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 - 2002
In France public policy since 1999 covers all psychoactive substances (including legal ones), yet this statement of the situation in the only domain of illicit drugs in France operates at a key point.
At the end of October 2002, six months after the French presidential elections and general elections, the government announced the appointment of a new chair, Didier Jayle, to the Interministerial Mission for the Fight Against Drugs and Drug Addiction [Mission interministérielle de lutte contre la drogue et la toxicomanie] (MILDT) which has the task of coordinating and implementing actions by public authorities in this regard.
Level of consumption
Experimentation with (use of a substance at least once in a lifetime), and indeed current consumption (use over last 12 months) of illicit drugs is marginal in France).
One particular exception should be noted - cannabis, use of which has expanded in the general population during the 90s and which, in 2002 had been tried by nearly one in four French people aged between 15 and 75 (EROPP 2002). Between 1992 and 2002, the figures for experimentation with cannabis nearly doubled for the 18-44 age group, rising from 18% (Health barometer 1992) to 35% (EROPP 2002). This experimentation is particularly commonplace among young people since at 18 it has been tried by one in two adolescents (ESCAPAD 2001). In general, this experimentation takes place shortly after the age of 15. Regular use (at least 10 times in the course of the previous month) of cannabis is much lower, however. at the age of 18, it applies to less than 7% of girls and less than 20% of boys. As a comparison, in 2000, this figure was 1.4% between 18 and 75 (Health Barometer 2000).
As regards the other illicit psychoactive substances, we also note a trend towards increasing experimentation, particularly among young adults and men. For all illicit drugs, with the exception of amphetamines, for which there is no significant difference between the sexes, two or three times more men than women have experimented at some time in their lives. After cannabis, cocaine is the illicit substance most often the subject of experimentation among the 15-75 age group, followed by ecstasy, mushrooms and LSD, all of which come ahead of heroin (EROPP 2002).
At the age of 18, the levels of experimentation among the girls (ESCAPAD 2001), all lower than 4%, are always lower than those of the boys (from 1 to 7%). Just under 5% of young people have experimented with hallucinogenic mushrooms, poppers, ecstasy and inhaled substances. Ecstasy, although the subject of much media coverage, has only been the subject of experimentation for 2.7% of girls (behind inhaled substances and poppers) and 5.0% of boys (behind hallucinogenic mushrooms, inhaled substances and poppers). Experimentation with amphetamines, LSD, cocaine, heroin or crack is even more rare: it involves less than 2% of boys and girls questioned, for each of these substances. When such experimentation does take place, it does so largely in the seventeenth year.
Among populations of those who are already addicts, use of ecstasy is growing in the urban environment (treatment centres, streets, squats and low threshold institutions). Use of this drug is largely occasional and involves rather young, very diverse populations, including fully integrated people. In 2001, a downward trend was observed in the price of tablets and powder and a smaller quantity of MDMA per tablet (which represents a probable standardisation). Other trends: the increase in availability of cocaine and in its use both among urban users in temporary situations and among those taking part in the techno dance scene (locations where rave culture events take place). This greater availability (quantities seized are rising sharply in 2001) is accompanied by a fall in the average price of a gramme. In terms of perception, the fact that this substance has become more commonplace has brought about an alteration in its image in the urban environment. Even though distribution of ketamine remains highly secretive, there does appear to be more frequent use of this drug among drug users too. Its consumption seems to take place in large groups, since in parallel to its distribution on the dance scene, we can observe use of this substance by a small but not insignificant minority of people attending low threshold institutions. These are young users, mainly male, who start using this substance relatively early.
Public health problems
In total, the number of people with problematic use of opiates or cocaine is estimated to be between 150,000 and 180,000 in France. As regards the number of people registered by specialist organizations (which have increased greatly in number), the figures for November 1999 show 65,000 people, more than double the 1989 figures (28,000). As regards the substance giving rise to the registration, the proportion of heroin and opiates is still a majority (62% in 2000), but is in decline, while cannabis has increased its share correspondingly (24% in 2000). For recently consumed substances, 2001 represented a break from the trend, with a rise for heroin after the steady fall since 1995.
Regarding the number of patients undergoing substitution treatment, it is estimated that in France at the end of 2001, there were 90,000 such patients, including just over 10,000 treated with methadone. The other patients are treated with high-dose buprenorphine or Subutex®.
The practice of injecting is the origin of the main health issues suffered by drug users. But several sources now agree that this method of use is in decline, particularly among the youngest users and those who have been using for the least amount of time. This trend is undoubtedly explained by the influence of the risk reduction messages and actions produced by public authorities or by associations in the field: injection is a less attractive practice than it was and the perception of the risk of contamination by the HIV virus or hepatitis B and C is greater. The increase in the accessibility of the substitution treatment substances and the influence of the techno dance culture which basically promotes the non-intravenous methods of use also seem to have contributed to release a proportion of opiate users from the restrictions of injecting.
The total number of deaths due to illicit drugs cannot be estimated. However, deaths by overdose recorded by the police totalled 107 in 2001, the lowest level since the start of the 90s and in particular the maximum recorded in 1994 (564). Deaths associated with heroin are falling while those associated with cocaine and medications are rising. The year 2001 was marked by the emergence of deaths associated with ecstasy: 8 in total including 5 for which it was the only substance recorded. The number of deaths from AIDS amongst drug users continued its fall in 1994 (1044) and settled at 101.
