Country overview: France
- Drug use among the general population and young people
- Problem drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-related deaths
- Treatment responses
- Harm reduction responses
- Drug markets and drug-law offences
- National drug laws
- National drug strategy
- Coordination mechanism in the field of drugs
- Public expenditure
- Drug-related research
|Year||EU (27 countries)||Source|
|Population||2012||65 327 724 p||503 663 601 p||Eurostat|
|Population by age classes||15–24||2012||12.2 %p||11.7 % b p||Eurostat|
|25–49||32.7 % p||35.4 % b p|
|50–64||19.4 % p||19.5 % b p|
|GDP per capita in PPS (Purchasing Power Standards) 1||2011||108||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2010||33.8 % p||29.4 % p||Eurostat|
|Unemployment rate 3||2012||10.2 %||10.5 %||Eurostat|
|Unemployment rate of population aged under 25 years||2012|| |
|Prison population rate (per 100 000 of national population) 4||2011||111.3||:||Council of Europe, SPACE I-2011|
|At risk of poverty rate 5||2011||14.0||16.9 % e||SILC |
p Eurostat provisional value.
b Break in series.
1 Gross domestic product (GDP) is a measure of economic activity. It is defined as the value of all goods and services produced less the value of any goods or services used in their creation. The volume index of GDP per capita in Purchasing Power Standards (PPS) is expressed in relation to the European Union (EU-27) average set to equal 100. If the index of a country is higher than 100, this country's level of GDP per head is higher than the EU average and vice versa.
2 Expenditure on social protection contains: benefits, which consist of transfers, in cash or in kind to households and individuals to relieve them of the burden of a defined set of risks or needs.
3 Unemployment rates represent unemployed persons as a percentage of the labour force. Unemployed persons comprise persons aged 15 to 74 who were: (a) without work during the reference week; (b) currently available for work; (c) actively seeking work.
4 Situation of penal institutions on 1 September, 2011.
5 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold, which is set at 60 % of the national median equivalised disposable income (after social transfers).
General population surveys carried out in France indicate that cannabis remains the most widely used illicit substance. Despite an increase in lifetime prevalence rates for cannabis among people aged 15–64 from 22.5 % in 2000 to 32.1 % in 2010, cannabis use has remained stable — last year prevalence was 8.4 % in 2000 and 8.4 % in 2010, and last month prevalence was 4.3 % in 2000 and 4.6 % in 2010. Cocaine is the second most widely used narcotic substance, with a lifetime prevalence of 3.7 % in 2010. Lifetime prevalence rates for cocaine have increased (2.6 % in 2005; 1.6 % in 2000), and, unlike cannabis, last year prevalence is also increasing (0.2 % in 2000; 0.6 % in 2005; 0.9 % in 2010).
The prevalence of cannabis and cocaine use is much higher among young people. In 2010 the lifetime prevalence for those aged 15–34 was 45.1 % for cannabis, followed by 6.0 % for cocaine. For the same age group, last year prevalence was reported to be 17.5 % for cannabis, 1.9 % for cocaine and less than 1 % for other illicit substances. Last month prevalence of cannabis use for this age group was 9.8 %.
According to the European School Survey Project on Alcohol and Other Drugs (ESPAD) study, conducted in 2011 among young people aged 15–16, some 39 % had tried marijuana or hashish at least once in their lifetime (31 % in 2007). Lifetime prevalence was 12 % for inhalant use (the same as in 2007), 4 % for cocaine (5 % in 2007), 4 % for amphetamines (the same as in 2007) and 3 % for ecstasy (4 % in 2007). The results indicated 35 % for last year prevalence of cannabis use and 24 % for last month prevalence. Although lifetime prevalence of cannabis use was the same for male and female students, male students slightly more frequently reported recent use of cannabis.
