• Drug use among the general population and young people
• Prevention
• Problem drug use
• Treatment demand
• Drug-related infectious diseases
• Drug-related deaths
• Treatment responses
• Harm reduction responses
• Drug markets and drug-related offences
• National drug laws
• National drug strategy
• Coordination mechanism in the field of drugs
• Public expenditure
• Drug-related research

Drug use among the general population and young people

The first general population survey on drug use was conducted in Portugal in 2001. A sample of 15 000 individuals representative of the Portuguese population was surveyed. The results revealed that 7.8 % of respondents aged 15 to 64 had used an illegal drug at least once in their lives (lifetime prevalence). The most-reported substance in this context was cannabis (7.6 % lifetime prevalence). The use of other illegal substances was less frequently reported. Lifetime prevalence was less than 1 % for cocaine, heroin, ecstasy, amphetamines and LSD. Gender differences concerning illegal drugs experimentation were found for all substances. A higher proportion of males than females had used these substances at least once (11.5 % vs 3.9 % for cannabis, 1.2 % vs 0.2 % for heroin and 1.5 % vs 0.3 % for cocaine). The second national survey, carried out among the general population in 2007, a sample of 12 202 individuals representative of the Portuguese population was surveyed. Results show that 12 % of respondents aged 15 to 64 had used an illegal drug at least once in their lives (lifetime prevalence). The most reported substance in this context was cannabis (11.7 % lifetime prevalence). Lifetime prevalence was less than 1 % for amphetamines, LSD and hallucinogenic mushrooms; for cocaine (1.9 %), heroin (1.1 %) and ecstasy (1.3 %). Gender differences concerning illegal drugs experimentation were found for all substances. A higher proportion of males than females had used these substances at least once (18.4 % vs 5.2 % for cannabis, 1.8 % vs 0.4 % for heroin and 3.2 % vs 0.7 % for cocaine).

Surveys among young people attending school are currently carried out in Portugal nearly every two years: the National School Survey (Inquérito Nacional em Meio Escolar — INME) in 2001 and 2006 (a former version of the national survey was done in 1989 and 1995); and the ESPAD international school survey every four years since 1995 (students born 16 years before the year of data collection). Also, the Health Behaviour in School-aged Children — a survey promoted by the World Health Organization (HBSC/WHO) — is repeated every four years in Portugal and targets young people in school settings (6th, 8th and 10th grades).

In 2006, results from national studies implemented in the context of school populations, HBSC and INME, reveal decreases in the consumption in this target population, respectively between 2002–06 and 2001–06, with cannabis being once more the drug with higher prevalence of use between these populations. However, the latest HBSC/WHO study of 2009/10 indicates an increase in the prevalence of cannabis use in the period 2006–10.

The ESPAD survey results of 2011 showed that the lifetime prevalence for cannabis use was 16 % (compared to 13 % in 2007, 15 % in 2003 and 8 % in 1999). With regards to other drugs, the lifetime prevalence for inhalants was 6 % (4 % in 2007, 8 % in 2003, and 3 % in 1999), for all other substances lifetime prevalence was reported at 3 %. Results indicated 16 % for the last-year prevalence of cannabis use (10 % in 2007, 13 % in 2003, 9 % in 1999), 9 % for the last-month prevalence of cannabis (6 % in 2007, 8 % in 2003, 5 % in 1999). Despite the downward trend observed during 2002–06, the most recent ESPAD study corroborates the findings of the HBSC/WHO study, showing increasing consumption of illicit substances since 2006. In addition, the trend can be observed among both male as well as female students.

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Prevention

The Portuguese ‘National plan against drugs and drug addiction 2005–12’ aims to: (i) increase the number of drug prevention programmes based on scientific evidence; (ii) increase the number of selective prevention programmes directed to vulnerable groups; and (iii) improve the process of selection, monitoring and evaluation of prevention programmes. In the framework of the National Plan Against Drugs and Drug Addiction 2005–12, the Operational Plan of Integrated Responses (PORI) is an intervention framework targeted at drug demand reduction and organised at local/regional level. The principles are: (i) to integrate responses; (ii) to profit from synergies at local level; (iii) to empower citizens; and (iv) to promote their participation in partnerships that address identified needs of the community. Thus, in each specific territory, an intervention may address different problems and bring together different partners, working in different settings, depending on the identified needs. Within PORI, the most vulnerable territories have been mapped in order to prioritise them for resource and intervention allocation. This allowed identifying 163 territories in continental Portugal for development of integrated intervention responses at several levels (prevention, treatment, harm and risk reduction, and reintegration). In 2010, 68 integrated response prevention projects where implemented in the framework of the Operational plan covering nearly 93 700 persons mainly through awareness raising and information activities, which were followed by training and psychosocial interventions.

