Paulo picks up a lighter from the table in front of him, holds it beneath the foil-encased bowl of his thin metal pipe for a few seconds, and then inhales. For a brief moment, he falls silent, head slumped forward. Then the 47-year-old is back to his usual chatty self, conversing with the seven other drug addicts who, like him, are making the most of their 30-minute slot at Porto’s new “shoot-up” centre. “It beats getting stoned on the street, where, you know, anyone can come along, kids or whatever,” he says. “Here, we can just do our thing and no one hassles us.”
Lack of interference is not the only reason that Paulo and 400 or so other regulars visit the centre. The government-funded service also provides them with clean needles, strips of aluminium foil, and other materials to facilitate their drug-taking and prevent infections.
The overarching ethos of the centre revolves around harm prevention. A list of rules by the entrance contains no strict injunctions; it simply invites users to be courteous and preferably not leave litter on the floor. Even the free sachets of citric acid, which addicts use to dissolve heroin or crack cocaine for injection, come with a health warning on the packaging: “Can damage the veins if used in excess.”
Housed in a nondescript portable cabin in Pasteleira, a low-income neighbourhood of Porto, the centre, which opened in August 2022, serves as a highly visible flagship of Portugal’s long-standing policy of drug decriminalisation. The scene is far from salubrious. Set beside the road on a patch of scrub, the temporary facility faces out to featureless blocks of social housing. Behind is a small encampment of makeshift tents – home to some of the centre’s users, 75% of whom are unhoused. Just up the hill, smartly dressed pupils file through the gates of the elite Lycée Français.
Yet the centre offers a rare ray of hope in the scourge of drug addiction, locally and perhaps globally. First, its target users are alive and, if not exactly well, then at least using safely. Three decades ago, it was a different story. Heroin addiction in Portugal affected an estimated one in every 100 adults, and death by overdose or drug-related disease was commonplace.
Second, most of the centre’s users still enjoy their liberty. Again, rewind a few decades and the situation looked very different. At the end of the 1990s, the number of people behind bars for drug-related offences stood at 3,863. In 2017, that figure had dropped by more than two-thirds.
Both facts link back to a radical piece of legislation passed by the Portuguese government in 1999. Motivated by a widespread belief that the war on drugs was failing, the country’s lawmakers agreed to decriminalise the acquisition, possession and private use of small amounts of drugs. Law 30/2000 applied to all narcotic and psychotropic drugs at the time, from marijuana and amphetamines through to class A drugs such as LSD and heroin, explains Dr João Goulão, a drug treatment specialist and one of the policy’s architects. While reflective of a “spirit of humanism”, the policy was also highly pragmatic, says Goulão. “All along, our national strategy has … tended towards the idea that it is better to treat them than to criminalise them.”
At the time, the Portuguese public was overwhelmingly in favour of the measure; foreign legislators and drug enforcement agencies predicted it would unleash a tide of fresh drug use and criminality. Yet Law 30/2000 is far from an “anything goes” measure, its supporters insist. The trafficking of drugs (except for marijuana, which was legalised for sale in 2018) remains a criminal offence in Portugal.
The ability to consume drugs but not buy them sounds like legal chicanery, but Portugal’s progressive drug policy has successfully rested on this technical ambiguity for more than two decades. Police resources are directed to stamping out the supply of drugs, while public health services are committed to providing addicts with therapeutic care. The theory is relatively simple: better that drug users have a place within the health system, rather than being shunted to the margins and left to their fate, as they were before.
It is this thinking that has kept the psychologist Diana Castro and her colleagues turning up to Porto’s shoot-up centre (known formally as the Centre for Assisted Consumption). “Our end goal, of course, is to eventually help them get back on their feet and reintegrate them … but this is not primarily a service to get people to stop taking drugs; it’s to provide them with healthcare,” says Castro, who serves as the centre’s coordinator.
To that end, the centre has two nurses permanently in attendance: one for those who prefer to smoke their drugs; the other for those who choose to inject them. A psychosocial specialist is also on hand to welcome users as they arrive and provide a listening ear.
Two sparsely furnished rooms at one end of the cabin are set aside for consuming drugs, which the users procure by their own means. Both rooms have space for half-a-dozen or so people, with half-hour slots designated on a first-come, first-served basis. Opening hours run from 10am to 7pm, bar an hour over lunch when the doors close. Some users come and then leave, but, with average use rates at eight hits a day, many mill around until the next slot becomes available. The facility has a small toilet and a basic shower room where people can get a wash as they wait. In a spartan kitchen, plastic thimbles of strong black coffee are available, as are donated pastries and other sweet snacks, while stocks last.
At the other end of the cabin is a consulting room where visiting doctors from two local hospitals offer checkups twice a week. In addition to basic health appraisals, the medics conduct blood tests for infectious diseases such as HIV and hepatitis C. “Many of these people live very complicated lives, so most wouldn’t typically go to hospital, for example, or use a conventional health centre. That’s why it’s important for us to adapt a little,” says Castro.
Since its inauguration, Porto’s centre has clocked up 63,000 visits from more than 2,000 drug users – the vast majority of whom use either crack cocaine or heroin. Only two overdoses have occurred, both of which were treated successfully on the spot. Castro also points to the 1,500 or so screenings undertaken, and the 89 individuals now receiving treatment for hepatitis C as a consequence. About 10 people have also entered detox programmes of their own volition.