Drug use prevention in France is coordinated at the central level by the Interministerial Mission for the Fight against Drugs and Drug Addiction (MILDT), which is a Prime Ministerial service in charge of developing the National Action Plans and coordinating their implementation, liaising with the competent ministries. The latest plan was adopted to cover 2008–11. The Ministry of National Education is one of the main actors in the field of prevention, while the French national health insurance system also provides funding for prevention. At a decentralised level, prevention activities are implemented by a large number of local actors (teachers, non-government organisations, police officers, etc.) and are coordinated by the drug project managers (chefs de projet). The MILDT provides funding to implement the national prevention priorities at the local level (regions, cities).
The French prevention strategy embraces all psychoactive substances, both illicit and licit, according to a general harm reduction framework.
Environmental strategies on alcohol and tobacco use are well developed and have substantial political support.
Universal prevention is mostly carried out in the school environment, with the educational community involved in the coordination and implementation of prevention activities. In 2010 the MILDT and the Ministry of Education updated an intervention guide on prevention of addiction in school environments. In 2008 the National Institute for Prevention and Health Education (INPES) issued best practice guidelines for addressing health and risky behaviours in school settings. Both documents are circulated in all primary and secondary schools. Their use is strongly encouraged, but is not compulsory. The main focus of the school-based prevention activities is to develop students’ individual and social skills to resist drug use.
Selective and indicated prevention is mainly the responsibility of specialised agencies. Since 2005 some 250 outpatient cannabis abuse clinics have been opened throughout France to carry out early intervention.
View ‘Prevention profile’ for additional information.
The latest estimate of national problem drug use is from 2011, using several data sources and three methods. It is estimated that there were between 274 000 and 360 000 problem drug users in France in 2011 (ranging from 6.7 to 8.8 per 1 000 inhabitants aged 15–64). This estimate is higher than in 2006; however, the confidence intervals greatly overlap between two estimates, suggesting no statistical significance, and therefore this increase should be treated with caution. The ageing of the problem drug user population, which was subject to a higher mortality level prior to the introduction of opioid substitution treatment, and the renewal of the drug user population are plausible explanations of this upward trend. In 2011 local estimates carried out in six cities ranged from 8.9 per 1 000 in Rennes to 13.7 per 1 000 in Metz.
Up to 2012 the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) defined problem drug use as injecting drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis were not included in this category. Details are available here.
Treatment demand data in France is mainly collected from specialised addiction treatment support and prevention centres (CSAPA). In 2011 a total of 161 of an estimated 200 outpatient centres , 25 of 48 inpatient centres and 11 of 16 treatment units in prisons submitted data.
In 2011 a total of 47 519 clients entered treatment, of which 11 192 were new treatment clients. Among all treatment clients, 47.8 % reported cannabis as their primary drug, followed by 40.7 % for opioids and 6.9 % for cocaine. Among new treatment clients, 71.1 % reported cannabis as their primary drug, followed by 20.2 % for opioids (mainly heroin) and 5.1 % for cocaine. It is important to note that in France specialised consultation centres for young users, mainly for cannabis users, were created in 2005. Cannabis also remains the main drug in court-ordered treatment cases.
In 2011 some 32 % of all clients entering treatment were under the age of 25. More new treatment clients were under 25, at 51 %. With regard to gender distribution, 80.7 % of all clients entering treatment were male, and 19.3 % were female. A fairly similar distribution was reported among new treatment clients, where 82.6 % were male and 17.4 % were female.
A 2010 study conducted among clients of low-threshold centres (CAARUD) established the latest national prevalence estimates for drug-related infectious diseases among injecting drug users. Around 7 % of 1 337 injecting drug users tested were HIV positive in 2010. With regard to new HIV cases, and based on data collection between 2003 and 2010, each year in France between 6 000 and 7 000 people were diagnosed as HIV positive. In 2010 a total of 6 265 new HIV cases were reported and in about 1.13 % of these cases injecting drug use was registered as the likely route of transmission. With regard to 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 6 % in 2011.
