João Goulão, MD. EVIDENCE-BASED POLICIES 21 April April João Goulão

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1 INTER-AMERICAN DRUG ABUSE CONTROL COMMISSION C I C A D Secretariat for Multidimensional Security DRUGS SUMMIT EUROPEAN, LATIN AMERICAN AND CARIBBEAN MAYORS AND CITIES April 21 23, 2010 Lugo, Spain OEA/Ser.L/XIV.4.1 CICAD/DREU-LAC/doc.11/10 5 May 2010 Original: English 21 April 2010, MD Portuguese National Drugs Coordinator Chairman of the Management Board of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) 21 April 2010, MD Portuguese National Drugs Coordinator Chairman of the Management Board of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)

2 Reliable data is essential to the success of drug control efforts Allow the assessment both of the nature of the problem and of the impact of policies and actions 3 key player in promoting the implementation of standards and guidelines in collecting, analysing and disseminating drug-related information and data 4

3 Timely, objective and reliable information on the drugs situation Ensure that drug related policies and programmes are fully knowledge and evidence-based 5 National Information System Ministry of Economy, Innovation and Development Ministry of Finance and Public Administration Ministry of Education Ministry for Environment and SpatialPlanning IDT National Annual Report on the Situation of Drugs and Drug Addiction Ministry of Health Ministry of Foreign Affairs Ministry of Justice Ministry of Home Affairs Ministry of Labour and Social Solidarity Ministry of NationalDefence 6

4 Institute on Drugs and Drug Addiction (IDT) The IDT is the national governmental agency responsible for the coordination policy in the field of illicit drugs and alcohol. The IDT is a public Institute exercising his activity under the tutelage of the Minister of Health. 7 Mission of IDT promote the reduction of the use of licit and illicit substances and the decrease of addictions 8

5 Main areas of IDT: Prevention Treatment Harm Reduction Rehabilitation Scientific Research Training International Relations 9 The history of Drug Use/Abuse in Portugal can be summarised as follows: It began much latter than in the other Western European Countries; It happened with relevance only after the Portuguese Democratic Revolution (1974), when society was facing lots of deep and accelerated changes; It developed very fast, and society was not able to answer in the right time and to face the new needs created by drug use; as a consequence, there was a gap between the appearance of the needs and the answers.

6 As a consequence of that developmental pattern: Drug use spread under European average level, But a considerable number of problematic drug users appeared and, during a long period of time, had no access to treatment. By the end of the 20th Century, Portugal had one of the highest prevalence of Problematic Drug Use, at European Level. At the same time the social burden, associated to drug use, was very relevant top political concern The complexity of the situation called for some measures expected to reverse that cycle Society was mobilised to pay attention and analyse all the components of the phenomenon and: A new National Strategy was built (1999). A new Legal Framework appeared (Law 30/2000). A new institutional structure appeared to implement and coordinate an Integrated Approach to all the areas related to Drugs and Drug Use/Abuse.

7 1999 1st National Strategy on Drugs Evaluation of the National Strategy on Drugs through the Action Plan 2000/2004 New National Plan on Drugs : 2012: - Action Plan (evaluation( concluded) - Action Plan (to be approved) 13 Principles of the National Plan on Drugs CENTRALITY ON THE CITIZEN TERRITORIALITY INTEGRATED APPROACHES QUALITY IMPROVEMENT AND CERTIFICATION 14

8 Struture of the National Plan on Drugs POLICY FIELDS: DEMAND REDUCTION SUPPLY REDUCTION 4 CROSS-CUTTING THEMES: Coordination International Cooperation Information, research, evaluation and training Legal framework 15 Legal framework on drugs before 2001 Within the criminalization framework: Imprisonment or fee imposed didn t foster drug use decrease Imprisonment of first time offenders or occasional consumers could produce counter productive effects Sanitary protection was not being addressed => Consumption s criminalization policy did not foster drug demand decrease 16

9 Legal framework on drugs before 2001 Within the criminalization framework: Drug consumers feared going to public ambulatory clinics out of being referred to the judicial system Public ambulatory clinic professionals: ambiguity status as patients had to be referred to the judicial system Syringe exchange??? Very few people were imprisoned for drug consumption 17 Demand Reduction Prevention Treatment Dissuasion Harm Reduction Reinsertion 18

10 Decriminalization: It is different from liberalisation; The consumption and possession for own use of illicit substances is no longer a crime but constitute an administrative offence; The scope of the concept of acquisition and possession for personal use is limited to the quantity necessary for average individual use during a ten day period; 19 Decriminalization: It is still considered a crime to grow drugs for personal use; There is no distinction between occasional and regular use, neither between substances, except for the choice of the sanction to be applied; Distinction is made between drug addicts and non drug addicts for the effects of punishment of conduct (fines will never be applied to drug addicts). 20

