• 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
• Public expenditure
• Drug-related research

Drug use among the general population and young people

General population surveys report cannabis as the most widely used illicit substance. Despite an increase in lifetime prevalence rates for cannabis among the population aged 15 to 64 years from 23.9 % in 2000 to 32.1 % in 2010, cannabis use has remained stable: the last year prevalence was 8.6 % in 2000 and 8.4 % in 2010, and last month prevalence rates were  5% in 2000 and 4.6 % in 2010. Cocaine is the second most widely used narcotic substance with the lifetime prevalence of 3.7 % in 2010. The cocaine lifetime prevalence rates also have increased (2.5 in 2005 and 1.6 % in 2000), but unlike cannabis, the reported use of cocaine during the last year is rising (0.3 % in 2000, 0.6 % in 2005 and 0.9 % in 2010).

The prevalence of cannabis and cocaine use is much higher among young people. In 2010, the lifetime prevalence for the 15–34 age range was 45.1 % for cannabis, followed by 6.0 % for cocaine. For the same age group, the last year prevalence was reported to be 17.5 % for cannabis, 1.9 % for cocaine and less than 1 % for other illicit substances. Among the 15–34 aged people, last month prevalence of cannabis use was 9.8 %.

According to the  ESPAD survey conducted in 2011 among youth aged 15–16 years, 39 % had tried marijuana or hashish at least once in their lifetime (31 % in 2007). Lifetime prevalence was reported to be 12 % for inhalant use (same as in 2007), 4 % for cocaine (5 % in 2007) and 4 % for amphetamines (same as in 2007) and 3 % for ecstasy. The results indicated 35 % for the last year prevalence of cannabis use and 24 % for the last-month prevalence of cannabis use. Although lifetime prevalence of cannabis use is the same for male and female students, male students slightly more frequently report recent use of cannabis. 

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Prevention

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.

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 are well developed and have big political support.

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. In 2010, the MILDT and the Ministry of Education, updated an intervention guide on prevention of addiction at school environments. In 2008, the National Institute for Prevention and Education (INPES, in French) also issued ‘Best practice guidelines for addressing health and risky behaviours in school settings’. Both documents are today circulated in all French 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 associations. Since 2005, 250 outpatient cannabis abuse clinics have been opened throughout France to carry out early intervention.

View ‘Prevention profile’ for additional information.

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Problem drug use

A national problem drug use estimate was made in France in 2008 (on 2006 data), 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 addictology treatment support and prevention centres (CSAPA). In 2010, a total of 137 outpatient centres submitted data out of the 216 centres, 25 inpatient centres submitted data out of the 41 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 2010, in the centres which submitted data, a total of 46 606 clients entered treatment, of which 10 688 were first-time clients. Data on all clients entering treatment suggest that 45.7 % of all clients reported cannabis as their primary drug, followed by 42.8 % for opioids and 7.2 % for cocaine. Among first-time treatment clients, 67.8 % were treated for cannabis, 23.6 % were treated for opioids and 5.9 % 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 2010, 31 % of all clients entering treatment were aged less than 25 years. A higher percentage in age distribution was reported among new treatment clients, with 49 % being under the age of 25 years. As far as gender distribution is concerned, 81.1 % of all clients entering treatment were male, whereas 18.9 % were female. A similar distribution in gender distribution was reported among new treatment clients with 83.8 % for male and 16.2 % for female.

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Drug-related infectious diseases

The national prevalence estimates for drug-related infectious diseases among injecting drug users dates back to 2004, when around 11 % of injecting drug users were estimated to be HIV positive and around 74 % were estimated to have been infected with hepatitis C virus. 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 2010.

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Drug-related deaths

Data on drug-related deaths in France are collected from the General Mortality Registry. In 2009, 365 drug-related deaths were recorded (374 in 2008, 333 in 2007, 305 in 2006 and 303 in 2005). Opiates (alone or in combination) contributed to 77.8 % of DRD cases. The number of drug-related death cases decreased dramatically in the second half of the 1990s, but started to rise again since 2003.

