"Portuguese drug policy is detailed in three strategic documents (National Strategy for the Fight Against Drugs 1999, National Plan Against Drugs and Drug Addiction 2005-12 and National Plan for the Reduction of Addictive Behaviours and Dependencies 2013-20). Launched in 1999 and envisaged as a long-term policy document, the National Strategy for the Fight Against Drugs defines the general objectives in the drug field. The strategy is built around eight principles, six objectives and 13 actions. The National Plan for the Reduction of Addictive Behaviours and Dependences (2013-20) builds on the 1999 strategy and takes a broad and integrated view of drug and addiction problems, including illicit drug use, new psychoactive substances (NPS), alcohol, prescription medications, doping and gambling (Figure 1). It is guided by five overarching objectives and is built around the two pillars of drug demand and drug supply reduction. It consists of two structural measures (the Operational Plan of Integrated Responses (PORI) and the referral network) and four transversal themes (information and research; training and communication; international relations and cooperation; and quality). The National Plan has defined a set of indicators and targets that
are to be achieved during its timeframe (2013-20). Three management areas -- coordination, budget and evaluation -- support the plan’s implementation alongside two action plans covering the periods 2013-16 and 2017-20."

"Between 2007 and 2012 in the set of the Portuguese population there was a general decrease in lifetime prevalence6 (any illicit drug from 12% to 9.5%) and recent use (any illicit drug from 3.7% to 2.7%), with the exception of ecstasy and LSD, whose lifetime prevalence remained the same and LSD use in last 12 months increased slightly.
"Among the young adult population was also found a generalized decrease in lifetime prevalence use (any illicit drug from 17.4% to 14.5%) and in the last 12 months (any illicit drug from 7% to 5.1%) except in the case of LSD where lifetime prevalence remained the same and recent use increased slightly.
"Emphasis is both in total population and in young adult population, in addition to declines in the prevalence of cannabis use, while most used substance, also of heroin, cocaine and amphetamines.
"Regarding continuity rates of consumption, i.e., the proportion of individuals having used a certain substance during lifetime prevalence, declare having used that substance in the last 12 months, as expected, the young adult population presented rates (35.2 % for any illicit drug) higher than the general population (28.1% for any illicit drug) for all drugs considered.
"In 2012, it is verified that the higher continuity rates of consumption are LSD and cannabis, is important, especially in the case of LSD which is the only substance that presents slight increases in the prevalence of use."

"In ESPAD [European school survey project on alcohol and other drugs] 2011 once more cannabis was the drug that presented the higher lifetime prevalence of use (16%) a value closer to lifetime prevalence of any drug (19%). Between 2007 and 2001 increased the lifetime prevalence of use of any drug (from 14% to 19%), decreases were verified in the prevalence of use of all drugs with the exception of heroin. The cannabis prevalence of use in last twelve months and 30 days also increased between 2007 and 2001 (respectively from 10% to 16% and from 6% to 9%). In 2011, Portugal registered prevalence’s of use very similar to the European average, being in some cases superior (namely the prevalence of use of cannabis in the last 12 months and last 30 days – european averages of 13% and 7% - and lifetime use of other drugs than cannabis – 6% european average and 8% in Portugal) contrarily to what occurred in 2007, where they were overall inferior."

"According to the results of the Flash Eurobarometer – Youth attitudes on drugs held in 2011 among young Europeans of 15-24 years, the perceptions of health risk associated with the use of drugs varied according the substances and the frequency of their use.
"In Young Portuguese, the perception of high risk to health associated with the occasional (once or twice) of illicit substances was much higher in relation to cocaine (65%) and ecstasy (51%) than to cannabis (24%). The vast majority considered as a high risk to health the regular use of cocaine (94%) and ecstasy (89%) as well as although in significantly lower proportion, the regular use of cannabis (64%).
"Compared to European averages, it appears that the perceptions of young Portuguese 15-24 years, generally follow European averages, being mentioned, though with not relevant differences, the small attribution of high risk to health in the regular use of cannabis and in the occasional and regular use of ecstasy."

