"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)."

Treatment

"In 2010, 47 outpatient treatment centres were working in mainland Portugal as well as 32 decentralised consultation units. These centres provide both drug free and medically assisted treatment.
"Inpatient units are usually a second step of the process, as most clients of detoxification units and therapeutic communities are referred to those units by their therapists. In detoxification units, medically assisted withdrawal treatment is available, whereas in therapeutic communities most, though all, available programs are drug free (in some cases patients can enter with agonist medication and stop it in the therapeutic community). Inpatient drug free treatment is mainly available in public and private therapeutic communities.
"In 2010, there were 69 therapeutic communities (3 public and 66 private units) in mainland Portugal. The number of clients in therapeutic communities increase 6% in comparison to last year (3 601 in 2009, 3 385 in 2008 and 3 167 in 2007), consolidating the grown of last years.
"In 2010 there were 13 Detoxification Units (4 public and 9 private units). The number of clients (2 446) in detoxification units decrease 9% in comparison to last year (2 676)."

"A survey made each year on the 31st of December 2011 allows differentiation in terms of substances involved in this type of treatment.
"On that date, 21,236 clients were registered in the outpatient public treatment network substitution programs, representing a decrease in relation to 2010.
"From those 78% (77% in 2010, 76% in 2009, 75% in 2008 and 74% in 2007) were registered in methadone programs and 22% (23% in 2010, 24% in 2009, 25% in 2008 and 26% in 2007) in buprenorphine programs.
"In comparison with the situation on the 31st of December 2010, methadone clients increased (+2%) and buprenorphine decrease (-3%) consolidating the inversion occurred in 2006 of the upward trend of clients in buprenorphine verified in previous years.
"Concerning the place of administration for the clients registered in methadone programs, on the 31st of December 2011:
"• 66% (67% in 2010, 69% in 2009 and 2008 and 70% in 2007) of these clients took their methadone in the ET;
"• 16%21 (16% in 2010, 17% in 2009 and 2008 and 18% in 2007) in health centres;
"• 3% (4% in 2010, 3% in 2009, 2008 and 2007) in pharmacies;
"• 3% in Hospitals (2% as in 2010, 2009, 2008 and 2007);
"• 7% (5% as in 2010, 2009, 2008 and 2007) in other settings²².
"In all Regions, ETs were the main place of administration, followed by the health centres (primary health care centres).
"The methadone therapeutic programs through pharmacies are the result of a protocol between IDT, I.P., National Association of Pharmacies (ANF), National Institute of Pharmacy and Medicines (INFARMED) and Pharmaceutical Order.
"Since the beginning of the program (July 1998) until 31 December 2011, integrated this project 506 pharmacies, 792 pharmaceutics and 2,913 clients."

"From the beginning of the program till know 3,817,192 syringes were exchanged by Mobile Units (in several places, such as Casal Ventoso, Curraleira, Cova da Moura, Bairro de Santa Filomena and Odivelas), 12.308.326 by partnerships and 32.995.964 by pharmacies.
"In 2011, 1,267 pharmacies (1,336 in 2010, 1,360 in 2009, 1,384 in 2008 and 1,314 in 2007) were active in this program."

Laws & Policies

"The National Plan for the Reduction of Addictive Behaviors and Dependences 2013-2020, (PNRCAD), appears in the sequence of an end of cycle of the National Plan Against Drug and Drug Addictions 2005-2012 (PNCDT) and the redefinition of policies and health services.
"Facing the new challenges identified in the last years, it was decide to enlarge the approach and responses to the ambit of other Addictive Behaviors and Dependencies that include not only psychoactive substances, illicit drugs, new psychoactive substances, harmful alcohol use, but also medecines, anabolisers and gambling. PNRCAD is an important reinforcement in the domain of health policies, by the repercussions and impact that these problematic have in individuals’ life, families and society. PNRCAD is composed by two main domains: demand and supply, approached in a balance way, two structural measures, PORI, referral network and 4 transversal areas (Information and research; training and communication, international relations and cooperation and quality).
"Concerning the demand reduction domain, the citizen is the center of the conceptualisation of policies and interventions in CAD, having as assumption that it is fundamental to respond to individuals needs, perspectivated in a dynamic way throughout his life cycle.
"As regards the supply field, the decrease in the availability and access to traditional and new illicit psychoactive substances, the regulation of licit substances and their market monitoring and harmonization of existing legal provisions or to develop, in particular on gambling area and internet constitute the center of policies and interventions based on the assumption of national and international cooperation.
"The principles of PNRCAD are Humanism and Pragmatism, Centrality in the Citizen, Integrated Intervention, territoriality, quality and inovation. The global strategy of action in the context of PNRCAD is based on a coordinated action, in order to enhance synergies between the strategic and budgetary frameworks of services and organizations with intervention in these areas. The PNRCAD defines general objectives, indicators and quantified targets to be achieved in the two years of reference, 2016 and 2020.
"PNRCAD will be operationalized through two Action Plans of 4 years, 2013-2016 and 2017-2020."

