Portugal decriminalised personal consumption of drugs almost a decade ago, showing a lead to other advanced nations. It is also about to introduce an innovative national alcohol program. Advisor to the national drugs board, Fatima Trigueros, reports in detail on what changes decriminalising drugs has made in consumption in general society, schools and prisons.
Portugal: progressive care
By Fátima Trigueiros*
With its decriminalisation of personal drug use, and needle and syringe programs in prisons, Portugal is taking an innovative lead amongst other EU countries in tackling alcohol and other drug issues.
Situated at the western edge of southern Europe, Portugal comprises of a continental mainland and two autonomous regions, the Archipelagos of Azores and Madeira on the Atlantic Ocean, west of the mainland. Australia is 84 times the size of Portugal, which totals 91 900 km. Portugal’s population is around 10,600,000, with approximately 23% of the population living in rural areas.
Portugal has been a semi-presidential constitutional republic since 1974, after a military coup d’état allowed civilians to hold democratic elections. The main constitutional organs are the President, the Parliament, the Government and the Courts.
Because of its geographic location and special ties with former colonies, Portugal is one of the main roads for drug traffic into Europe. In 2007 nearly 7.362 tons of cocaine were seized, 42.772 tons of hashish, 0.061 ton of heroin, 0.133 tons of liamba (an African herb with hallucinogenic effects similar to cannabis; 0.152 tons in 2006) and 113,835 pills of ecstasy.
Personal consumption of drugs was decriminalised in 2000 and the law was enforced from July 2001. It is a crime to possess drugs in a quantity greater than an average of 10 days consumption.
|
Population (2006 estimate) |
10.6 million |
|
People with problematic drug use |
1.5-3.0 per 1000 residents (aged 15-64 years) |
|
Most commonly used illicit drugs |
Cannabis, cocaine, heroin, ecstasy, liamba |
|
HIV prevalence among people who inject drugs |
9-29% |
|
Hep C prevalence among people who inject drugs |
39-52% |
|
Hep B prevalence among people who inject drugs |
3-10% |
Drug use snapshot
Drug use and abuse became socially visible from the 1970s onwards. This was partly due to large military contingents returning from colonial wars, having been exposed to various substances, particularly liamba. Around that time the first anti-drug campaign was launched. Its slogan, ‘Drugs, Madness and Death’ ignored prevention and dramatically emphasized the consequences of consumption.
A major change in policy occurred about 10 years ago, and the results of this more person-focused approach are positive. While results of a national study conducted in 2007 in the general population (people aged 15-64 years) showed a moderate increase in lifelong use of any drug between 2001 and 2007 (7.8% in 2001 and 12% in 2007), consumption of any drug decreased from 44.2% in 2001 to 31.2% in 2007. Compared to other European countries, Portugal has a lower prevalence of overall drug consumption, except for heroin, for which it has one of the highest life-long usage rates.
In greater detail, the 2007 survey showed that cannabis was the most used illicit substance, with a national prevalence of 11.7% (life-long use) and 2.4% (last 30 days), followed by cocaine 1.9% (life) and 0.3% (last 30 days), heroin 11.7 (life) and 0.2 (last 30 days), and ecstasy 1.3% (life) and 0.2% (last 30 days).
Among school students, the most recent studies conducted in 2001 and 2006 show a general decrease in consumption of all drug types for both life-long use (14% to 8%) and in the last 30 days (6% to 5%) for students aged 13-15 years and from 28% to 20% and 12% to 9% for those aged 16-18.
Results from national studies conducted in 2001 and 2007 on the prison population showed a general decrease of drug consumption, both before and after prison. Compared to 2001, a noticeable reduction of injecting consumption was registered, both in the context before prison (27% in 2001 and 18% in 2007) and during prison (11% in 2001 and 3% in 2007).
National drug control legislation and implementation
The first government structures aimed at drug use prevention, research and policing were created in 1975. In 1987, the government approved ‘Projecto VIDA’, a program aimed at demand reduction, and in 1989 this program was granted its own government ministry. Now known as the Institute for Drugs and Drug Addiction, it concentrates on drug use prevention, harm reduction, treatment, rehabilitation, statistical information, research and international cooperation.
