I give our work number to anyone who wants it. Users call when they need new needles or a safe place to stay the night. One of my patients used to call frequently, threatening suicide. Eventually he went to an addiction rehabilitation program.
We encourage users to collect their discarded material, but we help them. I always cover my legs when picking up needles to keep from getting stabbed. In summer, I wear loose satin trousers to stay cool. In winter, I prefer leggings or jeans.
Used needles can pass HIV or hepatitis, and the frequency of transmission is a real health crisis. When we visit neighborhoods, users deposit old spikes into the containers and take the new ones. Containers are then burned as a precaution.
We give foil out to people who smoke heroin. Some users are surprised we hand out the sheets and not just the new needles. We like to encourage people to smoke instead of inject, which is more dangerous, and most users don’t have money to buy foil.
This helps users recognize me when it’s dark. I have to be careful, though, because police look out for it, too. Even though personal drug use is not a crime, users complain about police brutality. I try my best to avoid meeting users if police are in the area.
These fliers show the safest way to inject. I don’t ever judge users on their methods, but I do explain that certain areas of the body present greater risk. For example, shooting into your legs increases the chance of a dangerous blood clot.
STDs are a huge problem in the drug-user community. They become an even bigger issue when users make money doing sex work. I always give them condoms and, if they ask for it, lube, which can minimize vaginal tearing and bleeding.
I used to wear latex gloves when picking up syringes and other trash from the street. Now I also use these tongs. They were a gift from one of my patients. He, like many users, collects scrap metal to make money. He found these and thought of me.
I also give pipes to crack users. They have complained about the design, which they say is difficult to smoke and clean because the metal filter is difficult to remove. I came up with a competition: Whoever finds a way to remove it more easily gets 50 euros.
Once I’m out of sight, I write down pertinent information: the patient’s medical issues, how many new needles were exchanged. Personal information is confidential, but the general data help us apply for government funding each year.
It’s almost midnight when Marta Nascimento strides up to a young sex worker and her john who are loitering in Lisbon’s run-down Martim Moniz neighborhood. Nascimento opens her backpack, which is brimming with syringes, aluminum foil, and crack pipes. The sex worker asks only for condoms, though — she doesn’t need drug paraphernalia tonight. Confused, the john asks if Nascimento is carrying. “She doesn’t sell drugs,” the sex worker explains, “just distributes the material to do them.”
Zipping up the backpack after handing the woman several condoms, Nascimento interjects to correct her: “It’s to make doing drugs less risky.”
A psychologist by training, Nascimento, 37, works for Crescer na Maior, a public health organization that facilitates needle and pipe exchanges among Lisbon’s drug users. The group’s methods reflect Portugal’s unique drug policies. In 2001, the country became the first in the world to decriminalize personal use of all narcotics. Dealing and trafficking are still illegal, but individuals are allowed to possess small amounts — up to two grams of cocaine, for example — without running afoul of the law. The government has also invested in harm-reduction initiatives for addicts, including methadone programs and needle exchanges. (Crescer na Maior is partially state-funded.) The results have been significant: From 2001 to 2014, new AIDS cases among drug users fell from 518 to just 42.
Not everyone supports the government’s approach. Nascimento says users and even some colleagues have been harassed for what critics say is “enabling drug use.” Yet she sees her work as necessary. “I don’t believe a drugs-free world is possible. Some people will always turn to substances to find solutions to their problems,” Nascimento told Foreign Policy in October. “This way, we’re improving their lives.”