Portugal

"The main drug law in Portugal is Decree Law 15/93 of 22 January 1993, which defines the legal regime applicable to the trafficking and consumption of narcotic drugs and psychoactive substances. Law 30/2000, adopted in November 2000 but in place since July 2001, decriminalised consumption, acquisition and possession of drugs for personal consumption.

"A regulation sets out maximum amounts of drugs in grams, these amounts being estimates of the average required for 10 days’ consumption. A person caught using or possessing less than the maximum amount of a drug for personal use, where there is no suspicion of involvement in drug trafficking, will be evaluated by the local Commission for Dissuasion of Drug Addiction, composed of three members, two being medical doctors, psychologists, sociologists or social workers and the third being a legal expert. Punitive sanctions can be applied, but the main objectives are to explore the need for treatment and to promote healthy recovery.

"Drug trafficking may incur a sentence of 1-5 or 4-12 years’ imprisonment, depending on specific criteria, one of which is the nature of the substance supplied. The penalty is reduced for users who sell drugs to finance their own consumption.

"Decree Law 54/2013 prohibits the production, export, advertisement, distribution, sale or simple dispensing of new psychoactive substances (NPS) named in the list accompanying the Decree Law and sets up a control mechanism for NPS. Administrative sanctions, including fines of up to EUR 45,000, can be imposed for offences under this law, while a person caught using NPS but who is not suspected of having committed another offence is referred to the local Commission for
Dissuasion of Drug Addiction.

"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). Moreover, some efficient harm-reduction measures are still very limited in scope (e.g. drug-checking services or supervised drug consumption facilities) or inexistent (e.g. provision of syringes in prisons or outpatient naloxone prescription). Additionally, the framing of Portuguese drug addiction as a ‘disease’ is somehow pathologizing and might undermine the right to agency and self-determination of people using drugs, who still experience stigma, discrimination and sometimes violence from police, service and health-care providers and the community at large [7]. Finally, the 2008 decision of the Supreme Court (discussed below) led to an increase in criminal sentences related to drug use.

"Nevertheless, it is undeniable that the system brought positive results. Hughes & Stevens, for example, have compared Portugal to neighbouring countries that did not introduce significant reforms in the period 2001–11 and showed that Portugal is the only country that exhibited a decline in hazardous drug use [8]. More recent data show that hazardous drug use in Portugal has continued to fall since 2010 and that the country has the lowest drug-related death rates in Europe today [5, 9]. Since the reform, moreover, Portuguese police officers have been able to shift resources from people using drugs to drug traffickers. Consequently, the amount of drugs seized has increased for all categories, and the number of people incarcerated on the account of drug use decreased—thus reducing justice overload [10]. The reform was also a profitable investment for the state, as the economic benefits (e.g. decrease in health-related and legal system expenditures) were higher than its costs. § Finally, the success is recognized internationally: despite strong initial opposition, the Portuguese approach has been described as a ‘model of best practices’ by the President of the International Narcotics Control Board (INCB) [10, p. 23]."

"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]. And yet, in Lisbon, interventions such as a new shelter that includes access to a safer consumption space (via a mobile drug consumption room) was not designed to include youth. In Vancouver, even when YPWUD are allowed to use those safer consumption sites that do exist, they often don’t feel comfortable in these adult-oriented spaces.

"In our experience, adult-oriented safer consumption spaces can be intimidating for YPWUD, who don’t always feel like they can ask questions or get appropriate help in these places. In adult-oriented spaces, it can seem like everyone already knows what they are doing and what they want to be doing when it comes to their substance use, and many YPWUD feel like they have to imply that they are equally experienced and confident in their decisions about drugs when they are in these places. YPWUD may also worry that if they access adult-oriented safer consumption spaces, someone might report them to child protective services, or tell a family member, caregiver, provider, or worker that they were seen there. In Vancouver, we have seen YPWUD turned away from adult-oriented safer consumption spaces because they looked "too young" and “too healthy” to be using drugs intensively, or “didn’t have any track marks.” When YPWUD are uncomfortable or actively turned away, it can drive them even further away from life-saving care. It can also send the message that their lives are not worth saving.

