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THE COBBLED LANEWAYS of Lisbon are thronged day and night with tourists enjoying the bars, restaurants and historic sites of the seaside city.
But take a walk 40 minutes from the centre, past the picturesque tiled houses and steep cobbled hillsides, and you arrive at a different vista to that experienced by tourists.
Here, next to a busy motorway and under low-flying jetliners bringing in holiday makers, there stands a sprawling, multi-storeyed flat complex in the district of Casal Ventoso.
On Rua da Quinta do Loureiro, in a building in the style of a medical centre, The Journal met psychologist Roberta Reis and the team of nurses, psychologists and social workers who run the city’s Drug Consumption Room (DCR).
In Ireland, this type of facility has become known as a “supervised injection centre” – and the subject of much debate.
The need for such a facility in Dublin has been fiercely advocated by those working with people in addiction, although the location originally chosen was opposed as unsuitable by many locally. Planning for one centre has now been granted but the service is not yet in place.
Debate is heating up about the future of Irish drug policy, with the Citizens’ Assembly on the subject due to resume its deliberations next month. The assembly’s chair, former HSE chief executive, has said a “step change” in policy is needed.
But what could that change look like in practice?
Views differ, but Portugal has often been cited, including at the assembly, as an example of a different and more radical approach to drugs. We wanted to find out what the country’s health-centred approach means in reality, starting at the DCR.
Reis, the DCR’s co-ordinator, works for the non governmental agency (NGO) Ares do Pinhal which is state-funded to provide the service.
Outside the facility on the street, a small group of people are sitting on the rough ground consuming drugs. A car is parked nearby which appears to be a makeshift home. Tents and makeshift camps are scattered across the steep slope rising away from the complex.
“This area that we are in here, it was the biggest drug supermarket in Europe, in the ’80s and ’90s,” Reis said, as she gave us a tour of the facility.
Reis, and all the other officials The Journal spoke to about Portugal’s drug policy mention the heroin epidemic of the 1990s that precipitated the country’s move away from a punitive criminal justice approach – treating addicts as criminals – to a more health-based, holistic policy.
In 2001, the Government moved away from police, arrests and court and essentially decriminalised consumption of all drugs for personal use. If a person is caught by police in possession of drugs they are entered into a diversion programme.
Personal use is not measured by the cost of the drugs discovered by police but instead is limited to the equivalent of a 10-day supply. Anything above that is dealt with as an offence equivalent to Ireland’s Section 15 of the Misuse of Drugs Act – sale and supply.
The Portuguese authorities have not stopped targeting organised crime. Law enforcement officials The Journal met in Lisbon confirmed that they are still seizing tonnes of drugs annually.
Personal consumption of drugs remains technically against the law but instead of appearances in court and a potential prison sentence, the police refer people they find to a “dissuasion commission”.
Officials have said that the police paperwork for the referral is purposefully less complex than that for a court case.
A “dissuasion commission” is akin to a clinical assessment. It involves a psychologist, a social worker and a lawyer. It evaluates a drug user’s risk and offers them counselling and other supports.
For those at the highest risk, authorities can impose sanctions including fines and recommend treatment. The decision to attend is voluntary.
Portugal’s legal system has a so-called administrative sanction system, separate from its criminal mechanism, and the drugs policy falls into the former.
According to legal officials in Lisbon familiar with Irish law, the closest comparison here to these administrative offences would be our road traffic penalty point offences.
Reis is keen to stress that much has changed since the crisis of the 1990s. This consumption centre has been open for just over two years and was positioned in this location because of its proximity to an area where addicts congregate.
The DCR is not the only service under Portugal’s health-centred drugs policy. There are methadone vans touring the city and meeting addicts where they are based. However, experts determined that the mobile clinics weren’t enough.
The DCR operates first in the morning and then for several hours in the evening. There is an injection room and a smoking room, and showers for those who are homeless. There are also clothes and food provided from donations from local people.
