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Drug treatment overview for France

Map of France

1. National context

The Inter-ministerial Mission for Combating Drugs and Addictive Behaviours (MILDECA) is responsible for defining, setting up and coordinating drug-related policy on illicit and licit drugs. Two systems are concerned with drug treatment: a specialised addiction treatment system, and a general care system comprising hospitals and GPs. Some care is also provided through a risk-reduction system. The provision of treatment to drug users falls under the responsibility of the regional and local authorities. Since 2003 drug treatment has been financed by the social security system.

Almost all of the 100 sub-regional administrative areas have at least one national specialised treatment and prevention centre for addiction (CSAPA). These centres provide two types of services: (i) outpatient care; (ii) inpatient care.  Treatment for prison inmates is provided either by outpatient care centres or by a limited number of addiction centres that only provide treatment to prison inmates. Both pharmacologically assisted and psychosocial treatments are provided in the same centres. In 2010 around 200 CSAPAs (out of more than 400) were mainly providing care to illicit drug user. But recently more and more former specialised alcohol centres are also providing treatment for illicit drug users. Additionally, a mixed type of CSAPA, treating a majority of alcohol users but also a large minority of drug users, is becoming more frequent. There are also 10 ‘drug-free’ therapeutic communities, which operate separately from CSAPAs; and about 300 services for young drug users have been established since 2005, providing early intervention and psychological care. The general addiction care system through hospitals is organised on three levels, with each new level building on services available in the previous level. First-level care manages withdrawal and organises consultations, the second level adds provision of more complex residential care and the third level expands the services to research, training and regional coordination. General practitioners (GPs) are heavily involved in the initiation and continuation of high-dosage buprenorphine (HDB) and methadone treatment, although methadone treatment can only be started within specialised centres or, since 2002, within hospitals.

Since 1995 opioid substitution treatment (OST) has constituted 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 dosage buprenorphine (HDB) are used for OST, though HDB, introduced in 1996, is still the most widely prescribed substitution substance. In rare cases, morphine sulphate is provided as substitution. Several directives regulate the dose, place of delivery and duration of OST. In 2012 an estimated 163 000 clients were prescribed OST (66 % HDB and 34 % methadone). HDB is mainly provided by GPs, while methadone is mainly provided by CSAPAs, although the share of GPs providing methadone is increasing.

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2. Treatment registries and monitoring systems

Specialised treatment centres implement RECAP, the monitoring system that is compatible with the Treatment Demand Indicator (TDI). Harm reduction facilities have a special monitoring system, ENa CAARUD, in which many items are common with RECAP but which is based on a short period survey (not permanent). The OPPIDUM survey (in October), is implemented with a focus on monitoring consumption patterns and trends in a panel of specialised centres, harm reduction facilities and selected GP practices. While a national register of clients in substitution treatment is not possible in France, this system can distinguish between data collected from clients in substitution and from other clients. The national health insurance fund (CNAMTS, Caisse Nationale d'Assurance Maladie) has data on clients who buy their medical drugs in "office pharmacies" (and ask for reimbursement). Nearly all buprenorphine prescriptions and around the half of methadone ones are dispensed through these "office pharmacies". 

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3. Treatment demand

Table 1: Number of clients entering treatment in France by year
Clients in treatment 2010 2011 2012 2013
Number of all clients entering treatment 46606 47519 47412 59763
Number of all clients entering treatment with known primary drug 36481 36858 36329 44659
% of which for opioid use 42.8 40.7 43 34.7
% of which for cocaine use 7.2 6.9 6 6.2
% of which for cannabis use 45.7 47.8 44 52.5
% of which for stimulants use (other than cocaine) 0.5 0.6 0 1.2
Number of new clients entering treatment 10688 11192 10629 11516
Number of new clients entering treatment with known primary drug 9951 10123 9922 10534
% of which for opioid use 23.6 20.2 27 16.9
% of which for cocaine use 5.9 5.1 4 5.2
% of which for cannabis use 67.8 71.1 63 73.4
% of which for stimulants use (other than cocaine) 0.3 0.5 0 1.4
Notes:
The variation across time, in particular with regard to the absolute numbers of clients in treatment, should be interpreted with caution as coverage data may have changed over time. For further information on coverage details please refer to the relevant EMCDDA Statistical Bulletin.
For an explanation of terms used, see the definitions of terms.
Sources:

Reitox national reports 2014 and TDI tables.
EMCDDA Statistical Bulletin 2015.

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4. Treatment provision

Table 2: Opioid substitution treatment provision in France
Opioid substitution treatment 2010 2011 2012 2013
Number of clients in opioid substitution treatment 145000 N.Av. N.Av.  
of which with methadone N.Av.      
of which with buprenorphine N.AV.      
Notes:
For a detailed European overview please see he EMCDDA Statistical Bulletin 2015 (HSR section).
‘N. Av.’ stands for ‘No information available’.
For an explanation of terms used, see the definitions of terms.
Sources:
Standard Table 24 (ST24) on 'Treatment availability' submitted in 2014.
Table 3: Year of official introduction of opioid substitution treatment substances in France
Applied substances in opioid substitution treatment Officially introduced in
Methadone (MMT) 1995
Buprenorphine (HDBT) 1996
Heroin assisted treatment,including as trials N.App.
Slow-release morphine N. Av.
Buprenorphine/naloxone combination N.App.
Notes:
For a detailed European overview please see he EMCDDA Statistical Bulletin 2015 (HSR section).
‘N. App.’ stands for ‘Not applicable’.
For an explanation of terms used, see the definitions of terms.
Sources:
Reitox national reports.
Table 4: Legal framework of opioid substitution treatment in France
Legal framework of opioid substitution treatment Methadone Buprenorphine
Do office-based medical doctors have the right to initiate the prescription of substitution treatment? No Yes
Do specialised medical doctors have the right to initiate the prescription of substitution treatment? No Yes
Notes:
For a detailed European overview please see he EMCDDA Statistical Bulletin 2015 (HSR section).
For an explanation of terms used, see the definitions of terms.
'Specialised medical doctors' refers to specifically trained or accredited office-based medical doctors.
Sources:
Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2014.

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5. References and links

Related EMCDDA resources

 

External links

Please note that the EMCDDA is not responsible for the content of external sites.

Monitoring systems

Treatment inventories

Treatment research centres

  • Research is carried out at the national health research centre (INSERM), university hospitals and some regional health monitoring centres (ORS).

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Page last updated: Friday, 22 May 2015