Retsudvalget 2013-14
REU Alm.del Bilag 408
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National Policy on
Addictive Behaviours and
Dependencies
Danish Parliament Legal Committee
22nd September
2014
M. D. João Goulão
General-Director
General-Directorate for Intervention on Addictive Behaviors
and Dependencies
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About this presentation:
•
Framework:
•
Geo-demographic situation
•The
problem
•
Milestones:
•
Response evolution
•
key measures
•
Responses:
•
A National Coordination
•
An institutional structure to coordinate and implement the policy
•
A Strategy (1999, 2005, 2013)
•
A new paradigm (Law 30/2000)
•
An Integrated Intervention Model
•
National Plan to Reduce Addictive Behaviours and Dependencies (2013-
2020)
•
Evaluation:
•
Internal
•
External
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Geo-demographic Situation
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Geo-demographic Situation
Population
North/South territorial units
maximum length
East/West
territorial units maximum
length
Surface
10 627 250
652 km
218 km
92 090 Km
2
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The Problem (1990s)
- Cannabis – the most consumed substance
-
Heroin
– the main problematic drug
-
Heroin + cocaine
-
Cocaine
- Intravenous drug use (share of injection paraphernalia)
- Main concern of the Portuguese population
-
1%
of the population (»«100 000 problematic drug users)
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Historical Evolution
- 1975 – CEPD/Cabinet Coordinator - Ministry of Justice
- 1987 – Project VIDA – Presidency of the Council Ministries
- 1987 – Response in the Health Ministry – Taipas Centre
- 1990 – SPTT (CEPD + Taipas) - MS
- 1993 – DL 15/93 (“drug law”)
- Syringe Exchange Program
– Creation of EMCDDA
- 1997 – Treatment network (Law 7/97)
- 1999 – IPDT (PV+GCCD)
- National Drug Strategy
- 2002 – IDT (SPTT + IPDT)
- 2003 – National Coordination (Decree Law 1/2003)
- 2007 – IDT, I.P. (illicits and alcohol)
- 2012 – SICAD + ARS (Addictive Behaviours)
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Key Measures
1.
2.
Treatment
(treatment units network – Law 7/97)
Innovative policies on harm reduction and public
health based on the assumption that
drug addict is
a sick person
- National Syringe Exchange
Program (1993)
- Network of integrated and complementary responses, public-
private partnerships (1999/2004 - DL 16/99 and DL 72/99)
3.
4.
5.
Decriminalisation of Consumption -
Dissuasion
-
Creation of the Commissions for the Dissuasion of Drug
Addiction (2000/2001 – Law 30/2000)
Risk and Harm Reduction Network (DL 183/2001)
Demand Reduction
(2006/2007)
-
Approach, Integrated and Focused Responses
- Centrality in the Citizen and Territory
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Responses
•A
National Coordination
• An
institutional structure to coordinate and
implement the policy
• A
Strategy
(1999, 2005, 2013)
• A new
paradigm
(Law 30/2000)
• An
Integrated Intervention Model
•
National Plan
to Reduce Addictive Behaviours
and Dependencies (2013-2020)
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NATIONAL COORDINATION
STRUCTURE
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COORDINATION STRUCTURE FOR DRUGS,
DRUG ADDICTION AND THE HARMFUL USE OF ALCOHOL
Subsidiary functions
MINISTER
OF HEALTH
INTERMINISTERIAL
COUNCIL
*
Headed by the
Prime-Minister
NATIONAL
COORDINATOR
NACIONAL
COUNCIL
Executive functions
Advisory functions
TECHNICAL
COMMISSION
*Headed by the
National
Coordinator
REPRESENTATIVES OF
CONSTITUCIONAL
BODIES AND CIVIL
SOCIETY
SUBCOMMISSIONS
IDT -
SICAD
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THE INTERMINISTERIAL COUNCIL
Foreign Affairs
Budget/Finances
National Defense
Internal Affairs
Justice
Economy
Agriculture
NATIONAL
COORDINATOR
Environment
Labour
Social Security
Health
Education
Science and Higher
Education
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NATIONAL COUNCIL
PRIME-MINISTER*
5 personalities to be designated by the Prime-Minister