Universal drug prevention is part of the Portuguese school curriculum. Prevention programmes are delivered through training sessions, awareness-raising activities and dissemination of information through printed material. In the ‘Safe school programme’, law enforcement agents patrol the areas surrounding schools to prevent and protect from criminal activities such as drug trafficking in the surrounding area and are also involved in awareness and training activities in teaching establishments (targeting students, parents, school staff and law enforcement agents). Since 2006, a programme ‘Me and others’ is implemented across various educational settings and focuses on promotion of a child’s healthy development. The 2009/2010 school year finished with the coverage of  218 institutions with 14 348 young people aged 10 to 24 years participated in the programme covering all the country. Drug-prevention activities aimed at university students, in vocational education settings and in workplaces are usually implemented within the framework of comprehensive health promotion programmes. In 2010, giving continuity to the work initiated in 2008, the project of risk and harm reduction in the university context was developed by 23 Centres of Integrated Responses, covering 23 Portuguese cities, which involved dissemination of information through experts and also volunteers at major events targeting university students.

Selective prevention is given high priority from both a political and practical perspective through the Program of Focused Intervention (PIF) which was evaluated in 2010. The PIF envisages selective preventive interventions in the drug addiction area, based in scientific evidence, dealing with problematic specific groups. In its lifetime, PIF reached a total of 210 117 individuals, mainly individuals with patterns of use in recreational settings, followed by vulnerable children and youngsters, as well as vulnerable families. In some areas, small but important steps were given to improve the intervention, particularly in the development of guidelines with regard to the care of young users of psychoactive substances, including alcohol, and in the intervention on recreational settings. Searching for the ‘family treasure’ is a well-researched selective programme for vulnerable families.

All government-financed prevention interventions are monitored.

View ‘Prevention profile’ for additional information.

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Problem drug use

Portugal has carried out four new multiplier-methods estimates based on the 2005 data, which were then compared to previous estimates based on the 2000 data. The size of the population of long-term and/or regular users of opiates, cocaine and/or amphetamines was estimated to be between 4.3 and 5.0 per 1 000 inhabitants aged 15–64 (30 833 to 35 576 individuals) using an outreach team multiplier. A broader definition, not restricting the population to long-term and regular users, calculated using a treatment multiplier, suggested a higher rate of 6.2–7.4 cases per 1 000. Injecting drug users were estimated at 1.8–2.2 per 1 000 inhabitants aged 15–64 using a treatment multiplier, and 1.5–3.0 using a mortality multiplier. In all cases, the 2005 estimates were lower than those from 2000, however, in all cases except in the estimate of injecting drug users calculated using a mortality multiplier, the confidence intervals for the estimates in 2005 and 2000 overlapped.

The EMCDDA defines problem drug use as intravenous drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.

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Treatment demand

Treatment demand data in Portugal is collected through the outpatient public network via the Multidisciplinary Information System (SIM) which was launched in 2010 and enables to report complete treatment demand data from all 79 outpatient public treatment centres across Portugal. In 2010, a total of 5 179 clients were in treatment, while 3 120 of them were in treatment for the first time in their life.

With regards to the primary drug of abuse, among all clients 64.7 % reported opioids, 15.9 % reported cannabis and 12.1 % reported cocaine as their primary drug. Similar distribution is observed also among first-time treatment clients as 56 % reported opioids as their main substance, followed by 21.3 % for cannabis and 14 % for cocaine.

In 2010, around 49 % of all treatment clients were older than 35 years, while around 40 % of new treatment clients were at that age group. These data indicate an ageing of the drug-users population in Portugal. With regards to gender distribution, 85.5 % were males and 14.5 % were females. Likewise, distribution was observed also among new treatment clients where 85 % were males, whereas 15 % were females.

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Drug-related infectious diseases

In Portugal, global estimations of the prevalence of infectious diseases among drug users are not available. However, some data concerning clients of some treatment facilities are available, and can provide information on rates among some sub-groups of drug users: (i) those demanding treatment for the first time at the outpatient treatment public network; (ii) those submitted to a detoxification treatment in public or certified private detoxification units; or (iii) those in treatment in public or certified private therapeutic communities.