Those who attend get access to a doctor and can avail of medical tests for diseases including HIV and Hepatitis.
Reis said many of the service users come from work in the evenings.
“They come here and they can function normally,” she said.
“We asked our service users why they come here and they tell us for dignity.
“They don’t want to consume on the streets and they can’t at home because they have children or a partner – no one judges here,” she said.
Reis’ team are social workers, nurses and psychologists. They interact in a jovial way with the clients, there is laughter and banter. The atmosphere is friendly.
The service users are a mix of well dressed men and women (mostly men) but also clearly struggling and at risk addicts. Most of the service users are in the former group, however – indistinguishable from other residents of this city.
We take a seat inside the glass-fronted medical staff area with a view of the separate smoking and injection rooms. The smoking room is a table with chairs, tiled walls and a loud fan in the roof to extract the fumes.
All the staff are trained in dealing with an overdose when it happens. There is a supply of naloxone – which can temporarily reverse the effects of opioids including heroin – along with specialist resuscitation equipment. Reis said there have been overdoses in the centre but no one has died.
She said the centre has not had an incident in months and usually it happens to relapsing addicts who mistakenly believe they can take the same dose they did before rehab.
Inside the bright, clean injection room there are separated cubicle desks with individual needle disposal boxes. There is a curtained off area for addicts who inject into their groin.
The main drug people are injecting is a cocktail of heroin and cocaine known as a “speedball”. The drug users inject it into their arm veins, their groin or their necks.
As they consume the drug, most are silent and quiet. When the task is done, they clean the desk, thank the staff and leave. Many are taking multiple injections and the only obvious physical discomfort is for one of the more high risk addicts who stands up having been injected in his neck by a friend and clutches his contorted hands and arms behind his head, his face twitching.
“It is sometimes difficult for us to watch, but this is the way they will be ok,” Reis said.
The manager is keen to emphasise that she and her team have a very good relationship with local police – on the rare occasion they need their help they come rapidly and deal with people in a direct but empathetic manner.
“It is super important to say that they have a job to do too,” she added.
Reis said the pandemic had a profound impact on addicts and undermined gains made by the health-based system, not least because outreach services were affected. Similar issues were experienced in the 2008 economic crisis.
The work of the NGO is funded 20% by the Lisbon local authority and 80% by the Government agency managing the policy, SICAD.
She believes there is a need for increased funding and that there needs to be many more injection centres across Lisbon. She added that her group is working with the resources they have.
“There is always a need for more. When we opened there were 300 people who signed up immediately but within days there were 2,000 people. That is the reality of the need.
“We have the same sized team that was made for 300 users not the number we have, so this is a trouble for the funding,” she added.
There are 300 service users on average daily, Reis said, with 150 to 160 “acts of consumption” – heroin and crack cocaine or a combination of heroin and cocaine are the drugs most used.
Reis believes it is critical to extend the service across the country and she believes that Ireland, in its decision making, should look at the possibility of having centres in every urban area.
“One Drug Consumption Room (DCR) is not enough – there need to be DCRs across the city,” she added.
It’s clear from speaking to Reis and her staff that they have immense pride and a sense of purpose and pragmatism in their work.
Reis stresses that the drugs issue is only one part of a broader societal issue. Expensive rents are forcing more Portuguese people into homelessness which in turn, Reis believes, creates the circumstances where addictive behaviours flourish.
“I think the [drug] policy is working, I think it is effective but we need to improve it.
“People are working but not able to pay the rent and they are then pushed onto the streets.
“No one who lives on the streets in Lisbon right now is ‘just a drug user’. They are people that used to have a house.
“But no one survives on the streets with nothing – they turn to alcohol or any other kinds of drugs and then it is normal for people to become disorganised.
“So there needs to be a way to solve these problems because people lose control of these issues and it gets worse.”
Reis said a delegation from Cork City Council had visited the injection centre to examine the Portuguese model.
