Breaking stigmas: a mixed-design study on social stigma after 22 years of drug use decriminalisation in Portugal

Background

In 2001, Portugal decriminalised personal drug use, reallocating resources to prevention, harm reduction, treatment, and social reintegration. Our study explores stigma's critical role in affecting the quality of life, rights, and dignity of People Who Use Drugs (PWUD). Addressing gaps in research, we examine post-2001 stigma evolution and public perceptions of PWUD, aligning with global movements against the war on drugs and supporting the 2021 Council of European Union's strategy. Our aim was to inform national and international policies by emphasising stigma's influence on legal frameworks.

Methods

Our specific objectives include studying adult Portuguese residents' perceptions of drug use, describing changes in social stigma toward PWUD post-2001, analysing perspectives on the best drug policy, assessing decriminalisation literacy, and understanding PWUD's views on the reform's impact on social stigma.

Conducting a mixed-methods approach, we employed a snowball sampling-based questionnaire, reproducing and adapting Oliveira's questionnaire (1997), and semi-structured interview. We described participant characteristics using absolute and relative frequencies and explored changes based on gender, age, education, and residence district through correlations and ANOVAs. Qualitative data underwent content analysis.

Results

A total sample of 214 participants, predominantly female (73.8%), highly educated (77%), and residing in Porto (43.5%) were considered. Content analysis highlighted social representations of PWUD characteristics, causes, consequences, and strategies to address drug use. Factors associated included age, unemployment, lack of family support, curiosity, influence of others, and desire to consume. Consequences encompassed crime, personal degradation, illness, death, family problems, and AIDS. Proposed strategies included permissive and prohibitionist approaches, combating trafficking, education, prevention, support for PWUD, integration, socioeconomic aid, and scientific research. Analysis revealed sociodemographic differences and shifts in perceptions since 1997, indicating also limited knowledge but prevailing belief in decriminalisation effectiveness. PWUD reported reduced social stigma, though some stagnation was noted.

Conclusion

Findings suggest reduced stigma post-Law 30/2000, but negative and stereotypical attitudes persist. Targeted interventions and education efforts are needed, considering demographic differences. Males with higher stigma’s levels. Older generations and those with lower education levels hold more negative views. Regional variations indicate less stigma in northern regions. 

Lack of awareness and knowledge about drug law contributes to stigma. Most support drug decriminalisation, with suggestions for regulated markets contrasting past punitive approaches. Prevention and education efforts should consider demographic differences and real-life case-based campaigns.