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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. 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. While some care is provided through a risk-reduction system as well. 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 addictology 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 2009, there were a total of 216 outpatient treatment centres, 41 inpatient treatment centres (including therapeutic communities), and 16 specialised prison treatment centre. Furthermore, both pharmacologically-assisted and psychosocial treatments are provided in the same centres. The general addiction care system through hospitals is organised in three levels, when each new level builds on services available in the previous level. Thus, the first-level care manages withdrawal and organises consultations, second level adds provision of more complex residential care but the third level expands the services towards the research, training and regional coordination activities.

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, GPs are significantly involved in the initiation and continuation of HDB and methadone treatment, although initiation of methadone treatment can only occur within specialised centres, or since 2002, within hospitals. Several circulars regulate the dose, place of delivery and duration of treatment. In 2010, an estimated  145 thousand clients have had a prescription for a substitution treatment, (75 % high-dose buprenorphine and remaining — in methadone). HDB is mainly provided by GPs while methadone is mainly provided by CSAPA, although the share of GP is increasing.

View ‘Treatment profile’ for additional information.

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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 135 low-threshold agencies (CAARUD), which receive funding directly by 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), 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 2010, 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). Available harm reduction measures are expanded and follow drug use trends in the country, and special sniff and base kits for crack smokers are made available as well.

Screening of infectious diseases (HIV and HCV) is facilitated by the existence of free, anonymous screening centres (Centres de dépistage anonymes et gratuits, CDAG). In 2006, 307 of such centres operated in the community and 73 inside prisons. 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 centres 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, however recently cross-border trading of herbal cannabis from Belgium and the Netherlands was noted. Cannabis resin mainly originates from Morocco and enters France through Spain. However the market of herbal resin seems to be loosing its dynamic due to refocusing to more profitable operations such as trafficking of cocaine.  What regards heroin, which mainly comes through Balkan route, availability remains comparatively low. In France, cocaine circulates in two chemical forms: the hydrochloride and ‘crack’ or ‘freebase’  forms.

In 2010, a total of  157 341 drug-related offences were reported, 87.5 % were cannabis related offences, followed by 6.8 % for heroin-related offences and 4.1 % for cocaine-related offences.

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, 5 tonnes in 2009 and 4 tonnes in 2010). Furthermore, in 2010, an increase was reported in the amounts of seized herbal cannabis, heroin and ecstasy when compared to previous years. While in 2010 amounts of seized cannabis plants and amphetamine were lower than amounts of the same substances seized in previous year. 

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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 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.

View ‘Legal profile’ for additional information.

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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.

View ‘National drug strategies’ for additional information.

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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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Public expenditure

The French 2008–11 action plan (extended to 2012) has an associated budget. Its execution has never been assessed in detail. The total drug-related public social costs, including public expenditures (¹), have been estimated on two occasions (²). Additionally, estimates for some elements of drug-related expenditures (central government and social security) have been provided annually. The methodology used and the completeness of data cannot, however, be assessed in detail.

The most complete estimate of total drug-related public expenditure (³) is for the year 2005. Total drug-related expenditure represented 0.1 % of GDP, with 50.7 % of the total for demand reduction activities and 47.3 % for supply reduction initiatives.

Available data suggest fluctuations in labelled drug-related expenditures between 2003 and 2010. A new estimate for drug-related public expenditure for the years 2008–10 is foreseen for 2012.

(¹) 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.

(²) Koop, P. and Fenoglio, P. (2004), Cout et bénéfices économique des drogues Focus consommateurs et conséquences, Observatoire français des drogues et des toxicomanies, June 2004 and Kopp, P. and Fenoglio, P. (2006), ‘Le coût social des drogues en 2003. Les dépenses publiques dans le cadre de la lutte contre les drogues en France en 2003’ (Réactualisation du rapport OFDT, mai 1998), OFDT, St Denis.

(³) Ben Lakhdar, C. (2007) Public expenditure attributable to illegal drugs in France in 2005, OFDT.

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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, OFDT in French) 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 2011 French National report mainly focused on aspects related to consequences of drug use and prevalence of drug use in different settings , but research on supply and market issues and on interventions were also tackled.

View ‘Drug-related research’ for additional information.

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