Portugal to introduce supervised drug consumption facilities

Fifteen years after Portugal lifted criminal sanctions against the use of any type of drug, drawing the line between consumption and trafficking, the outcomes of that move have seen Portugal in a better situation than any other country that adopted the same approach. Drug use has not increased, nor has the country become a refuge for drug addicts from other parts of the world.

Portugal was among the first countries to make the move, led by João Goulão, a doctor who currently heads the General-Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD). This week, the first supervised drug consumption facility was commissioned, a measure approved in 2001 that is finally about to become a reality in the coming months.

Since the issue was moved from the realms of crime enforcement to public health, the country has seen a sharp decrease in addict HIV infection rates, overdose deaths, and drug-related jail convictions. In 2001, drug-related offenders accounted for 41% of the total number of inmates in the country, but that ratio had dropped to 19% by 2015. The number of troublesome injectable heroin users fell from 100,000 to 40,000. But it's not all roses when it comes to Portugal's drug use scenario, and there's much more that needs to be done.

The positive outcomes have stemmed from the fact that illicit substance addicts were no longer persecuted as criminals—they are now treated as patients. This paradigm shift has made Portugal a best-practice benchmark for other countries around the world. And it can be mainly explained by the fact that, unlike other countries, where drug use spread among underpriviledged populations, Portugal was experiencing a boom of drug experimentation across all social groups, including the middle and upper classes.

Back then, you could hardly find a family that was not affected by the problem. It was precisely the fact that illicit substance use pervaded across Portugal's social spectrum that created a favorable environment for a more liberal approach to the issue, leading to the decriminalization of all drugs. “When things are confined to the margins [of society], it is hard to garner support for inclusive policies. In Brazil's case, for example, the issue is concentrated mainly in slums, and there it's going to remain,” said Goulão, who has visited Brazil a number of times and knows about its reality.

Supervised use

According to the doctor, decriminalization was an important first step in addressing the challenge, but Portugal is making further strides by focusing on risk mitigation and harm reduction, based on the perception that crime enforcement is not the best approach to address the issue of drugs. That's where supervised drug use rooms come in. Approved in 2001, these rooms still remain to be implemented in the country, because after the liberalization, there was a nearly abrupt fall in injectable drug use rates.

But as the economic crisis worsened in Portugal impacting drug addict reemployment and social recovery programs, use of injectables rose again,  which according to Goulão created the demand for the implementation of the first supervised consumption facilities in the country.

This kind of facility has existed in Europe for 30 years—there are 90 in total, in nine countries. In 2014 alone, 6,800 people died from overdose on the continent, but only one death occurred in a supervised injection facility in the period—it was in Germany, caused by anaphylaxis. All rooms have trained personnel in place to intervene in case of an overdose. Users have also learned how to help other users at lethal risk, and are provided with ready-to-inject naloxone kits.

The facilities aim to reduce behaviors that increase the risk of disease contagion and overdose deaths. Models vary between integrated and mobile units—the type that is likely to be implemented by Portugal in the coming months. In these facilities, addicts receive social and psychological counseling, drug substitution thereapies, care for injuries and diseases, and needle changes.

Eligibility requirements for using the service vary. In Germany, people on opioid substitution therapies are excluded, which leaves out about 70,000 addicts. Some facilities accept users as young as 16 years old (with written parental consent), but for most facilities the user must be 18 or older. None of them accepts occasional or first-time drug users, and users are not allowed to show up intoxicated or drunk.

Translated by Mayra Borges