Her advice for those Irish policy makers and the workers that could be tasked with implementing a health focused approach in Ireland is: “You must bring the service to the users.”
“You must not wait for people to come to you – go to where they are.
“You need to find answers, the DCR is only one answer and it doesn’t work for everyone. You also need specific answers for different people who consume. We have very young people coming here so I ask what is going wrong in the system.
“So you must always look in the panoramic and you cannot rest, keep changing the system, keep making it better.”
Back outside the centre, the addicts we met earlier wish us a pleasant stay in Lisbon. More people are coming down the hill, heading towards the drug consumption centre. Out of sight of much of the rest of this bustling city, the centre’s work for people living with addiction continues.
Tomorrow in The Journal we speak to experts about what lessons Ireland could learn from Portugal’s two decades of a different approach to drugs.
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Advocates deliberately ignore or conceal the reality that drugs are not provided meaning that addicts still commit crime to feed their habit then visit the centre to shoot up.
All those muggings, theft of every description, assaults, car crimes, black markets in pharmaceuticals, stolen goods etc etc It doesn’t go away just because there’s somewhere to shoot up.
A bit like offering a taxpayer funded warehouse as a meeting place for burglars.
If you’re unfortunate to live near one then you’re going to have large numbers of addicts roaming your neighbourhood on a daily basis.
Ever wonder why there are no drug treatment centres in posh leafy suburbs?
You’re right. They won’t have it. Let the peasants deal with them.
As with most societal ills it is working class people and communities who will absorb the impact.it is their kids who will grow up with a normalised view of addiction.
The well heeled keep it out of sight so their kids won’t be affected and their property kept secure
@Tommy Haze: I don’t really disagree with you Tommy. But it’s easy to always be moaning and griping in the comments. What’s to be done in your view? I take it you’re not against decriminalisation?
@Tommy Haze: Portugal has a half solution or less it only addresses use.
The supply side needs to be taken care of too so as to deprive organised crime of the business and weaken it’s hold. Supply should come via licensed premises with age controlled access or pharmacies depending on the type of drug.
Addiction support needs to be part of the solution for the users of highly addictive drugs.
The non addictive and mildly addictive drugs need to be treated consistently, canbabis, psilocybin and alcohol in particular.
Breaking the gateway effect requires separating these two groups of drugs.
@Bill Spill: criminalise end user. Tougher sanctions no matter your standing in society. Make it so hard to use/have drugs on your person that the risk to the individual is too great. Demand becomes low, then supply becomes unsustainable, ergo not worth the time and effort of the criminals importing it. If there’s a demand the supply will only increase, further increasing criminality. Time to end the pc, oh the poor guy/gal had a rough life. Drug users are a drain, society is better without them. The top players are proving to hard to stop. So end demand for product. Hit the lower tier. Hard, and make prision more difficult. No perks. Only food & a place to lies down.
@Mike Carson: “demand becomes low…”
@mani mus: oh, journal doesn’t do emoji. What happened was, I read as far as “demand becomes low”, and then I started laughing so much that two identical streams of tears began flowing down my face.
@Mike Carson: That3 been tried for decades and repeatedly proven not to work evening places with the death penalty.
@mani mus: Yes it does but only old style as invented on USENET in 1979 :-)
@Steve O’Hara Smith.: was going to go with ヽ(；▽；)ノ but they didn’t get my nose right.
@Mike Carson: a very quixotic approach, sure to draw favour from a banter point of view, but not worth considering in reality.
@Mike Carson: we’ll that’s a dumb idea. Anyone else?
@Bill Spill: damn you autocorrect. Dam you
@Bill Spill: Seconded
@Mike Carson: the war on drugs has been a complete failure and your solution is to double down? Typical out of touch old man
@Tommy Haze: Ruttland centre is in leafy knocklyon
@Steve O’Hara Smith.: “The non addictive and mildly addictive drugs need to be treated consistently, canbabis, psilocybin and alcohol in particular.”
