"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).

"In Vancouver and Lisbon, there are other critical gaps in harm reduction services and programs for YPWUD as well. In both settings, youth-dedicated safer injection, safer smoking, and overdose prevention sites do not exist. The COVID-19 pandemic prompted a scaling up of harm reduction initiatives in both Vancouver and Lisbon [9, 16].

"Despite the relatively progressive policy landscapes of both Vancouver and Lisbon, the soft left hand of low-barrier harm reduction programs continues to be paired with the hard right hand of criminal sanctions and other forms of control in both settings [31]. In Vancouver and Lisbon, police are often tasked with identifying “problem” YPWUD [Young People Who Use Drugs] and making referrals to services [11].

"Current data on individuals imprisoned under the Drug Law (December 31, 2019) points to 1862 inmates (the second lowest number in the decade), mainly convicted for dealing (76%), followed by minor dealing (24%). The category ‘other’ represents less than 1% [27]. Remarkably, there is no information available for the crime of drug use.

"The Supreme Court of Justice, considering that it was not intended to legalize drug use, but only to decriminalize less severe consumption, reestablishes the crime of drug use (article 40°, Decree-Law n. 15/93) for cases in which the amounts identified exceed those established. Later, in 2014, the Constitutional Court did not consider the interpretation of the Supreme Court of Justice unconstitutional and validated its position (judgment n. 587/2014, December 3). Although not fully binding, judgement n.

"In 2008, the Supreme Court of Justice took the position, by judgment (n. 8/2008, August 5), of reestablishing the crime of drug use (article 40°, Decree-Law n. 15/93) when the quantity detected exceeds the average individual use for a period of ten days (behaviour punishable by imprisonment for one year or fine up to 120 days). These quantities are defined by the ordinance Law n. 94/96, March 26, 1996, in use till current days. A number of factors contributed to this situation.

"Safer supply programs are not designed or implemented with the explicit goal of changing injection practices. However, the experiences of clients and providers help us understand how a structural intervention, such as safer supply, can impact other aspects of IDU (e.g., frequency of injection) and its associated health risks (e.g., HIV, HCV, etc.).

"Scaling-up interventions such as naloxone distribution programs, supervised consumption services, and opioid agonist treatment have averted thousands of overdose-related deaths in Canada, but the persistent predominance of fentanyl in the unregulated drug supply continues to fuel overdose-related deaths [4].

"Canada is in the midst of a devastating overdose crisis that has been further exacerbated by the COVID-19 pandemic and, in particular, the subsequent increased toxicity of the drug supply [1]. Between January 2016 and June 2022, close to 33,000 people died from an overdose in Canada, with the provinces of British Columbia, Ontario, and Alberta accounting for 88% of those deaths [2]. Fentanyl, and to a lesser extent fentanyl analogues, have contributed to a sharp rise in the toxicity of the unregulated drug supply and fatal overdoses [2].

"A growing body of data supports the need to deliver HIV prevention in low-barrier settings where PWUD already access services [9]. With opioid use disorder (OUD) increasingly recognized as a chronic and relapsing disease, evidence-based treatment (including medications for OUD [MOUD], harm reduction services, and others) should be integrated into primary care, pharmacies, methadone clinics, social services organizations, fire stations, or other settings alongside other chronic conditions.