The French prison directorate administers almost 200 prison establishments.
In studies conducted since 2010, just under half of prison inmates in France have taken illegal drugs in the 12 months before imprisonment and more than one fifth have used them regularly. The drugs most frequently used have been cannabis, cocaine and crack cocaine, as well as opioids and diverted medicines. 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; other substances detected in smaller quantities are cocaine, MDMA/ecstasy, morphine (marker for either morphine or heroin), EDDP (a marker for methadone) and buprenorphine.
In general, prison inmates in France have higher rates of drug-related infectious diseases than the general population, although a declining trend has been noted in the last decade. The Ministry of Health is responsible for health in French prisons, and the treatment of drug dependency in prison settings is based on a three-tier system: (i) prison-based hospital healthcare units, which are responsible for monitoring the physical health of inmates; (ii) 26 regional medico-psychological hospital services, which handle the mental health aspects of drug users in prisons in the absence of ; and (iii) 202 CSAPAs located in 162 prisons. Overall CSAPAs cover almost half of the incarcerated population. A reference CSAPA is appointed to each prison to offer support to inmates with drug dependency problems and ensure the continuity of care after their release.
A plan defining the health strategy for inmates was published in 2017, aiming both at increasing screening for human immunodeficiency virus (HIV), hepatitis B virus and hepatitis C virus by using rapid diagnostic tests and at improving measures to identify addictive behaviours by introducing a health assessment on prison entry.
The National Action Plan on Addictions 2018-22 includes several specific measures targeting prison populations, such as the implementation of the following: routine screening and health assessments, equivalence of and access to addiction care, prevention programmes for tobacco and cannabis use, harm reduction measures, actions to tackle diversion and misuse of medications, peer interventions, increasing infectious diseases screening and vaccinations, treatment access and provision inside prisons.
Opioid substitution treatment is available and can be initiated in prison. The main substance prescribed is buprenorphine, although methadone is also provided.