Drug use prevention policy in France is coordinated at the central level by the Inter-ministerial Mission for Combating Drugs and Addictive Behaviours (MILDECA). The Ministry of National Education, the Ministry of Agriculture, the Ministry of Health, the Ministry of the Interior and the Ministry of Justice are other central stakeholders in the field of prevention. A partnership has been set up between MILDECA and the Inter-ministerial Committee on Crime and Radicalisation Prevention within which a number of programmes can be co-financed, focusing on support for those in the criminal justice system, drug trafficking prevention and tobacco regulations. The French prevention policy embraces all psychoactive substances, both illicit and licit, and other forms of addictive behaviour (e.g. gaming, gambling). It aims to prevent experimentation or to delay it, or to prevent and limit the use of these substances and participation in addictive activities. MILDECA provides funding to implement the national prevention priorities at a local level (regions, local communities), at which activities are coordinated by MILDECA territorial representatives. Decentralised credits for prevention activities are allocated by these MILDECA territorial representatives or by regional health authorities, while the French national health insurance system also provides funding for prevention. At a local level, prevention activities are implemented by a large number of professionals (school communities, non-governmental organisations, police/gendarmerie officers, etc.) and, since 2016, prevention has also officially fallen under the remit of addiction treatment and prevention centres (Centres de soins, d’accompagnement et de prévention en addictologie, CSAPAs), which are specialised drug treatment centres.
Prevention interventions encompass a wide range of approaches, which are complementary. Environmental and universal strategies target entire populations, selective prevention targets vulnerable groups that may be at greater risk of developing substance use problems and indicated prevention focuses on at-risk individuals.
In France, priority is given to preventing drug use among young people in school settings, female drug users, partygoers, those in the criminal justice system and homeless people. Within the French Public Health Agency, the Health Promotion and Prevention Division’s main focus is supporting national and regional health policies and practitioner networks by developing evidence-based interventions for prevention and health promotion, including transferring international programmes into a French context.
Environmental strategies on alcohol and tobacco are well developed and have substantial political support. In 2017, guidelines for alcohol consumption were revised, with new benchmarks for alcohol consumption. This revision should be supported by public authorities’ coherent communication addressing taxation, availability and promotion, as well as education, communication and social marketing.
Universal prevention is the predominant type of drug use prevention in France, mostly carried out in secondary schools, with the school community involved in the coordination and implementation of prevention activities and external actors contributing as required (non-governmental organisations and police/gendarmerie officers). Best practice guidelines for addressing health and risky behaviours in school settings exist. While their use is encouraged, it is not compulsory. In September 2016, the Educative Health Pathway for pupils, which aims to reduce social inequalities in health and education, became the new framework for drug prevention in schools. The main focus of the school-based prevention activities, within the area of health education, is to develop students’ individual and social skills. Some examples include life skills and prevention programmes in secondary schools, while experimental implementation of internationally validated programmes has also been reported. Drug prevention is also recommended for secondary and higher educational settings under the responsibility of the Ministry of Agriculture.
The prevention of licit and illicit substance use in the workplace, incorporating, although uncommonly, the use of screening for substance use, has been in the remit of occupational physicians since 2012. Staff representative bodies are also engaged in workplace prevention as part of the legal obligation to ensure employee safety and to protect employee health. Implementation varies across companies and services. Some community-based prevention activities are carried out in youth counselling centres. The recent government strategy aims to develop the training of educators in recreational centres for children and teenagers to encourage awareness-raising actions on addictive behaviours and risky sexual practices. Activities that aim to reduce risk related to psychoactive substance use in recreational settings are employed in some large cities and are provided at large music festivals and sporting events.
Selective prevention is mainly the responsibility of specialised non-governmental organisations and is mainly delivered outside the school setting. The actions are promoted within neighbourhoods, in recreational settings and in at-risk families.
As for indicated prevention, some 260 youth addiction outpatient clinics (CJCs) have been opened throughout France to carry out ‘early screening and intervention’ at approximately 550 consultation points. A requirement to reinforce the CJC system, in particular through training professionals, is specified in the current Government Plan for Combating Drugs and Addictive Behaviours. PANJO, a home-based early parenting assistance programme during pregnancy or the first few months after birth, recruited 500 pregnant women in 11 French departments for its second phase in 2017. ‘Change le Programme’ (CLP), an adaptation of the ‘Break the Cycle’ programme, aims to reduce the number of initiations into injecting, to delay them or to make them safer. TAPAJ, a programme addressing homeless young adults (aged 18 to 25 years) by providing a legal source of income as an alternative to begging, and as a means of reducing health and social risks, and by allowing quicker access to addiction services, has been implemented in 17 cities.