Drug Policy Of Portugal

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Drug Policy of Portugal: A Shift from Punishment to Public Health

The drug policy of Portugal, often referred to as the "drug strategy," was a significant overhaul that commenced in 2000 and was fully implemented in July 2001. This pivotal shift, enacted through Decree-Law n. 130-A/2001, placed the responsibility for drug addiction under the purview of the Commissions for the Dissuasion of Drug Addiction. The primary impetus behind this new approach was a desperate attempt to curb the alarming rise in new HIV/AIDS cases, a substantial portion of which were attributed to injection drug use. Instead of prioritizing public order, this strategy reoriented itself towards public health concerns, leading to the decriminalization of public and private use and possession of all drugs. Consequently, when law enforcement encounters individuals engaged in drug use or possession, the substance is confiscated, and the individual is referred to a Dissuasion Commission rather than facing criminal prosecution.

The strategy was multifaceted, aiming to reduce HIV transmission through a combination of harm reduction initiatives, public awareness campaigns—particularly targeting populations most at risk—and the establishment of more accessible treatment facilities, including substitution treatment for addicts. The Dissuasion Commissions played a central role in encouraging drug users to seek treatment. All existing drug treatment and control units were consolidated into a single, comprehensive entity. Furthermore, the existing practice of providing drug users with a reprieve for drug possession was formally codified into law. Drug Law 30/2000 maintained the illegality of using or possessing any drug for personal use without authorization. However, for individuals identified as addicted, their offense was reclassified as an administrative matter. The authority to impose penalties or sanctions in these cases was transferred from the police and the broader justice system to the Dissuasion Commissions, provided the amount of the substance possessed did not exceed a ten-day supply.

Drug Use in Portugal Prior to 1999

Portugal's initial foray into drug legislation dates back to 1924 and 1926, largely influenced by the International Opium Convention. A more comprehensive update occurred in 1970, introducing a legal definition of narcotic products, a drug schedule, and a legal framework for penalizing drug trafficking and consumption. The early to mid-1970s witnessed a significant expansion of drug use, escalating into a major societal issue. While the 1963 Mental Health Act acknowledged the necessity of facilities for treating drug abuse, a nationwide infrastructure and coordinating structure were conspicuously absent. Following Portugal's ratification of the Single Convention on Narcotic Drugs in December 1971 and the Convention on Psychotropic Substances in April 1979, drug law was again revised in 1983. This revision aimed to intensify the fight against drug trafficking and criminal organizations while simultaneously softening penalties for drug consumption to encourage users to seek medical assistance. Concurrently, during the 1970s and 1980s, the Portuguese government established several organizations dedicated to studying and mitigating drug use, including the Drug Fighting Coordination Office (GCCD), the Drug Prophylaxis Studies Center (CEPD), and the Drug Control and Research Center (CICD). The 1990s saw a dramatic surge in heroin use, leading to widespread drug addiction and the rapid spread of the AIDS epidemic. By the late 1990s, estimates suggested between fifty and sixty thousand drug addicts resided in a country of 10 million people, creating a public health crisis that necessitated a fundamental shift in perspective—treating drug use as a health crisis rather than a criminal justice problem.

Status in 1999

In 1999, Portugal bore the ignominious distinction of having the highest rate of HIV infection among injecting drug users within the European Union. With approximately 2,000 new cases annually in a population of 10 million, and with 45% of reported AIDS cases in 1997 originating from IV drug users, targeting drug use was identified as a crucial avenue for HIV prevention. Estimates from the late 1990s placed the number of heroin users between 50,000 and 100,000, fueling a public health crisis that ultimately paved the way for the adoption of The National Strategy for the Fight Against Drugs (NSFAD) in 1999. This strategy was characterized by a substantial expansion of harm reduction efforts, a doubling of public investment in drug treatment and drug prevention services, and a significant alteration of the legal framework governing minor drug offenses.

According to Dr João Castel-Branco Goulão, one of the principal architects of the decriminalization policy, a key factor in its successful implementation was the absence of a clear ethnic or economic scapegoat for the drug problem in Portugal, unlike in countries like Brazil where it could be blamed on specific communities. Nevertheless, the policy faced initial opposition from right-wing politicians who harbored fears that it would transform Portugal into a narco-state.

Harm Reduction

The needle exchange program, aptly named "Say NO! to a used syringe," has been operational nationwide since October 1993, engaging approximately 2,500 pharmacies across Portugal. This initiative is managed by the National Commission for the Fight against AIDS, established by the Ministry of Health, and the National Association of Pharmacies, a non-governmental organization representing the majority of Portuguese pharmacies. Drug users can conveniently exchange used syringes for clean ones at pharmacy counters. Each exchange kit includes clean needle syringes, a condom, rubbing alcohol, and a motivational message promoting AIDS prevention and addiction treatment. Between 1994 and 1999, pharmacies distributed roughly three million syringes annually.

