The French prison directorate administers almost 200 prison establishments.
In studies conducted more than 10 years ago, one third of new inmates in France reported prolonged, regular use of illicit drugs, mainly cannabis, but also cocaine and crack cocaine, as well as opioids, during the year prior to entering prison.
Recently, studies on the analysis of illicit drug metabolites in the wastewater outlets of three French prisons indicate that cannabis appears to be the most widely consumed illicit drug in prison, while heroin and cocaine play a marginal role. Residues of opioid substitution treatment and other medications were also detected, but in doses corresponding to those prescribed by the healthcare units.
In general, prison inmates in France have higher rates of drug-related infectious diseases than the general population, although a declining trend was noted in the last decade.
Since 1994, the Ministry of Health has been responsible for health in French prisons, and the treatment of drug dependency in prison settings is based on a three-tier system: prison-based hospital healthcare units, which are responsible for monitoring the physical health of inmates; regional medico-psychological hospital services established in each French region, which handle the mental health aspects of drug users in prisons if no specialised treatment centre (Centre de soins, d’accompagnement et de prévention en addictologie, CSAPA) exists in the prison; and CSAPAs for prisons, established in the 16 largest prisons in France and covering approximately one quarter of the incarcerated population and three quarters of existing establishments. Furthermore, a reference CSAPA is appointed for each prison to offer support to inmates with drug dependency problems, particularly after their release.
The 2010-14 action plan on health policy for inmates stipulated the implementation of screening programmes and harm reduction measures for inmates, which included screening for human immunodeficiency virus (HIV) and hepatitis infections upon arrival; hygienic measures; provision of post-exposure treatments for both staff and inmates; and provision of bleach to disinfect equipment in contact with blood. A new government strategy document, adopted in 2017, emphasises the need to promote the health of detainees and includes among its priorities improved detection of addictive behaviours and screening for infectious diseases, as well as improved care in general and continuity of care after release.
Opioid substitution treatment is available and can be initiated in prison. The main substance prescribed is buprenorphine, although methadone is also provided.