"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).
"The use of illicit drugs is more frequent among the youngest (15-34 years old), especially in the age group 25-34 years.
"Gender analysis shows lifetime prevalence and last month use higher in men for all drugs. The preferential pattern of use of the Portuguese population - first cannabis followed by cocaine and ecstasy maintained in both genders in general and young adult population. The pattern evolution between 2001 and 2007 remained in both genders, among the exceptions a decrease in the prevalence of heroin lifetime use in women in young adult population and the decrease of cannabis prevalence and stabilisation of cocaine use in last month in women of both populations.
"A significant proportion of the population perceives a relatively low risk attached to these types of behaviour: take five or more drinks on the weekend; smoke one or more pack of cigarettes per day; and smoke hashish/marijuana regularly.
"In 2001, the Portuguese population perceived the access to substances in a 24-hour period as more difficult than in 2007.
"Finally and comparatively with studies results from other European countries, we can state that, even being the national results the most recent European results, Portugal remains among the countries with the lowest prevalence of use for most of the substances, with the exception of heroin, where Portugal shows higher prevalence’s."

"In 2012 concerning the administrative sanctions for drug use⁴⁰, the 18 Commissions for the Dissuasion of Drug Addiction (CDT) based in every capital district of Continental Portugal instated 8,573 processes⁴¹, representing the highest value since 2001 and an increase of 24% in comparison to 2011, most of which were, again, referred by the Public Security Police (PSP), National Republican Guard (GNR) and Courts.

"From the 7,394 rulings made, 82% suspended the process temporarily, 15% were punitive rulings and 3% found the presumed offender innocent.

"The number of presumed offenders was very similar to last year registering these last four years the highest values since 2002. Continues the trend manifested through the decade of the predominance of presumed offenders in the possession of cannabis and the increased visibility of presumed offenders in the possession of cocaine (the values registered in the last four years for cannabis and cocaine were the highest since 2002). In the case of heroin, after the downward trend verified in the first half of the decade, followed by a stability and a peak in 2009, it’s verified again a decrease in the number of presumed offenders. Concerning the number of presumed offenders in the possession of several drugs, the value registered in 2012 is the lowest since 2001, contrasting the stability trend occurred since 2006 (with a punctual peak in 2010).

"In the context of judicial decisions under the Drug Law, in 2012, 1 616 crime processes were finalised involving 2,376 individuals, the vast majority were accused of traffick (88%). Near 86% were convicted and 14% were acquitted.

"Concerning the sanctions applied in these convictions, mostly related with trafficking crimes, such as occurred in 2004 and contrary to previous years, these convictions involved mainly suspended prison (48%) instead of effective prison (31%). To refer specially since 2009, the increase of convicted only sentenced with an effective fine, predominantly applied to convictions related with consumption. Similarly to previous years, the majority of these convictions were related to only one drug, maintaining the predominance of cannabis by the tenth consecutive year and a higher number of convictions by possession of cocaine in relation to heroin by the seventh consecutive year, consolidating the trend verified in previous years of the increase visibility of cocaine in these convictions."

"Concerning the substances involved:
"• As in previous years, most cases involved only one drug (94%):
"• Mainly cannabis (78%) – 76 in 2011, 71% in 2010, 76% in 2009, 68% in 2008 and 64% in 2007;
"• 8% of these processes involved only heroin (9% in 2011, 14% in 2010, 11% in 2009, 14% in 2008 and 17% in 2007). 8% involved only cocaine (7%, 7%, 8%, 6% and 8%, respectively in 2011, 2010, 2009, 2008, 2007);
"• Similar to previous years, the predominance of occurrences involving only cannabis was found in all CDTs,
"For the processes involving more than one drug (6% in 2012, 7% in 2011 and 2010, 6% in 2009, 10% in 2008 and 2007), once more the association heroin-cocaine was predominant. Like in the last eight years. The association cocaine-cannabis, and for the first time the association ecstasy-cannabis surpassed the association heroin-cannabis."

"Decriminalization seems to have taken some pressure off of the Portuguese criminal justice system. In 2000, approximately 14,000 people were arrested for drug-related crimes in Portugal.¹⁵¹ This number dropped to an average of 5,000 to 5,500 people per year after decriminalization.¹⁵² The number of people that the police have cited for administrative drug use offenses has also remained constant at about 6,000 per year.¹⁵³ Therefore, there has not been a great surge in contact between drug offenders and the Portuguese police after decriminalization.¹⁵⁴"

"Taking only 2011, from the notified cases of HIV diagnosed at 31/12/2011, the cases associated to drug addiction represented 10% of the total diagnosed cases in the different stadiums of the infection: 17% of the AIDS cases, 8% Symptomatic Non-AIDS and 6% of the asymptomatic carriers cases.
"There has been a downward trend in last years on the weight of drug addicts, in the total number of cases diagnosed each year with HIV infection (10%, 14%, 15%, 20% and 22%, of the cases diagnosed in 2011, 2010, 2009, 2008, 2007), as in the cases diagnosed each year with AIDS (17%, 25%, 25%, 28% and 31% of the cases diagnosed in 2011, 2010, 2009, 2008, 2007). In addition to the decreasing trend of these proportions, it is worth of notice the continuous decrease over the past few years in the number of new cases diagnosed with HIV associated with drug addiction, safeguarding the future update of data (95 cases diagnosed in 2011, 254 in 2009, 423 in 2007 and 636 in 2005)."

