Review on the contribution to evaluating the policy for health risk reduction in intravenous drug users

The acronym SIAMOIS describes the system for information about accessibility to pharmacy materials for injection and replacement. A "risk reduction" policy was developed in France around ten years ago. Its aim is to prevent the development of health and social problems associated with drug use, particularly AIDS and Hepatitis B and C (HBV and HCV) infections from syringe sharing among intravenous drug users (IVDU). 

It is based both on improving access of IVDU who cannot or do not wish to give up this type of drug consumption, to sterile syringes, and on reducing injections for other users. In order to achieve these goals, sterile syringes have been sold without prescription in pharmacies since May 1987 or have been distributed free by more than one hundred associations since March 1995. substitution substances designed for oral use have been prescribed in primary care since March 1995 (méthadone) and February 1996 (Subutex®). 

Evaluation of accessibility to these risk reduction instruments is based principally on: 

• measuring the adoption level of this policy from the sale of sterile syringes and replacement substances in pharmacies. 
• assessing whether the distribution of these risk reduction instruments is appropriate for the local situation. 
• measuring the impact of accessibility from the national to local scales using specific indicators associated with drug use. 

We present here a database which helps to monitor the sales of risk reduction instruments and then examine the major trends which have emerged from this follow up between 1996 and 1999 by comparing these with specific indicators for both risk and health and social problems associated with drug addiction.