Drug-taking is not without its sanctions. All those caught by the police with class A drugs are required to attend a government-run “integrated response” clinic, where their use levels are assessed and a treatment programme proposed. These clinics house psychotherapists, psychiatrists, social workers, pharmacologists and primary healthcare specialists, explains Dr Severiano Pinto, a psychologist at one of three such facilities in the Porto district. “The problem of drug addiction has a lot of variables – individual, familial, social and so on. So we find it’s better to work with a collection of professionals to try and address the problem,” he says. “Normally, they want to stop taking narcotics when they first come in, but it’s a long process. It’s not something we can resolve in just a couple of weeks or even months.”
Ana Paula is a case in point. A long-term sex worker, the 59-year-old Porto resident got hooked on heroin through a boyfriend who later died of an overdose. When she was referred to a clinic 23 years ago, she weighed less than 40kg (6st 4lb). After being prescribed methadone, she quit injecting heroin and shifted to smoking crack cocaine in lower doses. Six months ago, she was diagnosed with ovarian cancer, which prompted her to go clean entirely. Despite breaking her crack habit, Ana Paula continues with a 5ml prescription of methadone. “I’m part of the furniture in this place,” she says, of the clinic. “But, I tell you, if it weren’t for the help I’ve received here, I’d have died years ago.”
In extreme cases, hospitalisation is also an option. Specialist units exist within the Portuguese public health system for addicts who are pregnant, suffering from some form of psychosis, or are otherwise judged to be at dangerous risk to themselves or others.
Likewise, had Ana Paula decided to go cold turkey, there are government-run centres where addicts are supported to abstain from their habit. Most programmes run for a week to 10 days. They might then choose to join a longer-term residential programme where, over the course of three months to a year, they receive support to help them “reinsert” back into society.
Many credit decriminalisation with introducing a more liberal attitude towards drug-taking in Portugal. Shops selling cannabis CBD products are now commonplace in large cities, such as Lisbon and Porto, although THC – the psychoactive ingredient of cannabis – remains illegal for retail. Similarly, the use of psychedelics such as LSD, ecstasy and ketamine is now largely normalised in recreational settings such as bars and nightclubs. The health authorities even set up pill-testing facilities at major festivals and music gigs to guard against bad batches.
Portugal’s decriminalisation policy has faced criticisms, though. According to the most recent government figures, 75% of Portuguese residents perceive drug use as a problem in their community. Although drug use by the general population has crept up since 2001, from 7.8% to 12.8%, consumption rates for most drug types are far below the European average. Portugal now ranks near the bottom for cocaine and cannabis use in the EU.
The real test is among problematic users. Here, the picture is less conclusive. After falling dramatically at first, for instance, drug-induced deaths have begun to climb back up. Even so, the numbers remain small. In 2021, Portugal registered 74 deaths from overdoses (compared with 37 in 2014). In Scotland, by contrast, a country with a population of about half the size, “drug misuse” deaths for 2021 stood at 1,300.
On the flipside, drug users complain that low thresholds for illegal possession make it easy for them to be criminalised. Users are permitted to possess enough for 10 days – which the government sets at 1g for heroin and 2g for cocaine. Users carrying larger amounts can be designated “traffickers” and subject to jail time. In 2021, Portuguese courts issued 1,459 such guilty verdicts, marking a steady increase in criminalisation over the past decade, according to the drug support agency Sicad.
These mixed results give ammunition to both sides of the decriminalisation issue, which remains hotly debated around the world. To date, more than 20 countries have removed some (if not all) drugs from their list of banned substances. Others have opted to crack down even harder – Rodrigo Duterte’s murderous “war on drugs” in the Philippines being a notorious case in point.
In few countries is the debate more polarised than in the US, where drug overdoses have cost more than 1 million lives since 1999. Recent years have seen some tentative attempts at liberalisation. Half of the US government’s $42bn drug-control budget currently goes to health or social services, for example, while recreational marijuana use is now legal in 24 states as well as the District of Columbia.
Oregon is the only state to have embraced Portugal’s model fully, with residents voting 58% in favour of legal possession of small amounts of all drugs in 2020. Following an alleged surge in fentanyl use and a spike in opioid-related deaths, however, a new legislative committee on addiction recently proposed reversing the policy.
Even in Portugal, the debate over decriminalisation continues. Supporters of the policy fear that opposition parties could seek to politicise the issue ahead of national elections in March. André Ventura, the leader of the far-right Chega party, issued an early salvo last year, characterising a new law decriminalising synthetic drugs as a “disaster” and “designed by the left”. He said at the time: “We do not need to be softer on drugs. We need a war.”
Goulão is not blind to the imperfections of the policy he helped inspire. To treat drug addiction as a therapeutic problem is both time-consuming and resource-intensive. But as problematic drug use reduces, he notes, so too does government prioritisation. From being right at the top of public concerns in the 1990s, the issue has slipped to “13th or 14th place”, Goulão laments. With the drugs crisis of the 1990s now a distant memory, he observes social prejudices towards drug users resurfacing. “Today, the problem is mostly limited to people living in very difficult circumstances and it’s easy for certain political groups to exploit fears towards them as being different and problematic.”
Back in Pasteleira, however, the views of those shooting up under the nurses’ caring eye are broadly positive. Paulo’s only complaint is with the centre’s opening hours. “I mean, it’s not like any of us stop taking drugs just because it’s night-time.”
• This article was amended on 26 January 2024. The original stated that shops selling marijuana are now commonplace in Portugal. In fact only CBD cannabis products are legal for retail. This has been corrected.
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