The last survey on drug use among the Portuguese adult (aged more than 16 years) prison population was conducted in 2014. According to the survey, 69 % of adult prisoners reported lifetime drug use. Cannabis was the most common illicit substance, with 56 % reporting having used it at some point during their lifetime and 28 % reporting having used it during imprisonment, followed by cocaine (39 % lifetime use and 8 % during imprisonment) and heroin (26 % lifetime use and 8 % during imprisonment).
Having ever injected an illicit substance was reported by 14 % of prisoners, with 4 % reporting injecting drugs during their current period of imprisonment. In addition, a survey of young offenders (aged 12-16 years) in custody, conducted in 2015, found that almost 89 % of those who responded had lifetime drug use experience.
The prevalence of human immunodeficiency virus (HIV) infection among those receiving treatment for drug use in prison is reported to be 19 %; the majority of HIV-infected prisoners receive antiretroviral therapy. More than half of inmates are HCV positive, and 1 in 20 has HIV and HCV comorbidity. All prisoners are screened for infectious diseases on entry to prison and tests are repeated at least once a year.
Prison healthcare is managed by health services under the responsibility of the Ministry of Justice in partnership with the National Health Service. All prisons make detailed yearly plans for health promotion and disease prevention, which include initiatives (awareness-raising and training actions) to tackle infectious diseases, drug dependency and addictive behaviours focusing on the relationship between these phenomena.
The detection of addictive behaviours and dependences is part of the evaluation protocol when a prisoner enters prison. Referral to treatment is encouraged in the prison setting, which ensures the continuity of opioid substitution treatment (OST) and other treatments initiated before imprisonment, as well as allowing prisoners to access the different interventions available in prisons. OST can be initiated in prisons.
Interventions in this area are divided into two types of responses: programmes oriented towards abstinence (drug-free wings and exit units) and medication-assisted treatment programmes (with opioid agonists and antagonists). At the end of 2017, around 1 000 prisoners were enrolled in programmes of pharmacological treatment with opioid agonists or antagonists in Portuguese prison establishments. In the past 5 years, a downward trend in the number of inmates participating in drug treatment programmes (both abstinence oriented and providing pharmacological treatment) has been observed. This may be related to a possible reduction in the number of opiate users in general, as evidenced by the recent national prison survey.
Interventions targeting infectious diseases are also available in prison in Portugal. The legal framework for establishing a syringe exchange programme in prison was ratified by the Ministry of Health in 2007, but no activity has been reported.