Lisbon currently counts about 1400 drug users, already followed by specialist teams. The Lisbon City Council has now developed a long-awaited response: the Monitored Use Mobile Programme. This pilot project, the first of its kind in the country, was launched in April 2019, in Beato, and has already been extended to the Arroios Parish Council.
Aimed at socially disadvantaged users suffering from several health conditions, the mobile unit allows the use of illegal substances, brought by the users themselves, under the supervision of professionals trained to act in emergency situations.
The unit is not only a safe place to use drugs, but seeks to provide medical and psychological support to users and find adequate social responses, tailored to each case.
‘Instead of using drugs on the streets, as is usually the case, users come to the mobile unit, where they are supervised by specialised technicians, adequately trained to act in case of an adverse event, such as an overdose,’ explains Diana Gautier, a social assistant with Doctors of the World and responsible for the implementation of this project, in partnership with the Group of Activists for Treatment (GAT).
The team, which travels in a nondescript van between Beato and Arroios, two neighbourhoods where drug use is prevalent, is formed by psychologist Adriana Curado (GAT), peer educator Vítor Correia and nurse Patrícia Nunes.
This programme has by no means encouraged crime, traffic or theft, as drug use already existed at the locations where the project was implemented.
A starting point for other types of support
In addition to using drugs, many of the people who seek this service are homeless and suffer from several health conditions (namely HIV or hepatitis C), mental health problems and estrangement from their families: ‘Therefore, we have a multidisciplinary team, such as to identify the best responses for each individual each case,’ stresses Diana Gautier.
‘Sometimes people just want to chat, drink a cup of coffee and have something to eat. They get their problems off their chest, talk about their doubts and tell me they’ve been long waiting for a solution like this’, explains peer educator Vítor Correia.
About 120 people are currently registered with the programme. Although a small number are former users who are now clean but still experience health or social problems, the majority are users of injectable drugs who live on the streets.
‘We are able to reach an extremely vulnerable group of users. More than 70% are homeless, their use habits entail high risks and their social and health condition is also very fragile. Through our evaluation, we manage to reach a group urgently in need of this type of intervention,’ explains psychologist Adriana Curado.
Impact on the community
This project was implemented with the support of residents, local associations, parish councils and police forces, which were given the opportunity to become familiar with the programme in advance, clarify doubts and discuss locations.
It was a peaceful process, where all parties participated, explains Diana Gautier: ‘We witnessed huge engagement and participation, which was important to ensuring the project was well-received and gathered the support of all. When we take people off the streets, drug use in the open decreases, as does waste, which brings benefits to the entire community.’
Injectable drugs are used at one of two small tables installed inside the van for this purpose. The van is equipped with disinfectant, a recipient for contaminated materials and all necessary consumables. Users bring the drugs and must declare what they will use and what they’ve already used on that day.
Sharing of consumables is one of the main modes of Hepatitis C transmission. To reduce this risk, the team provides users with individual pipes and syringes. All users wishing to come to the mobile unit must be over 18 and register with the programme.
The efficacy of peer educators
Adriana Curado underlines the key role played by peer educators in the success of this programme. Peer educators are people who use or have used drugs in the past, which allows them to better identify with users: ‘We believe that peer educators reach the target population very effectively. They speak the same language, manage to bring people to us, identify needs a lot more quickly and often achieve what technicians fail to accomplish.’
This is the case of peer educator Vítor Correia, who says he’d never imagined he’d be part of a project like this: ‘If this programme had been created 40 years ago, 75% of people with this problem wouldn’t have died.’ Vítor defends this programme with all his heart and underlines that the people who are using on the streets have no idea of the dimension of this problem. ‘They gain knowledge they didn’t have and that’s good, because they’ll share what they’ve learned and start using drugs in a much more correct way, without risking their health, which brings benefits to all.’
The Monitored Use Mobile Programme, a pioneer project in the country, is promoted and funded by the Municipality and is being implemented by Doctors of the World and GAT.
The programme is monitored by a commission composed of the Lisbon City Council, the Intervention Service for Addictive Behaviour and Dependence, the Intervention Department for Addictive Behaviour and Dependence and the Lisbon and Tagus Valley Regional Health Administration.
Objectives of the Monitored Use Programme
To reduce the number of new infections: HIV, Hepatitis C, Hepatitis B and others;
To identify and monitor Tuberculosis treatment;
To avoid lethal overdoses;
To reach heavy-drug users, such as to ensure they receive healthcare and other support;
To reduce the use of drugs and associated consumables in public areas.
Services available at the Mobile Unit
Provision of consumables for Risk Reduction and Damage Minimisation purposes;
Monitoring and/or forwarding of users to other services;
Screening of infections: HIV, HBV, HCV and Syphilis (forwarding in case of positive tests).
Diana Gautier – Social Assistant and Project Co-coordinator – Doctors of the World
Avenida de Ceuta (Sul), Lote 4 – Loja 1,
Telephone: 213 619 521
Adriana Curado – Psychologist and Project Co-coordinator – GAT - Group of Activists for Treatment
Avenida de Paris, 4, 1º dto.,
Telephone: 210 967 826
Adriana Curado - Psicóloga e Co-Coordenadora do projeto - GAT - Grupo de Ativistas em Tratamentos
Avenida de Paris, número 4, 1º direito,
Telefone: 210 967 826
Text: Mafalda Ferraz
Photography: Armindo Ribeiro and Manuel Levita
Video: Cláudia Silva and Jorge Ramalho