How Portugal is tackling drug addiction with help from delivery vans
The van, containing supplies of methadone, is part of Portugal's answer to a heroin epidemic going back 20 years.
Saturday 30 May 2020 04:09, UK
On a Lisbon street we watch as a queue forms in the early morning. People are holding bottles of water and waiting for a delivery van to arrive.
When it pulls up, there's an initial rush to the front to be the first to get some of the supplies inside.
The hatch - like you'd see on a food takeaway truck - goes down and the first small plastic cup is handed over. But there's no ordinary beverage inside it.
The liquid is the heroin substitute methadone and what we are seeing is Portugal's answer to a heroin epidemic going back 20 years.
The country decriminalised personal possession and consumption of drugs in 2001 and set up treatment and harm reduction programmes. The methadone programme lies at the heart of that strategy.
The drug users mix the methadone with water (they've had to bring their own bottles since COVID-19) to dilute the bitter taste and swallow it quickly and then head off to their lives.
Some are homeless, others men in suits who arrived in nice cars, there are a handful of council workers in their uniforms. The methadone not only keeps them off street heroin but allows them to function, have jobs, look after their families.
We talk to Tiago Praca whose been a prolific drug user all his adult life. Heroin, crack cocaine, LSD, cannabis, ecstasy - you name it and he's used it. But for the first time in 30 years, since he's been on the methadone programme, he's barely used heroin.
He tells us: "It wasn't necessary to use heroin because I have methadone and this lets me have a regular life. Drugs don't have to be a political, social, economical, criminal problem. This can be a medical problem. This changes my life".
And then he's off on his bike to his pottery studio to make a living.
Close by, we meet Carlos Gomes. A young man whose family live in the UK. He's stopped street drugs for the daily methadone and he turns up religiously at 10am every morning to get his treatment. He tells us that not only is his life better but so is society. He no longer resorts to crime to get a fix.
"I used to steal from people and shops and get the drugs in the ghettos. When I started this programme I stopped stealing. It was the first thing I did, stopped stealing right away. This programme has stopped me doing wrong things."
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He also points to the clean needles they hand out on the van for addicts still using heroin and other drugs. Mr Gomes tells us he has never injected himself but says: "People who inject, before they used to pick up needles from the floor and some people get diseases. Now they come to the van to get (and later dispose of) needles."
And a radical drop in HIV and other infections has been one of the success stories associated with Portugal's approach.
We meet the man widely credited with being the main architect of Portugal's approach. He modestly insists he is just one of the architects. But Dr Joao Goulao, who is now the drugs coordinator for Portugal, insists it is a programme that works.
"We can say for instance in terms of HIV spread we had a dramatic drop in the last 20 years. We have very low numbers. And during the nineties we used to have at least one overdose death a day, around 360 a year.
"Now we around 50, 40 a year. Drug-related criminality has also dropped. So all the indicators show this works."
He goes on: "Of course we did not solve all the problems related to drugs but the problem used to be the top of issues. Now it is very down the list of priorities."
He says the strategy has broad political support and believes that is because for so long in Portugal drugs cut across all of society.
"The epidemic of heroin in the late nineties touched every family. It was across the whole of society, not just the marginalised but the middle class and upper class. We had 1% of the population hooked on heroin."
But the programme has been under extra pressure in recent weeks. COVID-19 has changed all our lives, including addicts.
Because of the lockdown, street supplies of drugs dried up and hundreds more people have been coming to the vans for help.
As we travel in the methadone van the driver Nuno Governo tells us: "No plane, no shop, no cars, means no drugs so we had a lot of people coming to us to search for help. It was stressful. A lot of people wanted to start the programme".
The team has kept operating in Lisbon providing methadone to around 1,300 drug users every day but with fewer staff on the trucks so they can socially distance. Some counselling and other services have had to be done by phone but the priority is to keep links with the addicts.
Hugo Faria, a psychologist and team leader for Area do Pinhal - the non-profit organisation which runs the scheme with government funding, said: "For us it is easy when we see the addiction as a health issue and not a criminal issue.
"If we look at addiction like that it is easy to understand that we have to find people in need of help because otherwise they won't go to the services and there is a public health question, because if they don't go to the services they are not being treated for infections for example."
But there are still some drug users who shun methadone and treatment in favour of the real thing. And in response, this year Portugal set up arguably its most controversial facility yet.
On a late sunny evening, we sit at the side of the road waiting for another van to turn up. It arrives with a nurse and social worker on board.
This is the first and for now only van where addicts can inject drugs safety, with new needles under medical supervision. Most take heroin, crack cocaine or in the case of the man we are watching benzodiazepines.
I ask the nurse Joana Pires whether she sees any contradiction in her role as a healer and being present while people inject potentially lethal drugs.
She says, "No not at all". She is there to make sure the doses are safe, that the user hasn't recently taken other hard drugs, to offer treatment options and to help if anything goes wrong.
"I think this kind of job is a prevention for people who use drugs. It's a prevention of bacterial infection, viral infection, HIV, hepatitis C, tuberculosis. I think we are helping them to consume more safely. It's better to take it here than on the streets," she said.
She says there have been few objections from residents in the area where the van parks, and indeed other communities have asked for similar vehicles. Portugal's approach may be controversial but it has garnered international interest. Other nations exploring whether lessons can be learned here which could work at home.