Welcome back guys to another episode of Untold Perspectives, where we explore topics that are not really spoken about. Today our topic is the war on drugs and the different approaches that countries have taken on the war of drugs. We see how things have panned out in countries like North America,
where it’s like an actual war and what’s interesting to us is how countries in Europe, such as Portugal, have attacked the war on drugs.
So today I have with me Ms. Alcina Correia, who is currently the director of Monitoring and Information Services at the Directorate for Intervention and Addictive Behaviours and Dependencies. So I appreciate you coming out and talking to us today Ms. Alcina. How are you? Can you please tell us a little bit about yourself?
Hi everybody. Thank you very much for the invitation for inviting us and for the interest in Portugal drug policy. I’m very happy to be here. I am Alcina Correia, I am 56 years old, I have three children, and I’ve always worked in the addiction field. I started working when I was still in college in 1988 and I started the first public treatment center on the behalf of Health Ministry, which opened the previous year. So since then I’ve assumed coordination and management responsibilities in prevention, primary prevention, social reintegration, victim realization, information communication and training. Currently, I’m the director of monitoring and information department at SICAD which SICAD is the service desk of intervention of addictive behaviors and dependencies ? and have responsibilities that the international information system on drugs, alcohol and other addictive behaviors, research, communication and training. These departments where I currently am the director wants to contribute to a better Addictive Behaviors Literacy of decision makers technicians and citizens.
So how exactly did SICAD come about? What was the Genesis of SICAD?
SICAD is the general directorate for intervention on addictive behaviors and dependencies. It is attached to the Ministry of Health and has the mission to promote the reduction in the use of psychoactive substances, the prevention of addictive behaviors and a reduction in the dependencies. We also have the national focal point of EMCDDA that’s the European Monitoring Centre for Drugs and Drug Addiction, and we also are directly responsible for the implementation of the national plan that includes all the public sectors with responsibilities in the area of drug fields.
We plan, we implement, we coordinate drug demand interventions and at the same time we collect, analyze and disseminate information on drug use and the responses that there are in the field. So we have very actualized information of the situation, the national situation in concerns to the use and abuse of drugs in the supply area or demand area. To tell you how decriminalization came about we have to go back to 1998 more than 20 years ago when the Portuguese government created a commission that had the task to bring out sustainable protection, orientations and the national strategy on drugs and drug addiction and that’s what this commission did.
Of course, by the time we had a lot of work done and many studies have been carried out and they identify what it was needed. But there were strategic work guidelines that were very important, and they still are nowadays. So this commission that builds the national strategy was composed by experts from demand and supply reductions, judges, medical doctors, psychologists, etc. They are in scientific communities from different disciplines. They have drug addiction professionals in the area, some of them with responsibilities, others just making his work ban religious community that had a really important task and by that time, to answer the needs of these people, and also NGOs that were our main stakeholder and still are.
So this commission they did a lot of auditions and public sessions with hundreds of participants, citizens and they heard them and they try to discuss what was their needs and thus our Portuguese model was born and decriminalization got shaped. Of course we had by that time a lot of public service and specialized treatment public networks that in so it was easier to implement the decriminalization regime.
So how are users being dissuaded from using illegal substances?
By that time at the end of the 90s we had a huge problem, a huge heroin problem. We had one of the highest prevalence of problematic drug use at European level among all social groups. It was a very democratic problem, you have [inaudible] of everyone. So we have the perception by the time that each family had someone with heroin addiction. So it was really really the first concern and priority of the decision makers by the time it was like a health problem and a security problem.
So by the time our priority was to bring up the health services to problematic drug users that were using drugs in the streets, and committing crimes to get money to buy drugs and it was really concerning and frightening. All of the communities were really frightened with the situation. So it was like a drastic decision to decriminalize the use and abuse of illicit drugs. Actually, at first, the police authorities were a little very skeptical, and mistrustful about the change but after and nowadays they work together with the service that implement the law, and they developed an integrated approach, namely among young people. This integrated approach has linked the health services and the police authorities has been proven to be successful at helping individuals and communities. For sure decriminalisation has brought currents in facing people who use drugs that are not criminals, what they need is they have a health issue, a social problem and they need support and health care. So, decriminalisation doesn’t mean liberalisation or legalization, drugs, the use of drugs is still forbidden in Portugal.
