Portugal has been one of the most lauded and discussed examples of global drug decriminalisation. The model was praised for eliminating the distinction between hard and soft drugs, shifting away from a criminal model towards a public health model and focusing on destigmatising people who use drugs (PWUD), ultimately becoming the face of innovation and progression in European drug policy.
This change in legislation came as a response to a rapid increase in drug use in the 1990s, particularly heroin, and a consequential increase in reported cases of HIV in the Portuguese population. Decriminalisation proved to be highly effective at reducing drug-related harms: drug deaths fell dramatically, as did the HIV transmission rate, among other benefits. As a result, Portugal’s model has been widely studied and promoted as a case study for alternatives to drug prohibition.
However, the system is now almost a quarter of a century old. Since its creation, the world has drastically altered: we have lived through a global financial crisis, an unprecedented pandemic, and seismic geopolitical shifts. Has the Portuguese model kept up with changing drug markets, use patterns, and drug-related developments? How relevant is it now? And what must be done to ensure that the system continues to be progressive?
An eternal “pilot” programme
The 2001 system was set up primarily as a reaction to a HIV and heroin epidemic, brought about in the 1970s by the end of the Salazar dictatorship. With almost a million citizens from former colonies returning or immigrating to Portugal, heroin and cannabis use was introduced to the rest of society. After 40 years of dictatorship, cultural and social isolation, the nation was suddenly exposed to new substances with no information on how to safely navigate them.
Problematic use, and its consequences, exploded: by the 1990s, Portugal had the highest rate of HIV infections in the European Union, with an estimated 1% of the population considered addicted to heroin. To address these harms, the government, informed by public health experts, trialled a system at the turn of the millennium built upon tailored harm reduction practices and public health approaches for those dealing with problematic use: this included social support and rehabilitation programmes for those using drugs, as well as needle and syringe exchanges, and opioid substitution therapy. This system was targeted at curbing the heroin-induced HIV epidemic – and it was highly effective. AIDS diagnoses in people injecting drugs dropped from 518 in 2000 to just 13 in 2019.
However, Portugal’s system has remained entrenched in this framework, struggling to reform its drug policy model to address contemporary drug-related issues. Institutional restructuring caused by European bailout fund commitments meant that the Portuguese public health system was eviscerated, losing its capacity to deliver progressive and on-the-ground interventions.
Joana Canêdo, a drug policy reform activist and co-creator of the women and non-binary collective MANAS/GAT, described the Portuguese system as stuck under a “HIV umbrella, which forgets a lot about other paths”.
This model, Canêdo said, is unable to respond to Portugal’s current drug market trends. With growing concerns around crack-cocaine consumption, as well as the emergence of New Psychoactive Substances (NPS), there is “not even a guide for treatment” by the drug health authorities for these substances. The first time that Portugal ever estimated crack use prevalence (separated from powder cocaine) was in 2023. This means people using crack or NPS are left without help, and ill-informed about existing harm reduction practices.
“This is a passive way to look at things from one side, as if everything can remain how it was and it’s fine, no policy evaluation – internal or external,” Canêdo told TalkingDrugs.
The lack of a systemic evaluation, and inability (or lack of interest) to move beyond past frameworks of action has meant that the Portuguese system is somewhat frozen in time. It does not recognise PWUD as active citizens with agency over their own lives; it does not allow or fund the political participation of PWUD in Portugal; and it does not adapt to changes in consumption patterns, altogether preventing the national implementation of updated harm reduction practices along with the purposeful destigmatisation of PWUD.
The issue with dissuasion committees
This is particularly evident with the dissuasion committees. Originally set up to encourage people using heroin to enter treatment, they are now primarily dealing with cases of non-problematic cannabis use. According to SICAD’s 2022 system analysis, 71% of the administrative offences issued by the dissuasion committees were for cannabis; 73% of those consuming cannabis were considered non-problematic, with only 8% of cases considered problematic. The dissuasion system is dealing with many cases that do not require such attention, nor are they built to support or inform those using cannabis or other drugs non-problematically.
