Portugal is praised for its decriminalisation model but austerity measures often undermine the well-being of people who use drugs and thus, endanger the whole system. Ximene Rego from the research team of our Portuguese partner, APDES assessed the situation.
It has been widely acknowledged that Harm Reduction (HR) services were affected by the austerity policies implemented in the face of the new socioeconomic state of affairs that followed the financial crisis in Southern Europe, in 2008. APDES was at Nicósia, Chipre, for the conference “Treatment and Harm Reduction Services in the Context of the Economic Crisis”, organised by Diogenis – Drug Policy Dialogue, which shed light on some of the challenges faced by the Portuguese HR services.
Several stakeholders – people who use drugs (PWUD), professionals from different backgrounds, NGO representatives, and researchers – with privileged roles in the Portuguese drug phenomenon participated in the inquiry developed by APDES’ Research Department – which is summarised and disseminated henceforward.
One of the main drawbacks outlined concerns the absence or weakening of specific services to PWUD, which have reflected mostly on their well-being. The main flaw was associated with the inconsistent funding to support HR interventions – austerity translated into the field by several delays registered in the publishing of decrees that approved funding regulations – and the reversal in the tendency to invest in outreach teams and community programs, causing direct consequences for the outreach teams – namely their elimination or poor and inadequate working conditions.
The outreach interventions have always been considered the most effective action among vulnerable populations. Outreach teams are the main link to traditional state structures and (many times) the only ones who can reach territories other services aren’t able to reach. If the working conditions of outreach services are worsening vulnerable groups have less access to basic healthcare, social, and psychological support. The funding of these services is not only inadequate but it requires applications every two years, despite the fact that NGOs are permanent service providers. The NGOs’ attempts to guarantee minimum services has, in turn, deeply compromised their financial sustainability. Moreover, it is said, one of the main and most serious consequences is the risk of “ending the idea that the drug use phenomenon should be managed through an ‘integrated and flexible entity/body’”.
This circumstance has been particularly striking, not only in terms of access to medicines and healthcare, social, and civil services, but also concerning the discontinuity and undermining of opioid substitution therapies, needle exchange programs, liaison between HR and formal healthcare, social and citizenship services; the disappearance of networks and partnerships was also one of the consequences. In addition, the processes of social support/action became more bureaucratised. Taking into account the target-groups’ difficult access and adherence to treatment and low willingness to attend medical appointments, the budget cuts allowed relevant drop outs of services and programs, loss of social support, lack of other therapies, and significant setbacks in terms of risky behaviours prevention – namely concerning use patterns and sharing of paraphernalia.
As stated by one participant, the “civil society organisations had a vital role during this period when the State gave up on its responsibilities” by counteracting the impact of the austerity policies in PWUD lives. Professionals and peer educators have described how the “cushion effect” (the retreat of the welfare state is mitigated by harm reduction NGOs) was operationalised throughout the continuity of services, despite the lack of funding: the advocacy and representation of PWUD and their interests among the authorities; the support in the purchase of medicines, many times resorting to personal financial resources; volunteer work; presentation of proposals and commitment of all agents involved, in order to address the absence of funding to HR teams.
Admitting that Harm Reduction is one of the key elements of the Portuguese Drug Decriminalisation Model, it is vital to recover it in a broader and more complete way; hence, the participants mentioned the need to consolidate the on-going paradigm shift – from a public order and justice question, to a public health and healthcare question – highlighting that this change could be more ambitious if drug use became a human rights question, privileging individual and informed decisions.
The main issue left is its effective implementation; the execution of the Portuguese Model ought to be coherent and meet its conceptualisation. It is vital to assume that the benefits of this paradigm are not solely associated with the decriminalisation law itself, but with the existence of a set of integrated measures that should be perceived as equally important.
Ximene Rego, APDES Research Department, Portugal