"In Portugal, safer drug consumption spaces in general are not widely available (the first safer smoking and injecting sites were opened in 2021), and there are no youth-dedicated spaces. Drug checking is only available in Lisbon, and take-home naloxone kits and peer-to-peer overdose prevention (naloxone) programs are also not available despite ongoing advocacy. In both Vancouver and Lisbon, there has been a primary focus on connecting people who use drugs with OAT and sterile drug use paraphernalia. As others have argued, the focus is on mediating drug-related risks and harms (e.g., syringe sharing, blood borne infections), and treating substance use “disorders” via licit replacement therapies (e.g., methadone, buprenorphine-naloxone), rather than on making the use of substances such as heroin, fentanyl, crack, and meth safer via safe supply and harm reduction programs [11]. In both settings, a focus on substance use as either criminal or pathological undermines the self-determination of YPWUD in relation to their drug use, harm reduction, and care."

"The Portuguese National Coordination Structure for Drugs, Drug Addiction and Alcohol-Related Problems comprises a number of bodies. The interministerial Council for Drugs, Drug Addiction and Alcohol-Related Problems has overall responsibility for the endorsement, coordination and evaluation of drug policy. It is chaired by the prime minister and consists of ministers from all relevant areas (currently 13) and the national drug coordinator. It is supported by the Interministerial Technical Commission, chaired by the national coordinator and composed of representatives designated by the different ministers. Its main function is to design, monitor and evaluate the national plan and support action plans on illicit substances and alcohol. The General-Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD), attached to the Ministry of Health, supports the national strategy’s implementation, through planning and evaluating demand reduction interventions, and provides technical and administrative support to the Commissions for Dissuasion of Drug Addiction. SICAD is the EMCDDA’s national focal point in Portugal; the SICAD General-Director is the National Coordinator for Drugs, Drug Addiction and Alcohol-Related Problems."

"The most recent general population survey shows that cannabis remains the most frequently used illicit substance in Portugal, followed by MDMA/ecstasy and cocaine. Use of illicit substances is more common among young adults (aged 15-34 years). The available data indicate an increase in last year and last month cannabis use during the period 2012-16, mainly among those aged between 25 and 44 years.

"In 2017, the third edition of the Survey on Addictive Behaviours among people aged 18 years took place; young people participating in the National Defence Day were surveyed. Cannabis was the substance with the highest prevalence of use. A slight decrease in the prevalence of cocaine use relative to previous years was observed.

"Lisbon, Almada and Porto participate in the Europe-wide annual wastewater campaigns undertaken by the Sewage Analysis Core Group Europe (SCORE); 2018 data are not available for Porto, however. This study provides data on drug use at a municipal level, based on the levels of illicit drugs and their metabolites found in wastewater. The results indicate an increase in cocaine and MDMA use in Lisbon between 2013 and 2018, and the use of these substances seems to be more common in Lisbon than in Porto or Almada (in 2016 and 2017). Moreover, in all locations the presence of these substances in wastewater was higher at weekends than on weekdays. In 2018, amphetamine and methamphetamine levels detected in the two cities remained low, indicating very limited use of these substances in these cities."

"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."

"The most recent data on drug use among students were reported in the 2015 European School Survey Project on Alcohol and Other Drugs (ESPAD). Lifetime use of cannabis and other illicit substances among Portuguese students was slightly lower than the European average (based on data from 35 countries), with lifetime use of new psychoactive substances much lower than the average. Similarly, use of cigarettes in the last 30 days was just below the European average and alcohol use and binge drinking in the last 30 days were much lower than the average. Lifetime use of cannabis showed an increase in the 2003 survey, but it has remained relatively stable since, as indicated in the three subsequent surveys."

"The National Plan for the Reduction of Addictive Behaviours and Dependencies 2013-20 states that treatment interventions should be based on a comprehensive diagnosis of each citizen’s full medical and social needs, be accessible and adaptable, be based on scientific evidence in terms of effectiveness, efficiency and quality, and be underpinned by guidelines.

