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
1. Drug policy: legislation, strategies and economic analysis
The 2013-2017 Government Plan for Combating Drugs and Addictive Behaviours, presented in September 2013, has three major priorities: basing public action on observation, research and evaluation, considering the most exposed populations (young people, women and marginal populations) and reinforcing public security, order and health on a national and international level. In January 2014, this plan was completed with an action plan outlining 131 actions to be undertaken from 2013 to 2015 and an evaluation of certain measures for achieving the plan's strategic objectives (prevention and communication, anti-trafficking, law enforcement, research and coordination of national and international public actions).
Replacing the term "drug addiction" with "addictive behaviours" both in the title of the plan and the Interministerial Mission (which is now known as the MILDECA) responsible for implementing the plan is indicative of the government's desire to widen the scope of intervention to include all addictions.
Three legislative items can be highlighted: for the first time, a cannabis-based medication (Sativex®) was authorised in France; methoxetamine, a new psychoactive substance (NPS), was classified as a narcotic, and the Council of State (Conseil d’Etat) issued a negative opinion on the draft governmental decree regarding lower risk drug consumption rooms. Experimentation with such drug consumption rooms has nevertheless been announced as part of a draft public health law.
2. Drug use in the general population and specific targeted-groups
The latest data on the prevalence of use in the general population are from 2010-2011 (INPES 2010 Health Barometer for adults, HBSC 2010, ESPAD 2011 and ESCAPAD 2011 for adolescents). Regardless of the age bracket, cannabis is by far the most frequently used substance. Problem use, which is identified using the Cannabis Abuse Screening Test (CAST), is only estimated in adolescents 17 years of age: in 2011, of those who had engaged in last year cannabis use, 18% had a high risk of problem use, and the majority of this population were boys.
With regard to the perceived risks of drugs, half of French people consider cannabis dangerous from the first time it is used; over eight in ten believe this for cocaine and heroin. Moreover, 70% of the population believe that smoking cannabis leads people to use more dangerous substances.
Alcohol and tobacco prevention policies largely employ an environmental strategy established by lawmakers. In 2013, the main lever for prevention was taxation, with fairly positive results in terms of curtailing tobacco and beer sales.
There are many areas targeted by the Government Plan for Combating Drugs and Addictive Behaviours, such as developing prevention in schools and at the workplace, raising awareness among key people in neighbourhoods sensitive to addictive behaviours and supporting families in difficulty, etc. For many, the conceptual and initial implementation work is in progress. Against this background, the Interministerial Commission for the Prevention of Addictive Behaviours was launched in February 2014. Its purpose is to promote prevention policy based on promising, evaluated programmes.
In 2013, media campaigns conducted in the addiction field pertained only to tobacco (first in May and then in October with a youth-targeting campaign) and alcohol (in November).
4. High risk drug use (HRDU)
France does not have an estimate of the number of high risk drug users, according to the EMCDDA definition, but the last evaluation of the number of problem users, performed in 2011, estimated the number of people in question to be 275,000 to 360,000 (7 to 9 per 1,000 inhabitants). This means that, compared with other European Union member states, France has an average number of problem users. There are no statistics on the number of adult at-risk cannabis users; there are only figures on 17 year-olds.
The characteristics of high-risk drug users and their use are mainly revealed in studies conducted on people frequenting harm reduction facilities. This population is mainly male (80%) and over the age of 35 (54%). They are very socially vulnerable and mainly consume alcohol and cannabis, but also use opioids, cocaine and benzodiazepines.
5. Drug-related treatment: treatment demand and treatment availability
In 2012, over 149,000 people were reimbursed for opioid substitution treatment, predominantly buprenorphine (71%), even though the proportion represented by methadone is on the rise. This trend may become more prominent since, as part of the governmental plan, there is a strategy being deployed to expand the conditions under which methadone can be prescribed and dispensed, particularly in light of the findings of an experimentation conducted in a primary care setting (Méthaville).
The latest usable data on requests for treatment date back to 2012. Treatments for cannabis use tended to drop while those for opioids increased. In terms of patient sociodemographic profile, the mean age has increased from 28 in 2005 to 31 years in 2013. The proportion of people living in stable housing also trended upwards.