I don’t disagree with your comment per say but this idea of nonaddictive or mildly addictive is a myth. Cannabis addiction is rife, hallucinogenic addiction is extremely rare and alcohol is one of the most destructive substances around.
The point though is that the substances are not the problem but the reason why people become addicted in the first place. Substance addiction and behavioural addictions are psychological and emotional painkillers for trauma. No addict sets out to become addicted but by taking substances or behavioural process addictions they find comfort from trauma and a means to function. I heard it said many times that addiction has saved many people’s lives, but unfortunately, after some time it becomes another issue with its own traumatic concerns. To quote Dr.Gabor Maté: ” Not everyone that suffers trauma becomes an addict but every addict has suffered trauma.”
The Portugal model is a good standard as it is more of a medical approach than a criminal one. Substance and behavioural addiction is just one piece of a bigger issue.
@Dr. Oisin Maccumhaill: exactly no such thing as mildly addictive, that’s like being a bit pregnant.
@Michael Walsh: Caffeine is mildly addictive, nicotine is highly addictive.
There are large variations in how easily addiction starts, how difficult it is to end and how physically debilitating withdrawal is.
To say that there is no variation is an indication of profound ignorance.
@Steve O’Hara Smith.: Some people will procedurally repeat the same innefective process time and again, until, by sheer luck, it will happen! Like the lottery, or €uromillions. Maybe a little less probable even, but in science, faith and belief in your biases is the road to success! :D
@Mike Carson: @Mike Carson: Hitting the lower end hard was the war on drugs anf it failed.
Demand becomes low that is funny as that has never happened. People just get more aggressive in finding what they need or the money to pay for it oir try different substances to get high.
Ivory towers and all of that.
Do any of them ever stop taking drugs in the long term. These consumption rooms are the facilitators for continuing drug use.
@rory Mcgovern: that’s your common sense talking. Turns out common sense isn’t fool-proof:
“Heroin Assisted Treatment clinics prevent overdose and HIV infection, provide regular access or referral to counselling, social, health-care and treatment services, while preventing diversion of prescribed heroin to the illicit market.
Studies looking at long term impacts, found that after 6 years, over half of clients were no longer being prescribed heroin. Both those still in the programme, and those who had left it, had maintained their reductions in illegal drugs use, and illegal income, with sustained improvements in most social variables.”
transformdrugs.org/drug-policy/uk-drug-policy/heroin-assisted-treatment
@rory Mcgovern: It’s the right kind of question, I feel you can only gather the answer by doing something about it tho (which, some 30 years later we have yet to do)
@rory Mcgovern: Millions of people function properly with long term drum use. Billions actually.
You are deciding which drugs can be used and which cannot.
Nicotine and alcohol are the two obvipus ones.
Insulin is the OBVIOUS MEDICAL ONE.
Then you have you cooffee drinkers etc.
So strop being so myopic and listen and learn from experts
Imagine going to work on m50 everyday and looking to your right and seeing a hill full of people injecting themselves.This was the reality in Lisboa for many years but that’s gone now thanks to programmes like in the article.
This programme removes hazards off the streets like spread of disease and used syringes. Imagine your kid go play outside and falling on a syringe infected with HIV.
These programmes were created due to public health concerns and to help the most vulnerable, not to stop crime.
@Reader: The irony that the school objected to the clinic in D8 as it was too close to them so they now continue to watch adults defecate between cars, shoot up and smoke crack directly in front of their windows.
People just don’t get it do they. More enforcement! Force the addicts to give up! Stop facilitating them! We even have the classic zero tolerance! Do all these armchair experts ever stop and think that maybe just maybe they don’t know what they’re talking about and after decades of these approaches failing over and over again it’s time to try something else.
