Drug policy of Portugal

The drug policy of Portugal was put in place in 2000, to be legally effective from July 2001. The EU had in effect forced the Portuguese government to make radical measures to reduce Portugal's record high incidence of HIV/AIDS^{[citation needed]}. In 1999 Portugal had the highest rate of HIV amongst injecting drug users in the European Union. The number of newly diagnosed HIV cases among drug users has decreased to 13.4 per million population in 2009 but that is still high above the European average (2.85 cases per million).^[1] There were 2000 new cases a year, in a country of 10 million people. 45 % of reported AIDS cases recorded in 1997 originated among IV drug users,^[2] so targeting drug use was seen as an effective avenue of HIV prevention. The number of heroin users was estimated to between 50.000 and 100.000 in 2000.^[3] This led to the adoption of The National Strategy for the Fight Against Drugs in 1999. A vast expansion of harm reduction efforts, doubling the investment of public funds in drug treatment and drug prevention services, and changing the legal framework dealing with petty drug offences were the main elements of the policy thrust.

Harm reduction

The needle exchange programme, "Say NO! to a used syringe," is a nationwide syringe exchange programme which has been ongoing since October 1993, involving some 2 500 pharmacies throughout Portugal. It is run by the National Committee against AIDS - set up by the Ministry of Health and the National Association of Pharmacies - a nongovernmental organisation representing the majority of Portuguese pharmacies. All drug users can exchange used syringes at pharmacy counters across the country. They get a kit with clean needle syringes, a condom, alcohol and a written message motivating for AIDS prevention and addiction treatment. From 1994 to 1999, pharmacies delivered around 3 million syringes annually.^[4]
Several low threshold projects were initiated after 1999, particularly in the period 2003-2005, where outreach teams have promoted safe injection practices and supplied needles and injecting equipment on the street. Many of these projects are still running.

At programme start, a media campaign was launched by television,radio and the press, and posters were put up in discotheques and bars in order to attract the attention of the target population to the problems associated with drug addiction, in particular HIV transmission through needle-sharing.^[5]

Project objectives have been threefold: To reduce frequency of sharing needles and syringes, to change other IDU behaviours that create negative attitudes among the population in general, and to change attitudes towards IDUs in the general population to facilitate addiction prevention and treatment.^[6]

Expanding drug treatment

In 1987, the Centro das Taipas in Lisbon was created, an institution specialising in the treatment of drug addicts. This centre consisted of a consultation service, a day centre and an inpatient detoxification unit. This facility was the responsibility of the Ministry of Health, and was the first in the network of centres specialising in treating drug addiction which now covers the whole country.
Healthcare for drug users in Portugal is organised mainly through the public network services of treatment for illicit substance dependence, under the Institute on Drugs and Drug Addiction, and the Ministry of Health. In addition to public services, certification and protocols between NGOs and other public or private treatment services ensure a wide access to quality-controlled services encompassing several treatment modalities. The public services provided are free of charge and accessible to all drug users who seek treatment.
There are 73 specialised treatment facilities (public and certified private therapeutic communities), 14 detoxification units, 70 public outpatient facilities and 13 accredited day centres. Portugal is divided into 18 districts. There is full coverage of drug outpatient treatment across all but four districts (districts not covered are located in the North of the country: Viana do Castelo, Bragança, Viseu and Guarda).

Substitution treatment

Substitution treatment is today widely available in Portugal, through public services such as specialised treatment centres, health centres, hospitals and pharmacies as well as NGOs and non-profit organisations.

The Portuguese substitution programme started in 1977 in Oporto. The CEPD/North (Study Centre on Drug Prevention/North), using methadone as the substituting substance, was the only unit using opioid substitution until 1992. However, the increase in numbers of drug addicts (including an "explosion" at the beginning of the 1990s), together with the growth of AIDS and hepatitis C among this population, led to a change in attitude. After 1992, methadone-substitution programmes were extended to several CATs (Centres of Assistance to drug addicts). Overall, the programmes were medium or high threshold. With the exception of occasional activities in a slum area in Lisbon, there were no true low-threshold programmes (risk- and harm reduction)prior to 2001.

