Portugal Country Drug Report 2018

Treatment

The treatment system

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 is 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 the regional health administrations of the Ministry of Health, non-governmental organisations and other public or private treatment service providers interested and competent in the provision of care. The public services are provided free of charge and are accessible to all people who use drugs and 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).

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).

Inpatient treatment is mainly provided through third-level care services. It 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. A programme of extended duration (up to three years) is available to clients who require longer term support services. Special treatment programmes for people who use cannabis and cocaine have also been put in place.

In Portugal, OST is widely available. 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 Service covering 40 % of the market price of the medication.

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Treatment provision

In 2016, a total of 27 834 clients received treatment, and the majority were treated in outpatient services. Of the 3 294 clients entering treatment in 2016, 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.

The number of OST clients in Portugal decreased between 2010 and 2013; however, the number has remained relatively stable since then. In 2016, more than 16 000 clients received OST, mainly MMT.

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Methodological note: Analysis of trends is based only on those countries providing sufficient data to describe changes over the period specified. The reader should also be aware that monitoring patterns and trends in a hidden and stigmatised behaviour like drug use is both practically and methodologically challenging. For this reason, multiple sources of data are used for the purposes of analysis in this report. Caution is therefore required in interpretation, in particular when countries are compared on any single measure. Detailed information on methodology and caveats and comments on the limitations in the information set available can be found in the EMCDDA Statistical Bulletin.