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Drug treatment overview for Portugal

Map of Portugal

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 non-governmental organisations (NGOs) and other public or private treatment services ensure a wide access to quality-controlled services encompassing several treatment modalities. The public services are provided free of charge and are 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-care 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. Short-term and long-term residential psychosocial drug treatment is also available. There are 68 specialised treatment facilities (public and certified private therapeutic communities), 9 detoxification units, 78 public outpatient facilities and 8 accredited day-care centres. Although treatment of heroin addiction remains a main focus of the drug treatment system, during the period 2005–10 special programmes for cannabis and cocaine users have also been created.

Continuous efforts are also taken to systematise the best practice experience and promote new treatment approaches. Thus, in 2011, guidelines defining the early treatment of youth at risk and adolescent users and on treatment and rehabilitation in a therapeutic community were published.

Substitution treatment is widely available in Portugal through public services such as specialised treatment centres, health centres, hospitals, pharmacies, NGOs and non-profit organisations. Methadone has been available since 1977, buprenorphine since 1999, and the buprenorphine/naloxone combination has recently been approved for use.

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, and that buprenorphine treatment can be initiated by any medical doctor, specialised medical doctors and treatment centres. The provision of buprenorphine in pharmacies started in 2004.

In 2011 some 26 351 clients were registered in opioid substitution programmes (29 325 in 2010), 78 % of whom were in methadone maintenance treatment and the remaining 22 % in high-dosage buprenorphine treatment. Opioid substitution treatment is also available in prison settings. 

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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). 

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3. Treatment demand

Table 1: Number of clients entering treatment in Portugal by year
Clients in treatment 2009 20102011
Number of all clients entering treatment N. Av. 51794388
Number of all clients entering treatment with known primary drug   31573764
% of which for opioid use   64.770.1
% of which for cocaine use   12.110.5
% of which for cannabis use    15.913.9
% of which for stimulants use (other than cocaine)    0.20.1
Number of new clients entering treatment 7643 31202265
Number of new clients entering treatment with known primary drug 5178 21801800
% of which for opioid use 55.8 56.054.4
% of which for cocaine use 8.7 14.014.4
% of which for cannabis use 11.7 21.325.4
% of which for stimulants use (other than cocaine) 0.1 0.30.3

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.
In 2010 a new national information system was implemented.
‘N. Av.’ stands for ‘No information available’.
For an explanation of terms used, see the definitions of terms.
Sources:

Reitox national reports 2012 and TDI tables (ST34) V. 1.0-2007, questions 13.1.1 and 13.1.2.
EMCDDA Statistical Bulletin 2013 (Tables TDI 2 and 5).

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4. Treatment provision

Table 2: Treatment availability in Portugal
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):
  • Full: nearly all persons in need would obtain it
  • Extensive: a majority but not nearly all of them would obtain it
  • Limited: more than a few but not a majority of them would obtain it
  • Rare: just a few of them would obtain it
Sources:
Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2011.
Table 3: Opioid substitution treatment provision in Portugal
Opioid substitution treatment 2009 20102011
Number of clients in opioid substitution treatment 28708 2932526351
of which with methadone 20185 23067N.Av.
of which with buprenorphine 6846 6258N.Av.
Notes:
For a detailed European overview please see Table HSR-3 in the EMCDDA Statistical Bulletin 2013.
‘N. Av.’ stands for ‘No information available’.
For an explanation of terms used, see the definitions of terms.
Sources:
Standard Table 24 (ST24) on 'Treatment availability' submitted in 2011.
Table 4: Year of official introduction of opioid substitution treatment substances in Portugal
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 2013.
‘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.
Table 5: Legal framework of opioid substitution treatment in Portugal
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 2013.
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:
Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2011.

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5. References and links

Related EMCDDA resources

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.

Treatment inventories

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About the EMCDDA

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU’s decentralised agencies. Read more >>

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EMCDDA
Cais do Sodré
1249-289 Lisbon
Portugal
Tel. (351) 211 21 02 00
Fax (351) 218 13 17 11

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Page last updated: Friday, 31 May 2013