"According to the EMCDDA protocol in 2011 were registered 10 cases of drug-related deaths, representing the lowest value since 2006 and a decrease of 62% in relation to 2010.
"In 2011, there is no specific information38, about the cause of death. However in 2009, last year with this information available - the predominant causes of these deaths were disorders (63%): multiple dependence or other (code F19.2 ICD10) cause that include polydrugs use. For the same reasons it’s not possible to provide the information by gender (in 2010 all the cases were from the male gender and in 2009 male gender predominated with percentages above 84%) in relation to age the only information available is for the age group above 49 (ith [sic] 40% according the EMCDDA).
"Concerning the information on specific mortality registries related with drug use from the INML, I.P., it is important to contextualize within some indicators related to the activity of this Institute.
"In 2011, despite the number of autopsies performed by INML, I.P. (7,673) increased in relation to last year (+16%), the number of requests for post-mortem toxicological exams (illicit substances) (3,089), decrease slightly (-3%), however representing the second highest value of the decade and an increase of 42% in relation to 2005. The number of cases with positive toxicological results (216) decreased (-27) in relation to 2010, decreasing the percentage of positivity in the set of exams made (7%, 9%, 9%, 11%, 12%, 9% and 10% respectively in 2011, 2010, 2009, 2008, 2007, 2006 and 2005)."

"In absolute numbers, drug-related deaths from 2002 to 2006 for every prohibited substance have either declined significantly or remained constant compared with 2001. In 2000, for instance, the number of deaths from opiates (including heroin) was 281. That number has decreased steadily since decriminalization, to 133 in 2006 (see Figure 11).⁵⁶
"As is true for drug usage rates, these postdecriminalization decreases were preceded by significant increases in drug-related problems in Portugal throughout the 1990s. Throughout the predecriminalization 1990s, the number of acute drug-related deaths increased every year, increasing more than tenfold from 1989 to 1999, reaching a total of almost 400 by 1999 (see Figures 12 and 13).⁵⁷
"The total number of drug-related deaths has actually decreased from the predecriminalization year of 1999 (when it totaled close to 400) to 2006 (when the total was 290)."

"The information we have presented adds to the current literature on the impacts of decriminalization. It disconfirms the hypothesis that decriminalization necessarily leads to increases in the most harmful forms of drug use. While small increases in drug use were reported by Portuguese adults, the regional context of this trend suggests that they were not produced solely by the 2001 decriminalization. We would argue that they are less important than the major reductions seen in opiate-related deaths and infections, as well as reductions in young people’s drug use. The Portuguese evidence suggests that combining the removal of criminal penalties with the use of alternative therapeutic responses to dependent drug users offers several advantages. It can reduce the burden of drug law enforcement on the criminal justice system, while also reducing problematic drug use."

"2011 national first treatment demand data concerned 5,960 individuals from the outpatient public network centres (78) from these population only 2,265 are Drug Users, this year for the second time it was possible to have TDI data fully in line with EMCDDA TDI Protocol (see also Standard Table 34).
"These individuals (2 265) in first treatment demand were mainly:
"• Male gender (84%);
"• Mean Age 33, 31.4% were aged 25-34, 29% were aged 35-44, 24.5% were aged under 25.
"• Using heroin as the main substance (52.3%, 54% in 2010, 47.5% in 2009, 51.1% in 2008 and 59.5% in 2007), followed by cannabis (25.3%, 21% in 2010, 11.7% in 2009, 10.5% in 2008 and 10.9% in 2007);
"• cocaine (12.5%, 12% in 2010, 8.7% in 2009, 10.8% in 2008 and 11,6% in 2007);
"• Data concerning the administration route of the main substance indicate that (73.4%, 93% in 2010, 64.3% in 2009, 63.1% in 2008 and 74.3% in 2007) of these clients refer smoking/inhaling and 7.2% referred injecting (7% in 2010, 12.5% in 2009, 21.5% in 2008, 19.0% in 2007, 21.9% in 2006);
"In 2011, were integrated in the drug addiction treatment public network 26,351 clients in substitution and maintenance programs, representing a decrease of 4% in relation to 2010 (27,392 in 2010, 27,031 in 2009, 25,808 in 2008 and 24,312 in 2007), after the continuous increase verified through the last decade."

