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23 A1 1405 Ricardo Baptista Leite What is the future role of policy makers to facilitate better integration of hepatitis C and drug user health? RICARDO BAPTISTA LEITE, MD, MP Medical Doctor and Member of the Portuguese Parliament Member of the Parliamentary Health Committee | Foreign Affairs Committee National Spokesperson for Health | Social Democratic Party Founder and President | ‘UNITE – Global Parliamentarians Network to End Infectious Diseases’ Vice President | ‘Parliamentary Network on the World Bank and International Monetary Fund’ Head of Public Health | Católica University of Portugal Guest Lecturer | NOVA Medical School Former Deputy Mayor of Cascais [email protected] | @RBaptistaLeite Portugal: Cascais – Sintra – Estoril Coast @RBaptistaLeite Portugal • Iberian Peninsula (South West Europe) • Population of 10,264,226 • Area of 91,590 km2 • Recognised for: @RBaptistaLeite World0meters (2019). Portugal population. Available at: http://www.worldometers.info/world-population/portugal-population/ Accessed: 27/03/19 Portugal: the history behind the drug law 1926–1974 Salazar dictatorship Contributing factors include: Return of soldiers and Portuguese citizens from the colonies 1974 Democratic revolution Lack of knowledge due to the closed nature of the autocratic regime Lack of preparation for the new political and socio-economical status Problematic consumption of drugs @RBaptistaLeite Cabral, T. (2017). The 15th anniversary of the Portuguese drug policy: Its history, its success and its future. Drug Science, Policy and Law. https://doi.org/10.1177/2050324516683640 Portugal: the landscape of drug use pre-2001 Health and Market issues: social issues: • - number of seizures • - treatment demand and in the quantity • - infectious diseases of seized – HIV, HCV reported substances • - drug-related deaths • - LSD and ecstasy • - number of presumed availability drug offenders • - in drug prices at retail level Heroin was the main substance of problematic drug use Increases in reported HIV infections and drug-related deaths between 1991–1998 highlighted the public health risks of heroin injecting and the need for drug policy reform @RBaptistaLeite IPDT for EMCDDA (2000) National report 2000: Portugal. EMCDDA (Lisbon) Available: http://www.emcdda.europa.eu/html.cfm/index34675EN.html Accessed: 22/03/19 Hughes and Stevens (2007) The effects of decriminalization of drug use in Portugal. The Beckley Foundation Drug Policy Programme. Available: https://core.ac.uk/download/pdf/91904.pdf Accessed: 21/03/19 Drug policy options Criminalisation Depenalisation Decriminalisation Legalisation The process in which a A policy in which a criminal When the status of an The process in which a permitted legal act is case previously punished offence is reclassified from prohibited illegal act turned into a criminal can be closed without constitutionally criminal to becomes permitted legal offence by making it proceeding punishment non-criminal behaviour in the country’s illegal legal framework @RBaptistaLeite EMCDDA. Motion graphic: What is decriminalisation of drugs? Accessed: http://www.emcdda.europa.eu/media-library/motion-graphic-what-decriminalisation-drugs_en Available: 20/03/19 2001: policy changes in Portugal 1st July 2001 Pre- 1st July 2001 st Implementation of the Post- 1 July 2001 Drug possession and use Referral to ‘Commissions Law 30/2000. were punishable criminal for the Dissuasion of Drug Decriminalisation of drug offences. Abuse’ within 72 hours. possession, acquisition, Individuals were liable to Administrative sanctions and consumption for fines or up to 3-months of can be given. imprisonment.. personal use*. * ‘Personal use’ was defined as a quantity of drugs that did not exceed the average quantity that an average user consumes over a period of 10 days. Drug use is not legal in Portugal! Hughes and Stevens (2007) The effects of decriminalization of drug use in Portugal. The Beckley Foundation Drug Policy Programme. Available: https://core.ac.uk/download/pdf/91904.pdf Accessed: 21/03/19 EMCDDA Country Legal Profiles (2012) Country legal profiles: Portugal. Available: http://www.emcdda.europa.eu/html.cfm/index5174EN.html?pluginMethod=eldd.countryprofiles&country=PT Accessed: 22/03/19 2001: policy changes in Portugal 1979 1983 1996 2001 (~100.000 Heroin Users) DRUG RELATEDEU COMPARED IMPRISONMENTS CONSUMPTION REHAB SUCCESS RATES DRUG TOURISM CRIME Less than 2% are drug-related (MSW 57,5% | Source: INSA, 1983-2017 1st Dx HIV HAART Drug Addiction as MSM 36,7%) (notified cases until 15.04.2018) in Portugal Health Problem @RBaptistaLeite Main features of the Law 30/2000 Introducing a system of Ending the use of penal sanctions referral to Commissions of for drug possession Dissuasion of Drug