 Good afternoon, everyone. My name is Naomi Berkshine. I'm the Executive Director of Harm Reduction International. As you know, Harm Reduction International hosts the conference here, and I'm happy to welcome you all to the conference in Portugal. This is our official opening press conference, and we hope today to give you a small snapshot of what you can expect to hear tonight in the opening ceremony. This press conference is being streamed live on our conference website. Before I introduce my esteemed colleagues sitting with me here today, let me briefly touch on a few points to set the scene for today and the rest of the week. We're deeply privileged to be here today in Portugal to learn about the health advances made under the Portuguese decriminalisation model. Of course there's room for continued progress, but we must recognise the world still looks to the reforms that Portugal made 20 years ago. We're delighted to have worked with leaders in Portugal to create this opportunity for exposure to the Portuguese model. I understand many of you took a field trip yesterday, and it was a success. I'd like to particularly thank AppDash and Caso for providing our media delegates with such a special opportunity. It's a strong start, and we're really looking forward to being with you here this week in Portugal. But of course as I alluded to, it's not all good news, and sadly where we have advanced, many governments and decision makers continue to sit on their hands. There's been some strong progress in the past three decades, both in terms of governments providing harm reduction services and open political support for health-based, rights-based approach to drugs. But in many cases governments do remain gripped by complacency and are failing to keep up with what is actually required. Globally the availability of harm reduction services has stagnated, and we see this in particular over the past four years. Harm reduction at a government and national level is failing to adapt to new trends in drug use and overdose deaths, which are at crisis level in some parts of Europe, North America and Canada. Globally 99% of the population of people who inject drugs face limited or no coverage of harm reduction services, and we know that injection use is just part of the broader picture. Worst of all, and possibly not surprisingly, there's little money being committed to address this. There's nearly 90% shortfall in funding for harm reduction services in low and middle income countries. In the face of all of this governments continue to spend billions of dollars on law enforcement and punitive drug control. Internationally we're seeing some particularly brutal and violent expressions of the war on drugs, the Philippines being the most egregious example. In 2008 a human rights organization in Bangladesh reported 292 deaths associated with a crackdown on the war on drugs, and we're deeply concerned that there's going to be a mimic effect from the Philippines. So we're now for the harm reduction movement. In the first instance, I think this conference continues the important recognition that drug policy, public health and human rights are inextricably interlinked, and that we need to continue to call for political commitment and for funding in order to mount an effective response. Secondly, as we'll see this week, we need to keep reaffirming the Bank of Scientific Evidence that supports key harm reduction interventions such as drug checking, safe injection sites and opioid substitution treatment. In the US we've had an overdose crisis that's now killing more people than the AIDS did in the same country at the height of the crisis in the 1990s, and we cannot end that without harm reduction. We cannot end it until drug checking and consumption rooms are a non-exceptional everyday part of public health policy. So before I turn over to my esteemed speakers, a bit of housekeeping, we'll be hearing three to four minutes brief remarks from each of our speakers, and then I'll open the floor for your questions. Once the press conference has ended, you're welcome to approach our speakers to arrange a one-on-one. So let's begin. Our first speaker is Jose Kairos, the Executive Director of APDESH, and our local conference partners. I welcome Jose's reflection on what this conference means to the harm reduction community here in Porto and more widely in Portugal. Thank you. I'd like to welcome our fourth speaker, Hui Cuinbras, from Casa. Good afternoon. Thank you very much, Naomi, for your nice words and for your speech. Actually I was with some of you two days ago, so it will be a little bit strange to repeat some of my sentences, but still, when I think about the name of this conference that I told people before politics, what it came to my mind is this idea that our decommissioned model was based on relationship, was based on participation, and was based in creating a common ground between people, between different stakeholders, between professionals, between drug users, between agents from law enforcement, between politicians, between researchers. And I do believe that this was making the difference on those times, 20 years ago, when some political actors in Portugal called a group of experts to design our decommissioned model. And actually one of the greatest things on the work that this group has done, and we have Zhuang alone was one of the members of this group, was the idea to design a new law based on evidence-based, but also based on the knowledge that was already out there, based on the good political models that we could see on those times in the Netherlands, for example, or in Switzerland, even in some parts of the UK, for example, and also it was based on the idea of pragmatism and humanism. And of