A 2014 essay by Puma Shen, now the Democratic Progressive Party's (DPP) candidate for Taipei mayor, has put drug decriminalization back at the center of Taiwan's politics. More than a decade of experiments abroad, however, shows the policy is far messier than either camp's talking points suggest.
Writing under the pen name "Puma," Shen argued for decriminalizing drug use. If that proved too radical, he wrote, Taiwan could at least follow other countries in "setting up community centers that provide drug users with drugs and clean needles," with social workers on hand. The resurfaced passage has set off a clash between Shen and Taipei Mayor Chiang Wan-an of the Kuomintang (KMT) over methadone, clean needles, and harm reduction ahead of the November 28 local elections.
The international record has changed a lot since Shen wrote the essay. Switzerland still runs heroin-assisted treatment, and Portugal has kept its noncriminal approach. Oregon sharply reduced penalties for possessing small amounts of drugs, then brought some criminal penalties back a few years later. British Columbia's three-year decriminalization pilot formally ended in early 2026 and was not renewed. None of these cases adds up to a simple verdict.
Four Different Policies Often Treated As One
Much of the confusion comes from lumping harm reduction, methadone, decriminalization, and state-supplied drugs into a single argument.
Taiwan adopted harm reduction around 2005, when HIV was spreading among people who inject drugs. It introduced clean needle programs and methadone substitution therapy on a practical premise: someone who cannot quit yet should at least avoid infection from shared needles and the health risks of street drugs. The approach worked. Citing National Taiwan University public health research, Taiwan's Centers for Disease Control estimates that the programs prevented 13,664 HIV infections among injecting drug users between 2005 and 2020. It also found that every NT$1 spent on prevention saved about NT$19 in related medical costs.
Methadone is a controlled oral medication available for substitution or maintenance therapy only through designated medical institutions. Clean needle programs reduce the risk of infection from shared needles, but they do not exempt anyone from prosecution for possessing or using illegal drugs.
Decriminalization addresses a separate question: whether a person caught with a small amount of drugs for personal use should still be treated as a criminal. Having the state or medical institutions supply controlled drugs sets a higher bar still. Programs of that kind exist, but they are usually limited to specific groups of severely addicted patients under strict rules on eligibility, dosage, and medical supervision.
These policies can coexist, but one cannot stand in for another. Supporting methadone does not mean supporting decriminalization, and opposing decriminalization does not mean rejecting every harm reduction measure.
Switzerland Supplies Heroin Under Strict Medical Control
Switzerland began trials of heroin-assisted treatment (HAT) in 1994 using pharmaceutical-grade diacetylmorphine, which is in effect medical heroin. The program was never scrapped. Instead, it became a formal part of the country's addiction treatment system. According to the Swiss Federal Office of Public Health, about 1,700 people received treatment in 2021 at 22 specialized centers and one prison. Official evaluations found improvements in patients' physical, mental, and social well-being, along with a decline in criminal behavior.
The program is also very hard to get into. Patients generally must be at least 18 years old and have been severely dependent on heroin for at least two years. They must also have failed at least two other forms of treatment and suffered serious physical, psychological, or social harm from their addiction. Clinics and doctors are regulated, and the medication comes with medical and psychosocial care. The goal is to move severely addicted patients for whom other treatments have failed out of the illegal market and into the health system.
That structure is expensive. It requires doctors, nurses, social workers, drug controls, case tracking, eligibility reviews, and long-term funding. A debate that cites "Switzerland supplies heroin" while leaving all of that out is no longer describing the Swiss policy.
Portugal And Oregon Show Treatment Must Fill The Gap
Portugal overhauled its drug laws around 2001, moving personal use and possession of small amounts out of the criminal system. Decriminalization is not legalization: drug trafficking remains a crime, and people caught with small amounts are still dealt with. Instead of going through the courts, they may be referred to administrative panels, health assessments, and treatment. The reasoning is that jailing someone with an addiction for months or years does not end the addiction. The reform produced a number of positive results, and Portugal has long been the example decriminalization advocates cite most.