In 2010, 3 % of drug users treated for the first time, were found to be HIV positive (7 % in 2009, 9 % in 2008 and 2007). For the same treatment environments, rates for acute hepatitis B infections varied between 2 % and 4 % and for hepatitis C between 24 % and 46 % and tuberculosis between 0.1–1%.

When interpreting these results, it should be taken into consideration that the sample of tested drug users at various services is not always representative of the group. It must also be mentioned that some of the treatment samples included IDUs and non-IDUs, and consequently the rates among IDUs will probably be higher than those presented.

In general, a decreasing trend in the percentage of drug users in the total number of notifications of HIV and AIDS cases continues to be registered (since 1999–2000). Likewise, the decline in the incidence of HIV and AIDS among IDUs is also registered since 1999–2000 (116 new HIV cases in 2010 and 1 482 in 2000; 88 new AIDS cases in 2010 and 675 in 1999). A downward trend can be observed also in the prevalence of HIV, HCV and HBV among clients of drug treatment settings.

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Drug-related deaths

There are two sources of information about drug-related deaths in Portugal: the General Mortality Registry of the Statistics National Institute and the Special Registry of the National Institute of Forensic Medicine.

In 2010, the General Mortality Registry of the Statistics National Institute registered 26 cases of drug-related deaths, which is slightly less than 27 cases reported in 2009. The values registered in 2009 were the highest since 2003, but inferior to the ones registered in 2002 (year when ICD-10 was implemented in Portugal). The increase in drug-related death may be a reflection of the increase in the number of deaths and of the methodological improvements on the general mortality registries.

In 2010, the provisional data from the Special Registry of the National Institute of Forensic Medicine estimate that 52 drug-related death cases (selection D) in Portugal (56 in 2009 and 94 in 2008). The majority of death cases occurred among men, at a mean age of 39 years. All the provisionally reported DRD cases were toxicologically confirmed and 90.4 % of them were linked to opiates.

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Treatment responses

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 69 specialised treatment facilities (public and certified private therapeutic communities), 13 detoxification units, 79 public outpatient facilities and 9 accredited day centres. Although addressing heroin addiction remains a main focus of the drug treatment system, during the period from 2005–10, special programmes for cannabis and cocaine users have been also created.

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 2010, 29 325 clients were registered in opioid substitution programmes (28 708 in 2009), 79 % of whom were in methadone maintenance treatment and the remaining clients (21 %) in high-dosage buprenorphine treatment.

View ‘Treatment profile’ for additional information.

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Harm reduction responses

The main priorities established by the national plan for the 2005–12 period in the area of risk and harm reduction are: (i) to set up a global network of integrated and complementary responses in the harm reduction area with public and private partners; and (ii) to target specific groups for risk reduction and harm minimisation programmes. A network of harm reduction programmes (syringe exchange, low threshold substitution programmes, etc.) and structures, including drop-in centres, refuges, shelters, contact units and mobile centres, is being consolidated throughout the country in critical zones of intensive drug use with the aim to prevent drug-related risks such as infectious diseases and social exclusion and delinquency.

The National Commission for the Fight Against AIDS (Comissão Nacional de Luta Contra a SIDA), in cooperation with the National Association of Pharmacies (Associação Nacional de Farmácias) implements the national syringe exchange programme ‘Say no to a second-hand syringe’ which was set up in October 1993 to prevent HIV from spreading amongst IDUs. The programme currently involves 1 336 pharmacies (approximately 48 % of all pharmacies on the Portuguese mainland), several mobile units, other public and NGO facilities as well as prison settings. Approximately 47 million syringes have been exchanged through this programme since its launch in October 1993 until December 2010. In 2010 alone, 1 846 000 syringes have been distributed within the programmes supported by the Institute on Drugs and Drug Addiction (IDT), while including data from pharmacies and other non-IDT supported entities the number raises to 2 057 497 distributed syringes. Overall trends in syringe exchange show that an increase in syringe numbers until 2001 (total 3.5 million) was followed by a stabilisation on a lower level (2.7 million) until 2005, and a decline thereafter. An evaluation of the programme in 2002 concluded that it had been successful in preventing HIV infections among drug injectors. Districts such as Lisbon, Porto, Setúbal and Faro are still those with the higher quantity of exchanged syringes, and have taken part in the programme since its beginning.

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Drug markets and drug-related offences

Portugal remains an important transit point on international drug trafficking for many drugs, but particularly for cocaine. The Netherlands is the origin of heroin and ecstasy seized in Portugal. While cocaine seized in Portugal comes mainly from Brazil, Venezuela and Colombia and cannabis from Morocco. Most of the cannabis and ecstasy seized in Portugal is destined for the external market, in particular to Spain.

