In France, one of the objectives of the Government Plan for Combating Drugs and Addictive Behaviours 2013-17 was 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 not only to protect drug users from 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. The National Action Plan on Addictions 2018-22 makes provision for the creation of facilities designed to reduce risk and harm to complement the work of specialised drug treatment centres and the network of harm reduction facilities (CAARUDs). They are, for the most part, funded directly by the social security system.
Harm reduction services provided in CAARUDs include needle and syringe programmes (NSPs), 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 increasingly 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 6-year trial period, after which an evaluation of their impact on public health will be carried out.
A naloxone product for nasal use has been available through hospital-based take-home programmes since July 2016. In January 2018, the naloxone distribution 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 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 and specialised drug treatment centres. Since June 2016, the treatment of HCV infection with direct-acting antiviral medication has been fully reimbursable by the National Health Insurance Fund to high risk drug users, and, in 2017, treatment access was extended to all adults with chronic hepatitis C, irrespective of fibrosis stage. Data on the provision of new treatments with direct-acting antivirals show that, since their introduction in 2014 (and until March 2018), about 60 000 patients have been successfully treated.
|Country||Needle and syringe programmes||Take-home naloxone programmes||Drug consumption rooms||Heroin-assisted treatment|