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 medical and social 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 providing 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 incorporates 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 health care).
Outpatient treatment is available at all three levels of care; however, the main providers of outpatient treatment are the 72 specialised treatment teams from the integrated response centres. These treatment teams are usually the first point of contact for 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 3 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.
In 2017, a total of 27 150 clients received treatment, with most being treated in outpatient services. Of the 3 307 clients entering treatment in 2017, 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. In addition, the number of OST clients in Portugal decreased between 2010 and 2013; however, it has remained relatively stable since then. In 2017, more than 16 000 clients received OST, mainly MMT.