• 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
• 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.

The ESPAD survey results of 2007 showed that the lifetime prevalence for cannabis use was 13 % (compared to 18 % in 2003, 12 % in 1999). As regard to other drugs, the lifetime prevalence for inhalants was 4 % (8 % in 2003, 3 % in 1999), for all other substances lifetime prevalence were below 2 %. Results indicated 10 % for the last year prevalence of cannabis use (13 % in 2003, 9 % in 1999), 6 % for the last month prevalence of cannabis (8 % in 2003, 5 % in 1999).

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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 a 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 where a pressing development for an integrated intervention is needed. An identified territory does not match administrative delimitations, but several places related between themselves by the existence of common problems associated with the use of psychoactive substances, that need responses at several levels (prevention, treatment, harm and risk reduction, and reintegration).

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 schools’ 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). A well evaluated programme (grow-up-playing) is delivered in elementary schools.

Selective prevention is given high priority from both a political and practical perspective through the PIF programme with 23 new pilot projects. The Program of Focused Intervention (PIF) envisages selective preventive interventions in the drug addiction area, based in scientific evidence, dealing with problematic specific groups, namely families, vulnerable children and youngsters and individuals with patterns of use in recreational settings. Searching for the family treasure is a well researched selective programme for vulnerable families.

All government financed prevention interventions are monitored.

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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). A broader definition applied in treatment multiplier estimation was suggesting a higher rate (6.2–7.4 cases per 1 000). Injecting drug users were estimated at 1.5–2.2 per 1 000 inhabitants aged 15–64, according to two used methods.

In all cases, the 2005 estimates were lower than those from 2000, however, with overlapping confidence intervals with the exception of one figure.

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. In 2007, the network received treatment demand data from all 78 treatment centres across Portugal. Data were available only on clients who entered treatment for the first time in their life (new clients) and not on all those who entered treatment in 2007.

In 2007, 34 266 clients were in treatment, and of those 5 124 (14.96 %) requested treatment for the first time. The total number of active clients increased 6 % in comparison to previous years (32 460 in 2006, 31 822 in 2005, 30 266 in 2004) and passed the maximum value of 2001 (32 064). Among first-time treatment clients, 70 % reported opioids as their main substance followed by 11.6 % for cocaine and 10.9 % for cannabis. In 2007, 41 % of new treatment clients were more than 35 years of age. With regards to gender distribution, 84 % were males whereas 25 % 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 2007, rates of HIV infections ranged from 9.1 % to 19.9 % among voluntarily-tested drug users treated for the first time at public outpatient units (36 % of them submitted tests), public or certified private detoxification units (83 % submitted tests), and public or certified private therapeutic communities (93 % submitted tests). For the same sub-groups, in 2007, rates for acute hepatitis B infections ranged between 3 % and 10 % (with 27 %, 82 % and 94 % of the respective total clients being tested) and for hepatitis C between 39 % and 52 % (with 28 %, 84 % and 92 % of the respective totals being tested).

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 AIDS cases continues to be registered (since 1999). Concerning HIV, HCV and HBV in the treatment settings, positive cases remained stable in comparison to previous years.

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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. The most reliable data are provided by the Special Registry and are based on toxicological tests.

In 2007, 314 direct drug-related deaths were reported by the Special Register, defined as an individual whose post-mortem toxicological analyses is positive for any illicit drug of abuse. The national DRD definition relates to all positive toxicological results for drugs whatever the cause of death (overdose, traffic accident, etc), and is not in line with the EMCDDA DRD standard. The 2007 figures represents an increase of 45 % in relation to 2006 (216) and the highest value since 2001 (280). In approximately 55 % of cases, opiates or opiates in combination with other substances (mainly cocaine or alcohol) were the main substance involved in drug-related deaths. As regards the distribution by age and sex, the majority of cases were male (91 %) and the mean age was 34 years. Data from the General Mortality Registry are not comparable with the data from the Special Registry.

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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 in therapeutic communities and is mainly available in private services. There is also short-term and long-term residential psychosocial drug treatment available.

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.

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 2007, 24 312 clients were registered in opioid substitution programmes (22 922 in 2006), 74 % of whom were in methadone maintenance treatment and the remaining clients in high dosage buprenorphine treatment. 4 953 were new admissions (4 833 in 2006) and 6 530 (6 087) left the programme during the year, 15 % of whom with medical release (16 % in 2006).