Harm Reduction

"Prevention of drug-related infectious diseases amongst problematic drug users is mainly ensured through the national syringe exchange program 'Say no to a second hand syringe', established by the National Commission for the Fight Against AIDS (CNLCS) in collaboration with the National Association of Pharmacies (ANF), with the aim to prevent HIV transmission between intravenous drug users through the distribution of sterilized material and the collection and destruction of the materials used by IDUs.
"Over the years the program was adjusted according to the evolution needs of IDUs and harmonization of procedures among the various partners.
"Since it was set up, in October 1993, it has been using the national network of pharmacies and has enlarged its partner network through protocols with mobile units, NGOs and other organisations in order to reach a wider population (49 partners in 2010 and 2009 and 36 in 2008). This program was externally evaluated (as reported in previous National Reports) and it was concluded that it had avoided 7,000 new HIV infections per each 10,000 IDU at that time of existence of this program, having estimate savings to the State between 400 to 1,700 million Euros, reinforcing the importance of this program in term of public health.
"50,463,192 syringes have been exchanged through this program since October 1993 and until December of 2012 by all the entities involved in this program. The number of syringes exchanged increased progressively till 1997, with some fluctuations in the following years. From 2005 has been registered a downward trend in the number of syringes exchanged.
"In 2012, 1,341,710 syringes were exchanged (1.650.951 in 2011), and distributed 1,086,400 (1,210,000 in 2011), representing a decrease of 19% and 10% in relation to last year.
"The Partners in this program are all Governmental and nongovernmental organizations that signed the cooperation protocol with the National Coordination HIV/AIDS and ANF under the program 'Say no to a 2nd hand syringe.'"

"In the Portuguese case, the statistical indicators and key informant interviews that we have reviewed suggest that since decriminalization in July 2001, the following changes have occurred:
"• small increases in reported illicit drug use amongst adults;
"• reduced illicit drug use among problematic drug users and adolescents, at least since 2003;
"• reduced burden of drug offenders on the criminal justice system;
"• increased uptake of drug treatment;
"• reduction in opiate-related deaths and infectious diseases;
"• increases in the amounts of drugs seized by the authorities;
"• reductions in the retail prices of drugs.
"By comparing the trends in Portugal and neighbouring Spain and Italy, we can say that while some trends clearly reflect regional shifts (e.g. the increase in use amongst adults) and/or the expansion of services throughout Portugal, some effects do appear to be specific to Portugal. Indeed, the reduction in problematic drug users and reduction in burden of drug offenders on the criminal justice system were in direct contrast to those trends observed in neighbouring Spain and Italy. Moreover, there are no signs of mass expansion of the drug market in Portugal. This is in contrast with apparent market expansions in neighbouring Spain."