According to the Coquelicot 2004 survey, which collected blood samples for drug users who had injected drugs at least once in their lifetime, prevalence of hepatitis C virus (HCV) was 74 %, and about a third of these people were unaware of their HCV status. More recent data on the prevalence of HCV are self-reported and come from the population followed in CAARUD. As many drug users are unaware of being infected, the reported prevalence is much lower than that derived from laboratory tests. However, there are indications that the prevalence of HCV among drug users is declining. Self-reported HCV seropositivity has declined, particularly among young drug injectors (under the age of 25) from 23 % in 2006 to 8.5 % in 2010.
In 2004 about 10 % of drug users who injected and/or snorted illicit substance at least once during their life were infected by HIV and HCV.
Data on drug-related deaths (DRD) in France are collected from the General Mortality Registry. In 2010 some 392 DRDs were recorded (365 in 2009; 374 in 2008; 333 in 2007; 305 in 2006; 303 in 2005). Opiates (alone or in combination) contributed to 86.2 % of DRD cases. The number of DRDs decreased dramatically in the second half of the 1990s, but has started to increase since 2003. The increase in DRD cases is mainly attributed to deaths due to heroin and methadone overdoses.
The Interministerial 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. Two systems are concerned with drug treatment: a specialised addiction treatment system operating within medico-social establishments, 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 French social security system.
Almost all of the 100 sub-regional administrative areas across France have at least one specialised addiction treatment support and prevention centre (CSAPA). These centres provide three types of services: (i) outpatient care; (ii) inpatient care; and (iii) treatment for prison inmates. In 2011 there were around 200 outpatient treatment centres, 48 inpatient treatment centres (including therapeutic communities) and 16 specialised prison treatment centres. Furthermore, both pharmacologically assisted and psychosocial treatments are provided in the same centres. The general addiction care system through hospitals is organised on three levels, when each new level builds 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.
Since 1995 substitution has constituted the main form of treatment for opiate users, and has been integrated into a total therapeutic strategy for drug dependence. 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 rare cases, morphine sulphate is provided as substitution.
In France, general practitioners (GPs) are heavily involved in the initiation and continuation of HDB and methadone treatment, although methadone treatment can only be started within specialised centres or, since 2002, within hospitals. Several Directives regulate the dose, place of delivery and duration of treatment. In 2010 an estimated 145 000 clients had a prescription for a substitution treatment (75 % HDB and 25 % methadone). HDB is mainly provided by GPs, while methadone is mainly provided by CSAPAs, although the share of GPs providing methadone is increasing.
View ‘Treatment profile’ for additional information.
The governmental action plan to fight drugs and drug addiction for the period 2008–11 made harm reduction one of the five axes on which the strategy was built. Since 2004 the harm reduction policy has been incorporated into public health regulations and state jurisdiction. Harm reduction is officially defined as being 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 135 low-threshold agencies (CAARUD), which receive funding directly from the French social security system, forms an important component of the response. Harm reduction services provided include: the open sale of syringes in pharmacies (since 1987); syringe exchange programmes (135 in 2009); and emergency services and methadone buses in order to improve access to substitution treatment. Frontline and outreach teams further improve the service provision to drug users. Syringes are also available from 276 dispensing machines, and pharmacies sell state-subsidised ‘sterikits’ (latest available sterikit sales data: 4.7 million in 2010). Overall, the risk and harm reduction system covers most of the French territory, partly due to the sale of syringes through pharmacies. In 2011 the estimated number of syringes distributed or sold in France to injecting drug users is 13.8 million syringes, of which 4.8 million were distributed by specialist agencies (needle and syringe programmes and dispensing machines). Harm reduction measures have been expanded and follow drug use trends in the country, and sniff and base kits for crack smokers have also been made available.