"Healthcare for drug users is provided by the Referral Network for Addictive Behaviours and Dependencies. The network encompasses public specialised services providing treatment for illicit substance dependence, under the authority of the regional health administrations of the Ministry of Health, non-governmental organisations and other public or private treatment service providers interested and competent in the provision of care. The public services are provided free of charge and are accessible to all people who use drugs and who seek treatment. The network incorporates three levels of care: (i) primary healthcare services; (ii) specialised care, mainly in outpatient settings; and (iii) differentiated care, mainly in inpatient settings (detoxification units, therapeutic communities, day centres and/or specialised mental or somatic health care).

"Outpatient treatment is available at all three levels of care; however, the main providers of outpatient treatment are the 72 specialised treatment teams from the integrated response centres. These treatment teams are usually the first point of contact for clients. From there, referrals are made to public or private detoxification units or therapeutic communities. All centres provide both psychosocial care and opioid substitution treatment (OST).

"Inpatient treatment is mainly provided through third-level care services. It includes short-term withdrawal treatment (7-10 days usually), which is available in eight public and private detoxification units. There are also 59 therapeutic communities, which usually provide 3- to 12-month residential treatment programmes. Therapeutic communities are mainly privately owned and publicly funded. A programme of extended duration (up to 3 years) is available to clients who require longer term support services. Special treatment programmes for people who use cannabis and cocaine have also been put in place.

"In Portugal, OST is widely available. Methadone maintenance treatment (MMT) can be initiated in treatment centres, and buprenorphine treatment can be initiated by any medical doctor, specialised medical doctors and treatment centres. MMT is free of charge to the client, while buprenorphine-based medications are available in pharmacies, with the National Health Service covering 40% of the market price."

"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.

"In 2000, and contrary to what has happened with drug use, Law n. 30/2000 kept drug dealing (production, manufacture and trade of illegal drugs) stayed legally framed by the Decree-Law n. 15/93, which penalizes “trafficking and other illicit activities” (article 21°), “less severe trafficking” (article 25°); and the “dealer/user” (article 26°). This last category regards those situations where the individual has the ultimate aim to get substances for personal use that do not exceed the quantities for a medium use of up to five days.⁸

"Concerning drug use, article 40° of the same Decree-Law established the crime of drug use and punished it with imprisonment up to three months (or penalty fine up to 30 days); if the quantities exceeded the amount necessary to the medium individual use up to three days, the penalty was of up to one year in jail (or penalty fine up to 120 days). Moreover, the Decree-Law n. 15/93 distinguished between dealing and using, criminalizing both practices, but - as long as this distinction was established - prevented drug use from being legally punished as dealing, regardless of the quantities seized. Differing from what happened with the decriminalization law, no quantitative limit was established for the purpose of distinguishing between the two behaviours."

"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. 8/2008 is currently used as an uniformizing instrument for judicial decisions. This position has been seen as polemical [24] even among renowned judges, who were persuaded that the Supreme Court action is contrary to the spirit of the decriminalization law [25].

"Notably, these sanctions are not directed at dealers, nor at dealers/users, but uniquely to those who have been proven only to be a drug user. It should also be underlined that it is not the quantity that serves to distinguish between use and trafficking. The Portuguese system is a model guided by threshold values only to differentiate between types of use (ones that should be considered a crime or a misdemeanour), and avoiding the hazards associated with the introduction of metrics that, in general, generate more punitive systems [26].

"Paradoxically, despite having decriminalized the use of all illegal drugs, Portugal has an increasing number of people criminally sanctioned - some with prison terms - for drug use [25,26,27]. Regarding criminal sanctions, in 2019, among the convictions under the Drug Law (1883 individuals), drug use (42%) was the second most common, behind drug dealing (58%); no one has been sanctioned for dealing-using [27]. Before 2008, reflecting the decriminalization law, sentences for drug use were almost non-existent and exclusively related to cultivation, which continued to be a crime (article 40° of the Decree-Law n. 15/93, of 22 January).

"After 2008 (Fig. 2), the sharp increase of sanctions for drug use - which includes fines (suspended or effective), jail time (suspended or effective) and a combination of fines and jail time - is seemingly attributable to the establishment of jurisprudence. According to SICAD [27], in 2019, the Supreme Court judgment n. 8/2008 is explicitly stated in about 99% of the convictions. Moreover, between 2010 and 2019, while convictions for the crime of drug use saw an increase, convictions for drug dealing, including the dealer-user category, registered a decrease [27]."

