In 2001, Portugal’s government decriminalised all drugs after a nationwide heroin epidemic. For the past 15 years, drug use is no longer a crime in the country, instead, it is treated as a health issue.
By: Alana Repstock & Gene Lin
“At 16, my cousin gave me a smoke of heroin. At that time, I didn’t know what it was. I tried it and I never stopped,” says Emanuel Domingues, a patient of the methadone program in Lisbon, Portugal.
Domingues has been visiting the methadone van for seven years. The methadone he receives is a substitution drug for heroin and is used for treating withdrawal symptoms. The substitute drug keeps him functioning normally.
“My daughters are the reason I came to this program. At that time I couldn’t see any other escape from drugs,” he says.
The nurse hands him the drug in a small plastic cup through the window. The former heroin user tops it up at water dispenser and drinks it casually like the others lining up before him.
Standing by the van is Hugo Faria, a psychologist working for the non-profit organisation that runs the methadone program, Ares do Pinhal.
This service is available to Lisbon residents every day of the year. Two vans run through Lisbon: one in the East and one in the West, each with five stops. The patients receive a personalised and carefully calculated dosage every day, and they count on Faria and the rest of the team to keep their life in a normalised state.
“This is our new van,” says Faria, while seeing it for the first time himself. It is immaculate inside, with a pullout table and two leather stools by the entrance. On the sides are cupboards with patients’ files and government subsidised AIDS prevention kits which contain condoms, clean needles, and other injecting paraphernalia.
Thirty years ago, Ares do Pinhal was founded by two psychiatrists in the infamous drug neighbourhood of Casal Ventoso, Lisbon. But the drug problem reached its worst in 1997 when the whole country suffered a heroin epidemic.
In response to the drug crisis, the Portuguese government adopted an unusually progressive policy at the time – to decriminalise all drugs.
Under the new law, people who are caught possessing or using drugs within a certain threshold for personal-use no longer receive jail time, instead, they receive treatment.
“It was dramatic,” says Joao Goulao, the doctor who spearheaded the drug decriminalisation reform in 2001, when asked to describe the 1997 drug crisis.
Goulao is now the general-director at SICAD (Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências), the organisation that oversees Portugal’s drug decriminalisation regime.
“We are roughly ten million inhabitants in Portugal and we assume we reached 100,000 people hooked on heroin at that time – one per cent of our population,” he says.
When a person is found in possession of drugs, he or she will be sent to a discussion commission that works under the government. The commission, known as CDT (Comissão para a Dissuasão da Toxicodependência), will decide what to do with the person.
At first glance, the CDT office is well concealed within Lisbon. Visitors enter what appears to be an empty building and proceed to find the office upstairs. The office is bright and organised in contrast to its exterior. There are drug information pamphlets laying on tables in the waiting area. An officer is asking a young man to sign a paper at the reception.
“We have a technical team that does the evaluation of each person that comes here,” says Raquel Lopez, a technical worker at the CDT.
A technical team at CDT consists of three members, namely a psychologist, a social worker and a person with a legal background. The technical workers speak to the person about their history with drugs, family issues, employment status and other factors that influence their life.
At the end of the meeting, the team will determine the person’s risk related to drug use. It is very common for CDT to suspend the proceeding on the condition that the person accepts treatment, which most people do.
”Usually in the case of drug addicts, we always refer them to treatment, but they are never obliged to go, it is a free choice. We can only decide to suspend the procedure if they accept the treatment. If they don’t accept it, we will apply another kind of decision,” says Lopez.
Once the person completes treatment without further offence, the CDT will close the proceeding after a certain period of time.
“Twenty years ago we had this heroin epidemic. I think what has changed is that we now have more services for people. We have more access to treatment and harm reduction,” says Adriana Curado, a staff at a harm reduction centre in Lisbon called IN-Mouraria.
Curado says that drug users are more willing to seek help after the decriminalisation reform, as it reduced discrimination towards this population.
The harm reduction centre does not present itself as a clinic, instead, it is like a living room. The clients gather around the couch to socialise during the open hour, one couple brings their dog in with them. The counter displays a range of harm reduction items in a glass cabinet, such as condoms, and clean needles and crack pipes. Behind the counter is a clothing area, where the visitors can take what they need.
Curado says her organisation does not provide treatment, but harm reduction services to clients. The organisation provides tests for HIV and Hepatitis C, which is common among their clients.
The harm reduction centre does not pressure clients to abstain from drugs. If a client decides to quit drugs, IN-Mouraria will refer them to a separate treatment centre.
