The Government Plan for Combating Drugs and Addictive Behaviours 2013-17 addresses quality assurance by basing public action on observation, research and evaluation, and by reinforcing training strategies. Quality assurance is defined as ‘promotion of evidence-based preventive strategies’ and ‘improvement of the quality of healthcare for patients receiving opioid substitution treatment (OST) and increasing its accessibility’.
In France, quality assurance in drug demand reduction (prevention, risk reduction, treatment and rehabilitation) builds on specific advocacy, guidelines or training from professional organisations or public health institutions, but it is not institutionally structured or imposed. As for risk reduction and treatment, different guidelines exist on (i) OST; (ii) early intervention and risk/harm reduction for crack cocaine or freebase users; (iii) clinics for young drug users; and (iv) the treatment of cocaine users. However, the implementation of these guidelines is not compulsory: there is no formal requirement to meet guidelines in order to obtain support or subsidies. Professional federations are also engaged in developing quality and professional supports; the new portal on addictions for health professionals is an example.
A growing, although still limited, number of prevention organisations are involved in adopting and implementing international evidence-based programmes. Nevertheless, establishing good and evidence-based practices in prevention is among the government’s drug policy priorities. Within the framework of the Inter-ministerial Commission for the Prevention of Addictive Behaviours, the ASPIRE toolkit [https://www.ofdt.fr/aide-aux-acteurs/prevention/grille-aspire/) and (http://www.drogues.gouv.fr/cipca/grille-aspire], a quality assurance tool inspired by the European Drug Prevention Quality Standards, was issued in January 2017.
The specialised drug treatment centres (Centres de soins, d’accompagnement et de prévention en addictologie, CSAPAs) and the low-threshold facilities (Centres d’accueil et d’accompagnement à la réduction des risques pour usagers de drogues, CAARUDs) are in the scope of the activities of the National Agency for the Quality Assessment of Health and Social Care Organisations and Services (ANESM). They are only marginally affected by the existing accreditation and certification processes for health establishments under the French National Authority for Health. However, ANESM is also involved in quality control activities. It accredits external evaluators who carry out mandatory independent evaluations of activities and service quality every five years and also makes recommendations on professional best practices.
The National Institute for the Training of the National Police is the service for initial and continuing education for Police and Gendarmerie drug prevention officers. Over the last five years, several initiatives have been developed to increase knowledge and competence on addictions through medical curricula and continued training for health professionals, prevention or treatment practitioners, etc.
The following documents form a framework for quality assurance in France: Abus, dépendances et polyconsommations: stratégies de soins — Recommandations de la commission d’audition; Prise en charge des consommateurs de cocaïne — Recommandations de bonnes pratiques professionnelles; and La réduction des risques et des dommages dans les Centres d’accueil et d’accompagnement à la réduction des risques pour usagers de drogues. In addition, Addict’aide, is a virtual village dedicated to helping those addicted to alcohol, drugs or gambling.