Overview:
This is the second story in a three-part series on drug policy in Portugal and Canada. Canadian Affairs reporter Alexandra Keeler was in Portugal throughout December to conduct this reporting.
If a Canadian visiting Portugal is caught by police smoking a joint on the beach, they could find themselves in front of a panel of experts discouraging them from using drugs the very next day.
“If you’re caught smoking a joint in Vila do Bispo, you’ll be notified to go to the Dissuasion Commission in Faro the next morning, even if you’re not a resident and are just there working for a short time,” said Nuno Capaz, a member of an interdisciplinary Dissuasion Commission team that evaluates drug users in Portugal.
Dissuasion Commissions are a key part of Portugal’s innovative approach to drug policy, which has seen the country almost eliminate overdose deaths over the past 25 years.
Experts say these commissions are effective because they work quickly and direct individuals to resources that are tailored to their needs.
“The time lapse between being caught by a police officer on the street and being in front of a nurse or a medical doctor in a treatment centre — I can do that in less than 24 hours,” said Capaz.
“That’s unbeatable as a diversion scheme.”
Dissuasion Commissions
Portugal created Dissuasion Commissions in 2001 when the country passed a law decriminalizing all personal drug use.
Operating under the country’s health ministry, these administrative bodies receive most of their referrals from police, who are authorized to confiscate individuals’ drugs and direct them to commissions.
Today, 22 commissions serve the country of 10 million people. Each commission includes a team of legal and health or social service professionals who evaluate an individual’s drug use habits, social situation and motivation for change. They may offer warnings, provide guidance on accessing harm reduction services or refer individuals for treatment.
Portugal’s drug policy model is often cited in Canadian and international drug policy debates, and Canadian experts have referenced it when considering decriminalization reforms.
Yet, Canada does not have anything equivalent to Portugal’s Dissuasion Commissions, and decriminalization pilot projects have not tried to implement them.
‘Automatic’
In Portugal, police are mandated to refer people caught with illicit drugs to the Dissuasion Commissions.
“This diversion scheme works for us because … the diversion is automatically done by the law,” said Capaz. “When the police officer catches someone, they refer them [to a commission].”
However, individuals’ participation in the commissions is largely voluntary. “The only mandatory thing is the showing up after the first notification by the police forces,” said Capaz, who has been working for the commissions since they were created in 2001.
Individuals do not face criminal penalties for using drugs, either before or after a visit to a commission, and any decision to enter treatment is always voluntary.
Capaz describes the “dissuasion” as soft and non-coercive. “We confront people with [health impacts] they [may] already know, and we do it in a very open, humane, non-moralistic way.”
“We’re not trying to push people into treatment, we are just giving them a good opportunity to get into a treatment structure.”
Commissions assess individuals using the World Health Organization’s ASSIST tool, which asks about substance use. The commissions also evaluate lifestyle factors such as employment and housing status, family conflict and mental health.
“Most of the medium-risk users that we see here are not medium-risk because of the usage of the substance. It’s because of those other factors,” said Capaz.
“[Sometimes we recommend] not counseling for usage of drugs … or treatment, but an appointment at the unemployment centre of the residential area.”
Capaz says people are generally poorly informed about the health impacts of using drugs.
Commissions are strictly health-focused, says Capaz. “[Drug] tests are not ‘clean’ or ‘dirty’ — they’re ‘positive’ or ‘negative’,” he said.
“The courts do not have any other thing to use except humiliating users, and that’s why they use that sort of language, because it’s diminishing for the users and makes them afraid of them. We don’t do that.”
Breaking the cycle
Capaz says most of the people the Dissuasion Commissions see are non-problematic, recreational users.
For people considered medium- or high-risk, the commissions offer to connect them with health and social services, including employment or educational programs.
“What I’ve noticed working in the Dissuasion Commission for the last 24 years is that most of the drug users … are more than willing to go to treatment — they do know that they have a problem,” said Capaz.
“They are just postponing it because the hangover effects are fairly fast, so they need to work fast getting the next fix, and [say], ‘Tomorrow I’ll go look into treatment.’
“The problem is that when they wake up tomorrow … they go back to their cycle of getting the next fix and postponing the treatment.”
The commissions are therefore designed to work quickly, offering next-day appointments and requiring minimal paperwork.
Capaz says most people arrive uncertain of what to expect. “[People] don’t know how the system works, so normally they are thinking that we are some sort of court,” he said.
“In the end, people are fairly happier than when they show up.”
A report published in October found the commissions had conducted nearly 6,000 hearings in 2024. Adults aged 20-24 were the largest group.
Of the 4,357 referrals for low- or moderate-risk individuals, 90 per cent were directed to specialized services through Portugal’s Service for Intervention in Addictive Behaviours and Dependencies (ICAD), an agency that coordinates addictions services nationally.
The 545 high-risk individuals identified by the commissions received tailored interventions, including residential treatment.
‘Open to everyone’
When commissions refer individuals for treatment, it is to residential or outpatient programs largely run by NGOs or private providers and financed primarily by the state.
Dissuasion Commission reports do not track whether those referrals lead to successful treatment or long-term behavioural change.
In recent years, budget constraints and uneven funding across districts have narrowed referral options.
“Some of the programs had their budget cut, so they are not able to respond like they used to,” said Capaz. “Different [commissions also] have different resources in the network available for them to refer people.”
This resource disparity reflects political neglect, says Dr. Manuel Cardoso, deputy director-general of ICAD.
“In the last 12 years, after the boom [when] Portugal’s model [was known] as the best, governments decided not to invest in this field,” he said. “[We] have a very strong deficit of medical doctors, psychologists, nurses … and our capacity is very, very low at this moment.”
The government covers, on average, about 80 per cent of treatment costs, but fully covers low-income patients. Patients can pay privately to bypass waiting lists. Long-term residential treatment programs face the longest delays.
“But this is not the 28-days thing,” said Capaz, about their residential treatment programs. “People are not waiting six months to be one month inside an institution — it’s the 12-step, full abstinence approach. It’s one year [or] one year and a half, in the countryside somewhere.”
ICAD’s current mission is to rebuild capacity. “The most important [thing] to do is to … try to have treatment or the door open to everyone who wants to enter,” said Cardosa.
While individuals may face delays accessing treatment, Capaz says they are never left without support. “It’s not like people are left by themselves for six months until they have a bed,” he said. Individuals may be sent to short-term or outpatient programs or receive methadone while waiting for access to a long-term facility.
But Capaz says that expanding the referral network could dramatically improve outcomes. “If I had 2,500 different structures where I could refer people, I would be a very happy camper,” he said.
“I would be able to refer everyone to the specific thing that they actually need.”