course one of the things for me that somehow creates a different narrative on that period was the idea that people should be called to design also the law. And that's why the idea of participation was so important when the national strategy was built up. Saying this, I need to say that harm reduction in Portugal, but harm reduction everywhere, is based on these same principles of pragmatism, humanism, participation, inclusion. And that's why harm reduction works so well in Portugal. And that's why harm reduction is a fundamental pillar of our decommissioned model in our country. And this is the pillar that actually has created a huge resistance, a huge combat action that defended the model during the period of austerity. So when even Portugal was facing a huge crisis from the financial point of view, when we were facing unemployment once again, when professionals of harm reduction were being put out of the teams, when the money was not coming, the people from harm reduction, professional and peers, they were resisting and they were still working. Meaning with that, that maybe one of the most important things for people working in harm reduction in Portugal is the belief on the dialogical model that is upon them, but mainly is the belief on the people. And that's why our conference has the name the people before politics, because it's the people who makes the politics, it's the people that are the pillar for decommissioned in Portugal and it is the people that are, you know, the pillar of harm reduction and community progress and development. Thank you, Jose. Our next speaker needs no introduction. Joao Gulau is the current Director-General of the General Directorate for Intervention on Addictive Behaviours and Dependencies, also known as CCAD. But Joao, as most of you know, has been in many ways the official public face of Portugal drug policy over the years, and as an often quoted drug czar. Joao. Thank you. Good afternoon everybody. In fact, as Jose said, harm reduction is a crucial part of our policies, of our drug policies. The so-called Portuguese model is mostly known everywhere about the decision on decriminalising. And of course it is a very, very important decision that was taken 20 years ago, it was published on the 22nd of April of 1999, the strategy that included decriminalisation. But in fact, our policies stand in several mission areas, such as prevention, treatment, supplying treatment to all those in need of it, integration policies, and mostly on harm reduction policies. This is crucial and this is the main source that led us to the progress that we achieved during the last 20 years. So, hosting the International Conference on Harm Reduction here in Portugal, City of Portugal, and we are happy to have been invited to participate, to take an important role on it, I am very thankful to Harm Reduction International and to APRESH. It is for us very important because we have an experience to share, not only on the screen, which I insist is a very important part of our policies, but in all those integrated parts of the integrated policy that we have been putting in place. So, we will take the opportunity to share some views we already have. Yesterday, policy day, and this morning with the Portuguese speaking countries, launching the basis for a more active participation and a more active sharing of experiences in order to lead people to more humane and pragmatic approaches to the drug's problems. Thank you. I am very pleased to introduce our next speaker, Ricardo Baptista Leche. Ricardo is a Portuguese MP and president and founder of the Unite Network of Global Parliamentarians. Unite is a non-profit, non-partisan global network of parliamentarians from state, national and regional parliaments committed to eliminating HIV and AIDS, viral hepatitis and other infectious diseases as public health threats by 2030. Thank you, Ricardo. Thank you, Naomi, and boa tarde. Good afternoon and welcome to Porto. It's with great pleasure that we welcome you here as a physician, as a member of parliament, as a researcher. I couldn't be happier to endorse the efforts towards pushing for harm reduction and decriminalization in a people-centered public health approach as it is a cost-effective, evidence-based, data-based initiative that has saved lives in our country. I must say, as Naomi has mentioned, that I am here as president of Unite, a global network of parliamentarians that are committed to ending infectious diseases as a global health threat. And when the opportunity came about to join efforts with Harm Reduction International and APDES in partnering and supporting the Harm Reduction International Conference in Porto, we did not hesitate one second. We found that there was openness to discuss policy in an open manner, and we used that opportunity very shamelessly. We organized the pre-conference along with APDES and Harm Reduction International, and also INSU, and we organized what we called Joint Action Policy Day yesterday. And the main focus was to bring together parliamentarians from around the world, along with the scientific community, civil society, and media, to be able to discuss these issues and to look at the evidence, not only from Portugal, but beyond. What is working, what is not, and what we need to do better. Unite is a network, as I mentioned, and as Naomi also mentioned, it's a non-profit, non-partisan NGO that has the main focus of bringing together parliamentarians so that we can push parliamentarians in the direction of pushing for the concrete policies that are needed, changing budgets where they are needed, and making sure that they raise awareness when needed. And we do that working along with civil society and community-based organizations. We do it along