Prospective client survey and participatory process ahead of opening a mobile drug consumption room in Lisbon

Summary & key facts

In 2001 Portugal stopped treating small-scale drug possession as a criminal crime and moved to a health-led system that uses local panels, treatment offers, and harm-reduction services. Since then drug-related deaths fell and have stayed well below the EU average, fewer people are imprisoned for drug offences, HIV cases linked to injecting drug use dropped a lot, and overall drug use rates have stayed below the EU average. The reported changes come with important limits: many policies beyond decriminalisation changed at the same time (like needle programmes and treatment), some data are limited or hard to interpret, and trends have varied over time.

Key facts:

• Portugal decriminalised personal drug possession in 2001 and treats it as an administrative offence decided by district ‘Commissions for the Dissuasion of Drug Addiction’.
• In 2001 there were 76 recorded drug overdose deaths in Portugal; by 2011 there were 10, and in 2019 the drug death rate was 6 deaths per million people aged 15–64 versus the EU average of 23.7 per million.
• The share of the sentenced prison population held for drug offences fell from over 40% in 2001 to 15.7% in 2019.
• New HIV diagnoses attributed to injecting drug use fell from 1,287 in 2001 to 16 in 2019; Portugal’s share of EU new HIV diagnoses from injecting drug use fell from over 50% in 2001–02 to about 1.68% in 2019.
• As of 2015 there were an estimated 33,290 ‘high-risk’ opioid users in Portugal; per 100,000 this number is above the European average but lower than in 2001.
• In 2018, 90% of individual cases referred to the Dissuasion Commissions were assessed as not demonstrating problematic drug use.
• Outpatient drug treatment units rose from 50 to 79 between 2000 and 2009, but the number of people in treatment fell between 2009 and 2018, a period that included public health budget cuts.
• Hepatitis C prevalence among people who inject drugs in Portugal has been high (among the highest in Western Europe), but the number of new yearly hepatitis B and C reports has fallen over the past twenty years.
• Some data are uncertain or limited: drug seizure trends are hard to interpret, and apparent rises in past-year drug use since 2012 rely on limited datasets, so conclusions should be cautious.

Abstract

Continual participation of PWUD and other community members will be necessary to maximize the public health and social impacts of this intervention, relative to this baseline. The plan to continue the participatory and peer-led development of the MDCR includes integrating peer workers, clients, and local community members within the operation, management, and evaluation of the service. This research adds to a growing literature about drug consumption rooms (DCRs) in Europe, which is especially limited concerning MDCRs.

Topics

HIV, Drug Use, Sexual Risk HIV/AIDS Research and Interventions Opioid Use Disorder Treatment

Categories

Epidemiology Health Sciences Medicine

Tags

Business Consumption (sociology) Environmental health Intervention (counseling) Medicine Nursing Population Public health Social science Sociology