What happens when an entire country legalizes drug use?

(Armando Franca/AP Photo) In this Nov. 10, 2010 picture, a drug addict who identified himself as "Joao," held used needles to exchange for new ones in Lisbon's Casal Ventoso district. Street teams of Portugal's Institute for Drugs and Drug Addiction exchange used needles for new ones and try to direct drug addicts to treatment centers. Joao, who's 37 years old, has been consuming drugs for 22 years. Portugal decriminalized the use of all drugs in a groundbreaking law in 2000.

In the end, there was no way to ignore the problem, and no way for politicians to spin it, either. Young people across Portugal were injecting themselves with heroin. HIV and Hepatitis C infection rates were soaring. And Casal Ventoso, a neighborhood in Lisbon, had become a dark symbol of this small nation’s immense drug problem. Junkies openly injected themselves in the street, dirty syringes piled up in the gutters, alleyways reeked of garbage and human waste, and no one seemed to care.

“Welcome to Lisbon’s drugs supermarket,” a police officer said to a visitor in 2001, surveying the daily depravity with a shrug. But João Goulão, Portugal’s drug czar, admits now that the police officer was probably understating it. “Casal Ventoso,” Goulão said recently, “was the biggest supermarket of drugs in Europe.”

Faced with both a public health crisis and a public relations disaster, Portugal’s elected officials took a bold step. They decided to decriminalize the possession of all illicit drugs — from marijuana to heroin — but continue to impose criminal sanctions on distribution and trafficking. The goal: easing the burden on the nation’s criminal justice system and improving the people’s overall health by treating addiction as an illness, not a crime.

As the sweeping reforms went into effect nine years ago, some in Portugal prepared themselves for the worst. They worried that the country would become a junkie nirvana, that many neighborhoods would soon resemble Casal Ventoso, and that tourists would come to Portugal for one reason only: to get high. “We promise sun, beaches, and any drug you like,” complained one fearful politician at the time...

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Keith O'Brien @'The Boston Globe'