Heroin Addiction and Related Clinical Problems One handy web-tool. Abraham, R. Next City 5 January. Statistical Bulletin — overdose deaths. Drug-related deaths: Methods and definitions. European Drug Report Trends and Developments. Drug-related Deaths in Scotland in The UK was included in the dataset as it was in the EU for the years measured.
Death data on either measure was not available for Poland, meaning the EU death rate will be a slight underestimation as Polish population data have been included but death data have not.
Population on 1 January by age and sex. It is based on population on 1 January each year rather than average yearly population, however. The whole country population data is used, meaning the death rates produced for this graph are not age-aggregated. Torres, A. Council of Europe Space Project: Annual Reports Statistical Bulletin Illicit Substances.
IZA DP Statistical Bulletin — prevalence of drug use. Hughes, C. A resounding success or a disastrous failure: Re- examining the interpretation of evidence on the Portuguese decriminalisation of illicit drugs.
Drug and Alcohol Review SICAD Statistical Synopsis: Portugal Portugal, Country Drug Report Statistical Bulletin — problem drug use. Roy, L. Forbes 31 August. Trends across 25 countries. EuroHIV Harm Reduction International Global State of Harm Reduction ECDC HIV Surveillance Reports.
For this graph, therefore, the most recently recorded data is used in each instance. Palladino, C. Epidemic history of hepatitis C virus genotypes and subtypes in Portugal. Scientific Reports 8. Statistical Bulletin — drug-related infectious diseases. Criminologists find that other consequences of problematic drug use — such as harm to health, reduced quality of life and strained personal relationships — are more effective deterrents than criminal sanctions. Because criminalizing drugs does not really prevent drug use, decriminalizing does not really increase it.
Portugal, which decriminalized the personal possession of all drugs in in response to high illicit drug use, has much lower rates of drug use than the European average. Use of cocaine among young adults age 15 to 34, for example, is 0. Oregon will now divert some the money previously used on drug enforcement to pay for about a dozen new drug prevention and treatment centers statewide, which has been found to be a significantly more cost-effective strategy.
Not everyone who uses drugs needs treatment. Decriminalization makes help accessible to those who do need it — and keeps both those users and recreational users out of jail.
Another aim of decriminalization is to mitigate the significant racial and ethnic disparities associated with drug enforcement. Illegal drug use is roughly comparable across race in the U. But people of color are significantly more likely to be searched , arrested and imprisoned for a drug-related offense.
Drug crimes can incur long prison sentences. Discretion in drug enforcement and sentencing means prohibition is among the leading causes of incarceration of people of color in the United States — an injustice many Americans on both sides of the aisle increasingly recognize.
Freed up from policing drug use, departments may redirect their resources toward crime prevention and solving violent crimes like homicide and robbery , which are time-consuming to investigate. One common concern among Oregonians who voted against decriminalization was that lessening criminal penalties would endanger children.
But U. In fact, marijuana consumption among teens — though not among college-aged Americans — actually declined in some states with legal marijuana. Footnote 3. By isolating law enforcement from the operationalization of measures outside the criminal arena, the security inclination that so often characterizes drug policies should be obliterated; thus, distinguishing the Portuguese case from others, such as Spain or Italy, which had adopted earlier the administrative approach to sanction drug use [ 25 , 45 ].
Police forces are expected to remain the primary source of detection of drug use and subsequent referral. Footnote 4. Its main goal is encouraging adherence to treatment, or the decision to abstain from drug use Decree-Law n.
Moreover, while referral to health structures is optional, physically presenting oneself before the Commissions is mandatory for those who are caught using drugs. This circumstance is somehow contradictory to the mainstream perspective, which frames drug use in the health sphere, where consent is pivotal. This is the position, for instance, recommended by the Mental Health Law Law n. Divergent from the initial intuition, perhaps fed by the images of drug users in extreme situations of social exclusion, dominant in the end of the twentieth century, it quickly became apparent that the vast majority of the clients of the Commissions were and are cannabis users classified as non-dependents.
