• Drug use among the general population and young people
• Prevention
• Problem drug use
• Treatment demand
• Drug-related infectious diseases
• Drug-related deaths
• Treatment responses
• Harm reduction responses
• Drug markets and drug-related offences
• National drug laws
• National drug strategy
• Coordination mechanism in the field of drugs
• Drug-related research

Drug use among the general population and young people

Between 1992 and 2005, general population surveys reported cannabis as the most widely used illicit substance. Lifetime prevalence rates for cannabis among adults aged 15 to 64 years increased from 21.9 % in 1999 to 26.2 % in 2002. The latest results (2005) among 15–64 year olds indicate a lifetime prevalence of cannabis use of 30.6 %. In the same age group, reported lifetime prevalence was 2.6 % for cocaine (2.2 % in 2002; 1.5 % in 1999) and 2 % for ecstasy (0.9 % both in 2002 and 1999). In 2005, survey results also showed that among younger adults (15–34 years old), the lifetime prevalence was 43.6 % for cannabis, followed by 3.7 % for ecstasy and 3.5 % for cocaine. For the same age group, the last year prevalence was reported to be 16.7 % for cannabis, 1.2 % for cocaine and 1 % for ecstasy. Among the younger adults, last month prevalence of cannabis use was 9.8 % whereas prevalence for other substances was all below 1 %.

According to the latest ESCAPAD survey involving a nationwide sample conducted in 2008 among youth aged 17 years, in 2008, 42.2 % had tried marijuana or hashish at least once in their lifetime (49.4 % in 2005). Lifetime prevalence was reported to be 3.2 % for cocaine (2.5 % in 2005), 2.7 % for amphetamines (2.2 % in 2005), 2.9 % for ecstasy, 1.1 % for heroin, 1.2 % for LSD. Among the same age group, results indicated 35.9 % for the last year prevalence of cannabis use (41.3 % in 2005) and 24.7 % for the last month prevalence of cannabis use (27.9 % in 2005). Lifetime prevalence of cannabis use was 46.3 % among males and 37.9 % among females.

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Prevention

The French prevention strategy embraces all psychoactive substances, both illicit and licit, according to a general harm reduction framework. Prevention of drug use in France is coordinated at the central level by The Inter-ministerial Mission for the Fight against Drugs and Drug Addiction (MILDT) and the ministries with which it liaises via the multi-year government plan, the latest was adopted to cover the period 2008–11. Nonetheless, at a decentralised level (region, department, city), prevention actors enjoy considerable independence in terms of organisation and implementation of interventions.

In France, universal prevention is mostly carried out in the school environment, with the educational community being largely involved in the coordination and implementation of prevention activities. As part of the 2003–08 drug prevention and education plan, the MILDT and the Ministry of Education, assisted by several institutional partners, have drawn up an intervention guide for school environments, aimed at preventing addictive behaviour. This guide is today circulated in all French primary and secondary schools. The use of this guide is strongly encouraged, but is not compulsory. The guide clearly presents the authorities’ position concerning the content of drug prevention messages, and the need for a long-term strategy which is constantly developing and which tackles the problem at an early stage. Information on prevention interventions is collected in Relion survey experimented in some regions but aiming at a national coverage eventually. The design of this survey is still been adjusted for optimal outputs.

Selective and indicated prevention is mainly the responsibility of specialised associations. Since 2005, 250 outpatient cannabis abuse clinics have been opened throughout France to carry out early intervention. Environmental strategies on alcohol and tobacco are well developed and have big political support.

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Problem drug use

A national problem drug use estimate was made in France in 2008, using several data sources and three methods. It is estimated that there is somewhere 210 000 and 250 000 problem drug users in France (ranging from 5.4 to 6.4 per 1 000 inhabitants aged 15–64 years). This estimate is significantly higher than the one obtained in 1999, however the increase needs to be treated with caution as it may be a result of broadening definition and scope of estimate over the years or aging of the problem drug user population which was a subject to high mortality prior introduction of the opioid substitution treatment. In 2006 the local estimates carried out in six cities ranged from 7.6 per 1 000 in Rennes to 10.8 per 1 000 in Lille.

The EMCDDA defines problem drug use as intravenous drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.

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Treatment demand

Treatment demand data in France is mainly collected from specialised addiction treatment, support and prevention centres. In 2009, a total of 160 outpatient centres submitted data out of the 216 centres, 28 inpatient centres submitted data out of the 40 centres and 9 treatment units in prison submitted data out of the 16 units. Data on clients entering low threshold agencies are collected through a different system.

