Drug policy of Portugal

In 1999, Portugal had the highest rate of HIV amongst injecting drug users in the European Union. There were 2,000 new cases a year, in a country of 10 million people. In 1997, 45% of HIV reported AIDS cases recorded originated among IV drug users,[3] so targeting drug use was seen as an effective avenue of HIV prevention. The number of heroin users was estimated to be between 50,000 and 100,000 at the end of the 1990s.[4] 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 minor drug offences were the main elements of the policy thrust.

According to Dr João Castel-Branco Goulão, one of the architects of the decriminalisation policy, a reason why the programme was able to get off the ground was because in Portugal, the problem could not be blamed on any ethnic or economic group in society (as in Brazil and the favelas), allowing other prejudices to be put aside. The policy was, however, initially opposed by right-wing politicians, who feared it would turn Portugal into a narco-state.[5]

The needle exchange programme, "Say NO! to a used syringe," is a nationwide syringe exchange program which has been ongoing since October 1993, involving some 2,500 pharmacies throughout Portugal. It is run by the National Commission for the Fight against AIDS - set up by the Ministry of Health and the National Association of Pharmacies - a non-governmental 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, rubbing alcohol and a written message motivating for AIDS prevention and addiction treatment. From 1994 to 1999, pharmacies delivered around three million syringes annually.[6]

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 discothèques 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.[7]

Project objectives have been threefold: To reduce frequency of sharing needles and syringes, to change other IDU (Intravenous Drug User) behaviors 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.[8]

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 a patient 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).

In July 2001, 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 amount possessed was no more than a ten-day supply of that substance.[2] 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.[9] 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.[10][11] Despite this, the law was still associated with a nearly 50% decrease in convictions and imprisonments of drug traffickers from 2001 to 2015.[12]

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).[2]

There is little reliable information about drug use, injecting behaviour or addiction treatment in Portugal before 2001, when general population surveys commenced. Until then, there were the indicators on lifetime prevalence amongst youth, collected as part of the European School Survey Project on Alcohol and Other Drugs (ESPAD), and some other (less reliable) data available through the EMCDDA.[16]

Thorough studies on how the various efforts have been implemented were not conducted. Thus, a causal effect between strategy efforts and these developments cannot be firmly established.[10] 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 (roughly 60% increase as of 2012.)[10]
• Reduction in new HIV diagnoses amongst drug users by 17%[17] and a general drop of 90% in drug-related HIV infection
• In April 2009, the Cato Institute published a White Paper about the "decriminalization" of drugs in Portugal,[18] paid for by the Marijuana Policy Project [19] Data about the heroin usage rates of 13-16-year-olds from EMCDDA were used in the report to claim that "decriminalization" has had no adverse effect on drug usage rates and that drug-related pathologies - such as sexually transmitted diseases and deaths due to drug usage - had decreased dramatically.[18]
• The number of newly diagnosed HIV cases among drug users was 13.4 cases per million in 2009 which is high above the European average of 2.85 cases per million.[2][20][21]

• Reduction in drug related deaths, although this reduction has decreased in later years. The number of drug related deaths is now almost on the same level as before the drug strategy was implemented.[10][17] 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.[22]
• Reported lifetime use of "all illicit drugs" increased from 7.8% to 12%, lifetime use of cannabis increased from 7.6% to 11.7%, cocaine use more than doubled, from 0.9% to 1.9%, ecstasy nearly doubled from 0.7% to 1.3%, and heroin increased from 0.7% to 1.1%[17] It has been proposed that this effect may have been related to the candor of interviewees, who may have been inclined to answer more truthfully due to a reduction in the stigma associated with drug use.[22] However, during the same period, the use of heroin and cannabis also increased in Spain and Italy, where drugs for personal use was decriminalised many years earlier than in Portugal [22][23] while the use of Cannabis and heroin decreased in the rest of Western Europe.[24][25] The increase in drug use observed among adults in Portugal was not greater than that seen in nearby countries that did not change their drug laws.[26]
• Possibly unrelated, homicide rate increased from 1.13 per 100 000 in 2000 to 1.76 in 2007, then decreased to 0.96 in 2015 [27][28][29]
• Drug use among adolescents (13-15 yrs) and "problematic" users declined.[22]
• Drug-related criminal justice workloads decreased.[22]
• Decreased street value of most illicit drugs, some significantly
• The number of drug related deaths has reduced from 131 in 2001 to 20 in 2008.[30] As of 2012, Portugal's drug death toll sat at 3 per million, in comparison to the EU average of 17.3 per million.

• Drug liberalization
• Drug policy of the Netherlands

• EMCDDA: Drug treatment overview: Portugal
• Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies
• PGDL:Law 30/2000 (in Portuguese)