Oregon tested what happens when nobody is ready to take over once penalties are removed. In 2020, voters approved Measure 110, which sharply reduced criminal penalties for possessing small amounts of drugs. It aimed to replace arrest, prosecution, and jail with assessment, treatment, and support.
Practical problems arose quickly once the law took effect. The state had to ask whether it had enough treatment centers and clinical staff, and which agency should handle someone struggling with mental illness, addiction, and housing at the same time. In 2024, lawmakers passed HB 4002, which made possession of certain amounts of controlled substances a crime again. The law also kept diversion programs, so police can steer eligible people toward assessment, treatment, and social services instead of arresting and charging them.
A 2025 state audit found that Measure 110 had not fully achieved its goal of treating addiction as a public health issue rather than a criminal one. The auditors cited poorly integrated treatment networks, uneven access to services across regions, and long-standing weaknesses in Oregon's behavioral health system. Doctors, social workers, beds, and clinics do not appear simply because a law changes.
British Columbia's Pilot Collided With Public Spaces
British Columbia's experiment raised a further set of problems. Starting January 31, 2023, adults 18 and older could carry a combined total of up to 2.5 grams of certain illegal drugs for personal use without facing criminal charges or having the drugs seized, provided they met the conditions. The drugs covered were opioids, cocaine, methamphetamine, and MDMA.
Just over a year later, drug use in public places and neighborhood disorder had become political and social flashpoints. After concerns grew among residents and local governments, the province asked Canada's federal government in 2024 to amend the exemption and sharply restrict the possession and use of illegal drugs in public spaces.
Official data does not show that decriminalization itself increased public drug use. According to the BC Centre for Disease Control, deaths from unregulated drugs and paramedic-attended opioid overdoses showed no statistically significant change in the policy's first 11 months. The deeper problem was that once the policy reached city streets, an abstract right ran into competing claims on shared space. Residents, shopkeepers, commuters, and parents taking children to the park were all drawn in.
People struggling with addiction need treatment and support. Other residents also expect to use parks, train stations, and hospitals safely. The two goals can coexist, but only if the government draws clear lines. When the pilot expired on January 31, 2026, British Columbia did not seek to renew it. The province still treats addiction as a health issue, but it has acknowledged that the pilot did not deliver the results it had hoped for.
The Question Has Shifted From Prison To Capacity
Taken together, the four cases do not show the world returning to strict prohibition. Swiss heroin treatment continues, and Portugal has not restored full criminalization. Oregon brought back some penalties but kept treatment referrals, and British Columbia ended its pilot without abandoning the view that addiction is a health problem.
A decade ago, the main question in drug policy was whether there was any alternative to locking people up. Today the question is who takes over once they are not locked up. People who were once handled by police, prosecutors, and courts would partly become the job of hospitals, social workers, and local governments. Further questions follow: which drugs qualify, how use in public places is regulated, and what happens when someone refuses treatment. These issues do not fit into a campaign slogan, but they decide whether a policy can survive.
What Taiwan Would Need To Define First
Any serious decriminalization proposal in Taiwan would first have to specify which drugs, what amounts, and how police should respond. Heroin, methamphetamine, cannabis, and MDMA cannot all be covered by the single word "drugs." A Swiss-style program of prescribed controlled drugs would face an even higher bar: who qualifies, where the drugs are taken, whether patients may take them off site, and who supervises. Underneath all of it is whether Taiwan has enough addiction treatment, psychiatric care, and social workers to take on the caseload. British Columbia adds one more lesson: the policy has to plan for neighborhoods and public spaces, not only for the relationship between drug users and the state.
Neither "other countries have been doing this for years" nor "other countries have already failed" answers those questions. Twelve years ago, the debate was over whether an idea was worth trying. With more than a decade of real-world evidence now available, the questions can be far sharper.
Policy is not a matter of faith. When new evidence emerges, the answers should change with it, and there is nothing strange about that.
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