"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 increase of punitive responses raises the question of what happened in Portugal during the last decade and what is the actual role played by the Supreme Court judgment of 2008.

"Administrative sanctions (i.e., operated by the Commissions) and, in particular, trends from 2010 to 2019, also registered a global increase [27]. Among the decisions made on these occurrences (8150 in 2019), predominated the suspensive ones (80%), followed by the punitive (19%) and acquittal (1%). In 2018, compared to previous years, there is evidence of a higher weight of punitive decisions, although the proportion of suspended sentences, punitive sentences and acquittal have remained relatively stable over the past four years [27].^Footnote9 This suggests that, despite suspensive sanctions being the predominant measure used by the Commissions (80%), the rise of punitiveness might not be limited to the criminal sphere."

"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]."

"The data available have limitations in respect to quality and coverage, however, the information available suggests that heroin was only present in the majority of overdose deaths in a relatively small number of EU countries. A significant share of overdose deaths was reported by Austria (67%), Italy (56%), Ireland (46% in 2017), Poland (44% in 2016) and Romania (43%). In 7 other European countries, heroin was found in approximately a quarter to a third of reported overdose deaths: Portugal (37%), Slovenia (33%), Denmark (36%), France (33% in 2020), Türkiye (32%), Spain (28% in 2020) and Norway (23%). In 2021, in the north of Europe, less than 1 in 6 overdose deaths in Finland, Sweden and in the Baltic countries was reported to involve heroin."

"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."

"DCRs have been legally possible in Portugal for almost two decades but have not before been implemented. The overhaul of Portugal’s drug policy is summarized in the 1999 National Drug Strategy, which lays out a shift toward a less repressive drug policy and one centered on humanism, pragmatism, and public health. In 2001, both the decriminalization of low-level possession and use of illicit drugs and the Decree-law 183, regulating harm reduction responses, came into effect. DCRs are among the harm reduction measures detailed. However, the relevant law restricts DCR locations to areas that are not densely populated. The opening of a MDCR, which is part of a larger initiative by the city government and harm reduction NGOs to open 3 DCRs, two fixed and one mobile, allows service of the densely populated urban center. Only injection consumption is possible in the van due to limited space and lack of smoke extraction capacities."

"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)."

"The MDCR [Mobile Drug Consumption Room] is the first DCR in Portugal and has an integrated model of care, meaning that it provides a safer space for injected consumption, and basic healthcare, psychosocial support, peer education, referral to other health services, and assistance for clients to navigate the health and social systems. Among the MDCR's services, rapid testing for HIV, viral hepatitis and syphilis are open to all community members, regardless of whether they use drugs. The MDCR is housed in a van, allowing it to travel between locations, and has two spaces for consumption and an office. The team running the MDCR is multidisciplinary, consisting of peer workers, nurses, psychologists and social workers."

"Drug consumption rooms (DCR) are in place for more than three decades in Europe and have been proven to be effective as a public health response. However, their implementation remains slow and controversial in many countries. In Portugal, despite being legal since 2001, the first DCR only came into reality in 2019 by the initiative of the City Council of Lisbon."

"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)."

"Studies reporting estimates of high-risk drug use can help to identify the extent of the more entrenched drug use problems, while data on first-time entrants to specialised drug treatment centres, when considered alongside other indicators, can inform an understanding of the nature of and trends in high-risk drug use.

"It is estimated that there were 33,290 high-risk opioid users in Portugal in 2015, which is about 5.2 per 1,000 of the adult population. In the same year, the number of people who inject drugs was estimated at 13,160 (2 per 1,000 people aged 15-64).

"The Cannabis Abuse Screening Test included in the 2016/17 general population survey suggested that about 0.7 % of 15- to 64-year-olds could be considered high-risk cannabis users.

"Data from specialised treatment centres show that the first-time treatment demands attributable to heroin use have declined since 2009. In contrast, first-time treatment entries resulting from the primary use of cannabis increased until 2016 and have since stabilised. Following a period of stability in cocaine-related first-time treatment demands, an increase has been noted in the past few years. In general, males accounted for the majority of treatment entrants."

"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."