The reason behind this circumstance is that cannabis is the most widely used illegal drug [ 49 ], in Portugal and elsewhere, its use is socially widespread, and it occurs mostly on the street and in public spaces during leisure time [ 50 ]. Overlooking the diversification of drug use patterns, the dependent or non-dependent dichotomy proposed by Law n. Certainly the PDPM facet that has raised the most opposition, harm reduction policies expanded as a direct result of the decriminalization law.
Throughout its short history, from clandestinity to political legitimacy, it went through an experimental phase — in which programs e. The initial goal was the access to hard-to-reach heroin and crack-cocaine users who resisted the traditional socio-health approaches based on pathology [ 44 ].
Others worth mentioning are the absence of needle and syringe programmes in prison contexts; or the absence of naloxone prescription for outpatient use, either among outreach teams or peers, since it remains exclusive to hospitals and medical emergency services.
Footnote 7. Despite the fact that the vast majority of drug users are non-problematic, services are, with some notable exceptions, mainly focused on opioid substitution treatment partially serving purposes related with public order and on needle and syringe exchange with public health preoccupations underneath , thus configuring the weak version of harm reduction: the one that advocates mainly health rights, as opposed to its strong version , which fully recognizes the right to use drugs [ 33 ].
The implementation of solely uncontroversial measures has allowed the maintenance of the status quo. Despite being humanistic and pragmatic on the ground, political hesitation in this sphere works in compliance with the War on Drugs. In , the Supreme Court of Justice took the position, by judgment n. These quantities are defined by the ordinance Law n. A number of factors contributed to this situation.
In , and contrary to what has happened with drug use, Law n. 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. Footnote 8. Moreover, the Decree-Law n. Differing from what happened with the decriminalization law, no quantitative limit was established for the purpose of distinguishing between the two behaviours.
Law n. However, it does not provide any legal sanctions for those who, as drug users, hold larger amounts. This gave rise to a perturbing possibility: users with less than permitted quantities were sanctioned, even if not criminally; other users, with quantities exceeding those established, would not suffer any sanction, since these sanctions escape the direct provision of the law regarding the difficulty to categorize certain cases, see Domoslawski [ 12 ].
Later, in , the Constitutional Court did not consider the interpretation of the Supreme Court of Justice unconstitutional and validated its position judgment n.
Although not fully binding, judgement n. 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 ].
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 ].
After Fig. Moreover, between and , while convictions for the crime of drug use saw an increase, convictions for drug dealing, including the dealer-user category, registered a decrease [ 27 ]. Convicted individuals for drug use, by type of penalty. 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 Administrative sanctions i.
In , 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 ]. Portuguese drug policy has been, since , under great scrutiny, due to the decriminalization approach.
Yet, it appears that the PDPM has not proven influential enough to emancipate drug use from the stigma that associates it with either crime or pathology, where it is somehow captive. The analysis carried out allows the conclusion that the PDPM is marked by anachronisms, ambiguity and modest ambition - which reveals the remnants of arguments that see drug use through the lenses of transgression, whether in legal or health terms.
These findings lead us to the following final arguments. Since , there has been an increase of criminal sanctions for drug use. A tenacious dilemma - punishment or support? The long-lasting tension between the will to criminalize drug use and comply with United Nations conventions and the aspiration to support drug users has been shown since the very beginning by Portuguese legislation.
That tension appears to be heightened as the enthusiasm of the decriminalization law faded away and its execution has been eroded by time or routine. The reestablishment of the crime of drug use - that recaptures drug use in the criminal scope - had blurred the innovative features of the PDPM, standing out, not only as an example of the ambivalence that marks the history of Portuguese drug policy, but perhaps as its most serious setback, putting drug users at risk of criminal sanctions.
