Nearly 70,000 Americans died of a drug overdose in 2025. While that is a decline from the nearly 108,000 deaths recorded in 2022, these grim figures distinguish the U.S. from other high-income countries. At the peak of the opioid crisis, the U.S. overdose death rate was 68% higher than Canada’s and nearly five times that of Australia.

And death is only the starkest indicator: Substance use disorder imposes hundreds of billions of dollars in healthcare, criminal justice and lost productivity costs each year – to say nothing of the incalculable disruption to families and communities.

For decades, U.S. drug policy has aimed to reduce drug use by disrupting supply, punishing possession and use, and promoting abstinence.

But this isn’t the only approach to addressing drug use.

2026 marks the 25th anniversary of Portugal’s landmark decision to decriminalize the possession of all drugs for personal use. This is one of the world’s longest-running efforts to center public health and harm reduction in national drug policy.

As a criminologist and a political scientist, we have spent the past three years teaching a course on drug policy and harm reduction in Portugal, bringing dozens of students to the country to study its approach firsthand. That experience has given us a close look at both the promise and the limitations of the Portuguese model.

Surprising assumptions

While in Portugal, our students meet with policymakers, health and law enforcement officials, treatment providers and practitioners. These experiences complement our research on how policies once considered unthinkable can gain acceptance among the public and policymakers. We also examine nonpunitive approaches to problematic drug use – that is, recurrent drug use that significantly interferes with a person’s health or quality of life.

What always strikes us in our work here are the pragmatic and, compared with the U.S., surprisingly apolitical assumptions that underlie Portugal’s approach: People will use drugs, and public policy can reduce the harms associated with that use even when it cannot entirely prevent it.

In practice, this means measures such as providing sterile equipment to consume........

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