LISBON — Ines Diniz greets me with an infectious smile as I pop my head under a half-opened metallic awning. I had almost missed her office tucked between a local padaria (bakery) and an apartment building in the city’s northeast. She’s wearing a crimson scarf, washed jeans rolled at the bottom, and a black sweatshirt and boots. Her face, framed by long curly black hair, is buoyant with energy.
Ines’s office is a welcome center measuring the size of a shipping container. The off-white walls are covered with vibrant prints. The biggest one reads “A Rodas das Drogas” on which a colorful wheel details different drug categories and substances. There’s a small grey couch with yellow pillows, a small white table with two metal folding chairs, a brown wooden desk near the back, and, framing the doorway to the next room, postcards each describing an illegal drug, its dosage for human consumption, effects and duration, as well as practical precautions.
It’s a homey space meant to put people at ease. While the drug testing and counseling work Ines does here is legal, and the drugs people bring in for personal use are decriminalized, there is still a lot of stigma associated with discussing drug use and practical harm reduction techniques. Ines wants to change that.
She grew up in Lisbon but must commute into the city now that rents have become unaffordable for many locals like her. She holds an undergraduate degree in sociocultural animation—counseling that encourages active participation in one’s community—and a graduate degree in marketing. But her passion is working in harm reduction, helping guide people through the pleasures and risks of drug use in recreational settings. It’s what she’s wanted to do since she was 17.
That desire led her to working and volunteering as a harm reduction facilitator at festivals, nightclubs and other party settings. The largest in the country is the bi-annual BOOM festival, Portugal’s answer to Burning Man, which attracts more than 40,000 faithful—many, if not most, of whom take drugs during the week-long celebration.
To promote safety and keep the positive vibes flowing, event organizers started providing harm reduction services in 2008 including drug checking, harm reduction tips and crisis services with people like Ines manning tables. In 2016, the ad hoc service grew into its own non-profit called Kosmicare—where Ines works—to expand outside BOOM.
When not focused on combatting drug traffickers, policymakers usually focus on trying to help drug-dependent people in vulnerable situations like homelessness. Meanwhile, the entertainment industry thrives thanks to the much larger number of people who use drugs recreationally.
Around the world, at least 292 million people use drugs, but only 64 million—fewer than 5 percent—have a substance-use disorder, according to the 2024 United Nations World Drug Report. The UN estimates that 228 million people use cannabis, 60 million use opioids, 30 million use amphetamines, 23.5 million use cocaine, and 20 million use ecstasy. And that’s before counting the misuse of prescription drugs, which in the United States includes some 5 percent of the population. (The types of drugs used vary by region and country.)
The 95 percent of drug users who do it recreationally are motivated by a plethora of reasons from seeking enjoyment and relaxation to being part of a community, from simple curiosity to wanting to improve cognitive or physical performance, from overcoming boredom to relieving stress. They do so because of the benefits, experienced or perceived.
Who are these 95 percenters, the kind who use Kosmicare’s services? People who look like you and me, Ines replies. Everyday folks with jobs and roofs over their heads who go home for family holidays but are looking for something that alcohol, nicotine, coffee and other commercialized psychoactive substances can’t provide. I joke that even after a year touring drug consumption rooms on my fellowship, the most drugs I’d ever seen in one place was in a Princeton eating club and a MIT frat house.
Like many activities, the use of a drug comes with its own unique potential for mental, physical or emotional harm. Moreover, because drugs are bought on the black market, additional risks come when suppliers cut their products with adulterants to increase their profit margins.
Ines believes Kosmicare’s services—drug checking, counseling, staff trainings and providing harm reduction widgets—fill a critical hole left by other public health approaches. Educating people so they can make the best decisions for themselves enables them to maximize benefits while minimizing harm to themselves and others. For Ines, that means providing support during all phases of drug use, from before taking a substance of choice, during drug highs and after come downs.
Kosmicare works in three distinct settings: in its drop-in welcome center, at festivals and nightclubs, and at drug consumption rooms. Services are free to anyone who walks through the door or reaches out online, funded by the slim profits Kosmicare receives from servicing festivals, as well as private donors and, since 2019, meager financing from the city and state.
The drop-in center is open Tuesdays and Wednesdays from 4 p.m. to 9 p.m. Anyone can walk in with a sample of a drug for testing and get results back by Friday, in time for weekend plans.
In 2024, Kosmicare assisted 2,777 people at its drop-in center in the central Penha de França district, analyzed 1,188 drug samples on site (a similar number was tested at music events across Portugal), supported 53 people with psychological consultations, reached over 350,000 people online and trained over 540 professionals.
In 2023, for which the group has more specific data, the most common drugs brought in for testing were MDMA, commonly known as “ecstasy,” at 47 percent, LSD at 14 percent, cocaine at 11 percent, ketamine, a type of anesthetic, at 10 percent and 2C-B—an MDMA-like substance—at 5 percent.