Following 1999, and particularly between 2003 and 2005, several low-threshold projects were launched. These initiatives involved outreach teams providing safe injection practices and distributing needles and injecting equipment directly on the streets, with many of these projects continuing to operate.

A comprehensive media campaign, utilizing television, radio, print, and posters in discothèques and bars, was initiated at the program's inception. The goal was to capture the attention of the target population, highlighting the dangers associated with drug addiction, especially HIV transmission through needle-sharing. The project's objectives were threefold: to reduce the frequency of needle and syringe sharing, to alter other behaviors associated with intravenous drug use (IDU) that generated negative public attitudes, and to foster more positive attitudes towards IDUs within the general population to facilitate addiction prevention and treatment efforts.

Expanding Drug Treatment

In 1987, the Centro das Taipas in Lisbon was established, marking the first specialized institution for the treatment of drug addicts. This center offered a consultation service, a day center, and a patient detoxification unit. Operating under the Ministry of Health, it served as the foundational element of a network of specialized drug addiction treatment centers that now spans the entire country.

Healthcare for drug users in Portugal is primarily delivered through the public network of services dedicated to treating illicit substance dependence, coordinated by the Institute on Drugs and Drug Addiction and the Ministry of Health. In addition to public services, a system of certification and protocols involving NGOs and other public or private treatment providers ensures broad access to quality-controlled services offering various treatment modalities. These public services are provided free of charge and are accessible to all drug users seeking treatment.

Currently, there are 73 specialized treatment facilities (including public and certified private therapeutic communities), 14 detoxification units, 70 public outpatient facilities, and 13 accredited day centers. Portugal is administratively divided into 18 districts, and drug outpatient treatment is available in all but four of these districts, which are located in the northern part of the country: Viana do Castelo, Bragança, Viseu, and Guarda.

Substitution Treatment

Substitution treatment is now widely accessible in Portugal through various public services, including specialized treatment centers, health centers, hospitals, and pharmacies, as well as through NGOs and non-profit organizations.

The Portuguese substitution program originated in 1977 in Porto. The CEPD/North (Study Centre on Drug Prevention/North) was the sole provider of opioid substitution therapy, primarily using methadone, until 1992. However, the escalating numbers of drug addicts—marked by an "explosion" in the early 1990s—coupled with the burgeoning AIDS and hepatitis C epidemics among this population, prompted a significant shift in approach. After 1992, methadone substitution programs were expanded to numerous CATs (Centres of Assistance to Drug Addicts). Generally, these programs were characterized as medium or high threshold. With the exception of sporadic activities in a Lisbon slum area, truly low-threshold programs (focused on risk and harm reduction) were virtually non-existent prior to 2001.

Between 2000 and 2008, the number of individuals in Portugal receiving substitution treatment surged from 6,040 to 25,808 (with 24,312 receiving it in 2007). Approximately 75% of these patients were enrolled in methadone maintenance treatment, while the remainder received high-dosage buprenorphine treatment.

Buprenorphine became available in 1999, followed later by the buprenorphine/naloxone combination.

According to Decree-Law 183/2001 Article 44.1 and Decree-Law 15/93 Article 15.1-3, methadone treatment can be initiated by treatment centers, while buprenorphine treatment can be commenced by any medical doctor, specialized medical practitioners, and treatment centers. Since 2004, buprenorphine has also been available in pharmacies.

####### After-care and Social Re-integration

The organization of after-care and social re-integration for drug users in Portugal is managed through three primary programs targeting different regions: Programa Vida Emprego, Programa Quadro Reinserir, and the PIDDAC incentives for re-integration. Each of these programs funds a variety of initiatives and projects designed to support drug users through training opportunities, employment assistance, and/or housing solutions.

######## Monitoring Drug Treatment

A national system for monitoring drug treatment is in development but has not yet been fully implemented across all regions. National routine statistics are available concerning clients in methadone and buprenorphine substitution programs at outpatient centers.