French public action and perception
The transmission of reliable data amongst professionals and also the public was one of the objectives of the 1999-2001 three-year plan (extended to 2002) adopted by the government and implemented by the Inter-ministerial mission against drugs and drug addiction. There are slightly more French people, questioned in 2002 (EROPP 2002), than in 1999 that feel informed about the subject, 61,0 % as opposed to 57,9 %. As far as the ‘information’ flow is concerned, we also note the very slight increase in connections to the internet sitewww.drogues.gouv.fr, opened in December 1999 and making data and information about drugs and addiction available for all, finally the number of calls to DATIS, the national help line is also increasing (although it is reducing questions about drugs are still more frequent that those about alcohol and tobacco).
As in 1999, more than 8 out of 10 French people (EROPP 2002) think that simple experimentation with heroine or with cocaine is dangerous. In relation to 1999 the image of ecstasy has reduced and rejoins that of these two other substances. Half of the population continues to think that experimentation with cannabis is dangerous and two thirds of people questioned believe in the « escalation theory ». Only the proportion surveyed in favour of legally selling cannabis clearly increased between 1999 and 2002 rising from 17 to 24%. Debates. Besides, the law dated 31/12/1970 (in spite of changes in its implementation and the fact that it has in particular been asked to prosecutors to avoid imprisoning users that haven’t committed other crimes) continues to have the principle of the suppression of use. Thus, during 2001 almost 80,000 arrests for use or reselling of drugs were made in France. 93% are arrests for infringement of drug law; the remaining 7% is related to drug dealing. As far as arrests for use are concerned, cannabis is the substance in question, in 90% of cases. Of users questioned by police in 2001, 31 % were "without declared occupation" and 28% were high school pupils and students.
As far as the major objectives of the health policy are concerned, French people accept them. Only 5% of them are opposed (the figure rises to 21,5% when people are questioned about their immediate environment) to the establishment of care centres for drug-users. Almost three quarters of French people (EROPP 2002) think that it is not possible to achieve a world without drugs, which implicitly shows that it should be a priority for French policy: if unable to suppress drug use, then to be in a position to reduce as much as possible the different results of it. Seven out of ten French people know of the existence of the substitution and 8 out of 10 are in favour of prescribing these products. As far as the sale of syringes without a prescription is concerned, 6 out of 10 French people know of it and they are also 6 out of 10 in favour of it. The French are also in favour of information on the subject of drugs (including illicit drugs) at school, therefore, in favour of prevention.
The three-year plan of 1999
The three-year plan for the fight against drugs and the prevention of dependence (1999-2001, extended to 2002) has made the reduction of demand one of its priority areas. The main strategic orientations and actions undertaken to achieve this objective have been the following.
systemisation of prevention, in particular through:
generalisation of committees on education for health and citizenship [comités d’éducation pour la santé et la citoyenneté] (CESC) to ensure prevention in the educational environment. Set up around the head of the establishment, the educational community and the organised forces of social life and the local area, these committees exist in nearly 7 out of 10 schools and secondary establishments.
the development of departmental prevention programmes, in order to provide departmental coordination of prevention actions locally under the responsibility of the ‘drugs and dependence’ project managers. In spring 2001, more than half of all French departments (53) had produced a departmental prevention programme.
early identification combined with continuity of registration:
In order to guarantee early specialist registration (particularly for those teenagers who use several substances) the structures and professionals of the field need to be brought together in a network and to strengthen the liaison function between the registration structures. Over the three-year period, the multidisciplinary liaison teams in hospitals, responsible for guiding the patient towards the most suitable service or treatment centre have gained in strength – in 2000/2001, there were 252 of them. Furthermore it can be seen that 40% of teams up to then divided by substances used have come together to deal with all addictive behaviours. In addition, nearly 8 out of 10 professionals are aware of the existence of a treatment network.
Reduction of risks and damage:
An initial wave of actions concerned the extension of this approach to young people on the dance scene making use of the combined support of the network of organizations and the network of departmental programmes of prevention. The first concern, building on the rave missions of the major subsidized associations, is to help to reduce dangerous use and its consequences (e.g. in terms of road safety). Actions are set up via the departmental prevention programmes: in 2001, 40% of the French departments took preventive actions or provided first aid at dance events.
Operating this policy and developing it for the most marginalized users in particular means strengthening the system: we note a sharp increase in credits while 87 out of 99 departments are now covered. In 2001 there were 227 automatic dispensers of sterile injecting kits, 118 needle exchange programmes, 42 boutiques (emergency health and social provisions) and 4 ‘sleep’in’ (emergency accommodation system). The intention to promote social mediation, while contributing to establishment of a dialogue between users on one hand and risk reduction organizations and neighbours on the other is also acknowledged as is shown by the pilot project set up in the 18th arrondissement.
Development of the substitution policy
In order to reduce the lack of balance between the two substitution treatments in France by promoting use of methadone, the circular of 30th January 2002 extended its initial prescription authorization to doctors working in the hospital (before 2002 treatment instigation was limited to doctors in specialist centres) and therefore made it more accessible to marginalized users seen at the hospital.
At the same time, and in order to fight against the misuse of Subutex®, the limitation of its supply to 7 days was authorized by the decree of 20th September 1999.
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