drug traffickers. He's restoring a risk premium that allows them to charge even more money.

Similarly, you see this happening in the cannabis market. After legalization, the price of legal cannabis is collapsing. The price for an outdoor pound of marijuana, for using -- used for trim and concentrates, has fallen to about fifty dollars a pound [sic: that is the low end price for pounds of leaf trim in Oregon, while the wholesale price of the flowers or "buds" ranges from $300 to $1200 a pound]. That is remarkably low. I mean, it used to cost thousands of pounds, but now it's fifty bucks?

And here comes Jeff Sessions saying he's going to crack down on the industry, which actually ends up throwing them a lifeline because again, you're restoring that -- you're needing to restore some of that risk premium, so that allows them to charge more to the next person in the chain. Right? Because they have to balance that on the chances of getting arrested, prosecuted, jailed, or whatever. So the higher the risk, the higher the reward for these people.

And so you'll never make these drugs disappear by making them astronomically more valuable, which is what our policy has been doing.

The other ah-ha concept is the one of Darwinian evolution. Right? So that you're actually breeding super-traffickers by this ill-considered, you know, decade after decade all out war on drugs, you're thinning out the herd and catching the clumsy traffickers, and allowing the most efficient operations to take over that space and thrive.

DEAN BECKER: Sanho, your mention that the price of cannabis is falling, like a rock. I've been predicting that for well over a decade. I used to grow before I got into radio, here in Texas you can grow a 26 foot tall plant in one season. We have to quit fooling ourselves that these drugs have any value. I keep seeing, you know, drug induced homicide. It wasn't drug induced, it was prohibition induced. Am I right?

SANHO TREE: Exactly, exactly. It's the profits that are involved.

DEAN BECKER: I hope you had a chance to hear most of what the good doctor had to say, and you know, he's right, they have not solved the drug war, it's not perfect, but they are moving in the right direction, at least cutting down on overdoses and allowing people to not have such a frenzy.

He said they had 27 ODs in 2016, with a three million approximate population [sic: Portugal's population was 10.3 million in 2016], that works out to about a per capita 900 versus our 60,000. They must be doing something right. What's your thought there, Sanho?

SANHO TREE: Absolutely. I think, you know, they are approaching this from a public health, a genuine public health perspective, rather than let's be, you know, kinder gentler kind of thing, they're actually putting health first, and putting people first.

If you genuinely believe that drug addiction harms the individual, then what sense does it make for the state to harm them even more through punishment? What does that -- that doesn't help the society, it doesn't help the individual. And the Portuguese have been well on their way to reforming that.

And I think it's very encouraging that the Secretary-General of the UN, you know, Mister Gutteres, is the former prime minister of Portugal when they enacted their policy of decriminlization of all drugs, and focusing on public health. So here, the most, arguably them most powerful person on the planet, is someone who's been deeply involved in drug policy reform and really gets it. So that's going to help a lot.

DEAN BECKER: You know, I was on the road when most of the pronouncements from President Trump about maybe it's time to start killing drug sellers. I found it hard to believe. He said that these drug sellers can kill two, three, five thousand people, and maybe they'll get 30 days in jail, and that it's time to get tough. Your response there, Sanho.

SANHO TREE: Well, you know, he wants to kill drug traffickers, I wonder which, you know, pharmaceutical executives will be first in line. You know?


SANHO TREE: But he wasn't talking about those people, of course. I think, you know, the idea of death penalty, you know, Trump pointed to Singapore as a model. Well, Singapore does a funny thing. Yes, they do hang a lot of people, they execute people for drugs, but they publish no reliable statistics on drug use rates in the country so you can't really tell whether or not those executions have had any benefit whatsoever.

In fact, Harm Reduction International, my friend Rick Lines, found that despite their, all these executions in Singapore, the interdiction rates for methamphetamine and cannabis have actually gone up 20 percent in 2016. And the heroin seizure rate remains stable. This tells you, there's a healthy drug consumption market going on in this, in Singapore, they're just not talking about it or publishing any numbers about it.

And so, what Singapore does is they submit these numbers to the UN drug control, and they publish that in the global annual world drug report, and then Singapore then points to that report, saying, you see, we've been certified by the UN, they say that we're doing a great job. Well, they're basically data laundering, is what they're doing, and whitewashing their lack of numbers, and pointing back to that big fake news, if you will, and declaring it a success.

DEAN BECKER: If I remember right, Iran and China used to have a yearly drag them out into the courtyard and shoot them in the head execution of drug users, but, at least Iran has pulled back from their position. What's your response there, Sanho Tree?

SANHO TREE: I think, you know, Iran is a fascinating country. It's got, historically, very tough, very draconian drug laws, and they've hanged a lot of small time, you know, mules and traffickers, but even with that, they still have about 2.2 million illicit drug users in the country, most of them opioid users, opiate users. And this year, they decided to pull back on the death penalty. They're no longer going to use it for all these low level drug crimes, and instead reserve it for the highest level of crimes. They still use death penalty for murder and other crimes, but in terms of the drug war, they realized they can't hang their way out of this problem.

So, that puts Iran ahead of Donald Trump in terms of drug policy reform, in my opinion.

DEAN BECKER: Well, and don't we have Kellyanne Conway as our quasi-drug lady?

SANHO TREE: Oh, good lord. Yes. I've never seen anyone more unqualified to take on this issue in all the years I've worked on this problem. Trump only hires people he knows personally, and that's not the job of the president of the United States. It's to find the best people who are qualified to take on the issues, not your personal friends and family members and people you know personally. That's a very small world he lives in.

And we deserve better, and frankly this is much too urgent a crisis to hand off to cronies and people you trust personally but have absolutely no experience in the field.

DEAN BECKER: I heard a comment from her the other day that if you get a craving for drugs, eat some junk food instead.

SANHO TREE: Yeah. Yeah, she's really not helping. You know, her lack of qualifications, plus they've had this other guy as a deputy director of ONDCP who was finally forced to resign a few months ago, this 24 year old kid who, you know, volunteered on the campaign but has zero experience, and he's basically, you know, fulfilling the functions of a deputy director of the drug czar's office, in the midst of an opioid crisis. This is just insane.

DEAN BECKER: The fact that the New York Times wanted to publish your op-ed on Trump and the death penalty for drugs is a good sign that rational thought is starting to come forward. Well, friends, we've been speaking with Mister Sanho Tree, he's a Fellow with the Drug Policy Project at the Institute for Policy Studies there in Washington, DC. Thank you, Sanho.

SANHO TREE: My pleasure.

DEAN BECKER: Criminals get so emboldended,
Rip you off, thinking you're holding,
Can't tell the policeman what you know,
Got no recourse to the law.

Bad guys ducktape and beat you,
They're just looking for that easy score,
They will rob, rape, and kill you,
Because we've got no recourse to the law.

Damn, I'm proud of this week's show, and we'll have another great one next week, from Lisbon. Have an interview with Lucas Wiessing, he's the chief scientist for the European Monitoring Centre on Drugs and Drug Addiction. And from Bern, Switzerland, we'll hear from Doctor Christoph Buerki, the designer of the very successful Swiss heroin injection program, and once 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 an abyss.