Laws and Regulations

In July 2001, a new law was enacted that maintained the prohibition of using or possessing any drug for personal use without authorization. However, the offense was reclassified from a criminal offense, with potential imprisonment, to an administrative one, provided the quantity possessed did not exceed a ten-day supply. This change aligned with the de facto Portuguese drug policy that had been in practice before the reform. Drug addicts were now to be actively encouraged towards therapy or community service instead of facing fines or waivers. Crucially, these changes did not legalize drug use in Portugal. Possession remained illegal under Portuguese law, and criminal penalties continued to be applied to drug growers, dealers, and traffickers. Despite this, the law was associated with a nearly 50% reduction in convictions and imprisonments of drug traffickers between 2001 and 2015.

Regulation

Individuals apprehended with small quantities of drugs are issued summons. The drugs are confiscated, and the suspect is subsequently interviewed by a "Commission for the Dissuasion of Drug Addiction" (Comissões para a Dissuasão da Toxicodependência – CDT). These commissions are composed of three members: a social worker, a psychiatrist, and an attorney. The dissuasion commissions possess powers akin to an arbitration committee, but their jurisdiction is confined to cases involving drug use or the possession of small quantities of drugs. A CDT operates in each of Portugal's 18 districts.

The commissions have a broad spectrum of sanctions at their disposal when adjudicating drug use offenses. These include:

Fines, ranging from €25 to €150. These amounts are calculated based on the Portuguese minimum wage of approximately €485 (as of 2001) and are intended to represent lost work hours.
Suspension of professional licenses for users in licensed professions (e.g., medical doctors, taxi drivers) if their drug use could endanger others or their property.
Prohibition from visiting specific locations (e.g., certain clubbing venues).
Prohibition from associating with specific individuals.
Foreign travel ban.
Requirement to report periodically to the commission.
Withdrawal of the right to carry a firearm.
Confiscation of personal possessions.
Cessation of subsidies or allowances received from public agencies.

If an individual is found to be addicted to drugs, they may be admitted to a drug rehabilitation facility or assigned community service, if the dissuasion committee deems it a more effective means of keeping the offender out of trouble. While the committee cannot mandate compulsory treatment, its directive is to encourage addicts to enter and remain in treatment. The committee explicitly holds the authority to suspend sanctions contingent upon the individual voluntarily entering treatment. If the offender is not addicted or is unwilling to undergo treatment or community service, they may be subjected to a fine.

For instance, in 2005, there were 3,192 commission hearings concerning drug use. A significant majority, 83%, of these cases were suspended, either due to the offender having no prior convictions or because the offender agreed to seek drug addiction treatment. In 15% of cases, some form of sanction was imposed, which could have included a verbal warning, a fine, or the loss of professional licenses, among other administrative actions. The remaining 2.5% were found not guilty or not responsible. Arrest rates for possession plummeted to zero, as there were no longer criminal penalties attached to this offense.

Observations

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Reliable data on drug use, injecting behaviors, or addiction treatment in Portugal prior to 2001 is scarce, as comprehensive general population surveys only commenced that year. Prior to this, data was primarily derived from lifetime prevalence surveys among youth, collected as part of the European School Survey Project on Alcohol and Other Drugs (ESPAD), and some less reliable data from the EMCDDA.

Thorough studies evaluating the implementation and impact of the various initiatives have not been conducted, making it difficult to establish a definitive causal link between the strategy's efforts and subsequent developments. However, statistical indicators suggest the following correlations between the drug strategy and observed trends, commencing with the establishment of the NSAFD in 1999:

Increased uptake of treatment: A rise of approximately 60% in treatment seeking was observed by 2012.
Reduction in new HIV diagnoses: A 17% decrease in new HIV diagnoses among drug users was reported, alongside a significant overall drop of 90% in drug-related HIV infections.
In April 2009, the Cato Institute, with funding from the Marijuana Policy Project, published a White Paper on the "decriminalization" of drugs in Portugal. This report utilized EMCDDA data on heroin usage rates among 13-16-year-olds to assert that "decriminalization" had not adversely affected drug usage rates and that drug-related pathologies, such as sexually transmitted diseases and drug-related deaths, had dramatically decreased.
The number of newly diagnosed HIV cases among drug users stood at 13.4 cases per million in 2009. While this figure remained considerably higher than the European average of 2.85 cases per million, it represented a substantial reduction from the pre-2001 period.
Drug-related deaths decreased from 131 in 2001 to 20 in 2008. By 2012, Portugal's drug death rate was 3 per million, significantly lower than the EU average of 17.3 per million, positioning it among the lowest in the EU. However, this reduction has reportedly reversed in later years, with the number of drug-related deaths approaching pre-strategy levels. This trend may be partially attributed to improved measurement practices, including a doubling of toxicological autopsies, which likely leads to more accurate recording of drug-related deaths.
Reported lifetime use of "all illicit drugs" increased from 7.8% to 12%. Lifetime cannabis use rose from 7.6% to 11.7%. Cocaine use more than doubled, from 0.9% to 1.9%. Ecstasy use nearly doubled, from 0.7% to 1.3%. Heroin use increased from 0.7% to 1.1%. It has been suggested that this increase might be related to greater candor from interviewees, who may have felt more comfortable answering truthfully due to reduced stigma associated with drug use. However, during the same period, cannabis and heroin use also increased in Spain and Italy, countries where personal drug use had been decriminalized many years prior to Portugal. Conversely, cannabis and heroin use decreased in the rest of Western Europe. The observed increase in drug use among adults in Portugal was not demonstrably greater than that seen in neighboring countries that did not alter their drug laws.
Drug use among adolescents (aged 13–15) and "problematic" users showed a decline.
Drug-related criminal justice workloads experienced a decrease.
A reduction in the street value of most illicit drugs was noted, with some experiencing significant price drops.
It is estimated that the social cost of drug use decreased by an average of 12% in the five-year period following the establishment of the NSAFD in 1999, and by an average of 18% since 2010. The social cost of drug use is defined as the sum of public expenditure on drugs, private costs incurred by individual drug users, and societal costs, including lost income and productivity.