Screening for infectious diseases (HIV and HCV) is facilitated by free anonymous screening centres (CDAG). In 2006 some 307 of these centres were operating in the community and 73 within prisons. The 2009–12 National Hepatitis B and C Plan aims to ensure increased access for injecting drug users to prevention, screening and treatment. Hepatitis B virus (HBV) vaccination is recommended for children and adolescents and is also mandatory in some specific health occupations where employees are at risk. A Directive dated February 2008, creating the CSAPA (treatment centres dedicated to the care of drug and alcohol addiction), recommended free vaccination of HBV to any drug users attending a centre.
France is a transit area for illicit drugs smuggled to the Netherlands, Belgium, the United Kingdom and Italy. As in most EU countries, cannabis is the most available and accessible of all illicit substances. Herbal cannabis is the only illicit substance produced in France; however, cross-border trading of herbal cannabis from Belgium and the Netherlands is also reported. Cannabis resin mainly originates from Morocco and enters France through Spain. The market for cannabis resin seems to be less dynamic due to competition from domestically produced cannabis and widespread law enforcement operations, all of which increase the costs and reduce the profitability of trafficking operations. However, cannabis resin remains the main drug trafficked in France, even if some of the traditional cannabis resin trafficking organisations are refocusing their work to more profitable operations such as trafficking cocaine. Heroin originating in Afghanistan mainly comes via the Balkan route, and its availability has increased in recent years. Cocaine availability remains high and it enters France directly from South America via sea routes or by courier from Belgium, the Netherlands and Spain. Cocaine circulates in two chemical forms: salt (hydrochloride) and base (‘crack’ or ‘freebase’) forms. With regard to synthetic stimulants, they are chiefly smuggled from Belgium, the Netherlands or Germany, though only in small amounts.
In 2010 a total of 157 341 drug-law offences were reported, of which 87.5 % were cannabis-related, 6.8 % heroin-related and 4.1 % cocaine-related.
Following a steady rise since the 1980s, the quantity of cocaine seizures peaked in 2006 at more than 10 tonnes, and decreased to lower levels in the four subsequent years, while in 2011 a record amount of 10.8 tonnes of cocaine was seized. Furthermore, in 2011, an increase was reported in the amount of cannabis resin, herbal cannabis, cannabis plants, amphetamine and ecstasy seized, when compared to previous years. For heroin, in 2011 the amount seized dropped to 0.8 tonnes, which is below the levels seized between 2006 and 2010.
In 2012 a Directive establishing a criminal policy strategy for drug crimes reiterated that when sentencing, courst should take account of elements suggesting simple use of narcotics addiction, the principle of proportionality with respect to the seriousness of alleged offence, calls for systematic penal responses and increasingly effective judicial measures. Applications of educational and health measures are prioritised for simple drug-law crimes and for minors.
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 faces a maximum prison sentence of one year and a fine of up to EUR 3 750, though prosecution may be waived or a simplified procedure of a fine of up to EUR 1 875 can be ordered in minor cases. Alternatives to prosecution may include voluntary payment of a fine or carrying out socially useful unpaid work. Prosecutors may also prioritise treatment approaches for small-time offenders, whether related to personal drug use or to other minor crimes. A Directive to prosecutors in 2005 stated that any legal action before the magistrates’ courts must remain exceptional, but a new Directive 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 cases of particularly serious offences, and a fine of up to EUR 7 600 000.
View ‘Legal profile’ for additional information.
The Government action plan to fight drugs and drug addiction 2008–11 was adopted in July 2008. The plan included 193 measures covering drug demand reduction and drug supply reduction, as well as key cross-cutting themes related to drugs, such as foreign cooperation, research, domestic policy coordination, monitoring and evaluation issues.
A key theme of the plan was a renewed focus on prevention, aiming to prevent the onset of illicit drug use and alcohol abuse by reducing their everyday acceptance. The emphasis was placed on:
- prevention and, in particular, reminding individuals of drug-related laws and the central role played by parents;
- awareness-building messages aimed at avoiding or at least delaying experimentation with illicit drugs, alcohol and tobacco (among the measures envisaged are a ban on selling alcohol or tobacco to minors, and a ban on fixed-price or ‘all you can drink’ offers or ‘freebies’).
