Portugal is celebrated for its progressive drug policy, yet tobacco harm reduction remains sidelined. At GFN 2025 in Warsaw, Adriana Curado of GAT in Lisbon shows how nicotine became “the forgotten substance.” From her own move away from smoking to a pioneering vaping project with people who use drugs and those experiencing homelessness, Curado exposes public health contradictions, the persistence of stigma, and why safer nicotine options matter—especially for marginalized groups.
Featuring:
ADRIANA CURADO
Harm Reduction Expert, Community Research Officer
Grupo de Ativistas em Tratamentos (GAT)
@curadoadriana
Transcription:
00:10 - 00:40
[Brent Stafford]
Hi everybody, I'm Brent Stafford and welcome to another edition of RegWatch on GFN.TV. We're here in Warsaw, Poland for the 12th edition of the Global Forum on Nicotine, the annual conference on safer nicotine products and tobacco harm reduction. And joining us today is somebody fascinating, Adriana Curado, who's the Community Research Officer with GATT, the Group of Activists in Treatment in Lisbon, Portugal. What is harm reduction like on the ground in Portugal?
00:41 - 01:39
[Adriana Curado]
So, harm reduction is very well accepted in the drug Portuguese model that has been praised internationally. But on the ground, actually, we have a more complex picture since it is recognized, but it is also underfunded. And it's a very precarious pillar of our model. And we are not really reaching all people that could benefit. And one example for today is that we are not reaching tobacco smokers, for example. or we are ignoring, even among people who use drugs, those who are also smoking and we are not really addressing it.
01:40 - 01:44
[Brent Stafford]
Explain for our audience, if you would, what is the Portuguese model?
01:45 - 02:31
[Adriana Curado]
So Portugal decriminalized drug use and possession back in 2001 and this was really a huge step and also at around the same time we scaled up armed reduction services. But again, we are still having a lot of gaps. We took almost 20 years to have the first drug consumption room in the country. So we are still missing a lot of responses. And the coverage outside the big cities, it's really hard to get armed reduction services.
02:31 - 02:38
[Brent Stafford]
So was tobacco harm reduction always conceived to be a part of that model or is it something that came later?
02:38 - 03:08
[Adriana Curado]
No. Tobacco policies and tobacco programs are not under the National Drug Agency. So under this agency we have alcohol and illicit drugs, but not tobacco. It's a separate public health program. And I think this is also one of the reasons why harm reduction strategies are not really reaching the tobacco policies and programs in the country.
03:08 - 03:13
[Brent Stafford]
So there is a divide then between drugs harm reduction and tobacco harm reduction?
03:13 - 03:14
[Adriana Curado]
Yes, yes.
03:15 - 03:16
[Brent Stafford]
Why do you think that is?
03:17 - 04:08
[Adriana Curado]
Yeah, I think we have this institutional problem and divide, but then I think we are kind of normalizing tobacco. So even in our reduction programmes we are talking openly about all kinds of drugs, But we are ignoring tobacco. We don't talk about tobacco. So it's just normal, we think that is normal for people who use drugs that they smoke tobacco. So we are not incorporating in our strategies, in our daily work, this substance, this drug, nicotine. So it's a bit, it's a contradiction.
04:09 - 04:18
[Brent Stafford]
There's an old saying amongst those that are in Alcoholics Anonymous, for instance, if you take away the caffeine in the cigarette, you don't have a program.
04:19 - 04:21
[Adriana Curado]
Yeah.
04:22 - 04:26
[Brent Stafford]
What was it that first pulled you into tobacco harm reduction?
04:27 - 06:15
[Adriana Curado]
I think the first reason is personal. I've been a smoker or a cigarette smoker, let's say, for almost 30 years. And at my second pregnancy, I decided to act, to do something about it. So I started looking for options, alternatives, and it was also the time that I applied for KAC traineeship. It was at the same time, this personal movement and also doing this application to the program. So I went into different products, pouches, gums, patches, and vaping, disposable vapes, and now I'm more on heated tobacco, but also sometimes vaping. and the good thing is that i i didn't went go back to to cigarettes after this it's almost three years oh congratulations so at first it was also personal but then i decided okay i'm i'm also okay i'm working in trucksville for many years i'm working with a very vulnerable people that are living and using drugs in the street I might do something about tobacco as well. So I did this KAC scholarship which was great and it became a new area of activism for me, not only to provide services but also as an advocate.
06:15 - 06:24
[Brent Stafford]
So as an advocate, is there any difference between tobacco harm reduction and drugs harm reduction?
06:24 - 07:34
[Adriana Curado]
Yeah, again, in the illicit drugs, harm reduction is now mainstream, very well accepted. All the international authorities and they recommend to implement harm reduction for illicit drugs. And it makes all the sense. But for tobacco, no. So I feel that we are having much more difficulties nowadays in the tobacco advocacy. And when you go, and we have some conversation in Portugal when I did this project, to talk with some health officials or doctors. This is being looked with suspicion. We know that. This is, again, the industry plot and all this disinformation is around in a very, very strong way. So it's difficult.
