"Despite the relatively progressive policy landscapes of both Vancouver and Lisbon, the soft left hand of low-barrier harm reduction programs continues to be paired with the hard right hand of criminal sanctions and other forms of control in both settings [31]. In Vancouver and Lisbon, police are often tasked with identifying “problem” YPWUD [Young People Who Use Drugs] and making referrals to services [11]. While accessing these services is technically voluntary in Portugal, physically presenting oneself before the Commissions for the Dissuasion of Drug Addiction is mandatory for those who are caught using drugs (including cannabis), and accepting “invitations to treatment” can be enforced by fines and other kinds of sanctions. In fact, the last decade has seen a sharp increase in criminal sanctions targeted at people who use drugs in Portugal, despite decriminalization [11].4 In Vancouver, people who use drugs in the context of street involvement continue to be heavily criminalized, and as mentioned above, there have been growing calls for the decriminalization of substance use in this setting [15].

"Youth-dedicated drop-in centers and “one-stop-shop” service hubs that prioritize harm reduction are a better primary point of care for YPWUD than hospitals or criminal justice facilities. These kinds of centers and hubs do exist in Vancouver. They provide a range of harm reduction, drug use, mental health, and social services and are critical supports for YPWUD in this setting. In Portugal, harm reduction programs and centers are more explicitly targeted towards higher-income and older (> 18 years of age) YPWUD, such as those who use drugs at music festivals. In Lisbon, YPWUD in the context of street involvement have largely been left out of efforts to scale up harm reduction interventions, including in response to the COVID-19 pandemic [16]."


Canêdo, J., Sedgemore, K. O., Ebbert, K., Anderson, H., Dykeman, R., Kincaid, K., Dias, C., Silva, D., Youth Health Advisory Council, Charlesworth, R., Knight, R., & Fast, D. (2022). Harm reduction calls to action from young people who use drugs on the streets of Vancouver and Lisbon. Harm reduction journal, 19(1), 43. doi.org/10.1186/s12954-022-00607-7