The National Plan for the Reduction of Addictive Behaviours and Dependencies 2013-20 states that treatment interventions should be based on a comprehensive diagnosis of each citizen’s full biopsychosocial needs, be accessible and adaptable, be based on scientific evidence in terms of effectiveness, efficiency and quality, and be underpinned by guidelines.
Healthcare for drug users was reorganised in Portugal in 2013-14, and it is now provided by the Referral Network for Addictive Behaviours and Dependencies. The network encompasses public specialised services of treatment for illicit substance dependence, under the authority of Regional Health Administrations of the Ministry of Health, NGOs and other public or private treatment services interested and competent in provision of care. The network ensures wide access to quality-controlled services provided through several treatment modalities and in integration with other, non-health, services to this vulnerable population. The public services are provided free of charge and are accessible to all drug users who seek treatment. The network envisages three levels of care: (i) primary healthcare services (ii) specialised care, mainly in outpatient settings; and (iii) differentiated care, mainly in inpatient settings (detoxification units, therapeutic communities, day centres and/ or specialised mental or somatic healthcare).
Drug treatment in Portugal: settings and number treated
NBYear of data 2015.
Trends in percentage of clients entering specialised drug treatment, by primary drug, in Portugal
NB Year of data 2015.
Opioid substitution treatment in Portugal: proportions of clients in OST by medication and trends of the total number of clients
NB Year of data 2015.
Although the model accepts that clients can enter treatment at any of these levels, in the long term it is expected that clients will enter treatment through first-level services, that is, primary healthcare.
Outpatient treatment is available at all three levels of care; however, the main providers of outpatient treatment are second-level services and include 72 specialised treatment teams from the integrated response centres. These treatment teams are usually the first point of contact for the clients. From there, referrals are made to public or private detoxification units or therapeutic communities. All centres provide both psychosocial care and opioid substitution treatment (OST). Activities that are primarily aimed at early intervention and the provision of counselling take place in general healthcare centres, while mental health services provide care to drug users with mental comorbidities.
Inpatient treatment is mainly provided through third-level care services. This includes short-term withdrawal treatment (7-10 days usually), which is available in eight public and private detoxification units. There are also 59 therapeutic communities, which usually provide 3- to 12-month residential treatment programmes. Therapeutic communities are mainly privately owned and publicly funded. Recently, a new programme of extended duration (up to three years) has been designed to meet the needs of clients who require longer term support services. Although treatment of opioid use remains a focus of the drug treatment system, special programmes for cannabis and cocaine users have also been created. In Portugal, OST is widely available through public services such as specialised treatment centres, health centres, hospitals, pharmacies, NGOs and non-profit organisations. Methadone has been available since 1977 and buprenorphine since 1999; the buprenorphine/naloxone combination was approved for use in 2007. Methadone maintenance treatment (MMT) can be initiated in treatment centres, and buprenorphine treatment can be initiated by any medical doctor, specialised medical doctors and treatment centres. MMT is free of charge to the client, while buprenorphine-based medications are available in pharmacies, with the National Health System covering 40 % of the market price of the medication.
In 2015, approximately 27 000 clients — the majority of those in treatment — were treated in outpatient services, while about 3 500 clients were treated in inpatient services. This number has been decreasing since 2010. Of the 3 389 clients entering treatment in 2015, three out of every five were first-time clients. The number of previously treated treatment entrants has been decreasing since 2012, while the number of first-time entrants has been stable over this period. Since 2012, there has been an increase in the proportion of entrants reporting primary cannabis use and a decrease in the proportion reporting primary opioid use. Among first-time entrants, cannabis has been the most commonly reported primary drug since 2014.
In 2015, 17 011 clients received OST in Portugal. About 66 % of clients in OST receive MMT, while the remaining clients receive buprenorphine-based treatment. The number of OST clients decreased between 2010 and 2013 and has been relatively stable since.