InIntteegrgraattiionon ooff DDrugrug InIntteervrveenntitioonn SSttrraatteeggiieess aatt tthhee CCiittyy LLeevveell –– TThhee CCaassee ofof CoCoiimmbrabra

CCaarrllooss EEnnccaarrnanaççãoão Mayor of

Götenborg – May 27-29, 2009 PPoorrttuugguueessee FFrraammeewoworkrk MMaaiinn PPllaayyeersrs

Supply Side / S. Reduction Demand Side / D. Reduction

Police Departments Dissuasion Commissions Health Services • PSP • GNR • NHS • PJ • IDT, IP Judicial System Social Network • Cities Council’s for • Investigation Magistr. Social Intervention • Courts of Law • NGO’s Other National Gov. Depts IDIDTT,, IPIP InInsstittituuttee forfor DDrruuggss aandnd DDrugrug AAddddiicctitionon IDT – Institute for Drugs & Drug Addiction

• Mission • Illicit Drugs & Alcohol • Areas of intervention / responsibility • Treatment • Prevention • Risk and Harm Reduction • Rehabilitation • Demand reduction (dissuasion) • Investigation & Epidemiological surveillance • Training • International representation IIDDTT –– IInnsstittituuttee ffoorr DDrrugugss && DDrrugug AAddddictiictionon Main IDT national community intervention programs

PIF – Focus Intervention Programs (c. 20 projects funded by IDT – 2 years) • Intervention in leisure spaces / youth music festivals … • Dysfunctional families • Young people with risk behaviors

PORI – Operational Program for Integrated Responses • IDT funded programs developed for detected priority territories (92) • RAR methodology (more properly RARE…) • Integrated responses • both at technical and institutional levels • fully evaluated at all levels of implementation IDT – Institute for Drugs & Drug Addiction

General Strategic Principles

• Interventions centered on the citizen • Territory driven & designed programs • Integration of institutional efforts • Integrality & continuity of responses Drug Intervention Network in IDT • Treatment consultation teams all over the country • Teams & mediators for community intervention in • Prevention; harm reduction, rehabilitation… • National intervention programs (financed whenever necessary) • Specialized treatment units - alcohol (3), detox. Units (5), therapeutic communities (3 units + 1200 conventioned beds) • National network for demand reduction / dissuasion (18 teams / portuguese law enforcement) Other National Health Service (NHS) facilities TThehe CCitityy ooff CCooiimmbbrara

CCooimimbbrara

• More than 1.000 years old • Roman city of Aeminium • One of the world’s oldest universities (700 y. +) • 165.000 to 185.000 inhabitants • 35.000 university students; 10% from 40 countries • Activity mainly connected with services, teaching & health care • Cluster in biotech, pharma. & software industries Coimbra : International City Partnerships – Twin Cities

– da Califórnia EUA – Halle Alemanha – Poitiers França – Salamanca Espanha – Santos Brasil – Aix-En-Provence França – Cambridge EUA – Yaroslavl Rússia – Fès Marrocos – Santiago de Compostela Espanha – Mindelo Cabo Verde – Curitiba Brasil – S. Paulo Brasil – Beira Moçambique – Taipa China (Macau) – Pádua Itália – Díli Timor Leste – Damão India – Esch-sur-Alzette Luxemburgo – Saragoça Espanha

Coimbra : City Programs

• Urban Rehabilitation Projects - old quarters & city social housing developments

• “Nomads Park” - gypsies temporary housing facilities

• Project “Planalto Seguro” - urban rehabilitation, security & citizenship promotion

• CLAS - Coimbra’s Council of Social Partners (122 State Deps & NGOs)

• Strong civil society … • RIAC – Coimbra’s Network for Addictions (leader : IDT; c. 20 partners) • … CCLLASAS –– ““CCitityy CCoouunncilcil ffoorr SSoocialcial ActActiionon”” Na organ that directly depends of the Mayor City of Coimbra : Partners in the Social Council (122+ State Orgs & NGOs)