In this sense, it seems that the legislator - keeping, first, the spirit of the decriminalization law and, second, adopting an evidence-based orientation - should return proven cases of drug use to the Commissions, the body under which this behaviour was initially placed, assuring that drug use stays, as originally, an administratively sanctionable misdemeanor, but not a crime.
Adequate and tailored sanctions for these cases, that might foresee an update of the old ordinance Law n.
Notwithstanding the fact that Commissions might constitute the most original feature of the PDPM, the drug use landscape is marked by an ever-increasing heterogeneity of drug use patterns [ 22 ] for which the binary categorization employed, that of dependent and non-dependent users, is inappropriate. These transformations include the progressive substitution of compulsive consumption behaviours that are being replaced by self-care [ 55 ] and the diversification and multiplicity of drug uses [ 56 ], in which non-problematic ones are the vast majority, and in which hedonistic motivations assume a central role [ 57 ].
Furthermore, considering that consent and self-determination are crucial aspects of any intervention in the health realm, we endorse that appearance before the Commissions, instead of being mandatory, should be conditional on the consent of the individual, even if administrative sanctions are still to apply. The decision to undergo any type of diagnosis, clinical evaluation or therapeutic intervention is up to the citizen, within the scope of their rights, freedoms, and guarantees - as is recognized by, for example, the Law of Mental Health.
Were it otherwise, it would create a regime of exception within the scope of the response to drug use. Footnote Thirdly, regarding harm reduction policies, it might be observed that these are somehow still oscillating between the concerns that make justice and health priorities. This mirrors how the notion of drug use as something in the pathological scope is well assimilated by Portuguese society and political affairs.
Controversy and political opposition, and perhaps social reluctance, seem to arise when harm reduction policies go beyond pathology and highlight issues related to the well-being and the agency of the drug user. Good examples of measures which provoke such pushback whose implementation we nevertheless highly recommend include, for instance, the resistance to implementing drug checking services, crucial to assisting informed choices on drug use.
Or the failure to provide naloxone outside medical settings, which, though addressing pathology, would imply transferring powers from the hands of doctors to the hands of the individual. Other recommended programmes in need of implementation include needle and syringe programmes in prison contexts and, in line with the sociocultural transformation of drug use, tailored programmes aimed at poly-drug use, the most common consumption pattern [ 58 ]; and gender-sensitive programs, which are virtually nonexistent.
Following Portuguese sociocultural transformation and the diversification of drug use patterns, observed later in Portugal, but somehow identical to main European trends, drug use is escaping its label as something that unfolds at the margins of society. Besides the focus on the normalization of the use of certain illegal drugs and on recreational uses [ 59 ], research has addressed patterns of use that are defined as functional [ 60 ], non-dependent [ 61 ], religious [ 62 ], healthy [ 63 ], socially-integrated [ 64 ] and non-problematic [ 57 , 65 ].
These data gather momentum to advocate for the need to consolidate the on-going paradigm shift, namely by strengthening the notions of health that are broad enough to consider well-being and not solely pathology, which obviously is a poor concept when it comes to empowering and respecting the dignity of people who use drugs.
As mentioned, such pathologizing serves to undermine the agency and self-determination of people who use drugs [ 37 ]. Yet, the most ambitious challenge is to promote a debate that places the drug use phenomena in the Human Rights realm, thus favouring the respect for the principles of individual freedom and the right to an informed choice.
The interplay between drug phenomena and human rights is far from linear see Bone [ 2 ]. Different perspectives take shape in the debate, from conservative trenches as the right to equal access to health and justice to the right to use drugs for certain purposes - namely ritual-religious ones, these contemplated in the UN Conventions - or simply the right to use drugs [ 66 ].
In line with the United Nation General Assembly Special Session Against Corruption [ 67 ] - which emphasizes a comprehensive approach, but delimits it within the framework of the human rights of health and justice - the debate about the right to use drugs is nearly absent in the Portuguese political, social and academic panorama.