Portugal has been an active member of coordinated European efforts to curb drug use and trafficking. It is party to the UN conventions, and has been a member of the EU since 1986. It is also member of the Council of Europe’s Pompidou Group, a multidisciplinary co-operation forum to prevent drug abuse and illicit trafficking in drugs, set up in 1971.
In 1999 Portugal’s major policy document, the National Strategy on Drugs (NSD), was launched, based on eight principles. Among these, a ‘humanistic’ principle enforced the view of drug addicts as citizens with full rights, entitled to protection, treatment and harm reduction policies. Drug-addiction was also deemed a disease.
In 2000 the Parliament decriminalized personal drug consumption, subjecting illicit drug use to administrative rather than criminal sanctions. People who are found with less than the equivalent of 10 days’ supply of a drug are required to face a Drug Addiction Dissuasion Commissions (DADC). The membership of each DADC is a lawyer and two health and welfare clinicians. They may suspend the hearing (meaning no sanction is made), impose a fine or place restrictions on personal activities which might encourage drug use, such as associating with certain individuals, attending specific venues or travelling.
The main aim of this “dissuasion” is to identify emerging drug users and motivate them to undergo treatment, among other support responses. The program is registering success as the number of administrative sanction files is growing (6744 in 2007; 6260 in 2006). Out of the 622 primary drug addicts presented to DADC in 2008, 86% have voluntarily undergone treatment.
Two of the most important objectives of the NSD were to reverse the infection rates of HIV, hepatitis B and C and tuberculosis, as well as to reduce by 50% the number of deaths related to drug abuse. Evaluation conducted in 2004 showed definite progress towards these objectives.
The NDS was updated in 2005, with the publication of a National Drug Plan (NDP) for 2005-2012 and an Action Plan for 2006 to 2009. The new NDP contains innovative policy approaches, tailoring responses to local needs and available resources in each area. A national plan on the harmful use of alcohol is also currently being prepared.
Policy objectives and actions are organized around two main areas: transversal (coordination, international cooperation, information, research, training and evaluation and law); and mission areas (demand and supply reduction). Objectives and actions are closely knit with the 2005-2008 European Plan on Drugs to enable comparison.
As part of the NDP’s Action Plan, prevention and harm reduction programs are conducted by non-profit organizations. The Institute for Drugs and Drug Addiction (IDT) also runs a free helpline service, email counselling and a website aimed to guide and provide information on substances focused on young people, parents and educators. Public Security Police in urban areas and the National Republican Guard in rural areas run Program Escola Segura (‘Safe School’) aimed at pupils, teachers and parents, in co-operation with the Ministry of Education.
Specialised treatment for drug addicts was initiated in 1987 at the Taipas Centre in Lisbon, with the first Drug Addicts Attendance Unit. Based on this experience, units were also set up in the cities of Oporto and Algarve. Treatment is carried by a public network of out-patient, drug ‘weaning’ and therapeutic centres covering all territories, complemented by some private units. It constitutes a comprehensive or fully integrated system aimed at patients with drug and/or alcohol problems, and follows a medical and/or psychosocial approach.
Since 1999 measures have been taken to create, improve and certify street outreaching teams, licensed by IDT. By the end of 2008 the number of outreaching teams will be 43. Needle exchange programs were initiated in 1993. In 2007, 2,311,382 kits were distributed (2,591,150 in 2006). Kits are distributed in pharmacies and other harm reduction outreach points.
Help for inmates
Portugal has a progressive and caring approach to treatment for prison inmates. Specialised services are run in a number of prison establishments, including seven free drug treatment centres. Follow-up treatment is also assured to individuals entering or leaving prison. In some cases, inmates are allowed to maintain methadone treatment. In 2007, 245 beds and a half-way house were provided for inmates enjoying a special ‘open’ or minimum security regime and 669 inmates were under substitution treatment.
The approval of a program to provide needle exchange machines in prisons aroused controversy among prison guards. The program was launched in 2008 as a trial in one prison, but at April 2009, no needles had been exchanged. However, the program has sent a strong harm-reduction message to inmates, and promoted a vision of inmates as worthy of the same human rights as ordinary citizens. From it, 231 interventions were implemented in prisons under a pilot-project aimed at health promotion and disease prevention.
*Fátima Trigueiros is Advisor to the Executive Board, Institute for Drugs and Drug Addiction, Portugal