11 Ten Days Maximum Amount Allowed Illicit Substance Chart Illicit Substance Grams Heroin 1 Methadone 1 Morphine 2 Opium 10 Cocaine (hydrochloride) 2 Cocaine (methyl ester benzoilegonine) 0.3 Cannabis (leaves and flowers or fruited dons) Cannabis (resin) 5 25 Cannabis (oil) 2.5 LSD µg 0.1 MDMA 1 Amphetamine 1 21 Decriminalization in short Drug consumption: not a private choice, because of its social and sanitary effects Drug addiction: a disease Drug addict: a patient The dissuasion intervention: Opportunity for early, specific and integrated interface with consumers Aimed and targeted to the consumers characteristics and individual needs 22

12 Decriminalization challenges: A new destination for drug tourism? Compliance with the UN Conventions? Drug use increase in younger groups? Positive references in: April 2004 International Narcotics Control Board Mission to Portugal World Drug Report 2009 The Cato Institute Greenwald Report The 2009 EMCDDA Annual Report 23 Dissuasion Process When using or in possession of less that an average of ten days use of illicit substances (drugs) Police, Courts and Prisons refers users to DADC Motivation steps in view of treatment and drug use halt Sanctions imposed: District Authority surveys fees and other sanctions fulfillment Treatment accepted: process suspended DADC makes the indicter s psychological and social evaluation Audits indicters Writes a decision Decision is based on previous records, one s own abuse situation or psychosocial situation. 24

Treatment Demand Evidence Patients 40.000 35.000 30.000 25.000 20.000 15.000 10.000 5.

13 Treatment Demand Evidence Patients Total Utentes Utentes em Primeiras Consultas Consultas de Seguimento Total Patients 1st Appointments Follow up Appointments Ambulatory Source: Annual Report 2008, IDT, I.P., New Patients by Main Drug Type in Public Ambulatory * 2004* % 50% 62% 64% 60% 51% % * 2004* % 7% 20 8% 8% 12% 11% % 25% 15% 12% 10% 12% 24% 25% 15% 12% 10% 12% 10% 12% 11% 11% 11% 11% 0 Heroína+Cocaína Heroína Cocaína Cannabis * Heroin and Heroin & Cocaine categories are not directly comparable with following years categories. Source: IDT, I. P.: DR / DMFRI NE 26

14 AIDS/HIV Notifications %: Drug Addicts and Non Drug Addicts, per Year of Diagnosis, % In 2005, HIV infection was included in the mandatory diseases notification list. ** The possibilityof ongoing updates due to previous years diagnosis late notifications make this data provisional * ** % Toxicodependentes VIH % Toxicodependentes SIDA % Não Toxicodependentes VIH % Não Toxicodependentes SIDA INSA, I. P.: CVEDT, (2008/03/31) / IDT, I. P.: DMFRI-NE 27 PORTUGAL 2001/2007 General Population (15-64 years) % LIFETIME PREVALENCE (Any Ilicit Drug) ,6 17,4 15,4 12,4 12, , , , ,1 Source: Balsa, C. - INPP 28

15 PORTUGAL 2001/2007 General Population (15-64 years) % 25 LIFETIME PREVALENCE (any ilicit drug) 22, ,4 15,4 10, , Source: Balsa, C. - INPP Dissuasion Data: 7364 new processes in individuals present to a Dissuasion Commission for the first time in evaluation by the Dissuasion Commission -783 drug addicts 84,4% were referred to treatment non drug addicts (occasional users) 65, 6% evaluated as not being in a risk situation 34, 4% referred to specific support (motivational diligences) 30

16 Processes Type of Drug Involved in Administrative Offences by Year* Total Heroin Cocaine Cannabis Polydrugs * Data collected at31st Marchof the following year of the occurences IDT, I. P 31 CONCLUSIONS: There is a coherent articulation among ALL THE PORTUGUESE POLICY AND ACTIONS based on the idea that a DRUG ADDICT is a SICK PERSON with treatment needs instead of being addressed as a CRIMINAL or a DELIQUENT. Until now, the global drug situation in Portugal, seems to have a positive evolution in all the available indicators. 32

17 Institute on Drugs and Drug Addiction (IDT) Praça de Alvalade, nº 7 5th to 13th Lisboa Phone:

DRUG COURTS Study Day in Brussels 23 October 2015

DRUG COURTS Study Day in Brussels 23 October 2015 The Portuguese Experience João Goulão General-Director for Intervention on Addictive Behaviors and Dependencies National Coordinator on Drugs, Drug Addiction