Why Lisbon and Porto Are Beating Europe's Drug Problem—But Almada Tells a Troubling Story

The Portugal Institute for Addictive Behaviors and Dependencies (ICAD), working with the European Union Drugs Agency (EUDA), has identified a striking divergence in drug use patterns across three Portuguese urban areas: while Lisbon and Porto saw measurable declines in consumption of several illicit substances between 2024 and 2025, the smaller city of Almada bucked the trend with sharp increases in cocaine, amphetamines, and MDMA—a split that raises questions about the spread of recreational drug culture beyond major metropolitan centers.

Why This Matters

• Lisbon and Porto both recorded below-average European cocaine levels for the first time in years, signaling a potential policy win.

• Almada's cocaine residue jumped from 358.6 to 446.3 mg per 1,000 people daily, overtaking Porto on three key metrics.

• Data comes from wastewater analysis of 115 European cities conducted between March and May 2025—a forensic snapshot of real consumption, not self-reported surveys.

• The findings suggest urban drug patterns are migrating to mid-sized municipalities, complicating nationwide harm-reduction strategies.

What Wastewater Analysis Revealed

The EUDA collaborated with the SCORE research network to measure drug residues in municipal sewage systems, a method that captures actual consumption rather than relying on police seizures or hospital admissions. The study covered Lisbon, Porto, and Almada among 115 European cities, providing a comparative lens on Portugal's three monitored municipalities.

In Lisbon, cocaine traces dropped from 625.1 to 522.6 mg per 1,000 residents per day, while MDMA/ecstasy fell from 81.7 to 60.5 mg. Cannabis residues also declined, from 150.8 to 125.0 mg. The capital now sits below the European average for cocaine—a notable reversal from prior years when Lisbon ranked among the continent's highest consumers.

Porto mirrored the trend: cocaine residues declined from 415.6 to 254.4 mg per 1,000 people daily, and cannabis dropped from 53.3 to 44.6 mg. The city did register a modest uptick in ketamine, from 0.9 to 4.3 mg, though that figure remains far below levels detected in other European cities.

Almada, however, told a different story. The municipality—located across the Tagus estuary from Lisbon and home to roughly 175,000 residents—saw cocaine residues rise to 446.3 mg per 1,000 people daily, surpassing Porto. Amphetamine traces climbed from 5.3 to 10.6 mg, and MDMA from 17.4 to 30.2 mg. Paradoxically, cannabis consumption in Almada fell from 119.1 to 80.0 mg, continuing a nationwide downward trend for that substance.

The Almada Anomaly

Researchers have not pinpointed a single cause for Almada's upward trajectory, but the data aligns with a broader European observation: recreational drug use is no longer confined to capital cities. Mid-sized towns with younger populations, accessible nightlife, and proximity to major transit hubs are increasingly mirroring consumption patterns once associated with larger urban centers.

Almada's geography may play a role. The city benefits from direct ferry and bridge connections to Lisbon, making it a commuter hub and a spillover zone for the capital's nightlife economy. Analysts suggest that weekend recreational use—evidenced by higher residue levels on Saturdays and Sundays—drives the cocaine and MDMA upticks, a pattern consistent with party and festival contexts rather than daily dependency.

The ICAD has noted growing complexity in Portugal's addictive behaviors, with polysubstance use on the rise and social risk factors intensifying. Cocaine, in particular, has climbed to its highest treatment-admission rate in a decade as of 2024, and overdose deaths involving the stimulant accounted for 65% of fatal cases nationally in recent statistics.

National Context: Cannabis Down, Cocaine Up

Nationwide, cannabis remains the most widely consumed illicit drug, with 2% of the population aged 15 to 74 reporting recent use in the 2024 European Online Drug Survey—and 5% among those aged 15 to 34. Yet overall youth prevalence of any drug has fallen to its lowest level since 2015, according to ICAD.

Cocaine, by contrast, is ascendant. Portugal has emerged as a significant entry point for cocaine into Europe, with police dismantling six clandestine production sites in 2023 and 2024 and seizing a record 22 tonnes of the substance in 2023 alone. The stimulant's availability has contributed to rising health and social harms, including a troubling increase in crack consumption in Lisbon and Porto, where half of users smoked the substance and half injected it—often in combination with heroin.

Amphetamines and methamphetamines remain marginal in Portugal. The 2025 wastewater study found zero detectable amphetamine loads in all three monitored cities, a sharp contrast with northern and central European markets where those substances dominate.

Impact on Residents and Policy

For public health officials, the split between Almada and the two larger cities complicates resource allocation. Harm-reduction services—needle exchanges, overdose-prevention sites, and treatment clinics—have historically concentrated in Lisbon and Porto, where visible drug use and treatment demand were highest. Almada's surge suggests the need for a more distributed network of interventions, particularly targeting younger adults in recreational settings.

For municipal authorities, the findings underscore the limitations of policing alone. Wastewater data cannot identify individual users or pinpoint neighborhoods, but it does offer a real-time pulse on consumption trends, enabling cities to adjust outreach campaigns, allocate prevention budgets, and coordinate with nightlife venues.

Residents in Almada may notice an uptick in overdose incidents and associated emergency-service calls, a pattern already visible in national statistics. The Portugal Ministry of Health has flagged rising overdoses over the past three years, with cocaine implicated in the majority of cases. Community-based organizations and local governments are under pressure to expand naloxone distribution and peer-support networks.

What Comes Next

The EUDA and ICAD plan to continue annual wastewater monitoring, expanding to additional Portuguese municipalities. The next survey round, scheduled for spring 2026, will test whether Almada's spike was an anomaly or the start of a sustained pattern. Meanwhile, the national ECATD-CAD study—published in April 2025 and based on online surveys of students aged 13 to 18—will provide complementary data on youth attitudes and early-stage use.

Policymakers face a delicate balance. Portugal's decriminalization framework, in place since 2001, has been credited with reducing HIV transmission and stabilizing opioid overdoses, but it was designed for an era when heroin was the primary concern. The current landscape—dominated by cocaine, MDMA, and synthetic cannabinoids—demands updated strategies that address recreational contexts, polysubstance use, and the diffusion of drug culture into smaller cities.

For now, the data offers a mixed verdict: major cities are moving in the right direction, but the problem is migrating rather than disappearing. Almada's trajectory serves as a reminder that drug markets are fluid, and effective responses must be equally adaptive.