Topics
1. National context
Healthcare for drug users is organised in Portugal mainly through the public network services of treatment for illicit substance dependence, under the Institute on Drugs and Drug Addiction and the Ministry of Health. In addition to public services, certification and protocols between NGOs and other public or private treatment services ensure a wide access to quality-controlled services encompassing several treatment modalities. The public services provided are free of charge and accessible to all drug users who seek treatment.
Drug treatment in Portugal can be classified into four main categories: (i) outpatient drug treatment; (ii) day care centres; (iii) detoxification units; and (iv) therapeutic communities. All centres provide both psychosocial and substitution treatment. Day centres offering outpatient care are provided by public and non-governmental services. Withdrawal treatment is available in public and private detoxification units. Inpatient psychosocial treatment mostly consists of therapeutic communities and is mainly available in private services. There is also short-term and long-term residential psychosocial drug treatment available. There are 70 specialised treatment facilities (public and certified private therapeutic communities), 13 detoxification units, 79 public outpatient facilities and 9 accredited day centres.
In 2009, the number of guidelines defining early interventions for young people, on follow-up of high-risk groups, on referrals between the programmes and on admission criteria to therapeutic communities were made public, thus systematising the best practice experiences gained in the field.
Substitution treatment is widely available in Portugal, through public services such as specialised treatment centres, health centres, hospitals and pharmacies as well as NGOs and non-profit organisations. Methadone has been made available since 1977, buprenorphine since 1999 and recently also the buprenorphine/naloxone combination.
Decree Law 183/2001 Article 44.1 and Decree Law 15/93 Article 15.1–3 stipulate that methadone treatment can be initiated by treatment centres whereas buprenorphine treatment can be initiated by any medical doctor, specialised medical doctors and treatment centres. Moreover, the provision of buprenorphine in pharmacies started in 2004.
In 2009, 28 708 clients were registered in opioid substitution programmes (25 808 in 2008), 76 % of whom were in methadone maintenance treatment and the remaining clients (24 %) in high dosage buprenorphine treatment.
2. Treatment registries and monitoring systems
A national treatment monitoring system is being developed but has not yet been implemented in all regions. National routine statistics from outpatient centres on substitution clients are available (for clients in methadone and buprenorphine programmes).
3. Treatment demand
| Clients in treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of all clients entering treatment | N. Av. | N. Av. | N. Av. |
| % of which for opioid use | |||
| % of which for cocaine use | |||
| % of which for cannabis use | |||
| % of which for stimulants use (other than cocaine) | |||
| Number of new clients entering treatment | 5124 | 7019 | 7643 |
| % of which for opioid use | 70.0 | 62.9 | 55.8 |
| % of which for cocaine use | 11.6 | 10.8 | 8.7 |
| % of which for cannabis use | 10.9 | 10.5 | 11.7 |
| % of which for stimulants use (other than cocaine) | 0.4 | 0.0 | 0.1 |
| Notes: The variation across time, in particular with regard to the absolute numbers of clients in treatment, should be interpreted with caution as coverage data may have changed over time. For further information on coverage details please refer to the relevant EMCDDA Statistical Bulletin. ‘N. Av.’ stands for ‘No information available’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009 and TDI tables (ST34) V. 1.0-2007, questions 13.1.1 and 13.1.2. EMCDDA Statistical Bulletin 2007 (Tables TDI 4 and 5), 2009 and 2011 (Tables TDI 2 and 5). | |||
4. Treatment provision
| Type of treatment | Availability |
|---|---|
| Psychosocial out-patient interventions | Full |
| Psychosocial in-patient interventions | Full |
| Detoxification | Full |
| Substitution/maintenance treatment | Full |
| Notes: For an explanation of terms used, see the definitions of terms. Based on question 3.1 " Please assess the current availability of the treatment interventions below in relation to the user needs, judging the degree to which treatment capacity matches the demand" of Structured Questionnaire SQ27P1 on 'Treatment programmes'. Rating Scale (level of availability):
Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |
| Opioid substitution treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of clients in opioid substitution treatment | 24312 | 25808 | 28708 |
| of which with methadone | N. Av. | N. Av. | 21862 |
| of which with buprenorphine | N. Av. | N. Av. | 6846 |
| Notes: For a detailed European overview please see Table HSR-3 in the EMCDDA Statistical Bulletin 2011. ‘N. Av.’ stands for ‘No information available’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |||
| Applied substances in opioid substitution treatment | Officially introduced in |
|---|---|
| Methadone (MMT) | 1977 |
| Buprenorphine (HDBT) | 1999 |
| Heroin assisted treatment,including as trials | N.App. |
| Slow-release morphine | N.App. |
| Buprenorphine/naloxone combination | N. Av. |
| Notes: For a detailed European overview please see Table HSR-1 in the EMCDDA Statistical Bulletin 2011. ‘N. App.’ stands for ‘Not applicable’. ‘N. Av.’ stands for ‘No information available’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |
| Legal framework of opioid substitution treatment | Methadone | Buprenorphine |
|---|---|---|
| Do office-based medical doctors have the right to initiate the prescription of substitution treatment? | N.App. | Yes |
| Do specialised medical doctors have the right to initiate the prescription of substitution treatment? | Yes | Yes |
| Notes: For a detailed European overview please see Table HSR-2 in the EMCDDA Statistical Bulletin 2011. For an explanation of terms used, see the definitions of terms. 'Specialised medical doctors' refers to specifically trained or accredited office-based medical doctors. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | ||
Treatment availablity in Europe
The graphic below presents an overview of treatment provision by different types of service (psychosocial outpatient, substitution, psychosocial inpatient and detoxification) in different European countries and can be used for comparative purposes. Click on the thumbnail to view it.
Figure 1: Treatment availability in Europe, 2007
5. References and links
Related EMCDDA resources
- Health and social responses statistics
- Treatment demand statistics
- Annual report on the state of the drugs problem
- National reports for Portugal
- Country overview for Portugal
- Drug treatment responses page
- Best practice portal
- Treatment demand key indicator page
For a comprehensive overview on drug treatment systems, availability and utilisation in Europe, please consult the 2008 online report on ‘Quality of treatment services in Europe — drug treatment — situation and exchange of good practice’ published by the Directorate General for Health and Consumers.
External links
Please note that the EMCDDA is not responsible for the content of external sites.
- Associação Dianova Portugal (PT)
- Associação de Tratamento das Toxicodependências – ATT (PT)
- Centro de Tratamento Villa Ramadas (PT, EN, ES, FR, GR, IT)
- Centro de Recuperação de Doenças de Adicção, Lda. (PT, EN, ES)
- Clínica Sol Por Hoje (PT, DE)
- CRATO (PT)
- Desafio Jovem (PT)
Treatment inventories