with media and communication specialists, and we do that along with the scientific community. It is working with all of these different pillars for transformation that we are capable of promoting change globally. We believe that coming from the global health sector, drug policy is a fundamental angle to be able to end stigma and discrimination, especially when we are talking about blood-borne infections such as HIV, AIDS, and viral hepatitis. And it has been shown, and the Portuguese model is a clear example in that direction, that good policies can save lives. And that is, I think, one of the most important messages that we can take out of Portugal. And of course, there is always room to move forward. But as a parliamentarian, and I'll end on this note, I'll leave you with this example. Twenty years ago, when we were seen as an experiment, now we are not an experiment anymore, we are a proven experience. But twenty years ago, not all of parliament was in favor of decriminalization. Today, twenty years later, after millions of lives have been saved, after social calm has been recalled, after crime has gone down, after showing the successes of having a people-centered public health approach, twenty years after decriminalization was approved with part of the support of the parliament, if we were to pass the bill today, we would have unanimous support from all parties. And I can say this from the experience of working with my colleagues from different parties in parliament, through the acknowledgement of the social impact and the consensus that was generated through our actions and through the enormous work that has been done over these last two decades under the leadership of João Goulang and so many people in the civil society movements that have been able to have this transformative change in our society. And I guess that is the most impactful message I can leave you and I'm open to questions. Thank you. Thank you very much, Ricardo. Finally, I'm really pleased to introduce Rui Coimbois-Malera from CASO, which loosely translates to Consumers Survived Together, the local organization of people who use drugs. Rui will provide us with a community perspective and his vision for the future. This has been an amazing day, having all this energy of people fighting for better conditions. It has been 45 years since we are in a democratic country and we are civil society still in development, not a very strong civil society. Well, the model is as broad and from our opinion, from the drug users' opinion, the national strategy is still today fantastic. A brilliant document is translated in English and is still actual in fact. But since the financial crisis, I think that somehow lots of players have to re-read it again. We had a proposed biopsychosocial approach. We had this complex model, this integrated centers with answers that were multi-sectoral, not only from clinic but different sectors, training, employment, housing. With the financial crisis and since 2008, more or less, things have stopped evolving. We have seen that afterwards in 2011 due to the crisis, in fact it was really a blind cut to this mental institute that gave cohesion to the different parts and sectors that were intervening in this area. As we exist since 2008 as an informal group, so we began our work in the moment the model stopped to evolve more or less. So we see that lots of numbers and indicators have gone much better. We see HIV numbers, contagious, everything is gone for better. But this created a kind of invisibility around users. And there are still lots of places where users are living the same war that they were living in the 80s and in the 90s. This year we were working in, we have projects in the neighborhoods. We train the people from the neighborhoods to develop their own projects because they're the ones who know. The peers and the people that are there, they're the ones, they're the first ones. When there's an OD, they're the first ones to be there. And in fact we had a guy that died 20 meters away from us in an abandoned school with lots of users, with lots of homeless people, with lots of sex workers associated with use. And so we still feel that however the quantity, the numbers have gone down, in fact the intensity and the lives of people that are on this frontline of the war are still very miserable and somehow the state can't reach them. Well, the role we've been having is more or less to complement the state and to build the bridge between the outreach teams and these places where people use these more degraded spaces and lives. So we don't want these people to be forgotten, no one should be left behind them. But we feel that so many speeches are being made about inclusion and all this round speech that we want to bring some kind of reality into these issues. And this situation still happens every day. So each day we are not in the correct place. There's another HCV, there's another guy sharing material, then he goes home and so on and so on. We think that this part of the most week should be reinforced and well the model in fact with the crisis was under-invested and this area of arm reduction was under-invested for 20 years and this is a pillar of the Portuguese model like prevention or treatment. But this pillar has been mostly developed by civil society NGOs, not funded 100% in a scheme of pilot projects that lasted for 14 years and it's more than time that this kind of intervention being a pillar of the model becomes a program, becomes a service, something like this. Also in this field of arm reduction the peers can go and we hear a lot we have to work with the hard to reach populations and harder to reach populations and I smile because these are the guys we're with them daily and for us they're