“People can come here without showing their ID cards, in fact, many of our clients don’t have even one. We inform them about our services and people are completely free to decide if they want to come speak to a social worker. All the services are for free, and we always ensure the confidentiality of our clients,” says Curado.
Joao Santa Maria is a peer worker at IN-Mouraria. He started with tobacco at age 12, then cannabis at 13, and heroin at 18.
Speaking in Portuguese, Santa Maria says he decided to stop using heroin when he could not have a normal life anymore. As a result of his drug use, he lost his wife and son, his job, and his house. He was alone.
He once abstained from drugs for five years before relapsing. He had his own construction business at the time but had to fire employees due to an economic downturn. It was during this time when Santa Maria’s usual dealer offered him cocaine. At first, he said no, but later went to the cash machine and returned.
Today, Santa Maria is a full-time employee at IN-Mouraria. He has been tested as HIV positive and has Hepatitis C, which is common in the client’s demographic. He is updated on the treatments available and has an important role in helping clients access them.
“Even though we did not know each other beforehand, our experiences are very similar. I think clients share their problems more easily this way, because when a worker is very technical and very formal it keeps people away,” says Santa Maria through a translator.
He has since found cannabis to deter him from using harder drugs.
Curado says that there is room for improvement for Portugal’s drug decriminalisation system since it was implemented in 2001.
“It was great that we did it 15 years ago. It was good because it improved services and the accessibility to these services. People now have more options,” says Curado. “But our organisation – we think that we should move forward and improve this model. What we see in the past years is that this model is frozen.”
Curado said that drug use is still penalised in Portugal under the decriminalisation regime, which does not make sense to her. She added that her organisation supports the regulation of all drugs in order to stop people from taking risks in the black market. Alongside the dangers of taking drugs is the possibility of drug manufacturers using other substances and fillers in place of the drug they are marketing. However, there is no such public debate in Portugal right now.
“There’s a vast consensus in society, even at the political level about our current model. People are comfortable with this model,” says Goulao, when asked if he sees room for change in the decriminalisation policy he helped create 15 years ago.
“We don’t really feel pressured to change,” he adds.
The doctor’s office is fashioned with fine carpet and well-organised furniture. A small shelf at the back is occupied by photographs of Goulao’s meetings with authoritative figures. Among them are Pope Francis and business magnate Richard Branson. A photograph of his wife and daughter lies at the front.
Goulao says that Portugal needed to take immediate action to resolve the drug problem in the 1990s. However, there is time now to observe before taking action.
The doctor says the 2001 decriminalisation reform went as far as possible within the framework of United Nations treaty, and if Portugal is to adopt new changes, it will happen in a wider regional framework, rather than the initiative of a single country.
Under the decriminalisation regime, the Portuguese government is financially backing organisations such as Ares do Pinhal that provide harm reduction services to drug users.
Today, Ares do Pinhal has two methadone vans driving around Lisbon 365 days a year, with a total of 1,200 patients each day. Each van is equipped with methadone, two educators and one nurse.
As a psychologist travelling with the van, Faria says the methadone van program does not expect patients to abstain from heroin. The goal of a harm reduction program is to minimise the risk that drug users are exposed to.
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“There are some people that don’t want to or cannot stop using drugs. So they need somewhere to exchange their needles and to use drugs in a hygienic spot – not on the street or by a school,” says Faria.
However, Paul Alexander Mendes, one of the patients receiving methadone, disagrees with Faria.
Mendes is short with bright green eyes. He speaks fluent Portuguese but with a thick New York accent in English. He says that he was deported to Portugal from the United States after serving time in prison for a sentence related to drug trafficking.
“It does no good to have a safe, comfortable place for users to inject. That’s not a solution; methadone is a solution,” says Mendes.
Mendes has stopped using heroin since he joined the methadone program. Previously, he was rejected from a treatment centre for having a serious dispute with the centre’s manager.
“Paul, stopped using drugs, so he, like others who have quit, don’t want to see that kind of reality. It’s not comfortable for them. It’s his opinion, it’s okay. I understand that,” says Faria when asked about his differences with Mendes.
Among the patients who visit the methadone van every day, one is hopeful for his future.
Domingues, who now works in a restaurant during the day, sees himself returning to a normal life after years of heroin use. The father-of-two is taking care of his parents who have cancer, while his daughters are living with their mother in England.
“I sent my daughters to their mother in London,” says Domingues as he takes off his beanie, looking down. “I took this option so that they don’t have to see their grandparents suffer,” he says.
Domingues then smiles, revealing a set of crooked teeth. With a tinge of embarrassment, he recalled something that happened last Friday.
“I got a call from my daughter and she said happy birthday to me. I had forgotten.”