a public health approach as a base for drugs policy: the …€¦ · 1 a public health approach as...
TRANSCRIPT
Side Event, 20 April 2016, New York
João Goulão
General-Director for Intervention on Addictive Behaviours and Dependencies
National Coordinator on Drugs, Drug Addiction and the Harmful Use of Alcohol
Ministry of Health, PORTUGAL
(SICAD)
1
A public health approach as a base for Drugs
Policy: the Portuguese case
2
Coordinated Public Health-oriented Approach Based On 5 Pillars:
PORTUGUESE POLICY
2
Treatment
Prevention
Harm
Reduction
Reintegration
Dissuasion
DECRIMINALISATION
3
Decriminalisation Law:
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
15 years after
SOME RESULTS
4
Small increase reported in illicit drug use amongst adults;
Reduced illicit drug use among adolescents, at least since 2003;
Reduced burden of drug offenders on the criminal justice system;
Reduction in the prevalence of injecting drug use;
Reduction in opiate-related deaths and infectious diseases;
Reduced stigmatization of drug users;
Increases in the amounts of seized drugs ;
Reductions in the retail prices of drugs;
Increased efficiency of Police and Customs.
5
TRENDS SINCE 2001
5
Processes and Offenders 2001-2015
6
2125
4850 5669 5574 5925 5561 5563
6674 6417 6617 7388
8424 8740 8843
10327
2246
6025
6785
5900
7365 6972
7432
7342 8411 7870 7388
9046 9316 9455
11014
0
5000
10000
15000
20000
25000
2001* 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Number of Offenders Number of Processes
Source: SICAD: EMPECO
Intervention in Dissuasion
112.567 Processes
98.697 Offenders
50.438
Non – problematic Drug Users
11.877 Problematic Drug
Users
13.343
9.373
Specialized Support
7.693 Treatment
Teams/Centre of Integrated Responses
Referrals 2001-2015
Source: SICAD: EMPECO
Study – effects of the intervention based in the activity of the
Commission
In your opinion what is the purpose of the Commission?
8
(n=318)
Participants
Source: SICAD: EMPECO
5
9
16
43
63
67
71
0 20 40 60 80
Other function
To punish/penalise
Referal to Health Services
To inform about the law
To help change the lifestyle
To inform about the problems associated with theuse of illicit substances
Help to quit the use of illicit substances
%
Study – effects of the intervention based in the activity of the Commission
Globally do you consider that the Commission contributed to change your life?
9
(n=304)
Participants
Source: SICAD: EMPECO
Yes 55%
No 45%
Inform 9,9%
Law 0,7%
Induce reflection/awareness 9,2%
Quality of life (health focus) 7,6%
Others (+ appreciation family/friends,…) 6,9%
Reflect about Use 25,0%
Life Style 5,3%
Motivate for change 3,3%
Drugs and consequences of use 9,5%
NATIONAL SURVEY – GENERAL POPULATION
DRUG USE IN THE GENERAL POPULATION, PORTUGAL
TOTAL (15-64 YEARS) LIFETIME PREVALENCE BY TYPE OF DRUG (%)
10 Source: Balsa et al. , 2014 / SICAD: DMI-DEI
NATIONAL SURVEY – GENERAL POPULATION
DRUG USE IN THE GENERAL POPULATION, PORTUGAL
YOUNG ADULT POPULATION (15-34 YEARS)
LIFETIME PREVALENCE BY TYPE OF DRUG (%)
11 Source: Balsa et al. , 2014 / SICAD: DMI-DEI
Increase of treatment demand, specially amongst cannabis users
62 65 65
51
34
26 24
13 11
13
15
18
17 18
13 12 13
26
38 49 51
12 12 9 7 10 8 7
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2008 2009 2010 2011 2012 2013 2014
New Patients
Heroin Cocaine Cannabis Others
Source: SICAD - DEI
Injection drug Use in the last 12 months
14 14
21
18 17
10
12
11 10 11
9
6
3 3
24
22
27
24
23
15
21
0
5
10
15
20
25
30
2008 2009 2010 2011 2012 2013 2014
%
Total New Patients Readmitted Patients
Source: SICAD - DEI
Diagnose of HIV infection by characteristics of sampled population, Portugal 1983-2014
Source: INSA, IP (2015). Infeção VIH/SIDA: in Portugal a 31 de dezembro de 2014. Lisboa: Instituto Nacional de saúde Doutor Ricardo Jorge, IP
Year of diagnosis
Num
ber
of d
iagnosis
Drug addict Other Heterossexual Homo/bissexual
Reduction of drug-related deaths
…
15
168
64% 143
72%
141
73%
138
88% 158
84%
162
88% 187
85%
94
36%
56
28%
52
27%
19
12% 29
16%
22
12% 33
15%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2008 2009 2010 2011 2012 2013 2014
Other Causes of death Overdoses Total
Source: SICAD - DEI
Nowadays the decriminalisation model was redefined: the priority and the
strategic option is the early intervention approach among young cannabis
users.
We are taking advantage of the preventive potential of the Commissions,
together with the police authorities.
Dissuasion is, now, more than a
“second line” for preventive intervention
Lessons ....
19
DRUG POLICIES
SHOULD BE BASED ON HEALTH
AND NOT ON PUNISHMENT
SOME CONCLUSIONS
17
Scientific consensus that criminal sanctions are ineffective and
counter-productive; they do nothing to address drug use
consequences.
Nowhere International Drug Conventions require that personal
use should be criminalised
HEALTH PROTECTION
INSTEAD
OF PUNISHMENT
Thank you for your attention!
SICAD
General Directorate on Addictive Behaviours and Dependencies
Avenida da República n.º 61 - do 1º ao 3º e do 7ºao 9º 1050-189 Lisboa - Portugal
T. + 351 211 119 000 - F. + 351 211 112 795
[email protected] – www.sicad.pt