Topics
1. National context
The Inter-ministerial Mission for the Fight against Drugs and Drug Addiction (MILDT) is responsible for defining, setting up, and coordinating drug-related policy on illicit and licit drugs. Three systems are concerned with drug treatment: a specialised addiction treatment system operating within medico-social establishments, a general care system comprising hospitals and GPs and 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 French social security system.
Almost all of the 100 sub-regional administrative areas across France have at least one specialised drug addiction treatment centre. These centres provide three types of services: (i) outpatient care, (ii) inpatient care, and (iii) treatment for prison inmates. In 2009, there were a total of 216 outpatient treatment centres, 40 inpatient treatment centres and 16 prison treatment centres. Furthermore, both pharmacologically-assisted and psychosocial treatments are provided in the same drug addiction treatment centres.
Since 1995, substitution has constituted the main form of treatment, and has been integrated into a total therapeutic strategy for drug dependence. Both methadone and high dosage buprenorphine (HDB) are used for substitution treatment, though HDB, introduced in 1996, is now the most widely prescribed substitution substance.
In France, GPs are significantly involved in the initiation and continuation of HDB treatment. Several circulars regulate the dose, place of delivery and duration of treatment. Since January 2002, doctors working in a health unit may also prescribe methadone to drug addicts highly dependent on opiates, outside the context of specialised drug addiction treatment centres and hospitals.
In 2009, an estimated 137 541 clients were in substitution treatment, (73 % high dose buprenorphine and 27 % methadone). HDB is mainly provided by GPs while methadone is mainly provided by addiction treatment centres (CSST).
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".
3. Treatment demand
| Clients in treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of all clients entering treatment | 32542 | 43486 | 46886 |
| % of which for opioid use | 39.8 | 40.7 | 42.6 |
| % of which for cocaine use | 6.9 | 7.3 | 7.5 |
| % of which for cannabis use | 48.8 | 47.4 | 45.6 |
| % of which for stimulants use (other than cocaine) | 0.8 | 0.3 | 0.5 |
| Number of new clients entering treatment | 9702 | 9253 | 10844 |
| % of which for opioid use | 26.4 | 25.7 | 24.7 |
| % of which for cocaine use | 5.3 | 5.8 | 6.0 |
| % of which for cannabis use | 65.3 | 65.0 | 66.7 |
| % of which for stimulants use (other than cocaine) | 0.8 | 0.3 | 0.4 |
| 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 2009 and TDI tables (ST34) V. 1.0-2007, questions 13.1.1 and 13.1.2. EMCDDA Statistical Bulletin 2005, 2007 (Tables TDI 4 and 5) and 2011 (Tables TDI 2 and 5). | |||
4. Treatment provision
| Type of treatment | Availability |
|---|---|
| Psychosocial out-patient interventions | Extensive |
| Psychosocial in-patient interventions | Limited |
| Detoxification | Limited |
| Substitution/maintenance treatment | Full |
| Notes: For an explanation of terms used, see the definitions of terms. Based on question 3.1 " Please assess the current availability of the treatment interventions below in relation to the user needs, judging the degree to which treatment capacity matches the demand" of Structured Questionnaire SQ27P1 on 'Treatment programmes'. Rating Scale (level of availability):
Reitox national reports 2008, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |
| Opioid substitution treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of clients in opioid substitution treatment | 120000 | 130681 | 137541 |
| of which with methadone | 24000 | 33565 | 37711 |
| of which with buprenorphine | 96000 | 97116 | 99830 |
| Notes: For a detailed European overview please see Table HSR-3 in the EMCDDA Statistical Bulletin 2011. ‘N. Av.’ stands for ‘No information available’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |||
| 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 Table HSR-1 in the EMCDDA Statistical Bulletin 2011. ‘N. App.’ stands for ‘Not applicable’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |
| 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 Table HSR-2 in the EMCDDA Statistical Bulletin 2011. 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: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | ||
Treatment availablity in Europe
The graphic below presents an overview of treatment provision by different types of service (psychosocial outpatient, substitution, psychosocial inpatient and detoxification) in different European countries and can be used for comparative purposes. Click on the thumbnail to view it.
Figure 1: Treatment availability in Europe, 2007
5. References and links
Related EMCDDA resources
- Health and social responses statistics
- Treatment demand statistics
- Annual report on the state of the drugs problem
- National reports for France
- Country overview for France
- Drug treatment responses page
- Best practice portal
- Treatment demand key indicator page
For a comprehensive overview on drug treatment systems, availability and utilisation in Europe, please consult the 2008 online report on ‘Quality of treatment services in Europe — drug treatment — situation and exchange of good practice’ published by the Directorate General for Health and Consumers.
External links
Please note that the EMCDDA is not responsible for the content of external sites.
Monitoring systems
Treatment inventories
- Drogues Info Service (FR, EN)
- Mission interministérielle de lutte contre la drogue et la toxicomanie (FR, EN)
Treatment research centres
- Research is carried out at the national health research centre (INSERM), university hospitals and some regional health monitoring centres (ORS).
