Portugal: Challenges of A Model Country with Harm Reduction

February 5, 2013

The availability of syringes through the Portuguese National Program for Needle Exchange was temporarily at risk, despite the country’s reputation for having one of the most progressive European drug policies.

The Portuguese national organisation (National Association of Pharmacies) responsible for managing the Needle and Syringe Program (NSP) in Portugal informed the Government of their decision to abandon the program launched in 1993 to prevent HIV/AIDS. The contract between the Portuguese Government and the agency expired on the 27th of November, and they intimated that they were no longer able to comply with the protocol, leaving the Ministry of Health responsible for finding a solution to the needle supply crisis. The agency informed the government of its decision earlier in August 2012, but the news did not appear in the Portuguese media until November.

The National Association of Pharmacies, relying on its leftover stocks, informed the ministry that it would maintain the needle exchange program for drug users until December 2012, leaving time for the government to find another partner to continue the project.

The National Needle Exchange Program (called “Say No to a Second Hand Syringe”) was introduced in 1993 and managed the delivery of drug use paraphernalia and condoms to outreach harm reduction teams through pharmacies enrolled in the program. According to the National Coordination for HIV and a study made about its efficacy, it was estimated that, over the first 8 years of the program (between 1993 and 2001), 7,000 new HIV infections were avoided, among 10,000 injecting drug users. With this low cost health promotion solution, the Portuguese saved an estimated 400 million euros in the same period.

The solution found was to move the program management to a governmental agency, the General Health Directorate, through the National HIV/AIDS Infection Program.

The exchange sites will run in Health Centers across the country but it will also be possible to maintain informal partnerships with NGOs, local governments and even with pharmacies that wish to continue the program. According to the General Health Directorate, resources available for the NSPs are expected to increase.

Even though the question of continuity of the NSPs has been resolved, other questions remain which cannot be ignored. 

Running the NSPs in the Health Centers means that the staff involved in it are not trained to intervene with this target population. Therefore it is crucial to give specialized training to the Health Centers’ staff on lower risk substance use practices. APDES and the National Civil Society Forum for HIV/AIDS have offered to participate in this training process, but there has been no response yet. Besides this, an important step would be to form a group including drug users and NGOs, to do the program’s follow-up and updating.

Another issue relates to the fact that such alterations to a program which has been running unchanged for so many years, create an urgent need to disseminate information about the new exchange sites.

About 72 percent of the NSP is delivered by the harm reduction services of NGOs (source: Annual Report of the Program - "Say No Say No to a Second Hand Syringe". 2010), and therefore it is important to think about their situation. Adequate state support is particularly critical in Portugal, because these organizations are overwhelmingly state-funded. Meanwhile in the last two years (as has been regularly reported on the EDPI website) these outreach projects have been struggling to survive, because of two main problems: late and irregular payments from the State and great uncertainty about their future existence, in view of the fact that the Government's main political guidelines regarding harm reduction have not been publicised.

Nevertheless, a positive sign was sent recently: outreach projects which were to be evaluated up to the end of last year - and which did not know if it would still be possible to apply for renewed State contracts – were promised funding until the end of last year. Also, at the beginning of this year funding arrangements for harm reduction projects were settled in respect of some of the regions in the North of Portugal.

Even though it is still not known what will happen next, the government representatives insist that harm reduction services are important and that there is a strong will to continue them.

APDES (a Portuguese harm reduction service provider NGO) and R3 (the national Harm Reduction Network) are continuing their efforts to keep up the dialogue with the Government and with representatives of each parliamentary party in order to advocate for the preservation of the comprehensive Portuguese Drug policy and harm reduction interventions. In September 2012, APDES (also representing R3) attended two meetings of two different parliamentary working groups attached to the Parliamentary Health Commission: one responsible for discussing issues related to addictions, and another linked to problems of HIV infections. Those sessions were very productive and concluded with a proposal from the present deputies themselves emphasising the importance of the work, together with an interparty commitment to promote and protect harm reduction services in the country.