6. Health correlates and consequences
In 2012, only 1.2% of people determined to be HIV-positive were contaminated through intravenous drug use and the number of new AIDS cases among injecting drug users continued to fall (5.9% versus 7.4% in 2011). Moreover, the prevalence of HIV infection in drug users snorting or injecting at least once in their lifetime was 10% in 2011 (stable versus 2004). This figure reached 44% for HCV infection (versus 60% seven years prior).
The number of lethal overdoses in 2011 dropped (249 among 15-49 year olds), but for methodological reasons, this figure should be interpreted with care. The causal role played by substitution treatments, and methadone in particular, in these deaths rose (60% versus 54% in 2010). The mortality cohort study included 1,134 individuals, and for 970 (or 86%) of these subjects, the vital status was found again in July 2013. For men, the standardised mortality ratio was 5.2. For women, it was much higher (20.8).
7. Responses to health correlates and consequences
Preventing drug use-related infectious diseases relies on a harm reduction policy and an encouragement to undergo screening for HIV, HBV and HCV, as well as HBV vaccination. Recommendations for treating HBV- and HCV-infected individuals and the utility of rapid diagnostic tests for HCV, published in early 2014, have promoted the continuation and strengthening of actions conducted in this area.
Furthermore, drug-related health surveillance and alert measures exist in France, and an evaluation of injection kits has been performed in accordance with recommendations made public in 2014. These recommendations aimed to modify the contents of these kits (for example, by replacing alcohol with chlorhexidine, providing an ascorbic acid packet and a small container with a premounted handle, and adding 2 cm3 syringes in addition to 1 cm3 syringes, etc.).
8. Social correlates and social reintegration
The population seen in CSAPAs (National treatment and prevention centre for addiction) and CAARUDs (Support centre for the reduction of drug-related harms), centres that provide social support to drug users in France, is generally in a more unstable situation (e.g., unemployed, sporadic income, temporary housing, homeless) than the rest of the French population. However, the situation of this population does not seem to be worsening. Nevertheless, it is still difficult to identify the actions and programmes undertaken by these structures to promote the integration and reintegration of these people.
The 2013-2017 Government Plan for Combating Drugs and Addictive Behaviours reaffirmed the intention, already expressed in the previous plan, to provide comprehensive treatment to improve the chances of success, especially by improving dialogue between specialised treatment structures and more general social housing centres.
9. Drug-related crime, prevention of drug-related crime and prison
In 2013, 208,325 drug-related offences were recorded by law enforcement services, representing a 17% increase in the last five years. In more than eight in ten cases, these offences were related to use, primarily cannabis use. If all convictions are considered, the 53,113 for drug-related offences represented 9% of the total in 2012, and nearly 60% of these were for simple use.
Issues pertaining to inmates released from prison remain complex, especially regarding the discontinuation of treatment for OST users or HIV-/HCV-infected users. To avoid this, counselling programmes were established on an experimental basis in social and medico-social structures. The evaluation conducted by the OFDT in 2012 on these counselling programmes revealed the difficulty encountered in achieving treatment objectives within a population with an accumulation of significant social issues.
10. Drug markets
Three points emerge from the observation of the "traditional" drug market: the increase in herbal cannabis share is being confirmed, cocaine trafficking in the French Antilles is intensifying and heroin purity is on the rise. In 2013, quantities of seized drugs rose in general compared with 2012, and especially quantities of seized cannabis (and seeds in particular). The retail prices are fairly stable and purity seems to be increasing.
The New Psychoactive Substances (NPS) phenomenon is still very dynamic, with 36 new substances identified in 2013, most of which were cannabinoids. The TREND and SINTES schemes, mainly through the European I-TREND project, revealed the progressive expansion of NPS accessibility, as well as their use, to specific user subgroups. However, this was nothing compared to what was seen with the use of traditional substances, and this expansion is mainly seen in the digital market (except for methoxetamine, which is also seen on the "real" market).
Drugs in Europe
What do the latest data tell us about the European drug market? What are the new trends in drug use among European adults and school students? What are the harms associated with drug use and what is being done to counter them? These and other questions are explored in the 2017 EMCDDA European Drug Report.
Country drug reports
Developed by the EMCDDA, in cooperation with the Reitox national focal points, these graphic-rich reports cover: drug use and public health problems; drug policy and responses and drug supply.
The European Union and the drug phenomenon
The European Union & the drug phenomenon : Frequently asked questions , joint publication between the EMCDDA and the European Commission, october 2010, 12 p.