Adriana Curado, a public health and harm reduction specialist at GAT (Grupo de Ativistas em Tratamentos), a community-based NGO focused on providing information and treatment for HIV, as well as harm reduction services, highlighted that on top of this inadequate use of resources, there is also a “chronic underfunding” of harm reduction services such as consumption rooms, drug checking sites and treatment facilities since 2001. The persisting underfunding has made it financially and logistically impossible for adequate facilities to be created throughout the country and effectively function.
Currently, consumption rooms and testing sites exist only in the cities of Porto and Lisbon, with their funding falling under the responsibility of their municipalities. These interventions are expensive, and municipalities with tight budgets often struggle to fund them. Even in Lisbon and Porto, there is only one consumption room open in each city.
To this day, most harm reduction services are provided by civil society and NGOs, with government funding some of them once every two years. This means there are constant existential challenges around the financial dependability of these services, and whether they can survive if their funding is ever compromised.
Recent institutional and legal changes
SICAD (Service of Intervention for Addiction and Dependency Behaviours), the public agency responsible for implementing and administering Portugal’s drug policy system since 2001, was restructured in January 2024 into the ICAD (Institute for Addiction and Dependency Behaviours). Under this new structure, ICAD will be responsible for developing action plans on drug policy and ensure their implementation – assumedly with more policy influencing power than before.
According to Curado however, the new ICAD structure maintains its previous top-down, vertical organisational structure. Many of the same people leading SICAD since 2001 have been maintained in the new ICAD structure.
While the current leadership has done exceptional work in its mandate, especially in the early years of the decriminalisation model, ICAD has not been institutionally reactive enough to adjust to modern drug market trends, including developing new interventions for substances beyond opioids, such as stimulants and NPS. This has meant that global harm reduction practices have not been implemented nation-wide, nor are PWUD and related grassroots organisations engaged with or integrated in policy making processes.
“Activism and community initiatives are not enough, we need the state itself to be reformed, we need new leadership and professionals in the sector,” said Curado.
Until then, the Portuguese system is held back by its own institutional limits and systemic inertia to respond to change.
Not all is gloom
Despite this need for structural reform, Portugal has taken steps to improve the protection of the rights of PWUD. In September 2023, the Portuguese Parliament reversed a constitutional court decision from 2008 that re-criminalised the possession of more than a 10-day consumption quantity for individual use. The 2008 decision created a 10-day threshold based on a narcotics table introduced in 1996, outlining the penalties for possession of each substance. By 2019, the repercussions of this change became noticeable, with an increase in convictions of PWUD, as well as growing concerns around NPS, which were not included in the table, making them more popular and accessible.
The parliament responded to these consequences and concerns and reversed the 2008 ruling, removing the 10-day threshold and allowing for those caught in possession to defend themselves proving the quantities they held were for personal use and not trafficking. This marked a positive step for the Portuguese system, demonstrating that there is a will to redress past mistakes and improve the lives of PWUD, once again stepping away from criminalisation.
Moving Forward
A reallocation of resources and stronger funding of harm reduction services, treatment facilities, testing sites and consumption rooms is a clear step to take. But it’s not as straightforward as that – short and unstable political cycles, a reluctance to look beyond the current program and disagreeing perspectives within the government on budget are a strong barrier to this solution. So what else can be done?
Canêdo emphasises the need to alter public discourse surrounding drug use and PWUD, as well as advocating for stronger participation of PWUD in policy evaluation. While destigmatisation was an important action point of the original plan in 2001, Portuguese society still lacks a strong education on harm reduction and safe use, and those using drugs continue to be marginalised across the country.
This, together with a persisting vision of police forces as a legitimate source of authority, contradicts the initial principles of the 2001 action plan: to remove PWUD from the criminal justice arena and into the public healthcare arena, advocating for their safety without infringing upon their freedoms. As long as the police remains as the primary authority that searches, detains and sanctions people using drugs, violent responses are encouraged over harm reduction and community-based solutions. This goes together with the role of institutional bodies such as the Dissuasion Committees, which contain a persisting element of criminalisation and pathologising stigmatisation of PWUD.
There is a critical need for more dynamic and innovative approaches, inspired by international examples, to address changing trends in the drug market and ensure harm reduction becomes a more integral part of the decriminalisation system. Until this is put in place, it will be difficult to argue that the Portuguese system is as innovative today as it was a quarter of a century ago.
