Annual reports sent to the EMCDDA (European monitoring center for drugs and drug addiction), giving an overview of the latest developments on the drug problem in France.

National report to the EMCDDA 

2013 report

1. Drug policy: legislation, strategies and economic analysis

In France, new legal provisions in 2012-2013 focused mainly on supply reduction. More specifically, they aimed to regulate the sale of medication on the Internet and prevent counterfeiting. The government sought new bilateral agreements on international law enforcement cooperation. In the fight against local drug trafficking, measures that aim to reinforce domestic safety were also adopted.

In September 2013, the government's action plan against drug and addictive behaviours, prepared by the MILDT, was adopted during an interministerial committee meeting. This plan has three main priorities: to base public action on observation, research and evaluation; to take the most exposed populations into consideration to reduce risks and health and social harm; and to reinforce safety, tranquillity and public health, both locally and internationally.

The State budget credits approved to implement the anti-drug policy and treat addictive behaviour was €1,108 million in 2012. National Health Insurance Fund expenditures (Assurance maladie) to fund addiction structures amounted to €334 million in 2012. An additional €37 million in National Health Insurance funding went to two plans related to additions and health in prison settings. In total, the credits used by the government and National Health Insurance Fund in 2012 to implement the anti-drug and addiction behaviour prevention policy amounted to a total of €1,479 million, compared with €1,428 million in 2011.

2. Drug use in the general population and within specific targeted groups

The latest data available on the general population are those of the 2010 INPES Baromètre santé (health barometer survey of the French National Institute for Prevention and Health Education) and of the surveys conducted among teen and school populations (ESCAPAD 2011, ESPAD 2011 and HBSC 2010).

Data from the general population aged 15 to 64 years of age shows a current overall stabilisation of the levels of cannabis use (at around 8.4%). The increase in cannabis lifetime use is linked to a “stock” effect of former generations of smokers. Among the rarer substances, there was a significant increase in cocaine lifetime use and current use (from 2.4% to 3.6% and from 0.5% to 0.9% respectively). The survey furthermore revealed a significant increase in heroin lifetime use (from 0.8% to 1.2%) and hallucinogenic mushroom lifetime use (from 2.6% to 3.1%), whereas ecstasy lifetime use seems to be on the decline.

Among youths aged 11 to 17, the youngest are very little affected by the use of illegal drugs (lifetime use in children under the age of 13 was less than 6.4%). Cannabis remains the most widely used substance by young French people aged 15 and older. Of the other illegal drugs, poppers, inhalants and hallucinogenic mushrooms are the most frequently tried (by age 17, 9.0%, 5.5% and 3.5% of young people had tried these other drugs respectively, versus 41.5% for cannabis).

3. Prevention

Alcohol and tobacco prevention policies largely employ an environmental strategy established by lawmakers. Subsequently, in addition to health education measures, policies employ controls on prices (through taxation), sales (through composition and packaging), distribution and use (in young populations, in certain locations or in certain situations), as well as advertising restrictions.

The year 2012 was one of transition in expectation of the new policy strategies to prevent addictive behaviour. There were no new developments in this area. In 2012, the MILDT engaged into consultations with the different field players to determine a structured evidence-based prevention policy. The school setting (and mainly secondary educational environments) and the occupational environment remain the primary targets for universal prevention.

4. Problem drug use

A multi-centre “capture-recapture” study was launched at the end of 2010 in six French cities: Lille, Lyon, Marseilles, Metz, Rennes and Toulouse. The prevalence data collected in these cities enabled a new assessment to be performed on the number of problem drug users in 2011, leading to estimates ranging from 275,000 to 360,000 people. The mean prevalence values estimated by the different methods seem to be on the rise compared with those of 2006. Nevertheless, it is difficult to confirm an increase given the wide, overlapping confidence intervals for these two years.

The 2012 ENa-CAARUD study demonstrated the significant social vulnerability of problem drug users who frequented harm reduction facilities:
- nearly half of these users (47%) were living in unstable housing conditions (i.e., were homeless, living in squats or living in temporary housing)
- one out of every four users did not have a legal source of income; 57% lived on social welfare (mostly RSA, Active Solidarity Benefit and AAH, Disability Living Allowance)
- approximately 14% of problem drug users had been incarcerated at some point during 2012.

One third (31%) of problem drug users had taken heroin in the last month, nearly 37% had taken High-Dose Buprenorphine (78% of these had taken HDB as a substitution treatment) and 36% had taken cocaine. According to the TREND observation scheme, there was an observed dispersion of the most fragile users, which in turn tended to worsen their precarious situation. There were also increasing problems related to chronic alcohol use in older users. Furthermore, the upward trend in heating and inhaling drugs continued, and spread to the use of substances other than heroin and cocaine..

5. Drug-related treatment: treatment demand and treatment availability

The figures on new patients seen in outpatient CSAPAs in 2012 do not show marked changes in patient characteristics. Mean patient age rose steadily from 2005 to 2011, stabilising at nearly 31 years (30.8) in 2012. This "ageing" is essentially due to an approximate 10-point decrease in the proportion of 15-24-year-olds and a doubling in the proportion of 40-year-olds from almost 11% in 2005 to over 22% in 2012. The data on the primary drug for the 2007-2012 period revealed a slight downward trend for cannabis, despite the increase seen in 2011, and a nearly symmetric increase for opioids.