On the contrary, and despite the seemingly innovative character of Portuguese drug policy, there have been numerous hesitations, namely with regard to the regulation of medical cannabis, which was approved by the Portuguese government in Law n. Meanwhile, three proposals one in , two in regarding the regulation of recreational use of cannabis took place in the Portuguese parliament, most of them triggered by civil society organizations, and all unsuccessful.
These hesitations do not match the progressive transformation of drug use patterns, local and global, nor the several challenges, coming from different quadrants, posed to the War on Drug s , within what some call the transformational movement [ 46 ].
Opposition to punitive drug policies keeps growing [ 30 ]. Finally, casting drugs as malevolent agents that allow classifying users as bad or sick or both [ 31 ] became a fabrication that eases the stigmatization of users and human rights violations [ 31 ].
A non-paternalistic mid-term view, that broadens the scope of public health to include, for instance, the right to an informed choice and the right to risk taking behaviour - despite the controversial degree of control that individuals might exert over their bodies [ 33 ] - might offer a possibility.
The opportunity is taking shape. It is expected that the regulation of recreational use of cannabis will be soon brought again to public debate. Attributable, at least partially, to the many anachronisms, ambiguities and hesitations described above and, specially, to the reestablishment of the crime of drug use, the last decade has seen a clear increase of punitiveness targeted at drug users, which is not, we believe, in line with the decriminalization law neither with the set of devices forged and implemented alongside the legislative changes.
Positive results include a reduction in mortality and infections associated with dependent behaviour and, among youth, a reduction in the prevalence of recent cannabis use, a postponement of the age of initiation and an increase in perceptions of related-risks [ 17 ]. Overall, one might observe a reasonably low level of drug use when compared with most European countries [ 19 ], which contrasts to what was witnessed at the end of the last century, a period marked by social and political alarm around drug phenomena.
Consonant, social representations are now quite distinct from those that dominated the country earlier and which understood drug use as a serious social problem [e. Note that the decriminalization law has no impact on incarceration for drug trafficking, since this behavior is regulated by Decree-Law n. These tendencies might indicate either a change in law enforcement priorities, since law enforcement enjoys a certain discretionary power [ 38 ]; different sentencing practices [ 10 , 26 ] or a combination of both.
This decision was contradicted 4 years later, in , when the institute was extinguished and SICAD was established in its place, which meant that the operationalization of interventions in drug behaviours was delegated to the Regional Health Administrations [ 44 ]. This change, based on criteria of efficiency and administrative rationality, reinforced intervention on drugs in the health realm, giving less emphasis to a social and human rights approach.
Spain and Italy show crucial differences when compared to Portugal. In Spain, use or possession for use, when in a public space, constitutes a serious infraction, framed in the Ley de Seguridad Ciudadana i.
This circumstance does not exclude the fact that the normalization of cannabis use is more vigorous in Spain [ 47 ] - where Cannabis Social Clubs were formed - than in Portugal, a trend that has not been followed by political and legal normalization, since the Supreme Court of Justice has sentenced elements of those clubs with prison sentences, even if lightweight [ 38 ]. In Italy, drug use sanctions - of essentially a security nature - fall within the competence of the prefetto [ 48 ].
There are two exceptions to mention: Check-! Exceptions made for one Drug Consumption Room operating since May , and one mobile unit operating since April , both in Lisbon.
In , a Needle and Syringe pilot-project ran in the Portuguese prisons for 6 months, but was not used by a single prisoner, see Sander et al. When a person required to appear before the Commissions fails, in fact, to appear, it is common practice to apply the most minor of sanctions, depending on the substance in question. Towards good governance in drug policy: evidence, stakeholders and politics. Int J Drug Policy. Article PubMed Google Scholar. Bone M. Human rights and drug control.
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Accessed 20 Feb Coelho M. Drugs: the Portuguese fallacy and the absurd medicalization of Europe. Article Google Scholar. Laqueur H. Uses and abuses of drug decriminalization in Portugal.
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