From 2000 to 2008, the number of people in Portugal receiving substitution treatment increased from 6040 to 25 808 (24 312 in 2007), 75 % of whom were in methadone maintenance treatment. The remaining patients received high dosage buprenorphine treatment.

Buprenorphine had been available since 1999, and later also the buprenorphine/naloxone combination.
Decree Law 183/2001 Article 44.1 and Decree Law 15/93 Article 15.1-3 stipulate that methadone treatment can be initiated by treatment centres whereas buprenorphine treatment can be initiated by any medical doctor, specialised medical doctors and treatment centres. From 2004, there was also the provision of buprenorphine in pharmacies.

After-care and social re-integration

After-care and social re-integration of drug users in Portugal is organised through three major programmes targeting different regions in Portugal (Programa Vida Emprego, Programa Quadro Reinserir and the PIDDAC incentives for re-integration). All three programmes finance different initiatives and projects supporting drug users through training opportunities, employment support, and/or housing.

Monitoring drug treatment

A national treatment monitoring system is being developed but has not yet been implemented in all regions. National routine statistics from outpatient centres on substitution clients are available (for clients in methadone and buprenorphine programmes).^[5]

Laws and regulations

Main article: Portugal 2001 decriminalization of drug use

In July 2001, Portugal a new law maintained the status of illegality for using or possessing any drug for personal use without authorization. The offense was changed from a criminal one, with prison a possible punishment, to an administrative one if the possessing was no more than up to ten days' supply of that substance.^[1] This was in line with the de facto Portuguese drug policy before the reform. Drug addicts were then to be aggressively targeted with therapy or community service rather than fines or waivers.^[7] Even if there are no criminal penalties, these changes did not legalize drug use in Portugal. Possession has remained prohibited by Portuguese law, and criminal penalties are still applied to drug growers, dealers and traffickers.^[8][9]

Regulation

Individuals found in possession of small quantities of drugs are issued summons. The drugs are confiscated, and the suspect is interviewed by a “Commission for the Dissuasion of Drug Addiction” (Comissões para a Dissuasão da Toxicodependência – CDT). These commissions are made up of three people: A social worker, a psychiatrist, and an attorney.^[9][10] The dissuasion commission have powers comparable to an arbitration committee, but restricted to cases involving drug use or possession of small amounts of drugs. There is one CDT in each of Portugal’s 18 districts. Several options are available to the CDT when ruling on the drug use offence, including warnings, banning from certain places, banning from meeting certain people, obligation of periodic visits to a defined place, removal of professional licence or firearms licence. Sanctioning by fine, which may vary by drug involved, is an available option. If the person is addicted to drugs, he or she may be admitted to a drug rehabilitation facility or be given community service, if the dissuasion committee finds that this better serves the purpose of keeping the offender out of trouble. If the offender is not addicted to drugs, or unwilling to submit to treatment or community service, they may be given a fine.^[1][11][12]

Law enforcement

Every year, Portuguese law enforcement bodies confiscate several tonnes of cocaine, with a record amount of more than 34.5 tonnes seized in 2006. A regular increase in quantities of cannabis resin seized could also be observed over recent years, though there has been a recent decline between 2008 (61 tonnes) and 2009 (23 tonnes).^[1]

Observations

There is no reliable information about drug use, injecting behaviour or addiction treatment in Portugal before 2001, when general population surveys commenced. The only information about drug use before that time was the indicators on lifetime prevalence amongst youth, collected as part of the European School Survey Project on Alcohol and Other Drugs (ESPAD).