While the drugs’ effects vary, their goal is to produce euphoric effects and provide users with energy to last them through a long day or night of music-enhanced rapture. Ines explains that the types of adulterants found during testing change frequently as drug dealers try different mixes to boost their profits. They also change depending on the drug. At the moment, the most common additive in cocaine is phenacetin, an analgesic withdrawn from medical use due to safety concerns.
Another common danger for those buying substances from illegal or quasi-legal markets is the potential they are sold something different than what they thought they were receiving. In 2024, Kosmicare detected a mixture of O-PCE and caffeine sold as ketamine. O-PCE is a novel psychoactive substance with similar but much more potent and long-lasting effects. While a normal dose of ketamine can vary from 30 mg to 75 mg, an equally potent dose of O-PCE is 6-12 mg. The former usually lasts an hour while the latter can last up to five hours, with dissociative effects coming on later. That can lead people to use more in the beginning only to be overwhelmed later.
When a new or particularly dangerous adulterant is found, Ines and her team send warnings through social media and closed group chats for people who use drugs. On discovering O-PCE, Kosmicare’s team issued an alert to prospective ketamine buyers and thwart unscrupulous sellers.
Kosmicare’s machines can detect how many and which type of substances are present in a sample. But only MDMA and 2C-B samples can be tested for purity. Helena Valente, Kosmicare’s president, found through a peer-reviewed study that when people received an unexpected result from their tests, 86 percent of them did not use the substance, 11 percent took a smaller dose, and only 3 percent took it as planned.
Ines believes one of the greatest advantages of drug testing services is that they provide her team a point of contact to engage people over their drug use. While the organization believes it should not prescribe behavior, it offers one-on-one counseling for anyone who walks in the door.
For those trying an unfamiliar drug, counseling can involve a psychologist or psychiatrist advising how best to prepare for a drug-taking experience, explaining how prescribed medications might interact with the drug, exploring the best set and setting for the drug and what dosage could be appropriate for the setting.
When someone visits the drop-in center, Ines makes the most of their time together to share harm reduction widgets and tips. Her most popular tool is a “sniff kit” consisting of a small booklet of individual papers that can be rolled into a tube to snort a powdered drug. She uses it as an opportunity to explain the importance of not sharing snorting devices because of the risk of transmitting Hepatitis B and C, among other diseases.
Kosmicare’s team also offers counseling for folks who might have had challenging experiences and want someone to talk with. Causes include a “bad trip” where people react negatively because they take too much, don’t prepare their bodies and minds appropriately or simply because they happen to react negatively to certain substances. Other cases involve people taken advantage of physically, mentally or sexually during their drug experiences who are looking for a safe refuge to parse their experiences.
When such incidents happen because of drinking too much alcohol—not remembering parts of the night, throwing up or passing out unintentionally—people can often find support from friends, family or even doctors. That level of community and medical support is often lacking when it comes to the use of illicit and novel substances. Internet forums can be misleading, so Ines and her team try to fill the gap.
At the other end of the spectrum, people seek counsel to help moderate, reduce or stop their drug use. Ines and her team have been alarmed at the monthly and sometimes weekly use of drugs like MDMA, which deplete serotonin levels, and ketamine, which can cause permanent damage to the bladder. Kosmicare offers a judgement-free space in which to facilitate conversations with fellow recreational drug users who are trained as peers and experts and understand the particularities of the growing numbers of synthetic drugs.
The second distinct type of service Kosmicare offers is in party settings such as BOOM and Walking Life festivals, as well as some nightclubs. While there is no reliable data for what percentage of festival-goers takes drugs, the gatherings attract disproportionally high numbers of people who do. One festival survey in Australia found 73 percent of participants had used drugs in the previous 12 months, compared to 18 percent of the general population.
Ines wishes Kosmicare’s team could be at every festival in the country, but only a handful of organizers are willing to pay for its life-saving expertise. Money isn’t the only factor. Even in Portugal, where all drugs and drug use paraphernalia have been decriminalized, festival promoters are afraid drug-checking services attract unwanted attention from local governments and the press in a society that still views drugs as morally corrupting.
Still, Ines tells me she’s trying to expand Kosmicare’s services into Lisbon’s nightlife scene. Many of her staff members supplement their income with work in bars and nightclubs because Kosmicare’s limited budget can’t provide them full-time positions. Like festival organizers, most club owners prefer to overlook the white powders fueling their profits. Doing nothing does come at a cost, however: A study in Australia found drug-checking services at festivals could have prevented 64 substance-induced deaths between 2000 and 2019.
For those venues willing to prioritize the safety of their patrons, Kosmicare offers services similar to those in its drop-in center: drug purity testing with a one-hour turnaround, psychological care for those experiencing a “bad trip,” staff training in safely and sensitively handling people on drugs, drug alerts and harm reduction information and materials like saline water to clean and protect nasal passages for those snorting drugs.
Where do people looking to party buy drugs in Portugal? Unlike the Netherlands, which set up quasi-legal coffee shops to sell cannabis, and “smartshops” for psychedelics and other substances, Portugal has quashed commercial attempts to sell drugs in the open.
