Historically, pharmacies have acted as partners in the fight against AIDS, avoiding the sharing of needles, syringes and other materials used in usage and interrupting the chain of transmission of HIV, while avoiding the danger of abandonment of the leftover material in the streets.

The Programa de Troca de Seringas (PTS) “Diz Não a Uma Seringa em Segunda Mão” (“Exchange of Syringes Program – Say No to a Second Hand Needdle”), partnership funded in 1993 between the Comissão Nacional para a Luta Contra a SIDA - CNLCS, (“National Committee of Fight Against ADIS”), the Ministry of Health and ANF with a goal to prevent the transmission of HIV and other infections transmitted by bloodstream amid users of injectable drugs.

Contrary to expectations, this project did not end on the 31st of December of 1993. At the moment, it is a contractualised and renumerated service by the Ministry of Health, by Portaria nº 301-A/2016 of the 30th of November, available in the pharmacies in mainland Portugal. The PTS made Portugal a pioneer country in the fight against HIV infection among injection drug users: the 2.500 pharmacies that started the Exchange of Syringes on the 1st of October of 1993 exchanged more than 64 million  syringes over the course of three decades.¹ The result was a reduction in the new cases of HIV infection in this population, in addition to clear savings for the State.

The PTS is therefore one of the most important and relevant initiatives in public health where the pharmacies have active participation, being one of the pioneers in the role that pharmacies can and should play in the National Health System. The Program was even elected by the European Commission as the best project submitted by a European country and contributed to the recognition of Portugal as a pioneer in the fight against HIV infection and minimization of the stigma surrounding drug addicts.

Although the number of kits exchanges has progressively reduced, this program remains essential in the prevention of transmissible infections, such as HIV and hepatitis (see priority area 1), reinforcing as its main objective, the role of pharmacies as trusted and accessible agents as the primary point of contact in health promotion. The decline trend in new diagnosis of HIV infection related to the drug abuse since 2000 reflects the results of policies and strategies implemented in this area, specifically risk reduction and harm minimisation programmes that have had an impact on changing the behavior associated with consumption. 

Furthermore, aligned with national objectives to facilitate user access to addiction treatment and improve quality of interventions – as established in the “Plano Nacional para a Redução dos Comportamentos Aditivos e das Dependências 2030 (PNRCAD-2030)”, National Plan for the Reduction of Addictive Behaviours and Addictions 2030, and the Action Plan for the Reduction of Addictive Behaviours and Addictions, Horizon 2024 – pharmacies can once again be part of Opioid Agonist Treatment Programmes (OATP).

For the year 2022, it was estimated that 0,3% of the adult population in the European Union consumed opioids, with heroin being the most commonly used illicit opioid and the main responsible for the burden attributed to illicit drug use.² Pharmacological treatment is the first-line approach for opioid use disorder, combining opioid agonists or antagonists with psychotherapeutic support.

Opioid substitution therapy has been shown to be effective in reducing compulsive cravings and withdrawal symptoms, while also contributing to a decrease in associated risk behaviours, such as reducing the risk of overdose (fatal and non-fatal) and all-cause mortality among people with opioid dependence. Portugal has adopted an interventionist social policy based on preventing the consumption of these substances by promoting health literacy among citizens, particularly young people, and encouraging drug addicts to seek treatment and recovery.^3,4

In Portugal, community pharmacies first participated in opioid substitution therapy programmes between 1998 and 2013.

The OATP promotes a reduction in healthcare costs by reducing emergency care, hospitalizations and treatments for overdoses and preventable infections, as well as greater economic efficiency through their impact on reducing costs associated with the judicial system by reducing crime and incarceration, contributing to a safer and more equitable society. It is therefore imperative to develop initiatives and establish collaborations that aim to meet needs and facilitate access to services, especially in regions with greater needs in the existing support network.