"In 2017, a total of 27,150 clients received treatment, with most being treated in outpatient services. Of the 3,307 clients entering treatment in 2017, three out of every five were first-time clients. The number of previously treated treatment entrants has been decreasing since 2012, while the number of first-time entrants has been stable over this period. In addition, the number of OST clients in Portugal decreased between 2010 and 2013; however, it has remained relatively stable since then. In 2017, more than 16,000 clients received OST, mainly MMT."

"With regard to the ages of initiation of use, and focusing on the younger age group (15-24 years) where the probality of initiation use is higher, cannabis presents the earliest values, with an average age of 17 years and modal age 16 years, followed by ecstasy and hallucinogenic mushrooms with modal ages of 17 years and amphetamines with modal age of 18 years. Cocaine, heroin and LSD present later average and modal ages of initiation of use. Between 2001 and 2012, in the age group 15-24, there is a slight delay of the ages of initiation of use for most substances."

"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."

"The main priority established by the current national plan in the area of risk and harm reduction is to promote and develop the existing risk and harm reduction intervention model and adapt it to the evolving drug use phenomenon by promoting effective and integrated responses. The governance and implementation of harm reduction services and interventions occur within the framework of the Operational Plan for Integrated Responses (PORI). This plan, managed by the General-Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD), relies on the assessment made by the regional health authorities, based on which regional and local intervention needs are identified. While non-governmental organisations (NGOs) were instrumental in the creation of an infrastructure of health and social service providers under Decree Law 183/2001 and continue to play an important role, harm reduction has also become an integrated part of the services provided by the national network of health service providers. The current Action Plan for the Reduction of Addictive Behaviours and Dependencies Horizon 2020 continues to promote harm reduction, and legislation to strengthen state funding for harm reduction NGOs was adopted in 2018, increasing the sustainability of their work.

"Harm reduction interventions
"A nationwide network of harm reduction programmes and structures, including needle and syringe exchange programmes, low-threshold substitution programmes, drop-in centres/shelters, refuges, contact units and outreach teams, has been consolidated in areas of intensive drug use with the aim of preventing drug-related risks such as infectious diseases, social exclusion and delinquency.

"The National Commission for the Fight Against AIDS (Comissão Nacional de Luta Contra a SIDA), in cooperation with the National Association of Pharmacies (Associação Nacional de Farmácias), implements the national needle and syringe programme, Say No to a Used Syringe. The programme involves pharmacies, primary care health centres and NGOs, and includes several mobile units. Approximately 57 million syringes were distributed under this needle and syringe programme between its launch in October 1993 and December 2017, and the latest evaluation of the programme emphasises the important contribution made by pharmacies, drug facilities and outreach work to its delivery.

"An increasing trend in the number of syringes dispensed has been observed in recent years, with more than 1.4 million syringes distributed in 2017.

"Treatment for human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) and hepatitis B and C virus infections is included in the range of services provided by the National Health Service of Portugal and is available free of charge."

Click here for complete datatable of Lifetime, Past-Year, and Past-Month Prevalence of Use of Selected Substances in Portugal, 2001 and 2007

"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."

"Of the 2 051 convicted individuals under the Drug Law (2,041 in 2011, 770 in 2010, 1,684 in 2009, 1,392 in 2008 and 1,420 in 2007), 80% were convicted for traffic, 19% for use and 1% for traffic-use. The focus goes to the increase in the proportion of individuals convicted by use since 2008, related with the fixation of case law on situations for own use in superior amount than the required for the average individual use during a period of 10 days (Supreme Court of Justice n. o 8/2008, of 5 August). Indeed, in 2012, in about 74% of convictions for use was made express reference to this Judgment (76%, 75% and 84%, respectively of the convictions for use in 2011, 2010 and 2009).
"From the 1,638 individuals convicted for traffic, 1,635 were initially accused for that crime and 3 for traffic-use. From the 388 individuals convicted for use, 232 (60%) were accused for that crime, 152 (39%) for traffic and and 4 (1%) for traffic-use. Of the 25 individuals convicted of traffic-use, 19 (76%) were accused for traffic and only 6 (24%) for traffic-use.
"Once more Lisbon and Porto were the districts that registered the higher percentages of these convictions (respectavily 36% and 19%), followed by the Autonomous Region of Azores (6%), Setúbal (5%), Aveiro (5%) and Braga (5%).
"The higher rates per inhabitants aged 15-64 were registered in the autonomous Region of Azores and in the districts of Lisbon, Portalegre and Vila Real.
"Concerning the sanctions⁵¹ 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."

