In times of austerity, a threat to Portugal’s drug policies

OSF, February 10 2012, by Alexandra Kirby-Lepesh

The Portuguese Government’s decision amid the financial crisis to dissolve the Institute on Drugs and Drug Addiction (IDT) has worried supporters of Portugal’s decriminalization policies. The IDT—an institution under the Ministry of Health with responsibility for treating drug dependent persons—ceased to function on January 31 of this year and has been replaced by SICAD (Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências).

The future of funding for Portugal’s exemplary harm reduction services remains uncertain. New evidence from Agência Piaget para o Desenvolvimento (a national harm reduction network in Portugal) suggests that seven harm reduction projects face closure, and funding for Portugal’s specialized drug-related services is subject to systematic delays.

With drug treatment no longer under the IDT, drug users will have to go to regular health clinics or hospitals to access methadone and other drug-related services. For many who depend on this specialized treatment, the prospect of accessing mainstream services is likely to be intimidating, which means they may not go at all. Another concern is that psychologists and other health professionals will be asked to work in other parts of the health service, draining the drug dependence services of their most valuable employees.

In 2001, Portugal decriminalized the possession of drugs for personal use and concurrently initiated a national program of treatment and harm reduction measures. Ten years later a number of key health outcomes have improved: fewer people there die of overdoses and HIV transmission rates amongst drug users as a proportion of all newly diagnosed HIV-infected persons have decreased significantly. This innovative approach to solving drug problems has brought experts from around the world to see what lessons they can learn.

It also brought Richard Branson, a member of the Global Commission on Drug Policy, to Lisbon in early December to a press conference at which he congratulated the country on its drug policy.

With drug possession no longer a criminal offense, the focus shifted to treatment. More public funds are channeled into treatment rather than paying for lengthy stays in prisons, and police do not put up resistance to needle exchanges and other kinds of outreach work. If a person is caught with a small amount of drugs, he or she is sent to a dissuasion committee, which will refer him or her to treatment if necessary.

Outside Lisbon, in an area whose inhabitants are predominantly of African origin, there is a mobile drug treatment unit (Unidade Móvel), which previously belonged to the IDT. Comprised of a one-story building and a bus surrounded by a tall wire fence, the treatment center caters to around 6,000 clients, mainly from nearby Amadora (Portugal’s third-largest city) and Sintra. Every day, between 10 a.m. and 1 p.m., around 200 drug users queue outside the bus. A nurse hands out medicines through a hatch window.

In this "one-stop-shop," patients can access methadone and medicine for TB, HIV, and other illnesses, if there is an agreement with their doctor. Patients can also have informal consultations with health professionals whilst walking around the courtyard.

This exemplary commitment to harm reduction is under attack from some voices among Portugal’s right-wing parties, who favor prohibitionist approaches. In spite of the IDT’s dissolution however, the health minister, Paulo Macedo, continues to show support for existing drug policies.

Investment in specialized harm reduction services such as those provided in Amadora’s Unidade Móvel should not be compromised in the name of austerity. Indeed, there is a danger that short-term, cost-saving measures could prove costly further down the line.

While much is uncertain today for the patients and staff at Portugal’s drug dependence clinics, there is hope that the international praise of Portugal’s drug policy will help keep it firmly in place and that open dialogue based on hard evidence will help protect the country’s impressive achievements to date.

For more on Portugal’s drug policy, see our report Drug Policy in Portugal: The Benefits of Decriminalizing Drug Use.

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