"In 2021, the proportion of overdose deaths involving benzodiazepines increased in several countries and was present in more than half of the cases in Denmark, Austria, Portugal and Finland (see figure Proportion of drug-induced deaths with benzodiazepines involved in selected countries, 2019–2021 in Drug-induced deaths in Europe)."
"In 2022, generally very low levels of ketamine residues in municipal wastewater were reported by 15 cities, with the highest mass loads being detected in cities in Denmark, Spain, Italy and Portugal (see the figure Ketamine residues in wastewater in selected European cities, 2022, below)."
"Among first-time clients entering specialised drug treatment in 2021, or most recent year available, with heroin as their primary drug, 19% (down from 38% in 2013) reported injecting as their main route of administration. In this group, levels of injecting vary between countries, from less than 10% in Denmark, Spain, France and Portugal to 60% or more in Czechia, Estonia, Latvia, Lithuania, Romania and Slovakia."
"To be sure, the Portuguese model is not perfect. It has been criticized, for example, on the ground that there is a contradiction between the ideas of consent to treatment and the obligation to go to Commissions which, in turn, can apply sanctions (to people who do not have a substance use disorder) [6]. That is especially relevant today, as 90% of people using drugs are classified as not having a disorder (a vast majority of them using cannabis).
"In Vancouver and Lisbon, there are other critical gaps in harm reduction services and programs for YPWUD as well. In both settings, youth-dedicated safer injection, safer smoking, and overdose prevention sites do not exist. The COVID-19 pandemic prompted a scaling up of harm reduction initiatives in both Vancouver and Lisbon [9, 16].
"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].
"Current data on individuals imprisoned under the Drug Law (December 31, 2019) points to 1862 inmates (the second lowest number in the decade), mainly convicted for dealing (76%), followed by minor dealing (24%). The category ‘other’ represents less than 1% [27]. Remarkably, there is no information available for the crime of drug use.
"The Supreme Court of Justice, considering that it was not intended to legalize drug use, but only to decriminalize less severe consumption, reestablishes the crime of drug use (article 40°, Decree-Law n. 15/93) for cases in which the amounts identified exceed those established. Later, in 2014, the Constitutional Court did not consider the interpretation of the Supreme Court of Justice unconstitutional and validated its position (judgment n. 587/2014, December 3). Although not fully binding, judgement n.
"In 2008, the Supreme Court of Justice took the position, by judgment (n. 8/2008, August 5), of reestablishing the crime of drug use (article 40°, Decree-Law n. 15/93) when the quantity detected exceeds the average individual use for a period of ten days (behaviour punishable by imprisonment for one year or fine up to 120 days). These quantities are defined by the ordinance Law n. 94/96, March 26, 1996, in use till current days. A number of factors contributed to this situation.
"Safer supply programs are not designed or implemented with the explicit goal of changing injection practices. However, the experiences of clients and providers help us understand how a structural intervention, such as safer supply, can impact other aspects of IDU (e.g., frequency of injection) and its associated health risks (e.g., HIV, HCV, etc.).