07:34 - 07:41
[Brent Stafford]
So I guess with drugs, there wasn't some big bad corporation behind it.
07:41 - 07:54
[Adriana Curado]
Yeah. So there are no corporations, but there are the criminal activity. So it's, yeah. Yeah, that's one of the differences.
07:55 - 08:11
[Brent Stafford]
So the big bad corporation is almost worse than the criminals. Yeah. Does it shock you a little to see that there's so much resistance to tobacco harm reduction?
08:11 - 09:22
[Adriana Curado]
Yeah. It's a huge contradiction, but I think we also took many years in the illicit tracks to get harm reduction accepted. So it was not an immediate achievement. And I think another thing that has helped us in a sense, it was the HIV crisis in the 80s and 90s, where HIV medicines were not effective and a large number of people were dying. So I think the roots of harm reduction are are in this crisis and for tobacco that also kills people but kills slowly so maybe This is a... We don't have this huge crisis, public health crisis, or we have, but it's less visible for the public, for the politicians, for the... And that makes some sense, doesn't it?
09:22 - 09:24
[Brent Stafford]
Because an overdose is immediate.
09:25 - 09:25
[Adriana Curado]
Yes.
09:25 - 09:30
[Brent Stafford]
AIDS, you know, killed very quickly. Lung cancer could take decades.
09:31 - 09:37
[Adriana Curado]
Exactly. So we have this. But both are causing harm to people.
09:37 - 10:05
[Brent Stafford]
I would argue that nowhere near criminal penalties and all of the stuff that caused harm that was ancillary to drugs. But in a way, they're starting to ramp up the penalties and punishment for people who continue to smoke or to vape. You seem to be demonized Like a drug user used to be demonized.
10:05 - 10:05
[Adriana Curado]
Yes.
10:06 - 10:18
[Brent Stafford]
How does anybody in the harm reduction movement just accept the demonization of nicotine when they've spent so long fighting the demonization?
10:18 - 10:32
[Adriana Curado]
We shouldn't accept that because we know very well We have a long history of stigma, discrimination, criminalization, punishment, so we shouldn't accept this.
10:33 - 10:36
[Brent Stafford]
But yet it is being accepted, right?
10:37 - 11:24
[Adriana Curado]
Yeah, I don't see this kind of, at least in my bubble, let's say, I don't see that people are in for punishing smokers. Inside the armed reduction people, I don't see this thing or this desire for punishment of other users, tobacco users, I don't see. But we know very well, and this is one of the lessons from the illicit drugs, that restrictive, punitive policies don't work. We know this and there is a lot of evidence about this.
11:25 - 11:34
[Brent Stafford]
You ran a project offering vaping support to people who use drugs and those experiencing homelessness. How did that come together?
11:34 - 13:15
[Adriana Curado]
So this was in KAC scholarship and I decided to work with the people I'm already working so because they are smoking. And we did these community groups. We decided to run two different groups because we also want to grasp some of the diversity inside the community who use drugs. and we recruited in people in our army induction projects we are also running a housing first program it's not only for people who use drugs but I would say that most of the people in our housing first programs are also using drugs alcohol and tobacco and everything so we decided to to have a a group, a community group with women who use drugs because they were already doing some initiatives, community initiatives together, this group of women. So we wanted to build on that dynamic. And we also asked, recruited some people in the housing first, because they recently went to a home, so they were more, in a sense, more stable. And we want to see if there are any differences, at least with the new products, safer nicotine products. We wanted to see that.
13:15 - 13:21
[Brent Stafford]
So describe for us exactly what happened. I guess they met weekly. What are the things that you would do?
13:22 - 14:39
[Adriana Curado]
Yes. So this was weekly. We met weekly in our armed action spaces that they already know. It's familiar for people. And we just make a very informal meeting. People can come. They can pick up products for the week. We always have food around just to make a conversation. It was really flexible and we also worked with a colleague with creative or artistic skills. We played music. Also to explore the perceptions and narratives around nicotine tobacco use we talked a lot how we start smoking what we feel why we smoke when we smoke and all this in a very friendly way and our objective was never push people to adopt the product or or stop smoking or no, we really wanted each person to explore the products, to share the experience and to decide what to do.
14:39 - 14:41
[Brent Stafford]
So these were nicotine vapes?
14:42 - 15:29
[Adriana Curado]
Yeah. First, we start with disposable vapes because it's quite easy and we have to consider that most of our people, they have never tried any of these products. They might see around people around but they cannot afford to buy the product so they were most of them they have never tried before so we start with the disposable vapes and then we had a few sessions and we start also using the e-cigarette conventional that we can refill with the liquid and and it allows us more choice in terms of the level of nicotine and also the flavors that are available.