"This strategy specifies eight principles, which embody a set of values that should guide interventions in this area. ‘Humanism’, for example, is the recognition of the inalienable human dignity of citizens, including drug users, and translates into a commitment to offer a wide range of services to those in need and to adopt a legal framework that causes no harm to them. ‘Pragmatism’ calls for the adoption of solutions and interventions that are based on scientific knowledge, while ‘Participation’ calls for the involvement of the community in drug policy definition and implementation.
"This strategy also puts forward a set of 13 strategic options to guide public action in the drugs field: reinforce international cooperation; decriminalise (but still prohibit) drug use; focus on primary prevention; assure access to treatment; extend harm reduction interventions; promote social reintegration; develop treatment and harm reduction in prisons; develop treatment as an alternative to prison; increase research and training; develop evaluation methodologies; simplify interdepartmental coordination; reinforce the fight against drug trafficking and money laundering; and double public investment in the drugs field.
"These principles and strategic options, which are the foundations of the current drug policy in Portugal, were first implemented through the National Action Plan for the Fight Against Drugs and Drug Addiction — Horizon 2004 (IDT, I.P., 2001). The plan, adopted in 2001, introduced 30 primary objectives related to the increase and improvement of drug-related interventions and to the reduction of drug use, risk behaviours and drug-related harms. The Action Plan had also, for the first time, an associated budget, set according to national priorities and distributed by the entities in charge of its implementation. When the plan was conceived in 1999, drug-related public investment was expected to increase by 10 % every year between 1999 and 2004, reaching EUR 159 615 327 in its last year. An external evaluation carried out a few years later (see below) concluded, however, that it was not possible to assess whether the planned budgetary objectives were effectively attained."

"Portugal focuses much of its counternarcotic efforts on treatment and prevention. Drug use remains stable and below the EU average, despite decriminalization of personal drug use in 2001. 'Problem' drug use and HIV cases are referred to the Drug Addiction Dissuasion Commission, consisting of multi-disciplinary teams that assess users and decide the appropriate sanction and referral to educational or treatment programs. The Portuguese Ministry of Health’s Institute on Drugs and Drug Addiction (IDT) operates numerous dug treatment centers nationwide. The IDT also has prevention programs that include training sessions, awareness-raising activities, and dissemination of informational pamphlets. Universal drug prevention is part of the Portuguese school curriculum. In addition, in the 'Safe Schools' program, law enforcement patrols the areas surrounding schools to prevent and protect students from criminal activities such as drug trafficking in the surrounding area. Law enforcement also actively participates in awareness and training activities."

"Drug traffic is defined by chapter III art. 21 of the Decree Law 15/93: ‘traffic and other illicit activities’. Producing, offering, selling, preparing or cultivating illicit drugs are, among others, the classic offences constituting drug traffic. It must be mentioned that the same article expressly excludes drug use offences foreseen by article 40 of the same decree law.
"Portuguese law differentiates prosecution of drug traffic according to several criteria. The nature of the substance is one of the main criteria. Trafficking in substances included in the lists I to III attract a sentence of between 4 and 12 years of imprisonment, while substances in list IV (tranquilliser and analgesic) may be punished by between 1 and 5 years in prison.
"The state of addiction of the trafficker is also taken into account by art. 26 of Decree Law 15/93. If the user sells drugs to finance his own consumption (‘addict-trafficker’), the penalty is reduced: Lists I, II, III up to 3 years (instead of 4-12) - list IV up to 1 year (instead of 1-5).
"The ‘traffic of minor importance’, being defined by article 25, is also considered at the prosecution. In cases in which the crime can be defined as minor, according to the circumstances, modalities of the crime, quantity and nature of the substances, the penalties will be substantially reduced; between 1 and 5 years’ imprisonment (lists I to III) and up to 2 years or fine (list IV).
"Of course the law foresees also aggravating circumstances by which the minimum and maximum penalties for traffic can be increased by ¼ in all cases. Criminal association envisages 10-25 years. Traffic of precursors attract penalties up to 12 years of imprisonment and the abandonment of syringes is fined or punished by up to 1 year of imprisonment."