"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"

"Drug trafficking may incur a sentence of 1-5 or 4-12 years’ imprisonment, depending on specific criteria, one of which is the nature of the substance supplied. The penalty is reduced for users who sell drugs to finance their own consumption.

"Decree Law 54/2013 prohibits the production, export, advertisement, distribution, sale or simple dispensing of new psychoactive substances (NPS) named in the list accompanying the Decree Law and sets up a control mechanism for NPS. Administrative sanctions, including fines of up to EUR 45,000, can be imposed for offences under this law, while a person caught using NPS but who is not suspected of having committed another offence is referred to the local Commission for Dissuasion of Drug Addiction."

"In all ESPAD countries but one, 70% or more of the students have drunk alcohol at least once during their lifetime. The ESPAD average is 87% (range: 56–98%). The highest rates of lifetime alcohol prevalence (above 95%) are found in the Czech Republic and Latvia. There is one ESPAD country that stands out with a low figure, namely Iceland, but the proportion is actually the same (56%) in the United States (not an ESPAD country). Other countries with relatively low rates (below 80%) include Montenegro, Norway, Portugal, Romania and Sweden."

"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 31/12/2011, notification data (analytical tests) from the National Health Institute Doutor Ricardo Jorge (INSA, I.P.), the decreasing trend concerning the percentage of drug users in the total number of notified HIV positive cases continues to be reported. From the 41,035 notifications received since 1983, near 39% (41% in 2010, 42% in 2009 and 2008, 44% in 2007 and 45% in 2006) were drug use related. Considering the different stages covered by these notifications, 45% of the AIDS cases, 33% of Symptomatic Non-AIDS cases and 35% of the asymptomatic carriers cases were drug use associated, consolidating the proportional downward trend in this group in the different stadiums of the infection."

"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 1999, a few years prior to decriminalization, Portugal had the highest number of drug-related AIDS cases in the European Union and the second highest prevalence of HIV among drug-infected users.¹²⁷ The number of drug-related AIDS cases was also increasing, even though the number was decreasing in neighboring France, Spain, and Italy.¹²⁸ Research suggests that drug-related disease has declined in Portugal after decriminalization. Incidences of HIV and AIDS among drug users declined substantially.¹²⁹ The number of tracked cases of Hepatitis C and B in treatment centers also declined, despite the fact that many more drug users sought treatment after decriminalization took effect.¹³⁰
"Drug-related mortality in Portugal has also declined since decriminalization. During the 1990s, the number of drug-related deaths multiplied tenfold.¹³¹ Between 1999 and 2003, however, there was a significant drop in drug-related deaths within the country.¹³² Drug policy experts credit this decline to the increasing number of heroin users who entered substitution treatment programs after decriminalization.¹³³"

"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)."

"Contrary to critics’ expectations, available research does not indicate that drug use has skyrocketed in Portugal since decriminalization. Drug use seems to have increased within certain subgroups, and declined within other subgroups. Between 2001 and 2007, lifetime and past-year drug usage slightly increased among Portuguese adults for almost all illicit substances. Conversely, lifetime usage rates slightly declined for teenagers.¹²⁰ These trends are consistent with drug use trends in Italy and Spain.¹²¹ Therefore, changes in drug use in Portugal may reflect regional trends, not changes due to decriminalization.¹²²
"Existing research suggests that there is one significant trend that may be attributed to decriminalization in Portugal. Since Portugal decriminalized drug use in 2001, the prevalence of problematic drug use (“PDU”),¹²³ especially intravenous drug use, has declined.¹²⁴ This trend is inconsistent with trends in Italy and Spain, where PDU has increased.¹²⁵ This dissimilarity suggests that decriminalization may have reduced the most harmful forms of drug use in Portugal.¹²⁶"

"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."

"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."

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.'"

"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."

"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."

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."

"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."

"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."