"The current economic crisis that Europe is experiencing, with direct implications on our country, led to the adoption of measures of rationalization and containment of public expenditure, which resulted in the reduction of human and financial resources compromising the performance of the mission of IDT, I.P.
"Also, on the second semester of 2011, the activity of IDT, I.P. was defined by the instability caused by the announcement of the governmental decision to extinguish the IDT, I.P.1, on the context of the PREMAC (Plano de Redução e Melhoria da Administração Central) and the creation of a new structure within the Ministry of Health, the SICAD – Directorate General for Intervention on Addictive Behaviours and Dependencies, in charge of planning and monitoring programs of reduction of use of psychoactive substances, prevention of addictive behaviours and reducing dependencies. The implementation of interventions will lie on the competence of the regional health administrations (ARS).
"The mission of SICAD is to promote the reduction of use of psychoactive substances, the prevention of addictive behaviours and the reduction of dependencies.
"SICAD has the following assignments:
"a) Support the member of Government responsible for the elaboration of the national strategy and of policies for reducing the use of psychoactive substances, prevention of addictive behaviours and reduction of dependencies and their evaluation;
"b) Plan and evaluate the programs of prevention, risk and harm reduction and treatment of psychoactive substances, addictive behaviours and dependencies, namely the definition of standards, methodologies and requirements to ensure quality;
"c) Plan the intervention on addictive behaviours and dependencies, trough a network of primary care, centres of integrated responses and in patient or outpatient facilities, depending on the severity of the addiction or the use of psychoactive substances;
"d) Develop and promote the scientific research on psychoactive substances, addictive behaviours and dependencies, maintaining an information system on drugs and addictions phenomenon;
"e) Develop effective mechanisms for planning and coordinating the definition of policies for the interventions on addictive behaviours and dependencies;
"f) Perform diagnosis of the needs for interventions at national level, define priorities and the type of intervention to develop;
"g) Define the technical and normative guidelines for the intervention in addictive behaviours and dependencies;
"h) Promote training in psychoactive substances, addictive behaviours and dependencies;
"i) Ensure the collection, treatment and dissemination of data and information from public and private bodies with intervention in psychoactive substances, addictive behaviours and dependencies;
"j) Ensure international representation in its field of expertise and specific assignments, without prejudice of the competences of the Ministry of Foreign Affairs, as well as ensuring the obligations as National Focal Point of the European Information Network on Drugs and Drug Addiction of European Monitoring Centre for Drug and Drug Addiction, coordinating with Directorate General of Health, as the body responsible for the international relations of the Ministry of Health;
"k) Provide technical and administrative support and ensure the necessary structures for the functioning of the Commissions for Dissuasion;
"l) Define the requirements for the licensing of private units providing health care in the field of dependencies and addictive behaviours.
"The decision to extinguish IDT,I.P. coincided with the end of the cycle of the national policy on drugs and alcohol, initiated with the evaluation of the National Plan on Drugs and Drug Addiction 2005-2012 (PNCDT) and the National Plan for Reducing Alcohol Related Problems 2010-2012 (PNRPLA) – See chapter 1.3."

"The decriminalisation of possession and use of drugs, Law 30/2000 of 29 of November, is an operational instrument of objectives and policies to combat the use and abuse of drugs, and the promotion of public health, complementary to the strategies of other areas of intervention of IDT, I.P. in the field of demand reduction, representing as well a measure against social exclusion.
"The purpose of this legal change was the reduction of drug use and safeguard of the needs of individuals at preventive, health and therapeutic level. For this objective, Commissions for the Dissuasion of Drug Use (CDT) were created in each capital of district to develop a proximity work in the mediation between situations of use and the application of administrative sanctions (see chapter 9.2 for further developments).
"The CDT’s continued to play in 2011 an important role in the articulation with the CRI’s in the context of the preventive responses. There were a significant number of referrals to structures with responses in risk reduction and harm reduction, as well as regular contacts and meetings with the treatment facilities in the various districts, in a relation of proximity and positive articulation.
"In order to enhance the intra-ministerial articulation under the Health Ministry, regular referrals to structures within the Ministry, as health centers, hospitals and other integrated services were developed.
"Regarding the promotion of inter-ministerial coordination and as in 2011 were extinguished the Civil Governments, it was necessary to find alternative solutions to the functioning of CDT’s which wouldn’t prejudice the defendant and patients
"Under the same goal it should be noted the proximity work with the Public Ministry and Police Forces, maintaining also a regular joint working with partners in the field of social reintegration.
"To achieve these referrals is necessary to assess and evaluate the connexion that the individual has with the illicit substance consumed. This means trying to meet the actual needs of each individual, allowing for early detection of problem drug use and identification of dysfunctional behaviours, which involve greater risks, including escalation of consumption."

"The Harm and Risk Reduction model implemented in Portugal, aims to propose, through integrated work, to users who are unable or unwilling to renounce drug use, help to reduce harm they cause themselves trough alternatives paths that lead to treatment facilities and therefore a gradual process of stabilization and organization, which may allow the recovery process. Thus the focus is the National Network of Harm and Risk Reduction (RRMD) as an integrated intervention model, recommended by the Operational Program of Integrated Responses (PORI), via the implementation of projects under the Program of Integrated Response (PRIs).
"The main priorities established by the National Plan 2005-2012 in the area of Harm and risk reduction are:
"• To set up a global network of integrated and complementary responses in this area with public and private partners;
"• To target specific groups for risk reduction and harm minimisation programs.
"In 2011 the main objectives for the area of Harm and Risk reduction were:
"• Ensure the systematic collection of information through proximity structures with the view to a better knowledge of the phenomenon, specially for the group of users/consumers of psychoactive substances which don’t seek the conventional treatment network;
"• Consolidate the RRMD national Network through following and monitoring the work done and also invest in the training of the different intervinients;
"• Integrate and complement the intervention in this area with the several responses available at the level of prevention, treatment and reintegration at intra and interinstitutional level."