One of the highlights of my trip to Portugal was meeting psychologist Hugo Faria, the Coordinator and his team with the Mobile Low Threshold Methadone Program. It's van is one of two operating in Lisbon and was established in 2001 and provides an intervention-program that is part of an integrated harm reduction strategy. They are paired with a safe consumption site which allows both injectable and inhaling services.
The vans serve between 1300 and 1400 patients each day as they move throughout the community. The team take blood samples and urinalysis, screening for active disease such as HepC, HIV and TB. It is part of an integrated information system working directly with doctors and social workers as part of a patient-centred approach. The goal is to help people move towards a better life, stabilize themselves while staying connected to services.
The Portuguese model is based on this kind of connection and a belief it is better to have an inclusive system with a “wide open door” helping more people than to push them out through applied pressure which cuts them off from necessary resources. They don’t look at treatment as an institution or as a project, instead it’s a program based on meeting people where they are at and finding different ways to help support them towards recovery. People using drugs in Portugal aren’t dying the first time they use them, there is a difference between the substances available in Portugal vs what we are seeing in Canada. During national financial crises, such as in 2008 and 2012, consumption rates rise significantly. As Portugal deals with current inflationary pressures, it is quickly ramping up their systems because they are seeing a recent spike in relapses related to stress.