In France, one of the objectives of the Government Plan for Combating Drugs and Addictive Behaviours 2013-17 is to reduce risk among vulnerable populations that use drugs. In accordance with the provisions of the public health law of 2004 and the law on health system reform of 2016, harm reduction policies aim to protect people who use drugs from acquiring injecting-related infections but also to prevent them from dying as a result of a drug overdose. Moreover, the law defines further public health priorities, such as providing referral to the care system, contributing to improving the health of people who use drugs and facilitating their social reintegration. Facilities designed to reduce risk and harm complement the work of specialised drug treatment centres (Centres de soins, d’accompagnement et de prévention en addictologie) and the network of harm reduction facilities (Centres d’accueil et d’accompagnement à la réduction des risques pour usagers de drogues, CAARUDs). They are mainly funded directly by the social security system and form an integral component of the response to drugs in France. All French regions are covered by at least one CAARUD.
Harm reduction services provided in CAARUDs include needle and syringe programmes, advice on safer drug use and general health promotion activities, such as condom distribution. A state-subsidised kit containing sterile syringes and other paraphernalia is also available from pharmacies for a small fee or from dispensing machines for free. A recent estimate indicates that annually approximately 12 million syringes are distributed or sold to people who use drugs in France. Harm reduction measures have been expanded and diversified in recent years, following new drug use trends. Specific ‘sniff and base kits’ as well as foil are also being made available to drug users at harm reduction sites. Following the adoption of the 2016 law on health system reform, the first two experimental drug consumption rooms were opened in Paris and Strasbourg in 2016. These facilities are expected to operate for a six-year trial period, after which an evaluation of their impact on public health will be carried out.
As regards the implementation of a naloxone distribution programme, a naloxone product for nasal use has been available through hospital-based take-home programmes since July 2016, initially under temporary authorisation. Since 2017, the product obtained marketing authorisation and the programme was extended to all CAARUDs. Newly released inmates and those who have undergone opioid withdrawal treatment are defined as priority clients for the programme.
Screening for human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and sexually transmitted diseases is provided on an anonymous basis and free of charge at specialised information, screening and diagnosis centres. The costs of HIV and HCV antibody screening are fully covered by the French National Health Insurance Fund, while screening for markers of chronic HBV infection is reimbursed at a rate of 65 %. Specialised drug treatment centres also provide free screening for HIV and HCV infection and free vaccination against HBV for any drug user attending such a centre. The Ministry for Health and Social Affairs has committed to providing universal access to innovative treatments for HCV infection. Since June 2016, the treatment of HCV infection with direct-acting antiviral medication has been fully reimbursable by the National Health Insurance Fund for drug users who exchange their equipment (irrespective of their stage of fibrosis). Available treatment statistics for 2014 and 2015 document that 22 600 people suffering from chronic hepatitis C were treated using direct-acting antivirals.
|Country||Needle and syringe programmes||Take-home naloxone programmes||Drug consumption rooms||Heroin-assisted treatment|