15:30 - 15:31
[Brent Stafford]
Flavors were important?
15:31 - 16:00
[Adriana Curado]
Yes, very much. And as I saw a presentation today, a panel about the flavors, and it's very similar results. People, after a while, they prefer the fruit flavors and other flavors than the Baco. Yeah, that's what we saw also in our groups.
16:00 - 16:05
[Brent Stafford]
So did they gravitate more towards disposables or the reusable refillable?
16:06 - 16:51
[Adriana Curado]
I think disposables are very appealing for their simplicity. It's easy to use and it's for people who are in the street. They cannot charge the device or they cannot. So it's easier for some people. It was easier. But in the end, I think most of the people prefer the reusable ones because you have more choice and more personalized options and then it's cheaper over time that you can buy the liquid and refill it and you can have easily your needs are met in a cheapest way so
16:51 - 17:16
[Brent Stafford]
So those are two things that we've talked about over the years in terms of whether or not vaping was something that could really work for the marginalized community on the street, which would be charging the batteries, the e-juice and the cost. And so has that changed? Are they actually viable for people that don't necessarily have a home?
17:17 - 18:55
[Adriana Curado]
Yeah, I think they are. I think they are. Because people also need to charge their phones. There are always a place where you can charge. Of course, it's more difficult, but it's because life is more difficult in the street. It's not... So I think it's viable and some of our results show us that people with low incomes also are facing a lot of stress in their lives and they are facing an additional stress that they don't have enough money to suppress the cravings for nicotine. And these kind of products, if we find the right way to give support to people to access these products, can be very successful in helping people to manage their nicotine dependence. So I truly believe that people do care. and people want options as any other person so yeah the more cynical people would would be uh skeptical that somebody living on the street would care about their health enough to quit smoking but yet yeah yeah that's a myth you know people do care and they want to do something about but this was never addressed and So that's the reason why it's invisible. No one is talking about this. With the people.
18:56 - 19:03
[Brent Stafford]
So working with the people on this project, were they aware of safer nicotine products prior to the project?
19:03 - 19:50
[Adriana Curado]
They knew because now especially the disposable vapes are spreading. You can buy it at the grocery store, you can buy it everywhere. So they also see it in the streets. But it was not accessible because of the price. It costs almost a double of a pack of cigarettes. So it's quite expensive. And also what we saw is that they had the same access to the same kind of misinformation. Oh, vaping is more dangerous. And we also
19:52 - 19:54
[Brent Stafford]
So the misinformation knows no bounds.
19:54 - 19:57
[Adriana Curado]
Yeah, exactly. Exactly.
19:59 - 20:04
[Brent Stafford]
Where do you think those views came from, that misunderstanding?
20:04 - 20:34
[Adriana Curado]
I think it was not so specific. I think it was word of mouth, mostly, because people were repeating this type of things, but if you ask more details about this, they couldn't tell you. So it's this general misinformation that goes everywhere, maybe a media headline, and sometimes also the health professionals are playing a role there.
20:34 - 20:49
[Brent Stafford]
Right, that would have been my assumption that public health has not been the best advocate. So tell me, what should THR activists take from the project?
20:49 - 21:22
[Adriana Curado]
I think the main lesson is what we just said, that people do care. People want to do something about smoking, but they need options and support and easy access to the products. I think it's this. I think it's the same we did in the past with the syringe programs that we made them accessible. Because people do care about their elf.
21:24 - 21:29
[Brent Stafford]
With all of the bans and stuff that have been happening, I mean, are you worried that... Yeah.
21:31 - 21:49
[Adriana Curado]
Yeah. Because these bans are cutting options and Again, it's striking because they are not banning cigarettes, but are banning safer options. So we shouldn't go into that direction. People need options.
21:51 - 22:03
[Brent Stafford]
Could you ever imagine after all these years working in the drug harms reduction space, that public health and government and all these people would make such a big deal about nicotine?
22:03 - 24:06
[Adriana Curado]
Yeah, yeah. Because people, I think there is a big confusion about the nicotine itself, the substance. And I think also that we have also a big confusion about addiction. Because addiction is seen as always bad. But we know that that's not true. We humans, we need routines, we need connections. We are full of addictions around us and not all addictions are bad or cause harm. Because nicotine has a lot of benefits as well. We know very well that there is a lot of positive aspects of using nicotine. And one of them is mental health, dealing with anxiety, stress, focus. So there are a lot of, it's like caffeine in a sense. Why are we ignoring the benefits of the substances while we are ignoring the large number of adult smokers that need to switch or stop or reduce or go away from tobacco and from the combustion that is the critical aspect of harm? So this is totally crazy. We are seeing a tree and not the big picture. Okay, we all agree that we should prevent young people to become a smoker or nicotine dependent. We all agree on that, but we cannot ignore the large number of adults that need to stop to improve their health. This is nonsense.