National Coordinator (SICAD General Diretor)
Alcohol beverages trade and industry
representatives
National Association of Local Youth Associations
Regional Governments of Azores and
Madeira
Judiciary Higher Council
Attorney General's Office
National Association of Portuguese Municipalities
National Association of Local Districts
Union of Journalists
National Confederation of Family Associations
National Confederation of Parents' Associations
Associations of students in higher education
and secondary education
National Youth Council
Civic associations active in the field of the fight
against AIDS
Professional associations active in the field of
drugs and drug addiction
Union of Portuguese Mutual
Organizations
*
Or delegation in
the
Minister of
Health
or in the
National
Coordinator
NATIONAL
COUNCIL
Portuguese University Chancellors’ Council
Coordinating Council of Polytechnic Institutes
Portuguese Association of Private Higher
Education
Episcopal Conference
Churches and religious communities settled in
Portugal
Union of Portuguese Mercy Institutions
Union of Private Institutions of Social
Solidarity
Portuguese Federation of Institutions linked
to Drugs and Drug Addiction Fighting
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National Strategy/National Plan
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National Policy
1999 – 1st Portuguese Drug Strategy
(Action Plan 2000/2004)
National Plan Against Drugs and Drug Addiction 2005-2012
(Action Plans 2005-2008, 2009-2012)
National Plan on Alcohol 2010
National Plan to Reduce Addictive Behaviours and Dependencies
2013-2020
(Action Plan 2013-2016)
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Strategic options in the National Policy
1.
2.
3.
4.
5.
6.
7.
Reinforce International Cooperation…
Decriminalise consumption, forbidding it as unlawful
administrative offense
Redirect the bet in Prevention…
Expand and improve the care network…
Extend harm reduction policies…
Promote and encourage social reintegration…
Ensure conditions of access to treatment for addicted
inmates…
8.
Enlargement to other dependencies and addictive
behaviours…
…
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Dissuasion
A new paradigm
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A New Paradigm
Was approved in the Parliament a new legal framework (Law
30/2000); good social acceptance; huge public debate:
- UN Conventions
- Drug tourism destination
- Early consumption
The need to liberate resources from the supply reduction to the fight
against drug trafficking at large scale
Recognition that imprisonment of users has counterproductive
effects
The new Law entered into force the 1st of July 2001 – 13 years!
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The Dissuasion Model
Law No. 30/2000:
the consumption, acquisition and possession for own
consumption of plants, substances or preparations constitute an
administrative offence and can not exceed the quantity previewed for
individual use for a 10 days period. Exceeding this quantity, criminal
procedures take place.
•
•
•
The drug addict is considered a sick person in need of health care;
The dissuasion intervention provides an opportunity for an early, specific
and integrated interface with drug users;
The dissuasion intervention is aimed and targeted to the drug users’
characteristics and individual needs.
–
The use of drugs is still forbidden
Unlike models from other countries where “Drug Courts” were created with
streamlined procedures under the Ministry of Justice, the Commissions for the
Dissuasion of Drug Addiction privilege the health approach.
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Dissuasion Objectives
•
To dissuade consumption – a “second line” for preventive
intervention – the “yellow card”;
• Prevent or reduce the use and abuse of drugs;
• Ensure the health protection of users and the community;
• Guide drug users to more adequate responses regarding their
personal situation;
• Release resources for the fight against trafficking and drug use
related crime (acquisitive crime).