ACAPO - Ass. de Cegos e Amblíopes de Portugal Centro de Bem Estar Social de Junta d Freg. de ACIC Centro de Bem Estar Social Sagrada Família Junta de Freg. de Almalaguês ACM - Ass. Cristã da Mocidade Centro de Solidariedade Social "O Pátio" Junta de Freg. de ADAV - Ass. de Defesa e Apoio da Vida Centro de Solidariedade Social de Adémia Junta de Freg. de ADFP - Fórum Ocupacional Centro Distrital de Segurança Social de Coimbra Junta de Freg. de Brasfemes ADIS Centro Operário Católico da Conchada Junta de Freg. de Administração Regional de Saúde do Centro Centro Paroq. de Bem Estar de Almalaguês Junta de Freg. de Amigos do Cidadão Doente Centro Paroq. de Solid. Social da Freg. de Junta de Freg. de ANAI Centro Paroq. de Solidariedade Social de S. Martinho do Bispo Junta de Freg. de APELO - Apoio à Pessoa em Luto Centro Social da Marmeleira Junta de Freg. de APELO - Ass. de Apoio à Pessoa em Luto Centro Social e Recreativo da Cidreira Junta de Freg. de Ribeira de Frades APPACDM Centro Social Nossa Senhora da Conceição Junta de Freg. de S. Bartolomeu APPDA - Coimbra Centro Social Nossa SenhoraD’Alegria Junta de Freg. de S. João do Campo Ass. Cultural e Recreativa de Casal S. João Centro Social Paroq. de S. João do Campo Junta de Freg de S. Martinho de Árvore Ass. das Cozinhas Económicas Rainha Santa Isabel Centro Social S. João Junta de Freg de S. Martinho do Bispo Ass. de Moradores do bairro da Rosa Centro Social Junta de Freg. de S. Paulo de Frades Ass. de pais e Encarreg. de Educação da EB1 de Pereiros Centro Social, Cultural e Recreativo de Quimbres Junta de Freg. de S. Silvestre Ass. dos Diabéticos da Zona Centro Centro Social, Cultural e Recreativo do Botão Junta de Freg. de Santa Clara Ass. Integrar Centro Sócio-Cultural Nossa Senhora de Lurdes Junta de Freg. de Sé Nova Ass. para o Planeamento da Família Centro sócio-Cultural Polivalente de S. Martinho Junta de Freg. de Ass. Port. de Estudos e Intervenção em Psicologia Positiva Comissão de Protecção de Crianças e Jovens de Coimbra Junta de Freg. de Sta. Cruz Ass. Port. de Familiares Amigos e Pessoas com Epilepsia Comunidade Juvenil S. Francisco de Assis Junta de Freg. de Sto. António dos Olivais Ass. Portuguesa de Solidariedade e Desenvolvimento Conferência de S. Paulo Junta de Freg. de Ass. Reage CONSENSUS Junta de Freg. de Torres do Mondego Ass. Social recreativa Cultural Cigana de Coimbra Direcção Regional de Educação do Centro Junta de Freg. de Ass. Social, Cultural e Recreativa de S. Paulo de Frades Fábrica da Igreja Paroq. de S. João do Campo Junta de Freg. de Ass. Sócio Cultural de Recreio e Desportiva dos Pereiros Federação Regional das Associações de Pais do Centro LAHUC - Liga dos Amigos dos HUC ATENEU de Coimbra Fundação AMI - Porta Amiga de Coimbra Liga dos Amigos do C Saúde N de Matos Banco Alimentar Contra a Fome Fundação Beatriz Santos Liga Portuguesa Contra a Epilepsia Câmara Municipal de Coimbra Fundação Bissaya Barreto NRCentro - APPC Cáritas Diocesana de Coimbra Fundação Portug. "A Comunidade Contra a Sida" Obra de Promoção Social do Distrito de C Casa da Infância Dr. Elysio de Moura G.N.R. Obra Social de Torre de Vilela Casa de Repouso de Coimbra Ginásio Clube de Antuzede Policia de Segurança Pública Casa do Pai - Centro de Apoio Social Grupo Sócio Cultural e Desportivo de S. Martinho de Árvore Rede Europeia Anti-Pobreza / Portugal CEARTE Hospital Sobral Cid Santa Casa da Misericórdia de Botão CEIFAC - Centro Integrado de Apoio Familiar de Coimbra Humana Global – Ass. for Prom of H Rights, Culture and Develop Santa Casa da Misericórdia de Coimbra CELIUM - IPSS I.D.T., I.P. – CRI de Coimbra Saúde em Português Centro Comunitário de Desenvolvimento e Solidar. Social IAC - Instituto de Apoio à Criança SOL - Eiras Centro de Apoio Social de Souselas INATEL Sub Região de Saúde de Coimbra Centro de Apoio Social Pais e Amigos da Escola EB 10 Instituto de Reinserção Social - Direcção Regional do Centro Ven Ordem 3ª - Casa Abrigo Pe Américo Centro de Assistência Paroq. IEFP - Delegação Regional do Centro Drug Intervention & Other Health Facilities (1) • IDT, IP (NHS authonomous administration) • CRI – District of Coimbra Center for Integrated Responses on drugs • 1 Treatment Team (20 technicians – Psych., Psycol, S. Serv. Techn….) • 1 Community programs intervention team (6 technicians) • 4 IDT Specialized Units • 1 Therapeutic Community (5 techn.; 12 beds – long term treatment) • 1 Illicit drugs detoxication unit (12 beds) • 1 Alcohol Unit – Consult., infirmary, day care, etc. – 40 techn., 30 beds) • 1 Demand Reduction Team (CDT – 3 techn. +)