Humane, logical and clearly producing results, this is the way to go. Zero tolerance is a terrible idea. Going full blown authoritarian with vulnerable people, yeah great idea that! Drugs have been around since year dot. There is absolutely no chance of them going away. The best we can do is come up with non-hysterical solutions. Pearl clutching morality has no place in medical treatments and approaches either. And that’s all the criminalise everything crowd have. Old useless ideas for a problem they’ll never wish away or see stamped out with the kind of force they’re happy to encourage, like the wannabe hard men they are. Of course none of them have thought about what you unleash when you give draconian powers to the state. Zero tolerance breeds a culture of oppression and violence and it never stays focused purely on the target they fantasise about keeping under their boot. Time to grow up, detox from all the stupid war on drugs gibberish and approach it like enlightened, rational and sensible adults.
Would you give an alcoholic alcohol & expect it to work
@mainmsam: well it works with heroin.
transformdrugs.org/drug-policy/uk-drug-policy/heroin-assisted-treatment
@mainmsam: Stupid is as stupid does
@mainmsam: Yes you would. Detoxing from alcohol is one of the most dangerous withdrawal procedures there is. Far worse than other ‘illicit’ drugs. So you look at the situation logically and compassionately and try and provide the best possible chance of a safe detox and better life for the patient or person suffering.
@mainmsam: alcohol is one of the very few drugs that going completely cold turkey, the withdrawals can kill you. It would have been easier to just say I have no idea what I’m talking about and saved everyone from seeing how ignorant you are on the topic
@mainmsam: From that perspective we’d go back to the dry period… …How d’that go 100y ago? Oh wait!!
@mainmsam: Different drug with different issues and a lot of alcoholics are given drugs to handle their crqavings after being chemically detoxed
Jaysus i might take up the heroin speedball myself, probably be cheaper than the few pints anyways
Lots of comments lately about how “Portugal” are having doubts about their approach to drugs. No. They’re not. They cut funding massively for the system that they set up, with great success, when they decriminalised:
“After years of economic crisis, Portugal decentralized its drug oversight operation in 2012. A funding drop from 76 million euros ($82.7 million) to 16 million euros ($17.4 million) forced Portugal’s main institution to outsource work previously done by the state to nonprofit groups, including the street teams that engage with people who use drugs. The country is now moving to create a new institute aimed at reinvigorating its drug prevention programs.”
washingtonpost.com/world/2023/07/07/portugal-drugs-decriminalization-heroin-crack/
@mani mus: this has had an impact, obviously, and has caused problems. But even those who are pointing out the problem are not “having doubts” about Portugal’s approach to drug use:
“Porto’s mayor and other critics, including neighborhood activist groups, are not calling for a wholesale repeal of decriminalization — but rather, a limited re-criminalization in urban areas and near schools and hospitals to address rising numbers of people misusing drugs. In a country where the drug policy is seen as sacred, even that has generated pushback — with nearly 200 experts signing an opposition letter after Porto’s city commission in January passed a resolution seeking national-level changes.”
@mani mus: Good point. Some people will latch onto a couple of words that support their wishes and completely ignore the details, context and wider picture. It’s exhausting!
War on drugs doesn’t work. Read up boomers. I’m sure that Gardai time would be better spent chasing criminals, as opposed to raiding cbd shops, but hey chasing criminals is tough, we might need Police for that.
@Jak M: All in fqavour oCBD with THC buit not some of the stuff pretending to be good CBD oil with over 20% THC and not the max of 8% that is recomended medically.
Play by the rules and you ewill not have a problem!
Good article, I note the location of the Service, 40 mins from the city centre.
@Mark Conlan: People go to Lisbon for culture, architecture etc. People come to Ireland for the Guinness Storehouse
@Thesaltyurchin: Try popping into see the book of Kells or St Patricks Cathedral and see how everyone is at Guinnesses!
We only get one life. Why should anyone be expected to spend it suffering for people who make selfish and childish decisions to take drugs?