Thorough studies on how the various efforts have been implemented have not been conducted. Thus, a causal effect between strategy efforts and these developments cannot be firmly established.^[8] There are, however, statistical indicators that suggest the following correlations between the drug strategy and the following developments, from July 2001 up to 2007:

• Increased uptake of treatment.^[8]
• Reduction in HIV diagnoses amongst drug users by 17%^[13]
• Reduction in drug related deaths, although this reduction has decreased in later years, and the number of drug related deaths is now almost on the same level as before the Drug strategy was implemented.^[8][13] However, this may be accounted for by improvement in measurement practices, which includes a doubling of toxicological autopsies now being performed, meaning that more drugs related deaths are likely to be recorded.^[14]
• Lifetime use of illicit drugs increased from 7.8% to 12%^[13] Care must be taken in interpreting this result as it may be down to the lessening of stigma surrounding non medical drug use, leading interviewees to give more honest answers, and against the rising use in neighbouring Spain.^[14]
• Lifetime use of cannabis increased from 7.6% to 11.7%.^[13]
• Lifetime use of cocaine more than doubled, from 0.9% to 1.9%^[13]
• Lifetime use of Ecstacy nearly doubled from 0.7% to 1.3%^[13]
• Lifetime use of heroin increased, from 0.7% to 1.1%^[13]

See also

• Harm reduction
• Drug rehabilitation
• Drug liberalization
• Drug policy of the Netherlands

References

1. ^ ^{a b c d} EMCDDA:Drug policy profiles, Portugal, June 2011
2. ^ CNLCS, 1998
3. ^ EMCDDA, 2000
4. ^ EMCDDA, 2000. http://www.emcdda.europa.eu/attachements.cfm/att_33997_EN_Insight3.pdf
5. ^ ^{a b} EMCDDA
6. ^ Ferreira MO, Madeira A, Teles A, Matias L, Amaro F; International Conference on AIDS. Int Conf AIDS. 1996 Jul 7-12; 11: 152 (abstract no. We.C.3545).
7. ^ "Portugal legalizes drug use". BBC News. 7 July 2000. http://news.bbc.co.uk/2/hi/europe/823257.stm. Retrieved 21 August 2009.
8. ^ ^{a b c d} Hughes, Caitlin; Stevens, Alex (December 2007), "The Effects of Decriminalization of Drug Use in Portugal", Briefing Paper 14, Oxford: Beckley Foundation, http://www.beckleyfoundation.org/bib/doc/bf/2007_Caitlin_211672_1.pdf 
9. ^ ^{a b} United Nations Office on Drugs and Crime (2009) (PDF). Confronting unintended consequences: Drug control and the criminal black market. United Nations. 174. ISBN 978-92-1-148240-9. http://www.unodc.org/documents/wdr/WDR_2009/WDR2009_eng_web.pdf. 
10. ^ Hammond, Claudia (18 June 2009). "Lisbon's light-touch drugs policy". BBC News. http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspondent/8106689.stm. Retrieved 24 August 2009. 
11. ^ Gillespie, Nick. "Drug Decriminalization in Portugal". Reason 2009 (July). http://www.reason.com/news/show/133856.html. Retrieved 24 August 2009. 
12. ^ Easton, Mark (1 July 2009). "How Portugal treats drug addicts". BBC News. http://www.bbc.co.uk/blogs/thereporters/markeaston/2009/07/how_portugal_treats_drug_addic.html. Retrieved 24 August 2009. 
13. ^ ^{a b c d e f g} Cardoso, Manuel; Santos, Ana Sofia; Duarte, Óscar (2009). "New Development, Trends and in-depth information on selected issues". Portuguese Focal Point report (2008 data) to the EMCDDA. Lisbon, Portugal: Institute for Drug and Drug Addiction (IDT,I.P.). http://www.idt.pt/PT/IDT/Documents/Ponto_Focal/2009_NationalReport.pdf. Retrieved 2011-06-11. 
14. ^ ^{a b} Hughes, Caitlin; Stevens, Alex (2010-7-21), "What can we learn from the Portuguese decriminalization of illicit drugs?", British Journal of Criminology. Oxford University Press, pp. 1014, doi:10.1093/bjc/azq038, http://www.beckleyfoundation.org/bib/doc/bf/2010_Caitlin_211621_1.pdf 

External links

• EMCDDA: Drug treatment overview: Portugal.
• Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies