Fight Against the Drug National Strategy

 

Report of Recommendations of the Commission for the National Strategy of Combat to the Drug

 

Executive Summary

Until fairly recently, the bulk of efforts in the area of drug abuse, both at the national and international level, have been centered on how we should react to this phenomenon. All indications are that this strategy has not been very effective.

At the present, many feel that a different approach is warranted. A clear grasp of the reasons behind drug abuse is essential, not only for an understanding of the origin of the problem, but also in order to identify the most effective ways to combat it (a wide range of strategies will undoubtedly need to be tried out and evaluated).

This new approach has spawned various questions, including:

- What are the reasons, whether societal or personal, which lead so many young people to abuse drugs?
- What types of support and training to those who interface with drug abusers need?
- What are the factors, whether biological, psychological or sociological, which determines the course of the addiction in particular individuals?
- What services should be provided at the stages of prevention, treatment, harm reduction and re-integration?
- How can the legal system be altered and improved in order to make it function more effectively?
- Generally speaking, what is the best way to balance practical approaches characterised by pragmatism with theoretical notions that may be less flexible?

Unfortunately, there exist many pre-conceived notions about the use of drugs, many of which are false and which result from uninformed emotional reactions. In this regard, it must be clearly noted that: the great majority of young people not take drugs; many drugs are not lethal; not all drug abusers commit crimes; and drug users do not came from a single societal grouping but rather belong to different social and ethnic groups.

It is also know that the great majority of Portuguese have never tried any illegal substances, and that most of those who have tried them are casual users. Recreational drug taking is by far the most common form of drug use, and only a small percentage of those who take drugs become addicts. But it is with regard to this groups and the programs which interface with them that most of the questions highlighted above are raised. This is not only du to the high visibility which the "drug phenomenon" has gained, but also to the risks and coasts to public health associated with this problem, as well as the criminality which sometimes accompanies it.

The challenges we face are clear: how can we protect young people and others at risk?; what kinds of alternatives should be offered to those forced to the fringes of society?; how can we assure that laws are not infringed?; and how should those who benefit from drug trafficking be punished?

The "war against drugs" is a paradigm for those struggles in which the combatants, swept away by emotion, believe that they can win without giving considerable thought to their actions. The result: the drug problem not only has not been vanquished but remains a subject about which we do not have the solid information we'd like.

The strategic recommendations which follow are clearly limited by all the societal and individual factors referenced above, making periodic updating and modification essential.

 

1 - Prevention

1. Efforts at prevention should preferably begin at the end of childhood (ages 9 to 10) and the start of adolescence (ages 12 to 13) due to the importance that these critical stages represent. This must be done of course, without undermining a strategy of prevention which should encompass the entire growing up process and which should include all those adults involved in children's lives.
2. Wider involvement of the healthcare system.
3. Expansion of epidemiological studies on the use of toxic substances, with special emphasis on alcohol consumption.
4. Changes in the strategy of how information is provided about drugs, with special care taken to avoid either trivialization or demonization of drugs.
5. A large investment in streetwork programs and the training of youth mediators
6. Wide-ranging structural changes aimed at giving preventative work in the community a local administrative control center under the aegis of the Conselho Local de Acção Social (see 5.2), which would, in turn, be under the technical direction of a representative of the Instituto Portugues das Drogas e Toxicodependencia (IPDT).

 

2 - Treatment, Harm Reduction and Re-integration

2.1 - With regard to Treatment:

1. Involvement of the entire healthcare system and not just the Serviço de Prevenção e Tratamento das Toxicodependências (SPTT).
2. Empowerment of family practitioners as front-line care-givers
3. Offer the SPTT the human and material resources needed to expedite the current waiting lists.
4. Increase access to substitution therapy programs
5. Increase the number of spaces at Treatment Units and Therapy Centers
6. Give all imprisoned addicts treatment by appropriately trained personnel

2.2 - With regard to Harm Reduction:

1. Identify the children of addicts as a high risk group; give family practitioners the information an preparation they need to become primary co-ordinators of a support strategy.
2. Further develop substitutive treatment programs and create low-threshold substitute treatment programs.
3. Create support offices and shelters which would co-ordinate activities with the street teams.
4. Give renewed emphasis to the current syringe-exchange program.
5. Implement an effective harm reduction strategy in prisons (see 4.1.4).
6. Make efforts at providing information more rigorous and specific (see 1.4)
7. Enable addicts access to contraceptives

2.3 - With regard to Re-integration into society:

1. Create incentives for the development of networks of recreational and cultural clubs.
2. Augment the network of day centers.
3. Augment the networks of residential units aimed at re-integration.
4. Support the development of self-help groups and initiatives in the area of professional training.
5. Create scholarships for professional internships and support job-search and job-maintenance programs.
6. Support experimental guaranteed-employment programs and encourage the creation of businesses where addicts can re-enter the workforce.
7. Create permanent residences for sick and disabled addicts.
8. Give businesses, public services and schools the means to facilitate treatment in cases of early detection of addiction

 

3 - The Legal Framework and the International Perspective

3.1 - With regard to the functioning and structure of the Legal System:

1. Assemble a task force with the aim of getting the Legal System and Healthcare System to work together more rationally.
2. Give the courts the information they will need about those places and people who have the expertise to evaluate addiction.
3. Develop a better co-ordinated model for police actions on the area of drug trafficking.
4. Investigate the situations in prisons with regard to the link between addiction and crime so that treatment and Re-integration into society can be truly effective.
5. Better co-ordinated activities between the IRS and the Legal System

3.2 - In terms of legislation:

1. Make the application of the Article 25 of the Drug Law more flexible in order to be able to take in account factors which could imply less responsability, e.g. economic condition and level of addiction.
2. In certain special cases (minimum maintenance level) do away with the requirement of exclusivity mandated by Article 26 of the Drug Law.
3. Study ways of implementing a better punishment scale for drug trafficking.
4. Make co-operation during the trial a factor for lighter sentencing when the defendant demonstrate true contrition (Article 31)
5. Clarify the role of doctor prescribing substitute drugs (Article 27).
6. Decriminalise private drug taking and the possession or purchase of drugs for this kind of drugs (article 40) (* majority position two discordants)
7. Re-introduce plea-bargain with regard to drug use, with or without mandating methods of treatment.
8. Consider treatment as an alternative to prison and fine. Also consider the suspension of fines for drug taking, extending the possibility of suspension in cases having to do with Articles 44 and 45.
9. Reformulate Regulation 94/96 of March 26, making the active ingredient the basis for establishing an average individual daily dosage; make laboratories indicate such ingredients, as well as the make-up of mixtures being taken.
10. Consider permitting in law the use of photographs, audio-visual equipment and other materials in the investigation of drug trafficking cases.
11. Make a thorough study of the possibility of switching the burden of proof to the defendant in cases having to do with money laundering (cases in which distinctions between criminal and civil procedure could prove useful).
12. Provide regulations for the use of drug tests requested by businesses, safeguarding the interests of all concerned.
13. Consider evaluation criteria for authorisation of events in which drug use is encouraged (for instance, raves).

3.3 - At the international level:

1. Develop a world-wide plan and timetable according to the objectives approved in a Special Session of United Nations in July 1998.
2. Analyse the effectiveness of bilateral agreements and treaties between Portugal and other countries, taking whatever corrective measures are warranted.

 

4 - Research and Training

4.1 With regard to Research:

1. Scientific research receiving priority should revolve around interdisciplinary studies aimed at finding theoretical models which allow for integration of data from different areas.
2. The following specific types of studies should be given priority: those investigating the current scope of drug phenomenon; those seeking to explain and interpret the "law of effect"; comparative studies analysing the effect of different kinds of drugs (see 1.3); and those involving the macro- and micro-economy of drugs.
3. At the practical level of professional intervention, a critical survey of programs directed at prevention, treatment and re-integration should be carried out. Evaluation techniques for these programs should also be created and studies on the need, viability and make-up of experimental programs should be developed.
4. Development of the means to create a stable scientific community in this area.

4.2 - With regard to Training:

1. Immediate development of basic training programs within the curricula of appropriate areas of professional study.
2. Planing and organisation of training for professionals who interface with drug abusers.
3. Development of permanent information-exchange in the areas of intervention and evaluation.
4. Creation of training programs aimed at breaking professional and academic isolation.
5. Development of skills-training programs aimed at teaching how to work as a team.
6. Planing of training around emerging problems.
7. Creation of a Permanent Training Organisation (see 5)

 

5 - Organisational Implications

5.1 - With regard to Direct Intervention:

1. Maintain Law 15/93 and its associated regulations.
2. Create a National Service Responsible for: collection and analysis of data; promotion of research; professional training; community prevention activities; support for private initiatives; international co-operation; and program evaluation.

5.2 - With regard to National Co-ordination and Co-operation:

1. Discontinue "Projecto VIDA".
2. Make the Adjunct Minister responsible for co-ordinating efforts in the area of drug abuse, in conjunction with the ministers of Health, Education, Justice, National Administration, Science and Technology, Youth and Work and Solidarity.
3. Encourage forms of co-operation amongst local, regional and national programs which will follow directives of the Adjunct Minister and the Ministers in charge of relevant services, using simple and flexible decentralised programs as a guideline.

5.3 - With regard to Development and Implementation of Strategies:

1. Promote periodic evaluations by external organisations of how well strategies are being put to into practice.

 

 

The members of the Commission
(created by the Government Resolution n.º 3229/98)

Cândido Mendes Martins da Agra
Professor, Director, Centre of Deviant Behavioral Science
University of Porto
(Signatory of the Public Letter to Kofi Annan on the occasion of the United Nations General Assembly Special Session on Drugs in New York on June 8-10, 1998)

João Augusto Castel-Branco Goulão
General Medicine Assistant
SPTT Chairman

António Gomes Lourenço Martins
General Procurador Procurator Adjunct
Member of the International Narcotics Control Board

Júlio Guilherme Ferreira Machado Vaz
Psychiatrist
Auxiliary Professor of the Universidade do Porto
Regent of the Medic Anthropology Discipline at the Instituto de Ciencias Biomédicas Abel Salazar

Maria Manuela Azevedo Saraiva Calado Marques
Nurse, Mental Health and Psychiatry Specialist
Adjunct of the Adjunct Minister of the Prime Minister

Nuno Pereira Silva Miguel
Psychiatrist SPTT

Alexandre Tiedtke Quintanilha
Commission Chairman
Professor da Universidade do Porto

Joaquim Augusto Rodrigues
Psicologist
General Manager of the GPCCD

Daniel Sampaio
M.D., Ph.D.
Professor of Psychiatry, University of Lisbon
Psychiatrist at Santa Maria Hospital, Lisboa
(Signatory of the Public Letter to Kofi Annan on the occasion of the United Nations General Assembly Special Session on Drugs in New York on June 8-10, 1998)

 

Projecto VIDA - Programa Nacional de Combate contra à Droga
http://www.drugtext.org/count/portugal/pspgogpv.html

SPTT - Serviço de Prevenção e Tratamento da Toxicodependência
http://www.drugtext.org/count/portugal/pspgogst.html

GPCCD - Gabinete de Planeamento e Coordenaçao do Combate à droga
http://www.drugtext.org/count/portugal/pspgogcd.html

IRS - Instituto para a Reinsersão Social (Social Reinsertion Institute)

IPDT - Instituto Português das Drogas e Toxicodependências (Portuguese Institute of Drugs and Addictions)

For more about the referred Drug Law Articles (DL 15/93 altered 45/96) as folows

25º TRAFFIC OR GENERAL POSSESSION
26º TRAFFICKER-USER
40º USE AND POSSESSION FOR USE

See http://www.drugtext.org/count/portugal/psppnluk.html

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