In 2010, the total number of 13 635 reports of persons involved in drug-related offences were reported. Cannabis-related offences accounted for the biggest share with 60.9 %, followed by heroin-related offences with 12.4 %, and 8.9 % refer to cocaine-related offences.

In 2010, the number of seizures for all drugs except cocaine and ecstasy has gone down in comparison to 2009. As in previous years, the highest number of seizures involved cannabis resin (3 063), followed by cocaine and heroin (1 598 and 1 462 respectively). The number of herbal cannabis (liamba) and ecstasy seizures continue to be much lower. However, an increasing trend in the number of seizures of all drugs can be observed in the last six years, comparing to the first half of the decade.

Concerning the quantities seized, an increase is reported for the amount of cannabis resin, cocaine and ecstasy seized when compared to 2009 levels (34 774 kg, 3 244 kg and 48 370 tablets respectively), while the amounts of seized herbal cannabis, cannabis plants and heroin have dropped in comparison to 2009. With regards to heroin, the amount seized in 2010 was the lowest in the past decade (47 kg).

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National drug laws

The main drug law in Portugal is Decree Law 15/93 of 22 January, which defines the legal regime applicable to trafficking and consumption of narcotic drugs and psychoactive substances. Drug trafficking may be sentenced to one to 12 years imprisonment, depending on different criteria, one of them being the nature of the substance supplied. For users who sell drugs to finance their own consumption, the penalty is reduced.

The Portuguese legal framework on drugs changed in November 2000 with the adoption of Law 30/2000, in place since July 2001, which decriminalised illicit drug use and related acts, but maintains drug use as an illicit behaviour and also maintains the illegal status for all drugs included in the relevant United Nations Conventions. However, a person caught in possession of a small quantity of drugs for personal use (established by law, this shall not exceed the quantity required for an average individual consumption during a period of 10 days), without any suspicion of being involved in drug trafficking, will be evaluated by a local Commission for Dissuasion of Drug Addiction, composed of a lawyer, a doctor and a social worker. Sanctions can be applied, but the main objective is to explore the need for treatment and to promote healthy recovery.

View ‘Legal profile’ for additional information.

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National drug strategy

Portuguese drug policy is expressed in three strategic documents. Launched in 1999 and envisaged as a long-term policy document, the National Strategy for the Fight Against Drugs defined the general objectives in the drugs field. The strategy is built around eight principles. These are: (1) the principle of international cooperation; (2) the principle of prevention; (3) the humanistic principle; (4) the principle of pragmatism; (5) the principle of security; 6) the principle of coordination and rationalisation of resources; (7) the principle of subsidiarity; (8) the principle of participation. Six general objectives are set out in the strategy:

1. to contribute to an appropriate and efficient international and European strategy for the world drug problem, with regards to demand and supply reduction and which includes the fight against illicit trafficking and money laundering;
2. to provide Portuguese society with better information about the phenomenon of drugs and drug addiction, as well as the dangers of particular drugs, from a preventive perspective;
3. to reduce the use of drugs, especially among younger members of the population;
4. to guarantee the necessary resources for treatment and social reintegration of drug addicts;
5. to protect public health and the security of people and property.
6. to repress illicit traffic of drugs and money laundering.

These objectives are elaborated through a set of 13 strategic options.

The National Plan Against Drugs and Drug Addictions 2005–12 was designed to further implement and ensure continuity with the 1999 National Strategy. Six different axes are used to articulate the National Plan. These include four cross-cutting themes: (1) coordination; (2) international cooperation; (3) information, research, training and evaluation; (4) legal framework review. Mission areas are elaborated through two axes covering: (1) demand reduction, including prevention, dissuasion, risk and harm reduction, treatment and reintegration; and (2) supply reduction. The National Plan focuses on four main ideas: geographical proximity, integrated approaches and responses, focus on the citizen, and improving quality and accreditation mechanisms. In an overall sense, the National Plan’s objective is to significantly reduce the use of drugs amongst the population and its negative social and health consequences.

Two sequential action plans have been adopted to complement the National Plan for the periods 2005–08 and 2009–12.The 2009–12 Action Plan covers the areas of coordination, international cooperation, information/research/training/evaluation, the legal framework, demand reduction and supply reduction. It identifies those responsible for each action, as well as a timetable and the indicators/assessment instruments to monitor the plan’s implementation.

View ‘National drug strategies’ for additional information.

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Coordination mechanism in the field of drugs

An integrated approach is taken towards the coordination of policy on licit and illicit drugs in Portugal. After the adoption of the National Plan for the Reduction of Alcohol-related Problems, the Inter-ministerial Council approved extending the existing scope of the collective coordination structures in the drugs area. This resulted in the creation of the National Coordination Structure for Drugs, Drug Addiction and Alcohol-related Problems, as expressed in the Decree-Law 40/2010 of 28 April 2010. Accordingly, the monitoring of action plans on licit and illicit drugs, their evaluation and policy development in general now takes place in an integrated manner.

Several structures comprise the National Coordination Structure for Drugs, Drug Addiction and Alcohol-related Problems. At an inter-ministerial level, the overall responsibility for the endorsement, coordination and evaluation of drug policy rests with the Inter-ministerial Council. It is chaired by the Prime Minister and comprised of the Ministers for Justice, Health, Education, Science and Higher Education, Labour, Home Affairs, Foreign Affairs, National Defence, Finance, Environment, Agriculture, Economy and Social Security. The National Drug Coordinator is also a member of the Council.

The Inter-ministerial Council is supported in its work by the Inter-ministerial Technical Commission, which is chaired by the National Coordinator and composed of representatives designated by the different ministers. Its main function is to design, monitor and evaluate the National Plan and supporting action plans in the illicit drugs area, as well as the National Plan for the alcohol area.

The Institute on Drugs and Drug Addiction (IDT) is attached to the Ministry of Health. It has a range of strategic tasks at the operational day-to-day level of coordination. These include implementing the national strategy on illicit drugs, its supporting action plan, as well as the action plan on alcohol. It is also responsible for promoting the reduction of licit and illicit drugs consumption, supporting the Government Ministers tasked with developing the national policies and strategies on licit and illicit drugs and their evaluation. The President of the Institute’s Executive Board is the National Coordinator on Drugs and Alcohol-related Problems.

The National Council for the Fight Against Drugs and Drug Addiction is an advisory body, chaired by the Prime Minister that can delegate to the Minister of Health. It has a broad membership, which includes representatives from 23 institutions, public or private: Governments of the Autonomous Regions of Madeira and Azores, the Mayors’ Association, the Judges Council, the general public prosecutor, university deans, churches and religious communities, care services and non-governmental organisations, the Youth Council, students, parenting associations, the Family Federation, the Journalists Union, and since 2010 — representatives from the alcohol industry and commerce. It advises the Government on the national strategy and the action plan and follows the implementation reports.

The Criminal Police (Polícia Judiciária) at the Ministry of Justice coordinates interventions and information in the area of supply reduction.

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Public expenditure

The Portuguese action plan for 2006–08 had a comprehensive associated budget. This budget forecasted labelled drug-related expenditure to represent 0.05 % of GDP, with a 3 % annual nominal growth rate. The implementation of that budget was never fully assessed. An attempt to estimate the total drug-related expenditure (¹) was made for the year 2005. The methodology used was well defined, but some questions regarding the completeness of the data remain unanswered.

In 2005, drug-related expenditure was estimated to represent 0.03 % of GDP, with 52 % for drug-related health services and the remaining for defence and public order and safety activities. Since then, no comparable estimates have been made available, and therefore no trend analysis can be provided.

The available information does not allow reporting on the current total size and trends in drug-related public expenditure in Portugal. However, the new action plan (2009–12) recommends the creation of a subcommittee on public expenditures in order to better monitor this area.

(¹) Some of the funds allocated by governments for expenditure on tasks related to drugs are identified as such in the budget (‘labelled’). Often, however, the bulk of drug-related expenditure is not identified (‘unlabelled’) and must be estimated by modelling approaches. The total budget is the sum of labelled and unlabelled drug-related expenditures.

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Drug-related research

The national plan 2005–12 gives priority to the repetition of major epidemiological surveys but also to evaluation, social and economic research which can support the decision-making process in all intervention areas. Most of the research in this field is funded by the IDT, which is also a major actor in undertaking research, together with university departments. Since 2007, a university group of researchers developed a network to discuss and disseminate the work in this area. The IDT, through its website and reports, and national scientific journals are the main dissemination channels for drug-related research findings. Recent drug-related studies mentioned in the 2011 Portuguese National report mainly focused on aspects related to prevalence of drug use but research on interventions and on determinants of drug use was also mentioned.

View ‘Drug-related research’ for additional information.

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