not so hard to reach. This should be recognized not as voluntary, non-paid work. This should be developed to a profession or to a role in every outreach team so that the model can be also translated to reality. So welcome to this meeting and I just wanted to bring reality, also Portuguese reality to the table. However I have to say that I'm very grateful to live in Portugal and with this model because lots of places I go to, well, digitalization should be the first step of lots of other investments. Thank you. Thank you so much Roy. Now I'd like to open the floor for questions. We don't have a roving mic today so if you could just speak quite loudly to get your questions out and when I call on you it would be great if you could start by stating your name and the outlet that you're from and tell me who you'd like to direct the question to. The other one is there on legalization and you talk about where we want to process all the ones that are in the United States. Thanks Helen. Should we take one or two other questions and then turn to the panel? Thanks. Thank you. And the third question, great let's start with those two. So we've got a question about how Portugal plans to continue to lead and about perspectives on an overly medicalized approach. I think it's mostly up to me to respond as to the new ways to address the problems such as safe-injecting sites. In fact, those spaces are possible according to our law since 2001. In 2001 we passed a law that made possible a lot of harm reduction approaches including this one. But the political negotiation at the time led us to include in the law the principle that we should have the agreement of the municipality and the central government to open those sites as a pilot, not as a stable response as a pilot process. And the years following that approval we could not reach the consensus between the municipality and the central government when finally some almost ten years later we reached that we have political conditions to do it in Lisbon. When we went to the ground to the people working in harm reduction close to the people what was told to us was okay, not now because injecting drug use is dropping so fast that opening a safe-injecting room right now is completely against the mainstream against the tendency and it's probably a wrong sign to give to the society. That's why we stopped at the moment. At the time the prevalence of injecting drug use was around 3% of drug users. Then we had changes. As Rui said the financial and social crisis came and we had a rebound on injecting drug use mostly from ancient terrarium users. And that's the case and since then we have been trying again to open safe-injecting sites. And it happened last week in Lisbon. For the first time we have the first safe-injecting site, a mobile one circulating in the streets of Lisbon. And in the near future I hope next month probably we will have two fixed sites in Lisbon. And we had today the commitment of the Deputy Mayor of the Porto Municipality stating that is also available. Municipality of Porto is also available to study and endorse a proposal of a consortium of NGOs that presented a proposal to the municipality. So I think the next step is shortly we will have two more sites in Lisbon and I hope perhaps during this year one site at least in Porto. As to taking the lead into legalization of cannabis or whatever. In fact as Ricardo said the political will when we passed the law of decriminalization there was a clear division on the parliament. Some parties supporting the idea, others opposing it, more conservative opposing it. Nowadays we have a consensus about our drugs policies. And in fact all the political parties seem to be quite happy with the status that we have. Last year we had an initiative from one of the parties to pass the medical cannabis that was approved. And shortly after a new proposal came to pass social use of cannabis. That was not even admitted for a discussion in plenary. But I believe this is also due to the political context. We are approaching elections, we will have elections next October. And probably that's why nobody is stepping forward. In any case I believe that decriminalization was a decision that was taken when we were facing a devastating situation in Portugal. Nowadays even if we have, of course we have, we did not solve our drugs problems. All of them we still face new problems. But I believe that we have the tools to fine tune and to in those new targets. So I think we do not need a further legislative step as completely necessary to address those new challenges. And the official position of Portugal is ok. There are some experiences going on in other places. That's the case of Uruguay, that's the case in Canada, very recent experiences. Let's wait for the evidence to come from those experiences. And then we will decide if we move or not into that direction. So this is where we stand concerning this. This was alone. Let's go into principle society switch and then in the background. Is that ok? Just to say that I disagree a little bit with our friend João Galeão. And I think that Portugal actually has a kind of moral duty and moral responsibility to go further in this law. So deignalization has more or less 20 years or has already 20 years. It was quite progressive in some way because it was progressive and not so progressive actually. Because as you can see there were a lot, there were a lot of, not a lot but there were some deignalization laws already in this planet when our law came and was set up. There was also harm reduction as a strategy and as a methodology to work on the field that actually has came up and appeared in the Liverpool, in UK, Amsterdam and in Netherlands. So but I think to do the creative approach