Low threshold methadone program: 13 years of experience in Portugal

The Portuguese capital, Lisbon, is part of a metropolitan area consisting of troubled urban and suburban neighbourhoods. This area has characteristics which intensify and perpetuate the phenomenon of drug addiction, leading to a high number of drug addicts. The personal and social disturbances experienced by these individuals result in a lack of motivation and/or ability to seek treatment, creating street addicts, most of whom are opiate-dependent (polydrug users or otherwise). Successfully reaching this population entails the use of proximity strategies, including an ambulatory medical and psychosocial program with methadone administration in a low threshold program (LTMP-Lx). This report describes the key characteristics of this program, including how the program: (a) supports opiate users (including polydrug users) of legal age, with no social or familial supports; (b) contributes to the diagnosis and improvement of health and social conditions, and reduction in heroin use; (c) facilitates increased contact between this population and health and LTMP-Lx professionals; (d) enhances knowledge about infectious and other diseases; (e) contributes to harm reduction in drug use and sexual practices, and; (f) promotes referrals to other health, social services, and treatment facilities. Method: LTMP-Lx supports approximately 1250 users daily. Taking into account the most recent scientific studies, we will describe in this chapter the main tools and procedures used in LTMP-Lx.Results: We will outline the results regarding: a) demographic characterization (gender, age and housing situation), toxicological history and previous treatments, risk behaviors in drug use, sexual habits and legal situation; b) impact in respect of personal health (HIV, HCV, HBV, tuberculosis and syphilis); and c) impact with regard to public health. Conclusion: Preliminary results reveal that users of LTMP-Lx: i) were mainly male, 39 years old on average, and had several years’ history of illegal drug use, such as heroin and cocaine; around half of them used intravenous injections and showed risk behaviors in drug use and sexual habits before being admitted to LTMP-Lx, and there were a significant number of homeless users who had never gone through any kind of treatment; ii) regarding HIV, the majority did not know their serological status when admitted to the program, and of the few who did, almost half showed a positive result. Almost all users were submitted to medical tracking, after which it transpired that approximately 25% showed positive serology results. With regard to tuberculosis, only a few knew their situation when being admitted to LTMP-Lx, and medical tracking showed that there was a higher occurrence of the disease compared to the general population; the program has had a success rate close to 100% in its treatment with tuberculostatics administration in DOTS (Directly Observed Treatment Short course); iii) these data clearly demonstrate LTMP-Lx to be a fundamental support program to the marginalized population, with a considerable impact when it comes to personal and public health. Final results will be presented later in this chapter.