Addiction • Regional panels made up (CDTs)of three individuals: • Police refer people who are found in o A social worker, legal advisor and possession of drugs to the CDTs medical professional o The individual appears before the CDT within • Use targeted responses to drug users 72 hours o For example: sanctions like community • Focus police resources on those who profit from services; bans to specific locations the drugs trade • Primary aim is to encourage entry into treatment or education @RBaptistaLeite Hughes and Stevens (2007) The effects of decriminalization of drug use in Portugal. The Beckley Foundation Drug Policy Programme. Available: https://core.ac.uk/download/pdf/91904.pdf Accessed: 21/03/19 Post-2001 policy changes: drug-use Student reports of lifetime drug use between 1995–2011 • Since 2003, use of cannabis increased while use of other drugs remained relatively stable. cannabis drugs other than marijuana or hashish 18 • Rise in cannabis use corresponds to a general 16 trend seen across Europe in the late 1990s and 14 early 2000s 12 10 In 2015: • Lifetime use of cannabis and other substances were (%) 8 slightly lower than the respective European 6 averages of 16% for cannabis and 5% for other 4 substances among students (lower by 1% for each) 2 Percentage of students 0 • Psychoactive substances were also lower than the 1995 1999 2003 2007 2011 European average of 4% (lower by 3%) @RBaptistaLeite = Introduction of the decriminalisation law ESPAD (2015) ESPAD report 2015: Results from European School Survey Project on Alcohol and Other drugs. Available: http://www.espad.org/sites/espad.org/files/ESPAD_report_2015.pdf Accessed: 27/3/19 ESPAD (2011) The 2011 ESPAD report: Substance Use Among Students in 36 European Countries. Available: http://www.espad.org/sites/espad.org/files/The_2011_ESPAD_Report_FULL_2012_10_29.pdf Accessed: 27/3/19 Post-2001: drug-related deaths Opiates Cannabis Methadone Opiate-related deaths declined significantly 300 Cocaine Amphetamines since 2000 with other drug-related deaths remaining mostly constant 250 • Drug-induced deaths has continued to decrease 200 and stabilised between 2011 to 2016 (27 deaths in 2016). 150 • Opioids were detected in majority of these deaths Deaths 100 • In 2016: 50 o Drug-induced mortality rate within 15-64 year olds in Portugal was estimated 3.86 0 deaths per million – the European average 2000 2001 2002 2003 2004 2005 2006 was 21.8 deaths per million = Introduction of the decriminalisation law @RBaptistaLeite EMCDDA. (2018) Portugal Drug Report 2018. Available: http://www.emcdda.europa.eu/countries/drug-reports/2018/portugal/drug-use_en Accessed: 21/03/19 Greenwald. CATO Institute. Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies. 2009. Available https://www.cato.org/publications/white-paper/drug-decriminalization-portugal- lessons-creating-fair-successful-drug-policies Accessed: 20/03/19 Post-2001: treatment entries Between 1999-2003: Since 2007: The number of individuals on substitution 40000 treatment in 1999 and in 2003: 30000 6,04 147 14,87 20000 01999 % 72003 in opioid 10000treatment In 2016: substitution All treatment entrants by primary drug: Number of clients 0 2007 2009 2010 2012 2013 2014 2015 2016 Heroin Cannabis The number of opioid substitution clients decreased in Cocaine Other 2010 and 2013, and has not increased since EMCDDA. (2018) Portugal Drug Report 2018. Available: http://www.emcdda.europa.eu/countries/drug-reports/2018/portugal/drug-use_en Accessed: 21/03/19 Tavares, et al (2005) External and Independent Evaluation of the “National Strategy for the Fight Against Drugs” and of the “National Action Plan for the Fight Against Drugs and Drug Addiction – Horizon 2004”, Portuguese @RBaptistaLeite National Institute of Public Administration, Lisbon. Post-2001: drug-related crime Dealer User Dealer/ User Sentenced dealers decreased from 2003 whilst 2400 users were no longer sentenced to prison from 2001 2000 1600 • The proportion of drug-related offenders* in the prison population also declined: 1200 800 44% 21% 400 Individuals Sentenced 1999 2012 2000 2001 2002 2003 2004 2005 2006 * defined as those who committed offences under the influence of drugs and/or to fund drug consumption) @RBaptistaLeite Murkin. TRANSFORM. Drug decriminalisation in Portugal: setting the record straight. 2014. Available: https://transformdrugs.org/wp-content/uploads/2018/10/Portugal_0.pdf Accessed: 20/03/19 Greenwald. CATO Institute. Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies. 2009. Available https://www.cato.org/publications/white-paper/drug-decriminalization-portugal- lessons-creating-fair-successful-drug-policies. Accessed: 20/03/19 Decriminalisation: Perspectives from PWUDs (I) Factors that still need to be
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