But it is not a crime, but it is not a crime to use drugs. It is an administrative offense, it is a health issue. It is not sentenced with imprisoned penalties as in some countries in Europe still are, but with measures and penalties which we propose is the dissuasion of the use and abuse. I don’t know if you know but for heroin use the law considers quantities up to the unit of 10 days of [inaudible] individual use. So, seeking for healthcare and information about self practice seems to be a problem for problematic drug users and their families. So we look at a drug addict as a sick person and he doesn’t need to go to prison because he’s using.
That’s a very interesting take on the idea of drug users as being sick, as opposed to them being criminals. I know you mentioned that there was a little bit of apprehension from the police for initially, so how did Portugal obtain full cooperation from all agencies to actually promote this program and actually get it to work?
Actually, the decriminalisation created a legal framework for implementing the policies to reduce the use of drugs. The harm caused by drug consumption and to socially reintegrate drug dependent persons. So it translates more and more effective and quick intervention among the offenders. They’re still offenders because it’s still forbidden but if they were in the criminalized system, they will get lost and forgetten in waiting to having slow criminal proceedings and previous register record.
So actually, we managed to have an integrated approach and that’s, that’s what we think functioned and brought good results. So this, this framework, the decriminalisation have brought currents for implementing policies, as I’ve mentioned, reinforced public at the same time that criminalization was implemented. We reinforced public treatment reintegration network, that is the grounding of the decriminalization as well as the Harm and Risk Reduction Network.
Since 2001, the Harm and Risk Reduction programs and socio sanitary structures are ruled by a legal framework based on humanism and human rights, pragmatism and public health. Oh, and this comprehensive law regulates the general framework of prevention and harm reduction policies and responses that include needle and syringe exchange programs, low threshold substitution programs, drop-in centers and shelters, contact units and outreach teams has been consolidated throughout the country in critical zones of intensive drug use. So even the supervised drug consumption programs that were designed in 2001 and they only now two years ago, they start being implemented in Lisbon. So for this, we really need to work together because this is a problem that concerns a lot of areas, a lot of specialized support to these people. They need support at a social level and health level, employment, training and family. So we really are an integrated answer, with all the service connected with us in a network that really works and works also with the police authorities that are also a very important stakeholder in the implementation of this of law of the strategy of 1999.
I know you mentioned the framework that has really helped and jumpstart the good work that you guys have been doing in Portugal. So currently, what is the state of drug use in Portugal today? We’ve come from 1999 to 2022, so what kind of patterns are you seeing with drugs use currently in Portugal?
Most of the studies and data indicates that there is no significant increase in the use of drugs since 2001. We do a lot of studies, general population and specific studies, and the all of them talk about stabilized or sometimes a decrease, sometimes it will slightly increase, but nothing really serious about the use of illicit drugs. Maybe I can say that what we have nowadays, a concern, it’s a more intense use of cannabis among young people. We don’t have more people using cannabis but the ones that are using cannabis they do it more [intensively]. And that’s a concern that of course, this decriminalization law has to approach and has been doing really good work with police authorities, analyzing young cannabis users, young people that are using cannabis in the public places to the services that are the commissions for the [inaudible] of drug addictions that are the services that were created to implement the law and they have a multidisciplinary team that make the assessment of severe use from the guys, from the users and also make an intervention among them, a health intervention most of the time.
So just for you to have an idea of the previous years. So an inversion of the first time treatment demand, the majority of the treatment demand are now because of cannabis problems then cocaine and just in the end, heroin came as a problem for the first time demand. Comparing to the 90s, 98% of the first demand for treatment were because of heroin. So it is really, really decreasing the use of heroin in Portugal. Some like a decade ago or since 2001. This law could also bring to the health system and to specialized services heroin users.
So we we had a large increase of the treatment demand because of heroin by the beginning of 2000. We also can say that we assist a decrease of HIV and infectious disease reflecting as a result of the policies and strategy implemented in the area, particularly the risk and harm reduction programs, opiates substitution programs, syringe exchange programs, etc. So, also the deaths in 2000. Now we have a little increase of death, but we think it’s because of the high purity of the product that is circulating but data from 2018, we have 49 deaths from overdose, as direct cause of death, but that sucks. There are 49 persons, but we also could with these policies, at least we think they contribute for that, having less death among heroin users. So of course, as I was saying, we do not presume a direct link between the results achieved and the decriminalisation only by itself. Of course, all the policies together helps to achieve these, these results. That’s, that’s our thoughts.