of Portugal on those days was the perfect combination between the law and the practices. It was the idea that we should be capable to have a progressive law that opened the opportunities to go further from criminalization to health as João was saying and putting people in the centre of this process. Of course there was something, there was a kind of tricky scene on this that was the idea that the person was not seen as a criminal anymore but started to be seen as a sick person. And to be caught in this concept of sickness and illness. But at the same time that the person, the citizen was appearing with our law, harm reduction structure on the field started to work in a very, in a very, sorry, it's not running well. Can I have the opportunity because it's not what I mean. So my point is we have deignalization, we have a progressive law and then we have harm reduction on the field. With harm reduction what we have is a quite personal approach based on truth relationship to people, addressing people and creating a relation and a dialogue with them. This structural dialogue from my point of view was being missing in the last 20 years. So step by step the Portuguese government, the Portuguese officials from the state, somehow they were creating a huge bureaucratic machine that somehow was freezing the work of drug policy in Portugal. Peer involvement was forgotten during this process. That is not running well. Sorry for this. Thank you. Portugal has been leading, but that should not be our motivation to move forward. Our main motivation should be to do what is based on evidence and data and what is best for the people. And in that sense we need to do more. And I think that the Portuguese model has shown. And then when we look at other countries that have tried to decriminalize that the law alone is not enough. It is part of a greater process that includes of course harm reduction. But we need to acknowledge that there are parts of the system that are still not where we would like them to see. Naloxon access and distribution is still another reality within the system as a whole. And that is something that we need to address. Civil society as was mentioned here is still not perceived by the whole of the National Health Service as part of the National Health Service. It is still something completely external to our health system. And in that sense it leads to difficulties sometimes in terms of articulation of services and providing the care. And as was mentioned, what people called the hard to read population yesterday and the policy day, we heard the term the invisible population. They're real. They're out there. And they're not going to use formal care. And there is a need for us to acknowledge civil society community based organizations as a pillar of the health system as a whole. As we acknowledge primary health care, as we acknowledge hospital care, we need to acknowledge civil society care as part of that. And that's why in the last budget in November 2019 there was a shift in terms of funding from the 80% to the 100%. There is a need now to implement the law in a way that is effective. And it does not undermine the collective efforts that Zhuangolong has mentioned of involving the municipalities as active parts of that process. In terms of cannabis, I think that it's an important issue. I personally as a member of parliament and physician in the past was against legalization. And I changed my position based on evidence and data. Because seeing many countries and states shifting in that direction, I felt that it was my obligation as an elected representative to look at the data and to rethink my position. And by re-looking at the data from Uruguay, from the states in the US, and then from other models that were not as effective as in Spain with the social clubs or in the Netherlands, it became very clear that the impact from an economic, social, judicial and health perspective were all in favor of legalization with the strong regulatory framework. And in that sense I published in the Portuguese medical journal an article which collected all of that evidence and it ended with concrete recommendations for the Portuguese model. And I presented that model to the Social Democratic Party Congress, of which I belong to. And the Social Democrats, which is a center-right party here in Portugal, approved the motion for legalization within that framework. Which was a turning point within, I would say, Portuguese politics. The Social Democrats is currently the biggest party in parliament. And to having endorsed this shift from being against legalization towards being in favor of legalization within this strong regulatory framework, opened the door, and I agree, after the elections next October for the next political cycle to have a very serious discussion. And I could bet that we will see Portugal move in the direction of legalization using the lessons learned of what has worked and what has not worked as well in the states in the US, in Uruguay, and in other countries that have moved in this direction. And this is extremely important because when we look at the dissuasion committees within the model in Portugal, 90% are related to cannabis use. If we solve this issue, we will be opening the door to rethink the whole model. And I think that is a tremendous opportunity for Portugal to perfect what 20 years ago was progressive, but now is lagging and needs to continue to move forward. And on, we've got a really sharp schedule this afternoon, so I'm afraid we're going to have to wrap it up. But as I said at the beginning, we welcome you to approach the speakers one-on-one for more discussion, for better fuller responses to questions and interviews. I'm so sorry we're out of time. Thank you so much.