In 2009, a total of 46 886 clients entered treatment, of which 10 844 were first-time clients. Data on all clients entering treatment suggest that 45.6 % of all clients reported cannabis as their primary drug, followed by 42.6 % for opioids and 7.5 % for cocaine. Among first-time treatment clients, 66.7 % were treated for cannabis, 24.7 % were treated for opioids and 6.0 % for cocaine. It is important to note that in France, specialised consultation centres for young users, mainly for cannabis users, were created in 2005.

In 2009, 33 % of all clients entering treatment were aged less than 25 years. A higher percentage in age distribution was reported among new treatment clients, with 52 % being under the age of 25 years. As far as gender distribution is concerned, 81 % of all clients entering treatment were male, whereas 19 % were female. A similar distribution in gender distribution was reported among new treatment clients with 84 % for male and 16 % for female.

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Drug-related infectious diseases

There are no national estimates on prevalence rates for drug-related infectious diseases among injecting drug users in France. As regards new AIDS cases, and based on data collection between 2003 and 2006, each year in France between 6 000 and 7 000 people discover that they are HIV positive. Contamination through intravenous drug use accounts for a little less than 2 % of these new infections. As regards the number of new AIDS cases among injecting drug users, this figure has continued to fall from the mid-1980s onwards. Although injecting drug user cases accounted for a quarter of the people diagnosed with AIDS in the mid 1980s, this share dropped to approximately 5 % in 2009.

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Drug-related deaths

Data on drug-related deaths in France are collected from the General Mortality Registry. In 2008, 374 drug-related deaths were recorded (333 in 2007, 305 in 2006 and 303 in 2005). Opiates (alone or in combination) contributed to 85.5 % of DRD cases.

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Treatment responses

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).

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Harm reduction responses

The Governmental Plan to fight drugs and drug addiction (2008–11) makes harm reduction one of the five axes on which the strategy is built. Since 2004, harm reduction policy has been incorporated into public health regulations and state jurisdiction. Harm reduction is officially defined as intended to prevent transmission of infections, death from overdose by intravenous injection of drugs and social and psychological damage linked to drug addiction by substances classified as drugs.

Services relating to the reduction of risk and harm in France have been implemented to complement the specialised drug treatment centres. A network of 120 low-threshold agencies (CAARUD), which receive funding directly by the public health insurance, forms an important component of the response. Harm reduction services provided include: the open sale of syringes in pharmacies (since 1987), syringe exchange programmes (129 in 2009), emergency services and methadone buses in order to improve access to substitution treatment. Front-line and outreach teams improve the service provision to drug users further. Syringes are also available from 276 dispensing machines and pharmacies sell state-subsidised sterikits (latest available sterikit sales data: 5.5 million in 2008). Overall, the risk and harm reduction system covers most of the French territory, partly due to the sale of syringes through pharmacies. In 2008, the estimated total number of syringes distributed or sold in France to IDUs is 13.8 million syringes among them 4.3 million have been distributed from specialist agencies (needle and syringe programmes and dispensing machines).

 Screening of infectious diseases is facilitated by the existence of free, anonymous screening centres (Centres de dépistage anonymes et gratuits, CDAG). In 2002, 386 of such centres operated in the community and 109 inside prisons (no more recent data available). The 2009–12 National Hepatitis B and C Plan calls to ensure increased access for injecting drug access to prevention, screening and treatment activities. Hepatitis B vaccination is recommended for children and adolescents and it is mandatory also in some specific health occupations where employees are at risk. A circular dated February 2008, creating the CSAPA (treatment centre dedicated to the care of drug and alcohol addiction) recommended free vaccination of hepatitis B to any drug-users attending the centre.

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Drug markets and drug-related offences

Illegal drugs are trafficked via France to the Netherlands, Belgium, the United Kingdom and Italy, and to the United States in the case of synthetic drugs. As in most EU countries, cannabis is the most available and accessible of all illicit substances. Herbal cannabis is the only illegal substance produced in France. Heroin availability remains comparatively low. In France, heroin circulates in two chemical forms: the hydrochloride (white) and the base (brown) forms and the availability of them differ. The white form is extremely rare and appears to be restricted to confined circles whereas the brown form is far more readily available.

