In France, data on drug-related infectious diseases are collected from the national human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) monitoring database coordinated by the French Public Health Agency (Santé Publique France), and from self-reported or biological testing data from clients attending addiction treatment and prevention centres (Centres de soins, d’accompagnement et de prévention en addictologie, CSAPAs) or harm reduction facilities (Centres d’accueil et d’accompagnement à la réduction des risques pour usagers de drogues, CAARUDs). Studies on HIV and hepatitis C virus (HCV) prevalence among people who inject drugs (PWID) were carried out in 2004 and 2011 (the Coquelicot study). The 2011 study indicated that HIV prevalence was 13 % among PWID, while nearly 64 % of PWID tested positive for HCV.
Despite the introduction of compulsory notification for symptomatic acute hepatitis B virus (HBV) infection in 2003, it is estimated that only a small proportion of HBV-positive individuals are reported. HCV infection is not on the list of compulsory notifiable diseases in France.
In 2016, 49 cases of newly diagnosed HIV infections were related to injecting drug use, which constituted less than 2 % of all new HIV diagnoses in 2016. The number of HIV seropositive diagnoses associated with drug use remained stable between 2008 and 2014, while some decline is indicated in recent years.
|Year of data: HIV 2011, HCV 2011|
Additional data on the prevalence of drug-related infectious diseases are based on self-reporting by PWID attending CSAPAs and CAARUDs; however, the reported prevalence may be underestimated, as many drug users are unaware of being infected. In a 2015 study conducted among CAARUD clients (the ENa-CAARUD survey), 4.65 % of 1 764 PWID reported being HIV positive, more or less stable since 2012, following a slight decline between 2006 and 2012. The CAARUD survey indicated that the prevalence of HCV among injecting drug users has also remained largely stable since 2012, and the decline observed from the beginning of the 2000s has come to an end.
Nearly 10 000 hospital emergency presentations related to drug use were reported in France in 2015 through the Oscour network, which covers almost 9 out of 10 hospital emergency presentations. One quarter of presentations were related to cannabis use and one quarter to opioid use, whereas cocaine, other stimulants and hallucinogens were implicated in a smaller proportion of cases. Around one third of the cases were due to use of multiple or unspecified substances. Around one third of those who sought emergency care were admitted to hospital, while the remaining clients were discharged home. In 2015, the mean age of clients was 34 years, with males being slightly younger than females (33 years versus 36 years). Although the mean age has remained stable since 2008, the distribution by age group has changed. The proportions of younger individuals (under 24 years) and older individuals (over 45 years) have increased, whereas the proportion of 25- to 44-year-olds has decreased. The increase in the proportion of 15- to 24-year-olds is related mainly to a rise in emergency presentation among 15- to 17-year-olds.
An emergency department from Lariboisière Paris hospital participates in the European Drug Emergencies Network (Euro-DEN Plus) project, which was established in 2013 to monitor acute drug toxicity in sentinel centres across Europe.
Drug-induced deaths are deaths directly attributed to the use of illicit drugs (i.e. poisonings and overdoses).
Data on drug-induced deaths in France are collected from the General Mortality Registry (INSERM CépiDc) and the forensic Special Mortality Register (DRAMES, ANSM). The latest available data from the INSERM CepicDc refer to 2014 and indicate that more overdoses were reported in 2014 than each year during the period 2011-13. Nevertheless, it is suggested that the numbers of deaths may have been underestimated because of misclassification; for example, some drug-related deaths may be classified as ‘a death due to unknown cause’. In contrast, morphine overdose deaths, particularly those occurring among those aged over 50 year in a palliative care context, may be reported as drug-induced deaths. In 2014, nearly 70 % of drug-induced deaths were among 15- to 49-year-olds.
Toxicological data available from the Special Mortality Register indicate that opioid substitution treatment medications were involved in 4 out of 10 deaths recorded in 2015 and heroin was involved in about 3 out of 10 deaths. In the remaining cases, cocaine, cannabis, amphetamines, MDMA/ecstasy and new psychoactive substances were reported.
Additional data are available through the national health alert scheme related to psychoactive substance use, which focuses on unusual events reported by different sources (police, the TREND/SINTES network, the monitoring network for serious adverse effects, private analysis laboratories, scientific publications, etc.). In 2016, a total of eight deaths, of which six were related to new psychoactive substance use, were listed under this scheme.
The estimated drug-induced mortality rate among adults (aged 15-64 years) was 6.95 per million in 2014, which is less than the most recent European average of 21.8 deaths per million.
Data from a 2009-15 mortality study among a cohort of 1 134 drug users treated at CSAPAs and CAARUDs indicate that there are significantly higher mortality rates among drug users than among the general population. Moreover, the standardised mortality ratio is markedly higher among females than males.