And in my opinion, it would be a win if the majority of users stop using heroin and move to cannabis. Do you guys see that as a win? Or do you guys still view cannabis as a dangerous problem that that needs to be solved?
Of course we will think that using cannabis can be less dangerous than using heroin. But we also think that the problem is the relation that the person established with the product, not the product itself. So for us because of course we are very happy because heroin users are less than they were but we are now concerned with cannabis users because cannabis also very dangerous. The THC, tetrahydrocannabinol, is very high in the products that are with the police that police catch in the streets and they are [causing] also a lot of psychosis and a lot of mental health problems among people that are using cannabis and that’s a concern.
But with the decriminalization law, we will also have the opportunity to be in contact with more people that are using cannabis and atleast alert them – they can know if they have a problem or not. Because if maybe you can use cannabis and you don’t have a problem and I use cannabis the same amount as you and I can have a problem because I have other issues and I have another context of life etc, etc. And so we try to assess these kinds of things and that’s the the network that we’re built because of the decriminalisation law that allows use to do these interventions.
It’s super interesting to me how you guys actually factor in the life of the user to understand like what they are going through as a person to what leads them to actually using drugs and I think that is that is super important in understanding why people turn to drugs, or why people decide to use drugs. So one thing I want to know, what are the views in Portugal in terms of medical marijuana use? I know you said that the use of cannabis and marijuana products is illegal in Portugal, but do you guys have anything where people are allowed to use it for medical reasons like you know there’s medical cannabis for different things, is that something that happens in Portugal, or no?
Yes, it happens. There is medical use and we don’t have nothing to oppose of that because it’s a medical issue and if the doctor says that person needs to have that? Of course. We don’t have anything to oppose of that situation, it’s two different questions, issues. It’s two different issues we, we don’t even have in our responsibilities the medical cannabis. That’s not under our responsibilities as a public service. It’s another service from the Health that has this monitoring.
From viewing the results in Portugal, other countries may have taken notice and probably try to emulate what you guys have done or try to copy certain things. Have you seen or heard of any other European country that have adopted something similar or maybe reached out to you guys for help on their drug problem?
Yeah, we have some countries that study our case and some adopt some of our practice[s], but the our model is, is unique. No other country in the world do it as we do because they have other realities and they have other principles and Portugal is not lobbying other countries to follow our steps and we do not advocate these changes as an exportable best practice, you know? We believe that drug policies and the strategy options must be shaped based on human rights and humanism and that’s what we fight for when we are in, in other countries because there are some countries in Europe that still criminalize the use of drugs and we are not okay with that.
I think that our model has a profound respect for a person’s dignity, but also we are very pragmatic in our policies. We believe that there are people that will never be able to stop using drugs and they are going to use drugs for the rest of their lives or they will stop when they want or feel they can do it. And of course we have, as a public service, to be there for them and to help them to have even though they are still using drugs, cannabis, heroin, whatever, we must help them to have a better use and better health and that’s our mission.
So, our policies still call the attention of other countries and the last 20 years we have been visited by many other countries and we have been invited for hundreds of conferences abroad and, of course, we wish that somehow we help colleagues and decision makers from other latitudes to have at least a human rights and a humanist approach. So we’ve defined our public policies in this field putting the citizen in the center of the intervention based on the assumption that is, it is fundamental to respond to the needs of the individuals as early as possible. So, that’s our point.
It’s very interesting to see and I think now in certain communities, people are starting to realize how much of this is more of a social issue than a criminal one, right? If you look at the history of drugs, drugs have caused so much problems over the years that sometimes it’s hard for certain decision makers to really sit and say, “hey, well, let’s you know, let’s not treat this as a criminal case” when you look at the history of what has happened. But, it’s super enlightening and refreshing to see a country take a super, like, positive and humanistic approach. And when actually looking at the root causes of addiction, I appreciate your work and I’m super, super appreciative of you taking the time to talk to us this morning. Sometime in the future I definitely want to visit Portugal and actually see for myself the the entire process and how you guys were.
Of course, you’re very welcome, whenever you want. It was a pleasure for me to be here and have the opportunity to tell you a little bit about what we do here in our little country.
Transcribed by https://otter.ai