LISBON, Portugal In an obscure corner of the huge, ugly building that houses Santa Maria Hospital, lies the psychiatry department. A cluster of men mill around outside the office of psychiatrist Nuno Flix da Costa, waiting for their group therapy to start. Almost all are at least 40, some much older. Hardship is etched onto their faces. Deep wrinkles speak to long periods on the streets; gaunt cheeks and sagging skin are evidence of a lengthy history of drug abuse.

One of them goes to get a snack from a vending machine and punches the glass when the coin is returned. Another keeps saying hes in a hurry to get his prescription before he goes to work at 6 p.m. (its not even 3 p.m.). For years, these men did whatever was necessary to get their drugs of choice, usually heroin. They lost their jobs and often their families. Some have spent time in prison.

They are casualties of the drug crisis that gripped Portugal from the late 70s onward, leaving an estimated 1 in 100 people addicted to heroin by the late 1990s. But these men are also survivors. With access to health care and enrollment in a treatment program, they are symbolic of a radical turnaround in how the country decided to treat drug addiction.

Instead of doubling down on the policy of repression and criminalization it had been pursuing similar to Americas war on drugs stance Portugal became the first country to decriminalize all drugs. Drugs were still illegal and people would still be prosecuted for supplying or trafficking drugs, but those caught with small quantities would not be arrested.

Decriminalization was the most prominent part of a package of reforms designed to take a humane approach to addiction, to treat it as a disease rather than a moral failing. Drug users would be viewed as patients, not as criminals, and they would be met with treatment, rather than incarceration.

The approach worked. Over the last nearly two decades, the number of heroin users in Portugal has been cut by two thirds and drug-related deaths have plummeted from more than one a day in 1999 to 30 in all of 2016 . The fall in new drug-related HIV infections has been even more striking, with 18 recorded in 2016 , according to a 2019 report by the European Monitoring Centre for Drugs and Drug Addiction, compared with 907 in 2000 .