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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 developed 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 1 314 pharmacies (approximately 48 % of all pharmacies on the Portuguese mainland), several mobile units, other public and NGO facilities as well as prison settings. In 2007, pharmacies were responsible for 58 % of all 2.3 million syringes exchanged. About 41 million syringes have been exchanged through this programme since its launch in October 1993 until December 2007. 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. Regions with the highest population density such as the Lisbon, Porto and Setúbal districts 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

Heroin seized in Portugal comes mainly from the Netherlands, cocaine from Mexico,, cannabis resin from Morocco, herbal cannabis from South Africa and ecstasy from the Netherlands. Most of the herbal cannabis and cannabis resin seizures are destined for the external market.

In 2007, a total of 11 273 drug-related offences were reported, with 55.4 % for cannabis-related offences, 14.9 % for heroin-related offences, and 9.3 % for cocaine offences.

As regards the quantity of seized drugs, in 2007 a decrease was identified in the seized quantity of cocaine when compared to the previous year, with a total quantity of 34 477 kg in 2006 to a total quantity of 7 363 kg in 2007.  An increase was registered in the quantity of cannabis resin with a total quantity of 42 772 kg seized in 2007, when compared to a total quantity of 8 458 kg seized in 2006.

As regards the average prices of drugs, in 2007 there were no significant changes when compared to 2006, with the exception of herbal cannabis and ecstasy, which showed the highest prices reported since 2002. In 2002, the average price for herbal cannabis was EUR 2.6/gram whereas in 2007 the average price increased to EUR 4.7/gram. In 2002, the average price for ecstasy was EUR 5.9/tablet whereas in 2007, the average price decreased to EUR 3.2/tablet. In 2007, cocaine registered a price increase since 2002: in 2002, the average price for cocaine was EUR 38.6/gram whereas, in 2007 the average price was EUR 44.7/gram.

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National drug laws

The main drug law in Portugal is Decree Law 15/93 of 22 of January, which defines the legal regime applicable to trafficking and consumption of narcotic drugs and psychoactive substances. The legal framework in place since July 2001 (Law n. 30/2000, of the 29 of November), 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.

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.

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National drug strategy

The 1999 Portuguese ‘National strategy for the fight against drugs’ defined the general objectives in the drugs field and is currently being implemented through the ‘National plan against drugs and drug addiction 2005–12’, which focuses on four main ideas: geographical proximity, integrated approaches and responses, focus on the citizen, and improving quality and accreditation mechanisms. The objective set for the national plan is to significantly reduce the use of drugs amongst the population and its negative social and health consequences. The national plan is complemented by an ‘Action plan against drugs and drug addiction 2005–08’, which covers the areas of coordination, international cooperation, information/research/training/evaluation, the legal framework, demand reduction and supply reduction, and identifies for each action the party or parties responsible, a timetable and the indicators/assessment instruments to monitor the plan’s implementation.

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Coordination mechanism in the field of drugs

The overall responsibility for coordination of the drug policy lies with the Inter-ministerial Council, a coordinating body chaired by the Prime Minister and comprised of 10 ministers (Justice, Health, Education, Welfare and Employment, Home Affairs, Foreign Affairs, National Defence, Finance, Cities and Environment and the Assistant Minister of the Prime Minister) and the National Coordinator. The Inter-ministerial Council has set up an Inter-ministerial Committee chaired by the National Coordinator and composed by representatives designated by the Ministers themselves.

The Institute on Drugs and Drug Addiction (IDT) falls under the Ministry of Health and is in charge of implementing the national strategy and the action plan. The President of the IDT is the National Coordinator.

The National Council for the Fight Against Drugs and Drug Addiction is an advisory body, chaired by the Minister of Health. It is composed by representatives of the Regional Governments of Madeira and Azores, the Judiciary, the General Prosecutor and the civil society, as well as five personalities designated by the Government. 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 on the supply reduction area.

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Drug-related research

The external evaluation of the national strategy showed that drug-related research had increased by more than 200 % between 1999 and 2004. 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 (studies carried out in 2000 and 2001 were repeated in 2006 and 2007). 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 develop a network to discuss and disseminate the work in this area. This group of researchers met in 2008, and representatives of the African Countries of Portuguese Official Language (PALOP) participated in this symposium. The IDT, through its website and reports, and the national scientific journals are the main dissemination channels for drug-related research findings. Recent drug-related studies mentioned in the 2008 Portuguese National report mainly focused on aspects related to prevalence of drug use.

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