• IDT Regional Administration Services 30.000 consultations / year • Other IDT financed responses • 1 Harm Reduction Team + 1 Shelter Center (15 beds) + 1 HR Cabinet Drug Intervention & Other Health Facilities (2) • NHS – National Health Service

• 2 Central General Hospitals (beds: University Hosp. - 1.300 + CHC - 600) (1 Psychiatry & Mental Health Service with 40 psychiatrists) • 6 Primary health care Health Centers • 1 Psychiatric Hospital (60 Psychiatrists, c. 400 beds) • 1 Paediatric Hospital (c. 200 beds) • 1 Oncology specialized hospital (c. 300 beds)

• Private Practicioners & Clinics (22/1.000 medical doctors) • 1 NGO administered protected rehintegration appartment • 1 NGO administered socio-occupational forum • 1 NGO administered therapeutic community (IDT funded beds) • ... LLetet’’ss ggoo ffoorr aa ((vviirrttuuaall)) totourur……

Coimbra : Diagnosed Priority Territories Within the scope of the IDT’s PORI Program

Territory 1 – Coimbra Downtown Area • Heroin traffic & consumption + Buprenorphine Traffic • Petty crimes (pick pocketing, small thefts), damage to urban structures

Territory 2 – Suburban Barrios of Rosa & Ingote • Traffic + Consumption (mainly heroin & THC) • Occasional violent incidents, destruction of urban property

Territory 3 – University Campuses & Beyond • Alcohol consumption, “Club Drugs” • Student Festivities, Recreational Areas, Music Festivals Coimbra : Diagnosed Priority Territories

TTeerrrrititoorryy 11 –– CCooiimmbbrraa DDoowwnnttoowwnn AArreaea

POPORIRI

Territory 1

Coimbra : Diagnosed Priority Territories

TTeerrrrititoorryy 22 –– SSubuuburrbbaann BBaarrrriiosos ooff RRoossaa && IIngongotete

PORI

Territory 2 T2 Coimbra : Diagnosed Priority Territories

TTeerrrrititoorryy 33 –– UUnniivveerrssitityy CCaammpupusseess && bbeeyyondond

== …… alalll ooff tthhee citcityy ……

“Queima das Fitas” graduation feast One hundred years ago ? And nowadays… Night Serenade – Fado Songs Parents & Population from all over the country also participate… Graduated students parade…

Green - Agronomy Paradise at the reach of everybody… Orange - Psychology

SSaaffee SSeexx ??…… Medical care – I.V. BEER Girls do it to !... Discoverers of (Latin)America ?... Music festivals ... a week long… always drinking Yellow : Medicine A “Wine Barrel Tomography” … Red : Law School… ConConcclluussiionon -- SSttrraatteeggiicc ChChaalllleennggeses

1. New treatment protocols • Multiple drugs, alcohol & drug(s) • Comorbid mental health problems • Ultra Rapid Detox Protocols

2. Better integration of services & of programs with partners (PORI + …) • Harm reduction - … - Classical “indoor” treatment • After care services, follow-up protocols, treatment continuity

3. Evolution from RAR to RARE - Evaluation at all levels • Cost-efficacy / Efficiency / Health gains

4. Formal Accreditation of Treatment Facilities, Processes & Protocols Hundreds of thousands of people in the city… Bottles all over the place…

Every year the city Mayor has several huge headackes… CCooiimmbbrraa ((FFoottoo)) TTourour

TThhaanknk YYouou YYouou aarree aallll ininvvititeedd toto ththee CCoioimmbbrraa mmeeeetitinng!g! SSeeee youyou nneextxt DDeceecemmbbeer!r!

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