@Emma Marchand: you could equally ask why should anyone spend their one life being callous and uncaring?
@Emma Marchand: everyone who read your comment is now suffering as a result of your selfish and childish decision not to educate yourself on the subject of addiction.
@mani mus: Perhaps you believe I should sacrifice my life for people who have robbed my house and destroyed parts of my home town. If you do this then good for you but in my experience drug takers will only stop when it suits them, not based on any consideration of anyone else.
@Emma Marchand: Emma here thinks attacking the poor and mentally ill and makes her look tough.
In fact it makes her look like a sociopath.
@Emma Marchand: if you want drug-related harm to be reduced, and it looks like you do, then you need to begin with an understanding that drug addiction, and all the harm that flows from it, is not simply a selfish and childish choice. Wilfully ignorance, on the other hand, is absolutely a selfish and childish choice for anyone with literacy skills. Make better choices, educate yourself, and stop making bad things worse.
@Emma Marchand: Do you drink any of tea, coffee or alcohol? Smoke or vape nicotine? Eat chocolate?
If so then you take recreational drugs.
@Emma Marchand: Or how anybody could be so spoilt, selfish, and lacking any form of empathy. How the words, me, myself, I, can be used asa way to live a live.
It is nice to be noce and it always pays to hartnice, wvery religion in the world sys that and it has been shown to work.
If somnethibg bad happenened to you and you got hooked on painkillers theough no fault of your own, what would you think iof wht you saud.
Ohh and it only takee a split second to get hiurt and onn the road to painkiller addiction.
@Emma Marchand: I have not seen or heard of anybody been asked to scarafice their life.
Your experience of drug takers is limited, personal example are always biased due to the human emotion involved.
Hi, Portuguese citizen here.
1. Drugs are not given, there’s access to them through a safer mean. If someone wants to give it a go to find out how it is, they’ll send you off on the spot. It is only for addicted people.
2. I think our governments should manufacture and distribute drugs to addicted consumers because that would increase the quality, limit the access quantity and literally kill all drug trafficking. I know this may be a pipe dream due to morality and limited cognitive bandwidth.
3.Addicted people will do drugs even if you point a gun to their heads. There’s really no point punishing the sick (it’s a sickness, did you know?).
@Corporate Interests: So called vaccines, oh dear, you lost it there.
4. After drugs got decriminalized here there’s been a substantial increase in safety in the major cities. Some still happen, but you barely feel it, compared to decriminalization.
I can’t understand the punishing attitude, does it stem from frustration? I hear you, but this is a tested solution, as well as a zero tolerance approach, which has zero efficacy.
It has way better than what some people are proposing, conservative and stuck to the old ways of doing things.
What people need is community, forgiveness (self and for the next), means to contribute to society and to our next of kin, safety and a little bit of love and family.
Create a society where those basics are guaranteed, and you can forget the whole problem ever existed because it will literally vanish by itself.
@Corporate Interests: Wow yiou post was lets call it different but your reply to a fair comment is ammazing.
Speaking in the royal “We”
Way out there and as far as conspiracy theorist, the reverse is true, you wear th\t title on your own.
“Decriminalisation on the ground: Inside a drug consumption room in Lisbon”
Vs
“Personal consumption of drugs remains technically against the law”
So the entire article is predicated on a lie.
How stupid does our government and media think we are?
@Chris O’Brien: Bring against the law is not the same as being criminal!
“Decriminalisation ON THE GROUND”!!?? As opposed to decriminalisation where else? In the air? On the ocean floor? That dumb phrase is totally overused, particularly by Michael Martin. Some time ago a representative of Ryanair pilots spoke about “pilots on the ground are not happy with…”. We really have to get rid of these stupid cliches, going forward, at the end of the day. In all fairness, like.
In Japan not so long ago, phags were encouraged so as to avoid harder addictions later. There’s a reason why they’re half a euro a cig. Smack is more cillit bang to whole area populations.
have your say