Table and Chart Comparing Countries

The following data presents drug overdose death rates and counts for various European countries.

Drug overdose deaths per year

Location	2021	2020	2019	2018	2017
Austria	235	191	196	184	154
Belgium		168	152	148
Bulgaria	20	24	11	24	18
Croatia	77	99	97	85	65
Cyprus	10	6	5	12	16
Czech Republic	64	58	42	39	42
Denmark		197	202	183	239
Estonia	39	33	27	39	110
Finland	287	258	234	261	200
France				417
Germany	1,826	1,581	1,398	1,276	1,272
Greece		230	274	255
Hungary	42	48	43	33	33
Ireland				235
Italy	293	309	374	336	297
Latvia	17	21	12	20	22
Lithuania	62	47	52	59	83
Luxembourg	5	6	8	4	8
Malta	5		3	5
Netherlands	298	295	252	224	262
Norway	241	324	275	286	247
Poland		229	212	199	202
Portugal		63	72	55	51
Romania	30	33	45	26	32
Slovakia	28	37	34	32	19
Slovenia	65	70	74	59	47
Spain		774	546	450	437
Sweden	450	524	555	583	643
Turkey		314	342	657	941
United Kingdom					3,284

Legal Status of Cannabis in Portugal

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Consumption and Possession

In Portugal, the recreational use of cannabis is legally prohibited. However, in July 2018, legislation was passed to permit the medical use of cannabis and its dispensing in pharmacies. Portugal is a signatory to all UN conventions concerning narcotics and psychotropic substances. Following the 2001 decriminalization bill, individuals consuming drugs are now viewed as patients rather than criminals. Possessing an amount typically used for ten days of personal consumption is not considered a punishable crime. According to the libertarian think tank Cato Institute, illegal drug use among Portuguese teenagers saw a decline after 2001, and a notable 45% of the country's heroin addicts sought medical treatment. Cannabis use in Portugal, at 9.7%, is lower than the European average of 15.1%. While the lifetime prevalence of cannabis use is less in Portugal, it has been on an upward trend since 2012. Furthermore, Portugal exhibits a 2-3 times higher prevalence of moderate/heavy cannabis users compared to other European countries. During the same period, hospitalizations with a diagnosis of a psychotic disorder or schizophrenia associated with cannabis use increased by a staggering 29.4 times between 2000 and 2015.

Cultivation and Distribution

The cultivation of cannabis, even on a small-scale home-grown basis for personal consumption, is illegal in Portugal and can lead to prosecution. By the early 2020s, cannabis shops became a popular phenomenon in the country, though they were only permitted to sell cannabis products devoid of THC.

Despite the legal prohibition, an unknown number of individuals secretly cultivate cannabis plants for personal use due to the potential legal repercussions and social stigma. In neighboring Spain, small-scale cultivation for personal use is generally tolerated, and numerous grow shops operate both physically and online. In 2003, an amendment to the "Portuguese drugs law" criminalized the possession of cannabis seeds, with the exception of certified industrial hemp seed. This law made the purchase of cannabis seeds from legitimate online vendors in other EU member states, such as Spain or the Netherlands, an unlawful transaction for Portuguese residents. The provision of seeds and tools for cannabis production and consumption is also illegal. The production and distribution of hemp products, however, are legal but regulated. A limited number of hemp shops exist in Portugal, and their products are legally available.