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 - 2004
Political context 2003-2004
The year 2003-2004 was principally marked by government validation on 29th July 2004 of the action plan against illicit drugs, tobacco and alcohol (2004-2008). Publication of the plan marked the end of the process of reform of the law of 1970, a political objective made public some months previously.
The main action strategies in the five-year plan are: prevention (relaying on parents and schools), diversification of services and treatments to ensure more appropriate registrations for care, re-establishment of the scope of the law (implementation of the Evin law, intensification of the fight against trafficking etc.). The proclaimed objectives were accompanied by quantifiable indicators to facilitate evaluation.
The new five-year public health plan, adopted a few days after validation of the 2004-2008 action plan, included for the first time a policy to reduce risks linked to drug use within French legislation, defining it as falling within the responsibilities of the State. The public health plan defined quantified objectives to be achieved by the end of the scheduled five years.
2003 – Key figures
Between the ages of 12 and 18, cannabis is by far the most often tried illicit substance. Regular cannabis use (at least 10 times in the last 30 days) is as frequent as regular use of alcohol among young people aged 17 (12.6% for alcohol and 12.3% for cannabis).
11,200 to 16,900 people were undergoing methadone substitution; 71,800 to 84,500 were receiving HDB (Subutex®) but only 52,000 were actually involved in a treatment process.
Law enforcement authorities recorded 89 deaths due to overdose during the year (continuous downward trend for 10 years).
142 new cases of AIDS were diagnosed and 118 deaths from AIDS recorded among injecting drug users.
Among those attending low threshold facilities who had injected in the previous month, 10% stated they were HIV positive, 58% positive for HVC and 9% for HBV.
The police made 108,141 arrests for drug law offences (84% of which were for narcotic use).
There were 76,124 seizures of illicit narcotics in France during the year, 89% of which were cannabis.
Cannabis resin is sold on average for € 6 per gramme. The selling price of heroin appears to be falling (€ 65 per gramme for white heroin, € 40 per gramme for brown heroin). Three fifths of ecstasy tablets are sold at € 10.
The latest French ESPAD survey (European School survey Project on Alcohol and other Drugs) highlights the changes in use among school children aged from 12 to 18 over the last 10 years (Choquet et al., 2004). Experimentation and repeated use of cannabis have at least doubled among girls, as they have among boys, since 1993. Apart from inhalants and hallucinogenic mushrooms, experimentation levels for illicit substances other than cannabis are very low.
The ESCAPAD 2002 survey (Enquête sur la santé et les consommations lors de l’appel de préparation à la défense – Survey on health and consumption on call-up and preparation for defence day) among young people aged from 17-19 questioned during the call-up and preparation for defence day showed that cannabis remains easily the most frequently-tried illicit psychoactive substance: more than half the 17-19 year-olds stated they had already smoked it (F. Beck and Legleye, 2003b). Experimentation levels for most of the other illicit drugs are still low but are increasing slightly: this is particularly the case with inhaled products, hallucinogenic mushrooms, poppers, ecstasy and amphetamines.
Another remarkable fact highlighted by this survey was that regular use of cannabis among the young people questioned was as frequent as that for alcohol.
The fact that the populations attending the low threshold facilities are becoming younger has been observed for around 2 years by the TREND information system (Bello et al., 2004; Bello et al., 2003). These young users, generally more vulnerable than older ones, can be divided into 3 main groups: users very closely involved with the techno culture, users with social problems who are poorly integrated socially and people who are recent immigrants (particularly from eastern Europe). The young people from the first two groups move on the edges of the "urban scene"1 and the "party scene"2 which results in a certain decompartmentalisation of practices and use.
A decrease in injection practices was recorded at all TREND sites and this trend is confirmed by observations each year: the proportion of those who had injected in the past month in the low threshold facilities decreased from 54% in 2001 to 44% in 2002 and 37% in 2003. At the same time, other data gathered show a growth in sniffing as a method of administering numerous products (particularly cocaine hydrochloride).
The availability of cocaine, which was already increasing the previous year, still seemed to be growing in 2003. There was also more evidence of two other products in the two scenes studied: ecstasy, a product which is well-perceived by users and is becoming more widelyused in the urban scene, and natural hallucinogenic products, particularly because they are well-perceived and can be accessed without going through traffickers (by picking them, growing them at home or purchasing over the internet).
Health, social and criminal indicators
Among the substances which are the reason for patients registering for treatment in the specialised centres for drug addicts, opiates are still in the majority (57%), but the proportion they account for has decreased since the beginning of this decade in favour of cannabis (28%) and stimulants (10%).
The organisation of the consensus conference on substitution treatments provided an opportunity to take stock of the situation in France and in particular to produce a new estimate of the number of people receiving a treatment. In 2003, between 63,000 and 69,000 people began a treatment process (of which 75 to 82% used Subutex®) (A. Cadet-Taïrou et al., 2004) which is slightly less than half the estimated number of opiate consumers (150,000 to 180,000).
All available indicators on deaths linked to drug use, together with a recent survey of the mortality among arrested users (Lopez et al., 2004a; Lopez et al., 2004b), give the same results, confirming a drop in mortality and, more especially, in overdoses linked to opiate use, since the mid-90’s. This decrease coincides with the introduction of substitution treatments and the harm reduction policy in France.
As the trend observed in 2002 continues, criminal indicators (arrests, imprisonment) and seizures are still increasing.
Summary of selected issues
Buprenorphine, treatment, misuse and prescription practices (by Agnès Cadet-Taïrou, Pierre-Yves Bello, OFDT, and Serge Escots, association Graphiti)
High dose buprenorphine (HDB) is the principal substitution treatment used in France. Almost eight years after it came onto the market, the situation with regard to the introduction of this substitution medicine is quite mixed. The treatment enables people who are dependent on opiates to have better access to treatment and to improve their social situation, but there is widespread and growing trafficking in this product, it is frequently injected and its use in drug-taking, not for substitution, seems to be growing.
Alternatives to imprisonment (by Ivana Obradovic, OFDT)
There are many alternatives to imprisonment available in France (substitution orders, community service, personalised sentences, electronic monitoring etc.). Although public discussion inclines towards these alternative measures, the number of these measures used in sentencing for offences against the drug laws fell by almost 25% between 1996 and 2001. The reason for this may lie in the difficulty of implementing these penalties (particularly in relation to collaboration between the legal and welfare and health systems).
Public nuisances related to drug use (by Dominique Lopez, OFDT)
It is difficult to find information on public nuisances linked to drug use. Some cases of NIMBY ("not in my back yard") syndrome and situations where social mediation has been required have been identified but they remain sporadic (or very localised).
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