Nearly 150,000 people were reimbursed for opioid substitution treatments in 2011, with a clear predominance of HDB reimbursements (a typically French phenomenon) representing 71% of the total, even though the proportion of methadone is increasing every year.

6. Health correlates and consequences

The number of new AIDS cases among injecting drug users (IDUs) has fallen continuously since the mid-90s. Of the new AIDS cases diagnosed in 2011, 7.4% of these were among IDUs compared to one quarter in the mid-90s.

The prevalence of HIV and HCV infection appears to have been falling for several years, both because of public health measures and because of changes in practices by drug users. However, the reported HCV prevalence among IDUs is still high: it was approximately 33% in 2012, but the actual prevalence is most likely much higher.

According to the most recent data available, the number of fatal overdoses in 15-to-49–year-olds has stabilised at around 300 since 2008 (294 in 2010 compared with 305 in 2009). In 2010, opioid substitution treatments, and methadone in particular, allegedly caused more overdose deaths than heroin.

7. Responses to drug-related health correlates and consequences

The prevention of drug-related infectious diseases is based on the harm reduction policy, and particularly the distribution of sterile, disposable injection equipment as well as information on the risks related to drug use and on access to opioid substitution treatments. It is also based on encouraging people to undergo screening for HIV, HCV and HBV as well as inciting people to get vaccinated against HBV.

In 2010, 9.9 million syringes were sold or distributed by CAARUDs (including CAARUD automatic dispensing machines), non-CAARUD automatic dispensing machines and pharmacies (Stéribox® kits). Given the absence of data on syringes per unit in pharmacies, it is impossible to compare this figure with the 2008 estimate of 14 million and confirm the continuous downward trend since the late 90s. From 2008-2010, the proportion of CAARUD clients who had never been screened first declined, and then remained stable, before declining once again in 2012. The majority of users who stated being HIV- or HCV-infected had had at least one medical visit for their infection in the last year, but fewer of them were receiving appropriate treatment.

8. Social correlates and social reintegration

As in previous years, indicators in 2011 on the social situation of users seen in CSAPAs seemed to indicate a slight decrease in the precarious lifestyle of users. However, this may have been related to the increase in mean age and in the proportion of people with alcohol problems - two factors related to a lower level of precariousness. Nevertheless, in CAARUDs, there was an increase in the number of very precarious users seen.

Social support for drug users in France is mainly provided by specialised structures (CSAPA and CAARUD). However, in 2010, only 15% of CAARUD activities pertained to providing access to administrative and social entitlements. Of these activities, barely one quarter involved housing interventions, while job-seeking, job-maintaining and training activities only represented 10%.
Housing, training and employment programmes for drug users are implemented in specialised structures, but there is no system in place for monitoring their operations.

9. Drug-related crime, prevention of drug-related crime and prison

In 2012, the number of people accused by law enforcement for simple use was 5 to 6 times higher than for all other drug-related offences (119,185 versus 21,017). Arrests for simple use represented 86% of all drug-related offences. The remaining 14% were arrests for use-dealing or local trafficking; arrests for international trafficking occur with the lowest frequency (1% of all drug-related offences). Cannabis is the reason for 90% of use arrests and 70% of dealing and trafficking arrests.

From 1990 to 2010, the number of drug-related convictions doubled to nearly 50,100, of which more than 29,000 arrests were for simple use. The number of convictions for simple use experienced the biggest increase, tripling since 1990 and experiencing a real jump since 2004 (+16% of mean annual increase).

Convictions for driving under the influence of narcotics also rose sharply in recent years (16,264 in 2011 versus 12,428 in 2010 and fewer than 6,600 in 2008), representing a 31% increase over the last available year. Of these convictions 34% resulted in a prison sentence (a suspended sentence in 80% of these cases), nearly half resulted in a fine and 17% in an alternative sentence (usually driver’s licence confiscation).

10. Drug markets

Some substances, such as heroin and cocaine, were readily available and accessible in 2012. This situation was intensified by the strong presence of networks importing heroin from Afghanistan through the Balkans into Europe and the investment of certain trafficking organisations from disadvantaged suburbs in cocaine. In addition, the proximity of storage countries (Belgium, Netherlands, Spain) for these two substances enabled direct supply to border wholesalers.

For heroin and cocaine, there has been an observed decrease in the purity of seized street samples.

Like in 2011, the two main phenomena that stand out in 2012 pertain to the cannabis and New Psychoactive Substances (NPS) markets. In addition to cannabis factories and cannabis social clubs, there were reports of an increase in commercial indoor growing by individuals in France. Although the Internet is still the main vector for purchasing new psychoactive substances, "direct" sales are being seen with increasing frequency on the alternative techno scene. These sales tend to occur through users or isolated dealers having obtained the product through the Internet and preferring to microtraffic rather than deal through organised networks.

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