In France, the provision of drug treatment is the responsibility of the regional and local authorities. Since 2003, it has been financed by the social security system. Two systems are involved in drug treatment: a specialised treatment system and the general healthcare system comprising hospitals and general practitioners (GPs). Some care is also provided through the harm reduction facilities of the low-threshold network. Drug treatment for prisoners is mostly provided through hospitals.
Almost all of the 100 sub-regional administrative areas have at least one specialised drug treatment and prevention centre (CSAPA). These centres, managed mainly by non-governmental organisations, provide both outpatient and inpatient care as well as care for prison inmates. Care in CSAPAs is anonymous and free. Both pharmacologically assisted and psychosocial treatments are provided in the same centres. There are also nine ‘drug-free’ therapeutic communities and about 540 services for young drug users, which provide early intervention and psychological care on an outpatient basis.
The general addiction care system through hospitals is organised across three levels. First-level care manages withdrawal and organises consultations; the second level includes the provision of more complex residential care; and the third level expands the services to research, training and regional coordination.
Since 1995, opioid substitution treatment (OST) has been the main form of treatment for opioid users and has been integrated into a total therapeutic strategy for drug dependence, including for drug users in prison. Methadone and high-dose buprenorphine are used for OST, although in rare cases morphine sulphate is used for substitution treatment. Several directives regulate the dose, place of delivery and prescription of OST, which is mainly prescribed in a primary care setting by GPs and is usually dispensed in community pharmacies. Methadone treatment can be started only in specialised centres, hospitals or specialised units in prison.
In France, four out of five first-time clients in 2017 entered treatment for cannabis use-related problems, while two thirds of all clients entered treatment because of cannabis use. The second most reported substances are opioids, mainly heroin. The increasing trend in the proportion of first-time clients requesting treatment for cannabis use and the decreasing trend in the number of first-time opioid users seemed to stabilise in 2017.
The high number and proportion of cannabis users among treatment clients in France may be attributed to several factors, including an increased number of people with problems related to cannabis use; the existence of specialised consultation centres for young users, mainly cannabis users; and a large number of referrals for treatment from the criminal justice system.
Many drug users, particularly opioid users, are treated in the general healthcare system at hospitals and by GPs, rather than in CSAPAs, and are therefore not covered by the French system for data collection on dependencies and treatments.
The number of OST clients steadily increased between 1995 and 2013, although, since then, it has remained rather stable. Buprenorphine, introduced in 1996, is still the most widely prescribed substance for OST, although the proportion of clients receiving methadone for OST is increasing.