DISSUASION AS A TOOL FOR PREVENTION
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Ten Days Maximum Amount Allowed
Illicit Substance
Heroin
Methadone
Morphine
Opium
Cocaine (hydrochloride)
Cocaine (methyl ester benzoilegonine)
Cannabis (leaves and flowers or fruited dons)
Cannabis (resin)
Cannabis (oil)
LSD
MDMA
Amphetamine
Grams
1
1
2
10
2
0.3
25
5
2.5
0.1
1
1
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Composition of the Commissions (18 + 2
Autonomous Regions)
President and two
other members
Appointed by the
Minister of
Justice and by the
Minister of Health
Multidisciplinary technical support team
Psychologists, Social Service Workers, Lawyers
and Administrative
Prepares a report with all facts and makes a previous evaluation
that supports the decision
Evaluates Motivation of the user to undergo for treatment
Guarantees the function of the referral network
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Procedure
Police
Authority
•A
person is found at a public
place in possession or using drugs
•Occurrence
police report
•The
substance is seized
Commission
•Psychological and social evaluation
•Hearing of the user
•Decision
•The
user is brought to the
Commission in a maximum delay
of 72h
Motivation work
Situation regarding drug
use
Execution of penalties by
Law Enfocement
Authoriites
File Proceedings
Psychosocial situation
Previous register
When the suspension period
expires and the user stopped
to use drugs without record of
relapse, or if penalties were
carried out
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Network
Employment and
Training Services
Treatment Addicts
Centre
Police
Authorities
Coordination between services
with responsibilities in this area
Schools
Health Centre
Indicative Prevention
Answers
Welfare
Services
Prisons
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Decisions and Sanctions
•
Provisional Process Suspension;
•
Periodic Presentation to the Drug Addiction Dissuasion
Commissions;
•
Warning;
•
Community Service;
•
Forbiddance of attending certain places;
•
Apprehension of objects;
•
Interdiction to travel abroad;
•
Interdiction of receiving subsidies or other monetary social
grants;
•
(…)
•
Monetary fee.
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A Model of Integrated
Intervention
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A Model of Integrated Intervention
Prevention
Treatment
Dissuasion
Harm
Reduction
Reintegration
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STRUCTURE OF THE NATIONAL PLAN FOR THE REDUCTION
OF ADDICTIVE BEHAVIOURS AND DEPENDENCIES
2013-2020
DEMAND FIELD:
TRAINING AND COMMUNICATION
INTERNATIONAL RELATIONS AND
COOPEREATION
INFORMATION AND RESEARCH
Life
Cycle
Types of interventions
OPERATION PLAN FOR INTEGRATED
RESPONSES
REFERRAL NETWORK / ARTICULATION IN
THE FRAMEWORK OF THE ADDICTIVE
BEHAVIOURS AND DEPENDENCIES
QUALITY
Contexts
SUPPLY FIELD:
Ilicit
and new psychoactive substances
alcohol, medicines and anabolisers
gambling
COORDINATION
BUDGET
EVALUATION
(Interministerial Plan)
27
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ACTION PLAN 2013-2016
39
SPECIFIC
OBJECTIVES
134
ACTIONS
LIFE CYCLE
RESPONSIBLE ENTITIES
Public Administration
Local Authorities
Public and private entities
High Education Institutions
RESULTING FROM
CONSENSUS AND
ASSUMED BY 150
ENTITIES
SET OUT IN THE
STRATEGIC
DOCUMENTS OF
THE ENTITIES
RESPONSIBLE*
Actions in the demand field are
organised according to the stage of
the lyfe cycle
TIMETABLE
Actions are carried out following a
predetermined timetable
RESPONSIBLE ENTITIES
Scientific Societies
Professional Schools
Industry and Commerce Operators
Entities of the social sector (NGO)
The 150 responsible entities for the
implementation of all actions are
clearly identified
INDICATORS
Resulting from consensus according to
the Action Plans and the activities of
the entities
Trade Unions
National Forum on Alcohol and
Health
*Health
in all
Policies
VERIFICATION SOURCES
All the actions show the sources of
verification of their implementation
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•Some
Results
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Clients distribution by Year and Main Drug
120%
100%
80%
Cannabis
60%
Cocaína
Heroína
40%
20%
0%
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: IDT, I.P.
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Diagnosis of HIV infection by characteristics
of sampled population
Portugal 2003-2012
Number of diagnosis
Year of diagnosis
Source: Relatório Infeção VIH/SIDA: a Situação em Portugal a 31 de
dezembro de 2012 /INSA, IP
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General-Directorate for Intervention
on Addictive Behaviors and
Dependencies (SICAD)
Thank you for your attention
[email protected]
www.sicad.pt