However, just because there are no visible storefronts doesn’t mean drugs are hard to buy. Ines explains that most people don’t trust street dealers. In fact, the young men who not-so-silently whisper “cocaine, weed” to tourists visiting Cais do Sodre waterfront in central Lisbon aren’t selling drugs at all. “Whatever you want, they always have it,” Ines’s coworker jokes from the back of the room. That’s because it’s all just caffeine powder and tea leaves. It explains why the police are unable to take many dealers off the street through drug charges.
Portugal, along with the rest of Europe, is going through considerable changes in its drug market. The biggest Kosmicare has to confront is the growing number of so called designer drugs, synthetic analogues of prohibited substances devised to skirt the law. Although MDMA is illegal, slightly changing the molecular structure and renaming it methylone or mephedrone makes it not explicitly illegal if not exactly legal either.
Most designer drugs are sold under the auspices that they are “research chemicals” not intended for human consumption. But they are sold openly on the web with consumer reviews sharing personal research. That has led to an endless international cat-and-mouse game between prohibitionist lawmakers and law enforcement on one side and manufacturers and sellers on the other.
While production and supply routes for designer drugs vary, a common one originates in India as side hustles by legally operating pharmaceutical manufacturers. Substantiated reports by the US Department of Justice and the BBC have tracked Indian companies sending fentanyl precursors to the United States and other synthetic opioids to West Africa. The drugs are then directed to the Netherlands, where companies acting legally under Dutch law package them for online retail and sell them across Europe.
When living in the Netherlands, I visited one such retailer that operated out of an industrial park two hours by car outside Amsterdam. Its website is not on the dark web but available for all to see, like Amazon. While some online retailers do their best to test their supply and provide quality products, others are able to be as unscrupulous as street dealers because they operate in a legal grey zone not properly regulated by any government.
Ines points out that some of the novel substances are completely unstudied. MDMA, LSD and other commonly known drugs were created above board by pharmaceutical companies and have been submitted to peer-reviewed scientific studies for decades. Their short- and long-term effects on mind and body are known, so are their typical dosages, duration and how they interact with other drugs and prescription medicine. But information about new synthetic drugs is emerging only as users report their experiences on internet forums. Such commentaries are highly subjective and tend to be untrustworthy, not least because sellers can manipulate reviews to boost their sales.
Ines and her team do their best to stay on top of all new substances but it’s an endless chase. Until governments properly regulate popular drugs, the volatility in the illicit and quasi-legal supply makes it more critical than ever for recreational drug users to have places like Kosmicare to test substances for safety and receive expert advice. When in doubt, the adage “start low and go slow” never fails.
For those wary of using debit cards or bank transactions to purchase quasi-legal substances on the web, messaging apps and social media offer safer refuge. People looking to buy cannabis usually have dealers they know and trust who may not sell anything else and can be summoned by a simple WhatsApp text since fear of law enforcement action is minimal.
Drugs like cocaine, MDMA, ketamine and other synthetics can be purchased through invitation-only group chats on messaging apps like Telegram, which offer stronger end-to-end messaging encryption, protecting users’ communication from prying eyes.
“Are people afraid of fentanyl in the supply?” I ask Ines. She describes two groups of users. One consumes a lot of US news about the fentanyl crisis and tends to be fearful anything may be laced. The second, larger group sees the fentanyl crisis as mainly America’s problem. The reality is that fentanyl and its nitazene opioid cousins have already crossed the Atlantic, causing deaths in the British Isles and northern Europe.
Kosmicare will be at the front lines of fentanyl’s arrival if it does make its way here. Once a month, the organization provides drug checking services for Lisbon’s most vulnerable users at the city’s two drug consumption rooms, where heroin use is most common and fentanyl would likely strike first. Ever smiling, Ines takes the possibility in stride. She’s not going anywhere, she says, and is ready to support and advocate for her community of people who use drugs, come what may.
In early April, I attended one night of the Sonar festival in Lisbon, where I had planned to see Ines and her team at work. Unfortunately, the festival operators decided not to renew their contract with Kosmicare this year. The official website states that drugs are prohibited, but that didn’t seem to be a directive event staff took seriously. As I displayed my Saturday night ticket, the bouncers gave me only a light pat before waving me through.
Inside the Carlos Lopes Pavillion, a beautiful Baroque-style building featuring blue tiled panels on its external and internal façades, locals, expats and tourists gyrated alongside each other to the pounding electronic dance music. The dark cavernous event space flashed red, purple and blue as spotlights crisscrossed the crowd.
Heineken was the official sponsor of the night’s party but few people had drinks in their hands. Many wore dark sunglasses. Protected by the night and given the space to let loose from their daily problems, partygoers of all ages danced for hours in ecstatic unison, each fueled by energy uninitiated onlookers could only speculate about.
As I walked outside for some fresh air, a group of friends surrounded a well-dressed man in his 30s sitting with his face in his hands, seemingly overwhelmed. One friend was trying to coax him to drink water while another looked out for any nearby event staff they’d need to avoid. I thought of Ines and wished the man could have received the care he needed.
Top photo: Sonar Festival Night Stage
