What Scotland can learn from Lisbon's approach to drug addiction

A third is now in progress as plans to set up Scotland’s first remain hamstrung by UK drug laws.

In 2019 there were 72 deaths associated with drugs in Portugal, compared to 1264 in Scotland - the highest in Europe, prompting a £250million treatment plan.

Figures published this week show the number of fatalities has dropped by 20% in the past year - to 1187 - a death rate tha Drugs Policy Minister, Angela Constance admitted is “still far too high”.

Drug policy has been informed by morality rather than by rationality and knowledge

Labour MSP Paul Sweeney has now launched a consultation which aims to overturn the legal barriers that have prevented the Scottish Government from opening a drug consumption facility in Glasgow.

The easiest approach would require the UK Government to update the Misuse of Drugs Act, but Conservative ministers have insisted they have no desire to do so.

“We know drug consumption rooms work,” says Mr Fuertes, who oversees harm reduction policy in Portugal's capital city.

“They reduce overdose deaths by reducing risk and link marginalized people to the health and social care system.

“However, we know that worldwide this is the type of drug service that faces the most opposition. 

“To implement a drug consumption room there is usually a very long and exhausting process and creative legislative solutions in other countries had to be invented to make them possible - pilots, research projects, legal exceptions.

READ MORE: Scotland's drug death toll "still too high" government admits despite 20% reduction 

“So many obstacles to create a formal health service, while in contrast drug use is already happening informally everywhere in the street, toilets, cars, private houses.”

He believes laws should be made more flexible to allow injection facilities to be set up rapidly and as part of other services but believes opposition is largely due to drug policy being influenced by “morality rather than expert knowledge and rational thought".

On July 1, 2001, Portugal became the first country in the world to decriminalise the possession of drugs including heroin.

Within five years the number of deaths from drug overdoses dropped from 400 to 290 annually.

“In a way, the construction of drug policy in Portugal was one of these examples of building a public policy through a new, non judgemental vision”, said Mr Fuertes. 

“Towards the end of the 1990s, the problems had piled up. There was high visibility of heroin use, 58% of new HIV cases per year were due to sharing of syringes or needles, there was a high number of overdose deaths (369, 1999)). petty crime, crowded prisons, unnecessary suffering, hopeless families. 

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“With these problems and a growing public concern, the government of the time asked a renowned scientist, Alexandre Quintanilha, to help design the National Drugs Strategy. 

“He hesitated, he had never worked in this area, but the decision to choose him was intentional. 

“He was someone who was prepared to analyse the situation, to look for solutions, to identify gaps.

“And Portugal didn’t want to replicate what was already being done and wasn’t working. “

Based on his recommendations for harm prevention, treatment and support, Portugal approved a set of legislation in 2000 and 2001 that made the country a world reference point.

Mr Fuertes stresses that it is still not legal to use drugs in Portugal (penalties including fines and community service are still administered) but the approach is to consider severe dependence as a health problem rather than a punishable crime.

Other elements of Portugal’s ground-breaking legislation are less known but have been pivotal in reducing drug deaths he says. Needle exchange service have been in place since 1993 while drug users have access to services where the composition of substances is checked to reduce the risk of harm or overdose.

“The difficulties [in setting up drug consumption rooms] are probably related to the fact that we all live under a prohibitionist paradigm for almost a century already,” he says.

“It becomes very difficult and counterintuitive to convince society that providing a safer space for drug use is not only a matter of public health, that benefits all, but also a human rights approach. 

“No community benefits from leaving part of its population unprotected, marginalised and without access to care. 

“But unfortunately, and not infrequently, drug policy has been more informed by morality than by rationality and knowledge. 

“There is still a long way to go before we accept the use of substances (today considered illegal) and before we accept the right to pleasure and to alter our minds, or even recognize the role of substances in social interactions. 

“We accept all that in the case of alcohol and tobacco, and we understand that regulating them is a protection for those who use them and to the wider society.”

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He said he wouldn’t presume to know what approach would work best in Scotland and cautions against other countries blindly replicating their polices but says there is a "catalogue of tested, feasible solutions" many of which do not require years of complex legal negotiations.

“The problem with models, in the sense of an example to follow or imitate is that they risk becoming static,” he says.

“There are nowadays many signs that it is necessary to readjust the Portuguese model to new profiles - to those who have grown older and also to those who started using drugs in the 21st century. 

"We read about what is happening in Scotland, but in the end, it’s the people who use drugs and the professionals who will know best what works. 

“Treatment, social support and harm reduction respond to different people, or to the same person at different times. 

“Alone, none of those services is a silver bullet, in fact it is the set of diverse solutions combined that works. 

“It is better to have small, different services than a big one that is not needed, or that takes many, many years and resources to be implemented.

He added: “If we listen to what people have to say and respect their rights and experience, services will be useful and relevant, the impact of drugs will be minimised, creating a better situation for everyone. 

“Nothing is simple, but it may be simpler than it seems.”