In 2009, a total of 159 412 drug-related offences were reported, 87.9% were cannabis related offences, followed by 6.3 % for heroin related offences and 4.1 % for cocaine-related offences. The proportion of arrests related to heroin have shown a stable trend since 2000 (between 5 % to 7 %), however the number of offence have been increasing since 2004 reaching in 2008 a similar level as in the late 1990s. In 2009, the number of heroin-related offences has dropped slightly in comparison with 2008 (10 089 in 2009 and 11 619 in 2008).

Since the 1980s, the quantity of cocaine seizures peaked in 2006 at more than 10 tonnes and decreased to lower levels in the three following years (approximately 7 tonnes in 2007, 8 tonnes in 2008 and 5 tonnes in 2009). Furthermore, in 2009, an increase was reported in the amounts of seized cannabis plants and amphetamine when compared to previous years.

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National drug laws

Use or possession of illegal drugs is a criminal offence in France. The law itself does not distinguish between possession for personal use or for trafficking, nor by type of substance. However, the prosecutor will opt for a charge relating to use or traffic that is based on the quantity of the drug found and the context of the case. An offender charged with personal use only faces a maximum prison sentence of one year and a fine of up to EUR 3 750, though prosecution may be waived. Alternatives to prosecution may include voluntary payment of a fine or non-remunerated work useful to society. Prosecutors may also prioritise treatment approaches for small-time offenders, both those related to personal drug use or other minor crimes. A circular to prosecutors in 2005 stated that any legal action before the magistrates’ courts must remain exceptional, but a new circular of 9 May 2008 defined a new ‘rapid and graduated’ policy. Addicts would continue to receive the therapeutic injunction, directing them to treatment. Users in aggravating circumstances, such as drivers or those in educational establishments, as well as recidivists, might be imprisoned. Users in simple cases may receive a caution, but this should usually be accompanied by a request for a compulsory drug awareness course introduced in March 2007, for which the non-addicted offender may have to pay up to EUR 450.

Drug trafficking is punishable with imprisonment of up to 10 years, or up to life in prison in case of particularly serious offences, and a fine of up to EUR 7 600 000.

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National drug strategy

The current French ‘Action plan on drugs, tobacco and alcohol’ (2008–11) was adopted in July 2008. The plan includes 193 measures covering many aspects of drug addiction.

A key theme of the plan is the focusing anew of prevention on the onset of illicit drug use and on alcohol abuse, by curbing their everyday acceptance. The emphasis is placed on:

• prevention and, in particular, the interest attached to reminding individuals of drug-related laws and the central role played by parents;
• awareness-building messages aimed at avoiding or at least delaying experimentation, including with alcohol (among the measures envisaged, we should mention a ban on selling alcohol to minors, a ban on consuming alcohol on the public highway around educational establishments and a ban on fixed-price or ‘all you can drink’ offers or ‘freebies’);

Where punishments are concerned, efforts to stamp out sources of supply will include:

• an intensification of the fight against cannabis (particularly ‘home growing’) and the misuse of psychotropic medicines;
• increased international police cooperation between the European Union Member States and the nations on the Mediterranean south shore;
• tougher economic penalties for traffickers.

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Coordination mechanism in the field of drugs

The Inter-ministerial Committee on Drugs is the authority in France designated to prepare the decisions of the government in all domains related to the drug problem, and this committee approves the national plan on drugs. The committee is placed under the authority of the Prime Minister and is composed of ministers and state secretaries.

The Inter-ministerial Mission for the Fight against Drugs and Drug Addiction (Mission interministérielle de lutte contre la drogue et la toxicomanie, MILDT) prepares, coordinates and partly implements the decisions of the committee. There are also regional, local and territorial project managers (chefs de projet) who are responsible for implementing the national plan.

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Drug-related research

In France, the Inter-ministerial Mission for the Fight against Drugs and Drug Addiction (MILDT) coordinates all aspects of the government’s drug-related research, including its promotion and funding. Several major academic research centres and governmental agencies including the national focal point itself (French Monitoring Centre for Drugs and Drug Addiction) cover a large scope of research areas, ranging from neuroscience, through public health and clinical research, to social sciences. The two main national priorities in this area are to actively support policy for the development of new knowledge, and to promote the synthesis and dissemination of scientific findings and knowledge. Dissemination is also part of the mandate of the national focal point which, together with an extensive publishing effort in international scientific journals, promotes the use of research results in practice and policymaking. Recent drug-related studies mentioned in the 2010 French National report mainly focused on aspects related to prevalence of drug use in different settings as well as research on consequences of drug use.

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