"To be sure, the Portuguese model is not perfect. It has been criticized, for example, on the ground that there is a contradiction between the ideas of consent to treatment and the obligation to go to Commissions which, in turn, can apply sanctions (to people who do not have a substance use disorder) [6]. That is especially relevant today, as 90% of people using drugs are classified as not having a disorder (a vast majority of them using cannabis). Moreover, some efficient harm-reduction measures are still very limited in scope (e.g. drug-checking services or supervised drug consumption facilities) or inexistent (e.g. provision of syringes in prisons or outpatient naloxone prescription). Additionally, the framing of Portuguese drug addiction as a ‘disease’ is somehow pathologizing and might undermine the right to agency and self-determination of people using drugs, who still experience stigma, discrimination and sometimes violence from police, service and health-care providers and the community at large [7]. Finally, the 2008 decision of the Supreme Court (discussed below) led to an increase in criminal sentences related to drug use.

"Nevertheless, it is undeniable that the system brought positive results. Hughes & Stevens, for example, have compared Portugal to neighbouring countries that did not introduce significant reforms in the period 2001–11 and showed that Portugal is the only country that exhibited a decline in hazardous drug use [8]. More recent data show that hazardous drug use in Portugal has continued to fall since 2010 and that the country has the lowest drug-related death rates in Europe today [5, 9]. Since the reform, moreover, Portuguese police officers have been able to shift resources from people using drugs to drug traffickers. Consequently, the amount of drugs seized has increased for all categories, and the number of people incarcerated on the account of drug use decreased—thus reducing justice overload [10]. The reform was also a profitable investment for the state, as the economic benefits (e.g. decrease in health-related and legal system expenditures) were higher than its costs. § Finally, the success is recognized internationally: despite strong initial opposition, the Portuguese approach has been described as a ‘model of best practices’ by the President of the International Narcotics Control Board (INCB) [10, p. 23]."