Efforts to stamp out sources of supply included:
- an intensification of the fight against cannabis supply (particularly ‘home growing’) and the misuse of psychotropic medicines;
- increased international police cooperation between the European Union Member States and the nations on the south shore of the Mediterranean.
A new government action plan against drugs and drug addiction is currently being developed and will be agreed upon at the government level.
View ‘National drug strategies’ for additional information.
The Interministerial Committee on Drugs prepares government decisions in all domains related to the drug problem, and also approves the national plan on drugs. The committee is under the authority of the Prime Minister and is composed of ministers and state secretaries.
The Interministerial Mission for the Fight against Drugs and Drug Addiction (MILDT) prepares, coordinates and partly implements the decisions of the committee. There are also territorial project managers (chefs de projet) who are responsible for implementing the national plan.
The French 2008–2011 action plan had an associated budget. Prior to that, the total drug-related public social costs, including public expenditure, had been estimated twice. (1) (2) Since 2008 the total expenditure (3) of the central government and social security has been presented annually in a general document submitted to the Parliament. (4)
In 2010 total drug-related expenditure represented 0.08 % of gross domestic product (approximately EUR 1.5 billion), with 45 % of this used for supply reduction activities and 53 % for demand reduction initiatives.
Available data suggest total drug-related expenditure grew at a slower pace after 2008, following the national fiscal consolidation trend registered in France.
(1) P. Kopp and P. Fenoglio (2004), ‘Coût et bénéfices économique des drogues’, OFDT, 121 p.; P. Kopp and P. Fenoglio (2006), ‘Le coût social des drogues en 2003. Les dépenses publiques dans le cadre de la lutte contre les drogues en France en 2003’, OFDT, 57 p.
(2) C. Ben Lakhdar (2007) ‘Public expenditure attributable to illegal drugs in France in 2005’, National report 2007 to the EMCDDA, OFDT, p.78–87.
(3) Some of the funds allocated by governments for expenditure on tasks related to drugs are identified as such in the budget (‘labelled’). Often, however, the bulk of drug-related expenditure is not identified (‘unlabelled’) and must be estimated by modelling approaches. The total budget is the sum of labelled and unlabeled drug-related expenditures.
(4) This document describes, for each Ministry, the goals and the budget dedicated to the prevention and fight against drugs.
View ‘Public expenditure profile’ for additional information.
In France, the Ministry of Research and Higher Education (MESR) designs, coordinates and implements national policy on research and innovation. Two primary academic organisations, the National Centre for Scientific Research (CNRS) and the National Institute for Health and Medical Research (INSERM), cover a wide range of research areas, from neurosciences, through public health and clinical research to social sciences.
The French focal point (OFDT) is the main body involved in data collection, studies and network development. It collaborates extensively with national and European research on drugs, and drug addictions and dissemination is also part of its mandate, together with publishing in national and international scientific journals, and promoting the use of research results in practice and policymaking. Recent drug-related studies mentioned in the 2012 French national report mainly focused on aspects related to prevalence and consequences, on supply and market issues and on interventions.
The Interministerial Mission for the Fight against Drugs and Drug Addiction (MILDT) is the central structure responsible to the Prime Minister for coordinating governmental action in the drugs field. Part of its role is to promote and fund drug-related research. In line with the Governmental Action Plan 2008–11, the MILDT supported new annual calls for proposals and extended collaboration with research organisations/universities and with the French Research Agency (ANR). It also promoted clinical research networks and dissemination initiatives towards the scientific community and policymakers. The Ministry of Research together with the MILDT also supported the ERANID research network, which includes most of the major academic research centres (INSERM, CNRS) and agencies, including the national focal point itself.
View ‘Drug-related research’ for additional information.